The nature stroke study; NASTRU: A randomized controlled trial of nature-based post-stroke fatigue rehabilitation

Objective: To determine whether nature-based rehabilitation, as an add-on to standard care, has a long-term influence on post-stroke fatigue, perceived value of everyday occupations, disability, health-related quality of life, anxiety, and depression at follow-up 8 and 14 months after randomization. Design: Single-blinded, 2-armed, randomized controlled trial. Methods: Stroke survivors, identified through routine 3-month follow-up visit (sub-acute) or medical records (chronic stroke >1 year previously), were randomized to standard care + nature-based rehabilitation (intervention group) or standard care alone (control group). Blinded evaluations were conducted at follow-up 8 and 14 months after randomization, for the following outcomes: post-stroke fatigue (Mental Fatigue Scale; MFS), perceived value of everyday occupations (Occupational value instrument with predefined items), disability (modified Rankin Scale; mRS), health-related quality of life (Euro-QoL-5 Demension Questionnaire), anxiety (Hospital Anxiety and Depression Scale; HAD) and depression (HAD). Results: Approximately one-quarter of the screened patients were eligible for inclusion in the study; of these, half agreed to participate; a final total of 101 patients were randomized (mean age 67 years, 60% female). The patients with sub-acute stroke were highly compliant with the intervention. The participants in both the intervention and control groups improved, However, no statistically significant differences in improvement were found between the intervention and control groups for any of the outcome measures. Fatigue decreased to a value below the suggested cut-off for mental fatigue (<10.5) in the intervention group, but not in the control group. Conclusion: Nature-based rehabilitation is feasible and well tolerated. A larger randomized controlled trial is warranted

Work ability- Health professionals' perspectives and rehabilitation outcomes

The overall aim of this thesis was to deepen the understanding of work ability by analyzing how different health professionals experience and perceive work ability and assessments of work ability, and also by analyzing rehabilitation outcomes that are related to work ability. The focus has been on musculoskeletal disorders with associated psychosocial factors. Method. The general approach was inductive and explorative. In studies I and II, in-depth interviews with physicians (n=14) and physiotherapists (n=16) were conducted, while study III comprised five focus groups within a group of experienced and specially trained physiotherapists (n=7). Qualitative content analysis was applied to the data. Study IV comprised a predefined cohort (n=406), consisting of individuals with musculoskeletal disorders, all included in the national rehabilitation program. All patients were offered multimodal rehabilitation including evidence-based interventions with the aim of promoting work ability. The cohort was studied in order to find out how the patients responded to the rehabilitation and also what factors were associated with health-related quality of life and sick leave. Results. Physicians and physiotherapists shared a holistic view of work ability and wanted to represent and support the patient. They experienced contradictory roles in relation to the patient. More extensive collaboration within health care was desired, but this was not always possible. The physiotherapists wanted to take part in assessments, but felt that they were not always asked to. To be able to take part, experience and further education were needed. Collaboration was also requested with other involved parties, such as occupational health services, the Social Insurance Agency and the employer. There was a need for better knowledge concerning the workplaces. After education and specially training, PTs took more initiatives. They believed that they could contribute with structured work ability assessments and benefitted from continuity. There was need to emphasize the PT role in the organizations. Patients in the national rehabilitation program improved health-related quality of life and function. Patients with no sick leave or disability pension the year before rehabilitation seemed to benefit more from the program. Compared to patients with sick leave or disability pension the year before rehabilitation, a minor proportion within this group reported work ability limitations after completing the program. Limitations with exercise tolerance functions and sick leave history were associated with being on sick leave and having lower health-related quality of life at follow-up

Motivation for change in patients with prolonged musculoskeletal disorders : a qualitative two-year follow-up study

BACKGROUND AND PURPOSE: The purpose of this study was to obtain a deeper understanding of the process of motivation for change in patients with prolonged musculoskeletal disorders and to identify factors that might influence change resulting in increased independence.METHOD: A qualitative two-year follow-up study. Data collection and analysis were performed according to the qualitative case study design. An initial conceptual framework was developed to bound and guide the study. Twenty patients were selected using purposive sampling with respect to motivation level (highly motivated to less-motivated) to create a sample of maximum variation. Data were collected using repeated interviews and standardized scales. The study comprised three data collection periods.RESULTS: Motivation for change followed different processes depending on the level at entry to the study. The highly motivated patients improved in independence, the moderately motivated ones remained at an unchanged level and the less-motivated patients became more dependent. Central themes of importance to the process of motivation for change were: the utilization of professional networks (healthcare, regional social insurance office), emotional support (nuclear family, close relatives), use of personal coping resources (energy, positive beliefs, problem-solving) and social support at work (employers, colleagues).CONCLUSIONS: The performance of a structured motivation analysis, including questions about emotional networks and social support at work in addition to the clinical examination of the patient, is recommended. This might guide healthcare professionals when it comes to motivation for change in the patient

Work ability - experiences and perceptions among physicians.

Purpose. To describe experiences and perceptions of work ability and how it can be assessed among Swedish physicians. Method. We interviewed eight men and six women in the fields of general practice, occupational health, rehabilitation and orthopaedic surgery. Qualitative content analysis was applied to the data. Results. The approach striving to support the patient in mutual confidence was what primarily affected how work ability was understood and how it could be assessed. Two main categories, with sub categories were settled: familiar but vague, with subcategories conflicting expectations and relations and consensus within speciality and the second main category relying on intuition and examinations, with sub categories life as a whole, reasonableness, progression plan, external obstacles and need for knowledge and collaboration. Conclusions. We found that physicians mainly rely on what patients were telling about their work situation when assessing work ability. But it was not clear if they should consider the patient's whole life situation, motivation and wishes. Protecting the physician-patient relationship was seen as important as well as the need for teamwork assessments and increased work place knowledge

Work ability: Concept and assessment from a physiotherapeutic perspective. An interview study.

The aim of this study was to ascertain experiences and perceptions among physiotherapists (PTs) in Sweden regarding the concept of work ability as well as their perspectives of their professional role in work ability assessments. We conducted an in-depth interview study with four male and twelve female physiotherapists working in the field of occupational health care, orthopaedics, primary health care or rehabilitation. Qualitative content analysis was applied to the data. Work ability was perceived as the ability to perform work tasks as requested. Having the potential to adjust at work and to allocate resources, having an attachment to the workplace and time factors were vital. The physiotherapists were striving for a well-defined role within a multiprofessional team, where work ability assessments were performed in a real work environment. The PTs experienced contradictory roles in relation to the patient but believed they could contribute with valuable material for assessments; this professional help was not always requested. It was noted that there was a need for experience and further education to enable PTs to further engage in work ability assessments. It is important to improve collaboration and to further discuss the work ability concept from the viewpoints of different professionals