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Andersdotter Sandström A, Fjellman-Wiklund A, Sandlund M, Eskilsson T. Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context. Glob Health Action 2023; 16:2212950. [PMID: 37314383 DOI: 10.1080/16549716.2023.2212950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important. OBJECTIVE The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder. METHOD A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison. RESULTS The analysis of the data was developed into the core category 'trying to integrate physical activity into daily life in a sustainable way', and three categories: 'acceptance of being good enough', 'learning physical activity by doing' and 'advocation for physical activity in rehabilitation'. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was 'good enough' in terms of dose and intensity of physical activity, and how to listen to the body's signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested. CONCLUSION Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.
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Affiliation(s)
- Anna Andersdotter Sandström
- Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
| | | | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Nelson A, Malmberg Gavelin H, Andersson M, Josefsson M, Eskilsson T, Slunga Järvholm L, Stigsdotter Neely A, Boraxbekk CJ. Subjective cognitive complaints and its associations to response inhibition and neural activation in patients with stress-related exhaustion disorder. Stress 2023; 26:2188092. [PMID: 36883330 DOI: 10.1080/10253890.2023.2188092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Stress-related exhaustion is associated with cognitive deficits, measured subjectively using questionnaires targeting everyday slips and failures or more objectively as performance on cognitive tests. Yet, only weak associations between subjective and objective cognitive measures in this group has been presented, theorized to reflect recruitment of compensational resources during cognitive testing. This explorative study investigated how subjectively reported symptoms of cognitive functioning and burnout levels relate to performance as well as neural activation during a response inhibition task. To this end, 56 patients diagnosed with stress-related exhaustion disorder (ED; ICD-10 code F43.8A) completed functional magnetic resonance imaging (fMRI) using a Flanker paradigm. In order to investigate associations between neural activity and subjective cognitive complaints (SCCs) and burnout, respectively, scores on the Prospective and Retrospective Memory Questionnaire (PRMQ) and the Shirom-Melamed Burnout Questionnaire (SMBQ) were added as covariates of interest to a general linear model at the whole-brain level. In agreement with previous research, the results showed that SCCs and burnout levels were largely unrelated to task performance. Moreover, we did not see any correlations between these self-report measures and altered neural activity in frontal brain regions. Instead, we observed an association between the PRMQ and increased neural activity in an occipitally situated cluster. We propose that this finding may reflect compensational processes at the level of basic visual attention which could go unnoticed in cognitive testing but still be reflected in the experience of deficits in everyday cognitive functioning.
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Affiliation(s)
- Andreas Nelson
- Department of Social and Psychological studies, Karlstad University, Karlstad, Sweden
- Department of Anaesthesiology, Central Hospital of Karlstad, Karlstad, Sweden
| | | | - Micael Andersson
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Maria Josefsson
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
| | - Anna Stigsdotter Neely
- Department of Social and Psychological studies, Karlstad University, Karlstad, Sweden
- Department of Social Sciences, Technology and Arts; Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Carl-Johan Boraxbekk
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
- Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
- Institute of Sports Medicine Copenhagen (ISMC) and Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Norström F, Järvholm LS, Eskilsson T. Healthcare utilisation among patients with stress-induced exhaustion disorder treated with a multimodal rehabilitation programme - a longitudinal observational study. BMC Psychiatry 2022; 22:642. [PMID: 36229810 PMCID: PMC9563845 DOI: 10.1186/s12888-022-04300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stress-induced exhaustion disorder is a major challenge in Swedish working life. Despite its increase in prevalence, there is still limited knowledge about the effectiveness of different rehabilitation methods. In this study, we aim to describe the healthcare utilisation for patients with stress-induced exhaustion disorder before, during and after a multi-modal rehabilitation (MMR) programme, as well as the health-related quality of life, work ability, sick leave level and psychological measures, and their possible relations. METHODS In this longitudinal observational study, 53 patients who were part of an MMR programme at the Stress Rehabilitation Clinic participated with survey data, and among them 43 also contributed with healthcare data. Data were collected from one year before start of MMR to one year after the end of it. The patients also answered a questionnaire at the start of, end of and at a one-year follow-up of the MMR, which included questions about health-related quality of life, work ability, clinical burnout, sick leave level, anxiety and depression. RESULTS There was a statistically significant increase in healthcare consumption during MMR, if including visits to the Stress Rehabilitation Clinic, while it decreased if excluding such visits, when comparing with before and after MMR. During the follow-up period there was a non-statistically significant (p=0.11), but still rather large difference (15.4 compared with 12.0 visits per patient), in healthcare consumption in comparison with the period before MMR, when excluding follow-up visits at the Stress Rehabilitation Clinic. Health-related quality of life was rated as poor before MMR (mean 0.59). There was a statistically significant improvement, but values were still below normal at the end of follow-up (mean 0.70). In addition, the level of sick leave, the work ability and signs of clinical burnout improved statistically significantly after MMR, but were not fully normalised at the end of follow-up. Individual healthcare consumption was related to residual health problems. CONCLUSIONS Patients with stress-induced exhaustion disorder have not reduced their healthcare consumption notably after MMR, and residual health problems remain for some patients. More studies are needed for a deeper understanding of the individual effectiveness of MMR, and also of its cost-effectiveness.
