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  • 1.
    Ahmed, Mobyen Uddin
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Begum, Shahina
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Petrovic, Nikola
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Third Eye: An Intelligent Assisting Aid for Visual Impairment Elderly2016In: Medicinteknikdagarna 2016 MTF, 2016Conference paper (Refereed)
    Abstract [en]

    Background Visually impaired older persons need support in daily activities, e.g. moving around inside the house; making and eating food and taking medicine independently. A system that simulates the environment based on both dynamic and static objects, identify obstacles, navigates and translates sensory information in voice would be valuable to support their daily activities. Today several sensors and camera-based systems are popular as ambient-assisted living tools for older adults. However, intelligent assisting aid (IAA) to support older individuals with a recently acquired visual impairment is limited. The proposed system ‘Third Eye’ focuses on the advanced research and development of an IAA to support older individuals with a recently acquired visual impairment. The main goal in this system is to provide a usable, feasible and cost-effective solution for older persons to support their daily activities using intelligent sensor based system. Method The system consists of the following five phases to meet several central challenges in developing IAA in such domain. • User-perspective, focuses on user-driven technical development, investigating needs of potential users. The study will have a participatory design with focus group interviews of lead users. • Sensor-based system, focuses on the identification obstacles based on ultrasounds and/or radio frequencies embedded in white-cane or weaker. • Camera-based system, focuses on image based information translation into voice embedded in white-cane or weaker or glasses. • System of systems, focuses on integration of above systems where knowledge is engineered and suitable representations are learned and reasoning for decisions are made [9]. • Experimental, focuses on usability and feasibility of the IAA, with idiographic and group studies Results The initial results have shown the necessity of the proposed AAI systems for older individuals with a recently acquired visual impairment. However, more extension work e.g., process and analyze the information and synthesize it with existing literature for developing the system is ongoing.

  • 2.
    Asenlof, Pemilla
    et al.
    Uppsala Univ, Uppsala, Sweden..
    Igelstrom, Helena
    Uppsala Univ, Uppsala, Sweden..
    Sandborgh, 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.
    INTEGRATION OF PHYSIOTHERAPY IN BEHAVIORAL MEDICINE INTERVENTION RESEARCH2018In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, no Suppl 1:1, p. S3-S3Article in journal (Other academic)
  • 3.
    Chatchumni, Manaporn
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Namvongprom, Ampaporn
    Rangsit Univ, Sch Nursing, Rangsit, Thailand.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Mazaheri, Monir
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eriksson, Henrik
    The Red Cross University College, Stockholm, Sweden.
    Nurses’ perceptions of patients in pain and pain management: a focus group study in Thailand2015In: Pacific Rim International Journal of Nursing Research, ISSN 1906-8107, Vol. 19, no 2, p. 164-177Article in journal (Refereed)
    Abstract [en]

    In Thailand, nurses have a key role in the assessment of symptoms and advising on pain management in patients with post-operative in a surgical ward. This study provides insight into nurses’ perceptions of patients in pain and subsequent pain management. A focus group discussion method was used with 18 registered nurses working in surgical wards. The data were analysed using qualitative content analysis. The participants’ descriptions of their perceptions of patients in pain and pain management were condensed into four themes. Two themes revolved around their perceptions of patient pain, uncomfortable patient, and restricted mobility and changed mood. The two remaining themes comprised intolerable pain would be managed, and managing pain through our own experience seems to be of importance in their professional assumption that evidence-based practice is inadequate for patients’ postoperative care. It is suggested that nurses work to a organized pain assessment guideline and pain management models according to cultural contexts. This should be developed within an understanding of the nurse-patient relationship, and specifically holistic nursing models of care can play an important role in bridging the connection between training and practice, not only between personal and professional perceptions of pain and selected strategies, but also between professional knowledge and nurses’ perceptions of patients in pain.The findings may have relevance for other similar contexts and settings.

