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Lo, H. K., Johnston, V., Landen Ludvigsson, M., Peterson, G., Overmeer, T., David, M. & Peolsson, A. (2018). Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial. Journal of Rehabilitation Medicine, 50(9), 828-836
Open this publication in new window or tab >>Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial
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2018 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 9, p. 828-836Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the efficacy of exercise interventions and factors associated with changes in work ability for people with chronic whiplash-associated disorders. Design: Secondary analysis of a single-blind, randomized multi-centre controlled trial. Setting: Interventions were conducted in Swedish primary care settings. Patients: A total of 165 individuals with chronic whiplash-associated disorders grade II-III. Methods: Participants were randomly allocated to neck-specific exercise, neck-specific exercise with a behavioural approach, or prescribed physical activity interventions. Work ability was evaluated with the Work Ability Index at baseline, 3, 6 and 12 months. Results: The neck-specific exercise with a behavioural approach intervention significantly improved work ability compared with the prescribed physical activity intervention (3 months, p = 0.03; 6 months, p = 0.01; 12 months, p = 0.01), and neck-specific exercise at 12 months (p = 0.01). Neck-specific exercise was better than the prescribed physical activity intervention at 6 months (p = 0.05). An increase in work ability from baseline to one year for the neck-specific exercise with a behavioural approach group (p < 0.01) was the only significant within-group difference. Higher self-rated physical demands at work, greater disability, greater depression and poorer financial situation were associated with poorer work ability (p < 0.01). Conclusion: This study found that neck-specific exercise with a behavioural approach intervention was better at improving self-reported work ability than neck-specific exercise or prescribed physical activity. Improvement in work ability is associated with a variety of factors.

Keywords
employment, whiplash injuries, exercise, persistent neck pain
National Category
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-41266 (URN)10.2340/16501977-2374 (DOI)000447771700008 ()30132011 (PubMedID)2-s2.0-85053639587 (Scopus ID)
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2019-01-04Bibliographically approved
Overmeer, T. & Boersma, K. (2016). What Messages Do Patients Remember?: Relationships Among Patients' Perceptions of Physical Therapists' Messages, Patient Characteristics, Satisfaction, and Outcome.. Physical Therapy, 96(3), 275-283
Open this publication in new window or tab >>What Messages Do Patients Remember?: Relationships Among Patients' Perceptions of Physical Therapists' Messages, Patient Characteristics, Satisfaction, and Outcome.
2016 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 96, no 3, p. 275-283Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: 

Based on a behavioral medicine perspective, modern recommendations for physical therapists treating patients with spinal pain include performing a trustworthy physical examination, conveying the message that back pain is benign, and stressing that activity is a key to recovery. However, little evidence is available on how patients perceive these biopsychosocial messages and how patients' perceptions of these messages relate to their recovery.

OBJECTIVES: 

The aim of this study was to explore the relationships between perceptions of treatment delivery that are related to an evidence-based approach and psychological factors, treatment outcome, and treatment satisfaction.

DESIGN: 

A cohort study with 3 measurement points was conducted.

METHODS: 

Data on 281 participants were collected.

RESULTS: 

High catastrophizing and lower mood in the participants were correlated to "not perceiving the biopsychosocial message" measured at 6 weeks after treatment start. Participants who did not perceive the biopsychosocial message were at higher risk for disability and had lower treatment satisfaction 6 months after treatment start even when controlling for pretreatment pain intensity. "Not perceiving the biopsychosocial message" was not a mediator for treatment outcome and treatment satisfaction. Physical therapists' treatment orientations or attitudes were not related to the perception of the message by the patients.

LIMITATIONS: 

There was no measure of actual practice behavior.

CONCLUSIONS: 

Maladaptive cognitions and negative emotions appear to affect the way information provided during treatment is perceived by patients. The way information is perceived by patients influences treatment outcome and treatment satisfaction. Physical therapists are advised to check that patients with higher levels of catastrophizing and lower mood are correctly perceiving and interpreting a biopsychosocial message.