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Affiliation(s)
- Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
| | - Lisbeth Slunga Järvholm
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden ,grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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Abstract
The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
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Affiliation(s)
- Gunilla Stenberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | | | - Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Carin From
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Birgit Enberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Eskilsson T, Norlund S, Lehti A, Wiklund M. Enhanced Capacity to Act: Managers' Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work. J Occup Rehabil 2021; 31:263-274. [PMID: 32737671 PMCID: PMC8172407 DOI: 10.1007/s10926-020-09914-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Purpose To explore if and how a dialogue-based workplace intervention with a convergence dialogue meeting can support a return to work process from the managers' perspective. Methods Individual interviews were conducted with 16 managers (10 women and 6 men) who had an employee on sick leave because of stress-induced exhaustion disorder. The manager and employee participated in a dialogue-based workplace intervention with a convergence dialogue meeting that was guided by a healthcare rehabilitation coordinator. The intervention aimed to facilitate dialogue and find concrete solutions to enable return to work. The interviews were analyzed by the Grounded Theory method. Results A theoretical model was developed with the core category enhancing managerial capacity to act in a complex return to work process, where the managers strengthened their agential capacity in three levels (categories). These levels were building competence, making adjustments, and sharing responsibility with the employee. The managers also learned to navigate in multiple systems and by balancing demands, control and support for the employee and themselves. An added value was that the managers began to take preventive measures with other employees. When sick leave was caused only by personal or social issues (not work), workplace actions or interventions were difficult to find. Conclusions From the managers' perspective, dialogue-based workplace interventions with a convergence dialogue meeting and support from a rehabilitation coordinator can strengthen managerial competence and capacity to act in a complex return to work process.
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Affiliation(s)
- Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden.
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
| | - Sofia Norlund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Arja Lehti
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Section of Professional Development, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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Nelson A, Gavelin HM, Boraxbekk CJ, Eskilsson T, Josefsson M, Slunga Järvholm L, Neely AS. Subjective cognitive complaints in patients with stress-related exhaustion disorder: a cross sectional study. BMC Psychol 2021; 9:84. [PMID: 34006315 PMCID: PMC8132387 DOI: 10.1186/s40359-021-00576-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/22/2021] [Indexed: 01/23/2023] Open
Abstract
Background Stress-related exhaustion is associated with cognitive impairment as measured by both subjective cognitive complaints (SCCs) and objective cognitive test performance. This study aimed to examine how patients diagnosed with exhaustion disorder differ from healthy control participants in regard to levels and type of SCCs, and if SCCs are associated with cognitive test performance and psychological distress. Methods We compared a group of patients with stress-related exhaustion disorder (n = 103, female = 88) with matched healthy controls (n = 58, female = 47) cross-sectionally, concerning the type and magnitude of self-reported SCCs. We furthermore explored the association between SCCs and cognitive test performance as well as with self-reported depression, anxiety and burnout levels, in the patient and the control group, respectively. Results Patients reported considerably more cognitive failures and were more likely than controls to express memory failures in situations providing few external cues and reminders in the environment. In both groups, SCCs were associated with demographic and psychological factors, and not with cognitive test performance. Conclusion Our findings underline the high burden of cognitive problems experienced by patients with exhaustion disorder, particularly in executively demanding tasks without external cognitive support. From a clinical perspective, SCCs and objective cognitive test performance may measure different aspects of cognitive functioning, and external cognitive aids could be of value in stress rehabilitation. Trial registration Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) study (ClinicalTrials.gov: NCT03073772). Date of registration: 8 March 2017 Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00576-9.
