Work conditions, support, and changing personal priorities are perceived important for return to work and for stay at work after stroke - a qualitative study.

PURPOSE: To explore work related and personal facilitators and barriers for return to work (RTW) and stay at work after stroke. MATERIALS AND METHODS: Twenty individuals post-stroke (median age 52 years; seven women) were interviewed in focus groups. Data were analyzed by using qualitative content analysis. RESULTS: An overall theme "Work conditions, support and changed personal priorities influenced RTW and stay at work after stroke" emerged and covered three categories: "Adjustments and flexibility at the work place facilitated RTW and a sustainable work situation", "Psychosocial support and knowledge about stroke consequences facilitated work and reduced stress", and "Changed view of work and other personal priorities". Physical adjustments at the work place and flexibility in the work schedule were perceived facilitators. Support from family and colleagues were important, whereas lack of knowledge of stroke disabilities at the work place was perceived a barrier. Also changed personal priorities in relation to the work and the current life situation influenced RTW in various ways. CONCLUSIONS: The individual's opportunities to influence the work situation is a key factor for RTW and the ability to stay at work after stroke. Adjustments, flexibility, support, knowledge of stroke, and receptivity to a changed view of work are important for a sustainable work situation.Implications for rehabilitationPhysical adjustments at the work place, a flexible work schedule and support increase the individual's possibility to RTW and maintain a sustainable work situation after stroke.Changed work and life priorities after a stroke need attention in the RTW process.Rehabilitation professionals have an important role in providing knowledge about the disabilities following stroke, and how they impact work ability. Individually tailored recommendations for work place adjustments which enable RTW and a sustainable work situation are warranted.

Physiotherapists' experiences of the meaning of movement quality in autism: a descriptive phenomenological study.

Introduction: Movement quality, represented in unrestricted movements, flow and pleasure, is often lacking in people with autism. One aspect is the non-verbal expression of the present emotional and psychological state of an individual.Purpose: To describe the meaning of movement quality in autism, as experienced by specialized physiotherapists.Method: Ten physiotherapists were interviewed. The data were recorded, transcribed verbatim, and analyzed using Giorgiá¾½s descriptive phenomenological method.Findings: The general structure of movement quality in people with autism included eight key constituents: 1) reduced postural control; 2) deviant muscle tone and tension; 3) deviant sensory processing; 4) a lack of conscious awareness; 5) difficulties with body boundaries; 6) coordinating movements (including breathing); 7) lack of anticipatory preparations of movements; and 8) need of cognitive thoughts to control movements.Conclusions: This study provide an understanding of how movement quality in people with autism is expressed. Their lived bodies constantly need to protect themselves from sensory impressions from within or the surroundings, causing emotional distress and obscuring the meaning of their movements. Their bodily expression becomes restrained, fragmented, and hesitant. Understanding movement patterns and emotional reactions following their struggle with movements may facilitate constructive interaction and communication, which give important implications when designing physiotherapy interventions.

Perceived work situation and work ability among persons who are working one year after stroke.

OBJECTIVE: To explore how persons who have returned to work perceive their work situation and work ability one year after stroke. DESIGN: Cross-sectional design. SUBJECTS: A total of 88 persons of working age (mean age 52 (standard deviation; SD 8) years, 36% women), with mild to moderate disabilities following stroke, who had returned to work within one year after stroke participated in the study. METHODS: A survey including a questionnaire regarding psychological and social factors at work (QPS Nordic) and 4 questions from the Work Ability Index (WAI) was posted to the participants. RESULTS: According to the QPS Nordic survey, 69-94% of respondents perceived their work duties as well defined, and were content with their work performance. Most participants had good social support at work and at home. Between 51% and 64% of respondents reported that they seldom felt stressed at work, seldom had to work overtime, or that work demands seldom interfered with family life. According to the WAI ≥75% of respondents perceived their work ability as sufficient, and they were rather sure that they would still be working 2 years ahead. CONCLUSION: Persons who have returned to work within one year after stroke appear to be content with their work situation and work ability. Appreciation at work, well-defined and meaningful work duties and support seem to be important for a sustainable work situation.