National Category
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-29557 (URN)10.2522/ptj.20140557 (DOI)000371452200003 ()26183588 (PubMedID)2-s2.0-84960155936 (Scopus ID)
Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2019-06-18Bibliographically approved
Agnew, L., Johnston, V., Ludvigsson, M. L., Peterson, G., Overmeer, T., Johansson, G. & Peolsson, A. (2015). Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III: A cross-sectional analysis. Journal of Rehabilitation Medicine, 47(6), 546-551
Open this publication in new window or tab >>Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III: A cross-sectional analysis
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2015 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 6, p. 546-551Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic whiplash-associated disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R2= 0.65, p < 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

Keywords
Neck pain and disability, Whiplash-associated disorders, Work ability
National Category
Physiotherapy General Practice
Identifiers
urn:nbn:se:mdh:diva-28213 (URN)10.2340/16501977-1960 (DOI)000356318300010 ()2-s2.0-84930062440 (Scopus ID)
Available from: 2015-06-11 Created: 2015-06-11 Last updated: 2018-01-11Bibliographically approved
Peolsson, A., Landén Ludvigsson, M., Overmeer, T., Dedering, A., Bernfort, L., Johansson, G., . . . Peterson, G. (2013). Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study. BMC Musculoskeletal Disorders, 1(14), 311
Open this publication in new window or tab >>Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study
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2013 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 1, no 14, p. 311-Article in journal (Refereed) Published
Abstract [en]

Background: Up to 50% of chronic whiplash associated disorders (WAD) patients experience considerable pain and disability and remain on sick-leave. No evidence supports the use of physiotherapy treatment of chronic WAD, although exercise is recommended. Previous randomised controlled studies did not evaluate the value of adding a behavioural therapy intervention to neck-specific exercises, nor did they compare these treatments to prescription of general physical activity. Few exercise studies focus on patients with chronic WAD, and few have looked at patients' ability to return to work and the cost-effectiveness of treatments. Thus, there is a great need to develop successful evidence-based rehabilitation models. The study aim is to investigate whether neck-specific exercise with or without a behavioural approach (facilitated by a single caregiver per patient) improves functioning compared to prescription of general physical activity for individuals with chronic WAD. Methods/Design. The study is a prospective, randomised, controlled, multi-centre study with a 2-year follow-up that includes 216 patients with chronic WAD (> 6 months and < 3 years). The patients (aged 18 to 63) must be classified as WAD grade 2 or 3. Eligibility will be determined with a questionnaire, telephone interview and clinical examination. The participants will be randomised into one of three treatments: (A) neck-specific exercise followed by prescription of physical activity; (B) neck-specific exercise with a behavioural approach followed by prescription of physical activity; or (C) prescription of physical activity alone without neck-specific exercises. Treatments will be performed for 3 months. We will examine physical and psychological function, pain intensity, health care consumption, the ability to resume work and economic health benefits. An independent, blinded investigator will perform the measurements at baseline and 3, 6, 12 and 24 months after inclusion. The main study outcome will be improvement in neck-specific disability as measured with the Neck Disability Index. All treatments will be recorded in treatment diaries and medical records. Discussion. The study findings will help improve the treatment of patients with chronic WAD. Trials registration. ClinicalTrials.gov identifier: NCT01528579.

Keywords
Whiplash injuries, Neck pain, Spine, Rehabilitation, Physical therapy, Exercise
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-23172 (URN)10.1186/1471-2474-14-311 (DOI)000328052200002 ()2-s2.0-84886735268 (Scopus ID)
Available from: 2013-12-05 Created: 2013-12-05 Last updated: 2017-12-06Bibliographically approved
Overmeer, T., Boersma, K., Denison, E. & Linton, S. (2011). Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes?: A randomized controlled trial. Physical Therapy, 91(5), 804-819
Open this publication in new window or tab >>Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes?: A randomized controlled trial
2011 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, no 5, p. 804-819Article in journal (Refereed) Published
Abstract [en]

Background. Psychosocial prognostic factors are important in the development of chronic pain, but treatment providers often lack knowledge and skills to assess and address these risk factors. Objective. The aim of this study was to examine the effects on outcomes (pain and disability) in patients of a course about psychosocial prognostic factors for physical therapists. Design. This study was a randomized, controlled trial. Setting. The setting was primary care practice. Participants. Forty-two primary care physical therapists attended an 8-day university course (over 8 weeks) aimed at identifying and addressing psychosocial risk factors. Intervention. The physical therapists were randomly assigned to either the course or a waiting list. They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course. Measurements. We measured physical therapists' attitudes and beliefs about psychosocial factors, knowledge, and skills before and after the course. We measured patients' pain, disability, catastrophizing, and mood at the start of treatment and at a 6-month follow-up. Methods. The physical therapists were randomly assigned to either the course or a waiting list. They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course. Results. Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course. Pain and disability outcomes in patients with a low risk of developing long-term disability-and pain outcomes in patients with a high risk of developing long-term disability-were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course. However, disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed. Limitations. A limitation of this study was that actual practice behavior was not measured. Conclusions. An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability. However, patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course.

