Самостоятельная работа студента с периодической прессой – метод и источник получения инновационных знаний

Материалы учебн.-метод. конф., Гомель, 9-10 апр. 2009 г

Rehabilitation for patients with burnout

Stress-related diseases and burnout have increased in Sweden during the last decades. In 2006, the most common diagnoses for new cases of sickness compensation were mental and behavioural disorders in both women and men. In spite of the large group of people seeking care for and on long-term sickness absence due to stress-related diseases and burnout, there is no agreement on which treatment they should be offered. The overall aim of this thesis was to describe patients on longterm sick leave because of burnout and to evaluate rehabilitation programs for this patient group. Two patient samples were recruited from the Stress Clinic at the University Hospital in Umeå, Sweden: REST (Rehabilitation for stressrelated disease and burnout; n=136) and QIST (Qigong for stress-related disease and burnout; n=82). A general population sample was from the 2004 Northern Sweden MONICA survey (n=573). Patients in REST were randomised into a 1-year rehabilitation program to either program A (Cognitively-oriented Behavioural Rehabilitation (CBR) and Qigong), or to program B (Qigong alone). In Paper I, baseline data were compared with data from the MONICA sample. In paper II, programs A and B were compared regarding effects on psychological variables and sick leave rates, and in Paper III, 18 patients from program A and B were interviewed to explore subjective experiences of the rehabilitation programs. Patients in QIST were allocated to an intervention with Qigong twice a week for 12 weeks or a control group. Psychological and physical measurements were assessed in QIST. Data were collected by questionnaires, physical measurements, the register on sick leave, and interviews. Patients with burnout reported a more restricted social network and higher work demands than the general population. In relation to women from a general population, women with burnout more often worked “with people”, reported high job strain, a more sedentary work situation and less emotional support. A per-protocol analysis showed no significant differences in treatment effect between program A and B in REST or between the intervention and control group in QIST. All groups improved significantly over time with reduced levels of burnout, anxiety, depression, and fatigue. In REST, lower scores on obsessive-compulsive symptoms, stress behaviour, and sick leave rates were found in both programs and in QIST both groups increased dynamic balance and physical capacity. In an intention-to-treat analysis, patients in program A in REST had significantly fewer obsessive-compulsive symptoms, and larger effect sizes in stress behaviour and obsessive-compulsive symptoms compared to patients in program B. Patients in both REST programs perceived that the 1-year rehabilitation program gave them specific tools to use in secondary prevention. They also emphasised that the good encounters, affirmation and group cohesiveness they perceived during the 8 rehabilitation was a necessary basis for initiation of a behavioural change leading to recovery. In conclusion, compared to a general population, patients with burnout perceived more demands at work and less social support. Lack of emotional support seemed to be more associated with burnout among women. There were no differences in effect between CBR and Qigong compared to Qigong alone, or between a 12 week Qigong intervention compared to a control condition. Improvements were found in all groups in the rehabilitation programs. CBR combined with Qigong have some advantages compared to Qigong alone. An environment with good encounters and affirmation of the patients was experiences as important by the patients and group rehabilitation had advantages as recognition and support from the group. Early rehabilitation measures are important to prevent long-term sickness absence. In future rehabilitation programs it might be necessary to have a more individualized approach and choose treatments preferred by the patient

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Effects of rehabilitation programmes for patients on long-term sick leave for burnout : A 3-year follow-up of the REST study.

Objective: To evaluate the long-term effects of two different rehabilitation programmes for patients on long-term sick leave for burnout. Design: Three-year follow-up of a randomized controlled trial with two 1-year group programmes: (A) cognitively oriented behavioural rehabilitation in combination with Qigong; and (B) Qigong alone. Patients: A total of 107 patients with burnout (78 women and 29 men), who all completed the 1-year rehabilitation programme per-protocol, were asked to participate in the follow-up. Methods: At the 3-year follow-up, data on psychological measures, sick leave and use of medication were compared between the programmes. Results: Patients in programme A reported being significantly more recovered from their burnout (p = 0.02), reported lower levels of burnout (p = 0.035), used more cognitive tools learned from the programme (p < 0.001), and had reduced their use of medication for depression (p = 0.002). No significant differences were found between the groups in terms of sick leave rates; both groups had improved. Conclusion: A multimodal rehabilitation including cognitively oriented behavioural rehabilitation and Qigong showed positive effects 3 years after the end of intervention. The results indicate that, for many burnout patients on sick-leave, it takes time to implement cognitive tools and to establish new behaviours

