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  • 1.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain: a literature review2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 23, p. 2255-2270Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

    Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

    Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".

    Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

    Implications for rehabilitation

    Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

  • 2.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hammarström, Anne
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Sandberg, Susanne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Larsson, Christel
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden .
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Engagement in New Dietary Habits: Obese Women's Experiences from Participating in a 2-Year Diet Intervention2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 1, p. 84-93Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time.

    PURPOSE: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention.

    METHODS: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles.

    RESULTS: A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase".

    CONCLUSION: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.

  • 3.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Steinholtz, K
    Slunga- Birgander, L
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Perceived benefits from a rehabilitation program: A study on patients with burnout2007Conference paper (Other academic)
  • 4.
    Alex, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Beyond a Dichotomous View of the Concepts of 'Sex' and 'Gender' Focus Group Discussions among Gender Researchers at a Medical Faculty2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 11, p. e50275-Article in journal (Refereed)
    Abstract [en]

    Introduction: The concepts of 'sex' and 'gender' are both of vital importance in medicine and health sciences. However, the meaning of these concepts has seldom been discussed in the medical literature. The aim of this study was to explore what the concepts of 'sex' and 'gender' meant for gender researchers based in a medical faculty. Methods: Sixteen researchers took part in focus group discussions. The analysis was performed in several steps. The participating researchers read the text and discussed ideas for analysis in national and international workshops. The data were analysed using qualitative content analysis. The authors performed independent preliminary analyses, which were further developed and intensively discussed between the authors. Results: The analysis of meanings of the concepts of 'sex' and 'gender' for gender researchers based in a medical faculty resulted in three categories; "Sex as more than biology", with the subcategories 'sex' is not simply biological, 'sex' as classification, and 'sex' as fluid and changeable; "Gender as a multiplicity of power-related constructions", with the subcategories: 'gender' as constructions, 'gender' power dimensions, and 'gender' as doing femininities and masculinities; "'Sex and gender as interwoven", with the subcategories: 'sex' and 'gender' as inseparable and embodying 'sex' and 'gender'. Conclusions: Gender researchers within medicine pointed out the importance of looking beyond a dichotomous view of the concepts of 'sex' and 'gender'. The perception of the concepts was that 'sex' and 'gender' were intertwined. Further research is needed to explore how 'sex' and 'gender' interact.

  • 5.
    Björck van Dijken, Christina
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Orthopaedics. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Physiotherapy.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
    Hildingsson, Christer
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Orthopaedics.
    Low back pain, lifestyle factors and physical activity: a population-based study.2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 10, p. 864-869Article in journal (Refereed)
    Abstract [en]

    Objective and designThe prevalence of low back pain was assessed in relation to physical activity, for both work and leisure activities, in a randomly selected population in the northern part of Sweden. Additionally, the associations between age, sex, level of education, lifestyle factors, demographic characteristics, and low back pain were evaluated. Subjects: A total of 5798 subjects aged 25–79 years were selected randomly from a geographically well-defined area in northern Sweden. Methods: Additional questions concerning people's experience of low back pain were added to the questionnaire of the World Health Organization MONICA (MONItoring of trends and determinants in CArdiovascular disease) health survey with the aim of investigating prevalence rates and factors associated with low back pain. Results: Forty-one percent of the participants reported having low back pain (of these 55% were women and 45% men). The prevalence rate was highest in the age group 55–64 years. Chronic low back pain was the most frequent occurring problem. Of those with low back pain, 43% of the women and 37% of the men reported having continuous low back pain for more than 6 months. Individuals with low back pain often experienced a more physically heavy workload at work and lower physical activity during leisure time, and they were also more likely to have been smokers, have had higher body mass index, lived in smaller communities, and were less educated than people without low back pain. Conclusion: Low back pain seems to be associated with physical activity at work and in leisure time, certain lifestyle factors and demographic characteristics.

  • 6.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sex and gender traps and springboards: a focus group study among gender researchers in medicine and health sciences2012In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 33, no 8, p. 739-755Article in journal (Refereed)
    Abstract [en]

    We explored the difficulties that gender researchers encounter in their research and the strategies they use for solving these problems. Sixteen Swedish researchers, all women, took part in focus group discussions; the data were analyzed using qualitative content analysis. The problems reported fell into four main categories: the ambiguity of the concepts of sex and gender; traps associated with dichotomization; difficulties with communication; and issues around publication. Categories of suggested problem-solving strategies were adaptation, pragmatism, addressing the complexities, and definition of terms. Here the specific views of gender researchers in medicine and health sciences-"medical insiders"-bring new challenges into focus.

  • 7.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Musicianship and teaching: aspects of musculoskeletal disorders, physical and psychosocial work factors in musicians with focus on music teachers2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Musculoskeletal disorders are common among musicians at all levels of performance. Since music teachers train our future musicians it is important to understand their work environment. By creating good examples of a healthy work environment, they can teach their students how to stay healthy and to prevent pain. The aim of this thesis was to study the work environment of music teachers at municipal music schools, with regard to physical and psychosocial factors and musculoskeletal disorders with the focus on neck and shoulder disorders. An additional aim was to investigate the variability of the playing technique in string players and to investigate if they could play with greater variation in the trapezius muscle activity pattern after a training intervention program.

    In a cross-sectional study at 23 municipal music schools, 171 out of the 208 (82%) music teachers reported that they had experienced work related musculoskeletal disorders (WMSDs) during the previous year. Women reported significantly more symptoms in the neck, the shoulders and the upper back compared to men. Both physical and psychosocial work factors were associated with neck and shoulder disorders. For women “high mental work demands” and “teaching at many schools” could be seen as risk factors and for men “lifting”, “playing the guitar” and “low social support at work” were risk factors.

    The occurrence of WMSDs was also investigated, over an eight-year period, in music teachers at one music school. The result showed that neck, shoulder and lower back disorders were common and tended to be of long duration and to increase over the years.

    In an interview study, nine music teachers focused on what they perceived to be important for their health and well-being. Replenishing and using up energy was found to be the core category. Creativity in the music and working with other musicians were perceived as sources of energy, while the goals of the organisation were experienced as stressful and used up energy. Whether the work was regarded as pedagogical or musical could affect the perception of health and the strategies for dealing with the strains of work.

    In two studies using electromyography, the variation in the trapezius muscle activity pattern in string musicians was investigated. The results suggested that each musician could repeat their muscular activity pattern in a similar way between two playing sessions. No difference was found in the trapezius muscle activity between five violinists who trained basic Body Awareness Therapy (BAT), a technique having its roots in Tai Chi Chuan tradition, compared to a reference group of nine violinists who did not take part in any training. However, the training group perceived positive changes in breathing, muscular tension, postural control and concentration during practice sessions.

    Neck and shoulder disorders were associated with physical and psychosocial factors at work. A process of replenishing and using up energy was important for music teachers’ health. The playing technique in string musicians seemed to be repeatable but difficult to affect over a short-term period. For future musicians it is crucial to learn good working technique at an early age. In the learning process the music teacher is a vital role model.

  • 8.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Physical and psychosocial work-related risk factors associated with neck-shoulder discomfort in male and female music teachers.2003In: Medical problems of performing artists, ISSN 0885-1158, E-ISSN 1938-2766, Vol. 18, no 1, p. 33-41Article in journal (Other academic)
  • 9.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Chesky, K
    Health promotion in music schools: A new arena for physical therapists2007Conference paper (Other academic)
  • 10.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Chesky, Kris
    Musculoskeletal and general health problems of acoustic guitar, electric guitar, electric bass, and banjo players2006In: Medical problems of performing artists, ISSN 0885-1158, E-ISSN 1938-2766, Vol. 21, no 4, p. 169-176Article in journal (Refereed)
    Abstract [en]

    The aim of this cross-sectional study was to describe self-reported problems among guitarists and to examine differences associated with type of guitar played. Data for the study were extracted from the University of North Texas Musician Health Survey (UNT-MHS) data set. Subjects for the present study (n = 520) were included if they identified acoustic guitar, electric guitar, electric bass or banjo as their primary instrument. Prevalences for musculoskeletal problems were determined for the total group, by guitar-specific groups, and by gender. Prevalences for nonmusculoskeletal, overall health problems were established for the whole guitar group and by instrument. Of the total subjects, 81% reported one or more musculoskeletal problems. The acoustic guitar group reported the highest prevalence (83%), followed by the banjo (78%), electric bass (77%), and electric guitar groups (74%). The highest site-specific prevalences for the whole group were the left fingers (32.9%), left wrist (29.8%), and left hand (24.7%). Regarding nonmusculoskeletal problems, 66% of the total group perceived stress due to work environment as a moderate to high problem. The total group reported mostly problems with fatigue, depression, headache, and eye strain. The overall findings of the study show that musculoskeletal problems as well as stress-related health problems are a major concern for the guitar community.