Fatigue in men and women who have returned to work after stroke: Assessed with the Fatigue Severity Scale and Mental Fatigue Scale.

OBJECTIVE: To assess the occurrence of self-reported fatigue among men and women who have returned to work after stroke, and the association between 2 fatigue rating scales. DESIGN: A cross-sectional study. SUBJECTS: A total of 91 adults (58 men/33 women, mean age 53 years) with mild to moderate disability. METHODS: Questionnaires were posted to participants approximately one year after stroke. Fatigue was assessed with the Fatigue Severity Scale (FSS) and the Mental Fatigue Scale (MFS). RESULTS: In total, 58% of the women and 33% of the men reported fatigue on the FSS (total score ≥ 4), and 46% of the women and 28% of the men reported mental fatigue on the MFS (total score ≥ 10.5). Being easily fatigued, decreased motivation, mental fatigability and sensitivity to stress were the most reported problems. FSS and MFS were moderately associated (rho 0.517-0.732). CONCLUSION: Fatigue is common among persons who have returned to work after stroke, and interferes with daily life. The long-term consequences of fatigue should be addressed after stroke, especially in women. The FSS and the MFS can be used in combination, as they provide information on different aspects of fatigue.

Perceived work stress, overcommitment, balance in everyday life, individual factors, self-rated health and work ability among women and men in the public sector in Sweden - a longitudinal study.

BACKGROUND: The aim was to investigate whether perceived work stress, overcommiment, balance in everyday life, individual factors and self-rated health in combination predict work ability among women and men in the public sector in Sweden. METHODS: A sample was randomly selected from the employee records of the participating public health care organisation in Western Sweden. In total, 2223 employees were included and answered a postal survey twice, at a 2 year interval. The survey included questions about work ability, perceived work stress, overcommitment, balance in everyday life, individual factors and self-rated health. Odds ratios with 95% confidence intervals for work ability were estimated using logistic regression. RESULTS: Imbalance in everyday life and overcommitment predicted reduced work ability in women and imbalance in everyday life and low educational level predicted reduced work ability in men. However, when poor self-rated health was added to the models this was the strongest predictor of work ability for both genders. CONCLUSION: A combination of poor self-rated health, imbalance in everyday life, and overcommitment predicted reduced work ability. This multifactorial nature of work ability should be taken into account in health promotion programmes.

A vocabulary describing health-terms of movement quality - a phenomenological study of movement communication.

Purpose: The aim of the study was to develop a vocabulary targeting communication of health-terms of movement quality, establishing professional knowledge of a movement terminology usefull within rehabilitation.Methods: A phenomenological study design was chosen, inviting movement experts working in rehabilitation to describe movement observations when a change into more functional, health related ways of moving appeared in the rehabilitation processes. 15 physiotherapy experts were recruited, five from the field of neurology, primary health care and psychiatry. The informants had between 12-38 years of clinical practice, treating patients of all ages with a wide specter of diagnoses. Data collection followed a qualitative study design, of individual, in-depth interviews, based on a semi-structured interview guide. The interviews were taped, transcribed and sent to the informants for validation. Data analysis followed recommendation of Giorgi, modified by Malterud. Ethical considerations were followed.Results: Data revealed a vocabulary, clustered in five themes, Biomechanical, Physiological, Psycho-socio-cultural, Existential and Overarching perspective, 16 underlying categories and 122 descriptive health-terms of movement quality.Conclusion: The study demonstrated a multi-perspective movement vocabulary of 122 health characteristic terms, developed to facilitate movement communication within the broad field of rehabilitation. The result calls for further research concerning a movement vocabulary.Implications for RehabilitationThe phenomenon of movement quality has a potential for promoting rehabilitation-specific skills.A vocabulary describing health-terms of movement quality is useful within the overall rehabilitation field providing enhanced and specific health directed communication.A movement specific health-terminology will have impact on implications and facilitating a person-centered and goal directed rehabilitation.Rehabilitation professionals will have a multi-perspective, movement specific and structured terminology to communicate direct and concretely with patients, the multi-professional team, in society, and with politicians.

Clinician perspectives of Basic Body Awareness Therapy (BBAT) in mental health physical therapy: An international qualitative study.