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Affiliation(s)
- Andreas Nelson
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden. .,Department of Anaesthesiology, Central Hospital of Karlstad, Karlstad, Region Värmland, Sweden.
| | - Hanna Malmberg Gavelin
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia.,Department of Psychology, Umeå University, Umeå, Sweden
| | - Carl-Johan Boraxbekk
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden.,Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Therese Eskilsson
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Maria Josefsson
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden.,Department of Statistics Umeå, University, Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.,Department of Social Sciences, Technology and Arts, Luleå University of Technology, Luleå, Sweden.,Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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7
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Strömbäck M, Fjellman-Wiklund A, Keisu S, Sturesson M, Eskilsson T. Restoring confidence in return to work: A qualitative study of the experiences of persons with exhaustion disorder after a dialogue-based workplace intervention. PLoS One 2020; 15:e0234897. [PMID: 32735586 PMCID: PMC7394387 DOI: 10.1371/journal.pone.0234897] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Background Stress-induced exhaustion disorder (SED) is a primary cause for sickness absence among persons with mental health disorders in Sweden. Interventions involving the workplace, and supporting communication between the employee and the supervisor, are proposed to facilitate return to work (RTW). The aim of this study was to explore experiences of persons with SED who participated in a dialogue-based workplace intervention with a convergence dialogue meeting performed by a rehabilitation coordinator. Methods A qualitative design based on group interviews with 15 persons with SED who participated in a 24-week multimodal rehabilitation program was used. The interviews were analyzed with the methodology of grounded theory. Results The analysis resulted in a theoretical model where the core category, restoring confidence on common ground, represented a health promoting process that included three phases: emotional entrance, supportive guidance, and empowering change. The health promoting process was represented in participant experiences of personal progress and safety in RTW. Conclusions The intervention built on a health-promoting pedagogy, supported by continuous guidance from a rehabilitation coordinator and structured convergence dialogue meetings that enhanced common communication and collaboration with the supervisor and others involved in the RTW process. The intervention balanced relationships, transferred knowledge, and changed attitudes about SED among supervisors and colleagues in the workplace. The inclusion of a rehabilitation coordinator in the intervention was beneficial by enhancing RTW and bridging the gaps between healthcare, the workplace, and other organizational structures. In addition, the intervention contributed to a positive re-orientation towards successful RTW instead of an endpoint of employment. In a prolonged process, a dialogue-based workplace intervention with convergence dialogue meetings and a rehabilitation coordinator may support sustainable RTW for persons with SED.
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Affiliation(s)
- Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Department of Clinical Science, Psychiatry, Umeå University, Umeå, Sweden
- * E-mail:
| | | | - Sara Keisu
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marine Sturesson
- Department of Community Medicine and Rehabilitation, Occupational therapy, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
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Gavelin HM, Neely AS, Dunås T, Eskilsson T, Järvholm LS, Boraxbekk CJ. Mental fatigue in stress-related exhaustion disorder: Structural brain correlates, clinical characteristics and relations with cognitive functioning. Neuroimage Clin 2020; 27:102337. [PMID: 32652491 PMCID: PMC7348057 DOI: 10.1016/j.nicl.2020.102337] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Structural correlates of mental fatigue investigated in stress-related exhaustion. Patients were divided into high and low-moderate mental fatigue group. Patients with high mental fatigue had smaller caudate and putamen volumes. No significant differences in cortical thickness between the groups. Mental fatigue mediated the relationship between caudate volume and working memory.
Emerging evidence suggests that mental fatigue is a central component of the cognitive and clinical characteristics of stress-related exhaustion disorder (ED). Yet, the underlying mechanisms of mental fatigue in this patient group are poorly understood. The aim of this study was to investigate cortical and subcortical structural neural correlates of mental fatigue in patients with ED, and to explore the association between mental fatigue and cognitive functioning. Fifty-five patients with clinical ED diagnosis underwent magnetic resonance imaging. Mental fatigue was assessed using the Concentration subscale from the Checklist Individual Strength. Patients with high levels of mental fatigue (n = 30) had smaller caudate and putamen volumes compared to patients with low-moderate levels of mental fatigue (n = 25). No statistically significant differences in cortical thickness were observed between the groups. Mediation analysis showed that mental fatigue mediated the relationship between caudate volume and working memory; specifically, smaller caudate volume was associated with higher level of mental fatigue and mental fatigue was positively associated with working memory performance. Our findings demonstrate that the structural integrity of the striatum is of relevance for the subjective perception of mental fatigue in ED, while also highlighting the complex relationship between mental fatigue, cognitive performance and its neural underpinnings.
