liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The Rehabilitation Process for Individuals with Musculoskeletal and Mental Disorders: Evaluation of Health, Functioning, Work Ability and Return to Work
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
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: urn:nbn:se:liu:diva-76149ISBN: 978-91-7519-976-4 (print)OAI: oai:DiVA.org:liu-76149DiVA: diva2:512745
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
List of papers
1. Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?
Open this publication in new window or tab >>Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?
2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 13-14, 1147-1156 p.Article in journal (Refereed) Published
Abstract [en]

Purpose. The aim of this study is to determine differences in self-reported work ability, work conditions, health and function between ICD-10 groups with musculoskeletal disorders (MSD), mental disorders (MDs) and MSD+MD and to determine which variables are associated with sick leave.

Method. A cross-sectional study of 210 employees was conducted at an occupational health service unit. Physiotherapists and physicians classified the employees’ health problems according to ICD-10 and the employees answered a questionnaire with questions on demographic variables, health, functioning, work ability and work conditions.

Results. Forty-four per cent of the employees had MSD, 22% had MD and 34% had a MSD+MD. The group on sick leave had worse results for all health and work measures. Belonging to the MD group, belonging to the MSD+MD group, having poor work ability and functioning were associated with being on sick leave. The value for the model explaining being on sick leave was 0.63 (Nagelkerke R2).

Conclusions. Having a diagnosis of MD based on a professional opinion and having poor work ability and functioning based on self-reports are associated with being on sick leave. The results suggest that self-reported data could be used to complement the expert-based diagnosis.

Place, publisher, year, edition, pages
Informat Health Care, 2011
Keyword
Work ability, musculoskeletal disorders, mental disorders, sick leave, ICD-10, work ability index
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65843 (URN)10.3109/09638288.2010.523509 (DOI)000290950400008 ()
Funder
FAS, Swedish Council for Working Life and Social Research, 2004-0582
Note

Original Publication: Charlotte Wåhlin Norgren, Kerstin Ekberg and Birgitta Öberg, Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?, 2010, Disability and Rehabilitation. http://dx.doi.org/10.3109/09638288.2010.523509 Copyright: Informa Healthcare http://informahealthcare.com/

Available from: 2011-02-22 Created: 2011-02-22 Last updated: 2013-09-03
2. Clinical reasoning in occupational health services for individuals with musculoskeletal and mental disorders
Open this publication in new window or tab >>Clinical reasoning in occupational health services for individuals with musculoskeletal and mental disorders
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
Keyword
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:nbn:se:liu:diva-76145 (URN)10.3109/14038196.2012.729609 (DOI)
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
3. Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders
Open this publication in new window or tab >>Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders
Show others...
2012 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 4, 355-362 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjects with musculoskeletal or mental disorders. Factors associated with return-to-work were also analysed.

Design: A prospective cohort study.

Methods: A total of 699 newly sick-listed patients responded to a questionnaire on sociodemographics, measures of health, functioning, work ability, self-efficacy, social support, work conditions, and expectations. The 3-month follow-up questionnaire included patients' self-reported measures of return-to-work, work ability and type of interventions. The most frequent International Classification of Diseases-10 diagnoses for patients' musculoskeletal disorders were dorsopathies (M50-54) and soft tissue disorders (M70-79), and for patients with mental disorders, depression (F32-39) and stress reactions (F43).

Results: Patients with mental disorders who received combined interventions returned to work to a higher degree than those who received only clinical intervention. The prevalence of work-related interventions was higher for those who were younger and more highly educated. For patients with musculoskeletal disorders better health, work ability and positive expectations of return-to-work were associated with return-to-work. However, combined interventions did not affect return-to-work in this group.

Conclusion: Receiving combined interventions increased the probability of return-to-work for patients with mental disorders, but not for patients with musculoskeletal disorders. Better health, positive expectations of return-to-work and better work ability were associated with return-to-work for patients with musculoskeletal disorders.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-73425 (URN)10.2340/16501977-0951 (DOI)000303850800010 ()
Funder
FAS, Swedish Council for Working Life and Social Research, 2004-0582
Note

funding agencies|FAS (Swedish Council for Working Life and Social Research)||

Available from: 2012-01-03 Created: 2012-01-03 Last updated: 2017-12-08Bibliographically approved
4. Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients
Open this publication in new window or tab >>Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients
Show others...
2013 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 1, 32-43 p.Article in journal (Refereed) Published
Abstract [en]

Aim To describe the types of intervention offered, to investigate the relationship between the type of intervention given, patient-reported usefulness of interventions and the effect on self-reported work ability in a cohort of sick-listed patients with musculoskeletal disorders (MSD) or mental disorders (MD).

Methods A prospective cohort study was performed including 810 newly sick-listed patients (MSD 62 % and MD 38 %). The baseline questionnaire included sociodemographic characteristics and measures of work ability. The 3-month follow-up questionnaire included measures of work ability, type of intervention received, and judgment of usefulness.

Results Twenty-five percent received medical intervention modalities (MI) only, 45 % received a combination of medical and rehabilitative intervention modalities (CRI) and 31 % received work-related interventions combined with medical or rehabilitative intervention modalities (WI). Behavioural treatments were more common for patients with MD compared with MSD and exercise therapy were more common for patients with MSD. The most prevalent workplace interventions were adjustment of work tasks or the work environment. Among patients with MD, WI was found to be useful and improved work ability significantly more compared with only MI or CRI. For patients with MSD, no significant differences in improved work ability were found between interventions.

Conclusions Patients with MD who received a combination of work-related and clinical interventions reported best usefulness and best improvement in work ability. There was no difference in improvements in work ability between rehabilitation methods in the MSD group. There seems to be a gap between scientific evidence and praxis behaviour in the rehabilitation process. Unimodal rehabilitation was widely applied in the early rehabilitation process, a multimodal treatment approach was rare and only one-third received work-related interventions. It remains a challenge to understand who needs what type of intervention.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2013
Keyword
Musculoskeletal disorders; Mental disorders; Sick leave; Self-reported; Work ability; Usefulness; Interventions, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76147 (URN)10.1007/s10926-012-9376-y (DOI)000314505200004 ()22760957 (PubMedID)
Funder
FAS, Swedish Council for Working Life and Social Research, 2004-0582
Available from: 2012-03-29 Created: 2012-03-29 Last updated: 2017-12-07Bibliographically approved

Open Access in DiVA

The Rehabilitation Process for Individuals with Musculoskeletal and Mental Disorders: Evaluation of Health, Functioning, Work Ability and Return to Work(1310 kB)2449 downloads
File information
File name FULLTEXT01.pdfFile size 1310 kBChecksum SHA-512
cdec7032e231d4d508545fd97ac1f6690661a9275ba42a24267a411d4a0e107db4499d208cc622f721eed22dfaa9f0f5632c0bd971e9f4512412ee36c0f34205
Type fulltextMimetype application/pdf
omslag(228 kB)50 downloads
File information
File name COVER01.pdfFile size 228 kBChecksum SHA-512
9b8db49dce45f44c72d0b1d7efcb4c3fe430f74b3aabcaec5e0ceacfda172a5a9be5b52a2a4301645f851e2e32f9360284348b03a1106b72671ff961aabc9865
Type coverMimetype application/pdf

Authority records BETA

Wåhlin, Charlotte

Search in DiVA

By author/editor
Wåhlin, Charlotte
By organisation
PhysiotherapyFaculty of Health Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 2449 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1468 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf