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Rehabilitation in light of different theories of health: Outcome for patients with low-back complaints - a theoretical discussion
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions.

This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells. 

What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system.

If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual. 

This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2001. , 66 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 760
Keyword [en]
Low-back complaint, self-report, sickness absence, social class, education, occupation, physical capacity, work capacity, work environment, social support, ADL, perceived health and smoking
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-33475ISBN: 91-7305-135-7 (print)OAI: oai:DiVA.org:umu-33475DiVA: diva2:313391
Public defence
2001-11-23, Sal B, 9 trappor, Tandläkarhögskolan, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Projects
digitalisering@umu
Available from: 2010-10-21 Created: 2010-04-26 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Health as a measure of rehabilitation: outcome for patients with low-back pain
Open this publication in new window or tab >>Health as a measure of rehabilitation: outcome for patients with low-back pain
1992 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 8, no 2, 67-77 p.Article in journal (Refereed) Published
Abstract [en]

Low back pain (LBP) has become a serious economic problem and a multifactorial problem to be solved within medicine. Investigations have demonstrated that the problem may best be solved outside medicine or, if within, in cooperation with behavioural scientists and with involved elements outside medicine such as the National Health Insurance System. How is LBP defined? Do all people involved in the rehabilitation of LBP define it in the same way? Are there any alternative ways to define it? In this paper, I will present a humanistic-social perspective of how LBP can be denned. This perspective or theory of health takes into account these outside factors as well as a person's ability to act in relation to the social context within which that person is living. In order to provide more effective treatment, in the sense of giving people the support they need to get better, other methods of treating LBP must be developed. This humanistic-social perspective indicates that a person's goals and actual circumstances at the time of rehabilitation should be the base for the planned activity. From this perspective, the objective findings should only be the base for the choice of technical method, not the base for the overall rehabilitation strategy.

Identifiers
urn:nbn:se:umu:diva-37107 (URN)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2017-12-12Bibliographically approved
2. Conditions for acting: a theoretical discussion
Open this publication in new window or tab >>Conditions for acting: a theoretical discussion
1998 (English)In: Nordisk fysioterapi, ISSN 1402-3024, Vol. 2, 37-40 p.Article in journal (Other academic) Published
Identifiers
urn:nbn:se:umu:diva-37109 (URN)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2017-12-12Bibliographically approved
3. Self-reported low-back complaints in a random population sample: specific versus non-specific complaints
Open this publication in new window or tab >>Self-reported low-back complaints in a random population sample: specific versus non-specific complaints
(English)In: Article in journal (Other academic) Submitted
Abstract [en]

The purpose of this study was to investigate the distribution of selfreported low-back (LB) complaints in the social structure, and to investigate how the variables - physical work load, physical ability, Activities of Daily Living (ADL), mental job strain, social support, health and smoking - were associated with the different LB complaints. The Survey of Living Conditions carried out by Statistics Sweden 1980-81 has been used as the basis of the investigation. The LB complaints were dichotomised into specific and non-specific LB complaints according to an assumed grade of measurability. The non-specific LB complaints showed a social gradient which specific complaints did not despite the association with some of the variables. People, with a non-specific LB complaint, were besides that associated with a higher risk to become a sickness and disability pensioner than people with a specific LB complaint. This may indicate that either strategies used within the health care system in general are more suitable for specific complaints perhaps due to their higher grade of measurability or that people with a non-specific complaint suffers from an incapacitating illness that cannot be cured.

Keyword
Low-back complaint, self-report, social class, physical capacity, work capacity, work environment, social support, ADL, health and smoking
Identifiers
urn:nbn:se:umu:diva-37110 (URN)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2015-04-29Bibliographically approved
4. Low-back complaints and other complaints as a reason for sick listing: a comparative study regarding work-related factors, socio-demographic factors, leisure-time, social support and perceived health
Open this publication in new window or tab >>Low-back complaints and other complaints as a reason for sick listing: a comparative study regarding work-related factors, socio-demographic factors, leisure-time, social support and perceived health
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this study was to investigate in what way people on sick leave due to low-back troubles distinguish as a group from other individuals on sick leave. The population in this study consisted of all individuals 20-64 years of age, who in 1991 belonged to a local health insurance office in northern Sweden. All individuals, born on day 5, 15 and 25, who had been on sick leave due to low-back (LB) complaints (low-back group) and a random sample of individuals, who had been on sick leave due to other kinds of complaints (reference group) constituted the study sample. Information was collected from their sickness records and from a questionnaire sent to each individual comprising questions about education, working environment, perceived health, social support, leisure time activities and smoking habits. There were no differences found regarding the sex of the individuals, leisure time activities or social support between the two studied groups. In the multivariate logistic regression analysis the result revealed that the LB group had longer sick leave periods, more spells and was to greater extent blue-collar workers.

This may indicate differences in the working situation between the groups, which in turn may aggravate LB problems leading to longer sick leave or more spells. 

Keyword
Low-back complaints, sickness absence, education, occupation, work environment, social support, health
Identifiers
urn:nbn:se:umu:diva-37113 (URN)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2015-04-29Bibliographically approved

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Grönblom-Lundström, Lena

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