  • 11.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Andersson, Hans
    Karlsson, Jan Stefan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    EMG trapezius muscle activity pattern in string players: Part II - Influences of basic body awareness therapy on the violin playing technique2004In: International Journal of Industrial Ergonomics, ISSN 0169-8141, E-ISSN 1872-8219, Vol. 33, no 4, p. 357-367Article in journal (Refereed)
  • 12.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Karlsson, J Stefan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    EMG trapezius muscle activity pattern in string players: Part I - Is there variability in the playing technique?2004In: International Journal of Industrial Ergonomics, ISSN 0169-8141, E-ISSN 1872-8219, Vol. 33, no 4, p. 347-356Article in journal (Refereed)
  • 13.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordin, Ellinor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Skelton, Dawn A.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. School of Health and Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, United Kingdom.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Reach the Person behind the Dementia Physical Therapists' Reflections and Strategies when Composing Physical Training2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 12, article id e0166686Article in journal (Refereed)
    Abstract [en]

    Dementia is a disease characterized by cognitive impairment and physical decline that worsens over time. Exercise is one lifestyle factor that has been identified as a potential means of reducing or delaying progression of the symptoms of dementia, maximizing function and independence. The purpose of this study was to explore physical therapists' (PTs) experiences and reflections on facilitating high-intensity functional exercise with older people living with dementia, in residential care home settings. The study used a qualitative design based on interviews, individually or in small groups, with seven PTs engaged as leaders in the training of older people with dementia. The interviews were analyzed with a modified Grounded Theory method with focus on constant comparisons. To increase trustworthiness the study used triangulation within investigators and member checking. The core category "Discover and act in the moment-learn over time" reflects how the PTs continuously developed their own learning in an iterative process. They built on previous knowledge to communicate with residents and staff and to tailor the high intensity training in relation to each individual at that time point. The category "Be on your toes" highlights how the PTs searched for sufficient information about each individual, before and during training, by eliciting the person's current status from staff and by interpreting the person's body language. The category "Build a bond with a palette of strategies" describes the importance of confirmation to build up trust and the use of group members and the room to create an interplay between exercise and social interaction. These findings highlight the continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) and building a relationship and trust with residents in the effective delivery of high intensity functional exercise to older people living with dementia in care settings.

  • 14.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Näsström, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Patients' perceived treatment need owing to temporomandibular disorders and perceptions of related treatment in dentistry: a mixed method study2019In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 46, no 9, p. 792-799Article in journal (Refereed)
    Abstract [en]

    Background: To easily identify patients who could benefit from a temporomandibular disorder (TMD) examination, three screening questions (3Q/TMD) have been introduced in large parts of Sweden. The questions are related to a TMD diagnosis. However, how the questions relate to a treatment need is unknown.

    Objectives: The first aim of the study was to identify predicting factors for perceived treatment need among adult individuals who screened positive to the 3Q/TMD. The second aim was to explore individuals' thoughts and experiences related to treatment of their TMD complaint.

    Methods: This mixed‐method study with a case‐control design was conducted in Västerbotten, Sweden, during 2014. Individuals who screened positive to at least one of the 3Q/TMD questions were allocated 3Q‐positives, whereas those with negative answers to all questions were allocated 3Q‐negatives. In total, 300 individuals (140 randomly selected 3Q‐positives, and 160 age‐ and gender‐matched 3Q‐negatives) were included. All individuals answered questions related to treatment need. The answers were analysed in a qualitative approach with qualitative content analysis.

    Results: In total, 81% of 3Q‐positives expressed a treatment need related to their TMD symptoms. The perceived treatment need was predicted by frequent pain (Q1) and frequent functional disturbances (Q3). Among the 3Q‐positives, 54% reported mistrust in dentists' ability to treat TMD symptoms. The informants expressed a need for information about their symptoms and possible treatment options.

    Conclusion: Affirmative answers to 3Q/TMD were associated with TMD treatment need. Dentists should give advice to patients with TMD symptoms and address their concerns.

  • 15.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Steinholtz, Katarina
    The Stress Clinic, University Hospital of Umeå.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Take charge: Patients' experiences during participation in a rehabilitation programme for burnout2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 5, p. 475-481Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the experiences of patients with burnout during a rehabilitation programme.

