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  • 1.
    Alwin, Jenny
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies.
    Krevers, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Johansson, Ulla
    Center for Research and Development Uppsala Universitet.
    Josephsson, Staffan
    Karolinska institutet.
    Haraldsson, Ulla
    Stockholms Sjukhem.
    Boström, Carina
    Primärvården Gästrikland.
    Rosshagen, Anna
    Primärvården Gästrikland.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Health economic and process evaluation of AT interventions for persons with dementia and their relatives - A suggested assessment model2007In: Technology and Disability, ISSN 1055-4181, Vol. 19, no 2-3, p. 61-71Article in journal (Refereed)
    Abstract [en]

    There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article. © 2007 IOS Press. All rights reserved.

  • 2.
    Alwin, Jenny
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Äldre - vård - civilsamhälle (ÄVC) .
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Health Related Quality of Life in Dementia as Effect Measure of AT Interventions - Methodological Aspects2007In: 9th European Conference for the Advancement of Assistive Technology in Europe,2007, Amsterdam: IOS Press , 2007, p. 217-Conference paper (Refereed)
  • 3.
    Alwin, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Perception and significance of an assistive technology intervention - the perspectives of relatives of persons with dementia2013In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 18, p. 1519-1526Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to examine relatives' perception of an assistive technology intervention aimed at persons with dementia (PwDs) and their relatives, and to examine whether, and how, experiences of the intervention process differed between relatives valuing the intervention to be of high, and relatives perceiving it to be of low significance. Method: A total of 47 relatives of PwDs within the Swedish Technology and Dementia project were interviewed telephonically using a modified version of the Patient perspective on Care and Rehabilitation process instrument. A total of 46 participants were divided into two groups depending on whether they valued the intervention to be of great significance (GS group; N = 33) or of some/no significance (SNS group; N = 13). Results: Several aspects of the intervention were perceived as highly important, e.g. being shown consideration and respect, and having somewhere to turn. The results indicate that relatives in the GS group perceived certain aspects of the intervention process as highly fulfilled to a larger extent than did relatives in the SNS group. Conclusions: This study illustrates how process evaluations can be used to increase the understanding and to identify improvement aspects of interventions.

  • 4.
    Alwin, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Teknik för personer med demens: En utvärderingsstudie av teknikintervention för personer med demenssjukdom och deras närstående2008Report (Other academic)
    Abstract [en]

    The overall aim of this study was to study costs and effects of an assistive technology intervention that included assistive technology, support and strategies for persons with dementia and their relatives. Further, the aim was to study the quality of the intervention process and how it was perceived by the participants in the project.

    This assessment study was performed within a project called “Technology and Dementia – development work, create methods and increase competence”. This project was coordinated by the Swedish Institute of Assistive Technology in collaboration with the Alzheimer Society in Sweden and the Dementia Association and was funded by the Swedish Inheritance Fund, Linköping University and the County Council of Östergötland. Two national resource centres were appointed within the project. These developed the assistive technology intervention.

    The study was designed as a pre/post study. Data was collected at three different occasions of measurement: baseline, first follow-up (four weeks after the intervention) and second follow-up (twelve weeks after the intervention). Different outcome measures were used to study the effect of the intervention: health related quality of life (HRQoL), support/caregiving situation, quality of sleep, perception of time and ability to perform everyday life activities. The costs in the study had a societal perspective. A process oriented instrument was used to study the quality of the intervention process. Persons with dementia as well as their relatives answered questionnaires and interviews in the study.

    Data was collected via interviews at the resource centres, via self ratings and through telephone interviews from the research team. The total population included in the analyses was 48 persons with dementia and 47 relatives.

    The results showed that there were no significant differences in effects between baseline and the two follow-ups, except for ability to perform everyday activities where data indicated deterioration during the study period. In one dimension of HRQoL for the relatives there was also a significant difference; the relatives rated greater difficulties at the second follow-up. Cognitive ability was used as a measure for disease stability during the study, and showed no significant differences. There was, however, a rather large drop-out at the second follow-up (15 %) in data on cognitive ability, therefore this result should be interpreted with caution; the persons with dementia may have deteriorated during the study period. This could be reflected in the deterioration in the ability to perform everyday life activities measure.

    The persons with dementia rated their HRQoL higher than the relatives’ proxy ratings (i.e. relatives’ ratings of the HRQoL of the persons with dementia), the differences between the proxy ratings and the persons’ own ratings were significant at all three occasions of measurement. The relatives rated their own HRQoL somewhat higher than the persons with dementia rated their own HRQoL. There were no significant differences between baseline and the followups.

    The intervention included many different types of assistive technologies. The cost of the intervention was 16 000 SEK/person with dementia and relative. There were no significant differences in costs of formal care during the study period. Many relatives performed informal care many hours of the day. Even though the differences in informal caregiving between baseline and the second follow-up were not significant there was a tendency of a slight increase in informal care time of everyday life activities and there was also a decrease in time spent supervising, a little less than one hour per day.

    An evaluation of the quality of the intervention process and how it was perceived was performed. Most relatives perceived that their needs were well fulfilled during the intervention process. Some aspects were brought forward where the intervention process could be improved. Seventy-two percent of the relatives rated the intervention as of great importance, 28 percent rated the intervention as of some importance or of no importance. The persons with dementia had higher expectations on the intervention than the relatives and most persons with dementia perceived the intervention as of great importance.

    Technology and Dementia was a trial project where potential effects and costs were studied. The study was explorative and contributes to increasing the knowledge on use of assistive technology in dementia and also on assessment methodology within this field. There were limitations in the study regarding size of the study population and lack of a comparison group.

    Assessing assistive technology for persons with dementia and their relatives from a socioeconomic perspective entails certain methodological challenges. A model for assessment of assistive technology interventions was developed and tried in this study. Results and methodology are discussed in relation to the assessment model. From this assessment study, areas have been identified for future studies. Future studies will be performed through subgroup analyses to identify groups where the intervention was successful and groups where the intervention was not successful.