  • 4.
    Denison, Eva
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Asenlöf, Pernilla
    Uppsala University, Uppsala, Sweden.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala University, Uppsala, Sweden.
    Lindberg, Per
    Uppsala University, Uppsala, Sweden.
    Musculoskeletal pain in primary health care: subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables2007In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 8, no 1, p. 67-74Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to identify and describe subgroup profiles based on self-reported pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing in patients with musculoskeletal pain. Two primary health care samples (n = 215 and n = 161) were used. Self-report questionnaires were completed at the start of physical therapy treatment. Cluster analysis was used to generate subgroups. Three subgroups were identified in sample 1 and replicated in sample 2. These were labeled "High self-efficacy-Low fear-avoidance," "Low self-efficacy-Low fear-avoidance," and "Low self-efficacy-High fear-avoidance." The subgroups differed significantly in work-status in both samples (P < .001), but not in age, gender, or duration of pain. The results show the presence of subgroups based on pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing. The profile patterns suggest that different management strategies may be relevant in each subgroup. PERSPECTIVE: This article presents subgroups of patients with musculoskeletal pain with different profiles in pain intensity, disability, and psychosocial variables possible to modify by physical therapy management. The results could potentially aid clinicians in tailoring assessment and treatment approaches to each subgroup.

  • 5.
    Emilson, C.
    et al.
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Asenlof, P.
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Pettersson, S.
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Karolinska Univ Hosp, Dept Rheumatol, Stockholm, Sweden..
    Bergman, S.
    Res & Dev Ctr Spenshult, Halmstad, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Martin, C.
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Demmelmaier, I
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    PHYSICAL THERAPISTS' ASSESSMENTS, ANALYSES AND USE OF BEHAVIORAL CHANGE TECHNIQUES IN INITIAL CONSULTATIONS ON MUSCULOSKELETAL PAIN: DIRECT OBSERVATIONS IN PRIMARY HEALTH CARE2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, p. S187-S187Article in journal (Other academic)
  • 6.
    Emilson, C.
    et al.
    Uppsala University, Uppsala, Sweden.
    Åsenlöf, P.
    Uppsala University, Uppsala, Sweden.
    Pettersson, S.
    Karolinska University, Sweden.
    Bergman, S.
    University of Gothenburg, Gothenburg, Sweden .
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Martin, C.
    Uppsala University, Uppsala, Sweden.
    Demmelmaier, I.
    Uppsala University, Uppsala, Sweden.
    Physical therapists' assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: Direct observations in primary health care2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 1, article id 316Article in journal (Refereed)
    Abstract [en]

    Background: Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain. Methods: A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice. Results: Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings. Conclusion: Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy. 

  • 7.
    Fritz, Johanna
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderbäck, Maja
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    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.
    The complexity of integrating a behavioral medicine approach into physiotherapy clinical practice2018In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed)
    Abstract [en]

    Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy is challenging, and studies regarding the determinants are sparse. Thus, the aim of this study was to explore determinants of applying a BM approach in physiotherapy for patients with persistent pain across the micro-, meso-, and macro-levels. Methods: A qualitative multiple-case study design was used. Data were collected from four cases through semi-structured interviews with physiotherapists (PTs), patients, and managers; observations of video-recorded treatment sessions; and reviews of local directives and regulations. Data were analyzed with inductive content analysis and cross-case analysis, followed by mapping to the domains of determinants at the micro-, meso-, and macro-levels within the Implementation of Change Model. Results: Similar determinants were found across the cases. At the micro-level, these determinants concerned the PTs’ ambivalence toward a BM approach, a biomedical focus, embarrassment asking about psychosocial factors, BM knowledge, skills for applying the approach, and self-awareness. Others concerned the patients’ role expectations of the PT, patients as active or passive agents in the treatment process, patients’ focus on biomedical aspects, and confidence in the PT. At the meso-level, support from managers and peers, allocation of time, and expectations from the organization were identified as determinants. No determinants were identified at the macro-level. Conclusion: The complexity of integrating a BM approach into physiotherapy clinical practice arises from multiple determinants functioning as both facilitators and barriers. By selecting strategies to address these determinants, the implementation of a BM approach could be supported.