    Patients and methods: Eighteen patients with burnout were interviewed at the end of a one-year rehabilitation programme. The programme consisted of 2 groups, one with a focus on cognitively-oriented behavioural rehabilitation and Qigong and 1 with a focus on Qigong alone. The interviews were analysed using the grounded theory method.

    Results: One core category, Take Charge, and 6 categories emerged. The core category represents a beneficial recovery process that helped the patients to take control of their lives. The common starting point for the process is presented in the 3 categories of Good encounters, Affirmation and Group cohesiveness. The categories were basic conditions for continuing development during rehabilitation. In the categories Get to know myself, How can I be the one I want to be? and Choice of track, the more group-specific tools are included, through which the patients adopted a new way of behaving.

    Conclusion: Patients in both groups experienced group participation as being beneficial for recovery and regaining control of their lives, although in somewhat different way. An experience of affirmation and support from health professionals and group participants is of importance for behavioural change

  • 16.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Musculoskeletal discomfort of music teachers: an eight-year perspective and psychosocial work factors1998In: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 4, no 2, p. 89-98Article in journal (Refereed)
    Abstract [en]

    Musicians at all levels of performance, especially string players, are known to have a high prevalence of work-related musculoskeletal disorders. The disorders seem to be most common in the neck, shoulders and low back. In 1988, a survey of the work-related musculoskeletal disorders of 36 music teachers was carried out at a music school in northern Sweden. In 1996, the teachers were reinvestigated. The study also included an investigation of the psychosocial work environment according to the Karasek demand-control theory, as well as measurements of upper-arm elevation during a working day in five violin teachers. The results showed that music teachers, like other professional musicians, often experience discomfort in the neck, shoulders, and low back. The discomfort tended to be of long duration, increasing over the years. The psychosocial work environment was characterized by high psychological demands and low authority over decisions. This was compensated for through good social support. The work required skill and creativity but was monotonous. The measurements of upper-arm elevation indicated considerable variations in shoulder positions between teachers. There were also differences in the work done with the right and left arms, with repetitive motions more commonly involving the right arm. Approximately a fourth of the working day was spent with the arm elevated 30-90 degrees. The relationships between upper-arm movements and ratings of discomfort were moderate.

  • 17.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Musicianship and teaching: positive health factors in music teachers2002In: Medical problems of performing artists, ISSN 0885-1158, E-ISSN 1938-2766, Vol. 17, no 1, p. 3-10Article in journal (Other academic)
  • 18.
    Geithner, Christina A.
    et al.
    Department of Organizational Leadership, Gonzaga University.
    Molenaar, Claire E.
    The School of Physical Therapy, Regis University.
    Henriksson, Tommy
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Relative Age Effects in Women’s Ice Hockey: Contributions of Body Size and Maturity Status2018In: Women in Sport & Physical Activity Journal, ISSN 1063-6161, E-ISSN 1938-1581, Vol. 26, no 2, p. 124-133Article in journal (Refereed)
    Abstract [en]

    Research on relative age effects (RAEs) in women’s ice hockey is lacking data on participant characteristics, particularly body size and maturity status. The purposes of our study were to investigate RAEs in women’s ice hockey players from two countries, and to determine whether RAE patterns could be explained by chronological age, body size, and maturity status. Participants were 54 Swedish elite and 63 Canadian university players. Birthdates were coded by quartiles (Q1–Q4). Weight and height were obtained, and body mass index and chronological age were calculated for each player. Players recalled age at menarche, and maturity status was classified as early, average, or late relative to population-specific means. Chi-square (χ2), odds ratios (OR), 95% confidence intervals (CI) and effect sizes (Cohen’s w) were calculated using population data across quartiles and for pairwise comparisons between quartiles. Descriptive statistics and MANOVAs were run by quartile and by country. Significant RAEs were found for Canadian players across quartiles (p < .05), along with a Q2 phenomenon (Q2: Q3, Q2: Q4, p < .05). Swedish players were overrepresented in Q3 (Q3: Q4, p < .05). Q4 was significantly underrepresented in both countries (p < .05). The oldest, earliest maturing, and shortest players in both countries were clustered in Q2, whereas the next oldest and latest maturing Swedish players were found in Q3. Age, physical factors, and interactions may contribute to overrepresentations in Q2 and Q3. These findings do not suggest the same bias for greater relative age and maturity found in male ice hockey.

  • 19. Halvarsson, Sara
    et al.
    Asplund, Ragnar
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    From authority to coach: parents' experiences of streching as a home programme for childrern with cerebral palsy2010In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 4, p. 208-216Article in journal (Refereed)
    Abstract [en]

    Stretching is a common treatment for children with cerebral palsy, carried out by parents together with their children in the home. The aim of the present study was to explore parents’ experiences of carrying out stretching as a home programme. In order to capture the informants’ own perceptions and experiences, a qualitative method, the Grounded Theory, was chosen. Fifteen semi-structured interviews with parents, using open-ended questions, were analysed. One core category, “From authority to coach”, and two categories, “Prerequisites for parenting during stretching” and “Child and parent interaction”, emerged. The parents described a gradual development of their own role in the home stretching programme, from that of an authority, when the child was young, to that of a coach when the child grew older. With this gradual development came an increased level of participation from the child, enabling stretching to be carried out regularly. According to the parents, stretching could not be carried out without the child's active participation. Along with the process, the parents perceived increasing stress through added pressure and demands. Mobility, time, coping strategies for stress and support from professionals, in particular physiotherapists, were important prerequisites for parents to help their child best with stretching exercises.

    Read More: http://informahealthcare.com/doi/abs/10.3109/14038196.2010.528023

  • 20.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Larsson, Christel
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Sweden.
    Ahlgren, Christina
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Experiences of barriers and facilitators to weight-loss in a diet intervention: a qualitative study of women in Northern Sweden2014In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 14, p. 59-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a lack of research about the experiences of participating in weight-reducing interventions. The aim of this study was to explore barriers and facilitators to weight-loss experienced by participants in a diet intervention for middle-aged to older women in the general population in Northern Sweden.

    METHOD: In the intervention the women were randomised to eat either a Palaeolithic-type diet or a diet according to Nordic Nutrition recommendations for 24 months. A strategic selection was made of women from the two intervention groups as well as from the drop-outs in relation to social class, civil status and age. Thematic structured interviews were performed with twelve women and analysed with qualitative content analyses.

    RESULTS: The results showed that the women in the dietary intervention experienced two main barriers - struggling with self (related to difficulties in changing food habits, health problems, lack of self-control and insecurity) and struggling with implementing the diet (related to social relations and project-related difficulties) - and two main facilitators- striving for self-determination (related to having clear goals) and receiving support (from family/friends as well as from the project) - for weight-loss. There was a greater emphasis on barriers than on facilitators.

    CONCLUSION: It is important to also include drop-outs from diet interventions in order to fully understand barriers to weight-loss. A gender-relational approach can bring new insights into understanding experiences of barriers to weight-loss.

  • 21.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Haukenes, Inger
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Fjellman Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Evengard, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Low-Educated Women with Chronic Pain Were Less Often Selected to Multidisciplinary Rehabilitation Programs2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5, article id e97134Article in journal (Refereed)
    Abstract [en]

    Background: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education. Methods: The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS). Results: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high-and low-educated men. Conclusion: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.

  • 22.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Annandale, Ellen
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Elwer, Sofia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Harryson, Lisa
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Stenberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Verdonk, Petra
    Central gender theoretical concepts in health research: the state of the art2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 2, p. 185-190Article in journal (Refereed)
    Abstract [en]

    Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

  • 23.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Haukenes, Inger
    Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health; Research Unit for General Practice, Uni Research Health, Kalfarveien 31, Bergen, Norway.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients: A Study of Pain Rehabilitation2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 4, article id e0152735Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.

    METHODS: In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.

    RESULTS: The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.

    IMPLICATIONS: The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.

    CONCLUSIONS: Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.

  • 24.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neurophysiology.
    Limousin, Patricia
    UCL Institute of Neurology, Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, London, United Kingdom.
    Tisch, Stephen
    Department of Neurology, St. Vincent’s Hospital, Darlinghurst, NSW, Australia.
    Jahanshahi, Marjan
    UCL Institute of Neurology, Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, London, United Kingdom.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Patients' perceptions of life shift after deep brain stimulation for primary dystonia: a qualitative study2011In: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 26, no 11, p. 2101-2106Article in journal (Refereed)
    Abstract [en]