     

  • 5.
    Bernfort, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nordfeldt, Sam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    ADHD from a socio-economic perspective2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 2, p. 239-245Article, review/survey (Refereed)
    Abstract [en]

    Aim: Attention deficit hyperactivity disorder (ADHD) and related disorders affect children's ability to function in school and other environments. Awareness has increased in recent years that the same problems often persist in adulthood. Based on previous studies, we aimed to outline and discuss a descriptive model for calculation of the societal costs associated with ADHD and related disorders. Methods: Following a literature review including childhood and adult studies, long-term outcomes of ADHD and associated societal costs were outlined in a simple model. Results: The literature concerning long-term consequences of ADHD and related disorders is scarce. There is some evidence regarding educational level, psychosocial problems, substance abuse, psychiatric problems and risky behaviour. The problems are likely to affect employment status, healthcare consumption, traffic and other accidents and criminality. A proposed model structure includes persisting problems in adulthood, possible undesirable outcomes (and their probabilities) and (lifetime) costs associated with these outcomes. Conclusions: Existing literature supports the conclusion that ADHD and related disorders are associated with a considerable societal burden. To estimate that burden with any accuracy, more detailed long-term data are needed. © 2007 The Author(s).

  • 6.
    Bernfort, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Bredbandstjänster för funktionshindrade - utvärdering av brukarnyttan2004Report (Other academic)
  • 7.
    Bernfort, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Mobil videokommunikation för döva - utvärdering av brukarnyttan2005Report (Other academic)
  • 8.
    Bernfort, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Ekberg, Kerstin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Nordlund, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Economic evaluation in a cluster randomized controlled study of work place intervention in south-east Sweden2006In: International workshop Economic Evaluations of Occupational Health Interventions,2006, 2006Conference paper (Refereed)
  • 9.
    Brodtkorb, Thor- Henrik
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Decision Modeling for Cost-Effectiveness When Introducing New Technologies - the Case of Positron Emission Tomography2006In: World Congress on Medical Physics and Biomedical Engineering,2006, 2006Conference paper (Refereed)
  • 10. Calltorp, Johan
    et al.
    Carlsson, PerLinköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.Holmström, StefanLevin, Lars-ÅkeLinköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.Persson, JanLinköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Att beställa hälso- och sjukvård: teori och praktik utifrån fem exempel1998Collection (editor) (Other academic)
  • 11.
    Carlsson, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Brodtkorb, Thor-Henrik
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Heintz, Emelie
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Nationellt system för utvärdering, prioritering och införandebeslut av icke-farmakologiska sjukvårdsteknologier: en förstudie2010Report (Other academic)
    Abstract [en]

    The need for a national system to evaluate medical technologies other than pharmaceuticals is being considered. Several proposals advocate establishing a type of “Treatment Benefits Board”. To highlight problems and analyse the conditions for national assessments in this context, the National Board of Health and Welfare, the Medical Products Agency, the Swedish Council on Technology Assessment in Health Care (SBU), and the Dental and Pharmaceutical Benefits Agency (TLV) jointly appointed the Centre for Medical Technology Assessment (CMT) at Linköping University to conduct a preliminary study. The preliminary study should provide a foundation for the agencies to decide whether or not the issue needs to be investigated further.

    The preliminary study aims to develop background information concerning how Sweden and other countries currently assess, prioritise, and implement decisions involving new nonpharmaceutical health technologies. The basic questions addressed are:

    1. How can nonpharmaceutical technologies be defined and categorised for the purpose of setting parameters for an approval process?
    2. How is the current process of assessment, prioritisation, and approval in Sweden structured, focusing on SBU, the Medical Products Agency, the National Board of Health and Welfare, and TLV?
    3. How have other countries organised their systems for assessment, prioritisation, and approval of nonpharmaceutical technologies?

    Within the framework of the project it was not possible to conduct detailed, onsite studies of the healthcare systems in other countries. Hence, we relied on descriptions of other countries’ systems as reported in scientific articles, reports, and official documents available from various organisations and other sources via the Internet. In some instances the information was complemented by interviewing key individuals. The same applies to the descriptions of Swedish agencies. Information concerning the prevalence of various technologies was collected from official reports/reviews and registry data. We present information from six countries where we found sufficient information to preliminarily answer the questions we formulated in advance. The countries are Australia, New Zealand, England, Spain, Italy, Canada, and the USA.

    We draw the following conclusions from the preliminary study: It is relatively complicated to define nonpharmaceutical technologies and delineate the technologies that potentially could be subject to regulation. Our practical attempts to describe the technologies that SBU Alert has assessed show that:

    surgical and medical interventions dominate, but a relatively high number of screening programmes have also been assessed;

    • medical equipment and pharmaceuticals are the predominant input factors. Active implants and biological products are also relatively common. Assistive devices and dental products are seldom considered to be primary input factors;
    • most technologies are used primarily for treatment purposes. Diagnostic technologies are also relatively common.

    By removing pharmaceuticals from the equation and combining interventions and input factors, SBU Alert arrived at 18 different categories of health technologies that it assesses. The predominant combination is surgical intervention and biomedical equipment. This is followed by surgical intervention and insertion of active implants. In the report, we propose a way to define and classify technologies that we found to be appropriate for the purpose. This does not exclude pharmaceuticals. Rather, pharmaceuticals are included as one input factor among others.

