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  • 1.
    Ahlgren, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Selection of clients for vocational rehabilitation at six local social insurance offices.: a combined register and questionnaire study on rehabilitation measures and attitudes among social insurance officers.2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 3, p. 178-184Article in journal (Refereed)
    Abstract [en]

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

  • 2.
    Ahlgren, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Work resumption after vocational rehabilitation: a follow-up two years after completed rehabilitation2007In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 28, no 4, p. 343-354Article in journal (Refereed)
    Abstract [en]

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

  • 3.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Harms-Ringdahl, Karin
    Schüldt, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    linder, Jürgen
    Mobility, muscular strength and endurance in the cervical spine in Swedish air force pilots2001In: Aviation, Space, and Environmental Medicine, ISSN 0095-6562, Vol. 72, no 4, p. 336-342Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Muscle strength, endurance and range of movement of the cervical spine in a group of Swedish Air Force jet pilots (AF) and in a reference group of conscripts doing their military service (RG) were compared. METHODS: We tested 30 (AF) 24-42 yr and 33 (RG) 19-22 yr. A questionnaire was used to document complaints. Maximum voluntary isometric muscle strength of the flexor and extensor muscles of the cervical spine and sub-maximum isometric endurance in the flexor and extensor muscles were measured. RESULTS: Eleven AF (37%) and four RG (12%) had experienced discomfort in the neck within the previous year. The pilots' flexor and extensor muscle strength (47 Nm and 65 Nm) was superior to that of the conscripts (36 Nm and 59 Nm) (p = 0.0001, p = < 0.05, respectively). However, the RG group had greater isometric endurance in the flexor muscles than AF (p = < 0.05) and greater neck rotation (p = <0.005). There was no difference between the two groups in the other variables. CONCLUSION: Differences between the groups with regard to muscle strength and endurance might depend on variations in work-related physical muscle strain, and/or differences in fiber composition in the muscles, which might be reflected by pilot selection procedures.

  • 4. Axelsson, R
    et al.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, J
    Marnetoft, Sven-Uno
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Selander, John
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Vahlne Westerhäll, L
    Rehabiliteringsvetenskap: rehabilitering till arbetslivet i ett flerdisciplinärt perspektiv2006Book (Other academic)
  • 5.
    Björnhagen, Viveca
    et al.
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Ekholm, Kristina Schüldt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Larsen, Flemming
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Ekholm, Jan
    Danderyd University Hospital, Stockholm.
    Burn survivors' pulmonary and muscular impairment, exercise tolerance and return-to-work following medical-vocational rehabilitation: A long-term follow-up2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 5, p. 465-471Article in journal (Refereed)
    Abstract [en]

    Objective: To follow up the long-term outcome in return-to-work (RTW) rate in burn-injury patients, and to determine the degree of impairment in pulmonary and muscular function and exercise tolerance. Design: A prospective, longitudinal follow-up study without a control group. Patients: Twenty-five burn-injury patients referred for medical-vocational rehabilitation. Methods: Return-to-work rate was followed after completed medical-vocational rehabilitation. Pulmonary function was evaluated with spirometry, diffusing capacity and radio spirometry. Exercise capacity was determined using a bicycle ergometer. Muscle functions evaluated in the arms and legs were: isokinetic torque, isometric strength, endurance and muscular strength utilization. Results: Return-to-work rate was 87%. During bicycle exercise tests the patients, on average, reached their expected workloads. The dominating lung function abnormality observed on lung scintigraphy was delayed wash-out time of inhaled radioactive xenon gas, suggesting airway obstruction. All tests of shoulder-flexor and knee-extensor muscle function showed large minimum-maximum differences. Mean isometric endurance of shoulder flexors was lower than mean of references, and isokinetic knee extensor torques were slightly lower. Conclusion: High return-to-work rates can be achieved after burn injury requiring hospital-ward care. Despite measurable impairments in muscle strength/endurance and pulmonary function in a substantial proportion of these patients, overall normal bicycle exercise capacity was observed except for a few cases.

