"I knew who I was this morning, but I've changed a few times since then": A study combining register and self-reported QoL data in assessing how response shift may occur in an injury population.

AIMS: The phenomenon of response shift may occur when people are exposed to a traumatic event and reevaluate the meaning of important aspects of their lives; a phenomenon that a traditional pre- and post-assessment cannot catch. Hence, the aim of the study was to increase the knowledge of how response shift may occur in people who have suffered an injury. METHODS: The current study is a register-based cohort study including 2512 participants. Data were retrieved from the Swedish LifeGene project and an online questionnaire, including the EQ5D. In order to analyze how response shift may occur, a "Then-test" and Structural Equation Model (SEM) were used. RESULTS: The results showed a clear indication of response shift through recalibration. The SEM analysis confirmed that participants significantly shifted their response between the post- and retrospective measurements. Significant differences were found for the VAS and for two of the five EQ5D dimensions: anxiety/depression and pain. CONCLUSION: This study provides additional knowledge to how response shift can occur in an injury population. This information can guide the next generation of QoL measures and be used as guidance for designing interventions for those suffering injuries. Furthermore, it may have an impact on how to interpret evaluations of interventions.

A snapshot of an eCohort: A comparison of the LifeGene population at baseline with the Swedish general population.

AIMS: With access to technologies and internet around the globe, opportunities have been provided to contact and recruit participants at a more rapid pace, without face-to-face contact. However, 'eCohorts' may yield substantial volunteer bias. Few studies have compared eCohorts to general populations or samples where traditional research methods have been applied. To our knowledge, no prior analyses have reported on Swedish-based LifeGene eCohort, in comparison with the Swedish general population. The aim of this study was to compare the LifeGene eCohort at baseline with the Swedish general population. METHODS: The LifeGene eCohort (n = 39,862) was compared with the general population in Sweden represented by weighted data from the Swedish Public Health agency and Statistics Sweden. LifeGene is a nationwide project with yearly data collection. Descriptive statistics were used to compare demographic characteristics, and self-reported data on diagnosis of depression. RESULTS: The LifeGene eCohort overrepresented younger people, females, those with a higher socio-economic status, non-smokers and people with a diagnosis of depression. Surprisingly, the eCohort included a larger percentage of people born outside of Sweden compared to the general population, which is not in line with previous studies. CONCLUSION: The results show that the participants in the LifeGene eCohort are different regarding demographic variables and some health indicators from the Swedish general population. Hence, if comparisons are made between the LifeGene eCohort and a general population it becomes important to be aware of the differences that might exist between the different cohort populations and how these might affect the estimates.

Interventions for return to work following work-related injuries among young adults: A systematic literature review.

OBJECTIVE: To provide a review of current knowledge about interventions aimed to facilitate young adults to return to work following work-related injuries. METHODS: A systematic review of published literature from the year 2010 and onwards was conducted to identify studies examining return to work interventions for young adults (aged 19-29) following work-related injuries using PubMed and Web of Science. Two reviewers conducted the screening process and assessed the study quality using the National Heart, Lung, and Blood Institute assessment tool for Observational Cohort and Cross-Sectional studies. Due to wide heterogeneity and small number of studies retained post-screening, a descriptive summary analysis of the included studies was conducted. RESULTS: No studies were identified that focused exclusively on interventions for young adults. However, two studies, in which an age category of young adults was available, were included and assessed for quality. The study populations were primarily suffering from work-related injuries in the lower back or lower limbs. Both studies revealed that return to work interventions using a case manager coordinating and providing consultation, advice, and risk management to multidisciplinary teams was associated with lower sick leave days. CONCLUSIONS: Despite the emerging evidence that young adults have higher rates of work-related injuries compared to older colleagues, information concerning work-related injuries and return to work interventions specifically targeting young workers is still lacking. Further research is therefore needed to develop and evaluate return to work interventions for the population of young adults.

Return to work and sick leave patterns following a work injury among young adults: a study protocol of a Swedish multimodal study.

