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Brink E, Pilegaard MS, Bonnesen TG, Nielsen CV, Pedersen P. Employment status in cancer patients the first five years after diagnosis-a register-based study. J Cancer Surviv 2024:10.1007/s11764-024-01576-5. [PMID: 38587762 DOI: 10.1007/s11764-024-01576-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Work is important for identity formation, social status, and economic independency. Although some evidence within the field of work and cancer survivorship exists, no study has so far investigated employment status across all cancer diagnoses. Thus, the aim of the present study was to investigate the impact of all cancer diagnoses on employment status. METHODS Danish cancer patients aged 20-60 years, diagnosed between 2000 and 2015, were identified through Danish registers and matched 1:5 with cancer-free controls. Logistic and linear regression was performed separately in 11 cancer types to assess and compare work status and work participation between cancer patients and cancer-free controls one, three, and five years after diagnosis. RESULTS A total of 111,770 cancer patients and 507,003 cancer-free controls were included. All cancer types had lower chances of working one year after diagnosis (ORs between 0.05 and 0.76), with lung, colorectal, upper gastrointestinal, and blood cancer patients having the lowest chances. After three years, 10 of 11 cancer types had lower chances (ORs between 0.39 and 0.84). After five years, there were minimal differences between cancer patients and controls among most cancer types (ORs between 0.75 and 1.36). CONCLUSION Most cancer patients had lower chances of working compared with the general population until five years after diagnosis. However, patients with certain cancer types experienced lower chances of working all years, despite improvement over time. IMPLICATIONS FOR CANCER SURVIVORS The knowledge will help increase awareness on challenges regarding work-life after cancer. Furthermore, the distinguishing between diagnoses can inform to more targeted vocational rehabilitation.
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Affiliation(s)
- E Brink
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- DEFACTUM, Central Denmark Region, Aarhus, Denmark.
| | - M S Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - T G Bonnesen
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - C V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - P Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Pedersen CG, Nielsen CV, Lynggaard V, Zwisler AD, Maribo T. Cardiac rehabilitation: pedagogical education strategies have positive effect on long-term patient-reported outcomes. Health Educ Res 2023; 38:597-609. [PMID: 37534750 DOI: 10.1093/her/cyad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/07/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023]
Abstract
This study examined whether patients attending cardiac rehabilitation (CR) based on the pedagogical strategy learning and coping (LC) led to improved health-related quality of life (HRQL), reduced symptoms of anxiety and depression and improved self-management 6 and 12 months after the completion of CR compared with patients attending CR based on the pedagogical strategy 'Empowerment, Motivation and Medical Adherence' (EMMA). A pragmatic cluster-controlled trial of two pedagogical strategies, LC and EMMA, including 10 primary health care settings and 555 patients diagnosed with ischaemic heart disease and referred to CR between August 2018 and July 2019 was conducted. In total, 312 patients replied to the questionnaires collected at baseline, 12 weeks, 6 months and 12 months after completing CR. Linear regression analyses adjusted for potential confounder variables and cluster effects were performed. We found clinically relevant and statistically significant improvements in HRQL, anxiety, depression and self-management after completing CR. The improvements were sustained at 6 and 12 months after the completion of CR. We found no differences between the two evidence-based patient education strategies. In conclusion, this study supports the use of evidence-based patient education strategies, but there is no evidence to suggest that one pedagogical strategy is superior to the other.
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Affiliation(s)
- C G Pedersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd. 11, Aarhus 8200, Denmark
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
| | - C V Nielsen
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
- DEFACTUM, Central Denmark Region, Evald Krogs Gade 11, Aarhus 8000, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Hospitalsparken 15, Gødstrup, Herning 7400, Denmark
| | - V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, Gødstrup, Herning 7400, Denmark
| | - A D Zwisler
- REHPA The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, Nyborg 5800, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløws Vej 19, Odense 5000, Denmark
| | - T Maribo
- Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
- DEFACTUM, Central Denmark Region, Evald Krogs Gade 11, Aarhus 8000, Denmark
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Valentin G, Nielsen CV, Nielsen ASM, Tonnesen M, Bliksted KL, Jensen KT, Ingerslev K, Maribo T, Oestergaard LG. Bridging Inequity Gaps in Healthcare Systems While Educating Future Healthcare Professionals-The Social Health Bridge-Building Programme. Int J Environ Res Public Health 2023; 20:6837. [PMID: 37835107 PMCID: PMC10572531 DOI: 10.3390/ijerph20196837] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Social inequity in healthcare persists even in countries with universal healthcare. The Social Health Bridge-Building Programme aims to reduce healthcare inequities. This paper provides a detailed description of the programme. The Template for Intervention Description and Replication (TIDieR) was used to structure the description. The programme theory was outlined using elements from the British Medical Research Council's framework, including identifying barriers to healthcare, synthesising evidence, describing the theoretical framework, creating a logic model, and engaging stakeholders. In the Social Health Bridge-Building Programme, student volunteers accompany individuals to healthcare appointments and provide social support before, during, and after the visit. The programme is rooted in a recovery-oriented approach, emphasising personal resources and hope. The programme finds support in constructs within the health literacy framework. Student volunteers serve as health literacy mediators, supporting individuals in navigating the healthcare system while gaining knowledge and skills. This equips students for their forthcoming roles as healthcare professionals, and potentially empowers them to develop and implement egalitarian initiatives within the healthcare system, including initiatives that promote organisational health literacy responsiveness. The Social Health Bridge-Building Programme is a promising initiative that aims to improve equity in healthcare by addressing individual, social, and systemic barriers to healthcare. The programme's description will guide forthcoming evaluations of its impact.
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Affiliation(s)
- Gitte Valentin
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
| | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Anne-Sofie Meldgaard Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
| | - Merete Tonnesen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
| | | | - Katrine Tranberg Jensen
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
- Department of Public Health, Copenhagen University, 1353 Copenhagen, Denmark
| | - Karen Ingerslev
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
| | - Thomas Maribo
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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Momsen AMH, Tonnesen M, Zwicky-Hauschild B, Nielsen CV, Escorpizo R, Langagergaard V, Stapelfeldt CM. Usability of self-reported assessment of work functioning in municipal occupational rehabilitation teams: A qualitative study. Front Rehabil Sci 2023; 3:971574. [PMID: 36743835 PMCID: PMC9893786 DOI: 10.3389/fresc.2022.971574] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/08/2022] [Indexed: 01/21/2023]
Abstract
Aims This study aimed to explore (1) whether self-reported assessment on work-related functioning, workability, return-to-work (RTW) self-efficacy, and expectation was useful in the professionals' assessment of sick-listed workers and could guide referral to interventions and (2) whether self-reporting in addition to "usual practice" could improve the RTW dialog and involvement in case management. Methods The qualitative study took place in two municipal job centers in 2021. The assessment was based on the Work Rehabilitation Questionnaire, RTW-Self-efficacy Scale-19, and single items of self-rated health, workability, and RTW expectations. Sick-listed workers (n = 36) were interviewed by telephone. Three focus-group interviews were conducted with professionals who had used the questionnaire. Data were coded and analyzed thematically. Results Three themes with seven subthemes emerged: (1) accessibility; (2) one tool in the RTW toolbox (subthemes: a supplementary tool, a tool for reflection, facilitating interdisciplinary communication, and enhancing active participation); and (3) the value of "ticking boxes" (subthemes: good days, bad days, the issue of power, and the cultural meaning of words). Conclusion The professionals would not recommend the present questionnaire for use during their rehabilitation team meeting for assessment, interdisciplinary communication, or choice of interventions. However, using the parts assessing RTW self-efficacy and expectation combined with a dialog may be of value early in the RTW process. The self-reporting assessment tool was perceived to be meaningful to some sick-listed workers, as it provided reflections on important aspects of the RTW process. Some workers believed that it might contribute to the rehabilitation team, and thus, it could improve their involvement.
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- DEFACTUM—Public Health and Rehabilitation Research, Central Denmark Region, Aarhus C, Denmark,Correspondence: Anne-Mette Hedeager Momsen
| | - Merete Tonnesen
- DEFACTUM—Public Health and Rehabilitation Research, Central Denmark Region, Aarhus C, Denmark
| | | | - Claus Vinther Nielsen
- DEFACTUM—Public Health and Rehabilitation Research, Central Denmark Region, Aarhus C, Denmark,Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington, VT, United States,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Vivian Langagergaard
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
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Ravn MB, Berthelsen C, Maribo T, Nielsen CV, Pedersen CG, Handberg C. Understanding Facilitators and Challenges to Care Transition in Cardiac Rehabilitation: Perspectives and Assumptions of Healthcare Professionals. Glob Qual Nurs Res 2023; 10:23333936231217844. [PMID: 38107551 PMCID: PMC10722928 DOI: 10.1177/23333936231217844] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
Cardiac rehabilitation is an essential part of treatment for patients with cardiovascular disease. Cardiac rehabilitation is increasingly organized outside hospital in community healthcare services. However, this transition may be challenging. The aim of this study was to examine assumptions and perspectives among healthcare professionals on how facilitators and challenges influence the transition from hospital to community healthcare services for patients in cardiac rehabilitation. The study followed the Interpretive Description methodology and data consisted of participant observations and focus group interviews. The analysis showed that despite structured guidelines aimed to support the collaboration, improvements could be made. Facilitators and challenges could occur in the collaboration between the healthcare professionals, in the collaboration with the patient, or because of the new reality for patients when diagnosed with cardiovascular disease.
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Affiliation(s)
- Maiken Bay Ravn
- Aarhus University, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Connie Berthelsen
- Zealand University Hospital, Køge and Roskilde, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Thomas Maribo
- Aarhus University, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Aarhus University, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
- Region Hospital Goedstrup, Denmark
| | | | - Charlotte Handberg
- Aarhus University, Denmark
- National Rehabilitation Center for Neuromuscular Diseases; Aarhus, Denmark
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6
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Lund H, Tang L, Poulsen I, la Cour K, Bjerrum M, Nielsen CV, Maribo T. Lack of systematicity in research prioritisation processes - a scoping review of evidence syntheses. Syst Rev 2022; 11:277. [PMID: 36564846 PMCID: PMC9784020 DOI: 10.1186/s13643-022-02149-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A systematically and transparently prepared research priority-setting process within a specific scientific area is essential in order to develop a comprehensive and progressive evidence-based approach that will have a substantial societal impact on the site of interest. On the basis of two consensus workshops, the authors suggest the following methods for all such processes: use of experts, stakeholder involvement, literature review, and ranking. OBJECTIVES The identification, categorisation, and discussion of methods for preparing a research prioritisation process. METHODS Eligibility criteria: Evidence synthesis includes original studies presenting a research prioritisation process and which listed the methods used to create a research prioritisation process. Only evidence syntheses related to health research were included. DATA SOURCES We searched the following electronic databases, without limiting by date or language: MEDLINE Ovid, Embase Ovid, Epistemonikos, and CINAHL EBSCO. CHARTING METHODS The methods used were mapped and broken down into different elements, and the use of the elements was determined. To support the mapping, (A) all of the elements were collapsed into unique categories, and (B) four essential categories were selected as crucial to a successful research prioritisation process. RESULTS Twelve evidence syntheses were identified, including 416 original studies. The identification and categorisation of methods used resulted in 13 unique categories of methods used to prepare a research agenda. CONCLUSION None of the identified categories was used in all of the original studies. Surprisingly, all four of the essential categories were used in only one of the 416 original studies identified. There is seemingly no international consensus on which methods to use when preparing a research prioritisation process. PROTOCOL REGISTRATION The protocol was registered in Open Science Framework ( https://osf.io/dygz8/ ).