    Studies of deep brain stimulation for dystonia have shown significant motor improvement. However, patients' perceptions of surgery and its effects have been less studied. We aimed to explore perceptions of changes in life in patients with primary dystonia after deep brain stimulation. Thirteen patients underwent thematic interviews 8-60 months after pallidal deep brain stimulation. Interviews were transcribed verbatim and analyzed with grounded theory. Patients described a profound impact of dystonia on daily life. After surgery, physical changes with a more upright posture and fewer spasms translated into an easier, more satisfying life with greater confidence. Notwithstanding this positive outcome, the transition from a limited life before surgery to opportunities for a better life exhibited obstacles: The "new life" after deep brain stimulation was stressful, including concern about being dependent on the stimulator as well as having to deal with interfering side effects from deep brain stimulation. The whole coping process meant that patients had to quickly shift focus from struggling to adapt to a slowly progressive disorder to adjustment to a life with possibilities, but also with new challenges. In this demanding transition process, patients wished to be offered better professional guidance and support. Even though deep brain stimulation provides people with primary dystonia with a potential for better mobility and more confidence, patients experienced new challenges and expressed the need for support and counseling after surgery. Grounded theory is a useful method to highlight patients' own experience and contributes to a deeper understanding of the impact of deep brain stimulation on patients with dystonia.

  • 25.
    Henriksson, Tommy
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Correlation between Off-ice Strength and Power Variables and Skating Performance in Women's Ice Hockey2015In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 47, no 5S, p. 962-962Article in journal (Refereed)
    Abstract [en]

    The relationship between off-ice tests and skating performance has not been previously investigated in elite women ice hockey players (WIHP).

    PURPOSE: The aim of this study was to investigate the relationship between off-ice strength-, and power- variables and different components of skating performance in Elite WIHP. 

    METHODS: Elite WIHP (n=32) age: 18.3±2.1 years, were evaluated via physiological tests of; Vertical power (squat jump (SJ) and countermovement jump (CMJ)); Horizontal power (standing long jump on two legs (SLJ) on one leg (SLJR) and 20m linear sprinting); Strength (isometric leg pull, squat and isokinetic leg extension on 90° and 210° (Iso90, Iso210)). Right leg measurements were selected for the isokinetic leg extension and SLJ(R). Skating performance was assessed on-ice via three agility tests; S-cornering agility skate (SCAS), Transition agility skate (TAS), Cone agility skate (CAS), and anaerobic endurance test; Modified repeat sprint skate (MRSS). Pearson ́s bivariate correlations were used to investigate the associations between physical variables and on-ice variables. Statistical significance was set to p<.05.

    RESULTS: SLJR, SLJ, Iso90, Iso210, isometric leg-pull and 20m sprint were correlated with TAS, r = .698 (p.001), r = .509 (p.026), r = -.514 (p.050), r = -.529 (p.043), -.479 (p.038) and r = .631 (p.007) respectively. SLJR and Iso90 was correlated with SCAS, r = -.619 (p.005) and r = -.520 (p.047). SLJR, SLJ, CMJ and Iso210 were correlated to MRSS, r = -.588 (p.01), r = -.539 (p.021), r = -.482 (p.037) and r = -.544 (p.04) respectively. CAS was not significantly correlated with any of the physiological tests.

    CONCLUSIONS: Off-ice power and strength tests were significantly correlated to skating performance in elite WIHP. 

  • 26.
    Henriksson, Tommy
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. The National Graduate School of Gender Studies.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Running a team is like laying a puzzle: Elite coaches' perspective on women's ice hockey2013Conference paper (Refereed)
  • 27.
    Henriksson, Tommy
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Running a team is like laying a puzzle: elite coaches' experiences of women's ice hockeyManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: The aim of the study was to explore aspects important for sport development and performance in women’s ice hockey, and to reflect on the conditions in Sweden and in North America.

    Method: Data were collected using individual interviews analyzed by qualitative content analysis. The sample including eight ice hockey coaches, two women and six men from being active coaches for female teams on the highest national level.

    Result: The analysis resulted in the theme “Coaching with a holistic approach” and three categories; “Individually oriented and humane leadership”, “Insight and understanding of performance requirements”, and “Necessary conditions for sport development”. The results displayed the complex task of managing a top-level team. In order to coordinate available preconditions into a beneficial environment for the players to develop and perform, the coached had adopted a holistic approach to coaching. A holistic approach to coaching was considered necessary to promote human-, as well as athletic-development in WIH.

    Conclusion: This study suggests that leadership, conditions and requirement of the game, are interrelated and all has to be considered to meet the requirements of the sport and provide opportunities for development. Furthermore, we suggest WIH would benefit from being treated as its own unique experience, instead of being compared to MIH.