INTRODUCTION: There is a lack of studies that focus exclusively on return to work (RTW) and sick leave patterns following a work injury among young adults. This study aims to close the gap by contributing with knowledge regarding young adults' sick leave pattern after a work injury and their experience of RTW after a work injury in Sweden. METHODS AND ANALYSIS: The present study is a multimodal study, which will use Swedish national register data and qualitative data collection by photovoice. Injuries classified as work injuries according to the Swedish injury classification were included. Registry data will be retrieved from the Swedish National-based registers of Swedish Information System on Occupational Accidents and Work-related diseases, the Swedish Social Insurance Agency's database MicroData for Analysis of Social Insurance and the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. Persons who have registered a work injury at the Swedish Work Environment Authority in 2012 will be included. Sick leave patterns will be analysed using group-based trajectory models and multivariate analyses to explore how sick leave patterns have developed over 5 years. Subsequently, a participatory approach using photovoice method will be conducted to explore young adults' perceptions of barriers and facilitators in RTW after a work injury. Results from the photovoice group sessions will be analysed using a grounded theoretical approach. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Ethical Review Board (case number 2019/028-6) in Sweden. Results of the study will be disseminated through peer-reviewed journals, print and media presentation, conferences and via reports to the funding agency.

Quality of life in the limelight: a study protocol of a Swedish register-based cohort study on quality of life after an injury.

INTRODUCTION: Currently, there are very few published studies on preinjury and postinjury assessments of quality of life (QoL) based on a prospective appraisal; specifically, knowledge of those who do not seek medical care following injury is lacking. To close these knowledge gaps, this study aims to identify the psychosocial consequences in terms of loss of QoL following injury in a Swedish population and to investigate the response shift in retrospective measures of self-reported QoL. METHODS AND ANALYSIS: We will analyse preinjury and postinjury (including both minor and severe unintentional injuries as well as different injury mechanisms) assessments of QoL, including the phenomenon of response shift, using register-based data from the nationwide collaboration project LifeGene, which includes over 52 000 individuals living in Sweden. In addition to LifeGene data, a short online survey including a 'ThenTest' questionnaire, that is, comparison of previous QoL to current using EuroQoL five-dimensional questionnaire, was sent out to the participants of LifeGene. This study will provide a unique opportunity to study the changes in QoL by comparing preinjury and postinjury assessments using a prospective appraisal, both for populations who have sought medical care as well as those who have not due to their injury. Similarly, the study will also assess the response shift in retrospective measures of QoL. This information can guide the next generation of QoL measures and interventions for those suffering injuries and have an impact on how to interpret evaluations of interventions. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Regional Ethical Review Board in Stockholm, Sweden (case number 2018/352-31). The results will be disseminated through peer-reviewed journals, conference presentations, print media and internet and via a report for the funding agency.

Trajectories of sickness absence after road traffic injury: a Swedish register-based cohort study.

OBJECTIVES: Despite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns' interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity. DESIGN: A register-based prospective cohort study. SETTING: Administrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data. PARTICIPANTS: Individuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL. RESULTS: Three distinct patterns of SA were identified; 'Stable', 'Quick decrease' and 'Gradual decrease'. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable. CONCLUSION: The study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.

I did NOT feel like this at all before the accident: do men and women report different health and life consequences of a road traffic injury?

BACKGROUND: Worldwide, injuries represent one of the leading causes of mortality, and nearly one-quarter of all injuries are road traffic related. In many high-income countries, the burden of road traffic injuries (RTIs) has shifted from premature death to injury and disability with long-term consequences; therefore, it is important to assess the full burden of an RTI on individual lives. OBJECTIVE: To describe how men and women with minor and moderate injuries reported the consequences of an RTI on their health and lives. METHODS: The study was designed as an explorative qualitative study, in which the answers to an open-ended question concerning the life and health consequences following injury were analysed using systematic text condensation. PARTICIPANTS: A total of 692 respondents with a minor or a moderate injury were included. RESULTS: The respondents reported the consequences of the crash on their health and lives according to four categories: physical consequences, psychological consequences, everyday life consequences and financial consequences. The results show that medically classified minor and moderate injuries have detrimental long-term health and life consequences. Although men and women report some similar consequences, there are substantial differences in their reported psychological and everyday life consequences following an injury. Women report travel anxiety and PTSD-like symptoms, being life altering for them compared with men, for whom these types of reports were missing. CONCLUSION: These differences emphasise the importance of considering gender-specific physical and psychological consequences following an RTI.

Colored body images reveal the perceived intensity and distribution of pain in women with breast cancer treated with adjuvant taxanes: a prospective multi-method study of pain experiences.

