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Biomedical subjects

Jan Ekholm

Publications and source records attributed to Jan Ekholm.

At least 19 recordsLinked to original sources
PubMed2006

'A constant struggle': successful strategies of women in work despite fibromyalgia.

PURPOSE: This study aimed to explore, and obtain increased knowledge of, the strategies used by working women with fibromyalgia regarding control of pain, fatigue and other symptoms. METHOD: Qualitative methods with an emergent design were used. The informants were women with fibromyalgia who had participated in rehabilitation 6-8 years earlier, and were still in work. Diaries, focus groups and individual interviews were used for data collection. Content analysis and grounded theory were used for the analyses. RESULTS: A model with three categories emerged. The core category 'constant struggle' contains eight sub-categories: enjoying life, taking care of oneself, positive thinking, setting limits, using pain as a guide, creative solutions, learning/being knowledgeable and 'walking a tightrope'. The category 'grieving process' was a prerequisite for managing the struggle and the category 'social support' contained what facilitated the struggle. CONCLUSION: The informants fought a constant struggle against the symptoms and the consequences of their fibromyalgia. Their strategies were action-oriented and evinced a positive spirit. To have grieved and accepted their situation was a prerequisite for managing, and support from the family was a help in the struggle.

Adaptation, Psychological↗
PubMed2006

Effects on work resumption of a co-operation project in vocational rehabilitation. Systematic, multi-professional, client-centred and solution-oriented co-operation.

PURPOSE: The present aim was to evaluate the effect of systematic multi-professional co-ordinated rehabilitation (the Stockholm Co-operation Project) on the number of days' sick leave during the first and second half-years after the rehabilitation co-ordination period, compared to the year before. Another aim was to evaluate the economic effects at national level. METHOD: A matched-pairs design was used. The study group was based on 64 rehabilitees employed by a public employer in Stockholm, who took part in a systematic multi-professional co-operation project. To obtain pairs, the 64 individuals were individually matched with 64 people who received conventionally organised rehabilitation. Thus, there were 128 subjects altogether. RESULTS: The study group had substantially less sick leave days per month than the comparison group during the second half-year after the rehabilitation co-ordination period. The effect was even greater in a subgroup with more previous sick leave. During the first half-year after the intervention the comparison group had relatively more sick leave. No effect was found for a subgroup with less previous sick leave. The economic benefit of the intervention was estimated to 1,278 euros per month and person based on the whole group, and to 2,405 euros per month and person based on those with more sick leave. CONCLUSIONS: People who undergo co-ordinated rehabilitation have more working days after the intervention period than those with conventional rehabilitation. This way for rehabilitation actors to co-operate gives better outcomes for rehabilitation cases with long previous sick leave, but not for cases with less previous sick leave. It also generates economic gains at several levels.

Case-Control Studies↗
PubMed2006

Ethnic background does not influence outcome for return-to-work in work-related interdisciplinary rehabilitation for long-term pain: 1- and 3-year follow-up.

BACKGROUND: It is often suggested that immigrants with long-term pain do not benefit from rehabilitation to the same extent as native Swedish patients. In this study, an 8-week rehabilitation programme was evaluated according to its adaptation for immigrants. OBJECTIVES: To establish whether there is a difference between immigrants and native Swedes concerning: (i) return-to-work, the patients' own estimation and their actual ability; (ii) higher level of activity; (iii) reduction in pain and analgesic use. PATIENTS: A total of 67 patients with persistent non-malignant pain completed the rehabilitation programme. Thirty (45%) of the patients were immigrants. METHODS: A 1- and a 3-year follow-up were made to compare the outcome between the 2 groups. RESULTS: There was no significant difference in the return-to-work rate between immigrants and native Swedes. However, the patients' prediction of their ability to return to work was higher among the non-immigrants. The level of activity was lower and pain intensity and use of analgesics were higher among the immigrants than the non-immigrants. CONCLUSION: Immigrants can benefit from a rehabilitation programme to the same extent as native Swedes concerning return-to-work rate, but seem to have limitations in assimilating the other objectives of the programme.

Adult↗
PubMed2006

Agreement of a work-capacity assessment with the World Health Organisation International Classification of Functioning, Disability and Health pain sets and back-to-work predictors.