INTRODUCTION: Body awareness is a movement therapy used in Physical Therapy in Mental Health especially in Scandinavia. The method Basic Body Awareness Therapy has been scientifically investigated in particular for patients with Depression, Schizophrenia and Post Traumatic Stress Syndrome (PTSD). METHODS: Thirty-four Physical Therapists from 13 countries working with the Basic Body Awareness Therapy method in Mental Health Care were interviewed in six focus groups about what effects they have experienced in their work with patients. The Physical Therapists worked within the whole Mental Health spectra. Content analysis was used to analyze the informants' experiences of the clinical effects of body awareness. RESULTS: Five categories emerged: To be in contact, Refocus and coping, Sense of Self, Relations to others and Daily life activities. The results are discussed in relation to previous research, existing theories of body awareness and cognitive neuroscience and findings of experimental psychology. CONCLUSION: The informants experienced that Basic Body Awareness Therapy worked mainly by helping the patients to be in better contact with their "bodily self." Stability, balance, improved grounding and the ability to relax were understood as the basis to establish an improved sense of self and leading to improved acceptance of oneself and one's ability to relate to others.

Need for structured healthcare organization and support for return to work after stroke in Sweden: Experiences of stroke survivors.

OBJECTIVE: To explore stroke survivors' experiences of healthcare-related facilitators and barriers concerning return to work after stroke. DESIGN: A qualitative study. SETTING: Outpatient stroke rehabilitation unit at a University Hospital in southern Sweden. PARTICIPANTS: A convenient sample of 20 persons admitted to Skåne University Hospital for acute stroke care (median age 52 years), in employment of at least 10 h per week at stroke onset and having been referred to stroke rehabilitation within 180 days. METHODS: The interviews were performed by focus groups, and the data were analysed by content analysis. RESULTS: Facilitating factors were a tailored rehabilitation content with relevant treatments, adequate timing and a structured stepwise return-to-work process. A lack of sufficient early healthcare information, rehabilitation planning and coordination were perceived as barriers. An early rehabilitation plan, a contact person, and improved communication between rehabilitation actors were requested, as well as help with work transport, home care, children and psychosocial support for families. CONCLUSION: Tailored rehabilitation content and a structured stepwise return-to-work process facilitated return to work. Insufficient structure within the healthcare system and lack of support in daily life were perceived barriers to return to work, and need to be improved. These aspects should be considered in the return-to-work process after stroke.

Gait Speed with Anti-Slip Devices on Icy Pedestrian Crossings Relate to Perceived Fall-Risk and Balance.

It is important to find criteria for preventive measures and appropriate assistive devices to reduce pedestrian injuries and increase walking in winter. Reducing the rate of falls on icy surfaces and improving people's ability to safely cross a street in winter conditions by achieving an adequate walking speed, for example, need to be considered. This study explores pedestrian perceptions of fall risk, balance, and footfall transitions while using different designs for anti-slip devices on ice and snow-covered ice and relates these to measures of gait speed and friction. Trials were performed with nine pedestrians testing 19 anti-slip devices on ice and ice covered with snow. Laboratory tests of the dynamic coefficient of friction (DCOF) on plain ice were also performed. The findings suggest that there was conformity in the participants' perceptions of good balance and low fall risk for one-fifth of the devices (three whole-foot designs and one design with built-in spikes). We also found that gait speed on icy pedestrian crossings is related to perceived fall-risk and balance control, but not to DCOF of the anti-slip devices.

Pain management strategies among persons with long-term shoulder pain after stroke - a qualitative study.

OBJECTIVE:: To explore strategies that persons with persistent shoulder pain after stroke use to manage their pain in daily life. DESIGN:: A qualitative study using semi-structured face-to-face interviews, analysed by content analysis. SETTING:: A university hospital. SUBJECTS:: Thirteen community-dwelling persons (six women; median age: 65 years; range 57-77) with shoulder pain after stroke were interviewed median two years after the pain onset. RESULTS:: An overall theme 'Managing shoulder pain by adopting various practical and cognitive strategies' emerged from the analysis. Three categories were identified: (1) practical modifications to solve daily life problems; (2) changed movement patterns and specific actions to mitigate the pain, by non-painful movements, avoidance of pain-provoking activities and various pain distracting activities and (3) learned how to deal with the pain mentally. Several strategies were used simultaneously and they were experienced successful to various degrees. CONCLUSION:: The findings in the present study indicate that persons with persistent shoulder pain after stroke use both practical and cognitive strategies to manage their pain.

