The vulnerable superhero-a qualitative study investigating how spinal cord injury peer mentors experience their role in Active Rehabilitation training programs.

STUDY DESIGN: Qualitative study. OBJECTIVES: To explore how peer mentors with spinal cord injury (SCI) experience their role in Active Rehabilitation programs in Sweden. SETTING: Community peer-based training programs in Sweden. METHODS: Twenty active peer mentors were strategically selected and invited to participate. Nine individuals of diverse age, level of SCI and time since injury participated in semi-structured interviews via video link. Qualitative content analysis was used to analyze the data. RESULTS: The theme: Being a vulnerable superhero-a balancing act with rewards was based upon five categories: Being a suitable fit for a demanding culture, Offering a shortcut to coping with spinal cord injury life, Feeling rewarded by helping others, Building trust is reciprocal, and Constituting the norm in a temporary community. The peer mentors expressed vulnerability of sharing life experiences, being a role model and building relationships with mentees. The theme emerged from notions of high expectations and demands of the SCI peer mentor role. Being a peer mentor empowered, educated and inspired the peer mentors themselves. CONCLUSIONS: Peer mentors were continuously balancing between being open and vulnerable, and being strong and capable. Personality traits were reported as more important aspects of the role than physical skills. The individual mentor-mentee meetings and relationships were considered more important than the actual training sessions. Feeling part of a community and the norm through meeting others in a similar situation was perceived as a reward and motivation for participating as a peer mentor.

The behavioral effects of cooperative and competitive board games in preschoolers.

Traditional board games are a common social activity for many children, but little is known about the behavioral effects of this type of game. The current study aims to explore the behavioral effects of cooperative and competitive board games in four-to-six-year-old children (N = 65). Repeatedly during 6 weeks, children in groups of four played either cooperative or competitive board games in a between-subject design, and shortly after each game conducted a task in which children's cooperative, prosocial, competitive, and antisocial behavior were observed. The type of board game did not have an effect on cooperative, prosocial or antisocial behavior. Cooperative and competitive board games elicited equal amounts of cooperative and prosocial behavior, which suggest that board games, regardless of type, could have positive effects on preschoolers' social behavior. Our results suggest that children may compete more after playing competitive board games; but the measure of competitive behavior in particular was unreliable. Preschoolers enjoyed playing cooperative board games more than competitive board games, which may be one reason to prefer their use.

Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres.

BACKGROUND: For patients with chronic pain, the heterogeneity of clinical presentations makes it difficult to identify patients who would benefit from multimodal rehabilitation programs (MMRP). Yet, there is limited knowledge regarding the predictors of MMRP's outcomes. This study identifies predictors of outcome of MMRPs at a 12-month follow-up (FU-12) based on data from the Swedish Quality Registry for Pain Rehabilitation (SQRP). METHODS: Patients with chronic pain from two clinical departments in Sweden completed the SQRP questionnaires-background, pain characteristics, psychological symptoms, function, activity/participation, health and quality of life-on three occasions: 1) during their first visit; 2) immediately after the completion of their MMRP; and 3) 12 months after completing the MMRP (n = 227). During the FU-12, the patients also retrospectively reported their global impressions of any changes in their perception of pain and their ability to handle their life situation in general. RESULTS: Significant improvements were found for pain, psychological symptoms, activity/participation, health, and quality of life aspects with low/medium strong effects. A general pattern was observed from the analyses of the changes from baseline to FU-12; the largest improvements in outcomes were significantly associated with poor situations according to their respective baseline scores. Although significant regressors of the investigated outcomes were found, the significant predictors were weak and explained a minor part of the variation in outcomes (15-25%). At the FU-12, 53.6% of the patients reported that their pain had decreased and 80.1% reported that their life situation in general had improved. These improvements were associated with high education, low pain intensity, high health level, and work importance (only pain perception). The explained variations were low (9-11%). CONCLUSIONS: Representing patients in real-world clinical settings, this study confirmed systematic reviews that outcomes of MMRP are associated with broad positive effects. A mix of background and baseline variables influenced the outcomes investigated, but the explained variations in outcomes were low. There is still a need to develop standardized and relatively simple outcomes that can be used to evaluate MMRP in trials, in clinical evaluations at group level, and for individual patients.

