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  • 1.
    Ahlgren, Asa
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Bergroth, Alf
    Mid-Sweden University, Östersund, Sweden.
    Ekholm, Jan
    Mid-Sweden University, Östersund, Sweden.
    Work resumption or not after rehabilitation?: A descriptive study from six social insurance offices2004In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 27, no 3, p. 171-180Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to describe measures and outcomes of vocational rehabilitation at six local national insurance offices in the same county in Sweden. Data were collected from mainframe registers and other records at each office. There were great differences in sickness allowance, incapacity rate, selected rehabilitation measures and resuming work. The percentage of sick-listed people who received any rehabilitation measure differed from 1.2 to 8.7%. The gender distribution for the study population was 36% men and 64% women and the predominant diagnosis was musculoskeletal pain conditions, which was followed by psychiatric disorders. Outcomes varied from office B, which reported 58% fully fit after completed planned rehabilitation, to office C, which reported only 24% fully fit. The clear differences in outcome between the offices indicate that various rehabilitation measures differ in effectiveness. The rehabilitation measure 'investigation of working ability' was not linked to any great proportion of people resuming work, but showed a greater correspondence to full disability pension. There were also large differences in social and demographic factors in the different municipalities. The effect of these on the rehabilitation process requires further investigation.

  • 2.
    Ahlgren, Asa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mid Sweden University, Östersund, Sweden.
    Broman, Lisbet
    Karolinska Institutet, Stockholm, Sweden.
    Bergroth, Alf
    Mid Sweden University, Östersund, Sweden.
    Ekholm, Jan
    Mid Sweden University, Östersund, Sweden.
    Disability pension despite vocational rehabilitation?: A study from six social insurance offices of a county2005In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 28, no 1, p. 33-42Article in journal (Refereed)
    Abstract [en]

    Many long-term sick-listed individuals move from vocational rehabilitation to pension, rather than reaching the goal of return to work. There is thus reason to consider whether rehabilitation resources are being used optimally. Individuals receiving disability pensions are consuming financial and personnel resources at the insurance offices and also consume a large amount of health care. The general objective of the study was to evaluate the proportion of individuals granted vocational rehabilitation but then obtaining temporary or permanent disability pensions. All persons receiving any kind of rehabilitation and attending one of six local national insurance offices in a county in Sweden in 1998 and 1999 were studied. A 2-year follow-up was carried out to assess changes in status among those who had received temporary disability pensions. Of all individuals receiving rehabilitation, 46.2% ended up with a disability pension allowance. In addition, a large portion of the temporary disability pensions was transformed to permanent disability pensions within 2 years. For clients with a temporary disability pension, the rate of resuming work was close to nil. Among rehabilitation measures, investigation showed the lowest figures of work resumption while job training showed the best outcome in this respect. The study concluded that a large portion of the financial and personnel resources allocated by the national insurance offices to rehabilitation resulted in disability pensions.

  • 3.
    Ahlgren, Åsa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Stockholm, Sweden .
    Bergroth, Alf
    Karolinska Institutet, Stockholm, Sweden .
    Ekholm, Jan
    Karolinska Institutet, Stockholm, Sweden .
    Ekholm, Kristina Schüldt
    Karolinska Institutet, Stockholm, Sweden .
    Selection of clients for vocational rehabilitation at six local social insurance offices: a combined register and questionnaire study on rehabilitation measures and attitudes among social insurance officers.2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 3, p. 178-184Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to evaluate possible differences between local social insurance offices with regard to their selection of clients for vocational rehabilitation. A further aim was to determine whether social insurance officers from different local insurance offices have uniform attitudes regarding professional practice in their application of the insurance system. METHODS: A register-based investigation of 815 vocational rehabilitees served by 6 local social insurance offices in a Swedish county. The study was supplemented with a questionnaire to 30 officers about attitudes to social insurance. RESULTS: The office with the lowest rate of sick-listing periods exceeding one year, and a high frequency of employment training, showed the highest degree of work resumption and the lowest pension rate after vocational rehabilitation. There were wide differences in attitude among the local social insurance officers regarding professional practice in their application of the system. CONCLUSION: Intra-county differences occur in handling people on sick-leave who undergo vocational rehabilitation. The local social insurance offices with the highest and lowest outcome rates of work resumption and disability pension, respectively, select clients for vocational rehabilitation from different categories of cases. Social insurance officers from different local offices differ in their attitudes towards the social insurance system and its clients.