Background and aims Breast cancer is the most prevalent adult cancer worldwide. A broader use of screening for early detection and adjuvant systemic therapy with chemotherapy has resulted in improved survival rates. Taxane-containing chemotherapy is one of the cornerstones of the treatment. However, taxane-containing chemotherapy may result in acute chemotherapy-induced nociceptive and neuropathic pain. Since this pain may be an additional burden for the patient both during and after taxane chemotherapy, it is important to rapidly discover and treat it. There is yet no gold standard for assessing taxane-induced pain. In the clinic, applying multiple methods for collecting information on pain may better describe the patients' pain experiences. The aim was to document the pain during and after taxane through the contribution of different methods for collecting information on taxane-induced pain. Fifty-three women scheduled for adjuvant sequential chemotherapy at doses of ≥75 mg/m2 of docetaxel and epirubicin were enrolled in the study. Methods Prospective pain assessments were done on a visual analog scale (VAS) before and during each cycle of treatment for about 5 months, and using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire's (EORTC-QLQ-C30) two pain questions at baseline, 3 months, and 12 months. Participants scoring pain on the VAS >30 and undergoing an interview also colored their pain on a body image during treatment and at 12 months. Results Surprisingly widespread, intense pain was detected using a multi-method approach. The colored body image showed pain being perceived on 51% of the body surface area during treatment, and on 18% 12 months after inclusion. In general, the pain started and peaked in intensity after the first cycle of taxane. After Cycle 3, most women reported an increase in pain on the VAS. Some women continued to report some pain even during the epirubicin cycles. The VAS scores dropped after the last chemotherapy cycle, but not to the baseline level. At baseline, 3 months and 12 months after inclusion, the women who estimated VAS >30 reported higher levels of pain on the pain questions of the EORTC-QLQ-C30. Conclusions This study contributes information on how different pain assessment tools offer different information in the assessment of pain. The colored body image brings another dimension to pain diagnostics, providing additional information on the involved body areas and the pain intensities as experienced by the women. A multi-method approach to assessing pain offers many advantages. The timing of the assessment is important to properly assess pain. Implications Pain relief needs to be included in the chemotherapy treatment, with individual assessment and treatment of pain, in the same way as is done in chemotherapy-triggered nausea. There is a time window whereby the risk of pain development is at its highest within 24-48 h after receiving taxane chemotherapy. Proper attention to pain evaluation and treatment should be in focus during this time window.

Quality of life following road traffic injury: A systematic literature review.

PURPOSE: To assess and provide a systematic overview of current knowledge about the relationship between quality of life (QoL) and road traffic injury, and to appraise how QoL is affected by road traffic injury. METHODS: A systematic review of the literature published since 1990 on QoL after a road traffic injury, including adult and paediatric populations, from three databases (Pubmed, PsychInfo and SafetyLit) was undertaken. The methodological quality was assessed according to the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Thirty articles were included and assessed for quality. The QoL scores of those injured were similar to population norms at the first assessment, followed by a drop at the second assessment. An increase of QoL from the second to third assessment was reported, but participants never reached the population norms at the last follow-up (range six weeks to two years), with an exception of those claiming compensation and those with lower extremity fractures. Age, gender, socioeconomic status, injury severity, injury type and post-traumatic stress disorder were associated with reduced QoL. CONCLUSIONS: Available literature regarding QoL among injured in road traffic crashes is heterogeneous with regard to aims and tools used for assessment. Our review confirmed that independent of measure, the overall QoL was significantly reduced after a road traffic injury compared to the general population norms. Persons who are older, of female gender, lower socioeconomic status, diagnosed with post-traumatic stress disorder, with more severe injuries or injuries to the lower limbs are more vulnerable to loss of QoL following road traffic injury compared to other patient groups injured in road traffic crashes.

A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients­a randomized study in group vs. individual setting.

OBJECTIVE: To evaluate the mode of delivery of a stress management intervention, in a group or individual setting, on self-reported cancer-related traumatic stress symptoms. A secondary aim was to evaluate a stepped care approach. METHODS: All study participants (n = 425), who were female, newly diagnosed with breast cancer and receiving standard oncological care were offered Step I of the stepped care approach, a stress management education (SME). Thereafter, they were screened for cancer-related traumatic stress symptoms, and, if present (n = 304), were invited to join Step II, a more intense intervention, derived from cognitive behavioral therapy, to which they were randomized to either a group (n = 77) or individual (n = 78) setting. To assess cancer-related traumatic stress symptoms, participants completed the Impact of Event Scale and the Hospital Anxiety and Depression Scale at the time of inclusion, three-months post-inclusion and approximately 12-months post-inclusion. RESULTS: The SME did not significantly decrease any of the cancer-related traumatic stress symptoms. No statistically significant differences were found between the group and the individual setting interventions. However, only 54% of the participants attended the group setting compared to 91% for the individual setting. CONCLUSION: The mode of delivery had no effect on the cancer-related traumatic stress symptoms; however, the individual setting was preferred. In future studies, a preference-based RCT design will be recommended for evaluating the different treatment effects.

