Naprapathic manual therapy and other factors of importance for the prognosis of neck and back ain

Introduction: Neck and back pain common health problems causing economic burden and individual suffering worldwide. Aim: The overall aim of this thesis was to increase understanding of naprapathic manual therapy and other factors of potential importance for the prognosis of back and neck pain. Specific aims: Study I: 1) to assess and compare the sex-specific recovery from spinal pain and psychological distress as single and comorbid conditions, 2) to describe the interrelationships between these conditions at baseline and at follow-up and 3) to explore whether spinal pain is a risk factor for onset of psychological distress and vice versa. Study II: to explore the role of the role of good sleep on the prognosis of non-specific neck and/or low back pain. Studies III and IV: to compare the occurrence and severity of adverse events (study III) and the treatment effect (study IV) of naprapathic manual therapy between different treatment technique combinations as part of naprapathic manual therapy. Methods: Study I: a cohort study based on The Stockholm Public Health Cohort including 23,794 participants. A random sample of the population in Stockholm was approached with postal questionnaires at baseline and at follow-up five years later. Study II: a cohort study that was a secondary analysis of data from a randomized controlled trial. Information was used from baseline and follow-up questionnaires at 12 and 52 weeks. Studies III and IV: a randomized controlled trial. Participants were recruited among patients, ages 18–65 years, seeking care for neck and/or back pain. Participants were randomly assigned to one of three treatment arms: 1) naprapathic manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage), 2) naprapathic manual therapy excluding spinal manipulation or 3) naprapathic manual therapy excluding stretching. Treatments were provided by students in the seventh semester of a total of eight. Results: Study I: comorbidity of spinal pain and psychological distress was twice as common among women as among men. Recovery was less likely with comorbidity than with single conditions of spinal pain or psychological distress. Overall, 24% of women and 17% of men with spinal pain without psychological distress at baseline had psychological distress at follow-up. The corresponding figures for spinal pain among participants with psychological distress without spinal pain at baseline were 24% and 20%. Spinal pain was a determinant of psychological distress and vice versa. Study II: patients with good sleep at baseline were more likely to experience a clinically important improvement in pain and pain-related disability compared to patients with impaired sleep at the 1-year follow-up. Study III: adverse events after combined manual therapy were common and mostly mild and transient. The most common adverse events were muscle soreness, increased pain and stiffness. No differences were found between the treatment arms. Women more often had short and long moderate adverse events compared to men. Study IV: There were no disparities between the treatment arms in clinically important improvement in pain or pain-related disability after 1 year of follow-up, in men or in women. Conclusion: Spinal pain with psychological distress is common, especially among women. Comorbidity of neck and/or back pain and psychological distress had a negative effect on the prognosis of these conditions. Good sleep had a positive effect on the prognosis of non-specific neck and/or back pain. Adverse events after manual therapy were common and transient. There were no differences in the occurrence of adverse events or in treatment effects when either spinal manipulation or stretching was excluded from the treatment arsenal of combined manual therapy for non-specific neck and/or back pain

Exploration of some personal factors with the International Classification of Functioning, Disability and Health Core Set for Stroke

Objective: The aim of this study was to explore the influence of personal factors (i.e. age, gender, place of residence and time since onset of stroke) on self-perceived functioning and environmental factors, using the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke (extended version) as a framework. Design: Cross-sectional study. Participants: A total of 243 community-dwelling persons (53% men) with prior stroke (6 months to 13 years) with a mean age of 68 years (age range 24-95 years). Methods: Regression analysis of 4 personal factors (age, gender, place of residence, and time since onset of stroke) was used to explore their influence on different components, domains and categories of functioning and environmental factors, evaluated with the extended version of the Comprehensive ICF Core Set for Stroke. Results: The personal factors had statistically significant predictive values for almost all the categories, domains and components of functioning and environmental factors examined in this study. These factors influence self-perceived functional outcome and environmental factors in terms of being barriers or facilitators in various ways. Conclusion: Personal factors, such as age, gender, place of residence and time since onset of stroke, influence self-perceived functioning and environmental factors.publishersversionPeer reviewe

Applying Comprehensive International Classification of Functioning Disability and Health

Abstract Stroke is the second most common cause of death worldwide and the most common cause of long-term disability in adults. Disability following stroke results from the interaction between persons with impairments and environmental barriers that hinder full participation in society. The International Classification of Functioning, Disability and Health (ICF) is intended to standardize the assessment of functioning of individuals in everyday life. To facilitate the use of the ICF in clinical practice purpose specific category-lists as Comprehensive ICF Core Sets for stroke were developed. The overall aim of this research project was to explore if the Comprehensive ICF Core Set for Stroke could serve as a basis for understanding the person with previous stroke perspective on functioning problems in daily activities. The face validity of the Comprehensive ICF Core Set for stroke was explored in study I and II by individual interviews in two different environments (in Sweden and in Finland). In study III the construct validity of the Comprehensive ICF Core Set for stroke was explored by the distribution of patient-reported item scores from the Stoke Impact Scale with respect to the ICF category scores linked to SIS items assessed by health-professionals. In study IV the influence of personal factors (PF) age, gender, place of residence and time since onset of stroke on self-perceived functioning was explored using the Comprehensive ICF Core Set for stroke as a framework. A total of 357 community-dwelling persons (45 % women) with previous stroke participated in studies I to IV. The face validity of the Comprehensive ICF Core Set for stroke was largely confirmed in study I and II. The construct validity of most of the ICF categories linked to SIS items was supported by the findings. The health professionals did not capture the magnitude of patient-reported emotional or social participation problems among the participants in study III. The selected personal factors had statistically significant predictive values for almost all the categories, domains and components of functioning and environmental factors examined. Conclusion: The results support the assumption that the categories included in the Comprehensive ICF Core Set for stroke represent the typical spectrum of functioning problems among people with previous stroke. In conclusion, the use of the Comprehensive ICF Core Set for stroke can provide a wider perspective of and a systematic coding system for understanding the needs of persons with previous stroke and has the potential to be used in the development of measures used in the assessment of stroke related functioning problems and stroke rehabilitation ultimately leading to better person centred care and outcomes. Keywords: Stroke, ICF, Core Set, person perspective, validation

