How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from neck-shoulder disorders? A content analysis of questionnaires and interviews

<p>Abstract</p> <p>Background</p> <p>Previous research has indicated neck-shoulder disorders to have a fluctuating course incorporating a variety of symptoms. These findings awoke our interest to make a comparison between symptoms experienced by people affected with the disorder and the content of questionnaires that assess pain and other symptoms in neck-shoulder disorders. Thus the aims of this study were: -to explore the symptoms experienced by people with non-specific neck-shoulder problems, as well as experiences of nuances and temporal variations (fluctuations) of symptoms; -to investigate which sources were used in the development of ten questionnaires for assessing pain and other symptoms in the neck-shoulder; -to analyse the item content of the questionnaires; -to analyse the correspondence between the item content of the questionnaires and the symptoms described by the informants.</p> <p>Methods</p> <p>Content analysis of interviews with 40 people with non-specific neck-shoulder pain, and 10 questionnaires used to assess pain and other symptoms in neck-shoulder disorders.</p> <p>Results</p> <p>The interviews revealed a variety of symptoms indicating a bodily, mental/cognitive, and emotional engagement, and more general and severe symptoms than are usually considered in neck-shoulder questionnaires. Taking all questionnaires together many of the symptoms were considered, but most questionnaires only included a few of them. The informants were able to distinguish fluctuation of symptoms, and a variety of different qualities which were not usually considered in the questionnaires. Only two questionnaires had made use of the opinions of affected people in the development.</p> <p>Conclusion</p> <p>Few of the questionnaires had made use of the experiences of affected people in the development. The correspondence between the symptoms expressed by those affected and the content of the questionnaires was low. A variety of symptoms were expressed by the interviewees, and the participants were also able to distinguish nuances and fluctuations of symptoms. The present study points to the importance of other aspects than just pain and physical functioning as clinical trial outcome measures related to neck-shoulder disorders. To develop a condition-specific questionnaire, it is important to decide on the specific symptoms for the condition. Using the experiences of those affected, in combination with relevant research and professional knowledge, can enhance the validity of the questionnaires.</p

Balancing intrusive illness : the experiences of people with musculoskeletal problems

The overall aim of the present thesis was to explore and describe the health experiences of men and women with musculoskeletal problems. The specific aims of the four papers were: (I) to explore the experience of illness and wellness among ambulance personnel with musculoskeletal symptoms; (II) to explore the experience of illness and wellness among female health care personnel with musculoskeletal symptoms; (III) to explore the experience of bodily illness among people with musculoskeletal problems in the neck-shoulder region, and; (IV) to investigate the symptoms described by people with non-specific neck-shoulder problems, to investigate the method of development of neck-shoulder questionnaires that assesses pain and other symptoms, to analyse the content and items of these questionnaires, and to compare the findings. The overall findings show that the occupationally active men and women with MSDs were “striving for balance” (I-II), that the disease course of chronic neck-shoulder disorders was characterised by “uncontrollable fluctuations” (III), and that most neck-shoulder questionnaires had a low correspondence to the variety of symptoms experienced during this course (IV). In the process of striving for balance (I-II), the informants’ health experiences were not a state of either wellness or illness, but of both, in varying degrees at different times. The balancing started when illness became too intrusive, and was a process of minimising the impact of illness by accepting and handling it, while attaining and maintaining wellness to feel well enough. When striving for balance, the interviewees kept on working to continue being nurtured at the same time as they made different efforts directed at minimising the impact of their illness. For both men and women, illness was characterised by disembodiment, vulnerability, and exhaustion. The illness experiences were counterbalanced by wellness, where some differences could be recognised between the men and the women. Study III further explored the experiences of bodily illness, focusing on people with chronic musculoskeletal disorders in the neck-shoulder region. The course of the disorder was described as characterised by uncontrollable fluctuations, and it usually developed from insidious symptoms to a state of constant discomfort. The participants experienced calmer periods during the course, but intermittent events of increasing illness were always lying in wait, with periodic moments of consuming intensity. In the interviews included in study IV a variety of symptoms were expressed, which indicated a bodily, mental, and emotional engagement, which included more general and more severe symptoms than are usually related to neck-shoulder disorders. Few of the questionnaires were developed using the experiences of the affected. Taken as a whole, did the questionnaires cover many of the symptoms of the interviewees, but each individual questionnaire only included a few. The fluctuations and nuances of symptoms were rarely considered. The correspondence between individual questionnaires and the experiences of those affected was most often low. This thesis reveals other aspects of health than just bodily experiences as important among occupationally active people with MSDs. It also provides a description of the disease course, and an indication of possibilities for improvement of neck-shoulder questionnaires

