Demand, Control and Support at Work Among Sick-Listed Patients with Neck or Back Pain: A Prospective Study

Purpose The main aim of this study was to assess changes in perceived demand, control and support at work of neck and back pain patients over 1 year. We also hypothesised that perceived changes in demand, control and support at work were associated with clinical improvement, reduced fear-avoidance beliefs and successful return to work. Methods Four hundred and five sick-listed patients referred to secondary care with neck or back pain were originally included in an interventional study. Of these, two hundred and twenty-six patients reported perceived psychosocial work factors at both baseline and 1-year follow-up, and they were later included in this prospective study. Changes in demand, control and support dimensions were measured by a total of nine variables. Results At the group level, no significant differences were found among the measured subscales. At the individual level, the regression analyses showed that decreases in fear-avoidance beliefs about work were consistently related to decreases in demand and increases in control, whereas decreases in disability, anxiety and depression were related to increases in support subscales. Conclusions The perception of demand, control and support appear to be stable over 1 year in patients with neck and back pain, despite marked improvement in pain and disability. Disability, anxiety, depression and fear-avoidance beliefs about work were significantly associated with the perception of the work environment, whereas neck and back pain were not. The published version is available at link.springer.co

Change in pain, disability and influence of fear-avoidance in a work-focused intervention on neck and back pain: a randomized controlled trial

Background Neck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important. Reduction of fear avoidance might be one mechanism behind improvement after interventions. The aim of the present study was to evaluate changes in pain and disability at the 12-month follow-up of patients with neck and back pain treated with a work-focused intervention compared to patients treated with standard interventions, and the influence of improvement fear avoidance beliefs during the interventions on pain, disability and return to work at 12-month follow-up. Methods 413 employed patients with back or neck pain referred to secondary care, and sick-listed between 4 weeks and 12 months, were randomized to a work-focused rehabilitation or control interventions. Follow-up was conducted 4 and 12 months after inclusion. The groups were compared (independent sample t-test) regarding differences in disability scores (Oswestry disability index/neck disability index) and pain (numeric rating scale) from baseline to 12-month follow-up. Changes in fear avoidance beliefs (FABQ) from baseline to 4 month follow-up were calculated, and the association between this change and return to work, pain and disability at 12 months were tested in stepwise multiple logistic regression models. Results Pain and, disability scores decreased to in both the work-focused and control intervention to 12-month follow-up, and there were no significant differences between the groups. FABQ decreased similarly in both groups to 4 month follow-up. The logistic regression model revealed an association between a reduced FABQ work score at 4 months and return to work within one year (adjusted OR 3.60, 95% CI 1.19 to 10.88). Reduced FABQ physical activity score at 4 months was associated with decreased disability after 12 months (adjusted OR (3.65. 95% CI 1.43 to 9.28). Conclusions Short work-focused rehabilitation had the same effect on pain and disability as control interventions. Reduction in FABQ-W score after treatment seems to be an important predictor for return to work in both groups

Perceived psychosocial work environment and effects of a work-focused intervention among patients with neck and back pain

A growing number of studies have focused on the return to work (RTW) processes associated with patients with back pain. Many studies have combined a workplace focus with multidisciplinary treatments; however, this focus has not been evaluated in Norway among patients with neck and back pain thus far. Several factors, including psychosocial factors at work as well as fear–avoidance beliefs (FAB), may influence the sick leave in these patients. The main aim of this study was to evaluate the perceived psychosocial work environment among sick-listed patients with neck or back pain and the effect of interventions with respect to sickness absence. The present multicentre randomised trial demonstrated that a work-focused intervention in secondary care added no supplementary effects compared to a control intervention with regard to the RTW rate or the proportion of patients who had achieved RTW during the first 12 months. In addition, the perceived psychosocial work factors were strongly associated with FAB about work in the current patient sample. However, the average perceived demand, control and support were quite similar to that of reference worker populations, except for a significantly increased demand for physical endurance. Furthermore, the overall perception of demand, control and support was fairly stable over one year, despite marked improvements in pain and disability. The evaluation of the measurement properties of the applied questionnaire, the Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic), showed that the demand, control and support domains of the QPS Nordic comprised unidimensional constructs with good targeting to the present patients problems regarding work demands. The lower resolution of the scaling of the items may have implications for the responsiveness of the QPS Nordic

Informasjon, isolasjon og desinfeksjon : kan nedgangen i barnedødelighet i Kristiansand og Vennesla rundt år 1900 forklares med tiltak satt i verk av de lokale sunnhetskommisjonene?