  • 28.
    Henriksson, Tommy
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Vescovi, Jason D.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Laboratory- and field-based testing as predictors of skating performance in competetive-level female ice hockey2016In: Open Access Journal of Sports Medicine, ISSN 1179-1543, E-ISSN 1179-1543, Vol. 7, p. 81-88Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of this study was to examine whether field-based and/or laboratory-based assessments are valid tools for predicting key performance characteristics of skating in competitive-level female hockey players.

    DESIGN: Cross-sectional study.

    METHODS: Twenty-three female ice hockey players aged 15-25 years (body mass: 66.1±6.3 kg; height: 169.5±5.5 cm), with 10.6±3.2 years playing experience volunteered to participate in the study. The field-based assessments included 20 m sprint, squat jump, countermovement jump, 30-second repeated jump test, standing long jump, single-leg standing long jump, 20 m shuttle run test, isometric leg pull, one-repetition maximum bench press, and one-repetition maximum squats. The laboratory-based assessments included body composition (dual energy X-ray absorptiometry), maximal aerobic power, and isokinetic strength (Biodex). The on-ice tests included agility cornering s-turn, cone agility skate, transition agility skate, and modified repeat skate sprint. Data were analyzed using stepwise multivariate linear regression analysis. Linear regression analysis was used to establish the relationship between key performance characteristics of skating and the predictor variables.

    RESULTS: Regression models (adj R2) for the on-ice variables ranged from 0.244 to 0.663 for the field-based assessments and from 0.136 to 0.420 for the laboratory-based assessments. Single-leg tests were the strongest predictors for key performance characteristics of skating. Single leg standing long jump alone explained 57.1%, 38.1%, and 29.1% of the variance in skating time during transition agility skate, agility cornering s-turn, and modified repeat skate sprint, respectively. Isokinetic peak torque in the quadriceps at 90° explained 42.0% and 32.2% of the variance in skating time during agility cornering s-turn and modified repeat skate sprint, respectively.

    CONCLUSION: Field-based assessments, particularly single-leg tests, are an adequate substitute to more expensive and time-consuming laboratory assessments if the purpose is to gain knowledge about key performance characteristics of skating.

  • 29.
    Henriksson, Tommy
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Vescovi, Jason D.
    Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada..
    Geithner, Christina A.
    Department of Organizational Leadership, Gonzaga University.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Performance profiling of female ice hockey players by country and positionManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: The purposes of this study were to determine whether physiological qualities and on- ice skating performance differ by country and by position in women’s ice hockey.

    Design: Cross-sectional study.

    Methods: A total of 109 female ice hockey players volunteered for the study: 45 players from Sweden (19.38 ± 2.56 years; body mass 69.43 ± 7.05 kg: height 169.83 ± 5.03 cm) and 64 players from Canada (19.84 ± 1.62 years; body mass 68.28 ± 7.72 kg: height 166.14 ± 13.67 cm). Anthropometric assessments included estimated body composition using skinfold measurements. Physiological assessments included tests for acceleration, strength, power and aerobic endurance. Performance assessments included on-ice agility and anaerobic tests. Data were analyzed for mean differences by country and position using a two-way ANOVA.

    Results: The Swedish players had less body fat (p=.007), more lean mass (p=.005), and higher Beep test scores (p=.001). The Canadian players performed better on leg strength (p=.026), acceleration (p=.001), single leg standing long jumps (right leg p=.002, left leg p=.030) and the modified repeat sprint skate (MRSS) (p=.029). Positional comparisons between forwards (F) and defenders (D) showed no significant differences. F and D performed better than goalies (G) on the beep test (p=.002 and p=.002, respectively).

    Conclusion: The findings showed that the physiological profile for the female ice hockey players in this sample differed by country. The results indicate that the Canadian profile may be better adapted for on-ice performance. No performance differences were found between F and D. G are subjected to completely different requirements, due to variation in equipment and movement patterns, and should not be compared to F and D.

  • 30.
    Häggqvist, Beatrice
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Westerberg, Kristina
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "The balancing act". Licensed practical nurse experiences of falls and fall prevention: a qualitative study2012In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 12, p. 62-Article in journal (Refereed)
    Abstract [en]

    Background: Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients.

    Methods: A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis.

    Results: The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer.

    Conclusions: Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.