    Another aim was to produce background information describing how Sweden and other countries currently assess, prioritise, and approve new nonpharmaceutical technologies. We identified several key components that we believe are worth considering in designing a national system for assessing, prioritising, and approving new nonpharmaceutical health technologies. These components are:

    • Organisational level – At what organisational level should the approval of nonpharmaceutical health technologies take place?
    • Scope – Should an all-inclusive or selective approach be taken towards inclusion/selection of health technologies for assessment?
    • Base package – Should there be a basic list showing what is financed with public funds, or is it sufficient to present only new decisions on the margin?
    • Diversity of actors – Should a single actor, or many actors, be responsible for assessment, prioritisation, and decisions regarding financing?
    • Fact producer – Who would be most appropriate to manage the factual information base?
    • Transparency – How transparent should one be in presenting the decisionmaking process and its results?
    • Political involvement – How politically independent should the decisions be?
    • Budgetary responsibility – Should the unit that recommends or decides on approval have a budgetary responsibility?
    • New and old – Should the decisions apply both to introducing new technology and phasing out old technology?
    • Fundamental values – Should there be an explicit set of fundamental values for prioritisation, and how should it be formulated?
    • Appeals – Should there be a mechanism to appeal decisions?

    To summarise, we see a trend in other countries towards an increasing level of assessment and prioritisation in decisions regarding the introduction of nonpharmaceutical health technologies. Our preliminary impression is that nearly every system that we studied continues to develop and remains “a work in progress”. For instance, in Australia and New Zealand official inquiries are under way to suggest or present proposals for improvement.

    Our studies of systems in different countries, although limited, indicate there is no perfect system to copy directly. The way in which the various systems are organised is somewhat related to how health care is organised in the respective countries and how many resources they have decided to dedicate to this purpose. The results from our preliminary study show, however, that several countries have more experience in “approving” nonpharmaceutical-based technologies than what we have in Sweden. The most interesting countries are England, New Zealand, Canada, and Australia. Spain could also be of interest. Hence, there is good reason to consider what might be the best way to analyse these countries’ systems in detail and complement this information with data from other nations that we were unable to include in the preliminary study, e.g. the Netherlands and Israel.

    To more rigorously analyse other systems, if this project is continued, investigators should probably start from one or more models for a Swedish mechanism. To arrive at one or more tentative models in this context, the county councils should be involved in the project. The format could be a workshop that engages representatives from public agencies, county councils, and professional associations, where they jointly outline conceivable models that could then be analysed and discussed in light of the experiences of other nations.

  • 12. Cuttini, M.
    et al.
    Casotto, V.
    Kaminski, M.
    de Beafort, I.
    Berbik, I.
    Hansen, G.
    Kollée, L.
    Kucinskas, A.
    Lenoir, S.
    Levin, A.
    Orzalesi, M.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Rebagliato, M.
    Reid, M.
    Saracci, R.
    Should euthanasia be legal? An international survey of neonatal intensive care units staff2004In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 89, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation. Design: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hungary, and the Baltic countries) or random sampling (in France, Germany, Italy, Spain, and the United Kingdom), 1391 doctors and 3410 nurses completed an anonymous questionnaire (response rates 89% and 86% respectively). Main outcome measure: The staff opinion that the law in their country should be changed to allow active euthanasia "more than now". Results: Active euthanasia appeared to be both acceptable and practiced in the Netherlands, France, and to a lesser extent Lithuania, and less acceptable in Sweden, Hungary, Italy, and Spain. More then half (53%) of the doctors in the Netherlands, but only a quarter (24%) in France felt that the law should be changed to allow active euthanasia "more than now". For 40% of French doctors, end of life issues should not be regulated by law. Being male, regular involvement in research, less than six years professional experience, and having ever participated in a decision of active euthanasia were positively associated with an opinion favouring relaxation of legal constraints. Having had children, religiousness, and believing in the absolute value of human life showed a negative association. Nurses were slightly more likely to consider active euthanasia acceptable in selected circumstances, and to feel that the law should be changed to allow it more than now. Conclusions: Opinions of health professionals vary widely between countries, and, even where neonatal euthanasia is already practiced, do not uniformly support its legalisation.

  • 13.
    Cuttini, M
    et al.
    Burlo Garofolo Children's hospital, Trieste, Italy.
    Nadai, M
    Burlo Garofolo Children's hospital, Trieste, Italy.
    Kaminski, M
    Epidemiological Unit on Women's and Children's health, U149 INSERM Villejuif, France.
    Hansen, G
    Department of Pediatrics, Martin-Luther University, Halle, Germany.
    de Leeuw, R
    Department of Neonatology, Amsterdam University, Netherlands.
    Lenoir, S
    Unit of Research on Reproduction, CJF 89-08 INSERM, Toulouse, France.
    Persson, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Rebagliato, M
    Department of Public Health, Miguel Hernandez University, Alicante, Spain.
    Reid, M
    Department of Public Health, University of Glasgow.
    de Wonderweid, U
    Lenard, HG
    Department of Pediatrics, Heinrich Heine University, Düsseldorf, Germany.
    Orzalesi, M
    Neonatal Intensive Care Unit, Bambino Gesû Children's Hospital, Rome, Italy.
    Saracci, R
    Division of Epidemiology, IFC, National Research Council, Pisa, Italy.
    End-of-life decisions in neonatal intensive care: physicians' selfreported practices in seven European countries2000In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 355, no 9221, p. 2112-2118Article in journal (Refereed)
    Abstract [en]

    Background

    The ethical issue of foregoing life-sustaining treatment for newborn infants at high risk of death or severe disability is extensively debated, but there is little information on how physicians in different countries actually confront this issue to reach end-of-life decisions. The EURONIC project aimed to investigate practices as reported by physicians themselves.

    Methods

    The study recruited a large, representative sample of 122 neonatal intensive-care units (NICUs) by census (in Luxembourg, the Netherlands, and Sweden) or stratified random sampling (in France, Germany, the UK, Italy, and Spain) with an overall response rate of 86%. Physicians' practices of end-of-life decision-making were investigated through an anonymous, self-administered questionnaire. 1235 completed questionnaires were returned (response rate 89%).

