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Clinical reasoning in occupational health services for individuals with musculoskeletal and mental disorders
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. (ReWESS)
Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences. (ReWESS)ORCID iD: 0000-0002-8031-7651
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. (ReWESS)
2012 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 14, no 4, 155-165 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To investigate whether there are associations between the professional assessment of a patient's main clinical problem and the patient's self-reported health among patients with musculoskeletal disorders and/or mental disorders. To investigate differences in self-reported health and work-related measures in patients who were recommended clinical versus work-related interventions. Method: A cross-sectional study, including a convenience sample of 210 patients, visiting occupational health service. Patients answered a questionnaire on demographic variables, dimensions of health, functioning, work ability and working conditions. Patients’ main clinical problem and type of intervention was classified by physiotherapists. Activity limitations were identified using the Patient-Specific Functional Scale. Findings: The main clinical problems were: medical/organic problems (39%), psychosocial problems (46%) and physical work-related problems (15%). The psychosocial group reported more problems in mental functioning and the medical/organic group had worse physical functioning. There were significant differences for the main clinical problem, educational level, work ability, social interaction skills and mobility in patients who were recommended clinical versus work-related interventions. Conclusions: There are associations between the professional biopsychosocial classification and the patient's self-reported health and functioning. Clinical reasoning may be improved by including systematic biopsychosocial assessment of specific health and working conditions, and activity limitations according to Patient-Specific Functional Scale.

Place, publisher, year, edition, pages
London, UK: Informa Healthcare, 2012. Vol. 14, no 4, 155-165 p.
Keyword [en]
Musculoskeletal disorders, mental disorders, biopsychosocial model, occupational health services, professional assessment, self-report, work ability, Patient-Specific Functional Scale, intervention.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-76145DOI: 10.3109/14038196.2012.729609OAI: oai:DiVA.org:liu-76145DiVA: diva2:512742
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2004-0582
Available from: 2012-03-29 Created: 2012-03-29 Last updated: 2017-12-07Bibliographically approved
In thesis
1. The Rehabilitation Process for Individuals with Musculoskeletal and Mental Disorders: Evaluation of Health, Functioning, Work Ability and Return to Work
Open this publication in new window or tab >>The Rehabilitation Process for Individuals with Musculoskeletal and Mental Disorders: Evaluation of Health, Functioning, Work Ability and Return to Work
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Musculoskeletal disorders (MSD) and mental disorders (MD) are common among working-age individuals, and reduced work ability is often a problem that influences functioning in working life. Having MSD and MD is also a common cause of seeking health care and these conditions account for the majority of sick leave in most western countries. The overall aims of the thesis were to increase knowledge about biopsychosocial assessment of health, functioning and work ability for individuals with MSD and MD seeking care. A further aim was to gain better understanding of praxis behaviour in the rehabilitation process for sick-listed patients by evaluating patient-reported work ability, type of interventions given, usefulness of interventions, and return to work.

This thesis comprises four studies based on two different cohorts. A cross-sectional design was used for studies I and II, which included 210 individuals diagnosed with MSD and MD seeking occupational health services. Data collection consisted of questionnaires to patients on self-reported health, functioning, work conditions, work ability and reports of professional assessment of diagnosis, main clinical problem, recommended intervention and sick leave. Studies III (n=699) and IV (n=810) were based on a longitudinal cohort study, ReWESS, with a 3-month follow-up comprising individuals who sought primary health care or occupational health services for MSD or MD and were sick-listed. The data collection included repeated questionnaires to the patients on self-reported health, functioning, work conditions, work ability, type and usefulness of intervention and return to work.

There was an association between the professional biopsychosocial assessment and patients’ self-reported measures of health, functioning and work ability in clinical reasoning. Self-reported health and work measures can complement the expert-based diagnosis. Patients who had MSD and MD with co-morbid conditions reported more problems with mental functioning, had higher psychological demands at work and reported poorer work ability compared with those with MSD only. Patients with co-morbid conditions also had worse outcome compared to having mental disorders only. Psychosocial problems and activity limitations concerning social interaction skills were a frequent problem. This can be identified in clinical screening by physiotherapists in dialogue with the patient using the Patient-Specific Functional Scale. Three-quarters of sick-listed individuals with MSD or MD returned to work within 90 days. The treatment approach to sick-listed persons is still very medical and clinically oriented. Access to work-related interventions seems to be limited in the early rehabilitation process and may not be equal in practice. Those who were younger, had higher educational level and reported stronger health resources were favoured. There is a need to strive for access to work-related interventions.

Return to work was associated with receiving combined clinical- and work-related interventions for patients with MD, and with better health-related quality of life, positive return to work expectations and better work ability for patients with MSD. Factors associated with return to work can be identified using self-reported measures. Patients with MD who received a combination of work-related and clinical interventions perceived best usefulness and best effect of health care contacts on work ability. Patients with MSD did not report as good usefulness. There seems to be a gap between scientific evidence and praxis behaviour in the early rehabilitation process; unimodal rehabilitation was widely applied, use of a multimodal treatment approach was limited and only one-third received work-related interventions. For patients with MSD, behavioural treatment seems to be underutilized in clinical practice considering the effect it may have on developing coping strategies and reducing symptoms. In order to meet recommendations in guidelines, physical activity needs to increase as a treatment strategy for patients with MD. A clinical implication is that the rehabilitation process needs to adopt a broader perspective for patients with MSD and MD to include patients’ individual health-related needs, aspects of employment and work conditions. Still, it remains a challenge to understand who needs what type of intervention.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 92 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1290
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76149 (URN)978-91-7519-976-4 (ISBN)
Public defence
2012-04-20, Berzeliussalen, ingång 64, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-03-29 Created: 2012-03-29 Last updated: 2013-09-03Bibliographically approved

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Wåhlin, CharlotteEkberg, KerstinÖberg, Birgitta

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