Teamwork and Safety Climate in Homecare: A Mixed Method Study.

A rapidly changing homecare service sector implies difficulties to control safety and health risks for staff and to guarantee standardised deliveries of services to recipients. This study aimed to describe staff perceptions of safety climate and practices in homecare service teams, and suggestions for improvements. A second aim was to identify if and how the appraisals of safety climate were related to individual perceptions of safety, mental strain and adverse events/injury. A convergent parallel mixed methods design was used. Nursing assistants and care aides (133 in total, representing 11 work teams) in the north of Sweden replied to a survey and participated in focus group interviews. Results were analysed with ANOVA (inter-team differences) and by qualitative content analysis. Significant diversity was identified between the teams in five of seven dimensions of safety climate. Important areas for improvement were: a need to define and agree on criteria for a safe working environment; leadership prioritising safety at work; and management able to provide trust, support and time. A prerequisite for these agreements was improved authority and communication between all parties involved. The safety climate dimensions were related to personal perceptions of safety and mental strain and, partly, to adverse events/injuries.

Understanding one's body and movements from the perspective of young adults with autism: A mixed-methods study.

BACKGROUND: There are but a few studies of how persons with autism perceive their bodies and movements. Difficulties in perceiving the surrounding world along with disturbed motor coordination and executive functions may affect physical and psychological development. AIMS: To explore the experiences of body and movements in young adults with autism and how two physiotherapeutic instruments may capture these experiences. PROCEDURES: Eleven young adults (16-22 years) with autism were interviewed and assessed using Bruininks-Oseretsky Test of Motor Proficiency (BOT2) and Body Awareness Scale Movement Quality and Experience (BAS MQ-E). Following a mixed- methods design, the interviews were deductively analyzed and conceptually integrated to the results of the two assessments. RESULTS: Experiencing conflicting feelings about their bodies/movements, led to low understanding of themselves. The assessments captured these experiences relatively well, presenting both movement quality and quantity. Positive experiences and better movement quality related to having access to more functional daily strategies. CONCLUSION: Combining motor proficiency and body awareness assessments was optimal to understand the participants' experiences. IMPLICATIONS: To capture body and movement functions in persons with autism in this standardized manner will lead to improved and reliable diagnoses, tailored interventions, increased body awareness and activity, and enhanced quality of life.

Standing balance on inclined surfaces with different friction.

Working and walking environments often involve standing positions on different surfaces with inclination and different friction. In this study, standing balance of thirteen participants during sudden and irregular external perturbation to calf muscles was investigated. The aim of the study was to evaluate the combined effect of surface inclination and friction on standing balance. The main findings when eyes closed revealed that the standing utilised coefficient of friction (µSUCOF) increased when the surface was inclined for both high and low friction materials. The anterior-posterior torque increased more anteriorly when the surface was inclined toes down and when the surface friction was low. The results indicate that the anterior-posterior torque is a sensitive parameter when evaluating standing balance ability and slip risk. On inclined surface, particularly on the surface with lower friction, the potential slip and fall risk is higher due to the increase of standing utilised coefficient of friction and increased forward turning torque.

The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial.

Aim To evaluate aerobic exercise in migraine and co-existing tension-type headache and neck pain. Methods Consecutively recruited persons with migraine and co-existing tension-type headache and neck pain were randomized into an exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 minutes, three times/week. Controls continued usual daily activities. Pain frequency, intensity, and duration; physical fitness, level of physical activity, well-being and ability to engage in daily activities were assessed at baseline, after treatment and at follow-up. Results Fifty-two persons completed the study. Significant between-group improvements for the exercise group were found for physical fitness, level of physical activity, migraine burden and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Within the exercise group, significant reduction was found for migraine frequency, pain intensity and duration, neck pain intensity, and burden of migraine; an increase in physical fitness and well-being. Conclusions Exercise significantly reduced the burden of migraine and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Exercise also reduced migraine frequency, pain intensity and duration, although this was not significant compared to controls. These results emphasize the importance of regular aerobic exercise for reduction of migraine burden.

