Return-to-work intervention while undergoing cancer treatment: Female cancer survivors' experiences.

BACKGROUND: This qualitative study followed participants enrolled in a return to work (RTW) intervention, aiming to address individual physical, psychological and work-related challenges. OBJECTIVE: To explore cancer survivors' experiences of receiving a tailored RTW intervention initiated parallel with chemotherapy and/or radiotherapy. METHODS: Two semi-structured interviews of eight female cancer survivors in treatment for breast cancer (n = 7) or ovaria cancer (n = 1) were conducted prior or close to their RTW and 3-5 months later. Inspired by Margrit Schreier's inductive analysis coding and identification of themes guided the analysis. RESULTS: Participants expressed satisfaction with the RTW intervention, which helped them to cope during the RTW process. Three themes with corresponding subthemes dominated the participants' experience of the RTW intervention. 1) Social workers made participants feel individually coached, 2) Collaboration with social workers helped over time to manage RTW, and 3) Social workers supported participants to conduct and adjust the RTW plan. CONCLUSION: This study shows how the interaction with social workers were based on mutual trust and sense of being cared for, which seems to have a positive impact on how participants managed their RTW. Future research needs to address the long-term challenges in cancer survivors' RTW.

Assessment of functioning and disability in patients with low back pain - the low back pain assessment tool. Part 2: field-testing.

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.

Assessment of functioning and disability in patients with low back pain - the low back pain assessment tool. Part 1: development.

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.

Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews.

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.

Women's perspectives on motivational factors for lifestyle changes after gestational diabetes and implications for diabetes prevention interventions.

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.

Cost-utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trial with 3 years of follow-up.

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.

Managing employees' depression from the employees', co-workers' and employers' perspectives. An integrative review.

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.

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.

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.

Betwixt and between: workplace perspectives on work reintegration in the eldercare sector in Denmark.

PURPOSE: Contemporary return-to-work (RTW) policies in Denmark and other welfare nations recommend employees on long-term sick leave, due to physical or mental health problems, to RTW gradually. Factors that influence the process of work reintegration (WR) is well documented, however, co-workers experiences of this process are a rather new research topic. Moreover, in the context of the present research, no studies have so far explored the workplace as an arena for social interaction. The aim of this study was to explore co-workers' experiences of the reintegration process and how these experiences are related to social positions at the workplace. METHODS: Ethnographic fieldwork was conducted at two nursing homes that were in a process WR after long-term sick leave. The data consist of field notes, policy documents, individual interviews, and focus group interviews. Data were organized by use of NVivo. A theoretical framework was adopted which enabled us to approach and interpret the reintegration process as one that changed the social position of the returning employee. RESULTS: The dataset demonstrates how the returnee is in a state of being betwixt and between the social positions of a co-worker and a non-co-worker. This is illustrated in three cases which show that this state prevents the returnee from taking on the role as a co-worker, excludes the returnee from the workplace, and creates uncertainty for all workplace actors. CONCLUSION: The study highlighted that WR creates a social position for the returnee that complicates the working routine and causes uncertainty in social interactions. Implications for Rehabilitation Work reintegration (WR) after long-term sick leave is commonly characterized by reduced working hours and modified working tasks. The WR process influences the whole work place including co-workers' everyday working life and complicates work situations where work tasks and roles are negotiated between the returning worker and co-workers. Future WR policies and guidelines could benefit from integrating co-workers' perspective to ensure that the returning worker is not socially excluded as well as ensuring that co-workers are not overburdened in the process.

Participation in pulmonary rehabilitation in routine clinical practice.

BACKGROUND AND AIMS: Denmark offers COPD rehabilitation to enable patients to tackle the consequences of COPD, but only a minority of the patients complete these programs. To increase the completion rate, an follow-up study was performed, to characterize COPD patients and to identify potential differences between those who complete and those who do not complete rehabilitation or do not even get a rehabilitation offer in daily clinical routine. METHODS: In- and out COPD-patients who participated in baseline tests were compared in terms of completion of rehabilitation, drop-out, and no rehabilitation offer. We obtained data on basic characteristics, co-morbidity, lung-function (FEV1), dyspnea (MRC), six-minute walkg-distance (6MWD), and quality of life (SF36). RESULTS: The source population counted 521 COPD patients of whom 256 were excluded (diagnosis withdrawn, death, moved away, long-term oxygen, severe illness). Patients who completed rehabilitation had a 15% longer 6MWD than patients not offered rehabilitation and a 10% longer 6MWD than drop-outs despite a significant lower subjective perception of physical function among completers than in the two other groups. Patients not offered rehabilitation had a slightly better lung function than the other two groups. This suggests that lower physical performance with the same (drop-outs) or even higher (not offered) lung function indicates a lower chance of completion. CONCLUSION: COPD patients who could potentially benefit most from completing rehabilitation seem to be deselected. A mere 9% completed rehabilitation within the study period and 23% ever completed. This demonstrates that the political target that 60% of COPD patients should be offered rehabilitation is still far away.

Pain responses in repeated end-range spinal movements and psychological factors in sick-listed patients with low back pain: is there an association?

OBJECTIVE: Repeated end-range spinal movements producing specific pain responses (i.e. centralization or non-centralization) may be used for diagnostic and prognostic purposes. However, possible associations between psychological factors and pain responses have been reported. The aim of this study was to investigate the associations between pain responses in repeated end-range spinal movement tests and psychological factors. DESIGN: Cross-sectional clinical study. PATIENTS: Data from 331 patients sick-listed for 4-12 weeks due to low back pain with or without sciatica. METHODS: Initially the patients completed a questionnaire including questions about psychological factors. Then they underwent a standardized physical test procedure and were classified according to centralized or non-centralized pain response. RESULTS: Statistically significant associations were found between non-centralization and mental distress (p < 0.009) as well as depressive symptoms (p < 0.049). These associations remained present after adjustment for potential confounders by logistic regression: mental distress odds ratio (OR) 1.16 (95% confidence interval (CI) 1.03-1.30) (p = 0.013), depressive symptoms OR 1.23 (95% CI 1.01-1.51) (p = 0.044). CONCLUSION: The pain responses in repeated end-range spinal movements were not independent of psychological factors. Mental distress and depressive symptoms occurred more often among non-centralizers than among centralizers. It is recommended that the possible influence of psychological factors on the result of mechanical testing be accounted for in future studies.