Rehabilitation for Multiple Sclerosis in Adults (I); Impairment and Impact on Functioning and Quality of Life: An Overview

Multiple sclerosis (MS) is a chronic, central nervous system, disabling disease. International Classification of Functioning and relevant generic and specific outcome measures are reported. Problems perceived by people with MS (PwMS) affect mobility, sight, continence, feeding, or cognitive impairment, depending on whether acute, chronic, or long-term disability was involved. The most common body function and structure impairments leading to disability and reported by health care professionals are fatigue, weakness, decreased fitness, sensory disorders, pain, upper motor neuron syndromes, ataxia and tremor, balance and postural control problems, gait pattern disorders, visual problems, and neurogenic lower urinary tract and bowel dysfunction; sexual, autonomic, neuropsychological, and neuropsychiatric impairment; dysarthrophonia, dysphagia, and respiratory and sleep disorders. The most frequently affected activities and relationships include mobility, domestic life, community and social activities, remunerative employment, interpersonal relationships, self-care, learning and applying knowledge, and economic life. Limitations in activities of daily life because of fatigue, pain, visual problems, incontinence, sexual and cognitive impairment, depressive disorders, sleep disorders, economic pressure, employment status, and lack of information have an impact on quality of life (QoL). Increased caregiving tasks, psychological burden, limitation in activities and participation, and reduced QoL have a profound influence on caregivers. This paper summarizes the perception of problems and needs, the disease's impact on functioning and QoL of PwMS, and the impact on their significant others and caregivers, according to health and social research.Martinez-Assucena, A.; Marnetoft, S.; Roig Rovira, T.; Hernandez-San-Miguel, J.; Bernabeu, M.; Martinell-Gispert-Sauch, M. (2010). Rehabilitation for Multiple Sclerosis in Adults (I); Impairment and Impact on Functioning and Quality of Life: An Overview. Critical Reviews in Physical and Rehabilitation Medicine. 22(1-4):103-178. doi:10.1615/CritRevPhysRehabilMed.v22.i1-4.90103178221-

Rehabilitation for Multiple Sclerosis, in Adults (II); Management and Impact on Impairment, Functioning, and Quality of Life: An Overview

Multiple sclerosis (MS) often leads to different levels of severity and progression of impairment and disability and to dissimilar levels of limitation in activities and participation in different social domains, with varying impacts on quality of life (QoL) among people with MS (PwMS). Results have shown that, for PwMS, prioritizing goal setting may enhance adherence to treatment. Interdisciplinary rehabilitation may prolong the functional status level of PwMS, may result in transient improvement in the aspects of impairment features, may increase their participation in activities, and may improve their QoL, even when disease progression is not modified. Single rehabilitation packages of comprehensive care have proven beneficial, such as physiotherapy, which enhances aerobic capacity, strength, pain, mood, mobility, and QoL. Occupational therapy can help reduce the impact of impairment on QoL, especially fatigue. Neuropsychological interventions, such as learning and memory remediation, psychological intervention for depressive disorders, and acquistion of coping skills and self-management techniques help PwMS to adjust to disease and disability. Speech therapy can improve intelligibility of communication. Learning swallowing techniques can help prevent material from entering the airway. Clean intermittent self-catheterization can help prevent urinary tract infections. Power wheelchairs enhance occupational performance and energy conservation. Further vocational rehabilitation settings and research are required for more appropriate interventions due to high unemployment rates among PwMS. Comprehensive care for PwMS should include planning for future independent living and long-term care needs.Martinez-Assucena, A.; Marnetoft, S.; Roig Rovira, T.; Hernandez-San-Miguel, J.; Bernabeu, M.; Martinell-Gispert-Sauch, M. (2010). Rehabilitation for Multiple Sclerosis, in Adults (II); Management and Impact on Impairment, Functioning, and Quality of Life: An Overview. 22(1-4):179-239. doi:10.1615/CritRevPhysRehabilMed.v22.i1-4.100179239221-

A Conceptual Definition of Vocational Rehabilitation Based on the ICF: Building a Shared Global Model

Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participatio

Vocational rehabilitation of unemployed sick-listed people in a Swedish rural area : an individual-level study based on social insurance data