The degree of agreement between a clinical multi-professional work-capacity assessment and the Comprehensive World Health Organisation International Classification of Functioning, Disability and Health (ICF) Core Sets for chronic pain and risk factors for no return to work was investigated. A review of data records and interviews with team members included measures of body function/structure, activities/participation and environmental factors. Predictors for return to work were reviewed. The team used eight different methods for data collection. Of the 29 categories concerning environmental factors, two were excluded; the methods used were more unstructured, e.g. interviews. The agreement with the 41 predictors of work resumption was high. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for the components body function, body structure, activities and participation. Nine categories out of 69 were not included. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for chronic pain conditions and with 40 predictors of work resumption. Clinically speaking, however, the current work-capacity assessment lacks on-the-job site evaluations and this most certainly affects reliability. The same is true for ICF, although the structure lacks proper coding for relevant factors found at work.

Humans↗
PubMed2005

Can the back-to-work rate of patients with long-term non-malignant pain be predicted?

The objective of this study was to evaluate the outcome of a structured multidisciplinary rehabilitation programme regarding the return-to-work rate. Sixty-seven patients were enrolled in an 8-week, structured rehabilitation programme. The prediction of the return-to-work rate was evaluated before entering the programme. The patients' own perception of returning to work as well as their pain intensity were estimated on a visual analogue scale and their period of sick leave was also recorded. The multidisciplinary rehabilitation team made an impairment and disability evaluation and analysis (IDEA) to assess possible work ability. This evaluation was made during the first 3 weeks of the 8-week programme. The return-to-work rate was also evaluated by means of the modified somatic perception questionnaire (MSPQ) and the disability rating index (DRI) before entering the programme. The results were compared with the actual return-to-work rate 1 year after completing the programme. A comparison group of 14 patients who were rejected due to lack of space in the programme was used in this study. There was a positive, statistically significant correlation (P<0.01) between the evaluation of the multidisciplinary rehabilitation team and the actual outcome of the return-to-work rate 1 year after completing the programme. At the 1-year follow-up, 63% of the patients had returned to work or were in work-related activities. The results on MSPQ or DRI, the patients' own perception of returning to work, the pain intensity, age or the period of time out of work did not predict the return-to-work ability. This study has shown that 63% of the patients with long-term non-malignant pain were back to work or in work-related activities 1 year after completing the rehabilitation programme. The IDEA made by the rehabilitation team was crucial in predicting the return-to-work rate in this patient group. The MSPQ and DRI questionnaires, the patients' own prediction, pain intensity, age and time out of work had a low value for predicting the return-to-work rate following a structured multidisciplinary rehabilitation programme.

Adult↗
PubMed2005

Disability pension despite vocational rehabilitation? A study from six social insurance offices of a county.

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.

Adult↗
PubMed2005

Do systematic multiprofessional rehabilitation group meetings improve efficiency in vocational rehabilitation?

PURPOSE: The aim of the present study was to investigate differences in the effects on employment between clients whose rehabilitation was coordinated in systematic multiprofessional rehabilitation group meetings and clients whose rehabilitation was coordinated in the "conventional" way. METHOD: The study was based on a sample of 51 individuals who received systematic group meeting coordination. All individuals in the study group were unemployed before the rehabilitation intervention. Two different comparison groups were chosen: one at a local level and another at a national level. The groups were matched on an individual level based on records obtained from The National Labour Market Board (AMS) and The National Social Insurance Board (RFV). The data were analysed by an analysis of variance (ANOVA) for repeated measures for binary responses. RESULTS: 68.6% in the study group and 49% in both the local comparison group and national group had some form of employment 24 months after rehabilitation. The ANOVA analyses (in terms of odds ratio) found that when all measurement points (6, 12 and 24 months after the rehabilitation) were included in the calculations that there was twice as high a chance of becoming employed after having received rehabilitation services through the multiprofessional group than for both comparison groups. The majority of employment in all the groups was associated with some form of subsidy or sheltered employment.

Adolescent↗
PubMed2004

BODIL: a molecular modeling environment for structure-function analysis and drug design.

BODIL is a molecular modeling environment geared to help the user to quickly identify key features of proteins critical to molecular recognition, especially (1) in drug discovery applications, and (2) to understand the structural basis for function. The program incorporates state-of-the-art graphics, sequence and structural alignment methods, among other capabilities needed in modern structure-function-drug target research. BODIL has a flexible design that allows on-the-fly incorporation of new modules, has intelligent memory management, and fast multi-view graphics. A beta version of BODIL and an accompanying tutorial are available at http://www.abo.fi/fak/mnf/bkf/research/johnson/bodil.html.

Algorithms↗
PubMed2004

From shame to respect: musculoskeletal pain patients' experience of a rehabilitation programme, a qualitative study.

