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A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients. Is sick leave outcome dependent on psychologically derived patient groups?

https://arctichealth.org/en/permalink/ahliterature149098
Source
Eur J Pain. 2010 Apr;14(4):426-33
Publication Type
Article
Date
Apr-2010
Author
Gunnar Bergström
Cecilia Bergström
Jan Hagberg
Lennart Bodin
Irene Jensen
Author Affiliation
Karolinska Institutet, Division of Intervention and Implementation Research, Department of Public Health Sciences, Stockholm, Sweden.
Source
Eur J Pain. 2010 Apr;14(4):426-33
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Absenteeism
Adult
Back Pain - classification - psychology - rehabilitation
Cost-Benefit Analysis
Costs and Cost Analysis
Disability Evaluation
Female
Follow-Up Studies
Humans
Income
Male
Middle Aged
Neck Pain - classification - psychology - rehabilitation
Pain Measurement
Patient care team
Pensions
Prognosis
Risk
Sick Leave - economics - statistics & numerical data
Sweden - epidemiology
Treatment Outcome
Abstract
A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
PubMed ID
19683950 View in PubMed
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Adverse outcomes of sick leave due to mental disorders: A prospective study of discordant twin pairs.

https://arctichealth.org/en/permalink/ahliterature299213
Source
Scand J Public Health. 2019 Mar; 47(2):127-136
Publication Type
Journal Article
Date
Mar-2019
Author
Lisa Mather
Victoria Blom
Gunnar Bergström
Pia Svedberg
Author Affiliation
1 Division of Insurance Medicine, Karolinska Institutet, Sweden.
Source
Scand J Public Health. 2019 Mar; 47(2):127-136
Date
Mar-2019
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Female
Humans
Male
Mental Disorders - epidemiology
Middle Aged
Prospective Studies
Sick Leave - statistics & numerical data
Sweden - epidemiology
Twins - psychology - statistics & numerical data
Young Adult
Abstract
The aim of this study was to investigate whether sick leave due to different mental disorders increased the risk of reoccurring sick-leave, disability pension and unemployment, taking genetics and shared environment into account.
This register-based cohort study contains 2202 discordant twin pairs 18-64 years old, where one twin had sick leave due to a mental disorder 2005-2006. The end of the sick-leave spell was the start of follow-up for both twins. The twins were followed up for reoccurring sick-leave, disability pension and unemployment (> 180 days in a year), until December 2012. Analyses were censored for disability pension, death, emigration and old-age pension. Cox proportional hazards models with time-varying covariates were used to calculate hazard ratios with 95% confidence intervals (CI).
Those with sick leave due to mental disorders had a 3.64 (CI: 3.24-4.08) times higher risk of reoccurring sick-leave within the first two years; after that, hazard ratios were attenuated and explained by genetic factors. The first year, they had 12.24 (CI: 8.11-18.46) times the risk of disability pension. The risk was attenuated but remained at 2.75 (CI: 2.07-3.65) after one year. The risk of unemployment was 1.99 (CI: 1.72-2.31) during the whole follow-up period. The risk of unemployment and disability pension was lower for those with stress-related than other mental disorders, this was less clear for recurrent reoccuring sick-leave.
Sick leave due to mental disorders increased the risk of reoccurring sick-leave within two years, disability pension and unemployment, independent of genetics and shared environment.
PubMed ID
29032743 View in PubMed
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An Underlying Common Factor, Influenced by Genetics and Unique Environment, Explains the Covariation Between Major Depressive Disorder, Generalized Anxiety Disorder, and Burnout: A Swedish Twin Study.

https://arctichealth.org/en/permalink/ahliterature286745
Source
Twin Res Hum Genet. 2016 Dec;19(6):619-627
Publication Type
Article
Date
Dec-2016
Author
Lisa Mather
Victoria Blom
Gunnar Bergström
Pia Svedberg
Source
Twin Res Hum Genet. 2016 Dec;19(6):619-627
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anxiety Disorders - epidemiology - genetics - pathology
Burnout, Professional - epidemiology - genetics - pathology
Depressive Disorder, Major - epidemiology - genetics - pathology
Diseases in Twins - epidemiology - genetics - pathology
Environment
Female
Humans
Male
Middle Aged
Risk factors
Sweden
Twins, Dizygotic - genetics
Twins, Monozygotic - genetics
Young Adult
Abstract
Depression and anxiety are highly comorbid due to shared genetic risk factors, but less is known about whether burnout shares these risk factors. We aimed to examine whether the covariation between major depressive disorder (MDD), generalized anxiety disorder (GAD), and burnout is explained by common genetic and/or environmental factors. This cross-sectional study included 25,378 Swedish twins responding to a survey in 2005-2006. Structural equation models were used to analyze whether the trait variances and covariances were due to additive genetics, non-additive genetics, shared environment, and unique environment. Univariate analyses tested sex limitation models and multivariate analysis tested Cholesky, independent pathway, and common pathway models. The phenotypic correlations were 0.71 (0.69-0.74) between MDD and GAD, 0.58 (0.56-0.60) between MDD and burnout, and 0.53 (0.50-0.56) between GAD and burnout. Heritabilities were 45% for MDD, 49% for GAD, and 38% for burnout; no statistically significant sex differences were found. A common pathway model was chosen as the final model. The common factor was influenced by genetics (58%) and unique environment (42%), and explained 77% of the variation in MDD, 69% in GAD, and 44% in burnout. GAD and burnout had additive genetic factors unique to the phenotypes (11% each), while MDD did not. Unique environment explained 23% of the variability in MDD, 20% in GAD, and 45% in burnout. In conclusion, the covariation was explained by an underlying common factor, largely influenced by genetics. Burnout was to a large degree influenced by unique environmental factors not shared with MDD and GAD.
PubMed ID
27620693 View in PubMed
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Clustering patients on the basis of their individual course of low back pain over a six month period.

https://arctichealth.org/en/permalink/ahliterature134441
Source
BMC Musculoskelet Disord. 2011;12:99
Publication Type
Article
Date
2011
Author
Iben Axén
Lennart Bodin
Gunnar Bergström
Laszlo Halasz
Fredrik Lange
Peter W Lövgren
Annika Rosenbaum
Charlotte Leboeuf-Yde
Irene Jensen
Author Affiliation
The Karolinska Institutet, Institute of Environmental Medicine, Sweden. iben.axen@ki.se
Source
BMC Musculoskelet Disord. 2011;12:99
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cellular Phone
Cluster analysis
Female
Humans
Low Back Pain - diagnosis - epidemiology - therapy
Male
Manipulation, Chiropractic
Middle Aged
Pain Measurement
Prognosis
Prospective Studies
Questionnaires
Sweden - epidemiology
Time Factors
Young Adult
Abstract
Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain.
This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain.
Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters.
It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.
Notes
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PubMed ID
21586117 View in PubMed
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The covariation between burnout and sick leave due to mental disorders is explained by a shared genetic liability: a prospective swedish twin study with a five-year follow-up.

https://arctichealth.org/en/permalink/ahliterature261078
Source
Twin Res Hum Genet. 2014 Dec;17(6):535-44
Publication Type
Article
Date
Dec-2014
Author
Lisa Mather
Gunnar Bergström
Victoria Blom
Pia Svedberg
Source
Twin Res Hum Genet. 2014 Dec;17(6):535-44
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adult
Burnout, Professional - epidemiology - genetics
Diseases in Twins - epidemiology - genetics
Female
Follow-Up Studies
Humans
Male
Mental Disorders - epidemiology - genetics
Middle Aged
Prospective Studies
Sick Leave - statistics & numerical data
Sweden
Time Factors
Young Adult
Abstract
This study aims to assess whether the associations between burnout and sick leave due to stress-related mental disorders, other mental disorders, and somatic conditions are influenced by familial (genetic and shared environmental) factors.
In this prospective cohort study, 23,611 Swedish twins born between 1959 and 1985, who answered a web-based questionnaire, including the Pines Burnout Measure 2004-2006, were included. Registry data on sick leave spells from the response date until December 31, 2010 were obtained from the Swedish Social Insurance Agency. Logistic regression analysis was performed to assess odds ratios with 95% confidence intervals for the association between burnout and sick leave for the whole sample, while conditional logistic regression of the same-sex discordant twin pairs was used to estimate the association between burnout and sick leave, adjusting for familial confounding. The Bivariate Cholesky models were used to assess whether the covariation between burnout and sick leave was explained by common genetic and/or shared environmental factors.
Burnout was a risk factor for sick leave due to stress-related and other mental disorders, and these associations were explained by familial factors. The phenotypic correlation between burnout and sick leave due to somatic conditions was 0.07 and the association was not influenced by familial factors. The phenotypic correlations between burnout and sick leave due to stress-related (0.26) and other mental disorders (0.30) were completely explained by common genetic factors.
The association between burnout and sick leave due to stress-related and other mental disorders seems to be a reflection of a shared genetic liability.
PubMed ID
25091089 View in PubMed
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Cultural adaptation and validation of the Swedish VEINES-QOL/Sym in patients with venous insufficiency.

https://arctichealth.org/en/permalink/ahliterature296027
Source
Phlebology. 2018 Sep; 33(8):540-546
Publication Type
Journal Article
Date
Sep-2018
Author
Helen Sinabulya
Gunnar Bergström
Jan Hagberg
Gunnar Johansson
Lena Blomgren
Author Affiliation
1 Department of Molecular Medicine and Surgery, Division of Vascular Surgery, Karolinska Institutet, Stockholm, Sweden.
Source
Phlebology. 2018 Sep; 33(8):540-546
Date
Sep-2018
Language
English
Publication Type
Journal Article
Keywords
Adaptation, Psychological
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Middle Aged
Surveys and Questionnaires
Sweden - epidemiology
Venous Insufficiency - epidemiology - psychology
Abstract
Objectives To translate and evaluate the psychometric properties of the Venous Insufficiency Epidemiological and Economic Studies (VEINES) questionnaire, divided into two subscales; symptoms (VEINES-Sym) and quality of life (VEINES-QOL), in a Swedish cohort of patients with venous disease. Methods The original questionnaire was translated into Swedish with forward-backward translation and administered to 112 patients who were consecutively recruited and had varying degrees of chronic venous disease. Mean age was 54.5?±?15.2 years (range: 19-83) and 75% of the participants were female. All patients completed the RAND 36-item health survey and the VEINES-QOL/Sym. Results The results showed excellent internal consistency for both VEINES-QOL (Cronbach's alpha (a)?=?0.93) and VEINES-Sym (a?=?0.89). Both the VEINES-QOL and VEINES-Sym correlated well to all the RAND-36 domains, demonstrating good construct validity. Exploratory factor analysis confirmed both subscales of the VEINES-QOL/Sym. Conclusions The Swedish VEINES-QOL/Sym is a valid health-related quality of life instrument for chronic venous disease, both for research purposes and for clinical evaluation.
PubMed ID
28954585 View in PubMed
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Development of evidence-based practice in occupational health services in Sweden: a 3-year follow-up of attitudes, barriers and facilitators.