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Affiliation(s)
- Hans Lund
- Section Evidence-Based Practice, Department of Health and Functioning, Western Norway University of Applied Sciences, 5063, Bergen, Norway.
| | - Lars Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Denmark.,Research Unit of Nursing and Healthcare, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Karen la Cour
- Research Unit of User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Merete Bjerrum
- Research Unit of Nursing and Healthcare, Department of Public Health, Aarhus University, Aarhus, Denmark.,The Centre of Clinical Guidelines, Department of Clinical Medicine & The Danish Centre of Systematic Reviews - a JBI Centre of Excellence, University of Adelaide, Aalborg University, Aalborg, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM Central Denmark Region, Aarhus, Denmark.,Regionshospital Gødstrup, Herning, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM Central Denmark Region, Aarhus, Denmark
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Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glümer C, Grønbæk M, Holmberg T, Køber L, la Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: association with readmission and mortality risk. Eur Heart J Qual Care Clin Outcomes 2022; 8:830-839. [PMID: 34850879 DOI: 10.1093/ehjqcco/qcab086] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
AIMS To examine the temporal trends and factors associated with national cardiac rehabilitation (CR) referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral. METHODS AND RESULTS This cohort study includes all adult patients alive 120 days from incident heart failure (HF) identified by the Danish Heart Failure Registry (n = 33 257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1 year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex [odds ratio (OR): 0.85; 95% confidence interval: 0.80-0.89], older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs. I (OR: 0.75; 0.60-0.95), left ventricular ejection fraction >40%, and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87-0.97) and all-cause mortality (OR: 0.65; 0.58-0.72). CONCLUSION Although increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients at highest risk of non-referral.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Line Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Hasnain Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK.,Primary Care Research Group, University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Kenneth Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - Charlotte Glümer
- Center for Diabetes in the City of Copenhagen, Copenhagen, Denmark
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen la Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Nakano
- The Danish Clinical Registries (RKKP), Aarhus. Denmark
| | - Claus Vinther Nielsen
- Institute of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Kirstine Lærum Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark.,Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Nielsen TB, Leth S, Pedersen M, Harbo HD, Nielsen CV, Laursen CH, Schiøttz-Christensen B, Oestergaard LG. Mental Fatigue, Activities of Daily Living, Sick Leave and Functional Status among Patients with Long COVID: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph192214739. [PMID: 36429458 PMCID: PMC9690484 DOI: 10.3390/ijerph192214739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 06/01/2023]
Abstract
Studies suggest that persistent symptoms after COVID-19 (long COVID) influence functioning and activities of daily living (ADL). However, it is still uncertain how and to what extent. This study aimed to describe patient-reported mental fatigue, ADL problems, ADL ability, sick leave and functional status among patients with long COVID. In this cross-sectional study, 448 patients, ≥18 years old and referred to occupational therapy at a Danish Post-COVID-19 Clinic, were included. Mental fatigue was measured by the Mental Fatigue Scale, ADL problems and ability were measured by the Canadian Occupational Performance Measure, sick leave was self-reported and functional status was evaluated by the Post-COVID-19 Functional Status Scale. Mean age was 46.8 years, 73% of the patients were female, and 75% suffered from moderate to severe mental fatigue. The majority reported difficulties performing productive and leisure activities. The median performance and satisfaction scores were 4.8 and 3, respectively. In total, 56% of the patients were on sick leave, and 94% were referred to rehabilitation. A decrease in functional status was found between pre-COVID-19 and assessment. Conclusively, the patients were highly affected in their everyday life and had distinct rehabilitation needs. Future research is needed to address causalities and rehabilitation for this patient group.
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Affiliation(s)
- Trine Brøns Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Steffen Leth
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Infectious Diseases and Internal Medicine, Gødstrup Regional Hospital, 7400 Herning, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Mathilde Pedersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Helle Dahl Harbo
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
- AmbuFlex—Center for Patient-Reported Outcomes, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Regional Hospital, 7400 Herning, Denmark
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Cecilia Hee Laursen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Berit Schiøttz-Christensen
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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9
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Tonnesen M, Nielsen CV, Andersen RS. Moving goals. Goal-work in Parkinson's disease rehabilitation. Front Rehabilit Sci 2022; 3:819862. [PMID: 36189001 PMCID: PMC9397665 DOI: 10.3389/fresc.2022.819862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022]
Abstract
Chronic diseases often demand considerable work by patients: they must adhere to medical regimes and engage with social and embodied discontinuities. In Denmark, rehabilitees in Parkinson's disease rehabilitation talk about Parkinson's as their new job. In this article, we introduce goal-work as an optical lens to enlarge and explore the micro-social practices that concern a core practice in rehabilitation where professionals and rehabilitees set goals for the future and work toward the goals. To work with goals adds a new task to living with Parkinson's. Rehabilitation research tends to focus on the actual goal-setting meeting. Drawing on data from long-term ethnographic fieldwork on goals and their setting in Parkinson's disease rehabilitation, we show how participants in rehabilitation imagine, set, enact, review or share their rehabilitation goals, and how goals are worked with before and after the goal-setting meeting, across settings. We conceptualize these micro-social practices as goal-work, which we argue is a spatio-temporal process. The concept of goal-work emphasizes the fact that goal-setting is one event in a string of goal-related activities, and it turns our attention to the intersubjective dimensions inherent in goal-work, such as the role of relatives and how acts of imagination and acts of sharing form part of goal-work.
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Affiliation(s)
- Merete Tonnesen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- *Correspondence: Merete Tonnesen
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Danish Region, Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Region Hospital West Jutland, Herning, Denmark
| | - Rikke Sand Andersen
- Department of Anthropology, Aarhus University, Aarhus, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Pedersen CG, Nielsen CV, Lynggaard V, Zwisler AD, Maribo T. The patient education strategy "learning and coping" improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial. BMC Cardiovasc Disord 2022; 22:364. [PMID: 35941553 PMCID: PMC9361528 DOI: 10.1186/s12872-022-02774-8] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA).
Method A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed. Result Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05). Conclusion This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02774-8.
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Affiliation(s)
- Charlotte Gjørup Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark. .,DEFACTUM, Central Denmark Region, Aarhus, Denmark. .,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Tonnesen M, Nielsen CV, Andersen RS. What are your goals? Goal-setting logics in Danish Parkinson's rehabilitation. Med Anthropol 2022; 41:574-590. [PMID: 35904254 DOI: 10.1080/01459740.2022.2102493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Across rehabilitation fields, rehabilitees and professionals meet to set rehabilitation goals. Portrayed as an ordinary, yet foundational practice in rehabilitation, participants often find goal-setting meetings challenging; ideal and real seem to clash. Based on a long-term fieldwork in Danish Parkinson's disease rehabilitation, we explore goal-setting and its rationale to gain insight into why goal-setting qualifies as challenging. We find that challenges relate to disease, organizational matters and an imbalance in institutional knowledge, but also that different logics, of choice, interdependence, and accountability, entangle and affect goal-setting. A competitive aspect between goal-setting logics appears pivotal to understand the challenges in goal-setting.
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Affiliation(s)
- Merete Tonnesen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Clinical Social Medicine and Rehabilitation, Region Hospital West Jutland, Herning, Denmark
| | - Rikke Sand Andersen
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Anthropology, Aarhus University, Aarhus, Denmark
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12
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Aadal L, Nielsen TL, Jensen AB, Bjerrum M, Nielsen CV, Angel S. What Does It Take for Research to Be Rehabilitation Research? Front Rehabil Sci 2022; 3:823159. [PMID: 36189071 PMCID: PMC9397732 DOI: 10.3389/fresc.2022.823159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/26/2021] [Accepted: 06/17/2022] [Indexed: 11/13/2022]
Abstract
Six recommendations to facilitate rehabilitation research and supplement existing research practices were identified. Rehabilitation practice requires research addressing different long-term multi-faceted needs and perspectives of end users, including service users, professionals, politicians, and administrators. Research in rehabilitation should therefore integrate different research traditions and methods. Rehabilitation research with a broad focus is sparse, and most of the research takes its starting point in the biomedical research tradition. Through a nominal group process, we developed recommendations to emphasize important issues in rehabilitation research.
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Affiliation(s)
- Lena Aadal
- Hammel Neurorehabilitation and Research Center, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tove Lise Nielsen
- Department of Occupational Therapy, Research Centre for Health and Welfare Technology, VIA University College, Aarhus, Denmark
| | | | - Merete Bjerrum
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, The Centre of Clinical Guidelines–Danish National Clearing House, Aalborg University, Aalborg, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus University, Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Central Denmark Region, Aarhus University, Aarhus, Denmark
| | - Sanne Angel
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Molde University College, Molde, Norway
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13
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Momsen AMH, Fox JC, Nielsen CV, Thuesen J, Maribo T. Rehabilitation Research in Denmark Between 2001 and 2020: A Scoping Review. Front Rehabil Sci 2022; 3:849216. [PMID: 36188956 PMCID: PMC9397721 DOI: 10.3389/fresc.2022.849216] [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] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
The demand for rehabilitation has increased, and evidence is rapidly growing; however, a rehabilitative health strategy receives less attention than treatment. Knowledge of what is being researched, who are the target groups and who contributes to rehabilitation research is deficient. We did not find any reviews mapping rehabilitation research regarding the research questions. The objective was to identify and synthesize existing scientific evidence on rehabilitation research published by Danish institutions between 2001 and 2021. The research questions to be explored were: Among which study groups has rehabilitation research been published?. Which types of studies on rehabilitation have been published?. Which institutions have been involved in rehabilitation research? Methods The process was guided according to the Joanna Briggs Institute's (JBI's) scoping review methodology. Four databases were searched. All types of peer-reviewed studies on any target group and rehabilitation setting, with any affiliation to a Danish institution, were eligible to be included. Studies referring to population and the type of design were categorized. Institutions were counted as Danish first authorship. Results The search revealed 3,100 studies, and following screening 1,779 were included. A total of 24 broad study groups were identified, mostly diagnosis-based health conditions. Musculoskeletal, cancer, and cardiac had 342, 228, and 174 studies, respectively. A total of 1,545 had a Danish first authorship, most of the Danish publications came from hospitals (56.6%) and universities (28.4%). The publication trend showed an almost linear development, with a 10-15% increase during the period. Conclusion Following screening 1,779 studies were included involving 24 broad study groups. Most categories were diagnosis-based; musculoskeletal, cancer, and cardiac health conditions encompassed most studies. All study designs were represented, and 1/10 were secondary studies. The majority (87%) of studies had a Danish first authorship. The majority of first affiliations were among hospitals followed by universities. A few municipalities were presented although they are yet to have research responsibility. Publication trends showed an increase primarily from 2013. Systematic Review Registration https://osf.io/, identifier [10.17605/OSF.IO/2AENX].