OBJECTIVE: This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained. DESIGN, METHODS AND SUBJECTS: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison. RESULTS: One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over one's employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively. CONCLUSION: The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment.

Adult↗
PubMed2004

Work resumption or not after rehabilitation? A descriptive study from six social insurance offices.

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.

Adolescent↗
PubMed2002

Improved cooperation in vocational rehabilitation with systematic rehabilitation group meetings.

PURPOSE: The present aim was to investigate the communicative pattern in two rehabilitation groups. The rehabilitation group consisted of the client, a supervisor, an employer representative, an occupational health physician, a rehabilitation counsellor from the national social insurance office and a support person. METHOD: Participatory observation of 22 rehabilitation meetings. The communication was tape-recorded and transcribed word for word. The transcripts were coded and analysed both qualitatively and quantitatively. RESULTS AND CONCLUSION: The client made the most utterances in the groups, but most often in the form of answers to questions from the other actors. Following the client, the physician made the next most frequent utterances, most often as questions. The subjects most discussed concerned the client's situation regarding work, health and material support. None of the "professionals" dominated the meetings, although one picture that emerged was that the physician and employer representative played more prominent roles as takers of initiative and as coordinators while the client was more passive than the other actors. The discussions were calm and much latitude was allowed for the participants to put forward their own requirements, thoughts and feelings. The rehabilitation group may be viewed as a meeting place for "experts" and clients. The further management of the rehabilitation was by the actor the client most immediately needed. In this, rehabilitation in the rehabilitation group differs from the "case management" common in the rehabilitation field.

Adult↗
PubMed2002

Pain--from periphery to brain.

Pain is not simply due to the activation of peripheral nociceptors but to multiple factors. Part of the article is a review of scientific work on such factors at the different levels of the peripheral and central nervous system, with particular reference to possible new therapy strategies. A second part describes some aspects of clinical assessment of persistent pain conditions, such as differential diagnostics between musculoskeletal nociceptive and neurogenic pain, between referred pain from a musculoskeletal focus and projected neurogenic pain, and between psychogenic pain and pain with a somatic cause.

Afferent Pathways↗
PubMed2002

Effects of a multiprofessional rehabilitation programme for patients with fibromyalgia syndrome.

The present study sought to evaluate the efficacy of a 12-week multidisciplinary rehabilitation programme mainly emphasizing physiotherapy, for patients with either fibromyalgia syndrome or chronic, widespread pain. Forty-three non-randomized female patients with fibromyalgia syndrome or chronic, widespread pain were assigned to the programme or served as waiting-list controls. The outcome was assessed with the Body Awareness Scale-Health, the Multidimensional Pain Inventory, the Quality of Life Scale, the Visual Analogue Scale and a pain drawing. Both groups were reassessed after 3 and 6 months, the treatment group also after 1 year. The treatment group improved in quality of movement and in vegetative disturbances according to the Body Awareness Scale-Health after the programme. At the 3-month and 1-year follow-ups the improvements were partly sustained. The control group showed deterioration after 3 and 6 months in three of the main scales of the Body Awareness Scale-Health. This clinical trial of a rehabilitation programme, proved beneficial for improving quality of movement and reducing the experience of vegetative disturbances.

Absenteeism↗
PubMed2000

Working environmental conditions as experienced by women working despite pain.

OBJECTIVE: This study looked at female hospital cleaners and home help personnel who continued working despite problems or pain in their musculoskeletal system and where there was a risk of increase in sickness absence. The aim was to determine whether supportive intervention for these personnel at the workplace had an effect on the way that they experienced the physical and psychosocial aspects of their working environments. METHODS: The design was prospective with non-rando-mised intervention and reference groups. A selection of 55 questions about physical and psychosocial working environment from a national survey were used. Comparisons were made between intervention and reference groups and with data on a selection of the Swedish population of people in these professions. RESULTS: The results showed that in the hospital cleaners' intervention group the introduction of new cleaning materials and new cleaning methods seemed to contribute to a reduction in workload during the intervention period, which in turn gave them a better chance of taking rest breaks during working time. In the home helps' intervention group the results showed that the group had had a reduction both in workload and in more responsible tasks, and at the same time the psychosomatic stress reactions reduced after the intervention. CONCLUSIONS: The results indicate that effects on the working environmental conditions as experienced could be obtained by a general multi-component support program at the workplace, but the number of variables influenced by the program was very small. The relatively limited effects may be explained by the fact that the impact of a support program depends on how well the remedial measures fulfil the need for such measures either at the workplace, in a work group or among the individual people at the workplace. This emphasises the importance of designing effective analysis tools for judging what remedial measures are needed before the measures themselves are tried out.