How to contribute without assuming you have the ultimate solutions : Social workers’understanding of the relationship between their expertise and the involvement of the client and his family network regarding child protection social work

This master-thesis examines the understanding among social workers regarding the relationship between their expertise and the involvement of the clients and their family networks regarding child protection social work. The participants consist of eight women age 26 to 62 working at a social service office in a smaller city in northern Sweden. Three of them works with investigation comprising assessments and five of them works with outpatient care with family treatment within child protection. The methods used are phenomenographic semi structured interviews and content analysis focusing on how the informants perceive things based on their lived experience and the living world. Main results shows that influence for the client is situational and at the same time negotiated in a tension between the images of the client as the expert yet alternatively as unable. The analysis showed three main themes; the client as an expert, influence for the client is situational and the function of the social worker. It further showed that the balance of relationship while also being the one doing the assessments is challenging. The importance of taking charge in the role by giving structure and a frame was also shown and empathy was found as the underlying basis to manage social work. It is important to not underestimate the professionalism of the client and his or her family network regarding their life situation. One conclusion is that it is important to go from accepting user involvement as a phenomenon to act upon it accordingly

How to contribute without assuming you have the ultimate solutions : Social workers’understanding of the relationship between their expertise and the involvement of the client and his family network regarding child protection social work

This master-thesis examines the understanding among social workers regarding the relationship between their expertise and the involvement of the clients and their family networks regarding child protection social work. The participants consist of eight women age 26 to 62 working at a social service office in a smaller city in northern Sweden. Three of them works with investigation comprising assessments and five of them works with outpatient care with family treatment within child protection. The methods used are phenomenographic semi structured interviews and content analysis focusing on how the informants perceive things based on their lived experience and the living world. Main results shows that influence for the client is situational and at the same time negotiated in a tension between the images of the client as the expert yet alternatively as unable. The analysis showed three main themes; the client as an expert, influence for the client is situational and the function of the social worker. It further showed that the balance of relationship while also being the one doing the assessments is challenging. The importance of taking charge in the role by giving structure and a frame was also shown and empathy was found as the underlying basis to manage social work. It is important to not underestimate the professionalism of the client and his or her family network regarding their life situation. One conclusion is that it is important to go from accepting user involvement as a phenomenon to act upon it accordingly

Grammatik på liv och död : En process- och deltagarinriktad textanalys av bästsäljande spänningslitteratur

Skönlitterära texter bidrar till att definiera vilka sociala identiteter, och därmed könsroller, som är möjliga i samhället (Fairclough 2010:75). Undersökningen syftar till att medvetandegöra hur könsroller, och maktstrukturer mellan dessa, reproduceras genom den grammatiska kodningen av romanpersoner i spänningslitteratur. Genom en anpassad systemisk-funktionell transitivitetsanalys (Halliday 2004) undersöks mäns och kvinnors dynamiska potential, samt deras processers riktning och agentivitet. Därtill analyseras i vilken utsträckning män och kvinnor nyttjar talarutrymmet i texten. Materialet består av spänningssekvenser ur tre romaner av Camilla Läckberg, Stieg Larsson och Lars Kepler. Resultaten visar att kvinnor i processfördelningen framstår som mer dynamiska än män, men att mäns processer i större utsträckning riktar sig mot yttre deltagare och påverkar dessa. Kvinnor blir oftare föremål för andras processer och påverkas i lika stor mån som de själva kan påverka. Män dominerar även talarutrymmet. Slutsatsen blir att även om kvinnor framstår som mer dynamiska än män, framstår män som mer handlingskraftiga och förmögna till påverkan än kvinnor

Balancing intrusive illness : the experiences of people with musculoskeletal problems