  • 6. Chamberlain, M A
    et al.
    Moser, V F
    Schuldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    O´Connor, Rory J
    Herceg, Malvina
    Ekholm, Jan
    Vocational rehabilitation: An educational review2009In: Journal of rehabilitation, ISSN 0022-4154, Vol. 41, no 11, p. 856-869Article, review/survey (Refereed)
    Abstract [en]

    The aim of this review is to describe aspects of vocational rehabilitation relevant for a physician aiming to become a specialist in physical and rehabilitation medicine (PRM). The review discusses the epidemiology of incapacity for work, the major patient groups in vocational rehabilitation (musculoskeletal and psychiatric diagnoses comprise approximately 50-70% of the patients), the influence of different kinds of environmental and individual risk factors on work resumption (such as the legal framework, application of the law, resources for rehabilitation and its effectiveness, the degree of co-operation between vocational rehabilitation agencies, economic factors/labour market situation, medical and personal factors). The review describes different models of vocational rehabilitation, the effectiveness of various vocational rehabilitation programmes on work resumption or sick leave (where strong evidence is reported for multimodal rehabilitation programmes for patients with long-lasting musculoskeletal pain). Finally, there are sections about the PRM physician's history-taking in vocational rehabilitation (using the International Classification of Functioning, Disability and Health (ICF)), and report writing with a Structure where ICF body functions and activity limitations are reported separately.

  • 7.
    Ekholm, Jan
    et al.
    Karolinska institutet.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Selander, John
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Marnetoft, Sven-Uno
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jakobsson, Björn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ludvigsen Ehnhage, Pia
    Åhrberg, Yvonne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kärrholm, Jenny
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hinder och framgångsfaktorer i rehabiliteringsprocessen: En sammanfattning baserad på kvantitativa och kvalitativa studier av faktorerer eller företeelser associerade med långtidsjukskrivnas återkomst i arbete2002Report (Other academic)
  • 8. Ekholm, Jan
    et al.
    Ekholm Schudt, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Vocational rehabilitation: Editorial2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 3, p. 113-114Article in journal (Other academic)
  • 9. Ekholm, Jan
    et al.
    Schuldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Vocational rehabilitation in musculo-skeletal disorders: with examples from neck and shoulder region2006In: Vocational Rehabilitation, Paris: Springer, 2006, p. 137-142Chapter in book (Other academic)
  • 10. Ekholm, Jan
    et al.
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Vocational rehabilitation: the Swedish model2006In: Vocational Rehabilitation, 2006, p. 389-394Chapter in book (Other academic)
  • 11. Ekholm, Jan
    et al.
    Schüldt Ekholm, Krsitina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Arbets(o)förmåga ur rehabiliteringsmedicinskt perspektiv2008In: Arbets(o)förmåga :: ur ett mångdisciplinärt perspektiv, Stockholm: Santérus Academic Press Sweden, 2008, p. 402-Chapter in book (Other academic)
  • 12.
    Jakobsson, Björn
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Svedlund, Marianne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Multi-professional vocational rehabilitation group meetings with female clients - a qualitative study.2008In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 30, no 4, p. 413-421Article in journal (Refereed)
    Abstract [en]

    Many women require vocational rehabilitation before they can return to work. The objective with the present study was to describe female clients' situation during the rehabilitation process, as it became apparent during the rehabilitation meetings with the various actors involved. The clients' diagnoses varied, but the majority was affected with musculoskeletal disorders. The meetings were audio-taped and transcribed verbatim, after which they were analysed by qualitative content analysis. The following themes emerged: Adaptation to the rehabilitation group; client's health status; the workplace's significance for rehabilitation; and the client's decision-point. Conflict between health and work was immensely important for rehabilitation. Differences in attitude were apparent during the rehabilitation meetings, as some clients were passive and exercised less influence on the planning, than the other more active clients did.

  • 13.
    Jakobsson, Björn
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Do systematic multiprofessional rehabilitation group meetings improve efficiency in vocational rehabilitation?2005In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 24, no 3, p. 279-290Article in journal (Refereed)
    Abstract [en]

    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.