    Findings

    In all countries, most physicians reported having been involved at least once in setting limits to intensive care because of incurable conditions (61–96%); smaller proportions reported such involvement because of a baby's poor neurological prognosis (46–90%). Practices such as continuation of current treatment without intensification and withholding of emergency manoeuvres were widespread, but withdrawal of mechanical ventilation was reported by variable proportions (28–90%). Only in France (73%) and the Netherlands (47%) was the administration of drugs with the aim of ending life reported with substantial frequency. Age, length of professional experience, and the importance of religion in the physician's life affected the likelihood of reporting of non-treatment decisions.

    Interpretation

    A vast majority of neonatologists in European NICUs have been involved in end-of-life limitation of treatments, but type of decision-making varies among countries. Cultur-related and other country-specific factors are more relevant than characteristics of individual physicians or units in explaining such variability.

  • 14.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Wåhlin, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center. Karolinska Institutet, Stockholm, Sweden.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 3, p. 627-637Article in journal (Refereed)
    Abstract [en]

    Objectives The study aims to identify individual and workplace factors associated with early return to work (RTW)-defined as within 3 months-and factors associated with later RTW-between 3 and 12 months after being sick-listed-in a cohort of newly sick-listed individuals with common mental disorders. Methods In a prospective cohort study, a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders. A total of 533 newly sick-listed individuals fulfilled the inclusion criteria and agreed to participate. A baseline questionnaire was sent by post within 3 weeks of their first day of certified medical sickness; 354 (66 %) responded. Those who were unemployed were excluded, resulting in a study population of 319 individuals. Sick leave was recorded for each individual from the Social Insurance Office during 1 year. Analyses were made with multiple Cox regression analyses. Results Early RTW was associated with lower education, better work ability at baseline, positive expectations of treatment and low perceived interactional justice with the supervisor. RTW after 3 months was associated with a need to reduce demands at work, and turnover intentions. Conclusions Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individuals need to secure her/his employment situation, whereas later RTW is associated with variables reflecting dissatisfaction with work conditions. No health measures were associated with RTW. The study highlights the importance of considering not only health and functioning, but also workplace conditions and relations at the workplace in implementing RTW interventions.

  • 15.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Wåhlin, Charlotte
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Is Mobility in the Labor Market a Solution to Sustainable Return to Work for Some Sick Listed Persons?2011In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 21, no 3, p. 355-365Article in journal (Refereed)
    Abstract [en]

    Aim: The study aims to identify characteristics associated with long-term expectations of professional stability or mobility among recently sick-listed workers, and to study whether expectations of professional mobility and turnover intentions were associated with duration of sick leave.

    Methods: A cross-sectional study was performed on baseline measures in a prospective cohort study of patients who were granted sick leave due to musculoskeletal (MSD) or mental (MD) disorders. A total of 1,375 individuals fulfilled the inclusion criteria. A baseline questionnaire was sent by mail within 3 weeks of their first day of certified medical sickness; 962 individuals responded (70%). The main diagnosis was MSD in 595 (62%) individuals and MD in 367 (38%).

    Results: Expectations of ability to remain in the present profession in 2 years was associated with better health and health-related resources, younger age, higher education, and better effort-reward balance. Effort-reward imbalance, MD, high burnout scores, and better educational and occupational position were associated with turnover intentions. Low expectations of ability to remain in the present profession defined two vulnerable groups with regard to RTW, those with no turnover intentions were older, had lower personal resources, more often had MSD, and slower RTW rate. Those with turnover intentions had a clear effort-reward imbalance and high burnout scores.

    Conclusions: The results of this explorative study underline the importance of differentiating RTW-interventions based on knowledge about the sick-listed person's resources in relation to the labor market and the work place, and their expectations of future employment and employability.

  • 16.
    Ekberg, Kerstin
    et al.
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Wåhlin, Charlotte
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Is mobility in the labor market a solution to sustainable return to work for some sicklisted persons?: Poster presentation2011Conference paper (Refereed)
  • 17.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Wåhlin, Charlotte
    Institute of Environmental Medicine, Karolinska Institutet.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predictive values for early and late return to work of the Work Ability Index (WAI), the single-item question (WAI-1), and EQ-5D among sick listed in musculoskeletal and mental disorders2013Conference paper (Refereed)
  • 18.
    Götherström, Ulla-Christel
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Jonsson, Dick
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    A comparative study of text telephone and videophone relay services2004In: Technology and Disability, ISSN 1055-4181, Vol. 16, no 2, p. 101-109Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to compare text telephone relay service and videophone relay service. The target group was people borne deaf. The following aspects were investigated: (1) socioeconomic costs, (2) costs of different actors, (3) qualitative aspects of the services, (4) outcomes (intermediate effects and quality of life). The study was longitudinal and measurements were made at three occasions. Data collection was made by post-mailed questionnaires. Of the 41 respondents, 16 persons had access to the text telephone relay service only and 25 persons had access to text telephone relay service supplemented with videophone relay service. The ratings of the quality of the services and the outcomes were significantly higher for videophone relay service than for text telephone relay service (at a 95%-level). The incremental cost was approximately SEK 40 000, or EUR 4 510 (1 EUR = 8.87 SEK, as of 31 December 2000) higher per person and year for the group with access to both text telephone relay service and videophone relay service compared with the group with access to text telephone relay service only.