The long trend of low unemployment and increasing economical growth in Sweden was broken in the early 1990 s. In a short time the rate of unemployment had risen from 1.3% in 1990 to 8.2% in 1993. A previous study made in Stockholm showed that among the long-term sick-listed 20% were unemployed. The sparsely populated areas in the furthermost northern counties of Sweden have had a high rate of unemployment and incapacity rates (sick days per insured and year) during many years. The primary aim of this study was therefore to investigate the unemployed long-term sick-listed and their vocational rehabilitation in a rural area of the county of Jämtland, Sweden. The study is based on a sample of 4 394 long-term sick-leave cases reported sick at all seven rural social insurance offices in Jämtland. Surprisingly, the study showed that the proportion of unemployed among the long-term sick-listed was lower in the rural area of Jämtland (15%) than in Stockholm (20%). However, as in Stockholm, the unemployed were over-represented among the long-term sick. This was especially true for men. Mental problems were more frequent among the unemployed (16%), than among the employed (6%), especially among the men. Unemployed people s potential need for rehabilitation was not investigated to the same extent (15%) as employed people s (37%). The unemployed had also to wait longer for a rehabilitation investigation to be drawn up by the social insurance office (168 days) compared with the employed (78 days). The study partly supports the hypothesis that the unemployed people are disregarded in vocational rehabilitation. A more important finding, however, was that vocational rehabilitation in general, regardless of employment status, seems beset with problems. Neither employers nor the social insurance offices seem to live up to the responsibilities that was given them according to the Rehabilitation Reform of 1992. For both employed and unemployed long-term sick-listed people with musculoskeletal problems, the time before start of vocational rehabilitation does not seem to be the determining factor that it so often is stated. However, when investigating all types of diagnoses the time before start of vocational rehabilitation does seem to be important. The results indicated that women had less chance than men in succeeding with their vocational rehabilitation. Women obtain more on-the-job training while men undergo vocational programmes containing education. Education has been shown to be an effective measure for successful vocational rehabilitation, so therefore it may be concluded that women are more or less unfairly treated with regards to vocational rehabilitation. The study also showed that an unemployed sick-listed person has much less chance of returning to the Labour Market after rehabilitation than an employed person. The short, limited and low-cost vocational rehabilitation that the unemployed are offered may not be adequate to sufficiently affect future sick-leave. They may need more individually adjusted measures. A multidisciplinary vocational rehabilitation programme, with work training and case management was shown, twelve months after the end of the programme, to be more effective regarding lowered benefit levels for unemployed sick-listed people, than a conventional rehabilitation programme

Students views on their upper secondary school choice : an educational sociological study of two upper secondary school programs

Denna kvalitativa utbildningssociologiska studie ämnar till att skapa en inblick i likheter eller olikheter i aspekter som ligger bakom elevens val av gymnasieprogram, utifrån elevernas egna berättelser om framtid och inställning till vidare studier på Högskola eller Universitet. Genom kvalitativa intervjuer som spelades in i en urvalsgrupp om fem stycken elever på varje program i det tredje och sista året på gymnasiet visar studien bland annat på att elever som valt att studera på det Naturvetenskapliga programmet motiverar sitt gymnasieval utifrån att de vill läsa ett program som underlättar för vidarestudier direkt efter studenten, medan elever på Barn- och fritidsprogrammet motiverar sitt val med att de bland annat vill skapa sig en yrkesidentitet efter studenten och att de vill ha mycket praktik, kul och roligt under studietiden. Gymnasievalet tyder på en medvetenhet hos samtliga elever utifrån varje elevs förutsättningar och utbildningskapital från tidigare studier. Nio av tio elever totalt ger uttryck för att de någon gång i framtiden kommer att studera vidare på Högskola eller Universitet. Elever från det Naturvetenskapliga programmet kommer från mer studievana hem där minst en av föräldrarna har en examen från Högskola eller Universitet. Synen på pengar och karriär skiljer sig mellan programmen då detta är av mer relevans hos eleverna på det Naturvetenskapliga programmet än hos eleverna på Barn- och fritidsprogrammet

The number of door openings during surgery and its causes - An observational study