'I am afraid to make the damage worse'--fear of engaging in physical activity among patients with neck or back pain--a gender perspective.

RATIONALE: Neck and back pain are major public health problems in Western societies and cause considerable disability and health service use. Swedish women report more severe neck and back pain compared with Swedish men. Most studies on the aetiology of gender differences in pain deal with biological mechanisms, and less with the role of psychological and sociocultural factors. 'Pain beliefs' is a sociocultural factor and can be expressed in different ways among women and men. It is important to know what pain beliefs are held by neck and back pain patients, especially when medical guidelines recommend that back pain patients stay physically active. AIM: Exploring pain beliefs in relation to physical activity among neck and back pain patients consulting primary health care. METHOD: Twelve patients (seven women, five men) consulting primary health care for an initial episode of neck or back pain were interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later. The interviews covered patient experiences of neck or back pain, consequences, strategies and treatment experiences. The interviews were analysed with qualitative content analysis from a gender perspective. RESULT: One theme 'Fear of hurting the fragile body' was expressed by all neck or back pain patients. Five categories were identified 'The mechanical body', 'Messages about activity', 'Earlier experiences of pain and activity', 'To be a good citizen' and 'Support to be active' supported or undermined beliefs about pain and physical activity. Gender expressions occurred in the categories 'Messages about activity', 'To be a good citizen' and 'Support to be active'. CONCLUSIONS: Neck or back pain patients in the study saw the body as fragile and were afraid of hurting it. Notions of gender had an impact on the given advice about activity and on how patients perceived the message about staying active.

'When I use the electric wheelchair, I can be myself' - real-life stories about occupational identity construction.

BACKGROUND: Young and adult users of electric wheelchairs (EWs) describe how EWs have personal, functional, emotional, and symbolic values and are considered by some to be part of the self. AIM: The aim of this study was to increase our understanding of how occupational identity is constructed in the daily practices of EW users. MATERIAL AND METHODS: Context-based, in-depth oral stories and filmed sequences of daily practice enactments of persons who have used an EW since childhood were the basis for the narrative analysis. FINDINGS: The findings elucidate how the informants enact and tell about their identity-development in response to daily and relational practices, and its relevance to the informant's sense of self, belonging, competence, life-prospects, conduct, and awareness of shifting values, and this was likewise demonstrated in different appearances and roles related to social recognition. A model illustrating the findings is proposed. CONCLUSIONS AND SIGNIFICANCE: Contextual values and exploring experiences, such as possibilities to develop competences and roles, along with encountering social recognition, but also hindering regulations and adversities, influence the development of occupational identities. Findings in this study can contribute to increased understanding, conscious political decisions, as well as a more person-centred approach within healthcare.

Interdisciplinary Multimodal Pain Rehabilitation in Patients with Chronic Musculoskeletal Pain in Primary Care-A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP).

Chronic pain is a major public health issue. Mounting evidence suggests that interdisciplinary multimodal pain rehabilitation programs (IMMRPs) performed in specialist pain care are an effective treatment for patients with chronic pain, but the effects of such treatment if performed in primary care settings have been less studied. The aims of this pragmatic study were to (1) describe characteristics of patients participating in IMMRPs in primary care; (2) examine whether IMMRPs in primary care improve pain, disability, quality of life, and sick leave 1-year post discharge in patients with chronic pain; and (3) investigate if outcomes differ between women and men. Data from 744 (645 women and 99 men, age range 18-65 years) patients with non-malignant chronic pain included in the Swedish Quality Registry for Pain Rehabilitation Primary Care were used to describe patient characteristics and changes in health and sick leave. At 1-year follow-up, the patients had improved significantly (p < 0.01) in all health outcome measures and had reduced sick leave except in men, where no significant change was shown in physical activity level. This study indicates that MMRPs in primary care improved pain and physical and emotional health and reduced sick leave, which was maintained at the 1-year follow-up.