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
| | - Jasmine Charlotte Fox
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Jette Thuesen
- Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
- Centre for Nutrition and Rehabilitation, Absalon University College, Sorø, Denmark
| | - Thomas Maribo
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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14
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Petersen KS, Madsen LS, Nielsen CV, Labriola M, Stapelfeldt CM. "To have and then lose the safety net" - Female cancer survivors' experiences of the process of becoming ready to return to work. Work 2021; 70:1121-1130. [PMID: 34864711 DOI: 10.3233/wor-213623] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Validation studies have not been able to confirm the stage-specific understanding as operationalised in the readiness for return to work (RRTW) questionnaire. OBJECTIVE To explore retrospectively how working female cancer survivors experienced the process of becoming ready to RTW during and beyond participation in an occupational rehabilitation intervention and thereby expand the understanding of the RRTW construct. METHODS A qualitative research design was employed. Thirteen female cancer survivors were included for semi-structured interviews one to two years after they had completed active treatment and returned to work. The RRTW construct guided data generation and analysis. Content analysis was performed in four analytical steps that combined a concept-driven and a data-driven analytic strategy. RESULTS Three themes were identified; "To have and then lose the safety net", "Realise a changed life situation", "Strive to balance work and everyday life". In a time span of approximately one to two years (from receiving treatment, being enrolled in an intervention and to gradually returning to work); the identified themes were interdependent of each other as one theme gradually evolved to the next theme in the process of engaging in sustained work participation. CONCLUSIONS The present study points towards continuous development of the RRTW construct and whether the addition of a preparedness dimension would improve validity.
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Affiliation(s)
- K S Petersen
- Department of Health Science and Technology, Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - L S Madsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Social and Health Services and Labour Market, Central Region Denmark, Aarhus, Denmark
| | - C V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Social and Health Services and Labour Market, Central Region Denmark, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - M Labriola
- Norwegian Research Centre (NORCE), Bergen, Norway
| | - C M Stapelfeldt
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Social and Health Services and Labour Market, Central Region Denmark, Aarhus, Denmark
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15
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Rasmussen B, Nielsen CV, Uhrenfeldt L. Enduring life in between a sense of renewal and loss of courage: lifeworld perspectives one year after hip fracture. Int J Qual Stud Health Well-being 2021; 16:1934996. [PMID: 34098860 PMCID: PMC8204972 DOI: 10.1080/17482631.2021.1934996] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose: To explore everyday life experiences of being active in aged adults´ with walking impairment one year after hip fracture (HF).Methods: A phenomenological-hermeneutic study design is based on Heidegger´s and Gadamer´s thinking focusing on aged adults being-in-the-world one year after HF. Individual semi-structured interviews were conducted from May to July 2017 in the homes of nine participants, who were part of a longitudinal qualitative study with four interview-rounds for a period of 18 months after the HF event. The analysis was interpretative and secured that the authors´ pre-understanding was put at stake through a five-step process of meaning condensation.Results: One theme, "Enduring life in between a sense of renewal and loss of courage", described aged adults´ experiences of being active in three sub-themes: "Facing loss and losing courage", "Taking up the challenge and maintaining courage ", and "Renewing the energy to be active". Living with being under change and increased vulnerability created a challenge in maintaining courage and reaching for possibilities to unfold their own being in life.Conclusion: This study contributes knowledge on how the aged adults´ experiences of the balance between courage and loss in being active one year after HF are profoundly connected with experiences of well-being.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio- and Occupational Therapy, Horsens Regional Hospital, Horsens, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark and Regional Hospital West Jutland, Herning, Denmark
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16
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Ibsen C, Maribo T, Nielsen CV, Hørder M, Schiøttz-Christensen B. ICF-Based Assessment of Functioning in Daily Clinical Practice. A Promising Direction Toward Patient-Centred Care in Patients With Low Back Pain. Front Rehabilit Sci 2021; 2:732594. [PMID: 36188866 PMCID: PMC9397761 DOI: 10.3389/fresc.2021.732594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022]
Abstract
Background: Patient-centred care has received increased attention in recent years. Patient-Reported Outcomes (PROs) and shared decision-making are key components of Patient-Centred care. Low back pain (LBP) is a complex symptom affected by multiple, interacting factors. Therefore, evidence strongly recommend a biopsychosocial and patient-centred approach in the assessment and management. The International Classification of Functioning, Disability and Health (ICF) provide a biopsychosocial model for describing functioning and disability. ICF is widely acknowledged, but implementation into clinical practice is lacking. To support the use of a biopsychosocial and patient-centred approach in daily clinical practice among patients with LBP we developed a practice-friendly tool based on ICF; the LBP assessment tool. Objective: To compare an ICF-based assessment facilitated by the LBP assessment tool with standard care in terms of the use of PROs and shared decision-making in order to promote patient-centred care in patients with LBP. Methods: A non-randomized controlled design was used. Eligible patients were allocated to one of two groups: the ICF group, assessed with the LBP assessment tool or the control group, assessed with a conventional LBP assessment. Primary outcome includes use of PROs. Secondary outcomes include use of a graphical overview displaying the patient profile and shared decision-making. A patient evaluation questionnaire was used to collect data. Results: Seven hundred ten patients were assessed for eligibility of whom 531 were allocated to the ICF group (n = 299) or the control group (n = 232). A significantly higher use of PRO data (p < 0.00) and the patient profile (p < 0.00) was reported in favor of the ICF group. Patients in the ICF group also experienced being more involved in decision-making (p = 0.01). Conclusions: This study showed that a functioning assessment, by means of the LBP assessment tool, increased use of PROs and shared decision-making when compared to a conventional LBP assessment. Additionally, this study demonstrated that routine use of ICF-based PRO data and shared decision-making promoted patient-centred care in patients with LBP. The LBP assessment tool may be a strong candidate for a user-friendly ICF-based tool with the potential to support health professionals in a shift toward a biopsychosocial and patient-centred approach to patients with LBP.
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Affiliation(s)
- Charlotte Ibsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- *Correspondence: Charlotte Ibsen
| | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Regional Hospital West Jutland, Herning, Denmark
| | - Mogens Hørder
- Department of Public Health, Research Unit of User Perspectives, University of Southern Denmark, Odense, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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17
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Abstract
OBJECTIVE The objective of this scoping review was to identify studies combining the concepts of eHealth and work participation for sick-listed employees across diagnostic groups in health care and workplace contexts. INTRODUCTION There is an increased demand for better health care services and technologies, and eHealth is proposed as a useful tool to improve efficiency and reduce costs. eHealth functions at the intersection of medical informatics, public health, and business, and may be a promising solution for managing the process of return to work among employees on sick leave. Assessment of work outcomes is essential in evaluating the effectiveness of health services, and there is a need to map the research literature on existing eHealth interventions to facilitate work participation. INCLUSION CRITERIA This scoping review considered studies combining two core concepts: eHealth and work participation. It considered studies on eHealth interventions for employees (18 to 65 years of age) on sick leave due to any type of diagnosis or disability, conducted by any stakeholder in workplace or health care contexts and in any country. Empirical data from both quantitative and qualitative studies were included. METHODS Published and unpublished studies from January 1, 2008, to August 21, 2020, written in English were included in this review. The search was conducted in MEDLINE, Scopus, Embase, PsycINFO, WHO clinical registry, and ClinicalTrials.gov. A three-step search strategy was followed. Data extraction was performed by two independent reviewers and undertaken using an extraction tool developed specifically for the scoping review objectives. RESULTS This review identified 15 studies eligible for inclusion. Four studies delivered the eHealth intervention by telephone, while 10 interventions were web-based. Of the web-based interventions, five had a blended approach, such as website and email support, or website and social media platforms. One study used an app-based intervention. Only eight studies targeted employees sick-listed due to common sick leave diagnoses, such as common mental disorders and musculoskeletal disorders. The workplace context was the target of the eHealth intervention in seven studies, although the intervention was still delivered by health personnel such as therapists or occupational physicians. Collaboration on individual cases between the health professional, employer, and employee to facilitate work participation seemed to be rare. Four studies reported both a theoretical and an empirical base for the intervention used. CONCLUSIONS This review demonstrated that the use of eHealth interventions to facilitate work participation is limited, and there is a need for future studies on the use of eHealth technology for this purpose. Developing eHealth interventions specifically for populations at risk of long-term sick leave, and encouraging collaboration between all relevant stakeholders, may help improve work participation.
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Affiliation(s)
- Tone Langjordet Johnsen
- NORCE, Norwegian Research Centre, Bergen, Norway
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Thomas Johansen
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | - Anne-Mette Hedeager Momsen
- Department of Public Health, Aarhus University, Denmark
- DEFACTUM - Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Denmark
| | - Torill Helene Tveito
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Horten, Norway
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Denmark
- DEFACTUM - Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Region Hospital West Jutland, Denmark
| | - Cecilie Varsi
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Irene Øyeflaten
- NORCE, Norwegian Research Centre, Bergen, Norway
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
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Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glumer C, Gronbaek M, Holmberg T, Kober L, La Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: a national Danish register-based study of predictors of referral and outcomes. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
Background
Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines.
Purpose
The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral.
Methods
All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients.
Results
Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF <50%, diagnosis of myocardial infarction and use of ACE inhibitor. Male gender, older age, region, unemployment, retirement, living alone, non-Danish ethnic origin, lower educational level, NYHA class IV, treatment for hypertension, existing chronic obstructive lung disease and stroke were associated with lower CR referral. CR referral was associated with lower risk of readmission (adjusted odds ratio: 0.90;95%CI: 0.85-0.95), HF-specific mortality (0.61; 0.39-0.95) and all-cause mortality (0.61; 0.55-0.69) as compared to no referral.
Conclusions
Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.
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Affiliation(s)
- LC Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - H Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom of Great Britain & Northern Ireland
| | - K Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - C Glumer
- Center for diabetes in the city of Copenhagen, Copenhagen, Denmark
| | - M Gronbaek
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - T Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K La Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Nakano
- The Danish Clinical Registries (RKKP), Aarhus, Denmark
| | - CV Nielsen
- DEFACTUM, Regional Hospital West Jutland, Central Denmark Region, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - KL Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - JS Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - AD Zwisler
- REHPA The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - RS Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom of Great Britain & Northern Ireland
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19
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Madsen LS, Poulsen DV, Nielsen CV, Handberg C. "It Was Definitely an Eye-Opener to Me"-People with Disabilities' and Health Professionals' Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context. Int J Environ Res Public Health 2021; 18:ijerph18115994. [PMID: 34204913 PMCID: PMC8199774 DOI: 10.3390/ijerph18115994] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
Research points to the health benefits of rehabilitation in urban green spaces. Nevertheless, more studies indicate complexity of utilising urban green spaces in an established health system context. An understanding of challenges related to rehabilitation in urban green spaces remains unaddressed. Therefore, the aim was to describe and analyse people with disabilities' and health professionals' perceptions on combining traditional indoor rehabilitation practice with an urban green rehabilitation context. The interpretive description methodology was applied supplemented by Edgar Schein's Model of Organisational Culture. Three online focus group interviews were conducted with people with disabilities (n = 4) and health professionals (n = 10). Three interrelated themes formed an understanding of rehabilitation practice in an urban green rehabilitation context: "ambivalence due to contextual change", "negotiating rehabilitation assumptions" and "expanding the frame of rehabilitation". Expanding the frame of rehabilitation to an urban green context may provide a basis for enhancing compatibility to everyday life for people with disabilities and still accommodate structural quality standards of professional rehabilitation practice.
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Affiliation(s)
- Louise Sofia Madsen
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark; (C.V.N.); (C.H.)
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Correspondence:
| | - Dorthe Varning Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, 1958 Frederiksberg, Denmark;
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark; (C.V.N.); (C.H.)
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Regional Hospital West Jutland, Central Denmark Region, 7400 Herning, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark; (C.V.N.); (C.H.)
