Psychometric properties and cut-off scores for the Swedish version of the Negative Acts Questionnaire: The full scale and short version.

The present study investigates the psychometric properties and cut-off scores of a Swedish version of the Negative Acts Questionnaire, the most frequently used instrument to measure exposure to workplace bullying. Based on a probability sample of the Swedish workforce (n = 1853), we investigate the validity of both the full version (NAQ-R) and the short version (SNAQ). We suggest optimal cut-offs for the NAQ-R and SNAQ, and for the subscales measuring work- and person-related bullying. Based on the cut-off scores we provide estimates of prevalence in a Swedish context. The factor structure and psychometric properties are comparable to the Norwegian original and the English versions of the instrument. We also tested the criterion validity using 11 outcome and antecedent variables to bullying, and all provided support for its validity. The identified cut-off scores differentiate clearly when tested against the 11 variables used to test criterion validity in the study. The results showed that the Swedish version of the NAQ-R, including the SNAQ, is a valid measure of workplace bullying. To our knowledge, this study is the first study presenting statistical cut-offs for the NAQ-R subscales as well as investigating both the NAQ-R and the SNAQ simultaneously. The present study also provides some criticism against and suggestions for improving the NAQ-R, aiming to capture even more of the overall experience of exposure, ability to defend oneself, overall duration, and on- and offline exposure.

The last resort: Workplace bullying and the consequences of changing jobs.

This study investigated the consequences of changing jobs for employees subjected to workplace bullying. First, we hypothesized that bullied employees would be more likely to change jobs than non-bullied employees. Moreover, we hypothesized that changing jobs would result in a reduction of exposure to bullying behaviors and an alleviation of mental health problems for those bullied at baseline. The study was based on a longitudinal probability sample of the whole Swedish workforce (n = 1,095). The time lag was 18 months. The results supported all hypotheses except one. Those employees who were bullied at baseline were more likely to have changed jobs at follow-up. Also, for the changers there was a reduction in exposure to subsequent bullying. The actual drop in exposure to bullying behaviors was significant and substantial. This gives further support for the work environment hypothesis, suggesting the work context may be a more important cause than individual characteristics. As for mental health problems, the association between bullying and subsequent anxiety was not significant for those changing jobs, suggesting that leaving a toxic workplace may reduce anxiety relatively quickly. However, depression symptoms were not affected by the change of jobs, and the association between bullying and subsequent depression was the same 18 months later. The conclusion is that changing jobs can be a useful, last resort on an individual level, improving the situation for the victim of bullying. However, it is important to note that it does not solve any underlying organizational problems and risk factors.

Killing two birds with one stone: how intervening when witnessing bullying at the workplace may help both target and the acting observer.

OBJECTIVE: This study examines under which conditions being an observer of bullying can be detrimental to health and well-being. It was hypothesized that health-related problems following observations of bullying are determined by (1) whether the observer has been exposed to bullying her/himself and (2) whether the observer have tried to intervene in the bullying situation that they witnessed. METHODS: The study was based on a longitudinal probability survey of the Swedish workforce, with an 18-month time lag between assessment points (N = 1096). RESULTS: Witnessing bullying at work were associated with an increase in subsequent levels of mental distress among the observers, although this association became insignificant when adjusting for the observers' own exposure to bullying. Intervening against bullying moderated the relationship between observations of bullying and mental health problems. Observers who did not try to intervene reported a significant increase in mental health problems at follow-up, whereas there were no significant changes in levels of mental health problems among those who did intervene. CONCLUSIONS: the findings suggest that observer interventions against bullying may be highly beneficial for both the targets and observers of bullying. Organizations should therefore invest in ways to increase constructive bystander behavior in negative social situations at the workplace.

Gender Matters: Workplace Bullying, Gender, and Mental Health.

The aim of this study was to examine the role of gender in the process of workplace bullying. In particular, we examined how gender affects reported prevalence rates and health consequences of bullying. In addition, we pay particular attention to if the measurement method - self-labelling or behavioural experience methods - affects potential gender differences. A longitudinal study, with two measurement points 18 months apart, was conducted in Sweden (n = 1854 at T1; n = 1096 at T2). It was a probability sample out of a population of all 3.3 million people in Sweden working at workplaces with ten or more employees. The results showed a slightly higher tendency for women to self-label as bullied (8% vs. 6%), while a higher proportion of men than women could be labelled as bullied based on the negative acts they had been exposed to (21% vs. 14%). Exposure to negative acts was associated with more subsequent mental health problems for both men and women, whereas self-labelling was associated with mental health problems for men only. Mental health problems at baseline also increased the risk of bullying for both men and women; however, the measurement method affected if the effect was stronger for men or women. Overall, the study advances our understanding of the role of gender in bullying, in particular highlighting the importance of the measurement method for understanding such gender differences.