  • 19.
    Götherström, Ulla-Christel
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Jonsson, Dick
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    A socioeconomic model for evaluation of postal and telecommunication services for disabled persons2004In: Technology and Disability, ISSN 1055-4181, Vol. 16, no 2, p. 91-99Article in journal (Refereed)
    Abstract [en]

    The Swedish National Post and Telecom Agency provides services in the postal and telecommunication area for disabled persons. The text telephone relay service, videophone relay service, free directory enquiries and extended rural postal service are aimed for various groups of persons with disabilities. The aim of this study was to develop a socioeconomic model for assessing such telecommunication services for disabled persons. The model development included the WHO Classification ICIDH-2 and ICF, literature review, reference panel opinions, expert opinions and pilot studies. The developed model encompasses quality of the services, costs and outcomes. The quality of the services refers to quality in structure and process. Costs for different actors are included, e.g. the user, family members, county councils, local authorities and the government. Outcomes of the services refer to intermediate outcomes (direct communicative outcomes) and generic outcomes (quality of life). The socioeconomic model is general and is applicable to different rehabilitation interventions.

  • 20.
    Hallert, Eva
    et al.
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences.
    Early predictors of TNFtargeted therapy in women and men with recent onset rheumatoid arthritis (the Swedish TIRA Project)2010Article in journal (Refereed)
  • 21.
    Jonsson, Dick
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Hass, Ursula
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    The Cost of the Swedish Handicap Service System: Implications for Technology Assessment1995In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 11, no 2, p. 269-275Article in journal (Refereed)
    Abstract [en]

    The total cost of the Swedish handicap system is estimated at US $ 10.7 billion for 1989. The cost is distributed across different authorities with separate legal and financial responsibility. The concept of technology must be extended to include consideration of both the resources spent and benefits gained in the public sector and the magnitude and distribution of transfer payments from social insurance to fulfill its function in handicap policy decision making.

  • 22.
    Orwelius, Lotti
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Fredriksson, M
    Linköping University, Faculty of Health Sciences.
    Bäckman, Carl
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Can ICU admission be predicted?2010Conference paper (Other academic)
    Abstract [en]

    After intensive care (IC), patients report poor health-related quality of life (HRQoL). Many factors affect the patients and influence the HRQoL after discharge. One of these factors is the patient's health status before the critical care period. In a previous study we found that the IC patients have a high frequency of pre-existing diseases. However, it is unknown to what extent these pre-existing diseases affect the consumption of hospital resources (measured as days as inpatients) in the time period before admission to the ICU and during the years following it. The consumption prior to the ICU event may also be claimed to herald an increased risk for a later ICU admittance? The aim of this study was to examine the hospital care consumption of former ICU patients 3 years prior to and 3 years after the intensive care period. This was examined in relation to the pre-existing health status.

  • 23.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Assistive technology, socioeconomic analysis and policy making2004In: RESNA 27th International Conference on Technology and Disability: Research, Design, Practice and Policy,2004, 2004Conference paper (Other academic)
  • 24.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Hjälpmedel för funktionshindrade - kostnadseffektivitet2004In: Svenska Läkaresällskapets riksstämma,2004, 2004Conference paper (Other academic)
  • 25.
    Persson, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Andrich, Renzo
    SIVA, Milano, Italy.
    Van Beekum, Taeke
    TNO-PG, Leiden, The Netherlands.
    Brodin, Håkan
    TNO-PG, Leiden, The Netherlands.
    Lorentsen, Öivind
    Rehab-Nor A/S, Norway.
    Wessels, Roelof
    iRv, Hoensbroek, The Netherlands.
    de Witte, Luc
    iRv, Hoensbroek, The Netherlands.
    Preference based assessment of the quality of life of disabled persons2002In: Technology and disability, ISSN 1055-4181, Vol. 14, no 3, p. 119-124Article in journal (Refereed)
    Abstract [en]

    A new method for assessing preference based outcome measures in rehabilitation with assistive devices is reported. The method uses a standard utility instrument, the EuroQol, with complementary items on mobility and social relationships. In addition, a problem solving scale (PIRS) is introduced. Validation has been carried out in a multicenter study of mobility, hearing and communication devices. Utilities and problem solving scores covary strongly for mobility interventions but not for those dealing with communication. So far it is not explained whether the investigated communication interventions result in moderate utility gain only, or whether there is a bias in the corresponding utility scores. Further research on this has been started. The issue of deriving utility weights for the PIRS has also been started. We recommend the described method to be used for cost-utility analyses of rehabilitation measures for disabled persons.

  • 26.
    Persson, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Arlinger, Stig
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Kostnader och effekter vid förskrivning av hörapparat2008Report (Other academic)
    Abstract [en]

    This study aimed at investigating effectiveness and cost-effectiveness of hearing aid fitting. Especially, two types, i.e. linear one-channel AGC (simple) and nonlinear multichannel AGC (advanced), were compared. Randomised cross-over design was used, blinded through similar shells of the devices without any identifications of type. Outcome measures were “speech in noise”, problem solving ability (IPPA, PIRS) and health related quality of life (EQ-5D, HUI3). In addition, the users’ preferences with regard to final choice of hearing aid with and without information on costs were studied.

    The study was a collaboration with hearing aid centres in the county councils of Östergötland, Kalmar and Jönköping in the southeast of Sweden. During 2002 and 2003, 161 users were recruited to the study, mean age was 70 years, 60 % were men and 40 % women. The intervention was fitting of hearing aids to first time applicants, bilaterally “behind the ear” model, if no contra-indication for bilateral fitting was present.

    Free choice of equipment without any information on costs resulted in prescription of about 60 % of simple and and 40 % of advanced hearing aids. With information on costs the corresponding figures were 50%/50 %. The costeffectiveness, measured as cost per quality adjusted life years gained (cost/QALY) was 80 000 SEK based on EQ-5D and 17 300 SEK based on HUI3 Assumptions were an improvement of quality of life which was sustainable over five years. The costs included visit to physician, audiogram, assessment and construction of two earmolds and investment costs for the devices. Without information about costs 88% choose bilateral fitting and 12% unilateral. With information of costs these figures changed marginally to 87% and 13%, respectively.