  • 8.
    Fritz, Johanna
    et al.
    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.
    Almqvist, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wallin, Lars
    Högskolan Dalarna.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Implementation of a behavioural medicine approach in physiotherapy – a process evaluation.2017In: World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017., 2017Conference paper (Refereed)
    Abstract [en]

    Background: A behavioural medicine approach in physiotherapy for patients with persistent musculoskeletal pain is recommended based on evidence. The approach aims at an individually tailored treatment targeting motor behaviour, cognition, disability and active patient involvement. The behavioural medicine approach is complex and it is challenging in implementation to achieve clinically relevant behaviours in physiotherapy. Process evaluation is an essential part of designing and testing implementation interventions to improve the quality of the implementation. However, studies evaluating the implementation process of a behavioural medicine approach in physiotherapy are sparse.

    Purpose: To explore the implementation process of a behavioural medicine approach in physiotherapy.

    Methods: Qualitative and quantitative methods were used. 15 physiotherapists working in six primary health care units were consecutively included. A theory based implementation intervention was tailored to the participating individual physiotherapists. Active and multifaceted implementation strategies were used during a total of seven days spread over a six months implementation period. The main implementation strategies were external facilitation and peer-learning. Ten two-hours outreach sessions were offered to each unit. The physiotherapists were encouraged to use individual goal setting and video recordings of treatment sessions to facilitate feedback and reflection during the sessions with the external facilitator. Process data were collected using semi-structured interviews, self-reports of time allocation for different implementation strategies and documented individual goals. Qualitative content analysis and quantitative frequency scorings were used for data analyses.

    Results: In median the physiotherapists participated in 9 (3-10) out of 10 sessions with the external facilitator. Discussing clinical experiences of the behavioural medicine approach together with the external facilitator was perceived as valuable. These discussions stimulated reflection and problem solving, and was also experienced as a reminder for practicing skills in behavioural medicine. Video recordings of treatment sessions were used by ten of the physiotherapists at 17 out of 57 possible sessions. Video recordings were experienced as too complicated to use in relation to the gains. Lack of time was also considered as a barrier for using video recordings. Individual goal-setting from one session to the next with the external facilitator was frequently used by all the participants. Relevant skills for the goals were practiced in between the sessions. However, goal setting was not considered important by the physiotherapists. In median the physiotherapists spent 3.25 (0-9.5) hours for peer discussions. Peer discussions were a strategy that the physiotherapists wanted to continue with, even after the implementation intervention period. Even though the physiotherapists had permission from the manager to spend time on the implementation intervention, it was challenging for the physiotherapists to prioritize the implementation intervention before patient care.

    Conclusion(s): External facilitation and peer discussions were perceived as important strategies for stimulating practice of behavioural medicine skills in physiotherapy. Further, peer discussions could stimulate sustainability of the implementation. The physiotherapists needed support to use the designated time for the implementation.

    Implications: Quantitative and qualitative analyses of the implementation process is useful for understanding the mechanisms of impact for the implementation intervention, how outcomes were achieved and for future replications.

  • 9.
    Fritz, Johanna
    et al.
    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.
    Wallin, Lars
    Univ Dalarna, Falun, Sweden..
    Almqvist, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    THE EFFECT OF FACILITATION WHEN IMPLEMENTING A BEHAVIORAL MEDICINE APPROACH IN PHYSICAL THERAPY PRIMARY HEALTH CARE2018In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, p. S38-S38Article in journal (Other academic)
  • 10.
    Hellström, K.
    et al.
    Uppsala University, Sweden.
    Sandström, M.
    Uppsala University, Sweden.
    Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    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.
    Thors Adolfsson, E.
    Primary Care, Central Hospital Ing., Västerås, Sweden.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fall-related self-efficacy in instrumental activities of daily living is associated with falls in older community-living people2013In: Physical & Occupational Therapy in Geriatrics, ISSN 0270-3181, E-ISSN 1541-3152, Vol. 31, no 2, p. 128-139Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this study was to identify fall risk factors in community-living people 75 years or older. Methods: From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75-101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls. Results: The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93-21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers. Conclusion: Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.