  • 4.
    Ahlgren, Åsa
    et al.
    Karolinska Institutet, Sweden.
    Bergroth, Alf
    Karolinska Institutet, Sweden.
    Ekholm, Jan
    Karolinska Institutet, Sweden.
    Schüldt, Kristina
    Karolinska Institutet, Sweden.
    Work resumption after vocational rehabilitation: a follow-up two years after completed rehabilitation2007In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 28, no 4, p. 343-354Article in journal (Refereed)
    Abstract [en]

    A short-term evaluation of vocational rehabilitation (VR) may give conclusions not automatically applicable over a longer term. The present study follows up alterations in work resumption or in social insurance benefits from the time of completed VR and during the following two years. AIM: The primary objective was to evaluate work resumption among previous sick-leavers granted vocational rehabilitation. The aim of the follow-up was to assess the stability of the outcome of VR over time and to analyse factors of importance for clients that remained at work. METHOD: A register investigation was based on 815 cases where the clients had taken part in vocational rehabilitation and were served by one of six local social insurance offices of a Swedish county. RESULTS: Of the clients studied, 52.4% had attained full working capacity The proportion had decreased to 37.4% two years later. One factor that differed between those who resumed work and those who returned to sick leave was the duration of the previous sick-leave period. Those who returned to work had had shorter sick leave, had jobs to return to and had received job training as a vocational rehabilitation measure. CONCLUSIONS: The clients with the best chances of being in work two years after completed vocational rehabilitation were those with short sickness absence, who had been selected for job training as a vocational rehabilitation, were aged 16-29 years and were employed in industry.

  • 5.
    Gustafsson, Lena-Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Mattsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dubbelman, Kerstin
    Snöljung, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aspects of nursing with evidence-base when nursing frail older adults: a phenomenographic analysis of interviews with nurses in municipal care2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, ISSN 0283-9318, Vol. 28, no 4, p. 793-801Article in journal (Refereed)
    Abstract [en]

    In earlier research as well as in political discussion and documents, the topic of evidence has been highlighted as one of the most important concerns in nursing care. This study focuses on understanding what lies behind nurses' ways of acting regarding evidence-based nursing through an illumination of the way they perceive the phenomena.AIM: The aim was to identify and describe the different ways municipal care nurses perceive aspects of working with evidence when nursing frail older adults.METHODS: An explorative design with a phenomenographic approach based on interviews with nurses working with home-based care within the municipality was used in order to gain understanding of nurse's perceptions of the phenomena.RESULTS: Findings revealed that the nurses perceived a variety of aspects when working with evidence when nursing frail older people. Aspects with a spectra of different perceptions shown in the analysis were as follows: Evidence-based nursing as a desired intention/mission, lack of practical supporting structures to apply evidence, lack of confidence in own capacity to apply evidence and a belief that it will work anyway.CONCLUSIONS: Findings reveal that it is a challenge to implement research both on an individual as well as on an organisational level. Understanding the contextual perceptions of evidence by nurses can cast light on the barriers as well as the prerequisites of working with evidence while caring for frail older adults in municipal care.

  • 6.
    Sandborgh, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. University of British Columbia , Vancouver , Canada.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Norwegian Institute of Public Health , Nydalen , Oslo , Norway.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fritz, Johanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Moberg, Johan
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Overmeer, Thomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Örebro University, Örebro, Sweden.
    Snöljung, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program: Rationale, Process and Ten-year ReviewIn: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed)
    Abstract [en]

    In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicinecontent and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

  • 7.
    Sandborgh, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Snöljung, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    IMPLEMENTATION OF BEHAVIORAL MEDICINE IN A PHYSIOTHERAPY UNDERGRADUATE CURRICULUM STUDENT EVALUATIONS2018In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, p. S64-S65Article in journal (Other academic)
  • 8.
    Snögren, Asa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Physiotherapy: How to work with evidence in daily practice2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 2, p. 216-223Article in journal (Refereed)
    Abstract [en]