Bakgrund: Studier har visat att dörröppningar samt rörelse av personal inne på operationssalen ökar mängden bakterier i luften. Vårdrelaterade infektioner är den mest förekommande komplikationen vid kirurgi och skapar onödigt lidande för patienten. Infektionsförebyggande åtgärder såsom ventilation i operationssalen har betydelse för att minska risken för att bakteriebärande partiklar ska kontaminera luften i operationssalen och åstadkomma infektion i operationssåret. Syfte: Syftet med denna observationsstudie var att studera hur frekvent dörrarna öppnades under pågående operation samt identifiera orsakerna till dörröppningarna. Metod: Data från observationer av 27 operationer har sammanställts och analyserats. Resultat: Totalt 216 dörröppningar har observerats under 1959 minuter. Största orsaken till dörröppningar kunde härledas till raster, 44,9 % (n= 97). Näst vanligaste orsaken föll inom kategorin övrigt 19,9 % (n= 43), tätt följt av transport/hämtnig av utrustning/material 19,4 % (n= 42). Vid en jämförelse av antal dörröppningar mellan kirurgklinikens operationer med ett medelvärde på 10,2/timme samt ortopedklinikens operationer med ett medelvärde på 3,04/timme förelåg en statistiskt säkerställd skillnad, p-värde 0,000. Diskussion: Stor skillnad fanns mellan klinikerna angående antal dörröppningar.  I vår studie var det övergripande medelvärdet för antalet dörröppningar lägre än vad som observerats i nationell och internationell forskning. För att hålla antalet dörröppningar så låga som möjligt bör personalen påminnas om betydelsen för dess inverkan på infektion. Slutsats: Trots att antalet dörröppningar var lägre än vid tidigare forskning så finns det goda möjligheter till att minska antalet, speciellt då största orsaken till öppningar var raster. Raster är en arbetsrättslig rättighet men planering, riktlinjer och rutiner bör förbättras för att ytterligare minska antalet dörröppningar.Background: Nosocomial infections are the most common complication of surgery and create unnecessary suffering for the patient. Infection prevention measures such as ventilation in the operating room has been instrumental in reducing the risk of bacteria-carrying particles to contaminate the air in the operating room and produce infection in the surgical wound. Studies have shown that the door openings and movement of personnel in the operating room gives a higher number of bacteria in the air. Aim: The purpose of this observational study was to investigate how frequent the door is opened during operation, and identify the causes of the openings. Method: Data from observations of 27 operations have been compiled and analyzed. Results: A total of 216 door openings have been observed in 1959 minutes. Biggest cause of doorways could be traced to breaks, 44.9% (n = 97). The second most common reason fell within the category other 19.9% ​​(n = 43), followed closely by transportation / retrieval of equipment / materials 19.4% (n = 42). At a steady implementation agreement of the number of doorways between surgeon clinic operations with a mean of 10.2 / h and the orthopedic surgery with a mean of 3.04, there was a statistically significant difference, p-value 0.000. Discussion: Significant differences existed between clinics regarding number of door opening. In our study, the overall mean number of openings were lower than they observed in national and international research. To keep the number of openings as limited as possible, the staff should be reminded of the significance of its effect on infection. Conclusion: Although the number of door openings were lower than in previous research, there is a good opportunity to reduce the number, especially when major cause openings were breaks. Breaks is a labor-law rights but planning, policies and procedures should be improved to further reduce the number of door openings

To return or not return? Predictive factors for return to work in persons with musculoskeletal disorders – prospective studies over a 10-year period