  • 11.
    Manasatchakun, Pornpun
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Boromarajonani College of Nursing Udon Thani, Udon Thani, Thailand .
    Chotiga, Pleumjit
    Boromarajonani College of Nursing Chiang Mai, Chiang Mai, Thailand.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Roxberg, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. School of Health and Welfare, Halmstad University, Halmstad, Sweden; VID Specialized University, Bergen, Norway .
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Asp, Margareta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand2016In: Journal of Cross-Cultural Gerontology, ISSN 0169-3816, E-ISSN 1573-0719, Vol. 31, no 4, p. 369-384Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand’s aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors. 

  • 12.
    Sandborgh, Maria
    Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Screening, Targeting, Tailoring, and Implementation in Primary Health Care: An integrated physical therapy and behavioural medicine approach to persons with persistent musculoskeletal pain2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis deals with a behavioural medicine approach to the management of patients with persistent musculoskeletal pain in primary health care physical therapy. The main aims of the thesis were; to develop, and evaluate the psychometric properties of, a screening instrument for risk of disability and; to evaluate the implementation and effects of a targeted and tailored treatment.

    The studies comprise four samples of patients with musculoskeletal pain exceeding one month. All subjects were recruited when consulting physical therapists in Swedish primary health care settings. For development and evaluation of the Pain Belief Screening Instrument (PBSI) four samples were used; two samples (n1 = 215 and n2 = 93) in Study I, one sample (n = 168) in Study II, and one sample (n = 45) in Study III. For evaluation of implementation and effects of targeted and tailored treatment the 32 patients who completed treatment in Study III were used. In Study IV treatment documents of 18 patient cases from Study III were studied to evaluate treatment integrity.

    The concurrent and predictive validity of the PBSI was good, and the instrument was therefore used to define subgroups with either a high or low risk for disability. A low treatment dosage of a tailored treatment for low risk patients was tried and found equally efficient as a longer treatment focusing physical exercise. Subjects who received a treatment tailored to individual patient characteristics perceived a better global outcome of treatment compared to subjects in the control group. However, no between-group differences in the disability measures were found. The evaluation of treatment integrity displayed low therapist adherence to the treatment rationale for the tailored treatment.

    The studies demonstrate ways to systematically integrate a behavioural medicine approach and physical therapy. The results indicate efficiency in managing patients with persistent musculoskeletal pain in primary health care.

  • 13.
    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.

  • 14.
    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)
  • 15.
    Sandborgh, Maria
    et al.
    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.
    The relation between the fear-avoidance model and constructs from the social cognitive theory in acute WAD2016In: Pain Research & Management, ISSN 1203-6765, E-ISSN 1918-1523, Vol. 2016, article id 8281926Article in journal (Refereed)
    Abstract [en]

    In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disabling process in whiplash associated disorder (WAD). The aim was to exemplify the possible input from Social Cognitive Theory on the FA model.Specifically the role of functional self-efficacy and perceived responses from a spouse/intimate partner was studied. A cross-sectional and correlational design was used. Data from 64 patients with acute WAD were used. Measures were pain intensity measured with a numerical rating scale, the Pain Disability Index, support, punishing responses, solicitous responses, and distracting responses subscales from the Multidimensional Pain Inventory, the Catastrophizing subscale from the Coping Strategies Questionnaire, the Tampa Scale of Kinesiophobia, and the Self-Efficacy Scale. Bivariate correlational, simple linear regression, and multiple regression analyses were used. In the statistical prediction models high pain intensity indicated high punishing responses, which indicated high catastrophizing. High catastrophizing indicated high fear of movement, which indicated low self-efficacy. Low self-efficacy indicated high disability, which indicated high pain intensity. All independent variables together explained 66.4% of the variance in pain disability, p < 0.001. Results suggest a possible link between one aspect of the social environment, perceived punishing responses from a spouse/intimate partner, pain intensity, and catastrophizing. Further, results support a mediating role of self-efficacy between fear of movement and disability in WAD.