Why do Infants Look at and Use Positive Information from Some Informants Rather Than Others in Ambiguous Situations?

Three laboratory experiments on social referencing examined whether infants' tendencies to look at and use positive information from the experimenter could be interpreted from a perspective of novelty or expertise. In Study 1, novelty was manipulated. Forty-eight 12-month-old infants participated. In a between-subject design, a more novel or a less novel experimenter presented an ambiguous object and provided positive information. The infants looked more at and regulated their behavior more in accordance with information coming from the less novel experimenter. In Study 2, expertise was manipulated. Forty-eight 12-month-old infants were exposed to one experimenter who showed expertise about the laboratory situation and one experimenter who did not show such competence. The infants looked more at and regulated their behavior more in accordance with information coming from the expert. In Study 3, 40 12-month-old infants participated. The infants were exposed to a toy-expert who was either novel or familiar. The infants, in both groups, looked as much at the toy-experts and used the information regardless of whether the novel or familiar toy-expert had provided information. The findings suggest that novelty does not increase looking in ambiguous situations. Instead, the results support the expertise perspective of infant looking preferences.

Individual Differences in Face Processing: Infants' Scanning Patterns and Pupil Dilations are Influenced by the Distribution of Parental Leave.

Fourteen-month-old infants were presented with static images of happy, neutral, and fearful emotional facial expressions in an eye-tracking paradigm. The emotions were expressed by the infant's own parents as well as a male and female stranger (parents of another participating infant). Rather than measuring the duration of gaze in particular areas of interest, we measured number of fixations, distribution of fixations, and pupil diameter to evaluate global scanning patterns and reactions to emotional content. The three measures were differentially sensitive to differences in parental leave, emotional expression, and face familiarity. Infants scanned and processed differently happy, neutral, and fearful faces. In addition, infants cared for by both father and mother (divided parental leave) distributed their gaze more across faces than did infants primarily cared for by one parent (in this study, the mother). Pupil diameter complemented these findings, revealing that infants had larger pupil diameter during observation of neutral emotions expressed by the parent who is not currently the primary caregiver. This study demonstrates how conclusions differ as a function of the particular eye-tracking measure used and shows that the three measures used here converge on the conclusion that 14-month-old infants' processing of emotional expressions is influenced by infants' exposure to fathers and mothers.

Sex and Age Group Focus on Outcomes after Multimodal Rehabilitation for Patients with Chronic Pain in Northern Sweden.

OBJECTIVES: To investigate the outcomes of a multimodal rehabilitation programme (MMRP) regarding pain intensity, emotional functioning, activity and physical functioning, social response, and health, with regard to sex and age. METHODS: This retrospective longitudinal study was based on data from patients at 2 specialist pain clinics in northern Sweden immediately after MMRP (short-term) and at 1-year follow-up (long-term). Data from 439 patients were analysed according to sex and to age groups 18-30, 31-45 and 46-65 years. RESULTS: The men improved with larger effect sizes (ESs) than women immediately after MMRP. The youngest age group showed improvements with greater ESs compared with the older age groups, both in the short and long term. Social support decreased for both women and men and in all 3 age groups in the long term. Improvements in both the short and long term were found in pain intensity, emotional functioning, and activity and physical functioning, in both women and men, as well as the different age groups. CONCLUSION: Both women and men with chronic pain, and from all of the different age groups, benefitted from MRRP. Since improvements for men were not sustained over time, they may need further support after the programme.

Multivariate correlations between pain, life interference, health-related quality of life and full-time sick leave 1 year after multimodal rehabilitation, focus on gender and age.