  • 14.
    Jakobsson, Björn
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm Schüldt, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Improved employment rates after multiprofessional cross-sector cooperation in vocational rehabilitation: A 6-year follow-up with comparison groups2010In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 33, no 1, p. 72-80Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to better understand the long-term effects of an improved model for cooperation on employment between rehabilitation professionals in vocational rehabilitation (VR). To compare these effects with those associated with the traditional model of cooperation. The study featured a group of patients who participated in a developmental project. All of the patients had some degree of restricted work capacity, which was evidenced somatically as well as mentally/socially. They had all experienced long periods of unemployment during the 2-year period before the intervention. A 'natural experiment study design' that relied on database records was used. Using matching criteria, we identified 'social twins' from a government register to create comparison groups at the local, county and national levels (n=4×51 patients). Repeated-measures analysis of variance and logistic regression were used to analyse the data. The majority (59%) of the study group was employed 3 years after the intervention compared with 39 and 41% in the two matched control groups, respectively. The corresponding figures after 6 years were 51 versus 39 and 37%. An individual with a somatically restricted work capacity was about twice as likely to secure gainful employment following VR as compared with an individual with a mentally/socially restricted work capacity. In conclusion, the study focused on an improved method of cooperation between rehabilitation actors in the context of VR programmes. A model that included systematic multiprofessional cross-sector group meetings was explored, and we concluded that a substantial percentage of the enrolled patients successfully secured employment over a 6-year period. This percentage exceeded that of matched pairs in a county and national group; we presume that these groups represented 'the usual form of cooperation'.

  • 15.
    Jansen, Gunilla Brodda
    et al.
    Department of Pain Management, Capio St Göran's Hospital.
    Linder, Jürgen
    Karolinska Institutet, Sweden.
    Ekholm, Kristina Schüldt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Karolinska Institutet, Danderyd Hospital.
    Differences in symptoms, functioning, and quality of life between women on long-term sick-leave with musculoskeletal pain with and without concomitant depression.2011In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 4, p. 281-292Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim was to describe the differences in symptoms, functioning and quality of life between women on long-term sick-leave due to protracted musculoskeletal pain with and without concomitant depression.

    DESIGN: Descriptive and comparisons with/without comorbid depression.

    METHODS: 332 female patients were examined by three specialist physicians in psychiatry, orthopedic surgery, and rehabilitation medicine and assigned to four groups according to the ICD-10 diagnoses: low back/joint disorders (LBJ, n = 150), myalgia (M, n = 43), fibromyalgia (FM, n = 87), or depression without somatic pain diagnosis (DE, n = 52).

    RESULTS: Patients with somatic pain conditions LBJ, M, or FM showed more activity-related difficulties if concomitant depression was present during the activities 'focusing attention', 'making decisions', and 'undertaking a single task'; and in the domains 'energy level', 'memory functions', 'emotional functions', and 'optimism/pessimism'. Patients with FM and concomitant depression perceived higher pain intensity than patients in group DE. No statistically significant differences in physically related activities were noted between each of the somatic pain conditions with and without coexisting depression. FM patients with coexisting depression reported fewer painful sites on their pain drawings compared with FM-patients without depression. Patients with LBJ or FM and concomitant depression reported lower quality of life in the dimensions vitality, social functioning, emotional role, and mental health. Comorbid depression affected disability and restricted working capacity by reducing mental activity and functioning but not by affecting physical activity problems.

    CONCLUSION: Women on long-term sick-leave, who have concomitant depression with LBJ or FM, also have more difficulties in focusing attention, making decisions, and carrying out tasks, and with memory functions and optimism/pessimism, as well as reduced quality of life in the dimensions of vitality, social functioning, emotional role, and mental health, than female patients without comorbid depression. As a consequence we suggest further efforts to integrate somatic and psychiatric interventions in the same rehabilitation program.

  • 16.
    Kärrholm, Jenny
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Section for Rehabilitation Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Ekholm, Karolina
    Department of Economics, Stockholm School of Economics, Stockholm.
    Jakobsson, Björn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Section for Rehabilitation Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Ekholm, Jan
    Section for Rehabilitation Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Section for Rehabilitation Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Schüldt Ekholm, Kristina
    Section for Rehabilitation Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Effects on work resumption of a co-operation project in vocational rehabilitation: Systematic, multi-professional, client-centred and solution-oriented co-operation2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 7, p. 457-467Article in journal (Refereed)
    Abstract [en]

    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.