The overall aim of the present thesis was to explore and describe the health experiences of men and women with musculoskeletal problems. The specific aims of the four papers were: (I) to explore the experience of illness and wellness among ambulance personnel with musculoskeletal symptoms; (II) to explore the experience of illness and wellness among female health care personnel with musculoskeletal symptoms; (III) to explore the experience of bodily illness among people with musculoskeletal problems in the neck-shoulder region, and; (IV) to investigate the symptoms described by people with non-specific neck-shoulder problems, to investigate the method of development of neck-shoulder questionnaires that assesses pain and other symptoms, to analyse the content and items of these questionnaires, and to compare the findings. The overall findings show that the occupationally active men and women with MSDs were “striving for balance” (I-II), that the disease course of chronic neck-shoulder disorders was characterised by “uncontrollable fluctuations” (III), and that most neck-shoulder questionnaires had a low correspondence to the variety of symptoms experienced during this course (IV). In the process of striving for balance (I-II), the informants’ health experiences were not a state of either wellness or illness, but of both, in varying degrees at different times. The balancing started when illness became too intrusive, and was a process of minimising the impact of illness by accepting and handling it, while attaining and maintaining wellness to feel well enough. When striving for balance, the interviewees kept on working to continue being nurtured at the same time as they made different efforts directed at minimising the impact of their illness. For both men and women, illness was characterised by disembodiment, vulnerability, and exhaustion. The illness experiences were counterbalanced by wellness, where some differences could be recognised between the men and the women. Study III further explored the experiences of bodily illness, focusing on people with chronic musculoskeletal disorders in the neck-shoulder region. The course of the disorder was described as characterised by uncontrollable fluctuations, and it usually developed from insidious symptoms to a state of constant discomfort. The participants experienced calmer periods during the course, but intermittent events of increasing illness were always lying in wait, with periodic moments of consuming intensity. In the interviews included in study IV a variety of symptoms were expressed, which indicated a bodily, mental, and emotional engagement, which included more general and more severe symptoms than are usually related to neck-shoulder disorders. Few of the questionnaires were developed using the experiences of the affected. Taken as a whole, did the questionnaires cover many of the symptoms of the interviewees, but each individual questionnaire only included a few. The fluctuations and nuances of symptoms were rarely considered. The correspondence between individual questionnaires and the experiences of those affected was most often low. This thesis reveals other aspects of health than just bodily experiences as important among occupationally active people with MSDs. It also provides a description of the disease course, and an indication of possibilities for improvement of neck-shoulder questionnaires

Content and psychometric evaluations of questionnaires for assessing physical function in people with arm-shoulder-hand disorders. A systematic review of the literature.

PURPOSE: The aim was to investigate how structured assessment of physical function can be performed in people with musculoskeletal disorders in arm-shoulder-hand. Specifically, we aimed to determine: • Which questionnaires are available for structured assessment of physical function in people with musculoskeletal disorders in arm-shoulder-hand? • What aspects of physical function do those questionnaires measure? • What are the psychometric properties of the questionnaires? MATERIALS AND METHODS: By means of a systematic review, questionnaires and psychometric tests of those were identified. ICF was used to categorise the content of the questionnaires, and the COSMIN checklist was used to assess the psychometric evaluations. RESULTS: Nine questionnaires were identified. Most items focused on activities rather than functions. Commonly, a couple of psychometric measurements had been tested, most often reported being adequate. Only one questionnaire had been tested for all aspects. Variation in scope and insufficient reports regarding validity and reliability make comparisons and decisions on use difficult both in clinical practice and for research purposes. CONCLUSIONS: The level of psychometric evaluation differs, and often only a few aspects of validity and reliability have been tested. The questionnaires address activity issues to a higher extent than function.IMPLICATIONS FOR REHABILITATIONThis review investigates the content and quality of nine ASH questionnaires.The questionnaires addressed activity issues to a higher extent than function.The level of psychometric testing of the questionnaires differed.DASH, Quick-DASH, and SPADI were the questionnaires that were most often evaluated with various psychometric tests, and with adequate results

Content and psychometric evaluations of questionnaires for assessing physical function in people with arm–shoulder–hand disorders. A systematic review of the literature

The aim was to investigate how structured assessment of physical function can be performed in people with musculoskeletal disorders in arm-shoulder-hand. Specifically, we aimed to determine: • Which questionnaires are available for structured assessment of physical function in people with musculoskeletal disorders in arm-shoulder-hand? • What aspects of physical function do those questionnaires measure? • What are the psychometric properties of the questionnaires? By means of a systematic review, questionnaires and psychometric tests of those were identified. ICF was used to categorise the content of the questionnaires, and the COSMIN checklist was used to assess the psychometric evaluations. Nine questionnaires were identified. Most items focused on activities rather than functions. Commonly, a couple of psychometric measurements had been tested, most often reported being adequate. Only one questionnaire had been tested for all aspects. Variation in scope and insufficient reports regarding validity and reliability make comparisons and decisions on use difficult both in clinical practice and for research purposes. The level of psychometric evaluation differs, and often only a few aspects of validity and reliability have been tested. The questionnaires address activity issues to a higher extent than function.IMPLICATIONS FOR REHABILITATIONThis review investigates the content and quality of nine ASH questionnaires.The questionnaires addressed activity issues to a higher extent than function.The level of psychometric testing of the questionnaires differed.DASH, Quick-DASH, and SPADI were the questionnaires that were most often evaluated with various psychometric tests, and with adequate results. This review investigates the content and quality of nine ASH questionnaires. The questionnaires addressed activity issues to a higher extent than function. The level of psychometric testing of the questionnaires differed. DASH, Quick-DASH, and SPADI were the questionnaires that were most often evaluated with various psychometric tests, and with adequate results.</p