BACKGROUND: Chronic pain is a major and complex health condition associated with reduced work performance. A multimodal rehabilitation programme (MMRP) is a common intervention for chronic pain conditions, the goal being for the person to maintain or return to work. AIM: To investigate the multivariate relationships between health-related quality of life, life interference, pain, physiological factors before MMRP and full-time sick leave 1 year after MMRP. MATERIAL AND METHODS: Data were collected from the Swedish Quality Registry for Pain Rehabilitation. The study included 284 participants. Separate analyses were performed for women, men and three age groups. RESULTS: There were correlations between sick leave, physical functioning, pain duration, health-related quality of life, and self-assessed importance of work before MMRP and sick leave 1 year after MMRP. The patterns of factors associated with full-time sick leave varied for women, men and age groups. CONCLUSIONS: These findings indicate that full-time sick leave for patients with chronic pain is affected by a number of interacting factors. Occupational therapy interventions aiming to develop activity skills in relation to work roles and enable patients to develop skills required to manage the physical, psychological and social demands to return to work or maintain work could be valuable to increase the possibility of attaining a sustainable work situation.

Gender matters in physiotherapy.

The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.

Obstacles and risks in the traffic environment for users of powered wheelchairs in Sweden.

OBJECTIVE: According to the European Union, fatal road accidents involving Vulnerable Road Users (VRUs) are equal in proportion to fatal car road accidents (46%). VRUs include individuals with mobility challenges such as the elderly and Powered Wheelchair (PWC) users. The aim of this interdisciplinary qualitative study was to identify obstacles and risks for PWC users by exploring their behaviour and experiences in traffic environments. METHODS: Videos and in-depth interviews with 13 PWC users aged 20-66 were analysed for this study. The interviews and videos, which include real-life outdoor observations, originate from a qualitative study exploring experiences of PWC use on a daily basis in Sweden. Underlying causal factors to identified risks and obstacles were identified, based on human, vehicle (PWC) and environmental factors in accordance with the Haddon Matrix. RESULTS: The results show significant potential for improvement within all three perspectives of the Haddon Matrix used in the analysis. Participants faced and dealt with various obstacles and risks in order to reach their destination. For example, this includes uneven surfaces, differences in ground levels, steep slopes, as well as interactions with other road users and the influence of weather conditions, resulting in PWC users constantly accommodating and coping with the shortcomings of the vehicle and the environment. CONCLUSIONS: There are still major challenges with regard to preventing obstacles and risks in the traffic environment for PWC users. To discern PWC users in traffic accident and injury data bases, a start would be to register type of aid used for persons involved in an accident. Furthermore, to emphasise PWC users' role as VRUs, it may also be advantageous to describe them as drivers rather than users when navigating the traffic environment. Given the limited sample, further research covering more data from a broader perspective would be beneficial. By incorporating emerging knowledge of PWC users' prerequisites and needs, and including them in research and traffic planning, the society will grow safer and more inclusive, and become better prepared for meeting future demands on accessibility from an aging population.

A cost-utility analysis of multimodal pain rehabilitation in primary healthcare.