- National Rehabilitation Centre for Neuromuscular Diseases, 8000 Aarhus, Denmark
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Ibsen C, Schiøttz-Christensen B, Vinther Nielsen C, Hørder M, Schmidt AM, Maribo T. Assessment of functioning and disability in patients with low back pain - the low back pain assessment tool. Part 1: development. Disabil Rehabil 2021; 44:4841-4852. [PMID: 33945363 DOI: 10.1080/09638288.2021.1913648] [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] [Indexed: 12/11/2022]
Abstract
PURPOSE To present the process used to develop the low back pain (LBP) assessment tool including evaluation of the initial content validity of the tool. METHODS The development process comprised the elements: definition of construct and content, literature search, item generation, needs assessment, piloting, adaptations, design, and technical production. The LBP assessment tool was developed to assess the construct "functioning and disability" as defined by the International Classification of Functioning, Disability and Health (ICF). Involvement of patients and health professionals was essential. RESULTS The elements were collapsed into five steps. In total, 18 patients and 12 health professionals contributed to the content and the design of the tool. The LBP assessment tool covered all ICF components shared among 63 ICF categories. CONCLUSIONS This study presents the process used to develop the LBP assessment tool, which is the first tool to address all ICF components and integrate biopsychosocial perspectives provided by patients and health professionals in the same tool. Initial evaluation of content validity showed adequate reflection of the construct "functioning and disability". Further work on the way will evaluate comprehensiveness, acceptability, and degree of implementation of the LBP assessment tool to strengthen its use for clinical practice.Implications for RehabilitationA biopsychosocial and patients-centred approach is a strong foundation for identifying the many relevant aspects related to low back pain (LBP).Responding to a lack of tools to support a biopsychosocial and patients-centred approach the LBP assessment tool was developed using a robust, multi-step process with involvement of patients and health professionals.The LBP assessment tool is a strong candidate for a user-friendly tool to facilitate use of the International Classification of Functioning, Disability and Health in routine clinical practice.
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Affiliation(s)
- Charlotte Ibsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Mogens Hørder
- Department of Public Health, Research Unit of User Perspectives, University of Southern Denmark, Odense, Denmark
| | - Anne Mette Schmidt
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark.,SANO Aarhus, Aarhus, Denmark
| | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark
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Ibsen C, Schiøttz-Christensen B, Vinther Nielsen C, Hørder M, Maribo T. Assessment of functioning and disability in patients with low back pain - the low back pain assessment tool. Part 2: field-testing. Disabil Rehabil 2021; 44:4853-4861. [PMID: 33941030 DOI: 10.1080/09638288.2021.1913649] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate comprehensiveness and acceptability of the patient-reported outcome instrument (PRO-LBP) and the clinician-reported outcome instrument (ClinRO-LBP) included in the low back pain (LBP) assessment tool. Second, to assess degree of implementation after three months. METHODS Feasibility-testing, training of health professionals, field-testing, and a feedback meeting was undertaken. Field-testing provided data to evaluate comprehensiveness, acceptability, and degree of implementation. RESULTS Feasibility-testing and training of health professionals revealed that the LBP assessment tool was usable and ready for field-testing. In total, 152 patients participated in the field-testing of whom 95% considered the PRO-LBP comprehensive and 59% found it acceptable. Health professionals found the ClinRO-LBP comprehensive and acceptable. The feedback meeting revealed that the LBP assessment tool broadened the health professionals' approach to functioning and facilitated a consultation based on the patient perspective. The degree of implementation reached 79%. CONCLUSIONS The PRO-LBP and the ClinRO-LBP covered key concepts of LBP and were found acceptable by patients and health professionals. Despite the reduced degree of implementation after three months the LBP assessment tool allowed the health professionals to apply a biopsychosocial and patient-centred approach. Future research should investigate whether the LBP assessment can enhance patient-centred care.Implications for rehabilitationThe low back pain (LBP) assessment tool is the first evidence-based tangible tool to cover biopsychosocial aspects related to LBP as defined by the International Classification of Functioning, Disability and Health (ICF).The LBP assessment tool allowed health professionals to apply a biopsychosocial and patients-centred approach and has the potential to be used in rehabilitation planning.Awareness to continuous facilitation and training of health professionals is important to facilitate and maintain implementation of new procedures into routine clinical practice.
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Affiliation(s)
- Charlotte Ibsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, University Hospital Lillebaelt, Middelfart, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Mogens Hørder
- Department of Public Health, Research Unit of User Perspectives, University of Southern Denmark, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark
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Langagergaard V, Jensen OK, Nielsen CV, Jensen C, Labriola M, Sørensen VN, Pedersen P. The comparative effects of brief or multidisciplinary intervention on return to work at 1 year in employees on sick leave due to low back pain: A randomized controlled trial. Clin Rehabil 2021; 35:1290-1304. [PMID: 33843296 DOI: 10.1177/02692155211005387] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare return to work (RTW) rates among patients with low back pain (LBP) and different job relations randomized to brief or multidisciplinary intervention. DESIGN A randomized controlled trial with 1-year follow-up. SETTING Silkeborg Regional Hospital, Denmark. SUBJECTS Four hundred seventy-six participants were divided into two groups concerning job relations: strong (influence on job and no fear of losing it) or weak (no influence on job and/or fear of losing it), and afterwards randomized to brief or multidisciplinary intervention. INTERVENTIONS Brief intervention included examination and advice by a rheumatologist and a physiotherapist. Multidisciplinary intervention included brief intervention plus coaching by a case manager making a plan for RTW with the patient. MAIN MEASURES Primary outcome was 1-year RTW rate. Secondary outcomes included pain intensity (LBP rating scale), disability (Roland Morris disability scale), and psychological measures (Common Mental Disorder Questionnaire, Major Depression Inventory, and EQ-5D-3L). RESULTS Mean (SD) age was 43.1 (9.8) years. Among 272 participants with strong job relations, RTW was achieved for 104/137 (76%) receiving brief intervention compared to 89/135 (66%) receiving multidisciplinary intervention, hazard ratio 0.73 (CI: 0.55-0.96). Corresponding results for 204 participants with weak job relations were 69/102 (68%) in both interventions, hazard ratio 1.07 (CI: 0.77-1.49). For patients with strong job relations, depressive symptoms and quality of life were more improved after brief intervention. CONCLUSION Brief intervention resulted in higher RTW rates than multidisciplinary intervention for employees with strong job relations. There were no differences in RTW rates between interventions for employees with weak job relations.
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Affiliation(s)
- Vivian Langagergaard
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Ole Kudsk Jensen
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Claus Vinther Nielsen
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark.,Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Chris Jensen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | | | - Vibeke Neergaard Sørensen
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Pernille Pedersen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Lynggaard V, Zwisler AD, Taylor RS, May O, Mortensen J, Nielsen CV. Short- and long-term effects of the patient education strategy-learning and coping-in cardiac rehabilitation: a randomized controlled trial (LC-REHAB). Health Educ Res 2021; 36:41-60. [PMID: 33755118 DOI: 10.1093/her/cyaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
The objectives were to assess the short- and long-term effect of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on health-related quality of life, patient education impact, cardiac risk factors and lifestyle. In total, 825 patients hospitalized with ischaemic heart disease or heart failure were randomized to either LC-CR or standard CR at three Danish hospitals. Teaching approach in LC-CR was situational, inductive and reflective, with experienced patients as co-educators and supplemental interviews. Teaching approach in standard CR was structured and deductive. Outcomes were assessed immediately after CR, and after 3 months (short term), and after 3 years (long term). Between-arm differences in favour of LC-CR were SF-12 'role emotional' (3.7, 95% CI: 0.6-6.8) and MDI depression score (0.9, 0.1-1.8) immediately after CR, exercise capacity (4 W, 1-9) at 3 months and SF-12 'role physical' (4.6, 0.1-9.0) (long term). Between-arm differences in favour of controls were waist circumference (-1.7 cm, -2.3 to -1.0) immediately after CR and HeiQ domain 'Constructive attitudes and approaches' (0.11, 0.04-0.18), triglycerides (-0.12 mmol/l, -0.21 to -0.02), systolic blood pressure (-3.12 mmHg, -5.66 to -0.58) at 3 months. Adding LC strategies to CR provides inconsistent short-term results but improves 'role physical' long term.
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Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital (Formerly known as Regional Hospital West Jutland), 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
| | - R S Taylor
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
- MRC/CSO Social and Public Health Sciences Unit, Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - O May
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - J Mortensen
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Ørtenblad L, Høtoft D, Krogh RH, Lynggaard V, Juel Christiansen J, Vinther Nielsen C, Hedeager Momsen AM. Women's perspectives on motivational factors for lifestyle changes after gestational diabetes and implications for diabetes prevention interventions. Endocrinol Diabetes Metab 2021; 4:e00248. [PMID: 34277972 PMCID: PMC8279634 DOI: 10.1002/edm2.248] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022]
Abstract
Introduction Gestational diabetes mellitus (GDM) is a common complication in pregnancy and constitutes a public health problem due to the risk of developing diabetes and other diseases. Most women face barriers in complying with preventive programs. This study aimed to explore motivational factors for lifestyle changes among women with a history of GDM and their suggestions for preventive programs. Methods This study used a qualitative approach in six focus group interviews with a total of 32 women. The selection criteria were time since onset of GDM, including women diagnosed with GDM, six months and five years after GDM, diagnosed and not diagnosed with diabetes. Inductive analysis was performed. Results The women reacted with anxiety about their GDM diagnosis and experienced persistent concerns about the consequences of GDM. They were highly motivated to take preventive initiatives, but faced major adherence challenges. The demotivating factors were lack of time and resources, too little family involvement, lack of knowledge and social norms that may obstruct healthy eating. A powerful motivational factor for complying with preventive strategies was the well-being of their children and partners. Conclusions Preventive initiatives should be rooted in the women's perception of GDM/diabetes and based on their experiences with barriers and motivational factors. The well-being and the quality of life within the family are dominant motivational factors which offer powerful potentials for supporting the women's coping capability. Further, there is a need to be responsiveness to the women and their families even a long time after the onset of GDM.