Journal Article↗
PubMed1996

Modulation of pressure pain thresholds during and following isometric contraction in patients with fibromyalgia and in healthy controls.

This study aimed at evaluating the influence of submaximal isometric contraction on pressure pain thresholds (PPTs) in 14 fibromyalgia (FM) patients and 14 healthy volunteers, before and after skin hypoesthesia. PPTs were determined with pressure algometry over m. quadriceps femoris before, during and following an isometric contraction. Maximum voluntary contraction (MVC) was assessed using a computerized dynamometer. A contraction of 22% MVC on average was held until exhaustion (max. 5 min) and PPTs were assessed every 30 sec. A local anesthetic cream and a control cream were applied following a double-blind design and PPTs were reassessed. In healthy volunteers PPTs increased during contraction (P < 0.001), then decreased after the end of contraction (P < 0.001) but remained above precontraction values during the 5 min of post-contraction assessments (P < 0.001). In FM patients PPTs decreased in the middle of the contraction period (P < 0.05) and remained below precontraction levels during the rest of the contraction period (P < 0.05) and during the 5 min of post-contraction assessment (immediately post-contraction NS; 2.5 min post-contraction P < 0.01; 5 min post-contraction P < 0.05). The normalized PPTs were significantly lower in patients than in controls during contraction (start P < 0.01; middle P < 0.001; end P < 0.001) and at all times during post-contraction assessments (P < 0.001). Anesthetic cream raised PPTs at rest in controls (P < 0.01) but not in FM patients, and did not influence contraction or post-contraction PPTs in either group. Therefore, the increased pressure pain sensibility in FM patients is more pronounced deep to the skin. The observed decrease of PPTs during isometric contraction in FM patients could be due to sensitization of mechanonociceptors caused by muscle ischemia and/or dysfunction in pain modulation during muscle contraction.

Adult↗
PubMed1995

Modulation of pressure pain thresholds during and following isometric contraction.

This study aimed at evaluating the influence of submaximal isometric contraction on pressure pain thresholds (PPTs) in 14 healthy volunteers before and after skin hypoesthesia. PPTs were determined with pressure algometry over m. quadriceps femoris before, during, and following an isometric contraction. Maximum voluntary contraction (MVC) was assessed using a computerized dynamometer. A contraction of 21% MVC was held until exhaustion (max: 5 min) and PPTs were assessed every 30 sec. A local anesthetic cream and a control cream were applied following a double-blind design and PPTs were reassessed. PPTs increased significantly at the start of contraction and continued to increase until the middle of the contraction period, then remaining at this level. After contraction PPTs decreased significantly but for 5 min remained slightly above precontraction levels. Anesthetic cream raised PPT at rest but not during and following contraction. The relative increase in PPTs during and immediately following isometric contraction was lower with anesthetic cream. Isometric contraction of m. quadriceps femoris increase PPTs during and following contraction. The results suggest that input from cutaneous and deeper tissues interacts with nociceptive activity set up by the pressure stimulus. Determining the degree of sensory modulation in muscle and skin in different chronic pain syndromes could become a functional method of patient assessment important for differential diagnosis, treatment evaluation, and follow-up.

Adult↗
PubMed1995

Increased pressure pain sensibility in fibromyalgia patients is located deep to the skin but not restricted to muscle tissue.

This study was aimed at comparing pressure pain sensibility in different tissues in fibromyalgia patients. Pressure pain thresholds (PPTs) were assessed in 16 fibromyalgia (FM) patients bilaterally at the bony part of epicondylus lateralis humeri, at the belly of m. extensor carpi ulnaris and at m. brachioradialis where the radial nerve branches pass underneath. Following a double-blind design, either a local anesthetic cream (EMLA) or a control cream was applied to the skin and PPTs were reassessed. The site with underlying nerve had a lower PPT than the bony site (P < 0.001) and the 'pure' muscle site (P < 0.001), respectively. These relations remained unaltered by skin hypoesthesia. The PPTs over the bony and the 'pure' muscle sites did not differ. Application of EMLA, compared to control cream, did not change PPTs over any area examined. The results demonstrated that pressure-induced pain sensibility in FM patients is not most pronounced in muscle tissue and does not depend on increased skin sensibility.

Adult↗