Masteroppgave i historie- Universitetet i Agder 201

Fear–avoidance beliefs associated with perceived psychological and social factors at work among patients with neck and back pain: a cross-sectional multicentre study

Background Neck and back pain are common and often account for absenteeism at work. Factors at work as well as fear–avoidance beliefs may influence sick-leave in these patients. The aims of this study were to assess: (1) how sick-listed patients in specialised care perceive demand, control, support, effort, reward, and overcommitment at work compared to a general reference group of workers; (2) if women and men report demand, control, support, effort, reward, and overcommitment differently; and (3) the association between psychological and social factors at work and fear–avoidance beliefs about work. Methods A cross-sectional multicentre study was carried out in 373 patients on sick leave due to neck and back pain. Psychosocial work factors were measured by demand, control, and support, (Nordic Questionnaire for Psychological and Social Factors at Work), and effort, reward and overcommitment (Effort Reward Imbalance Questionnaire). Fear avoidance beliefs about work were measured by the Fear–Avoidance Belief Questionnaire Work subscale (FABQ-W). Results Although the patients differed significantly from a reference working group regarding several subscales of demand, control, support, effort, reward, and overcommitment, the magnitude of these differences were small. The study population also reported significantly higher scores for ‘demand for physical endurance’ than the reference population, and Cohen’s d = 0.55 here indicated a medium degree of difference. Female patients reported significantly higher on support, whereas male patients reported significantly higher demand for physical endurance, quantitative demand, effort, and overcommitment. Demand for physical endurance, job control, job support, high reward, and overcommitment were significantly associated with FABQ-W. Conclusions Perceived psychological and social factors at work were strongly associated with fear–avoidance beliefs about work in sick-listed neck and back patients. The demand for physical endurance, control, support, high reward, as well as overcommittment at work outweighed pain and added to the burden of emotional distress and disability regarding fear–avoidance beliefs

Redusert bruk av antibiotika gjennom vent og se-resept ved akutt otitis media hos barn i allmennpraksis

Sammendrag Bakgrunn: Akutt otitis media (mellomørebetennelse) er en svært vanlig diagnose som sjelden krever antibiotikabehandling. Likevel har flere gruppemedlemmer observert liberal antibiotikaforskriving ved denne tilstanden i allmennpraksis. Ettersom uhensiktsmessig antibiotikabruk øker både resistensutvikling og risikoen for bivirkninger ønsker vi å redusere bruken av antibiotika ved akutt otitis media hos barn ved et allmennlegekontor i Larvik. Kunnskapsgrunnlag: Vi gjorde et systematisk litteratursøk for å finne evidensen for behandling av akutt otitis media. Etter en gjennomgang av litteraturen kunne vi konkludere med at enkelte høyrisiko grupper har nytte av antibiotika, mens majoriteten har liten eller ingen nytte. Tiltak,kvalitetsindikator og metode: Det er evidens for at vent og se-resept reduserer bruken av antibiotika ved øvre luftveisinfeksjoner. Videre har pop-up vist seg å ha en gunstig påminnelseseffekt. Med bakgrunn i dette valgte vi å innføre tre tiltak: Pop-up (melding i WinMed) hver gang en skriver ut et fenoksymetylpenicillin: ”Vurdert vent og se-resept?”, informasjonsskriv til foreldre om både vent og se-resept og akutt otitis media, samt en plakat på legekontorets venteværelse med informasjon om sykdommen og dets naturlig forløp samt bruk av vent og se-resept. For å vurdere effekten av disse tiltakene har vi valgt følgende prosessindikatorer: 1. Andel forskrevne vent og se-resepter 2. Andel innløste vent og se-resepter Vurdering: Etter en systematisk gjennomgang av litteraturen, kartlegging av den aktuelle allmennpraksisen, samt en vurdering av fordeler og ulemper ved tiltakene konkluderer vi med at prosjektet er både faglig godt begrunnet, og praktisk gjennomførbart

The Fear Avoidance Beliefs Questionnaire (FABQ) Does it really measure fear beliefs?

Study Design. A cohort study with 12 months of follow-up. Objective. To assess (1) the unidimensionality of the Fear-Avoidance Beliefs Questionnaire (FABQ) and (2) whether single questions in the FABQ predict future sickness absence as well as the whole scale. Summary of Background Data. The fear-avoidance model is a leading model in describing the link between musculoskeletal pain and chronic disability. However, reported measurement properties have been inconsistent regarding the FABQ. Methods. Individuals (n = 722) sick listed due to musculoskeletal, unspecified or common mental health disorders undergoing rehabilitation was included. A Rasch analysis was applied to evaluate the measurement properties of FABQ and its two subscales (physical activity and work). Linear regression was used to assess how well single items predicted future sickness absence. Results. The Rasch analysis did not support the FABQ or its two subscales representing a unidimensional construct. The 7-point scoring of the items was far too fine meshed and in the present population the data only supported a yes or no or a 3-point response option. The items were invariant to age, whereas two of the items revealed sex differences. The item “I do not think that I will be back to my normal work within 3 months” was the best predictor of future sickness absence. Adding the item “I should not do my regular work with my present pain” improved the prediction model slightly. Conclusion. The FABQ is not a good measure of fear-avoidance beliefs about work or physical activity, and the predictive property of the FABQ questionnaire is most likely related to expectations rather than fear. Based on these results we do not recommend using the FABQ to measure fear-avoidance beliefs

eRegistries: Electronic registries for maternal and child health

The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women's, Children's and Adolescent's Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health