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Affiliation(s)
- Hanna Malmberg Gavelin
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia; Department of Psychology, Umeå University, Umeå, Sweden; Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden.
| | | | - Tora Dunås
- Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden; Centre for Demographic and Aging Research (CEDAR), Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Carl-Johan Boraxbekk
- Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Department of Radiation Sciences, Umeå University, Sweden; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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9
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Eskilsson T, Fjellman-Wiklund A, Ek Malmer E, Stigsdotter Neely A, Malmberg Gavelin H, Slunga Järvholm L, Boraxbekk CJ, Nordin M. Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder. Scand J Psychol 2020; 61:361-368. [PMID: 31995652 DOI: 10.1111/sjop.12623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
It is important to understand how people with exhaustion disorder (ED) perceive interventions aiming to facilitate cognitive functioning. Therefore, the overall aim of this study was to explore experiences from persons with ED after participating in a 12-week intervention of either computerized cognitive training or aerobic training. Both interventions were performed in addition to a multimodal rehabilitation programme. Thirteen participants, 11 women and 2 men, were interviewed about pros and cons with participating in the training. The interviews were analysed with Qualitative Content Analysis. The analyses resulted in the theme hopeful struggling for health and the categories support, motivation and sensations. It was hard work recovering from ED. Support from others who are in the same situation, family members, and technology and routines for the training were strongly emphasized as beneficial for recovery. Timing, i.e., matching activities to the rehabilitation programme, getting feedback and perceiving joy in the training were important for motivation. Participants in both interventions experienced positive sensations with improved memory performance, everyday life functioning and increased faith in the prospect of recovery. However, it is important to consider various aspects of support and motivation in both computerized cognitive training and aerobic training to enable participants to pursue their participation.
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Affiliation(s)
- Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
| | | | - Elin Ek Malmer
- Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Anna Stigsdotter Neely
- Department of Psychology, Umeå University, Umeå, Sweden.,Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Hanna Malmberg Gavelin
- Department of Psychology, Umeå University, Umeå, Sweden.,Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
| | - Carl-Johan Boraxbekk
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.,Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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Wahlström V, Fjellman-Wiklund A, Harder M, Slunga Järvholm L, Eskilsson T. Implementing a Physical Activity Promoting Program in a Flex-Office: A Process Evaluation with a Mixed Methods Design. Int J Environ Res Public Health 2019; 17:ijerph17010023. [PMID: 31861424 PMCID: PMC6982266 DOI: 10.3390/ijerph17010023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022]
Abstract
The aim of this study was to investigate facilitating and hindering factors when implementing a physical activity (PA)-promoting program among office workers moving to a flex office, by conducting a process evaluation. Additionally, we evaluated self-reported and perceived PA behaviors. With a mixed methods design, analyses were based upon data from interviews with 70 employees and repeated questionnaires from 152 employees. The PA-promoting program was fully implemented and supported by management. There was a strong health promoting culture, encouraging PA in the organization already at the start of the study. The lecture and the office design were rated as the most motivating program components. The use of stairs, breaks during meetings and social acceptance for standing and walking at work increased. Employees described a strive for variation, and how managers, the office environment, productivity and ergonomic aspects influenced sedentary behavior (SB) and PA. The need for the PA-promoting program was questioned, and the timing of the program was debated. To conclude, a strong organizational health culture combined with a facilitating physical environment can create sustainable positive PA behaviors in office settings. A thorough understanding of organizational needs and a participatory process are needed to tailor organizational interventions to decrease SB.
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Affiliation(s)
- Viktoria Wahlström
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, 90187 Umeå, Sweden;
- Correspondence:
| | - Anncristine Fjellman-Wiklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, 90187 Umeå, Sweden; (A.F.-W.); (T.E.)
| | - Mette Harder
- Umeå School of Architecture, Umeå University, 90187 Umeå, Sweden;
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, 90187 Umeå, Sweden;
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, 90187 Umeå, Sweden; (A.F.-W.); (T.E.)
