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.

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.

Background The balance of activities in daily life can become disrupted after a stroke; however, previous research has mainly focused on the performance of daily activities. Therefore, it is important to understand the impact that stroke has on various aspects of balance in activities for working-age people.

Purpose To describe how persons with stroke perceived their occupational balance and to explore whether occupational balance was associated with the severity of disability, fatigue and sociodemographic characteristics.

Methods This cross-sectional study included 63 working-age persons with stroke. The Occupational Balance Questionnaire, Glasgow Outcome Scale and Fatigue Severity Scale were used and analyzed statistically.

Results The majority of participants disagreed or strongly disagreed that they perceived occupational balance in most of the investigated aspects. Moreover, few significant associations were found between total summed occupational balance and injury and sociodemographic characteristics.

Conclusion These results demonstrate the importance of considering occupational balance in the rehabilitation of persons with stroke to support their engagement in a variety of meaningful activities that contribute to health.

IMPLICATIONS FOR REHABILITATION

• Rehabilitation need to support persons with stroke to monitor their entire patterns of activities and perceived balance to support wider engagement in meaningful activities and promote health.
• Balance between all kinds of activities in daily life besides work, needs to be considered in the later phase of rehabilitation in persons with stroke.
• A majority of the participants with stroke in this study disagreed that they had a satisfying level of occupational balance.
• Perceived balance between all activities in daily life can together with performance of activities add to the understanding of consequences after stroke.

Background: It is well known that engagement in occupations becomes restricted after acquired brain injury (ABI), but little is known about how this influences occupational values and occupational balance.

Aim: To describe the extent to which persons with ABI perceived occupational value; to explore whether occupational value and occupational balance were associated with life satisfaction, and to explore how occupational value, occupational balance, the severity of disability, fatigue and sociodemographic characteristics influenced life satisfaction.

Materials and methods: A cross-sectional study was undertaken with 75 participants of work- ing age with ABI who responded to questionnaires on occupational value, occupational balance, and life satisfaction. Additionally, instruments covering fatigue and severity of disability were administered. Data were analyzed by means of comparisons, correlations and logistic regression.

Results: A high perceived occupational value and a high perceived occupational balance were significantly associated with satisfaction with life as a whole, psychological health and somatic health. The logistic regression showed that occupational value, occupational balance and sever- ity of disability significantly impacted satisfaction with life as a whole.

Conclusions and significance: Occupational value and occupational balance together with severity of disability, are important areas of focus in the later phase of rehabilitation after ABI to promote satisfaction with life as a whole.

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 multimodal rehabilitation program. The data were analysed 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 which 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 », consiste en quatre catégories : « un espace pour moi », « mon reflet », « j’ai de la valeur » et « le retour à la vie de tous les jours ». 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.

Introduction

Knowledge about the places people visit or do not visit after stroke is lacking. The aim of this study was to describe and compare the places visited for activities outside the home of people with stroke of working age and to explore the influence of the severity of disability, fatigue, driving a car and sociodemographic characteristics on the total number of places visited for activities outside the home.

Methods

An exploratory cross-sectional study was conducted and 63 people with stroke were interviewed with instruments that covered places outside the home, severity of disability and fatigue. Data were analysed using non-parametric tests, analysis of variance and the general linear model.

Results

Significant difference in the total number of places visited for activities outside the home were found between all three groups of severity of disability. The good recovery group visited eight places to a significantly higher extent than those with severe/moderate disability. The severity of disability and driving a car were the only aspects that significantly influenced the total number of places visited.

Conclusions

Places for activities outside the home people with stroke visit and changes therein can add valuable knowledge about participation that can be used in the design of rehabilitation.

Purpose

To ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care.

Design/methodology/approach

The first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care.

Findings

The intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes.

Originality/value

The expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.

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 functions 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.

Objective The aim of this study was to explore and describe how client-centred occupationaltherapy interventions may support and improve the ability to use everyday technology (ET) in worktasks in people with acquired brain injury (ABI). Method A qualitative, descriptive multiple-casestudy was designed, and occupation-based interventions were provided to three working-ageparticipants with ABI. Multiple sources were used to collect data throughout the three interventionprocesses, including assessments, field notes, and interviews. The Canadian OccupationalPerformance Measure and the Management of Everyday Technology Assessment were administeredbefore the interventions, after the interventions and at a follow-up session 2–3 monthssubsequent to the interventions. Results The three intervention processes initially consisted ofsimilar actions, but subsequently the actions took on a different focus and intensity for each case.All of the goals in each of the three case processes were achieved, and both perceived andobserved abilities to use ET in work tasks improved. Conclusions Client-centred occupationaltherapy interventions might have the potential to improve the ability to use ET in work tasks inpeople with ABI.