  • 16.
    Sandborgh, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala Universitet, Sweden.
    Lindberg, Per
    Uppsala Universitet, Sweden.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala Universitet, Sweden.
    Pain belief screening instrument: Development and preliminary validation of a screening instrument for disabling persistent pain2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 6, p. 461-466Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To develop and test the ability of a screening instrument to identify subgroups among primary healthcare patients with musculoskeletal pain. The Pain Belief Screening Instrument covers pain intensity, disability, self-efficacy, fear avoidance and catastrophizing. DESIGN: Cross-sectional, correlational and comparative study. SUBJECTS: Patients in primary healthcare (n1 = 215; n2 = 93) with a pain duration of 4 weeks or more were included. METHODS: Items for the Pain Belief Screening Instrument were derived from principal component analyses of: the Self-efficacy Scale, the Tampa Scale of Kinesiophobia and the Catastrophizing subscale in the Coping Strategies Questionnaire. Cluster solutions of scores on the screening instrument and the original instruments were cross-tabulated. The reliability of items in the Pain Belief Screening Instrument was examined. RESULTS: The screening instrument identified 2 groups: high- or low-risk profile for pain-related disability. Validity was in-between moderate and substantial (kappa = 0.61, p < 0.001). The reliability of each item in the Pain Belief Screening Instrument in relation to the corresponding item in the original instruments was moderate to high (rs 0.50-0.80, p < 0.01). CONCLUSION: The screening instrument fairly well replicated subgroups identified by the original instruments. The reliability of items in the screening instrument was acceptable. Further testing of predictive validity for a primary healthcare population is needed..

  • 17.
    Sandborgh, Maria
    et al.
    Uppsala University, Uppsala, Sweden.
    Lindberg, Per
    Uppsala University, Uppsala, Sweden.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala University, Uppsala, Sweden.
    The Pain Belief Screening Instrument (PBSI): predictive validity for disability status in persistent musculoskeletal pain2008In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 15, p. 1123-30Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated. METHOD: Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement. RESULTS: The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks' lambda = 0.848, p < 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months. CONCLUSION: The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.

  • 18.
    Sandborgh, Maria
    et al.
    Uppsala University, Uppsala, Sweden.
    Lindberg, Per
    Uppsala University, Uppsala, Sweden.
    Åsenlöf, Pernilla
    Uppsala University, Uppsala, Sweden.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala University, Uppsala, Sweden.
    Implementing behavioural medicine in physiotherapy treatment: Part I: Clinical trial2010In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 1, p. 2-12Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the capacity of the Pain Belief Screening Instrument (PBSI) to discriminate between subgroups for targeting of treatment, investigate effects of treatment tailored to patients' individual and functional goals, and identify a suitable treatment dosage for patients with low risk of disability. Explorative study, Part I. Design: Randomized, controlled clinical trial with four treatment conditions. Methods: Patients in primary healthcare (n=45) with musculoskeletal pain for ≥4 weeks were included. PBSI-identified subgroups were validated by comparing scores on four established instruments. Measures of disability and patients' ratings of global outcome were used to examine treatment effect. Results: PBSI data adequately defined patients with either high or low risk of disability. Patients in the tailored treatment rated global outcome as better than in the non-tailored treatment. No differences were found on disability measures. For the low-risk group, the brief tailored treatment was as effective as the non-targeted control treatment. Conclusion: The PBSI adequately defined subgroups. Tailored treatment was partially superior to physical exercise treatment. Targeting by treatment dosage was effective for low-risk patients but remains to be investigated for high-risk patients. Treatment integrity for tailored treatments was compromised and is to be further explored in the following study.