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Affiliation(s)
- Lisbeth Ørtenblad
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
| | - Diana Høtoft
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark
| | - Rubab H Krogh
- Department of Gynaecology and Obstetrics Gødstrup Hospital Herning Denmark
| | - Vibeke Lynggaard
- Steno Diabetes Center Aarhus Health Promotion Research Aarhus Denmark.,Cardiovascular Research Unit Department of Cardiology Gødstrup Hospital Aarhus Denmark
| | - Jens Juel Christiansen
- Steno Diabetes Center Aarhus Health Promotion Research Aarhus Denmark.,Department of Medicine Gødstrup Hospital Aarhus Denmark
| | - Claus Vinther Nielsen
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark.,Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Aarhus Denmark
| | - Anne-Mette Hedeager Momsen
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
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Stapelfeldt CM, Momsen AMH, Jensen AB, Andersen NT, Nielsen CV. Municipal return to work management in cancer survivors: a controlled intervention study. Acta Oncol 2021; 60:370-378. [PMID: 33287597 DOI: 10.1080/0284186x.2020.1853227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Resuming work during or after cancer treatment has become an important target in cancer rehabilitation. PURPOSE The aim was in a controlled trial to study the return to work (RTW) effect of an early, individually tailored vocational rehabilitation intervention targeted to improve readiness for RTW in cancer survivors. MATERIAL AND METHODS Participants diagnosed with breast, cervix, ovary, testicular, colon-rectal, and head-and-neck cancers as well as being employed were allocated to a vocational rehabilitation intervention provided by municipal social workers (n = 83) or to usual municipal RTW management (n = 264). The intervention contained three elements: motivational communication inspired by Acceptance and Commitment Therapy by which RTW barriers were addressed, municipal cancer rehabilitation and finally employer and workplace contact. RTW effect was assessed as relative cumulative incidence proportions (RCIP) in the control and intervention group within 52 weeks of follow-up, estimated from the week where treatment ended at the hospital. RCIP was interpreted and reported as relative risk (RR) with 95% confidence intervals (CI) adjusted for gender, age cancer diagnosis, education, comorbidity, and sick leave weeks. RESULTS Across cancer diagnoses 69 (83.1%) and 215 (81.4%) returned to work in the intervention and control group, respectively. No statistical effect was seen (RR 1.08 (95% CI 0.98-1.19)). Repeating the analyses solely for participants with breast cancer (n = 290) showed a significant effect of the intervention (RR 1.12 (95% CI 1.01-1.23)). CONCLUSION More than 80% returned to work in both groups. However, no statistical difference in RTW effect was seen across cancer diagnoses within one year from being exposed to an early, individually tailored vocational rehabilitation intervention compared with usual municipal RTW management. TRIAL REGISTRATION NUMBER ISRCTN50753764.
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Affiliation(s)
- Christina M. Stapelfeldt
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Social and Health Services & Labour Market, Central Denmark Region, Aarhus, Denmark
| | - Anne-Mette H. Momsen
- DEFACTUM - Social and Health Services & Labour Market, Central Denmark Region, Aarhus, Denmark
| | | | | | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Social and Health Services & Labour Market, Central Denmark Region, Aarhus, Denmark
- Goedstrup Hospital, Herning, Denmark
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Hedeager Momsen AM, Høtoft D, Ørtenblad L, Friis Lauszus F, Krogh RHA, Lynggaard V, Juel Christiansen J, Terkildsen Maindal H, Vinther Nielsen C. Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews. Endocrinol Diabetes Metab 2021; 4:e00230. [PMID: 34277958 PMCID: PMC8279604 DOI: 10.1002/edm2.230] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/01/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Aims To present an overview of reviews of interventions for the prevention of diabetes in women after gestational diabetes mellitus (GDM) with the overall aim of gaining information in order to establish local interventions. Methods Six databases were searched for quantitative, qualitative or mixed‐methods systematic reviews. All types of interventions or screening programmes were eligible. The outcomes were effectiveness of reducing diabetes incidence, encouraging healthy behavioural changes and enhancing women's perceptions of their increased risks of developing type 2 diabetes following GDM. Results Eighteen reviews were included: three on screening programmes and seven on participation and risk perceptions. Interventions promoting physical activity, healthy diet, breastfeeding and antidiabetic medicine reported significantly decreased incidence of postpartum diabetes, up to 34% reduction after any breastfeeding compared to none. Effects were larger if the intervention began early after birth and lasted longer. Participation in screening rose up to 40% with face‐to‐face recruitment in a GDM healthcare setting. Interventions were mainly based in healthcare settings and involved up to nine health professions, councillors and peer educators, mostly dieticians. Women reported a lack of postpartum care and demonstrated a low knowledge of risk factors for developing type 2 diabetes. Typical barriers to participation were lack of awareness of increased risk and low levels of support from family. Conclusions Lifestyle interventions or pharmacological treatment postpartum was effective in decreasing diabetes incidence following GDM. Women's knowledge of the risk of diabetes and importance of physical activity was insufficient. Early face‐to‐face recruitment increased participation in screening. Programmes aimed at women following a diagnosis of GDM ought to provide professional and social support, promote screening, breastfeeding, knowledge of risk factors, be long‐lasting and offered early after birth, preferably by face‐to‐face recruitment.
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Diana Høtoft
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Lisbeth Ørtenblad
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
| | - Finn Friis Lauszus
- Department of Gynaecology and Obstetrics Gødstrup Hospital Gødstrup Denmark
| | | | - Vibeke Lynggaard
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Cardiovascular Research Unit Department of Cardiology Gødstrup Hospital Herning Denmark
| | - Jens Juel Christiansen
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Department of Medicine Gødstrup Hospital Herning Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health Aarhus University Aarhus Denmark.,Steno Diabetes Center Copenhagen Health Promotion Research Gentofte Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
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Abstract
Background: In-depth understanding of the experiences of both well-being and suffering in relation to being severely obese and becoming active through lifestyle intervention is lacking.Aim: to explore and describe adults' existential experiences of being active, when living within a large body-before and during a lifestyle intervention.Methods: A longitudinal design of repeated individual interviews with 16 adults with BMI ≥40, based on hermeneutic phenomenology, existential philosophy and a theory of well-being was performed. The study was approved by the Danish health authorities.Results: Two dimensions of experiences were found; "Living within a downward spiral" and "Striving for enjoyment and settlement". The themes describing suffering were: 'Sense of being thwarted and defeated ' and "Tackling energy depletion and impact of sense of self". The themes describing well-being were: "Hoping for renewal and energised resoluteness" and "Enduring discomfort and feeling safe".Conclusions: Interacting existential experiences can be facilitators or barriers for physical activity. It seems relevant for health care providers to address the individual's lifeworld experiences of well-being, lack of well-being and suffering. Well-being as a sense of feeling "at home" when physically active may break down an inactivity spiral. Promoting well-being is a legitimate aim of lifestyle intervention.
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Affiliation(s)
- Bente Skovsby Toft
- Department of Lifestyle Rehabilitation, Horsens Regional Hospital, Brædstrup, Denmark
| | - Kathleen Galvin
- School of Health Sciences, University of Brighton, Brighton, UK
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Jensen OK, Nielsen CV, Stengaard-Pedersen K. Diffuse central sensitization in low back patients: A secondary analysis of cross-sectional data including tender point examination and magnetic resonance imaging of the lumbar spine. Medicine (Baltimore) 2020; 99:e22198. [PMID: 32957350 PMCID: PMC7505388 DOI: 10.1097/md.0000000000022198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Consistency between back pain intensity and degenerative changes on magnetic resonance imaging (MRI) of the lumbar spine is poor. This study aimed to show whether tender point (TP) examination, used as a test for diffuse central sensitization, may add valuable information to clinical assessment of patients with low back pain (LBP).This was a cross-sectional study including 141 patients with LBP on sick leave. Baseline measures comprised back pain, leg pain intensity, and LBP examination including TP examination. Degenerative MRI findings were assessed in a standardized manner and blinded for clinical data. The number of TPs was analyzed in relation to sex, widespread pain, radiculopathy, pain duration, and degenerative changes on MRI.The number of TPs was positively associated with the female sex, widespread pain, and pain duration. It was negatively associated with degenerative manifestations and radiculopathy, the latter displaying a low level similar to that of the general population. A positive association between back pain intensity and TPs was present in patients with and without radiculopathy and in patients with substantial degenerative changes. Men with >7-8 TPs and women with >10-11 TPs had more back pain and similar or fewer degenerative changes than patients with few TPs (<3 and <6 TPs, respectively), thereby identifying 34% to 44% of patients with nonspecific LBP and 5% to 8% of patients with radiculopathy, respectively, with disproportionate back pain in relation to degenerative changes.Supplemental TP examination improved clinical and MRI evaluation of patients with LBP. By using gender-specific cut points, patients with disproportionate back pain were identified, presumably indicating diffuse central sensitization.
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Affiliation(s)
- Ole Kudsk Jensen
- The Spine Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Claus Vinther Nielsen
- Institute of Public Health, University of Aarhus, DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Region Hospital West Jutland, Herning, Denmark
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Toft BS, Galvin K, Nielsen CV, Uhrenfeldt L. Being with others during physical activity: experiences of well-being among adults with severe obesity. Physiother Theory Pract 2020; 38:1003-1015. [PMID: 32875926 DOI: 10.1080/09593985.2020.1815262] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The experience of physical activity is influenced by social relations and gendered roles. Group-based lifestyle interventions are considered effective in promoting physical activity, yet the experiences of being active with others are unknown among individuals with severe obesity. PURPOSE To explore how individuals with severe obesity experience being with others during physical activity. METHODS A qualitative hermeneutic phenomenological study of repeated single-gender focus group interviews was conducted with adults living with severe obesity during group-based lifestyle intervention. RESULTS Three themes were developed: 1) 'Enjoying safety, kinship and belonging among peers'; 2) 'Feeling like a failure is shameful: A sense of aversion'; and 3) 'Striving to feel at home in physical activity: Needing distance from others.' The themes were drawn into an overall meaning 'Achieving wellbeing may always be a challenge: not feeling at home in the group or in body.' CONCLUSION Intersubjective and spatial dimensions of experiences are central and influence how individuals with severe obesity can feel wellbeing and 'at home' in physical activity. Physiotherapists should be aware of the individuals' vulnerability regarding feelings of failure, aversion, and shame as well as awareness of gendered norms and roles.