https://arctichealth.org/en/permalink/ahliterature285386
Source
Int Arch Occup Environ Health. 2017 May;90(4):335-348
Publication Type
Article
Date
May-2017
Author
Elisabeth Björk Brämberg
Teresia Nyman
Lydia Kwak
Akbar Alipour
Gunnar Bergström
Liselotte Schäfer Elinder
Ulric Hermansson
Irene Jensen
Source
Int Arch Occup Environ Health. 2017 May;90(4):335-348
Date
May-2017
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Clinical Competence - statistics & numerical data
Evidence-Based Practice - methods - organization & administration
Female
Follow-Up Studies
Humans
Male
Middle Aged
Occupational Health Services - methods - organization & administration
Qualitative Research
Surveys and Questionnaires
Sweden
Abstract
The Swedish government initiated an investigation of how to secure and develop the competence of the occupational health services. The primary aim of the present study was to investigate whether the development of evidence-based practice (EBP) in the Swedish occupational health services in relation to attitudes, knowledge and use improved during the first 3 years of the government's initiative.
The study has a mixed methods design combining questionnaires and interviews with data collection at baseline and at 3-year follow-up.
The response rate was 66% at baseline and 63% at follow-up. The results show that practitioners' knowledge of EBP was moderate at baseline and improved at follow-up (p?=?0.002; 95% CI 0.01; 0.21). Practitioners experienced lower levels of organizational and managerial support for EBP at follow-up (p?
Notes
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PubMed ID
28204870 View in PubMed
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Does sickness presenteeism have an impact on future general health?

https://arctichealth.org/en/permalink/ahliterature150508
Source
Int Arch Occup Environ Health. 2009 Nov;82(10):1179-90
Publication Type
Article
Date
Nov-2009
Author
Gunnar Bergström
Lennart Bodin
Jan Hagberg
Tomas Lindh
Gunnar Aronsson
Malin Josephson
Author Affiliation
Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. gunnar.bergstrom@ki.se
Source
Int Arch Occup Environ Health. 2009 Nov;82(10):1179-90
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Absenteeism
Adult
Female
Health status
Humans
Male
Middle Aged
Occupational Health
Private Sector
Prospective Studies
Public Sector
Risk factors
Socioeconomic Factors
Sweden
Abstract
The primary aim of this prospective study was to investigate whether working despite illness, so called "sickness presenteeism", has an impact on the future general health of two different working populations during a follow-up period of 3 years.
The study was based on two bodies of data collected at a number of Swedish workplaces from 1999 to 2003. The first material comprised 6,901 employees from the public sector and the second 2,862 subjects from the private sector. A comprehensive survey was issued three times: at baseline, after 18 months and after 3 years. Apart from the explanatory variable sickness presenteeism, several potential confounders were considered. The outcome variable was good/excellent versus fair/poor self-reported health.
Sickness presenteeism at baseline was consistently found to heighten the risk of fair/poor health at both the 18-month and 3-year follow ups even after adjusting for the detected confounders.
To the best of the authors' knowledge, this study is the first to show that sickness presenteeism appears to be an independent risk factor for future fair/poor general health.
PubMed ID
19504117 View in PubMed
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Do psychological and behavioral factors classified by the West Haven-Yale Multidimensional Pain Inventory (Swedish version) predict the early clinical course of low back pain in patients receiving chiropractic care?