OBJECTIVES: Multimodal rehabilitation programs (MMRPs) have been shown to be both cost-effective and an effective method for managing chronic pain in specialist care. However, while the vast majority of patients are treated in primary healthcare, MMRPs are rarely practiced in these settings. Limited time and resources for everyday activities alongside the complexity of chronic pain makes the management of chronic pain challenging in primary healthcare and the focus is on unimodal treatment. In order to increase the use of MMRPs incentives such as cost savings and improved health status in the patient group are needed. The aim of this study was to evaluate the cost-effectiveness of MMRPs for patients with chronic pain in primary healthcare in two Swedish regions. The aim of this study was to evaluate the cost-effectiveness of MMRPs at one-year follow-up in comparison with care as usual for patients with chronic pain in primary healthcare in two Swedish regions. METHODS: A cost-utility analysis was performed alongside a prospective cohort study comparing the MMRP with the alternative of continuing with care as usual. The health-related quality of life (HRQoL), using EQ5D, and working situation of 234 participants were assessed at baseline and one-year follow-up. The primary outcome was cost per quality-adjusted life year (QALY) gained while the secondary outcome was sickness absence. An extrapolation of costs was performed based on previous long-term studies in order to evaluate the effects of the MMRP over a five-year time period. RESULTS: The mean (SD) EQ5D index, which measures HRQoL, increased significantly (p<0.001) from 0.34 (0.32) to 0.44 (0.32) at one-year follow-up. Sickness absence decreased by 15%. The cost-utility analysis showed a cost per QALY gained of 18 704 € at one-year follow-up. CONCLUSIONS: The results indicate that the MMRP significantly improves the HRQoL of the participants and is a cost-effective treatment for patients with chronic pain in primary healthcare when a newly suggested cost-effectiveness threshold of 19 734 € is implemented. The extrapolation indicates that considerable cost savings in terms of reduced loss of production and gained QALYs may be generated if the effects of the MMRP are maintained beyond one-year follow-up. The study demonstrates potential benefits of MMRPs in primary healthcare for both the patient with chronic pain and the society as a whole. The cost-effectiveness of MMRPs in primary healthcare has scarcely been studied and further long-term studies are needed in these settings.

Multiprofessional assessment of patients with chronic pain in primary healthcare.

Background and aims Chronic pain is a common reason to seek health care. Multimodal rehabilitation is frequently used to rehabilitate patients with complex pain conditions. The multiprofessional assessment that patients go through before entering multimodal rehabilitation may, in itself, have a positive impact on patient outcome but little is known regarding patients own view. Therefore, the purpose of this study was to discover how patients experienced this multiprofessional assessment project. Methods Ten patients participating in a multiprofessional assessment at a primary healthcare centre in Western Finland were interviewed using a semi-structured interview. Qualitative content analysis was used to analyse the interviews. Results The analysis resulted in six categories of participant description of their multiprofessional assessment experiences and the rehabilitation plan they received. Feeling chosen or not quite fitting in was a category describing participant feelings upon starting the assessment. They expressed their thoughts on the examinations in the category more than just an examination. Being affirmed described participant desire to be taken seriously and treated well. Receiving support described the perceived roles of the team members. Participant negative experiences of the assessment were described in confusion and disappointment. Finally, in taking and receiving responsibilities, participants described their own role in the team. Conclusions Experiences of patients in a multiprofessional assessment were mostly positive. This highlights the value of a team assessment that takes several aspects of chronic pain into account when assessing complex patients.

Finding self-worth-Experiences during a multimodal rehabilitation program when living at a residency away from home.

BACKGROUND: Patients with chronic pain who live in rural areas often need to travel long distances to participate in multimodal rehabilitation programs. To reduce traveling during the programs, patients sometimes live at a residency close to the clinic and thus far from home. AIMS: The aim of this study was to explore how patients with chronic pain experience participation in an multimodal rehabilitation program while living at a residency. METHOD: Twelve patients from two specialist clinics in northern Sweden were interviewed about their experiences of participating in a multimodal rehabilitation program. The data were analyzed qualitatively using a grounded theory method with an emergent design. RESULTS: The analyses resulted in a model with the core category "finding my self-worth" consisting of four categories: "space for myself," "mirroring myself," "I am of value," and "dealing with returning to everyday life." The model illustrates the process whereby participants are given space for themselves and an opportunity to mirror themselves in interaction with other participants. That provided insight about their self-worth that was valuable for return to everyday life at home and work. CONCLUSION: Living at a residency during multimodal rehabilitation provided added value when patients were relived from the obligations of everyday life at home and given time for reflection and interaction with others in similar situations. This contributed to awareness of their own value and the necessity of taking care of themselves. This new insight led to increased motivation to act differently at home.