    The advanced device performed significantly better in the “speech in noise” test (p=0.004) and problem solving ability measured through IPPA (p=0.044). Quality of life showed significantly lower results (p=0.009) of the use of the advanced device.

    Only a small fraction, 12 persons, changed their decision on device after cost information, 11 of these changed from advanced to simple device and one from bilateral to unilateral fitting (still advanced). The additional costs between bilateral and unilateral fitting amounted to about 8000 SEK, which seems to be an amount which the main group of users were willing to pay. No adjustment to household incomes was made.

    It has been shown that hearing aid fitting for first time applicants has a high (favorable) cost-effectiveness. The advanced device yields an improved speech recognition in noise in comparison with the simple device. The measurements of quality of life indicate difficulties to discriminate between types of devices. It could be that subgroups’ value the two types differently. An hypothesis, which has not been tested, is whether people with better cognitive ability prefer the advanced device to a higher extent than do users with lower cognitive ablity.

  • 27.
    Persson, Jan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Bernfort, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Borg, Erik
    Danermark, Berth
    Gullbrandsson, A.
    Hellbom, Gunn
    Husberg, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Cost-effectiveness of a new regimen for rehabilitation at hard of hearing2004In: Health Technology Assessment Internationel HTAi,2004, 2004Conference paper (Other academic)
  • 28.
    Persson, Jan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Bernfort, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Hellbom, Gunn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Danermark, Berth
    Örebro Universitet.
    Borg, Erik
    Ahlséns forskningsinstitut.
    Gullbrandsson, Ann
    Karlstad sjukhus.
    Husberg, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Cost-effectiveness in rehabilitation of hearing impaired people.2005In: Assistive Technology: From Virtuality to Reality AAATE 2005 / [ed] Alain Pruski and Harry Knops, IOS Press , 2005, p. 750-754Chapter in book (Other academic)
    Abstract [en]

    The title of this book points towards the difficulty encountered in research and development carried out by laboratories to reach the users. From Virtuality to Reality aims at alerting  developers so that they pay a particular attention to the outcome of their work. Inventive research as well as new technologies which have a very high potential in the field of assistive technology are described in this publication. Despite the fact that recent products take more and more frequently into account the specific needs of the handicapped people, there remains a long road ahead until these products become available to everyone. Assistive technology has to adapt to today’s fast technological developments. Because new technologies are developing too rapidly, there is no choice but to adapt to this ceaseless evolution. The elderly or handicapped people are facing more and more difficulties in interacting with the assistive technology experts. Technology is an essential component of the activity but it is even more important to take into account the human factor if the aim is to enable users to benefit from assistive technologies. As a consequence, developers must work with a unique objective based on a user-centered approach. This requires a multidisciplinary collaboration  which is one of the prime movers of their research and also one of the keys of success.

  • 29.
    Persson, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Wåhlin, Charlotte
    Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institutet, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Costs of production loss and primary health care interventions for return-to-work of sick-listed workers in Sweden2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 9, p. 771-776Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to investigate, from the perspective of society, the costs of sick leave and rehabilitation of recently sick-listed workers with musculoskeletal disorders (MSD) or mental disorders (MD). Methods: In a prospective cohort study, 812 sick-listed workers with MSD (518) or MD (294) were included. Data on consumption of health care and production loss were collected over six months from an administrative casebook system of the health care provider. Production loss was estimated based on the number of sick-leave days. Societal costs were based on the human capital approach. Results: The mean costs of production loss per person were EUR 5978 (MSD) and EUR 6381 (MD). Health care interventions accounted for 9.3% (MSD) and 8.2% (MD) of the costs of production loss. Corresponding figures for rehabilitation activities were 3.7% (MSD) and 3.1% (MD). Health care interventions were received by about 95% in both diagnostic groups. For nearly half of the cohort, no rehabilitation intervention at all was provided. Conclusions: Costs associated with sick leave were dominated by production loss. Resources invested in rehabilitation were small. By increasing investment in early rehabilitation, costs to society and the individual might be reduced. Implications for Rehabilitation Resources invested in rehabilitation for sick-listed with musculoskeletal and mental disorders in Sweden are very small in comparison with the costs of production loss. For policy makers, there may be much to gain through investments into improved rehabilitation processes for return to work. Health care professionals need to develop rehabilitative activities aiming for return to work, rather than symptoms treatment only.

  • 30.
    Persson, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Wåhlin, Charlotte
    Institute of Environmental Medicine, Karolinska Institutet.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Costs to society related to sickness absence due to musculoskeletal or mental disorders in Sweden - results from a cohort study2013Conference paper (Refereed)
  • 31.
    Persson, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Brodtkorb, Thor-Henrik
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Collaboration between academia, manufacturers and healthcare services for development and adoption of medical devices with regard to costs and effects2009In: IFMBE World Congress on Medical Physics and Biomedical Engineering, München: Springer , 2009, p. 138-140Conference paper (Refereed)
    Abstract [en]

    The market for new medical devices depends on evidence on effectiveness and cost-effectiveness as well as ethical criteria based on patients needs and severity of disease. HTA is therefore increasingly used to provide appraisals for decision makers. In comparison to pharmaceuticals, medical devices face difficulties in providing studies with high evidence. There are, however, new promising developments in health economics and in the systems for valuing evidence which may improve the possibility of quicker appraisal of medical devices. This development, comprising Bayesian modeling and revision of systems for grading evidence, may be used in an iterative procedure to anticipate the market potential and to contribute to finding an optimal time when the implementation of a new device is worthwhile. In such a system, researches, developers and manufacturers, and healthcare services should gain from strengthened collaboration.