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Affiliation(s)
- Bente Skovsby Toft
- Department of Lifestyle Rehabilitation, Horsens Regional Hospital, Brædstrup, Denmark
| | - Kathleen Galvin
- Centre for Arts and Wellbeing, School of Health Sciences, Brighton, UK
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,DEFACTUM, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
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30
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Toft BS, Nielsen CV, Uhrenfeldt L. Balancing one's mood: experiences of physical activity in adults with severe obesity 18 months after lifestyle intervention. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2020; 153-154:23-31. [DOI: 10.1016/j.zefq.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/26/2022]
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Rasmussen B, Nielsen CV, Uhrenfeldt L. Being active 1½ years after hip fracture: a qualitative interview study of aged adults' experiences of meaningfulness. BMC Geriatr 2020; 20:263. [PMID: 32727376 PMCID: PMC7391487 DOI: 10.1186/s12877-020-01666-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/22/2019] [Accepted: 07/22/2020] [Indexed: 01/29/2023] Open
Abstract
Background Being active is vital and a source of well-being. However, 18 months after hip fracture (HF), progress seems to have come to a halt. Aged adults may feel vulnerable, experiencing ongoing dependency and limited possibilities for socializing. How they experience the meaningfulness of being active during these circumstances is unknown. The aim of this study was to explore experiences of the meaningfulness of being active for aged adults 18 months after HF. Methods A phenomenological-hermeneutic methodology based on the philosophies of Heidegger and Gadamer was applied. Data were collected using individual interviews conducted in participants’ homes. The study was part of a longitudinal study, and three former interviews helped build trusting relationships with participants and focus the semi-structured interview guide. An existential theory of well-being and suffering considering health to be a balancing of mobility and dwelling was applied. Participants were nine aged adults 65 years or older with pre-fracture dependency included in the study 18 months earlier while still in hospital after HF. The interpretation was a process of analyzing data by moving between the parts and the whole as a means of gaining a deeper understanding and continuously testing pre-understandings. The analysis followed five steps: a) getting a sense of the whole b) delineating and condensing meaning units, c) interpreting meaning units, d) relating to study purpose, and e) developing themes and sub-themes. Results Two main themes emerged. The main-theme “Feeling the continuity of life “had four sub-themes: “Gratitude for present possibilities, ““Connected with earlier life-experience, ““Thoughtfully managing vulnerability, “and “Belonging with other people. “The main-theme “Feeling vulnerable “had two sub-themes: “Thwarted “and “Sad and regretting lost continuity in life.“. Conclusions Eighteen months after HF, aged adults seem to be struggling on their own to be active in meaningful ways. To maintain hope, relieve the strain in everyday life, and maintain a sense of safety and self-confidence, they may need help. However, to avoid suffering, there is a need to balance additional training and a struggle for progress with well-being experiences in terms of feeling gratitude, restoring a sense of normality, and feeling kinship with other people.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio and Occupational Therapy, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Bartholinsallé 2, 8000, Aarhus C, Denmark.,DEFACTUM, Aarhus, Central Denmark Region, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Lisbeth Uhrenfeldt
- Faculty of Nursing and Health Science, Nord University, Universitetsalléen 11, 8049, Bodø, Norway
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Larsen FB, Sørensen JB, Nielsen CV, Momsen AMH, Friis K, Stapelfeldt CM. Population differences in health-related quality of life between cancer survivors and controls: Does low educational attainment widen the gap? Scand J Public Health 2020; 49:821-832. [PMID: 32122260 DOI: 10.1177/1403494820908757] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: This study aimed to compare health-related quality of life (HRQOL) among cancer survivors and controls in the Danish population, with special attention given to the impact of low educational attainment. Comparisons were made at population level and for subgroups stratified by education. Furthermore, comparisons were made for all cancer diagnoses combined and for the 14 most prevalent cancer sites and 'other cancer sites'. Finally, the importance of time since initial diagnosis was examined. Methods: HRQOL was measured using the physical component score (PCS) and mental component score (MCS) of the 12-item Short-Form Health Survey version 2 in a population-based survey. By linking data with the Danish Cancer Registry, 11,166 cancer survivors and 151,117 individuals with no history of cancer were identified. Results: HRQOL was reduced in cancer survivors for all cancers combined and most cancer sites. Differences were found at population level and stratified by educational attainment. PCS was reduced to a similar extent in the three educational groups, whereas MCS was reduced slightly more in the low than in the high educational attainment group. HRQOL increased with time since initial diagnosis during the first years. Conclusions: Cancer survivors had lower HRQOL than controls, and HRQOL was lower in the low than in the high educational attainment group. However, low educational attainment did not widen the gap in HRQOL following a cancer diagnosis. Despite this, the combined effect of low educational attainment and a cancer diagnosis markedly reduced HRQOL in some cancer survivors. The study identified groups of cancer survivors with low HRQOL who may have unmet rehabilitation needs.
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Affiliation(s)
| | | | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, Denmark.,Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Denmark
| | | | | | - Christina Malmose Stapelfeldt
- DEFACTUM, Central Denmark Region, Denmark.,Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Denmark
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Lynggaard V, Zwisler AD, Taylor RS, May O, Nielsen CV. Effects of the patient education strategy 'Learning and Coping' in cardiac rehabilitation on readmissions and mortality: a randomized controlled trial (LC-REHAB). Health Educ Res 2020; 35:cyz034. [PMID: 31999315 DOI: 10.1093/her/cyz034] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
We assessed the effects of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on mortality and readmissions by exploring results from the LC-REHAB trial. In all, 825 patients with ischaemic heart disease or heart failure were randomized to the intervention arm (LC-CR) or the control arm (standard CR) at three hospitals in Denmark. LC-CR was situational and inductive, with experienced patients as co-educators supplemented with two individual interviews. Group-based training and education hours were the same in both arms. Outcomes were time to death or readmission, length of stay and absolute number of deaths or readmissions. No between-arm differences were found in time to death, first readmission, or length of stay. Within 30 days after completion of CR, the absolute number of all-cause readmissions was 117 in the LC arm and 146 in the control arm, adjusted odds ratio 78 (95% CI: 0.61-1.01), P = 0.06. This trend diminished over time. Adding LC strategies to standard CR showed a short term but no significant long-term effect on mortality or readmissions. However, the study was not powered to detect differences in mortality and morbidity. Thus, a risk of overseeing a true effect was present.
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Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
| | - R S Taylor
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
- Institute of Health Research, University of Exeter Medical School, St. Luke's Campus, Heavitree Road, EX1 2LU Exeter, UK
| | - O May
- Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, Herning 7400, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, 2 Bartholins Allé, 8000 Aarhus C, Denmark
- MarselisborgCentret, DEFACTUM, Central Denmark Region, 11 P.P. Ørums Gade, 8000 Aarhus C, Denmark
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Oestergaard LG, Christensen FB, Nielsen CV, Bünger CE, Holm R, Helmig P, Søgaard R. Case manager-assisted rehabilitation for lumbar spinal fusion patients: an economic evaluation alongside a randomized controlled trial with two-year follow-up. Clin Rehabil 2020; 34:460-470. [PMID: 31964164 DOI: 10.1177/0269215519897096] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the cost-effectiveness of case manager-assisted rehabilitation as an add-on to usual physical rehabilitation after lumbar spinal fusion, given the lack of any clinical benefits found on analysing the clinical data. DESIGN Economic evaluation alongside a randomized controlled trial with two-year follow-up. SETTING Patients from the outpatient clinics of a university hospital and a general hospital. SUBJECTS A total of 82 lumbar spinal fusion patients. INTERVENTIONS Patients were randomized one-to-one to case manager-assisted rehabilitation programme as an add-on to usual physical rehabilitation or to usual physical rehabilitation. MAIN MEASURES Oswestry Disability Index and EuroQol 5-dimension. Danish preference weights were used to estimate quality-adjusted life years. Costs were estimated from micro costing and national registries. Multiple imputation was used to handle missing data. Costs and effects were presented with means (95% confidence interval (CI)). The incremental net benefit was estimated for a range of hypothetical values of willingness to pay per gain in effects. RESULTS No impact of case manager-assisted rehabilitation on the Oswestry Disability Index or estimate quality-adjusted life years was observed. Intervention cost was Euros 3984 (3468; 4499), which was outweighed by average reductions in inpatient resource use and sickness leave. A cost reduction of Euros 1716 (-16,651; 20,084) was found in the case manager group. Overall, the probability for the case manager-assisted rehabilitation programme being cost-effective did not exceed a probability of 56%, regardless of willingness to pay. Sensitivity analysis did not change the conclusion. CONCLUSION This case manager-assisted rehabilitation programme was unlikely to be cost-effective.
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Affiliation(s)
- Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Claus Vinther Nielsen
- Section of Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark
| | - Cody Eric Bünger
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Randi Holm
- Orthopedic Department, Region Hospital of Silkeborg, Silkeborg, Denmark
| | - Peter Helmig
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Oestergaard LG, Christensen FB, Bünger CE, Søgaard R, Holm R, Helmig P, Nielsen CV. Does adding case management to standard rehabilitation affect functional ability, pain, or the rate of return to work after lumbar spinal fusion? A randomized controlled trial with two-year follow-up. Clin Rehabil 2020; 34:357-368. [PMID: 31964172 DOI: 10.1177/0269215519897106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the effect of a case manager-assisted rehabilitation programme as an add-on to usual physical rehabilitation in patients undergoing lumbar spinal fusion. DESIGN A randomized controlled trial with a two-year follow-up. SETTINGS Outpatient clinics of a university hospital and a general hospital. SUBJECTS In total, 82 patients undergoing lumbar spinal fusion. INTERVENTIONS The patients were randomized one-to-one to case manager-assisted rehabilitation (case manager group) or no case manager-assisted rehabilitation (control group). Both groups received usual physical rehabilitation. The case manager-assisted rehabilitation programme included a preoperative meeting with a case manager to determine a rehabilitation plan, postsurgical meetings, phone meetings, and voluntary workplace visits or roundtable meetings. MAIN MEASURES Primary outcome was the Oswestry Disability Index. Secondary outcomes were back pain, leg pain, and return to work. RESULTS Of the 41 patients in the case manager group, 49% were men, with the mean age of 46.1 (±8.7 years). In the control group, 51% were male, with the mean age of 47.4 (±8.9 years). No statistically significant between-group differences were found regarding any outcomes. An overall group effect of 4.1 points (95% confidence interval (CI): -1.8; 9.9) was found on the Oswestry Disability Index, favouring the control group. After two years, the relative risk of return to work was 1.18 (95% CI: 0.8; 1.7), favouring the case manager group. CONCLUSION The case manager-assisted rehabilitation programme had no effect on the patients' functional disability or back and leg pain compared to usual physical rehabilitation. The study lacked power to evaluate the impact on return to work.
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Affiliation(s)
- Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Cody Eric Bünger
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Søgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Section of Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Randi Holm
- Orthopedic Department, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Peter Helmig
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Section of Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Tayyari Dehbarez N, Palmhøj Nielsen C, Risør BW, Vinther Nielsen C, Lynggaard V. Cost-utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trial with 3 years of follow-up. Open Heart 2020; 7:e001184. [PMID: 32076564 PMCID: PMC6999679 DOI: 10.1136/openhrt-2019-001184] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives To enhance adherence to cardiac rehabilitation (CR), a patient education programme called 'learning and coping' (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost-utility of the LC-programme compared with the standard CR-programme. Methods 825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3 years.A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves. Results No statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95% CI -3828 to 12 533) or in QALY (-0.006; 95% CI -0.053 to 0.042). At a threshold of 40 000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%. Conclusions While the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.
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Affiliation(s)
| | | | | | - Claus Vinther Nielsen
- DEFACTUM, Aarhus N, Denmark.,Department of Public Health, Aarhus Universitet, Aarhus C, Denmark
| | - Vibeke Lynggaard
- Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
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Ibsen C, Schiøttz-Christensen B, Maribo T, Nielsen CV, Hørder M, Handberg C. "Keep it simple": Perspectives of patients with low back pain on how to qualify a patient-centred consultation using patient-reported outcomes. Musculoskeletal Care 2019; 17:313-326. [PMID: 31430043 DOI: 10.1002/msc.1417] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patient-reported outcomes are expected to play an important role in patient-centred health care. To capture patients' perspectives, patient involvement in the development of patient-reported outcome (PRO) instruments is essential, but often lacking. This qualitative study explored the perspectives of patients with low back pain, to gain an understanding of how to qualify a patient-centred consultation by using PROs. This was done by exploring patients' perspectives regarding the assessment of functioning and disability as part of the development of a new PRO instrument based on the International Classification of Functioning, Disability and Health Core Set. METHODS Semi-structured focus group interviews with seven patients with low back pain were conducted. Data were analysed by drawing on the Interpretive Description methodology. RESULTS The analysis revealed three core themes: simplicity, individuality and application. Simplicity represented keeping items to a minimum and avoiding overlaps; individuality implied the need for individualized answers; and application signified that PROs should be utilized during the consultation, and that they can provide useful information for clinical decision-making. CONCLUSIONS The study provides essential knowledge about elements of importance to patients with low back pain when aiming for a patient-centred consultation using PROs. Furthermore, it underlines the importance of involving patients in PRO development because their perspectives improved the new PRO instrument.