Shoulder pain after stroke - experiences, consequences in daily life and effects of interventions: a qualitative study.

PURPOSE: To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions. METHOD: A qualitative interview study including 13 community-dwelling persons (six women; median age 65 years) with persistent shoulder pain after stroke. RESULTS: Three categories emerged from the content analysis. In "Multiple pain characteristics" an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In "Limitations caused by the pain" it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In "Multiple pain interventions with various effects" a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported. CONCLUSIONS: Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person's life, multidisciplinary rehabilitation interventions are important. Implications for rehabilitation Shoulder pain after stroke can lead to a variety of pain characteristics with radiation to the arm and hand Shoulder pain often influence personal care, household activities and leisure negatively, which may lead to emotional reactions Self-management interventions with gentle movements are perceived most effective As the shoulder pain after stroke is complex, interventions by a multidisciplinary team may be needed.

Upper-limb sensory impairments after stroke: Self-reported experiences of daily life and rehabilitation.

OBJECTIVE: To describe stroke survivors' experiences of sensory impairment in the upper limb, the influence of such impairment on daily life, coping strategies used, and sensory training for the affected hand. DESIGN: A qualitative study with a content analysis approach. SUBJECTS: Fifteen post-stroke patients interviewed individually. RESULTS: Five categories emerged from the data: "Changed and varied perception of the sensation"; "Affected movement control"; "Problems using the hand in daily life"; "Various strategies to cope with upper limb disability"; and "Lack of sensory training". Numbness and tingling, changes in temperature sensitivity, and increased sensitivity to touch and pain were reported. Many subjects had difficulty adjusting their grip force and performing movements with precision. It was problematic and mentally fatiguing managing personal care and carrying out household and leisure activities. Practical adaptations, compensation with vision, increased concentration, and use of the less affected hand were strategies used to overcome difficulties. Despite their problems very few subjects had received any specific sensory training for the hand. CONCLUSION: Stroke survivors perceive that sensory impairment of the upper limb has a highly negative impact on daily life, but specific rehabilitation for the upper limb is lacking. These findings imply that the clinical management of upper limb sensory impairment after stroke requires more attention.

Expectations of Qigong and Exercise Therapy in Patients With Long-term Neck Pain: An Analysis of a Prospective Randomized Study.

OBJECTIVE: The aim of the present study was to study differences in treatment expectations after participating in qigong and exercise therapy among participants with long-term neck pain, the impact of total group expectations on treatment outcomes, and the relationship between these treatment expectations and pain and disability. METHOD: Reliable questionnaires were used. Differences between qigong and exercise was studied in a randomized, controlled, multicenter trial (n = 122). The impact of total group expectations on treatment outcomes and the association between these treatment expectations and pain and disability were studied with nonparametric statistical analysis and Spearman's correlation coefficient. RESULTS: The exercise group had higher expectations than the qigong group before the intervention on how logical treatment seemed to be and after the intervention on treatment credibility (ie, that the treatment would reduce/eliminate neck pain). The exercise group was also more confident that the treatment could reduce neck pain and significantly increased their expectations of reduced neck pain over the 3-month intervention period. Both treatment groups had high expectations of the assigned treatment. Those with high expectations had better treatment outcomes in pain and disability. The relationship between treatment expectations and credibility, pain, and disability was weak. CONCLUSIONS: The current findings support the role of assessment of expectation/credibility for positive treatment results. An understanding of each patient's treatment expectations may be helpful in guiding patients with respect to appropriate interventions and as an indication of risk of poor outcome.

Therapeutically efficient components of Basic Body Awareness Therapy as perceived by experienced therapists - A qualitative study.