  • 17.
    Kärrholm, Jenny
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Karolina
    Jakobsson, Björn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Systematic co-operation between employer, occupational health service and social insurance office: A 6-year follow-up of vocational rehabilitation for people on sick-leave, including economic benefits2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 8, p. 628-636Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of systematic co-operation among municipal employees on the number of sick-leave days per month and the type of benefit granted by the Social Insurance Office. A further aim was to evaluate the economic consequences for society.Design: A 6-year follow-up study with a matched-pairs design.Methods: Days on sick-leave were calculated for each subject one year before the intervention started and yearly for the following 6-year period. Statistical mixed-model analysis was used. The economic benefit of the intervention was estimated as the increased production stemming from fewer days on sick-leave.Subjects: Sixty-four employees on long-term sick-leave were individually matched with controls from another Social Insurance Office in a county with a socioeconomic structure similar to that of the study group.Results: The study group had 5.7 fewer days on sick-leave per month and person over the 6-year period (p=0.003). The estimated average economic benefit of the intervention was (sic)36,600 per person over the 6-year period. In conclusion, those who received systematic co-operation in vocational rehabilitation had fewer days on sick-leave than their "treatment-as-usual" peers. This effect persisted over 6 years, generating substantial net economic gains for society.

  • 18.
    Kärrholm, Jenny
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jakobsson, Björn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Schuldt Håård, Ulrika
    Ekholm, Jan
    Schuldt Ekholm, Krstina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bergroth, Alf
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The views of sick-listed employees' immediate superiors on co-operation in vocational rehabilitation.2007In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 29, no 2, p. 101-111Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this research was to investigate the views of sick-listed employees' immediate superiors on co-operation in vocational rehabilitation before and during a systematic, multi-professional, client-centred, solution-oriented co-operation project in vocational rehabilitation (SMVR intervention). METHOD: A same-subject study with a questionnaire was used, with 95 immediate superiors giving their views on co-operation both before and during the SMVR intervention. RESULTS AND CONCLUSIONS: The immediate superiors felt that the SMVR intervention was successful in promoting co-operation, and reported a significant decrease in referrals of employees from one organisation to another without the problem being resolved. Hence SMVR co-operation was experienced positively by the immediate superiors and in fact led to a joint responsibility in finding solutions. The immediate superiors saw greater possibilities than before for employees to resume regular or other jobs during the SMVR intervention. A more elaborate co-operation model such as the SMVR intervention increased the immediate superiors' experience of successful vocational rehabilitation. Organizations seeking to increase efficiency in vocational rehabilitation might well analyse their work methods and improve their forms of co-operation.

  • 19.
    Linder, J
    et al.
    Karolinska Institutet.
    Ekholm, Kristina Schüldt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Institutet; Danderyds Sjukhus.
    Lundh, G
    Karolinska Institutet.
    Ekholm, J
    Karolinska Institutet; Danderyds Sjukhus.
    Long-term sick-leavers with fibromyalgia: Comparing their multidisciplinarily assessed characteristics with those  of others with chronic pain conditions and depression2009In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 2, p. 23-37Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to gain knowledge of fibromyalgia (FM) patients on long-term sick leave and with particular difficulties in resuming work, and to compare them with patients with myalgia, back or joint diagnoses, and depression.

    Methods: Patients were identified by and referred from social insurance offices and were multidisciplinarily examined by three board-certified specialists in psychiatry, orthopedic surgery and rehabilitation medicine. Ninety-two women were diagnosed with FM only. Three female comparison groups were chosen: depression, back/joint diagnoses, and myalgia.

    Results and conclusions: Ceaseless pain was reported by 73% of FM patients, 54% of back/joint diagnoses patients, 43% of myalgia patients, and 35% of depression patients. The distribution of pain (>50%) in FM patients was to almost all regions of the body, and in depression patients to the lower dorsal neck, upper shoulders and lumbosacral back but not in the anterior body. Reduced sleep was more evident in FM patients. FM patients did not meet more criteria for personality disorder than patients with the other somatic pain conditions. The most common dimension of “personality traits” of somatic pain conditions was the “obsessive compulsive” but at a level clearly below that indicating a personality disorder. More FM patients experienced disabilities, the most common being in the mobility and domestic-life areas.