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Wahlström V, Bergman F, Öhberg F, Eskilsson T, Olsson T, Järvholm LS. Effects of a multicomponent physical activity promoting program on sedentary behavior, physical activity and body measures: a longitudinal study in different office types. Scand J Work Environ Health 2019; 45:493-504. [PMID: 30860269 DOI: 10.5271/sjweh.3808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The aim of this study was to investigate effects of a multicomponent program promoting physical activity on sedentary behavior, physical activity, and body measures, when relocating from cell offices to either a flex or cell office. Methods The Active Office Design (AOD) study is a longitudinal non-randomized controlled study performed in a municipality in northern Sweden. A subsample of 86 participants were randomly recruited from the AOD study to objectively measure sedentary behavior and physical activity, using ActivPAL and ActiGraph, before and after relocation to the two different office types. The multicomponent program promoting physical activity was performed in both offices. Data were analyzed using linear mixed models. Results Eighteen months after relocation, the total number of steps per work day increased by 21% in the flex office and 3% in the cell office group, compared to baseline. Moderate and vigorous physical activity (MVPA) during work hours increased by 42% in the flex office group and 19% in the cell office group. No changes were seen regarding sitting time at work. Small additive effects for walking and MVPA were seen for both groups during non-work time. Weight increased in the flex office group. Conclusions This long-term study shows that a multicomponent workplace intervention can lead to increased walking time, steps, and MVPA in a flex compared to a cell office. Small additive increases of physical activity were seen during non-work time in both groups. More long-term controlled studies are needed to confirm these results.
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Affiliation(s)
- Viktoria Wahlström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87 Umeå, Sweden.
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Alkner BA, Halvardsson C, Bråkenhielm G, Eskilsson T, Andersson E, Fritzell P. Effect of postoperative pneumatic compression after volar plate fixation of distal radial fractures: a randomized controlled trial. J Hand Surg Eur Vol 2018; 43:825-831. [PMID: 29504445 DOI: 10.1177/1753193418760493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We investigated the difference between postoperative rehabilitation with or without adjunctive intermittent pneumatic compression therapy following distal radial fracture treated with volar plating. A total of 115 patients were randomized to a control or to an experimental group. After 4 weeks of immobilization the experimental group received intermittent pneumatic compression therapy in addition to conventional postoperative rehabilitation. Primary outcome up to 1 year postoperatively was assessed using the Canadian Occupational Performance Measure. No significant differences between groups were found. There were no clinically relevant differences regarding the secondary outcome measures swelling, strength, pain and flexibility. We conclude that postoperative intermittent pneumatic compression treatment had no major benefits. The results of the present study do not support general use of intermittent pneumatic compression initiated 4 weeks following volar plating surgery for distal radial fracture. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Björn A Alkner
- 1 Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | | | - Gustaf Bråkenhielm
- 1 Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | | | - Erika Andersson
- 2 Department of Occupational Therapy, Falun Hospital, Falun, Sweden
| | - Peter Fritzell
- 3 Center for Clinical Research, Falun and Futurum - Academy for Health and Care, Region Jönköping County, Sweden
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Malmberg Gavelin H, Eskilsson T, Boraxbekk CJ, Josefsson M, Stigsdotter Neely A, Slunga Järvholm L. Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO - a randomized clinical trial. Stress 2018; 21:279-291. [PMID: 29693483 DOI: 10.1080/10253890.2018.1461833] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stress-related exhaustion has been associated with selective and enduring cognitive impairments. However, little is known about how to address cognitive deficits in stress rehabilitation and how this influences stress recovery over time. The aim of this open-label, parallel randomized controlled trial (ClinicalTrials.gov: NCT03073772) was to investigate the long-term effects of 12 weeks cognitive or aerobic training on cognitive function, psychological health, and work ability for patients diagnosed with exhaustion disorder (ED). One-hundred-and-thirty-two patients (111 women) participating in multimodal stress rehabilitation were randomized to receive additional cognitive training (n = 44), additional aerobic training (n = 47), or no additional training (n = 41). Treatment effects were assessed before, immediately after and one-year post intervention. The primary outcome was global cognitive function. Secondary outcomes included domain-specific cognition, self-reported burnout, depression, anxiety, fatigue and work ability, aerobic capacity, and sick-leave levels. Intention-to-treat analysis revealed a small but lasting improvement in global cognitive functioning for the cognitive training group, paralleled by a large improvement on a trained updating task. The aerobic training group showed improvements in aerobic capacity and episodic memory immediately after training, but no long-term benefits. General improvements in psychological health and work ability were observed, with no difference between interventional groups. Our findings suggest that cognitive training may be a viable method to address cognitive impairments for patients with ED, whereas the effects of aerobic exercise on cognition may be more limited when performed during a restricted time period. The implications for clinical practice in supporting patients with ED to adhere to treatment are discussed.