https://arctichealth.org/en/permalink/ahliterature277299
Source
BMC Musculoskelet Disord. 2016 Feb 12;17:75
Publication Type
Article
Date
Feb-12-2016
Author
Andreas Eklund
Gunnar Bergström
Lennart Bodin
Iben Axén
Source
BMC Musculoskelet Disord. 2016 Feb 12;17:75
Date
Feb-12-2016
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Early Diagnosis
Female
Follow-Up Studies
Humans
Low Back Pain - diagnosis - epidemiology - psychology - therapy
Male
Manipulation, Chiropractic - psychology
Middle Aged
Pain Measurement - psychology
Predictive value of tests
Prospective Studies
Surveys and Questionnaires
Sweden - epidemiology
Abstract
To investigate if psychological and behavioral factors (as determined by the Swedish version of the West Haven-Yale Multidimensional Pain Inventory, MPI-S) can predict the early clinical course of Low Back Pain (LBP).
MPI-S data from patients (18-65 years of age) seeking chiropractic care for recurrent and persistent LBP were collected at the 1(st) visit. A follow-up questionnaire was administered at the 4(th) visit. The predictive value of the MPI-S subgroups Adaptive Copers (AC), Interpersonally Distressed (ID) and Dysfunctional (DYS) was calculated against the subjective improvement at the 4(th) visit and clinically relevant difference in pain intensity between the 1(st) and 4(th) visit.
Of the 666 subjects who were included at the 1(st) visit, 329 completed the questionnaire at the 4(th) visit. A total of 64.7 % (AC), 68.0 % (ID) and 71.3 % (DYS) reported a definite improvement. The chance of "definite improvement", expressed as relative risk (95 % CI) with the AC group as reference, was 1.05 (.87-1.27) for the ID and 1.10 (.93-1.31) for the DYS groups, respectively. The DYS and ID groups reported higher values in pain intensity both at the 1(st) and the 4(th) visit. The proportion of subjects who reported an improvement in pain intensity of 30 % or more (clinically relevant) were 63.5 % AC, 72.0 % ID and 63.2 % DYS. Expressed as relative risk (95 % CI) with the AC group as reference, this corresponded to 1.26 (.91-1.76) for the ID and 1.09 (.78-1.51) for the DYS groups, respectively.
The MPI-S instrument could not predict the early clinical course of recurrent and persistent LBP in this sample of chiropractic patients.
Clinical trials.gov; NCT01539863 , February 22, 2012.
Notes
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PubMed ID
26867930 View in PubMed
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Effectiveness of different interventions using a psychosocial subgroup assignment in chronic neck and back pain patients: a 10-year follow-up.

https://arctichealth.org/en/permalink/ahliterature130575
Source
Disabil Rehabil. 2012;34(2):110-8
Publication Type
Article
Date
2012
Author
Cecilia Bergström
Irene Jensen
Jan Hagberg
Hillevi Busch
Gunnar Bergström
Author Affiliation
Public Health Sciences, Intervention and Implementation Research (IIR), Stockholm, Sweden. cecilia.bergstrom@ki.se
Source
Disabil Rehabil. 2012;34(2):110-8
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Chronic Disease
Cognitive Therapy - methods
Combined Modality Therapy
Disability Evaluation
Female
Follow-Up Studies
Humans
Low Back Pain - rehabilitation
Male
Middle Aged
Neck Pain - rehabilitation
Patient Compliance - psychology
Physical Therapy Modalities
Quality of Life
Questionnaires
Sick Leave
Social Support
Sweden
Time Factors
Treatment Outcome
Young Adult
Abstract
The aim of this study was to evaluate the potential interaction between treatment content and subgroups according to the Swedish version of the Multidimensional Pain Inventory (MPI-S) on the effect on sickness absence during a 10-year follow-up in a population with chronic neck pain (NP) and/or low back pain (LBP).
This study is based on a randomized controlled multicentre trial with a 10-year follow-up using the MPI-S and included 214 participants. The interventions consisted of Behavioural-oriented Physiotherapy (PT), Cognitive Behavioural Therapy (CBT), Behavioural Medicine Rehabilitation (BM), and a "treatment-as-usual" control group (CG).
There appears to be a difference in the development of sickness absence after rehabilitation for the adaptive coper (AC) group even though the result did not reach statistical significance. AC seems to respond most favourably to the multidisciplinary programme compared to the CG. The development of sickness absence after intervention among interpersonally distressed (ID) and dysfunctional (DYS) patients were similar across all three treatment alternatives as well as CG.
In terms of long-term follow-up of sickness absence, the multidisciplinary programme appears to be most beneficial for DYS and AC patients. In contrast, the CBT and PT interventions failed to benefit any patient group.
PubMed ID
21988525 View in PubMed
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