  • 32.
    Persson, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Can we rely on QALYs for assistive technologies?2012In: Technology and Disability, ISSN 1055-4181, E-ISSN 1878-643X, Vol. 24, no 1, p. 93-100Article in journal (Refereed)
    Abstract [en]

    In decision making on the adoption of health care programmes, assistive technologies (ATs) and AT services for people with disabilities, cost-effectiveness analysis is increasingly important. The quality-adjusted life-year (QALY), which incorporates quality of life as well as survival, has become a standard unit of comparative efficacy, although there are methodological challenges in its use. The applicability of the concept of cost per QALY gained through intervention was investigated in one study of rollators and one of hearing aids. It was shown that two widely used instruments for deriving QALYs, HUI3 and EQ-5D, yield differing results, which may also differ depending on the type of disability. Because the magnitude of these differences could affect decision makers' willingness to provide reimbursement, the variability of cost-effectiveness results due to methodology should be considered in the policy-making process.

  • 33.
    Persson, Jan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Husberg, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Arlinger, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Advanced Signal Processing in Single and Bilateral Hearing Aids - User Benefits2006In: the World Congress on Medical Physics and Biomedical Engineering,2006, 2006Conference paper (Refereed)
  • 34.
    Persson, Jan
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Husberg, Magnus
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Hellbom, Gunn
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Fries, Anna
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Kostnader och effekter vid förskrivning av rollatorer2007Report (Other academic)
    Abstract [en]

    The aim of this study was to investigate effectiveness and cost-effectiveness of rehabilitation by means of walkers for persons with restricted mobility (fourwheeled walkers). The walkers were of a number of different brands and models.

    The study group included 205 first time users with several different diagnoses. The study was designed as a pre/post study with follow-up three months after the delivery of the walker. The “functional diagnosis” of the user the walker models prescribed and labour time used by thew staff were reported by the prescribing staff (physiotherapists and occupational therapists). Background data and various outcomes were reported through questionnaires by the users themselves.

    The users reported a number of positive effects of the intervention:

    • less need for help on a daily basis,
    • increased possibilities to participate in "activities outside home",
    • less problems in carrying out daily activities,
    • significant improvement in generic quality of life, measured by means of the instrument EuroQol (EQ-5D).

    The average cost of the walkers amounted to SEK 1 300. In addition, there were labour costs related to examinations and the delivery of the walkers, amounting to SEK 300. The direct costs per case amounts to about SEK 1 600 on average.

    The only indirect cost where a change due to the delivery of the walker could be expected was “special transport service”. There was a slight, although nonsignificant, increase in this cost, after delivery of the walkers.

    With the estimated gain in quality of life of 0,07 (on the scale of EQ-5D, ranging from 0,0 to 1,0), we derived a cost per quality adjusted years gained (cost/QALY) of SEK 24 000. This means a very favourable balance between costs and effects, supporting high ranking in priority lists.

  • 35.
    Rebagliato, Marisa
    et al.
    Department of Public Health, Miguel Hernandez University, Alicante, Spain .
    Cuttini, Marina
    Units of Epidemiology and Neonatal Intensive Care, Burlo Garofolo Children's Hospital.
    Broggin, Lara
    Units of Epidemiology and Neonatal Intensive Care, Burlo Garofolo Children's Hospital.
    Berbik, Istvan
    Department of Obstetrics and Gynaecology, Vaszary Kolos Hospital, Tergoti, Hungary .
    de Vonderweid, Umberto
    Units of Epidemiology and Neonatal Intensive Care, Burlo Garofolo Children's Hospital.
    Hansen, Gesine
    Department of Pediatrics, Martin-Luther University, Halle, Germany .
    Kaminski, Monique
    Epidemiological Research Unit on Perinatal and Women's Health U.149 INSERM.
    Kollée, Louis A. A.
    Department of Neonatology, University Hospital of Nijmegen, Nijmegen, the Netherlands.
    Kucinskas, Audrunas
    Neonatal Clinic, Vilnius University, Lithuania .
    Lenoir, Sylvie
    Villejuif, and Unit of Research on Reproduction, INSERM CJF 89-08 .
    Levin, Adik
    Newborn and Premature Children's Department, Tallinn Hospital, Estonia .
    Persson, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Reid, Margaret
    Department of Public Health, University of Glasgow.
    Saracci, Rodolfo
    Trieste, and Division of Epidemiology, IFC, National Research Council .
    Neonatal end-of-life decision making: physicians' attitudes and relationship with self-reported practices in 10 European countries2000In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 284, no 19, p. 2451-2459Article in journal (Refereed)
    Abstract [en]

    Context: The ethical issues surrounding end-of-life decision making for infants with adverse prognoses are controversial. Little empirical evidence is available on the attitudes and values that underlie such decisions in different countries and cultures. Objective: To explore the variability of neonatal physicians' attitudes among 10 European countries and the relationship between such attitudes and self-reported practice of end-of-life decisions. Design and Setting: Survey conducted during 1996-1997 in 10 European countries (France, Germany, Italy, the Netherlands, Spain, Sweden, the United Kingdom, Estonia, Hungary, and Lithuania). Participants: A total of 1391 physicians (response rate, 89%) regularly employed in 142 neonatal intensive care units (NICUs). Main Outcome Measures: Scores on an attitude scale, which measured views regarding absolute value of life (score of 0) vs value of quality of life (score of 10), self-report of having ever set limits to intensive neonatal interventions in cases of poor neurological prognosis. Results: Physicians more likely to agree with statements consistent with preserving life at any cost were from Hungary (mean attitude scores, 5.2 [95% confidence interval {Cl}, 4.9-5.5]), Estonia (4.9 [95% Cl, 4.3-5.5]), Lithuania (5.5 [95% Cl, 4.8-6.1]), and Italy (5.7 [95% Cl, 5.3-6.0]), while physicians more likely to agree with the idea that quality of life must be taken into account were from the United Kingdom (attitude scores, 7.4 [95% Cl, 7.1-7.7]), the Netherlands (7.3 [95% Cl, 7.1-7.5]), and Sweden (6.8 [95% Cl, 6.4-7.3]). Other factors associated with having a pro-quality-of-life view were being female, having had no children, being Protestant or having no religious background, considering religion as not important, and working in an NICU with a high number of very low-birth-weight newborns. Physicians with scores reflecting a more quality-of-life view were more likely to report that in their practice, they had set limits to intensive interventions in cases of poor neurological prognosis, with an adjusted odds ratio of 1.5 (95% Cl, 1.3-1.7) per unit change in attitude score. Conclusions: In our study, physicians' likelihood of reporting setting limits to intensive neonatal interventions in cases of poor neurological prognosis is related to their attitudes. After adjusting for potential confounders, country remained the most important predictor of physicians' attitudes and practices.