Exposure to bullying behaviours and support from co-workers and supervisors: a three-way interaction and the effect on health and well-being.

PURPOSE: Workplace bullying can be very stressful and it has detrimental effects on health and well-being which makes it an important area of study. Social support has traditionally been seen as important in moderating work-related stress. It was hypothesised that the negative association between exposure to bullying behaviours, and health and well-being is moderated by (a) perceived support from close co-workers and (b) perceived supportive leadership. In the study, we also investigated a three-way interaction between exposure to bullying behaviours, perceived support from close co-workers and perceived supportive leadership. This association has not been studied before and add new knowledge to the research field. METHODS: We used a moderated moderation analysis of workplace bullying, co-worker support and supervisor support using cross-sectional data from a work environment survey with 1383 respondents (75% response rate). RESULTS: The moderated moderation analysis confirmed the moderating effect of perceived co-worker support but not the moderating effect of perceived supervisor support. There was a three-way interaction, but not in the case of the lowest 12.6% of perceived supervisor support scores. CONCLUSIONS: These results indicate that the negative effect of workplace bullying on health and well-being is weaker if victims perceive that they have co-worker support, but this protective effect seems to be conditional on the perceived level of supervisor support. In other words, lack of supportive leadership may block the beneficial effect of perceived co-worker support.

Traction for low-back pain with or without sciatica.

BACKGROUND: Traction has been used to treat low-back pain (LBP), often in combination with other treatments. We included both manual and machine-delivered traction in this review. This is an update of a Cochrane review first published in 1995, and previously updated in 2006. OBJECTIVES: To assess the effects of traction compared to placebo, sham traction, reference treatments and no treatment in people with LBP. SEARCH METHODS: We searched the Cochrane Back Review Group Specialized Register, the Cochrane Central Register of Controlled Trials (2012, Issue 8), MEDLINE (January 2006 to August 2012), EMBASE (January 2006 to August 2012), CINAHL (January 2006 to August 2012), and reference lists of articles and personal files. The review authors are not aware of any important new randomized controlled trial (RCTs) on this topic since the date of the last search. SELECTION CRITERIA: RCTs involving traction to treat acute (less than four weeks' duration), subacute (four to 12 weeks' duration) or chronic (more than 12 weeks' duration) non-specific LBP with or without sciatica. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. As there were insufficient data for statistical pooling, we performed a descriptive analysis. We did not find any case series that identified adverse effects, therefore we evaluated adverse effects that were reported in the included studies. MAIN RESULTS: We included 32 RCTs involving 2762 participants in this review. We considered 16 trials, representing 57% of all participants, to have a low risk of bias based on the Cochrane Back Review Group's 'Risk of bias' tool.For people with mixed symptom patterns (acute, subacute and chronic LBP with and without sciatica), there was low- to moderate-quality evidence that traction may make little or no difference in pain intensity, functional status, global improvement or return to work when compared to placebo, sham traction or no treatment. Similarly, when comparing the combination of physiotherapy plus traction with physiotherapy alone or when comparing traction with other treatments, there was very-low- to moderate-quality evidence that traction may make little or no difference in pain intensity, functional status or global improvement.For people with LBP with sciatica and acute, subacute or chronic pain, there was low- to moderate-quality evidence that traction probably has no impact on pain intensity, functional status or global improvement. This was true when traction was compared with controls and other treatments, as well as when the combination of traction plus physiotherapy was compared with physiotherapy alone. No studies reported the effect of traction on return to work.For chronic LBP without sciatica, there was moderate-quality evidence that traction probably makes little or no difference in pain intensity when compared with sham treatment. No studies reported on the effect of traction on functional status, global improvement or return to work.Adverse effects were reported in seven of the 32 studies. These included increased pain, aggravation of neurological signs and subsequent surgery. Four studies reported that there were no adverse effects. The remaining studies did not mention adverse effects. AUTHORS' CONCLUSIONS: These findings indicate that traction, either alone or in combination with other treatments, has little or no impact on pain intensity, functional status, global improvement and return to work among people with LBP. There is only limited-quality evidence from studies with small sample sizes and moderate to high risk of bias. The effects shown by these studies are small and are not clinically relevant. Implications for practice To date, the use of traction as treatment for non-specific LBP cannot be motivated by the best available evidence. These conclusions are applicable to both manual and mechanical traction. Implications for research Only new, large, high-quality studies may change the point estimate and its accuracy, but it should be noted that such change may not necessarily favour traction. Therefore, little priority should be given to new studies on the effect of traction treatment alone or as part of a package.