  • 20. Linder, Juergen
    et al.
    Schüldt Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Brodda Jansen, G
    Lundh, Göran
    Ekholm, Jan
    Long-term sick-leavers with difficulty in resuming work: comparisons between psychiatric-somatic co-morbidity and monodiagnosis2009In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 32, no 1, p. 20-35Article in journal (Refereed)
    Abstract [en]

    The number of patients with difficulty in resuming work after long-term sick leave has increased in several European countries including Sweden. The general aim of this study was a comprehensive description - based on multidisciplinary diagnostics and assessments - of patients with the common feature of marked difficulty in resuming working life after a long absence. A particular aim was to elucidate the possible effect of comorbidity on pain descriptors, disability, quality of life, assessed working ability and rehabilitation needs. Six hundred and thirty-five long-term sick leavers were referred from National Insurance Offices and consecutively accepted for investigation. Several self-report questionnaires were used. All patients were examined by three board-certified specialist physicians in psychiatry, orthopaedic surgery and rehabilitation medicine, respectively. Fifty-five percent of the patients had psychiatric-somatic comorbidity. The three most frequent combinations of diagnoses in the comorbidity group were fibromyalgia/myalgia and depressive episode, fibromyalgia/myalgia and recurrent depression, spinal pain and depressive episode, whereas the three most frequent in those with psychiatric diagnosis only were depressive episode, recurrent depression, phobias/anxiety. Differences in pain descriptors and in difficulties with activities were found among the three groups. All had lower health-related quality of life than references. Only one-sixth had no assessed working capacity and only 3% were assessed as able to resume work without rehabilitation; 80% were multidisciplinarily assessed as needing rehabilitation. Patients with psychiatric diagnoses, with or without concomitant somatic diagnoses, need medical rehabilitation or medical/vocational rehabilitation in combination to a greater extent than patients with somatic diagnoses only. This implies that medical rehabilitation programmes ought to adapt increasingly to the needs of patients with psychiatric-somatic comorbidity.

  • 21.
    Linder, Jurgen
    et al.
    Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Jansen, Gunilla Brodda
    Karolinska Inst, Danderyd Univ Hosp, Dept Clin Sci, Div Rehabil Med, Stockholm, Sweden.
    Schüldt-Ekholm, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Karolinska Inst, Danderyd Univ Hosp, Dept Clin Sci, Div Rehabil Med, Stockholm, Sweden.
    RELATIONSHIP BETWEEN SLEEP DISTURBANCE, PAIN, DEPRESSION AND FUNCTIONING IN LONG-TERM SICK-LISTED PATIENTS EXPERIENCING DIFFICULTY IN RESUMING WORK2014In: JOURNAL OF REHABILITATION MEDICINE, ISSN 1651-2081, Vol. 46, no 8, p. 798-805Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the frequency of reported sleeping, depression and pain problems, the severity of these problems and the degree of self-estimated difficulties in mental functions and activities in relation to the sleep disturbance and pain category group in patients on long-term sick-leave. Design: Cross-sectional study. Patients: A total of 1206 patients experiencing difficulty in resuming work. Methods: Patient examinations by specialists in psychiatry, orthopaedic surgery and rehabilitation medicine. Validated questionnaires, including status regarding depression, sleep, pain and functioning were used. Results: The prevalence of sleep disturbance was 83%; 74% of the patients with moderate/severe sleep disturbance also had moderate/severe pain problems and 26% had no/mild pain problems. Fifty-seven percent of the patients with no/mild sleep disturbance and 83% of the patients with moderate/severe sleep disturbance also had depression. The degree of difficulty in performing the 6 selected International Classification of Functioning, Disability and Health activities and mental functions was higher for the category with moderate/severe sleep problems, compared with those with no/mild sleep problems. Conclusion: To optimize rehabilitation for patients on long-term sick-leave experiencing difficulties in returning to work, the results indicate a need also to focus attention on sleep problems and not only on pain and depression. This may entail the planning of measures to improve decision-making and concentration and alleviate lassitude, fatigability, sadness and pessimistic thoughts.

  • 22.
    Schüldt Ekholm, Kristina
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Björnhagen, Viveca
    Schult, Marie-Louise
    Rehabilitering vid omfattande brännskada: av vuxna i yrkesverksam ålder2006In: Rehabiliteringsmedicin: teori och praktik, Lund: Studentlitteratur, 2006, p. 329-334Chapter in book (Other academic)
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