Contexte: Les patients souffrant de douleur chronique qui vivent en milieu rural doivent souvent parcourir de longues distances pour participer à des programmes de réhabilitation multimodale. Pour réduire les déplacements pendant les programmes, les patients vivent parfois dans une résidence à proximité de la clinique et donc loin de chez eux.Objectifs: Le but de cette étude était de se pencher sur la façon dont les patients souffrant de douleur chronique vivent leur participation à un programme de réadaptation multimodale lorsqu'ils vivent en résidence.Méthode: Douze patients provenant de deux cliniques spécialisées du Nord de la Suède ont été interviewés sur leur participation à un programme de réadaptation multimodale. Les données ont été analysées de manière qualitative en utilisant la méthode de la théorie ancrée et un devis émergent.Résultats: Les analyses ont donné lieu à un modèle dont la catégorie principale, « trouver ma valeur personnelle ¼, consiste en quatre catégories : « un espace pour moi ¼, « mon reflet ¼, « j'ai de la valeur ¼ et « le retour à la vie de tous les jours ¼. Ce modèle illustre le processus par lequel les participants disposent d'un espace pour eux-mêmes et ont l'occasion de voir leur propre reflet, en interaction avec les autres participants. Cela leur a permis de mieux percevoir leur propre valeur personnelle, ce qui a été d'une grande utilité pour leur retour à la vie quotidienne à la maison et au travail.Conclusion: Le fait de vivre en résidence pendant une réadaptation multimodale a apporté une valeur ajoutée lorsque les patients ont été libérés des obligations de la vie quotidienne à la maison et ont eu le temps de réfléchir et d'interagir avec d'autres personnes dans des situations similaires. Cela a contribué à la prise de conscience de leur propre valeur et de la nécessité de prendre soin d'eux-mêmes. Cette nouvelle perspective a conduit à une motivation accrue pour agir différemment à la maison.

Patients selected to participate in multimodal pain rehabilitation programmes in primary care-a multivariate cross-sectional study focusing on gender and sick leave.

Background and aims A multimodal rehabilitation programme (MMRP) is an evidence-based treatment of chronic pain conditions. The complexity involved in chronic pain needs to be identified and evaluated in order to adapt the rehabilitation to patients' needs. The aim was to investigate the multivariate relationships between self-reported variables in patients with chronic pain before taking part in MMRP in primary care, with a special focus on gender and degree of sick leave. Methods Prior to MMRP, 397 patients (339 women and 58 men) filled in a questionnaire about pain, healthcare aspects, health-related quality of life, anxiety and depression, coping, physical function, and work-related variables e.g. sick leave. Data were analysed by principal component analysis (PCA) and partial least square analysis. Results The PCA identified four components that explained 47% of the variation in the investigated data set. The first component showed the largest variation and was primarily explained by anxiety and depression, quality of life, acceptance (activity engagement), and pain-related disability. Gender differences were only seen in one component with the pain variables having the highest loadings. Degree of sick leave was not well explained by the variables in the questionnaire. Conclusions The questionnaire filled out by the patients prior to participation in MMRP in primary care identified much of the complexity of chronic pain conditions but there is room for improvement, e.g. regarding explanation of work-related factors. In the multivariate analysis, gender did not fall out as an important factor for how most patients answered the questions. Implications There are not many studies that describe patients who undergo MMRP in primary care since previously such patients were treated mostly in specialist care. More knowledge is needed about these patients in order to improve rehabilitation plans and interventions. The results suggest that the questionnaire identifies the complexity among chronic pain patients in primary care. The identified components could improve assessment before MMRP and contribute to better tailored programmes.

Selectivity in Infant Social Referencing.

