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Promoting return to work: lay experiences after sickness absence with musculoskeletal diagnoses
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Musculoskeletal disorders constitute the greatest cause of sickness absence from work. Despite research and efforts at rehabilitation, sickness absence due to these disorders has not decreased, but has instead increased, particularly in women. Clients’ perceptions of care and rehabilitation, i.e. knowledge generated from a lay perspective, is a neglected area of research. This thesis deals with lay experiences of rehabilitation following sickness absence due to back, neck or shoulder problems, termed musculoskeletal disorders (MSD).

Aim: The overall aim was to examine hindering and promoting processes in rehabilitation after sickness absence due to MSD from a lay perspective. Specific aims were to study how lay persons experience rehabilitation agents and rehabilitation activities (paper I), how they describe themselves and their experience in relation to work (paper II), the significance of the private arena regarding return to work (paper III), and how clients who have experienced sickness absence due to MSD perceive contact with rehabilitation agents (paper IV).

Method: The study population in the four papers is part of a cohort of persons living in the same municipality and who in 1985 were aged 25-34 years and were sick-listed due to back, neck or shoulder diagnoses for 28 days or  more, n=213. During 1995, 148 persons in the cohort responded to a questionnaire, and in 1997-1998, 20 of these persons were interviewed concerning their experiences with rehabilitation. In papers I, II and III the qualitative method of Grounded Theory was used with a focus on creating an empirically-based theory concerning the area under study. Data collection was strategic and analysis of the tape-recorded interviews was done on a continual basis. How previously sick-listed persons experienced contact with professional rehabilitation agents in t he health care sector and social insurance office was investigated in paper IV. Factor analysis and multiple regression analysis were used to analyse the data in this study.

Results: The interview study shed light on lay persons’ experiences with medical, social and work-related measures in rehabilitation, their perceptions of rehabilitation actors and family members in relation to rehabilitation, and their self-presentations. The descriptions of lay persons concerned three arenas, the health care arena, the occupational arena, and the private arena. Dilemmas and difficulties in these arenas were described, such as handling the duty to work, experiencing domestic strain, and the experience of lacking socioemotional support from significant persons during the rehabilitation process. In paper I some ideal types of rehabilitation agents emerged from the interviewees’ descriptions concerning the health care arena, and we called these the routine bureaucrat, the empathic administrator, the distant technician, and the professional mentor. The latter agent was requested and was described as a person who could provide socioemotional support, who had professional competence, and who could function as a unifying link during the rehabilitation process. The results from paper II showed that in their self-presentations, the interviewees expressed having a duty to work and that there were differences in how they handled this sense of duty. The selfpresentations contained descriptions of work as a part of personal identity and could be summarised in the following ideal types: the work manic, the workhorse, the workaholic and the relaxed worker. The latter used a strategy that can be considered to promote rehabilitation in that the individual himself/herself had control over his/her work and worked in accordance with his/her own needs rather than those of others. Paper III focused on the private arena. Different patterns were found in the experiences of men and women. Women related that their responsibility for the home and domestic work seldom left any time for themselves, including any time for rehabilitation. Men more often reported having time for themselves that could be used for leisure activities and rehabilitation. Some of the women said that they lacked socioemotional support from their partner and that they had a great deal of responsibility for housework, which seemed to be a hindrance in returning to work after sickness absence. Furthermore, these women, like most of the men, had little education, which could make finding other work alternatives more difficult. Based on the interviews, a hypothesis was developed regarding domestic strain that is related to the distribution of domestic work, the distribution of responsibility for the home, and the quality of the marital relationship. Paper IV dealt with clients’ perceptions of contact with rehabilitation agents in health care and the social insurance office. Three latent dimensions were found in the respondents’ ratings of these contacts: supportive treatment, distant treatment, and empowering treatment. Sex, disability pension status, mental health and diagnostic group were significantly related to how these dimensionswere rated. Women perceived the treatment from both types of rehabilitation agents as more supportive than men. Contact with the social insurance offices were rated higher by persons with disability pensions than by those who had returned to work. Men rated their contact with rehabilitation agents at social insurance offices high on the dimension of distant treatment. Respondents with mental health problems rated the contact as distant for both types of rehabilitation agents, but contact with health care was also scored low on the supportive dimension. Finally, respondents with neck/shoulder diagnoses rated contact with rehabilitation agents in health care as more empowering than was done by persons with back diagnoses.

Conclusions: From a lay perspective rehabilitation following sickness absence due to MSD occured in three arenas, the health care arena, the occupational arena and the private arena, where the quality of relationships both with rehabilitation agents, persons at work and in one’s private life was described as important regarding the rehabilitation process. This thesis also showed that both sex and health were important factors regarding how lay persons’ perceived contacts with rehabilitation agents during the rehabilitation process following sickness absence due to MSD.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. , 79 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 759
Keyword [en]
Musculoskeletal disorders, back pain, neck and shoulder pain, sickness absence, sick leave, qualitative interview, lay knowledge, patient satisfaction, rehabilitation, gender
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26344Local ID: 10868ISBN: 91-7373-201-X (print)OAI: oai:DiVA.org:liu-26344DiVA: diva2:246892
Public defence
2002-12-06, Hälsans hus Aula, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved
List of papers
1. It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation
Open this publication in new window or tab >>It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation
2001 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no 4, 285-291 p.Article in journal (Refereed) Published
Abstract [en]

Aims : To explore the lay person's perspective on the rehabilitation process. Methods : A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. Results : The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private, occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. Conclusions : The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.

