Assessing the Role of Cognitive Behavioral Therapy in the Management of Chronic Nonspecific Back Pain

Purpose: The aim of this study is to provide a narrative review of the current state of knowledge of the role of cognitive behavioral therapy (CBT) in the management of chronic nonspecific back pain. Methods: A literature search on all studies published up until July 2012 (PubMed and PsycINFO) was performed. The search string consisted of 4 steps: cognitive behavioral therapy/treatment/management/modification/intervention, chronic, back pain (MeSH term) or low back pain (MeSH term), and randomized controlled trial (MeSH term). The conclusions are based on the results from randomized controlled trials (RCTs) and reviews of RCTs. Interventions were not required to be pure CBT interventions, but were required to include both cognitive and behavioral components. Results: The search yielded 108 studies, with 46 included in the analysis. Eligible intervention studies were categorized as CBT compared to wait-list controls/treatment as usual, physical treatments/exercise, information/education, biofeedback, operant behavioral treatment, lumbar spinal fusion surgery, and relaxation training. The results showed that CBT is a beneficial treatment for chronic back pain on a wide range of relevant variables, especially when compared to wait-list controls/treatment as usual. With regards to the other comparison treatments, results were mixed and inconclusive. Conclusion: The results of this review suggest that CBT is a beneficial treatment for chronic nonspecific back pain, leading to improvements in a wide range of relevant cognitive, behavioral and physical variables. This is especially evident when CBT is compared to treatment as usual or wait-list controls, but mixed and inconclusive when compared with various other treatments. Multidisciplinary and transdisciplinary interventions that integrate CBT with other approaches may represent the future direction of management of chronic back pain, with treatments modified for specific circumstances and stakeholders. There is a need for future intervention studies to be specific in their use of cognitive behavioral elements, in order for results to be comparable

Sykmeldtes jobbforventninger som prediktor for retur til jobb – en kunnskapsoppsummering med overføringsverdi til NAV

Denne rapporten er en kunnskapsoppsummering som omhandler jobbforventninger blant sykmeldte arbeidstakere. Vi har kartlagt og sammenstilt fagfellevurdert litteratur, publisert i perioden 2008–2024. Hensikten er å gjennomføre en systematisk gjennomgang av litteratur som omhandler sykmeldtes jobbforventninger. Overordnet undersøker vi om en persons jobbforventninger er en god prediktor for sykefraværets varighet og/eller personens retur til arbeid. Sekundært undersøker vi hvorvidt sykmeldtes jobbforventninger brukes inn i tiltak og i oppfølgingen av den sykmeldte. Den identifiserte litteraturen blir syntetisert og sammenstilt på en måte som gjør at kunnskapen har overføringsverdi til det utviklingsarbeidet som foregår i NAV knyttet til jobbforventninger. Dette perspektivet hensyntas både i hvordan resultatene sammenstilles og i drøftingen avslutningsvis.Sykmeldtes jobbforventninger som prediktor for retur til jobb – en kunnskapsoppsummering med overføringsverdi til NAVpublishedVersio

Protocol for the SEED-Trial: Supported Employment and Preventing Early Disability

Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits

The Impact of Music on Stress Biomarkers:Protocol of a Substudy of the Cluster-Randomized Controlled Trial Music Interventions for Dementia and Depression in ELderly Care (MIDDEL)

Recently, a large cluster-randomized controlled trial was designed-Music Interventions for Dementia and Depression in ELderly care (MIDDEL)-to assess the effectiveness of music interventions on depression in care home residents with dementia (ClinicalTrials.gov NCT03496675). To understand the pathophysiological mechanisms, we observed the effect of repeated music interventions on stress in this population since chronic stress was associated with depression and an increased risk for dementia. An exploratory study was designed to assess: (1) changes in hair cortisol concentrations as an indicator of longer-term stress; (2) whether baseline stress is a predictor of therapy outcome; (3) pre- and post-treatment effects on salivary α-amylase and cortisol response as an indicator of immediate stress in 180-200 care home residents with dementia and depressive symptoms who partake in the MIDDEL trial. Insights into mediatory effects of stress to explain the effect of music interventions will be gained. Hair cortisol concentrations were assessed at baseline and at 3, 6, and 12 months along with the Perceived Stress Scale. Salivary α-amylase and cortisol concentrations were assessed at 1, 3, and 6 months. Saliva was collected just before a session and 15 and 60 min after a session, along with a stress Visual Analogue Scale.</p