  • 36.
    Roback, Kerstin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Gäddlin, Per-Olof
    Neonatal Länssjukhuset Ryhov, Jönköping.
    Nelson, Nina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Adoption of medical devices: The neonatal intensive care unit as a case study2005In: 13th Nordic Baltic Conference on Biomedical Engineering Medical Physics,2005, Umeå: Swedish Society for Medical Engineering and Medical Physics , 2005, p. 18-Conference paper (Refereed)
  • 37.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Gäddlin, Per-Olof
    Division of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Adoption of medical devices: Perspectives of professionals in Swedish neonatal intensive care2007In: Technology and Health Care, ISSN 0928-7329, Vol. 15, no 3, p. 157-179Article in journal (Refereed)
    Abstract [en]

    Advances in biomedical engineering enable us to treat increasingly severe conditions. This implies an increased need for regulation and priority setting in healthcare, to ensure appropriate safety cautions and to avoid accelerating expenditures. This interview study investigates the mechanisms behind the adoption and use of medical devices through the subjective experiences of hospital staff working with devices for neonatal intensive care. The adoption was found to be primarily initiated by vendor activities, but professionals preferably sought information about functionality from close colleagues. Full integration of devices was sometimes not achieved, and even though the adopting units had good introduction routines, there was no systematic follow-up of how adopted devices had been integrated in the work practices. Diffusion variations were, however, mainly found for temporarily tested devices and not for permanently available technologies. Three factors were found to be the major explanatory variables of the adoption of medical devices: (1) the subjective expected value of the device, (2) information and learning, and (3) the innovativeness of the adopting unit.

  • 38.
    Roback, Kerstin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Gäddlin, Per-Olof
    Division of Pediatrics County Hospital Ryhov, Jönköping.
    Nelson, Nina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Implementation of Technological Change in Healthcare - Experiences from neonatal intensive care2007In: Fourth Annual Meeting of Health Technology Assessment International HTAi,2007, 2007Conference paper (Refereed)
    Abstract [en]

      

  • 39.
    Roback, Kerstin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Gäddlin, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Nelson, Nina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Managing Technological Change in the Innovative Hospital: Experiences from Neonatal Intensive Care2006In: World Congress on Medical Physics and Biomedical Engineering,2006, 2006Conference paper (Refereed)
    Abstract [en]

      

  • 40.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Hass, Ursula
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Transfer of health care technology in university-industry research collaboration environment2001In: Engineering in Medicine and Biology Society. Proceedings of the 23rd Annual International Conference of the IEEE, 2001, Vol. 4, p. 3938-3941Conference paper (Refereed)
    Abstract [en]

    The traditional innovation research has focused on the diffusion process and adoption of new technologies. This paper deals with health care technology in the early innovation stages preceding targeted development and marketing. A model of early research processes in the biomedical field and determinants of technology transfer will be presented. The study material is eleven projects in the Competence Center Noninvasive Medical Measurements (NIMED), Linkoping University, which is a collaboration center where academic researchers cooperate with industry and clinical departments. Data collection was made through semi-structured interviews. A qualitative approach has been adopted for data analysis. Research initiatives of the investigated projects do in most cases originate in the academic knowledge base and earlier connections in industry and health care play an important role in the formation of cooperation constellation. A number of internal factors are perceived as positive to project advancement, such as stable economy, proximity to clinical departments, and positive feedback from collaboration partners. Significant negative factors are all related to changes in cooperation structure. Clusters of related projects seem to be beneficial to research work and is an evident external factor which has to be added in a new model of technology transfer.

  • 41.
    Roback, Kerstin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment.
    Evidensbaserad sjukvård och kommersialisering av idéer2008In: Medicinteknikdagarna 2008. Svensk förening för medicinsk teknik och fysik,2008, 2008, p. 78-78Conference paper (Refereed)
    Abstract [sv]

       

  • 42.
    Roback, Kerstin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Spridning av MTP - fallstudier2004In: Svenska Läkaresällskapets riksstämma,2004, 2004Conference paper (Refereed)
  • 43.
    Roback, Kerstin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Hass, Ursula
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Spridning och implementering av medicintekniska produkter: Bakgrundsrapport2003Report (Other academic)
  • 44.
    Wigertz, Ove
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Teaching medical informatics to biomedical engineering students: experiences over 15 years1989In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 4, p. 309-312Article in journal (Refereed)
  • 45.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 4, p. 355-362Article in journal (Refereed)
    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.

  • 46.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 1, p. 32-43Article in journal (Refereed)
    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.

  • 47.
    Wåhlin Norgren, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Return to work interventions for patients with musculoskeletal and mental disorders – The gap between best and clinical practice.2010Conference paper (Refereed)
  • 48.
    Wåhlin Norgren, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Department of Medical and Health Sciences.
    Do patients with Musculoskeletal and Mental disorders receive recommended interventions to promote RTW? - How do they perceive what they get?2009Conference paper (Refereed)
  • 49.
    Öberg, Birgitta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Wåhlin, Charlotte
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, The Institute of Technology.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    A prospective cohort study on newly sick-listed patients with musculoskeletal disorders and sustainable return to work2013Conference paper (Other academic)
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