  • 19.
    Sandborgh, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderbäck, Maja
    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.
    The intention – action gap when using a behavioral medicine approach in physiotherapy for patients with persistent musculoskeletal pain.2017In: World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017, 2017Conference paper (Refereed)
  • 20.
    Sandborgh, Maria
    et al.
    Uppsala University, Uppsala, Sweden.
    Åsenlöf, Pernilla
    Uppsala University, Uppsala, Sweden.
    Lindberg, Per
    Uppsala University, Uppsala, Sweden.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala University, Uppsala, Sweden.
    Implementing behavioural medicine in physiotherapy treatment: Part II: Adherence to treatment protocol2010In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 1, p. 13-23Article in journal (Refereed)
    Abstract [en]

    Objectives: In a controlled clinical trial, targeted and tailored treatment strategies, based on cognitive–behavioural treatment principles were investigated. The intervention was aimed at patients with persistent musculoskeletal pain in primary healthcare. A preliminary examination indicated low treatment integrity for the tailored treatment. Therefore, the aim in this study was to evaluate physiotherapists' treatment adherence to a treatment tailored to physical, cognitive and behavioural factors of importance for the performance of patients' prioritized activities. Explorative study, Part II. Materials and Methods: Treatment documents for 18 patients, treated by four specially trained physiotherapists, were utilized for assessment of treatment adherence. A treatment integrity measure was developed, tested and used for evaluation of adherence to the treatment protocol. Results: Physiotherapists' adherence to the treatment manual was low concerning treatment components and the overall sequencing of the treatment. Intrapersonal physical and cognitive factors, and situational variations tied to the performance of prioritized activities targeted in treatment, were rarely found or specified in treatment documents. Statements about functional and causal relationships between determinants for activity performance were not documented or unspecified. Conclusion: The physiotherapists' adherence to the treatment protocol was low despite the pre-intervention training programme and supervision during the intervention period.

  • 21.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    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.
    Is self-efficacy and catastrophizing in pain-related disability mediated by control over pain and ability to decrease pain in whiplash-associated disorders?2017In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 5, p. 376-385Article in journal (Refereed)
    Abstract [en]

    Pain perception is influenced by several cognitive and behavioral factors of which some identified as mediators are important in pain management. We studied the mediating role of control over pain and ability to decrease pain in relation to functional self-efficacy, catastrophizing, and pain-related disability in patients with Whiplash-Associated Disorders, (WAD). Further, if the possible mediating impact differs over time from acute to three and 12 months after an accident, cross-sectional and prospective design was used, and 123 patients with WAD were included. Regression analyses were conducted to examine the mediating effect. The results showed that control over pain and ability to decrease pain were not mediators between self-efficacy, catastrophizing, and disability. Self-efficacy had a larger direct effect on pain-related disability compared to catastrophizing. Thus, healthcare staff should give priority to increase patients' self-efficacy, decrease catastrophic thinking, and have least focus on control over pain or ability to decrease pain.

  • 22.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson, Ann-Christin
    The fear avoidance model; does punishing responses of significant other and self-efficacy in activities have role in the model2013Conference paper (Refereed)
  • 23.
    Yuwanich, Nuttapol
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Rangsit Univ, Sch Nursing Sci, Ptumthani, Thailand..
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nantsupawat, Walaiporn
    Rangsit Univ, Sch Nursing Sci, Ptumthani, Thailand..
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Development and psychometric properties of the stressor scale for emergency nurses2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 39, p. 77-88Article in journal (Refereed)
    Abstract [en]

    Introduction: Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses. Methods: The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated. Results: The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and families' actions and reactions, Technical and formal support, and Conflicts. The Cronbach's alpha values ranged from 0.89 to 0.93 per factor, and the intra-class correlation coefficient was 0.89, indicating good homogeneity and stability. Conclusions: The instrument's content, face, and construct validities were satisfactory, and the internal consistency and test-retest reliability were good. This instrument can be useful in the management of emergency departments.

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