Protocol for the SEED-trial: Supported Employment and preventing Early Disability

Background: Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. Methods/design: The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. Discussion: The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age

Kortisol, subjektive helseplager og mestring blant pasienter med uspesifikke ryggsmerter

Background: Subjective health complaints are prevalent in the Norwegian population, and musculoskeletal pain accounts for the major part of sickness absence. Such non-specific conditions with high comorbidity can be viewed in context with coping with stressful situations, using a cognitive model of stress. Purpose: Investigate how patients with back pain and other subjective health complaints may differ from a normal stress profile of high reactivity in the morning followed by lower evening values, and whether there exists a relationship with coping. The study has a theoretical basis in cognitive activation theory of stress (CATS). Method: Cortisol was measured by saliva samples from 287 low-back patients on sick leave, upon awakening, after 30 minutes, afternoon and evening. Patients answered questionnaires measuring subjective health complaints, instrumental mastery orientation, social support and pain, forming the basis for correlation analyses and t-tests. Results: The sample does not seem to have an abnormal cortisol profile. There were weak relationships between cortisol and some health complaints, social support and pain, in agreement with CATS. However, the group with higher levels of instrumental mastery orientation had significantly higher evening values compared with the lower scoring group. Conclusion: The lack of significant findings is remarkable with respect to the expected relationship between cortisol and health and coping respectively. This may open for reassessments of cortisol as a measure of stress activation, or assumptions related to advantageousness in terms of activation. The subject requires further investigation, and there are various considerations to be taken into account in future research. Keywords: Cortisol, subjective health complaints, coping, social support, low back patients, pain

Supported Employment and preventing Early Disability (SEED)