In laboratory studies of social referencing, infants as young as 12 months have been reported to prefer looking at the experimenter over the caregiver for clarifying information. From an expertise perspective, such behavior could be interpreted as if the infant seeks information from others and can discriminate between persons who have or do not have relevant information to provide in the laboratory. If this is the case, higher order cognitive capacities might be involved in infant selectivity in looking in social referencing situations. However, it has also been proposed that associative learning processes might account for infant preferences in such studies. To examine whether an expertise perspective or if more basic learning processes best explain infant selectivity in looking, 40 12-month-old infants were assigned to 1 of 2 comparable conditions. The experimenter versus the caregiver presented an ambiguous toy and delivered positive information about the toy. The infants preferred to look at the experimenter and they regulated their behavior more in accordance with information coming from the experimenter. Thus, an associative learning account cannot explain infant preferences in looking. The results are discussed in terms of an expertise perspective.

Preschoolers' conformity (and its motivation) is linked to own and parents' personalities.

Previous studies on conformity have primarily focused on factors that moderate conformity rates overall and paid little attention to explaining the individual differences. In this study, we investigate five-factor model personality traits of both parents and children and experimentally elicited conformity in 3.5-year-olds (N = 59) using an Asch-like paradigm with which we measure both overt conformity (public responses) and covert opinions (private beliefs after conformist responses): A correct covert opinion after an incorrect conformist response results from a socially normative motivation, whereas an incorrect covert opinion results from an informational motivation. Our data show (1) low parental extroversion is associated with participants' overall rate of conformity, (2) and low participant extroversion and high openness are associated with an informational instead of a normative motivation to conform. This suggests that sensitivity to the social context or social engagement level, as manifested through extroversion, could be an important factor in conformist behaviour. Statement of contribution What is already known on this subject? We all conform, from early in life - and even when we should know better We can conform for normative and informational motivations Some are more prone to conform than others What does this study add? This is the first study to take an individual differences approach to developmental conformity Social engagement (extroversion) is an important factor in conformity.

"The acceptance" of living with chronic pain - an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care.

OBJECTIVE: To explore patient experiences of participating in multimodal pain rehabilitation in primary care. SUBJECTS: Twelve former patients (7 women and 5 men) in multimodal rehabilitation in primary care were interviewed about their experiences of multimodal rehabilitation. METHODS: The interviews were analysed using qualitative content analysis. RESULTS: Analysis resulted in 4 categories: (i) from discredited towards obtaining redress; (ii) from uncertainty towards knowledge; (iii) from loneliness towards togetherness; and (iv) "acceptance of pain": an ongoing process. The results show that having obtained redress, to obtain knowledge about chronic pain, and to experience fellowship with others with the same condition were helpful in the acceptance process. However, there were patients who found it difficult to reconcile themselves with a life with chronic pain after multimodal rehabilitation. To find what was "wrong" and to have a medical diagnosis and cure were important. CONCLUSION: Patients in primary care multimodal rehabilitation experience a complex, ongoing process of accepting chronic pain. Four important categories were described. These findings will help others to understand the experience and perspective of patients with chronic pain who engage in multimodal rehabilitation.

Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age.

OBJECTIVE: To evaluate patient-reported outcome measures in 2 different multimodal pain rehabilitation programmes and to determine whether outcomes are related to sex or age at 1-year follow-up. DESIGN: Longitudinal retrospective study. SUBJECTS: Patients who had participated in 1 of 2 multimodal pain rehabilitation programmes at 2 rehabilitation centres. A total of 356 women and 83 men, divided into 3 age groups. METHODS: Data from the Swedish Quality Registry for Pain Rehabilitation regarding activity and physical functions, pain intensity, health status and emotional functions analysed with descriptive statistics. RESULTS: Significant improvements in activity and physical functions, pain intensity and emotional func-tions were found in both multimodal pain rehabilitation programmes. Women improved more than men. The older group improved in all emotional functions (depression, anxiety, mental component summary), while the younger group improved only in depression. The intermediate group improved in all variables except anxiety. CONCLUSION: Patients improved regardless of the design of the multimodal pain rehabilitation programme. Although only small differences were found between men and women and among the 3 age groups in terms of the measured variables, these findings may have clinical relevance and indicate a need to vary the design of the interventions in multimodal rehabilitation programmes for these subgroups.