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Affiliation(s)
- Charlotte Ibsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Mogens Hørder
- Institute of Public Health, Unit of User Perspectives, University of Southern Denmark, Odense, Denmark
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- The Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Petersen KS, Momsen AH, Stapelfeldt CM, Nielsen CV. Reintegrating Employees Undergoing Cancer Treatment into the Workplace: A Qualitative Study of Employer and Co-worker Perspectives. J Occup Rehabil 2019; 29:764-772. [PMID: 31056724 DOI: 10.1007/s10926-019-09838-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/21/2023]
Abstract
Purpose The purpose of this study was to explore how employers and co-workers experience the return to work (RTW) process of employees undergoing cancer treatment. Methods Sixteen semi-structured individual interviews and participant observations at seven workplaces took place, involving seven employers and nine co-workers with different professions. A phenomenological-hermeneutic analytic approach was applied involving coding, identification of themes, and interpretation. Results We identified three employer themes: call for knowledge, Making decisions, and Feeling helpless. Also, three co-worker themes were identified: understanding and sympathy, extra work and burden, and Insecurity about future work tasks. Early initiated RTW, e.g. less work hours and work accommodations, did neither constitute challenges for employers nor co-workers in the beginning of the RTW process. However, when the RTW process was prolonged employers encountered difficulties in finding suitable work tasks, whereas co-workers were burdened by extra work. Conclusions Overall, cancer survivors' RTW process was welcomed and encouraged at the workplace level. However, employer and co-worker experiences suggested that RTW initiation parallel with cancer treatment raised challenges at the workplace level, when the RTW process was extended beyond the initial RTW plan; increased workload and difficulties in balancing the needs of the cancer survivor and co-workers. Mechanisms that support cancer survivors' RTW without introducing strain on co-workers should be investigated in future research. Furthermore, support for employers in their RTW management responsibilities needs to be addressed in general and in particular in future RTW interventions.
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Affiliation(s)
| | - A H Momsen
- Section of Social Medicine and Rehabilitation, Aarhus University and DEFACTUM, Central Region Denmark, P.P. Oerums Gade 9-11, Building 1B, 8000, Aarhus C, Denmark
| | - C M Stapelfeldt
- Section of Social Medicine and Rehabilitation, Aarhus University and DEFACTUM, Central Region Denmark, P.P. Oerums Gade 9-11, Building 1B, 8000, Aarhus C, Denmark
| | - C V Nielsen
- Section of Social Medicine and Rehabilitation, Aarhus University and DEFACTUM, Central Region Denmark, P.P. Oerums Gade 9-11, Building 1B, 8000, Aarhus C, Denmark
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Hald K, Meillier LK, Nielsen KM, Breinholt Larsen F, Johansen MB, Larsen ML, Nielsen CV, Christensen B. Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction? A 10-year follow-up study. BMJ Open 2019; 9:e030807. [PMID: 31662379 PMCID: PMC6830639 DOI: 10.1136/bmjopen-2019-030807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI). DESIGN A prospective cohort study with 10 years' follow-up. SETTING Department of cardiology at a university hospital in Denmark between 2000 and 2004. PARTICIPANTS Patients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network. INTERVENTION A socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration. MAIN OUTCOME MEASURES Participation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions. RESULTS At 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02 and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05). CONCLUSIONS The present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.
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Affiliation(s)
- Kathrine Hald
- Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Kirsten M Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Breinholt Larsen
- DEFACTUM, Social and Health Services and Labour Market, Central Denmark Region, Aarhus, Denmark
| | | | - Mogens Lytken Larsen
- Danish Centre for Inequality in Health, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bo Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Grundt Larsen I, Gregersen Oestergaard L, Thomsen LM, Vinther Nielsen C, Schiøttz-Christensen B. Effect of adding lay-tutors to the educational part of a back school programme for patients with subacute, non-specific low back pain: A randomized controlled clinical trial with a two-year follow-up. J Rehabil Med 2019; 51:698-704. [PMID: 31411338 DOI: 10.2340/16501977-2584] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the effect of adding a lay-tutor to the educational sessions of a back school programme for patients with subacute low back pain. METHODS Patients with subacute low back pain were randomized to a 10-week programme comprising 10 h education and 20 h physical exercise led by a former patient as lay-tutor, or a programme led by a physiotherapist. In the intervention group, former patients served as lay-tutors in the educational sessions, teaching in conjunction with physiotherapists. In the control group, 2 physiotherapists led the entire educational programme. Disability, back pain, leg pain and health status were evaluated blindly at 3 and 24 months. RESULTS Eighty-seven patients with subacute low back pain referred for treatment at 6 selected physiotherapy clinics were allocated to either an intervention group (n = 42) or a control group (n = 45). No statistically significant difference was found between the 2 groups. Both groups of patients showed a statistically significant improvement in health and pain measurements from the start of the study to the 3- and 24-month follow-up. CONCLUSION No short- or long-term effect was found of adding a lay-tutor to the educational sessions of a back school programme for patients with subacute low back pain with regards to functional activity, back pain, leg pain or general health. The main limitations are that the potential effect of including lay-tutors in the educational part of a back school programme as an intervention in itself has to be tested, and the programme has to be tested as a complete protocol. Also, no specific testing has been performed to confirm the ideal number of sessions in the programme.
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Affiliation(s)
- Inge Grundt Larsen
- Department of Physiotherapy and Occupational Therapy, University Hospital Aarhus , , 8000 Aarhus, Denmark
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Strøm J, Høybye MT, Laursen M, Jørgensen LB, Nielsen CV. Lumbar Spine Fusion Patients' Use of an Internet Support Group: Mixed Methods Study. J Med Internet Res 2019; 21:e9805. [PMID: 31274113 PMCID: PMC6637729 DOI: 10.2196/jmir.9805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/20/2019] [Accepted: 04/13/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Internet use within health care contexts offers the possibility to provide both health information and peer support. Internet Support Groups (ISGs) for patients may offer advantages, which are not found in face-to-face support. In patients undergoing lumbar spine fusion (LSF), ISGs could have a particular potential, as peer support on the web might bridge the decreased satisfaction with social life and social isolation found within these patients. ISGs might in this way contribute to increasing the functioning and overall health-related quality of life. However, LSF patients may generally belong to a group of citizens not prone to internet and online peer support. However, our knowledge of how LSF patients use ISGs is limited. OBJECTIVE The aim of this study was to describe the characteristics of users of an ISG and thematically explore the content of ISG interactions in Danish patients undergoing instrumented LSF because of degenerative spine disorders. METHODS Participants were recruited from a randomized controlled trial and included in a prospective cohort with a mixed methods design. Sociodemographic characteristics and information on psychological well-being (symptoms of anxiety and depression) were obtained at baseline and 1 to 5 weeks before surgery. Usage of the ISG was registered from baseline until 3 months after surgery. All posts and comments were collected, and content analysis was performed. RESULTS A total of 48 participants comprised the study population, with a mean age of 53 years (range 29-77). Of the participants, 54% (26/48) were female, 85% (41/48) were cohabitating, 69% (33/48) were unemployed, and the majority (69% [33/48]) had secondary education. Approximately one-third of the participants had symptoms of depression (35%, 17/48) and anxiety (29%, 14/48). Overall, 90% (43/48) of the participants accessed the ISG. No correlations were found between sociodemographic characteristics and access to the ISG. Women were more prone to be active users, contributing with posts (P=.04). Finally, active users contributing with posts or comments had viewed more pages, whereas passive users, users without posts or comments, had more interactions with the ISG (P<.001). The ISG contained 180 conversation threads, generating 354 comments. The 180 conversation threads in the ISG were constituted by 671 independent dialogue sequences. On the basis of those 671 dialogue sequences, 7 thematic categories emerged. CONCLUSIONS Sociodemographic characteristics were not predictors of ISG use in this study, and active use was found to be gender dependent. Content of interactions on the ISG emerged within 7 thematic categories and focused on social recognition, experience of pain or use of pain medication, experience of physical activity or physical rehabilitation, expression of psychosocial well-being, advising on and exploring the ISG, and employment, which seemed to correspond well with the prevalent occurrence of symptoms of anxiety and depression.
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Affiliation(s)
- Janni Strøm
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette Terp Høybye
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Malene Laursen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Section for Public Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Bastrup Jørgensen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Section for Public Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Regional Hospital West Jutland, Central Denmark Region, Aarhus, Denmark
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Øyeflaten I, Johansen T, Nielsen CV, Johnsen TL, Tveito TH, Momsen AMH. eHealth interventions to facilitate work participation. ACTA ACUST UNITED AC 2019; 17:1026-1033. [DOI: 10.11124/jbisrir-2017-003953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hald K, Larsen FB, Nielsen KM, Meillier LK, Johansen MB, Larsen ML, Christensen B, Nielsen CV. Medication adherence, biological and lifestyle risk factors in patients with myocardial infarction: a ten-year follow-up on socially differentiated cardiac rehabilitation. Scand J Prim Health Care 2019; 37:182-190. [PMID: 31122102 PMCID: PMC6566981 DOI: 10.1080/02813432.2019.1608046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: There is strong evidence that medication adherence and lifestyle changes are essential in patients undergoing secondary cardiovascular disease prevention. Cardiac rehabilitation (CR) increases medication adherence and improves lifestyle changes. Patients with cardiac diseases and a low educational level and patients with little social support are less responsive to improve medication adherence and to adapt lifestyle changes. The aim of the present study was to investigate the long-term effects of a socially differentiated CR intervention on medication adherence as well as changes in biological and lifestyle risk factors at two- five- and ten-year follow-up. Design: A prospective cohort study. Setting: The cardiac ward at Aarhus University Hospital, Denmark. Intervention: A socially differentiated CR intervention in addition to the standard CR program. Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N = 379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network. Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status. Results: No significant long-term effect of the intervention was found. Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status. Key points The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors. Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking. General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
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Affiliation(s)
- Kathrine Hald
- Section for Clinical Social Medicine and Rehabilitation Department of Public Health, Aarhus University, Aarhus, Denmark;
- CONTACT Kathrine Hald Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, P. P. Oerums Gade 9-11, Building 1B, 8000Aarhus C, Denmark
| | - Finn Breinholt Larsen
- DEFACTUM, Social and Health Services and Labour Market, Central Denmark Region, Aarhus, Denmark;
| | | | - Lucette Kirsten Meillier
- DEFACTUM, Social and Health Services and Labour Market, Central Denmark Region, Aarhus, Denmark;
| | | | - Mogens Lytken Larsen
- Danish Centre for Inequality in Health, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark;
| | - Bo Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation Department of Public Health, Aarhus University, Aarhus, Denmark;
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Strøm J, Nielsen CV, Jørgensen LB, Andersen NT, Laursen M. A web-based platform to accommodate symptoms of anxiety and depression by featuring social interaction and animated information in patients undergoing lumbar spine fusion: a randomized clinical trial. Spine J 2019; 19:827-839. [PMID: 30500464 DOI: 10.1016/j.spinee.2018.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 07/05/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Approximately one-third of patients undergoing spine surgery have symptoms of anxiety and depression that correlate with pain, disability, and lower health-related quality of life. The use of web-based informative strategies before surgery and principles from cognitive behavioral therapy, have been applied in other patient groups, facilitating mobility and encouraging beneficial coping behavior. PURPOSE To examine the effect of a web-based Spine Platform featuring Interaction and Information by Animation (w-SPIINA) on symptoms of anxiety and depression, pain, disability, and health-related quality of life. STUDY DESIGN A single-center, two-arm, randomized controlled trial PATIENT SAMPLE: One hundred fourteen consecutive patients scheduled for instrumented lumbar spine fusion due to degenerative disc disease or spondylolisthesis. OUTCOME MEASURES Primary outcome was the change in self-reported Hospital Anxiety and Depression Scale (HADS) scores from baseline to 3-month follow-up. Secondary outcomes were change in HADS 1-day before surgery 2days and 6 months after and changes in self-reported disability measured on the Oswestry disability index (ODI), quality of life (EQ-5D-5L questionnaire), and the low back pain rating scale (LBPRS) 2days and 3 and 6 months after surgery. METHOD Patients were randomized to either a control group receiving a standard information regimen or an intervention group gaining access to w-SPIINA in addition to the standard regimen. The independent charity Helsefonden contributed $45,000, the Health Research Fund of the Regional Hospital Central Jutland contributed $10,000, and the Toyota foundation contributed $10,000 to remunerate a dedicated investigator. The authors have no conflict of interest to declare. RESULTS There was no statistically significant difference within the w-SPIINA group and the control group regarding changes in HADS at 3-month follow-up (p≥.37). Approximately 40% reached minimum clinically important difference (MCID) in the w-SPIINA group on the HADS at 3 months. In the control group 50% reached MCID on anxiety subscale and 35% on the depression subscale at 3 months. No statistically significant differences were found between groups with regard to the overall outcomes at any of the predefined time points. CONCLUSION Providing patients with access to w-SPIINA in addition to a standard information regimen had no additional effect on HADS and patient-reported outcomes1day before, 2days, 3 or 6 months after surgery. However, a high compliance and degree of interaction with w-SPIINA indicates that this mode of web-based support could be applicable in this group of patients.