National Category
Medical and Health Sciences Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-13914 (URN)10.2522/Ptj.20100079 (DOI)000289961000020 ()2-s2.0-79960955694 (Scopus ID)
Available from: 2012-01-03 Created: 2012-01-03 Last updated: 2017-12-08Bibliographically approved
Bergbom, S., Boersma, K., Overmeer, T. & Linton, S. (2011). Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments.. Physical Therapy, 91(5), 754-764
Open this publication in new window or tab >>Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments.
2011 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, no 5, p. 754-764Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-13915 (URN)10.2522/Ptj.20100136 (DOI)000289961000016 ()
Available from: 2012-01-03 Created: 2012-01-03 Last updated: 2017-12-08Bibliographically approved
Overmeer, T., Boersma, K., Main, C. & Linton, S. (2009). Do physical therapists change their beliefs, attitudes, knowledge, skills and behaviour after a biopsychosocially orientated university course?. Journal of Evaluation In Clinical Practice, 15(4), 724-732
Open this publication in new window or tab >>Do physical therapists change their beliefs, attitudes, knowledge, skills and behaviour after a biopsychosocially orientated university course?
2009 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 4, p. 724-732Article in journal (Refereed) Published
Abstract [en]

Aim The aim of this study is to examine the effects of an 8-day university-based training course, aimed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment, in shifting therapists towards a more biopsychosocial orientation as measured by changes in beliefs/attitudes, knowledge, skills and behaviour. Method We combined a randomized controlled trail with a pre-post design. Forty-two physiotherapists applied for a university-accredited training course designed to enhance knowledge and management of psychosocial factors in their practice with patients suffering from musculoskeletal pain. The course participants were randomized either to receiving the course or to a waiting list for training. Attitudes and beliefs towards, and knowledge of psychosocial factors, patient vignettes and a video of an imaginary patient were tested before and after training. The patients of the course participants were asked to fill out a questionnaire with background questions at treatment start. The patients also received a questionnaire about the physical therapists' behaviour and patient satisfaction 6 weeks after treatment start. Results The results show that physical therapists' attitudes and believes became more biopsychosocially and less biomedically orientated, they were less convinced that pain justifies disability and limitation of activities, and their knowledge and skills on psychosocial risk factors increased after a university-accredited training course. Yet despite these changes their patients perceived their practice behaviour before and after the course as similar and were equally satisfied with their treatment and treatment result. Conclusion A course, which enhanced biopsychosocial attitudes and beliefs, as well as increased such knowledge and skills did not change the way patients perceived their physical therapists. A future question is whether it improves patient outcome.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-21295 (URN)10.1111/j.1365-2753.2008.01089.x (DOI)000268271000021 ()2-s2.0-68349103219 (Scopus ID)
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2017-12-06Bibliographically approved
Linton, S., Boersma, K., Jansson, M., Overmeer, T., Lindblom, K. & Vlaeyen, J. W. .. (2008). A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities. European Journal of Pain, 12(6), 722-730
Open this publication in new window or tab >>A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities
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2008 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 6, p. 722-730Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: 

Pain-related fear is related to disability in persistent pain conditions. Exposure treatment has been reported to be of great benefit in replicated single case experiments.

AIM: 

To evaluate the effects of exposure in vivo on fear and function in patients with persistent pain and work disability.

METHOD: 

We recruited 46 patients suffering from long-term back pain and reduced function, who also were deemed fearful according to standardized measures. Participants were randomized into either an exposure plus usual treatment or waiting list control plus usual treatment group. After the waiting period the control group crossed over and received the exposure treatment.

RESULTS: 

Between group comparisons showed a significantly better result for the exposure group on function, but not for fear or pain and effect sizes were modest (function=.6; fear=.4; pain=.1). When the control group crossed over to treatment significant treatment effects were noted for fear and function. For all patients treated, the pre to post-treatment effect sizes were large (function=.7; fear=1.1; pain=.9). There were 12 dropouts (8 in exposure and 4 in the control) during the first treatment phase and an additional 4 when the control group crossed over to exposure.