Young adults who are not in education, training or employment (NEET) represent an international challenge that causes worry due to the potentially harmful health-effects of unemployment, and the economic costs for society. The NEET population includes those who are temporarily unemployed or inactive, as well as more marginalized groups at high risk of prolonged or lifelong disengagement. Being excluded from the labor market in early adulthood can have severe consequences for later work participation, and the diversity of the NEET population implies a need to focus on specific subgroups. In Norway, the share of young adults receiving permanent disability benefits has increased considerably during the last years. The main reason for early disability benefits in Norway are mental and behavioral disorders, and risk factors include socioeconomic factors such as low educational attainment. There is however little knowledge about the individuals who are at high risk, but have not yet reached the point of more permanent exclusion from the labor market. This thesis focuses on young adults with impaired work capability who are at risk of early work disability due to various social and health-related challenges. Studies of vocational rehabilitation of NEETs are scarce, and existing knowledge is insufficient to guide policy-makers and other stakeholders in efforts for this group. Furthermore, policies aimed at NEETs in general may be more appropriate for those who are ready to work, while failing to reach the most vulnerable groups. Individual Placement and Support (IPS) is a high-contact approach that is effective for patients with severe mental illness. It is based on clearly defined principles with a main focus on ordinary paid employment in the competitive labor market. IPS is effective across a range of demographic and clinical subgroups with severe mental illness, but there is limited evidence about the effectiveness of IPS in non-psychiatric populations. The aim of the thesis was to generate knowledge about young adults at risk of early work disability in Norway, and to investigate whether the Individual Placement and Support (IPS) model of supported employment may help this group enter the labor market. The aim of paper I was to plan and design a randomized controlled trial to evaluate the effectiveness of repurposing IPS to young adults at risk of early work disability due to various social or health-related problems. The trial was named Supported Employment and preventing Early Disability (the SEED-trial), and compared IPS to a control group that received traditional vocational rehabilitation using traineeships in sheltered businesses. Participants were NEETs, aged 18-29 years old, receiving temporary benefits, and had been considered eligible for traineeships in sheltered businesses. The primary outcome was competitive employment, defined as any paid employment in the competitive labor market during the first year after enrollment. Secondary outcomes included physical and mental health, health behaviors, and wellbeing. Survey data were collected at baseline, 6, and 12 months. The trial design also included long-term follow-up using register data for benefit recipiency, income, and education for five years after inclusion in the study, and a cost-benefit analysis. The aim of paper II was to investigate social and health-related characteristics in young adults at risk of early work disability in Norway, and what they believe may have caused their illness. The paper used baseline data from the 96 participants who were included in the SEED-trial. The majority were male, single, childless, and nearly half were living with their parent(s). Participants had relatively low educational attainment, and more than half reported hazardous drinking or active alcohol use disorders. The prevalence of psychological distress was high, which coincides with previous knowledge about the major reasons for early work disability in Norway. The most noteworthy findings with important implications for efforts targeting this group were however related to psychosocial stressors, including a high prevalence of bullying and exposure to violence. When participants who considered themselves to have an illness were asked about the reasons for their illness, the most common responses were also related to non-medical causes, especially relational problems such as loneliness and isolation. The aim of paper III was to evaluate the effectiveness of IPS versus traditional vocational rehabilitation for young adults at risk of early work disability, on outcomes of competitive employment, and physical and mental health and well-being. Findings showed that significantly more participants in the IPS group (48%) obtained competitive employment compared to participants in the control group (8%) during 12-month follow-up. The groups did generally not differ on health-related outcomes in unadjusted analyses, with a few exceptions. However, when adjusted for baseline and missing observations in post hoc analyses, the IPS group reported significantly better outcomes in anxiety, subjective health complaints, pseudoneurology, helplessness, hopelessness, and drug use at 6-month follow-up, and in level of disability, subjective health complaints, optimism about future well-being, helplessness, hopelessness, and drug use at 12-month follow-up. The findings of this thesis have several implications. In addition to underlining the importance of preventive measures to reduce social exclusion by bullying and early dropout, the findings suggest that there is need for a broader focus on psychosocial aspects in vocational rehabilitation of young adults at risk of early work disability. The findings that IPS was superior to the control condition in increasing competitive employment among this group of NEETs, and that IPS may also have beneficial effect on health, furthermore indicate that vocational rehabilitation for this group should be redirected from traditional sheltered approaches to individualized support in competitive work settings. The SEED-trial is also the first to show that IPS can be successfully repurposed to this new and vulnerable target group at risk of being excluded from working life before having established themselves on the labor market

Music Interventions for Dementia and Depression in ELderly care (MIDDEL)

See www.middel-project.eu for information about the projec

Unge som står utenfor arbeid, opplæring og utdanning (NEET). En analyse av unge i NEET-kategorien

Denne rapporten presenterer resultatene fra et litteratursøk, en scoping review, for å kartlegge norske publikasjoner som omhandler unge som faller utenfor skole og arbeidsliv. Dette inkluderer studier om unge som faller ut fra videregående skole, som er arbeidsledige, og/eller som er mottakere av langtidsytelser slik som uføretrygd. Sammenstillingen av kunnskapen er gjort i tre steg, som også følger rapportens tre problemstillinger: 1) Oppsummering av litteratur basert på registerdata eller spørreskjema, som sier noe om andel unge i NEET-kategorien (Not in Education, Employment, or Training), og kjennetegn ved gruppen og undergrupper 2) oppsummering av litteratur som har undersøkt de unges egne beretninger om frakoblingsprosessen, og 3) en sammenstilling av de foregående kapitlene for å identifisere svakheter i systemet som skulle ha fanget opp de unge