Take charge : Patients' experiences during participation in a rehabilitation programme for burnout

Objective: The aim of this study was to explore the experiences of patients with burnout during a rehabilitation programme. Patients and methods: Eighteen patients with burnout were interviewed at the end of a one-year rehabilitation programme. The programme consisted of 2 groups, one with a focus on cognitively-oriented behavioural rehabilitation and Qigong and 1 with a focus on Qigong alone. The interviews were analysed using the grounded theory method. Results: One core category, Take Charge, and 6 categories emerged. The core category represents a beneficial recovery process that helped the patients to take control of their lives. The common starting point for the process is presented in the 3 categories of Good encounters, Affirmation and Group cohesiveness. The categories were basic conditions for continuing development during rehabilitation. In the categories Get to know myself, How can I be the one I want to be? and Choice of track, the more group-specific tools are included, through which the patients adopted a new way of behaving. Conclusion: Patients in both groups experienced group participation as being beneficial for recovery and regaining control of their lives, although in somewhat different way. An experience of affirmation and support from health professionals and group participants is of importance for behavioural chang

Implementing a Physical Activity promoting program in a flex-office : A Process Evaluation with a Mixed Methods Design

The aim of this study was to investigate facilitating and hindering factors when implementing a physical activity (PA)-promoting program among office workers moving to a flex office, by conducting a process evaluation. Additionally, we evaluated self-reported and perceived PA behaviors. With a mixed methods design, analyses were based upon data from interviews with 70 employees and repeated questionnaires from 152 employees. The PA-promoting program was fully implemented and supported by management. There was a strong health promoting culture, encouraging PA in the organization already at the start of the study. The lecture and the office design were rated as the most motivating program components. The use of stairs, breaks during meetings and social acceptance for standing and walking at work increased. Employees described a strive for variation, and how managers, the office environment, productivity and ergonomic aspects influenced sedentary behavior (SB) and PA. The need for the PA-promoting program was questioned, and the timing of the program was debated. To conclude, a strong organizational health culture combined with a facilitating physical environment can create sustainable positive PA behaviors in office settings. A thorough understanding of organizational needs and a participatory process are needed to tailor organizational interventions to decrease SB.Originally included in thesis in manuscript form.</p

“Nature's effect on my mind” : patients’ qualitative experiences of a forest-based rehabilitation programme

Aim: The aim of this study was to investigate the personal experiences and perceived effects on mind from visits to forest environments in a subset of patients with severe exhaustion disorder (ED), who participated in a randomized controlled trial for evaluation of forest-based rehabilitation. Participants: A subsample of 19 patients with diagnosed ED, who completed the three-month forest-based rehabilitation programme in the ForRest project, was interviewed. Method: The forest-based rehabilitation consisted of repeated forest visits with the main objective of spending time in rest and solitude in a chosen forest setting. Semi-structured interviews were carried out and analysed using Grounded Theory. Result: A core category and five subcategories were set up to describe the patients’ experiences and development during the forest-based rehabilitation. As patients mostly reported that they strove to achieve peace of mind during the forest visits, Striving for serenity was chosen to be the core category. At first the patients were frustrated when left alone with their own thoughts in an unfamiliar forest environment. They gradually became familiar with the forest environments and also found their favourite places where they experienced peace of mind. They were then able to rest and begin reflective thinking about their life situation, which led to ambitions to change it.The preferred forest environments were characterised by openness, light and a good view, and were felt to be undemanding, peaceful and stimulating. Conclusion: Visits to the forest provided favourite places for rest, were experienced as restorative, seemed to improved reflection and may have contributed to starting the coping process for these patients. However, forest visits, as the only treatment option, are not sufficient as rehabilitation from severe and long-term ED. We suggest that forest visits should be integrated with cognitive behavioural therapy to further improve the recovery and enhance coping in daily life for these patients