CONCLUSIONS: 

Compared to a group receiving usual treatment and waiting for exposure, the exposure in vivo group demonstrated a significantly larger improvement on function. Overall exposure had moderate effects on function, fear and pain intensity. We conclude that exposure may be important in treatment, but is not recommended as a "stand alone" adjunct to usual treatment.

National Category
Other Health Sciences
Identifiers
urn:nbn:se:mdh:diva-29559 (URN)10.1016/j.ejpain.2007.11.001 (DOI)000257637100006 ()2-s2.0-44649092606 (Scopus ID)
Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-12-01Bibliographically approved
Overmeer, T., Linton, S., Holmquist, L., Eriksson, M. & Engfeldt, P. (2005). Do evidence-based guidelines have an impact in primary care?: A cross-sectional study of Swedish physicians and physiotherapists. Spine, 30(1), 146-151
Open this publication in new window or tab >>Do evidence-based guidelines have an impact in primary care?: A cross-sectional study of Swedish physicians and physiotherapists
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2005 (English)In: Spine, ISSN 0362-2436, Vol. 30, no 1, p. 146-151Article, review/survey (Refereed) Published
Abstract [en]

Study Design. A cross-sectional study of physicians and physiotherapists in primary care. Objectives. To survey how familiar clinicians were with evidence-based guidelines for back pain and their opinion about their clinical usefulness and to compare self-reported practice behavior with the guidelines. Summary of Background Data. Guidelines, based on empirical evidence, are meant to ensure that patients get the most effective treatment. These evidence-based guidelines should steer clinical praxis, but clinicians may not read, let alone heed, them. Methods. Using a questionnaire, the authors surveyed all physicians and physiotherapists in primary health care in Orebro County, Sweden (N = 235). Results. Forty-two percent of the physicians and 37% of the physiotherapists were unfamiliar with the content of the guidelines, and 40% of the physicians and 25% of the physiotherapists were unfamiliar with the concept of "red flags." Less than half of the clinicians, 47%, were familiar both with the content of the guidelines and the concept of red flags. Their opinion about the guidelines showed that 54% of the physicians and 56% of the physiotherapists agreed that the guidelines were useful in clinical praxis. Concerning the self-reported practice behavior, the majority indicated that they followed the key points in the guidelines. Conclusions. A relatively large proportion of clinicians were unfamiliar with the content of evidence-based guidelines and/or with the concept of red flags. The process of implementing research into clinical practice is in need of an overhaul, and the impact of guidelines on clinical practice may be questioned.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-21296 (URN)000226064900023 ()2-s2.0-13444300928 (Scopus ID)
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2015-07-03Bibliographically approved
Overmeer, T., Linton, S. & Boersma, K. (2004). Do physical therapists recognise established risk factors?: Swedish physical therapists’ evaluation in comparison to guidelines. Physiotherapy, 90(1), 35-41
Open this publication in new window or tab >>Do physical therapists recognise established risk factors?: Swedish physical therapists’ evaluation in comparison to guidelines
2004 (English)In: Physiotherapy, ISSN 0031-9406, Vol. 90, no 1, p. 35-41Article in journal (Refereed) Published
Abstract [en]

Background and purpose. The Swedish Council on Technology Assessment in Health Care has widely distributed the most recent Swedish evidence-based review on neck and back pain. In this review psychosocial factors were acknowledged as important risk factors for developing chronic pain. We-surveyed physical therapists' evaluation of risk factors for the development of chronic pain. The results were compared to the review of the Swedish Council on Technology Assessment in Health Care. Methods. A postal questionnaire was sent to all 117 physical therapists working in primary care in Örebro County, Sweden. Results. The survey was responded to by 102 physical therapists (87%). Over 50% of them indicated as important more than twice as many risk factors than are supported by the evidence-based review. More than 50% of the physical therapists pointed out all eight evidence-based factors described in the evidence-based review but they also indicated a median of 10 additional factors with little or no support in the literature. More than 80% of the physical therapists responded according to the recommendations of the evidence-based review concerning sick leave and instructions to patients regarding activities and pain relief. Forty-four physical therapists (43%) indicated that they could predict which patients would develop chronic pain in the future. Conclusions. Physical therapists represented by this sample were well aware of the importance of psychosocial risk factors, but because of the large number of additional factors indicated it seems physical therapists lack specificity about which factors are important. 

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-21297 (URN)10.1016/S0031-9406(03)00002-6 (DOI)2-s2.0-1542398695 (Scopus ID)
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2015-07-03Bibliographically approved
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