BACKGROUND: Basic Body Awareness Therapy (BBAT) is a physiotherapeutic method used in rehabilitation to increase physical and emotional balance. The aim was to identify and describe perceived therapeutically efficient components of BBAT. METHODS: Twenty-four experienced BBAT therapists participated in focus group interviews. The data were analysed with content analysis. RESULTS: One central theme, the therapeutic space consisted of two categories; the therapeutic encounter and the therapeutic tools, which emerged as the core of the perceived therapeutically efficient components. The therapeutic encounter entailed the therapeutic approach, affect attunement, continuous interaction during treatment, affect mirroring and communicating by use of a person-centred approach. The therapeutic tools included adjustment and adaptation, the use of manual, verbal and non-verbal guiding, and creating an atmosphere of safety and sanctuary. CONCLUSION: The significance of interaction by use of a person-centred approach combined with the ability to continuously adjust the treatment constituted useful guidelines when designing rehabilitation using BBAT treatment.

"Blue flags", development of a short clinical questionnaire on work-related psychosocial risk factors - a validation study in primary care.

BACKGROUND: Working conditions substantially influence health, work ability and sick leave. Useful instruments to help clinicians pay attention to working conditions are lacking in primary care (PC). The aim of this study was to test the validity of a short "Blue flags" questionnaire, which focuses on work-related psychosocial risk factors and any potential need for contacts and/or actions at the workplace. METHODS: From the original"The General Nordic Questionnaire" (QPSNordic) the research group identified five content areas with a total of 51 items which were considered to be most relevant focusing on work-related psychosocial risk factors. Fourteen items were selected from the identified QPSNordic content areas and organised in a short questionnaire "Blue flags". These 14 items were validated towards the 51 QPSNordic items. Content validity was reviewed by a professional panel and a patient panel. Structural and concurrent validity were also tested within a randomised clinical trial. RESULTS: The two panels (n = 111) considered the 14 psychosocial items to be relevant. A four-factor model was extracted with an explained variance of 25.2%, 14.9%, 10.9% and 8.3% respectively. All 14 items showed satisfactory loadings on all factors. Concerning concurrent validity the overall correlation was very strong rs = 0.87 (p < 0.001).). Correlations were moderately strong for factor one, rs = 0.62 (p < 0.001) and factor two, rs = 0.74 (p < 0.001). Factor three and factor four were weaker, bur still fair and significant at rs = 0.53 (p < 0.001) and rs = 0.41 (p < 0.001) respectively. The internal consistency of the whole "Blue flags" was good with Cronbach's alpha of 0.76. CONCLUSIONS: The content, structural and concurrent validity were satisfactory in this first step of development of the "Blue flags" questionnaire. In summary, the overall validity is considered acceptable. Testing in clinical contexts and in other patient populations is recommended to ensure predictive validity and usefulness.

Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain.

BACKGROUND: The prevalence of migraine with co-existing tension-type headache and neck pain is high in the general population. However, there is very little literature on the characteristics of these combined conditions. The aim of this study was to investigate a) the prevalence of migraine with co-existing tension-type headache and neck pain in a clinic-based sample, b) the level of physical activity, psychological well-being, perceived stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain compared to healthy controls, c) the perceived ability of persons with migraine and co-existing tension-type headache and neck pain to perform physical activity, and d) which among the three conditions (migraine, tension-type headache or neck pain) is rated as the most burdensome condition. METHODS: The study was conducted at a tertiary referral specialised headache centre where questionnaires on physical activity, psychological well-being, perceived stress and self-rated health were completed by 148 persons with migraine and 100 healthy controls matched by sex and average age. Semi-structured interviews were conducted to assess characteristics of migraine, tension-type headache and neck pain. RESULTS: Out of 148 persons with migraine, 100 (67%) suffered from co-existing tension-type headache and neck pain. Only 11% suffered from migraine only. Persons with migraine and co-existing tension-type headache and neck pain had lower level of physical activity and psychological well-being, higher level of perceived stress and poorer self-rated health compared to healthy controls. They reported reduced ability to perform physical activity owing to migraine (high degree), tension-type headache (moderate degree) and neck pain (low degree). The most burdensome condition was migraine, followed by tension-type headache and neck pain. CONCLUSIONS: Migraine with co-existing tension-type headache and neck pain was highly prevalent in a clinic-based sample. Persons with migraine and co-existing tension-type headache and neck pain may require more individually tailored interventions to increase the level of physical activity, and to improve psychological well-being, perceived stress and self-rated health.