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Affiliation(s)
- Janni Strøm
- Centre of Elective Surgery, Regional Hospital of Silkeborg, Silkeborg, Denmark; Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Denmark
| | - Lene Bastrup Jørgensen
- Centre of Elective Surgery, Regional Hospital of Silkeborg, Silkeborg, Denmark; Department of Clinical Medicine, Section for Public Health, Aarhus University, Aarhus, Denmark
| | - Niels Trolle Andersen
- Department of Biostatistics, Section for Public Health, Aarhus University, Aarhus, Denmark
| | - Malene Laursen
- Centre of Elective Surgery, Regional Hospital of Silkeborg, Silkeborg, Denmark
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Abstract
Hip fracture (HF) incidents can severely restrict the activity and well-being of older people. While participation in activities may be related to lived experiences of meaningfulness, the aim of this study was to explore facilitators and barriers for being active as experienced by older people during the first six months after HF. The study used a phenomenological-hermeneutic methodology informed by the philosophies of Heidegger and Gadamer. Two men and 11 women with reduced functioning prior to the HF were interviewed 2 weeks (n=13) and again 6 months (n=11) after discharge. Referring to own pre-understanding including a theoretical framework of well-being, a method of meaning condensation was applied to structure the data. A deeper understanding was gradually achieved through a movement between the parts and the wholes. Two themes emerged: (1) "Inner dialogue and actions" with the sub-themes "Inner driving forces" and "Inner limitations"; (2) "Struggling and Striving" with the sub-themes "Building relationships" and "Considering complications and conditions". We conclude that facilitators for older people to experience well-being while being active involve meaningful relationships with other people, a sense of own identity and being at peace and may be influenced by relationships with staff, physical surroundings, public health services, and health problems.
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Affiliation(s)
- Birgit Rasmussen
- a Department of Rehabilitation , Horsens Regional Hospital , Horsens , Denmark
| | | | - Lisbeth Uhrenfeldt
- c Faculty of Nursing and Health Science , Nord University , Bodø , Norway.,d Department of Health, Science and Technology , Aalborg University , Aalborg , Denmark
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Thisted CN, Labriola M, Vinther Nielsen C, Kristiansen ST, Strøm J, Bjerrum MB. Managing employees' depression from the employees', co-workers' and employers' perspectives. An integrative review. Disabil Rehabil 2018; 42:445-459. [PMID: 30384779 DOI: 10.1080/09638288.2018.1499823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To synthesize evidence on factors promoting or hindering work participation (WP) of employees with depression from the employees', co-workers' and employers' perspectives, as well as an additional focus on the influence of the employee's occupation.Methods: An integrative review was conducted. Pre-defined eligibility criteria guided study selection. Articles were critically appraised using tools developed by Joanna Briggs and Mixed Methods Appraisal Tool. Findings were analysed and synthesised using qualitative inductive content analysis.Results: Seventeen studies were included: 12 quantitative studies, three qualitative studies and two mixed methods studies. From these, 144 findings were extracted and combined into six categories from which two syntheses were developed. One synthesis demonstrated that employees, co-workers and employers hold different perspectives on rehabilitation stakeholders' responsibilities hindering WP. The other synthesis revealed that WP is influenced by interactions between individual and occupational factors.Conclusions: Sufficient treatment from health professionals promotes WP. Employees' fear of stigmatization hinders WP. Co-workers and employers find that open communication is important, however, employers are concerned about entering employees' private sphere. When managing employees with depression, employers intervene at the individual level. There is a need for structural interventions to promote WP among employees with depression.Implications for RehabilitationThe responsibilities of rehabilitation stakeholders should be clarified to promote collaboration.Structural workplace interventions should be initiated to supplement individual level interventions.Workplace interventions may focus on more open communication and awareness towards mental illness.Interactions between the occupational factors and individual factors should be carefully considered.
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Affiliation(s)
- Cecilie N Thisted
- Department of Public Health, Section for Nursing Science, Aarhus University, Aarhus, Denmark
| | - Merete Labriola
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Sanne T Kristiansen
- Department of Affective Disorders, Aarhus University Hospital, Risskov, Central Denmark Region, Aarhus, Denmark
| | - Janni Strøm
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark.,Spine Unit, Elective Surgery Centre, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - Merete B Bjerrum
- Department of Public Health, Section for Nursing Science, Aarhus University, Aarhus, Denmark.,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Department of Medicine and Technology, University of Aalborg, Aalborg, Denmark
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Pedersen P, Labriola M, Nielsen CV, Maimburg RD, Nohr EA, Momsen AM. Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces. BMJ Open 2018; 8:e024032. [PMID: 30366917 PMCID: PMC6224771 DOI: 10.1136/bmjopen-2018-024032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The high rate of sickness absence from work during pregnancy is recognised as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in healthcare settings and workplaces targeting sickness absence among pregnant women. METHODS Studies were eligible if they included pregnant women participating in any intervention in healthcare settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomised controlled trials (RCTs) or quasi-experimental studies.The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO, ClinicalTrials.gov and WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardised quality assessment instrument. RESULTS A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in healthcare settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general, the frequency of women on sickness absence was lower in the intervention groups than the control groups, however, only among pregnant women who participated in a 12-week exercise programme, the frequency was significantly lower (22% vs 30%, p=0.04). CONCLUSION The evidence of interventions targeting sickness absence among pregnant women in healthcare settings is sparse, and no studies were conducted at workplaces.Future interventions including physical activity provided in collaboration with healthcare settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention and provide transparency of statistical methods. PROSPERO REGISTRATION NUMBER CRD42018084802.
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Affiliation(s)
- Pernille Pedersen
- Central Denmark Region, DEFACTUM - Social and Health Services & Labour Market, Aarhus, Denmark
| | - Merete Labriola
- Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynaecology Obstetrics, Aarhus Universitetshospital, Aarhus, Denmark
| | - Ellen Aagaard Nohr
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne-Mette Momsen
- Central Denmark Region, DEFACTUM - Social and Health Services & Labour Market, Aarhus, Denmark
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Maribo T, Nielsen JF, Nielsen CV. Wide variation in function level assessment after stroke in Denmark. Dan Med J 2018; 65:A5500. [PMID: 30269746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The aim of this study was to examine the use of standardised instruments to describe functioning in stroke patients in the transition from hospital to home-based rehabilitation. METHODS Questionnaires were sent to 26 hospitals discharging patients with stroke and 52 primary care health services treating stroke patients at home, within an area with a population of three million. Questionnaires were targeted at healthcare professionals who typically take part in home-based stroke rehabilitation asking: "Which instruments, outcome measures or tests are commonly used to describe functioning in persons with stroke?" Instruments routinely used to assess functioning were reported. RESULTS 85% of the hospitals and 90% of the primary care services returned the questionnaire. 95% of the hospitals and 96% of the primary care services used standardised instruments. Hospitals reported 61 standardised instruments and primary care services reported 60 standardised instruments. A total of 89 standardised instruments were reported. No instrument was used in every hospital or primary care service. CONCLUSIONS The vast majority of services use standardised instruments, but there is absolutely no consensus on which instruments to use. There is a strong need for recommendations on which instruments should be used in stroke rehabilitation in the transition from hospital-based to home-based rehabilitation. FUNDING This study was supported by a grant from the Management Forum for Collaboration between Aarhus University and the Central Denmark Region, Denmark. None of the authors have any personal financial interests in the work undertaken or the findings reported. TRIAL REGISTRATION not relevant.
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Abstract
Purpose The aim was to aggregate knowledge about the opportunities, challenges and need for support employees with common mental disorders experience in relation to work participation in order to develop recommendations for practice. Methods A meta-synthesis was conducted using a meta-aggregative approach to accurately and reliably present findings that could be used to meet our aim. Qualitative inductive content analysis was used to analyze and synthesize the findings. Results In all, 252 findings were extracted from 16 papers, and six categories were generated and aggregated into two synthesized findings. One synthesized finding indicates that a strong work identity and negative perceptions regarding mental disorders can impede work participation, creating an essential need for a supportive work environment. The other reveals that the diffuse nature of the symptoms of mental disorders causes instability in life and loss of control, but through the use of internal motivation and external support, employees may be able to regain control of their lives. However, external support is hampered by insufficient cooperation and coordination between vocational stakeholders. Conclusions Based on the synthesized findings, we recommended that the employer is involved in the rehabilitation process, and that rehabilitation professionals seek to strengthen the employee's ability to manage work-related stress. In addition, rehabilitation professionals should provide individualized and active support and ensure meaningful cooperation across the multidisciplinary disciplines involved in the rehabilitation process.
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Affiliation(s)
- Cecilie Nørby Thisted
- Department of Public Health, Section of Nursing, Aarhus University, Bartholins Allé 2, 3., 8000, Aarhus C, Denmark.
| | - Claus Vinther Nielsen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Merete Bjerrum
- Department of Public Health, Section of Nursing, Aarhus University, Bartholins Allé 2, 3., 8000, Aarhus C, Denmark
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Handberg C, Midtgaard J, Nielsen CV, Thorne S, Lomborg K. Healthcare Professionals' Attitudes to Rehabilitation Programming for Male Cancer Survivors. Rehabil Nurs 2018; 43:127-137. [PMID: 27766645 DOI: 10.1002/rnj.298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study is to describe and interpret the attitudes and conduct of hospital healthcare professionals (HCPs) in association with male cancer survivors and their municipal rehabilitation participation. DESIGN Ethnographic fieldwork was conducted, consisting of participant observation and nine semistructured focus group interviews with 58 hospital HCPs. METHODS Using interpretive description methodology with symbolic interaction as a theoretical framework, data were collected through fieldwork in three oncology wards in Denmark. FINDINGS Attitudes about both gender and rehabilitation were identified as overarching obstructions within hospital HCP conduct toward promoting men's participation in cancer rehabilitation. CONCLUSIONS Gender and rehabilitation perceptions formed barriers in this context, suggesting that male cancer survivors' rehabilitation outcomes may be compromised by HCP attitudes and conduct. CLINICAL RELEVANCE These findings provide insight into approaches to guide HCPs to take responsibility for rehabilitation and to take gender into account in their work.
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