A randomized controlled trial of the effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care on health-related quality of life in acute or subacute low back pain.

OBJECTIVE: To evaluate the health-related quality of life effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care in acute or subacute low back pain patients. STUDY DESIGN: A randomized, controlled trial during 10 weeks with four treatment groups. SETTING: Nine primary health care and one outpatient orthopaedic hospital department. SUBJECTS: One hundred and sixty patients with acute or subacute low back pain. INTERVENTIONS: Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or 'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching, manual therapy and steroid injections (group 4). MAIN MEASURES: The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score. RESULTS: In a multivariate analysis adjusted for possible outcome affecting variables other than the treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in groups 1-4, respectively (P for trend <0.05). There were significant trends for the well-being components patience (P < 0.005), energy (P < 0.05), mood (P < 0.05) and family situation (P < 0.05). The remaining two components and Complaint score showed a non-significant trend towards improvement. CONCLUSION: The effects on health-related quality of life were greater the larger the number of treatment modalities available. The 'stay active' treatment group, with the most restricted number of modalities, had the most modest health-related quality of life improvement, while group 4 with the most generous choice of treatment modalities, had the greatest improvement.

Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients.

BACKGROUND: There is a growing consensus on low back pain treatment. However, whether this extends to diagnostic labelling is still largely unknown. The aim of this report was to compare the diagnostic assessment of low back pain patients between general practitioners trained in manual therapy and orthopaedic surgeons. METHODS: Population-based randomized controlled trial in which 160 patients with acute or sub-acute low back pain were assessed and treated by general practitioners or orthopaedic surgeons. Information on diagnoses and use of diagnostic imaging was obtained from medical records and physician questionnaires covering the ten-week treatment period. The Quebec Task Force classification and free text analysis were used to group diagnostic labels. RESULTS: At baseline there were no significant differences in medical history, findings at physical examination and distribution of the Quebec Task Force diagnostic classification between the patient groups, indicating that they were similar. However, there were significant differences in physicians' use of diagnostic labels for local pain and their characterisation of radiating pain. General practitioners used more terms from manual medicine and reported more pseudoradicular pain than orthopaedic surgeons, who used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Differences were found at all times from first visit to ten week follow-up. CONCLUSIONS: There were significant differences in diagnostic assessment and use of diagnostic radiology between general practitioners and orthopaedic surgeons.

The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain.

BACKGROUND: Pain drawings are widely used as an assessment of patients' subjective pain in low back pain patients being considered for surgery. Less work has been done on primary health care patients. Moreover, the possible correlation between pain drawing modalities and other pain assessment methods, such as pain score and functional variables needs to be described. Thus, the objectives were to describe the course of pain drawings during treatment in primary health care for low back pain patients. METHODS: 160 primary health care outpatients with acute or sub-acute low back pain were studied during 10 weeks of a stay active concept versus manual therapy in addition to the stay active concept. The patients filled out 3 pain drawings each, at baseline and after 5 and 10 weeks of treatment. In addition the patients also reported pain and functional variables during the 3 measurement periods. RESULTS: The proportion of areas marked, the mean number of areas marked (pain drawing score), mean number of modalities used (area score), and the proportion of patients with pain radiation all decreased during the 10-week treatment period. Most of the improvement occurred during the first half of the period. The seven different pain modalities in the pain drawing were correlated to pain and functional variables. In case of no radiation some modalities were associated with more pain and disability than others, a finding that grew stronger over time. For patients with pain radiation, the modality differences were smaller and inconsistent. CONCLUSION: Pain modalities are significantly correlated with pain and functional variables. There is a shift from painful modalities to less painful ones over time.

Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration.

STUDY DESIGN: Systematic review. OBJECTIVE: To determine if traction is more effective than reference treatments, placebo/sham traction, or no treatment for low back pain (LBP). SUMMARY OF BACKGROUND DATA: Various types of traction are used in the treatment of LBP, often in conjunction with other treatments. METHODS: We searched MEDLINE, EMBASE, and CINAHL to November 2004, and screened the latest issue of the Cochrane Library (2004, issue 4) and references in relevant reviews and our personal files. We selected randomized controlled trials (RCTs) involving any type of traction for the treatment of acute (less than 4 weeks duration), subacute (4-12 weeks), or chronic (more than 12 weeks) nonspecific LBP with or without sciatica. Sets of 2 reviewers independently performed study selection, methodological quality assessment, and data extraction. Because available studies did not provide sufficient data for statistical pooling, we performed a qualitative "levels of evidence" analysis, systematically estimating the strength of the cumulative evidence on the difference/lack of difference observed in trial outcomes. RESULTS: A total of 24 RCTs (2177 patients) were included. There were 5 trials considered high quality. For mixed groups of patients with LBP with and without sciatica, we found: (1) strong evidence that there is no statistically significant difference in short or long-term outcomes between traction as a single treatment, (continuous or intermittent) and placebo, sham, or no treatment; (2) moderate evidence that traction as a single treatment is no more effective than other treatments; and (3) limited evidence that adding traction to a standard physiotherapy program does not result in significantly different outcomes. For LBP with sciatica, we found conflicting evidence in several of the comparisons: autotraction compared to placebo, sham, or no treatment; other forms of traction compared to other treatments; and different forms of traction. In the remaining comparisons, there were no statistically significant differences; level of evidence is moderate regarding continuous or intermittent traction compared to placebo, sham, or no treatment, and is limited regarding different forms of traction. CONCLUSION: Based on the current evidence, intermittent or continuous traction as a single treatment for LBP cannot be recommended for mixed groups of patients with LBP with and without sciatica. Neither can traction be recommended for patients with sciatica because of inconsistent results and methodological problems in most of the studies involved. However, because high-quality studies within the field are scarce, because many are underpowered, and because traction often is supplied in combination with other treatment modalities, the literature allows no firm negative conclusion that traction, in a generalized sense, is not an effective treatment for patients with LBP.

Fears, hyperacusis and musicality in Williams syndrome.

The study investigated the prevalence of fear and hyperacusis and the possible connections between fear, hyperacusis and musicality in a Swedish sample of individuals with Williams syndrome (WS). The study included 38 individuals and a cross-sectional design, with no matched control group. Two persons, who knew the participant well, completed a questionnaire. On reported fears, 58% of the participants scored higher than +2S.D., compared to a psychometric study. Thirteen percent scored above the suggested cut-off for hyperacusis, compared to 2.5% in a psychometric study. Female participants generally had higher reported fears and hyperacusis compared to male participants. There were also startling findings of correlations between reported fears and hyperacusis. This preliminary report supports a hypothesis that fears and anxiety could be associated with hyperacusis in the WS population. A hypothesis that musicality could serve as a protective factor and prevent anxiety, received no or very limited support. A hypothesis that hyperacusis could be connected to a general, readily arousal, tendency in the sympathetic nervous system and could be seen as vulnerability for psychopathology is discussed.

A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain.

OBJECTIVES: To compare the effect of manual therapy in addition to the stay-active concept versus the stay-active concept only in low back pain patients. STUDY DESIGN: A randomized, controlled trial during 10 weeks. METHODS: One hundred sixty outpatients with acute or subacute low back pain were recruited from a geographically defined area. They were randomly allocated to a reference group treated with the stay-active concept and, in some cases, muscle stretching and an experimental group receiving manual therapy and, in some cases, steroid injections in addition to the stay-active concept. Pain and disability rating index were used as outcome measures. RESULTS: At baseline, the experimental group had somewhat more pain, a higher disability rating index, and more herniated disks than the reference group. After 5 and 10 weeks, the experimental group had less pain and a lower disability rating index than the reference group. CONCLUSIONS: The manual treatment concept used in this study in low back pain patients appears to reduce pain and disability rating better than the traditional stay-active concept.