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Affiliation(s)
| | - Therese Eskilsson
- b Department of Community Medicine and Rehabilitation, Physiotherapy , Umeå University , Umeå , Sweden
| | - Carl-Johan Boraxbekk
- c Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
- d Centre for Demographic and Aging Research (CEDAR) , Umeå University , Umeå , Sweden
| | - Maria Josefsson
- d Centre for Demographic and Aging Research (CEDAR) , Umeå University , Umeå , Sweden
| | - Anna Stigsdotter Neely
- a Department of Psychology , Umeå University , Umeå , Sweden
- e Department of Social and Psychological Studies , Karlstad University , Karlstad , Sweden
| | - Lisbeth Slunga Järvholm
- f Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine , Umeå University , Umeå , Sweden
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Gavelin HM, Neely AS, Andersson M, Eskilsson T, Järvholm LS, Boraxbekk CJ. Neural activation in stress-related exhaustion: Cross-sectional observations and interventional effects. Psychiatry Res Neuroimaging 2017; 269:17-25. [PMID: 28917154 DOI: 10.1016/j.pscychresns.2017.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 12/16/2022]
Abstract
The primary purpose of this study was to investigate the association between burnout and neural activation during working memory processing in patients with stress-related exhaustion. Additionally, we investigated the neural effects of cognitive training as part of stress rehabilitation. Fifty-five patients with clinical diagnosis of exhaustion disorder were administered the n-back task during fMRI scanning at baseline. Ten patients completed a 12-week cognitive training intervention, as an addition to stress rehabilitation. Eleven patients served as a treatment-as-usual control group. At baseline, burnout level was positively associated with neural activation in the rostral prefrontal cortex, the posterior parietal cortex and the striatum, primarily in the 2-back condition. Following stress rehabilitation, the striatal activity decreased as a function of improved levels of burnout. No significant association between burnout level and working memory performance was found, however, our findings indicate that frontostriatal neural responses related to working memory were modulated by burnout severity. We suggest that patients with high levels of burnout need to recruit additional cognitive resources to uphold task performance. Following cognitive training, increased neural activation was observed during 3-back in working memory-related regions, including the striatum, however, low sample size limits any firm conclusions.
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Affiliation(s)
- Hanna Malmberg Gavelin
- Department of Psychology, Umeå University, Umeå, Sweden; Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden.
| | - Anna Stigsdotter Neely
- Department of Psychology, Umeå University, Umeå, Sweden; Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Micael Andersson
- Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden; Department of Integrative Medical Biology, Physiology Section, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Carl-Johan Boraxbekk
- Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Centre for Demographic and Aging Research (CEDAR), Umeå University, Umeå, Sweden
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Eskilsson T, Slunga Järvholm L, Malmberg Gavelin H, Stigsdotter Neely A, Boraxbekk CJ. Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial. BMC Psychiatry 2017; 17:322. [PMID: 28865430 PMCID: PMC5581420 DOI: 10.1186/s12888-017-1457-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/08/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patients with stress-related exhaustion suffer from cognitive impairments, which often remain after psychological treatment or work place interventions. It is important to find effective treatments that can address this problem. Therefore, the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program. METHODS In this open-label, parallel, randomized and controlled trial, 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program. After 12 weeks in the program the patients were randomized to either a 12-week aerobic training intervention or to a control group with no additional training. Primary outcome measure was cognitive function, and secondary outcome measures were psychological health variables and aerobic capacity. RESULTS In total, 51% patients in the aerobic training group and 78% patients in the control group completed the intervention period. The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance. No additional improvement in burnout, depression or anxiety was observed in the aerobic group compared with controls. CONCLUSION Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory. A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group. TRIAL REGISTRATION ClinicalTrials.gov: NCT03073772 . Retrospectively registered 21 February 2017.
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Affiliation(s)
- Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE- 901 87, Umeå, Sweden.
| | - Lisbeth Slunga Järvholm
- 0000 0001 1034 3451grid.12650.30Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | | | - Anna Stigsdotter Neely
- 0000 0001 0721 1351grid.20258.3dDepartment of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Carl-Johan Boraxbekk
- 0000 0004 0646 8202grid.411905.8Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark ,0000 0001 1034 3451grid.12650.30Center for Demographic and Aging Research (CEDAR), Umeå University, Umeå, Sweden ,0000 0001 1034 3451grid.12650.30Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
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