    Rationale, aims, and objectives The concept of evidence-based health care has gained increasing currency over the past decades; however, questions persist regarding how to overcome the gap between research and health care practice. The question arises whether this gap derives from a true knowledge deficit or from physiotherapists' perception of working with evidence. The aim of the current study was to illuminate changes to the meaning of working with evidence experienced by a cohort of physiotherapists following an education program. Methods A phenomenological hermeneutic design with open-ended group interviews was carried out with physiotherapists who had participated in an education program about evidence and how to implement evidence-based practice (EBP) in day-to-day practice. Findings The interviews provided descriptions of working with evidence according to three major themes: "Confidence with the concept of evidence in relation to a way of working"; "Experience of EBP as a duty to seek evidence for individual patients"; and "EBP experienced as an integrated and patient-oriented activity". Conclusions The physiotherapists' lived experiences demonstrated that the participants' perception of the concept of evidence mainly concerned a broadening of the definition of evidence, and this altered perception of evidence could interpreted as the physiotherapists viewing EBP as a more integrated and patient-oriented activity than before.

  • 9.
    Snöljung, Åsa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Mattsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    The diverging perception among physiotherapists of how to work with the concept of evidence: A phenomenographic analysis2014In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 6, p. 759-766Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives

    Changes in Sweden's municipal care have impacted the situation of physiotherapists by the adoption of practice based on research evidence. Even if physiotherapists appear to be in favour of the idea of evidence-based practice, barriers still exist that prevent many from keeping up with current research. The aim of this study was to identify and describe the different ways in which physiotherapists in municipal care perceive the concept of evidence in rehabilitation.

    Methods

    A phenomenographic design with semi-structured interviews was carried out with physiotherapists working with frail older people in three municipal care units in two neighbouring municipalities in Sweden. The physiotherapists' perceptions of evidence were explored in 12 interviews.

    Results

    Distinct perceptions of the concept of evidence are identified in three categories: ‘Confidence with the concept of evidence in relation to measurement instruments’; ‘Perception of evidence-based practice as a duty, condition and demand of the profession’; and ‘Evidence-based work as a separate rather than directly patient-oriented activity’.

    Conclusions

    Physiotherapists take full responsibility to comply with what they perceive to be the demands of their profession. However, what evidence actually meant, and therefore what the practical element of this responsibility consisted of, was not as clear.

  • 10.
    Snöljung, Åsa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Malardalen Univ, Sch Hlth Care & Social Welf, Div Physiotherapy, Vasteras, Sweden..
    Karrholm, Jenny
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden..
    Hinas, Elin
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden..
    Alexanderson, Kristina
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden..
    Neurologists dealing with sickness certification: Experiences of problems and need of competence2017In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, no 11, article id e00845Article in journal (Refereed)
    Abstract [en]

    Rationale and AimsMost studies on physicians' sickness certification practices include general practitioners (GP) while there hardly is any knowledge on this regarding neurologists although neurological diseases often involve work incapacity and need of sick leave. AimThe aim was to describe experiences among neurologists in Sweden concerning their work with sickness certification of patients. MethodA cross-sectional study of 265 neurologists' responses in a nationwide survey regarding their work with sickness certification of patients was conducted. ResultsThe majority (81.5%) had sickness certification consultations at least once a week and a third experienced problems every week in handling sickness certification. Among the 251 who at least sometimes had sickness certification consultations, the following two aspects were experienced as very or fairly problematic: assess the degree to which the reduced functional capacity limits a patient's capacity to perform his/her work assignments (67.3%) and make a long-term prognosis about the future work capacity of patients on sick leave (60.5%). At least once a week, 78.7% experienced lack of time regarding managing patient-related aspects of the sickness certification task. Moreover, 21.8% considered sickness certification to be a work environmental problem, at least once a week. In all, 84% stated that they had a large or fairly large need for more competence concerning sickness certification tasks. ConclusionsSickness certification is a common task among neurologists, involving several problematic aspects related to, e.g., lack of competence in assessing function and work capacity and of time. There is a need for improvement.

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