Group versus individual stress management intervention in breast cancer patients for fatigue and emotional reactivity: a randomised intervention study.

BACKGROUND: Fatigue and emotional reactivity are common among women suffering from breast cancer and might detrimentally affect these women's quality of life. This study evaluates if the stress management delivered either in a group or individual setting would improve fatigue and emotional reactivity among women with a newly diagnosed breast cancer. MATERIAL AND METHODS: Participants (n = 304) who reported elevated levels of distress at three-month post-inclusion were randomised between stress management in a group (GSM) (n = 77) or individual (ISM) (n = 78) setting. Participation was declined by 149 women. Participants completed the Multidimensional Fatigue Inventory (MFI-20) and the Everyday Life Stress Scale (ELSS) at the time of inclusion, 3- and 12-month post-inclusion. Analyses were made according to intention to treat and per-protocol principles. Mann-Whitney tests were used to examine differences between the two intervention groups. RESULTS: No significant differences were detected between the GSM and ISM groups on fatigue or emotional reactivity. In addition, there were no changes over time for these outcomes. CONCLUSIONS: There were no differences between the two intervention arms with reference to fatigue or emotional reactivity; however, a clinically interesting finding was the low number of women who were interested in participating in a psychosocial intervention. This finding may have clinical implications when psychosocial support is offered to women with a newly diagnosed breast cancer and also in the planning of future studies.

Cognitive processing in relation to psychological distress in women with breast cancer: a theoretical approach.

OBJECTIVE: To evaluable a cognitive procession model developed by Creamer and colleagues, this study examined the longitudinal relationship between intrusion and psychological distress, via avoidance, in women with breast cancer. METHODS: Participants included 189 patients who were newly diagnosed with breast cancer. The longitudinal association between intrusion, avoidance and psychological distress and the mediating role of avoidance between intrusion and psychological distress were examined. Intrusion was measured at inclusion (T1), avoidance at 3 months post-inclusion (T2) and psychological distress at 12 months post-inclusion (T3). RESULTS: Results suggested that avoidance at T2 did not mediate the relationship between intrusions at T1 and psychological distress at T3. CONCLUSION: The results did not provide support for Creamer's model in an early-stage breast cancer population, which suggests that early-stage breast cancer patient's process trauma differently from late-stage cancer patients. Therefore, it might be suggested that early-stage and late-stage cancer patients require different types of support and treatment for the distress experienced.

Design of the study: how can health care help female breast cancer patients reduce their stress symptoms? A randomized intervention study with stepped-care.

BACKGROUND: A life threatening illness such as breast cancer can lead to a secondary diagnosis of PTSD (post traumatic stress disorder) with intrusive thoughts and avoidance as major symptoms. In a former study by the research group, 80% of the patients with breast cancer reported a high level of stress symptoms close to the diagnosis, such as intrusive thoughts and avoidance behavior. These symptoms remained high throughout the study. The present paper presents the design of a randomized study evaluating the effectiveness and cost-effectiveness of a stress management intervention using a stepped-care design. METHOD: Female patients over the age of 18, with a recent diagnosis of breast cancer and scheduled for adjuvant treatment in the form of chemotherapy, radiation therapy and/or hormonal therapy are eligible and will consecutively be included in the study. The study is a prospective longitudinal intervention study with a stepped-care approach, where patients will be randomised to one of two interventions in the final stage of treatment. The first step is a low intensity stress-management intervention that is given to all patients. Patients who do not respond to this level are thereafter given more intensive treatment at later steps in the program and will be randomized to more intensive stress-management intervention in a group setting or individually. The primary out-come is subjective distress (intrusion and avoidance) assessed by the Impact of Event Scale (IES). According to the power-analyses, 300 patients are planned to be included in the study and will be followed for one year. Other outcomes are anxiety, depression, quality of life, fatigue, stress in daily living and utilization of hospital services. This will be assessed with well-known psychometric tested questionnaires. Also, the cost-effectiveness of the intervention given in group or individually will be evaluated. DISCUSSION: This randomized clinical trial will provide additional empirical evidence regarding the effectiveness of a stress-management program given in group or individually during adjuvant therapy in terms of decreased stress, minimizing fatigue, and maintaining or enhancing patients' quality of life and psychological well-being. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01555645.