Beauty and Social Media : Young women's perceptions of beauty ideals and cosmetic procedures, and their experience of social media's effect on these

Skönhetsideal och strävan efter dessa är inte ett nytt fenomen, utan har funnits i olika kulturer och samhällen genom tiderna. Däremot har vi idag nya metoder i form av skönhetsingrepp för att korrigera och uppnå det rådande idealet. Genom dagens sociala medier är det dessutom tillgängligare och lättare än någonsin att påverkas av både skönhetsideal och skönhetsingrepp. Syftet med denna studie var att undersöka unga kvinnors förhållningssätt till skönhetsideal och skönhetsingrepp, samt hur de upplevde att sociala medier påverkade dessa.  Detta gjordes genom åtta semistrukturerade intervjuer med kvinnor i åldrarna 18-29. Materialet analyserades genom en tematisk innehållsanalys som resulterade i temana (och kategorierna) Skönhetsideal (Naturlig skönhet, Idealkropp, Strävan, Skönhetsingrepp), Social påverkan (Trender och normer, Socialt sammanhang, Social feedback, Samhällets dubbelmoral) och Självbild (Införlivade ideal, Självkänsla, Medvetet undvikande). Resultatet visade att kvinnorna upplevde att deras syn på skönhetsideal och skönhetsingrepp utformas genom interaktion med individens sociala omgivning. Genom samhällets trender och normer, social kontext och social feedback uttrycktes, med olika grad av medvetenhet, internaliserade ideal som påverkade kvinnornas självbild och välmående. Beauty ideals and the aspiration to adhere to them is not a new phenomenon, but one that has existed in different cultures and societies throughout time. However, today we have cosmetic procedures as an increasingly accessible method to achieve the prevailing ideal. In addition, today it is more available and easier than ever to be exposed to beauty ideals and cosmetic procedures through social media. The purpose of this study was to explore how young women view beauty ideals and cosmetic procedures, and how they experience that social media affects these. This was done through eight semi-structured interviews with women of the ages 23-29. The material was analysed through a thematic analysis, which resulted in the themes Beauty Ideals (Natural Beauty, Ideal Body, Striving, Cosmetic Procedures), Social Influence (Trends and Norms, Social Context, Social Feedback, Society’s Double Standard) and Self Image (Internalised Ideals, Self-worth, Conscious Avoidance). The result showed that they experience their beauty ideals and opinions on cosmetic procedures as being created through the interaction with the social context of the individual. With different levels of awareness the women expressed their ideals as being internalised through society’s trends and norms, the social context and social feedback. These ideals affected their self image and well-being

Functioning and Disability in Community-Living People with Perceived Cognitive Impairment or Dementia: A Mixed Methods Study using the World Health Organization Disability Assessment Schedule

Objective: To explore how community-living people with perceived cognitive impairment or dementia and their next-of-kin perceive functioning and disability in major life domains. Methods: Individual interviews guided by the World Health Organization Disability Assessment Schedule (WHODAS 2.0) were conducted with 26 people with perceived cognitive impairment or dementia (age range 38–87 years) and 26 next-of-kin. Qualitative content analysis- and International Classification of Functioning, Disability, and Health (ICF) linking methods were used to analyse the transcripts. The perceived degree of disability in daily functioning was calculated and compared between people with perceived cognitive impairment or dementia and next-of-kin, using a Mann–Whitney U test. Results: A total of 38 of 47 (81%) established ICF categories corresponding to WHODAS items and 38 additional International Classification of Functioning, Disability, and Health (ICF) categories describing participants perceived cognitive and physical impairments, activity limitations and participation restrictions in interaction with the environmental factors were confirmed from the transcripts. The perceived disability of people with perceived cognitive impairment or dementia was scored higher by next-of-kin (48%) than by people with perceived cognitive impairment or dementia (16%, p < 0.0001). Conclusion: Interviews provided a comprehensive picture of participants’ perceived activity limitations and participation restrictions in the life domains cognition, mobility, self-care, getting along, life activities, and participation. For a better understanding of the impact of cognitive impairment on people’s daily lives, inclusion of the perspective of the next-of-kin and the factors that hinder or facilitate daily living in the community setting is necessary. LAY ABSTRACT Dementia is one of the leading causes of disability in Sweden, and most of the people with dementia and those with perceived cognitive impairment, i.e. persons not diagnosed with dementia, live at home. A comprehensive understanding of their needs is required in order to develop dementia care in the community. The aim of this study was to explore what kind of difficulties community-living people with perceived cognitive impairment or dementia and their next-of-kin perceive in their daily lives. Twenty-six people with perceived cognitive impairment or dementia and their next-of-kin were interviewed in their homes, and the perceived degree of difficulties was compared between the 2 groups. The interviews provided a broad picture of how people with perceived cognitive impairment or dementia and nextof-kin perceive difficulties in their daily lives. The nextof-kin perceived the difficulties as greater than did the persons with dementia. For a better understanding of the impact of dementia on people’s daily lives, inclusion of the perspective of the next-of-kin and the factors that hinder or facilitate daily living in the community setting are necessary