Keyword
Lay; Experiences; Neck; Qualitative; Interviews; Rehabilitation; Shoulder; And; Low; Back; Pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25751 (URN)10.1080/140349401317115240 (DOI)10184 (Local ID)10184 (Archive number)10184 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
2. Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders
Open this publication in new window or tab >>Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders
2002 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 11, no 2, 150-158 p.Article in journal (Refereed) Published
Abstract [en]

Musculoskeletal diagnoses account for the majority of cases of reduced work capacity. This article investigates lay persons' strategies in relation to work and musculoskeletal disorders. Twenty interviews were conducted and analysed using grounded theory. A typology of self-presentations was developed. The interviewees' self-presentations revealed a strong sense of a 'duty to work'. This sense of duty took four different forms, leading us to categorise persons expressing particular forms as workaholics, work manics, workhorses or relaxed workers. Relaxed workers seem to have the best prognosis for recovery as they had a confident self-agency and worked to fulfil their own needs rather than those of others. This was in contrast to work manics, with an uncertain self-agency and driven to work by others' needs. In conclusion, awareness of such linguistic forms as self-attributions and idiomatic phrases provides an opportunity to identify and talk about individual's self-agency and driving forces in the recovery process.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26250 (URN)10754 (Local ID)10754 (Archive number)10754 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
3. Domestic strain: A hindrance in rehabilitation?
Open this publication in new window or tab >>Domestic strain: A hindrance in rehabilitation?
2004 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, 49-56 p.Article in journal (Refereed) Published
Abstract [en]

Long-term sick leave due to musculoskeletal disorders has increased, especially for women. The aim of this paper was to explore women's and men's descriptions of the private arena in relation to rehabilitation and sickness absence. This study is part of a larger project focusing on consequences of sick leave. Individual interviews were conducted in 1997 and 1998 with 20 women and men who had been long-term sick-listed in 1985 with musculo-skeletal diagnoses. The data were analysed using Grounded theory in combination with gender analysis, which involved separately comparing men's and women's statements in order to find similarities and differences. According to the interviewees, factors in the private arena were closely associated with the rehabilitation process. Women described themselves as being responsible for the domestic work while men more often 'helped out' when asked to do so. Women and men described similar strategies to facilitate domestic work. Three dimensions of domestic life were identified, comprising division of domestic work and division of responsibility for domestic life and the amount of socio-emotional support or isolation at home. Using these dimensions, a 'domestic strain model' was developed. Our study indicates that long-term sicklisted women experiencing domestic strain would rather stay at home than return to work. Domestic strain involves inequities in the division of work and responsibilities and a lack of socio-emotional support at home. However, the model of domestic strain needs further empirical testing.

Keyword
gender, sick leave, sickness absence, back, neck or shoulder pain, qualitative interview, musculoskeletal diagnoses.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22066 (URN)10.1111/j.1471-6712.2004.00254.x (DOI)1143 (Local ID)1143 (Archive number)1143 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
4. Client’s perceptions of contacts with professionals within health care and social insurance offices
Open this publication in new window or tab >>Client’s perceptions of contacts with professionals within health care and social insurance offices
Show others...
2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 4, 275-282 p.Article in journal (Refereed) Published
Abstract [en]

Aims: An increasing number of people interact with professionals within healthcare and social insurance offices during periods of sick leave due to musculoskeletal disorders. Knowledge of clients' perceptions of such contact is scarce. This study analysed clients' perceptions of their contact with professionals within healthcare and social insurance offices.

Methods: A cohort study was conducted in the municipality of Linköping, Sweden. Participants were all citizens who in 1985 were aged 25 - 34 years and had at least one new sick-leave spell due to back, neck, or shoulder diagnoses exceeding 28 days (n=213). In 1996, 11 years after inclusion, a questionnaire about perception of contact with professionals, self-perceived health, and mental health was administered. Register data on sickness absence and disability pension from 1985 - 96 were also obtained.

Results: Factor analysis indicated the existence of three dimensions of contact with professionals: supportive treatment, distant treatment, and empowering treatment. Women perceived their contact with both social insurance officers and healthcare professionals as more supportive than did the men. Respondents with disability pensions perceived their contact with social insurance officers as more supportive and empowering than persons without disability pensions. Respondents with mental health problems perceived their contact with both types of professionals as more distant. Respondents with neck/shoulder diagnoses perceived their contact with healthcare professionals as more empowering than respondents with low back diagnoses.

Conclusion: There was a relationship between clients' perceptions of contact with professionals and the sex, disability pension, diagnosis, and mental health of clients.

Keyword
clients' perspective of treatment, musculoskeletal diagnoses, sick leave
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13676 (URN)10.1080/14034940210165037 (DOI)
Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2017-12-13

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