Background: Musculoskeletal disorders (MSD) are a major reason for sick leave and results in individual suffering as well as economical consequences for both the individual and society. It is important to study variables from a multidimensional perspective to predict sustainable return to work (RTW). The overall aim was to identify multidimensional predictors and psychosocial characteristics for RTW in persons with musculoskeletal disorders (MSD), over a 10-year period. Study I: Aim: To identify predictive factors for RTW in patients with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=377), were divided into two groups due to sickness certification one year after rehabilitation. The groups were compared with each other regarding predictive factors for RTW using logistic regression analysis. Result: Predictive factors for RTW were gender, age, education, number of sick-listed days before rehabilitation, physical capacity, self-rated pain, self-rated functional capacity and self-rated Quality of Life (QoL). Implication: Identifying predictors for RTW is an essential task for designing a suitable individual rehabilitation. Study II: Aim: To identify multidimensional predictive factors for sustainable RTW in a long-term follow-up study of persons with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=183) were divided into “working full-time” and “sick-listed” groups five and ten years after a rehabilitation program. The groups were compared with each other regarding predictive factors for RTW using stepwise logistic regression. Result: Long-term predictive factors were number of sick-listed days before rehabilitation, age, self-rated pain, life events, gender, physical capacity, self-rated functional capacity, educational level, and light physical labour. Implication: Sustained RTW can be facilitated by early planning of the sick leave period using instruments that take these predictors into account. Study III: Aim: To describe thoughts and feelings of future working life related to RTW in persons who are sick-listed due to MSD and to compare these descriptions with the person’s actual working situation to create predictors for RTW. Design: Prospective and explorative. Method: Persons aged 18-65 years (n=320) answered an open-ended question about thoughts and feelings of their future working life before participating in a rehabilitation program. The answers were analysed using qualitative content analysis. The emerging categories were compared with the persons working situation one, five and ten years after the rehabilitation program using Pearson’s chi-squared test. Result: Three categories; “motivation and optimism”, “limitations to overcome” and “hindrance and hesitation”, and nine subcategories, were defined. Persons in the subcategories driving force, new possibilities and demand another job had changed job. Those in the reduced work-time subcategory were working part-time after a five-year period. Implication: Persons with a motivation for RTW and those expressing some kind of hindrance should have different types of support. Study IV: Aim: To compare psychosocial factors between healthy and sick-listed persons, both groups with MSD ten years ago. Design: Prospective. Method: Ten years after a rehabilitation program persons aged 18-65 years (n=183) were divided into a healthy group and a sick-listed group. The groups were compared with each other in regards to psychosocial factors using logistic regression analysis and Pearson’s chi-squared test. Result: The healthy group had a higher QoL, more control over the working situation, better sense of coherence (SOC) and more life events. Implication: Using the knowledge about the characteristics of the healthy group, adequate rehabilitation can be given. General conclusion and implications: The focus of this thesis has been on healthy factors for RTW in line with the salutogenic theory. When predicting RTW for persons with MSD we must have a multidimensional perspective and physical, psychosocial and occupational factors must be considered. The instruments in this thesis can be used to predict RTW. Taking all dimensions and all predictive factors into account, sick leave can be reduced by directing the person to the correct amount rehabilitation, not more and not less. Keywords: Certified sick leave, functional capacity, job strain, motivation, musculoskeletal disorders, pain, physical capacity, qualitative content analysis, quality of life, return to work, sense of coherence, working life ISBN 978-91-628-8061-3 Abstract To return or not return? Predictive factors for return to work in persons with musculoskeletal disorders - prospective factors over a 10-year period Marie Lydell, Sahlgrenska School of Public Health and Community Medicine, Department of Primary Health Care, University of Gothenburg. Background: Musculoskeletal disorders (MSD) are a major reason for sick leave and results in individual suffering as well as economical consequences for both the individual and society. It is important to study variables from a multidimensional perspective to predict sustainable return to work (RTW). The overall aim was to identify multidimensional predictors and psychosocial characteristics for RTW in persons with musculoskeletal disorders (MSD), over a 10-year period. Study I: Aim: To identify predictive factors for RTW in patients with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=377), were divided into two groups due to sickness certification one year after rehabilitation. The groups were compared with each other regarding predictive factors for RTW using logistic regression analysis. Result: Predictive factors for RTW were gender, age, education, number of sick-listed days before rehabilitation, physical capacity, self-rated pain, self-rated functional capacity and self-rated Quality of Life (QoL). Implication: Identifying predictors for RTW is an essential task for designing a suitable individual rehabilitation. Study II: Aim: To identify multidimensional predictive factors for sustainable RTW in a long-term follow-up study of persons with MSD. Design: Prospective. Method: Persons aged 18-65 years (n=183) were divided into “working full-time” and “sick-listed” groups five and ten years after a rehabilitation program. The groups were compared with each other regarding predictive factors for RTW using stepwise logistic regression. Result: Long-term predictive factors were number of sick-listed days before rehabilitation, age, self-rated pain, life events, gender, physical capacity, self-rated functional capacity, educational level, and light physical labour. Implication: Sustained RTW can be facilitated by early planning of the sick leave period using instruments that take these predictors into account. Study III: Aim: To describe thoughts and feelings of future working life related to RTW in persons who are sick-listed due to MSD and to compare these descriptions with the person’s actual working situation to create predictors for RTW. Design: Prospective and explorative. Method: Persons aged 18-65 years (n=320) answered an open-ended question about thoughts and feelings of their future working life before participating in a rehabilitation program. The answers were analysed using qualitative content analysis. The emerging categories were compared with the persons working situation one, five and ten years after the rehabilitation program using Pearson’s chi-squared test. Result: Three categories; “motivation and optimism”, “limitations to overcome” and “hindrance and hesitation”, and nine subcategories, were defined. Persons in the subcategories driving force, new possibilities and demand another job had changed job. Those in the reduced work-time subcategory were working part-time after a five-year period. Implication: Persons with a motivation for RTW and those expressing some kind of hindrance should have different types of support. Study IV: Aim: To compare psychosocial factors between healthy and sick-listed persons, both groups with MSD ten years ago. Design: Prospective. Method: Ten years after a rehabilitation program persons aged 18-65 years (n=183) were divided into a healthy group and a sick-listed group. The groups were compared with each other in regards to psychosocial factors using logistic regression analysis and Pearson’s chi-squared test. Result: The healthy group had a higher QoL, more control over the working situation, better sense of coherence (SOC) and more life events. Implication: Using the knowledge about the characteristics of the healthy group, adequate rehabilitation can be given. General conclusion and implications: The focus of this thesis has been on healthy factors for RTW in line with the salutogenic theory. When predicting RTW for persons with MSD we must have a multidimensional perspective and physical, psychosocial and occupational factors must be considered. The instruments in this thesis can be used to predict RTW. Taking all dimensions and all predictive factors into account, sick leave can be reduced by directing the person to the correct amount rehabilitation, not more and not less. Keywords: Certified sick leave, functional capacity, job strain, motivation, musculoskeletal disorders, pain, physical capacity, qualitative content analysis, quality of life, return to work, sense of coherence, working life ISBN 978-91-628-8061-

A conceptual definition of vocational rehabilitation based on the ICF: building a shared global model

Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participation