  • 31. Johansson, L
    et al.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Limited possibilities-ventilated patients experiences of body awareness at an intensive care unit2007Conference paper (Other academic)
  • 32.
    Johansson, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fjellman Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ventilated patients' experiences of body awareness at an intensive care unit2005In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 7, p. 154-161Article in journal (Refereed)
    Abstract [en]

    Treatment with mechanical ventilation (MV) in an intensive care unit (ICU) can cause extensive problems for patients.There is, however, a dearth of research investigation into how ICU treatment affects a person’s body image. The aim of thisstudy was to enhance the knowledge and understanding of body awareness and body image in persons treated with MV in anICU. In order to capture the informants’ own perceptions and experiences, a qualitative method of Grounded Theory waschosen. Seven thematic in-depth interviews were carried out with former ICU patients. To increase credibility, triangulationof researchers and reference group checking was used. The analysis resulted in the core category Limited possibilitiesto act, which relates to the informants’ experiences of not being able to act as they normally would. The core category wasderived from the experiences of feeling like another person, the perceptions of not being in contact with their body andreality and the feeling of being restrained. This study adds a perspective of body awareness to the interpretations of ICUpatients’ experiences. It emphasizes the experience and movement aspects of the body and that physiotherapists have animportant role in the rehabilitation of ICU patients.

  • 33.
    Lehti, Arja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic: patient and professional perceptions of inequity in rehabilitation of chronic pain2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 45-53Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.

    SETTING AND METHODS: This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.

    RESULTS: The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.

    CONCLUSION: From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.

  • 34. Molenaar, Claire E.
    et al.
    Geithner, Christina A.
    Henriksson, Tommy
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports Medicine.
    The Relative Age Effect in Women's Ice Hockey: International and Positional Comparison2015In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 47, no 5S, p. 629-630Article in journal (Other academic)
    Abstract [en]

    A relative age effect (RAE), or chronological age differences among individuals within the same age group, has been observed in 14 sports (Cobley et al., 2009). A strong RAE has been reported in men’s ice hockey since 1985 (Barnsley et al., 1985). In contrast, research on RAE in women’s ice hockey is limited (Wattie et al., 2007; Weir et al., 2010) and findings are equivocal.PURPOSE: To determine whether there is a RAE in women’s ice hockey, and if it varies by country or player position.

    METHODS: Participants were 117 female ice hockey players (mean age=19.9±2.3 yr) on 2 Swedish elite-level club teams (n=54) and 4 Canadian university teams (n=63). Players reported birthdate and position (Forward=F, Defenseman=D, Goalie=G). Birthdates were coded by quartiles (Q1: Jan.-March, Q2: April-June, Q3: July-Sept., Q4: Oct.-Dec.) and by half-year. Birthdate data were submitted to chi-square analyses for the sample, by country, and by position. SPSS 17.0 for Windows was used for all analyses (significance level: p<0.05). RESULTS: A significant RAE was observed for the entire sample by quartile (Q1: 28.2%, Q2: 34.2%, Q3: 25.6%, Q4: 12.0%; χ2=12.402, p=0.006). More players were born in the first half of the year than the second (62.4% vs. 37.6%, respectively; χ2=7.188, p=0.007). In contrast, Q4 was underrepresented for the sample and by country (Canada: 12.7%, Sweden: 11.1%). A RAE was present for the Canadian players by quartile (χ2=13.381, p=0.004) and half-year (χ2=9.921, p=0.002); however, no RAE was observed for Swedish players. In addition, a significant RAE was observed for the entire sample by position for G and D by quartiles (G - χ2=10.077, p=0.018; D - χ2=8.444, p=0.038) and half year (G - χ2=6.231, p=0.013; D - χ2=4.000, p=0.046), but not for F.

    CONCLUSIONS: The significant RAE in this sample is consistent with that in men’s ice hockey and the tendency for greater participation by relatively older players in women’s ice hockey. RAE absence in the Swedish players may reflect lower participant number, competitive level, and sociocultural support, as well as greater variation in skill level. The significant RAEs observed in Canadian players and by position support the findings of Weir et al. (2010), but the positional differences found were inconsistent, perhaps due to differences in sample size and competitive level between studies. 

  • 35. Mulligan, Hilda
    et al.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hale, Leigh
    Thomas, David
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Promoting physical activity for people with neurological disability: perspectives and experiences of physiotherapists2011In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 27, no 6, p. 399-410Article in journal (Refereed)
    Abstract [en]

    Both New Zealand and Sweden have health and disability policies that promote recreational exercise within society for people with disability. Despite these policies, levels of physical activity by people with disability in these countries are low. Physiotherapists are equipped to assist people with disabling conditions into physical activity. This qualitative study explored the perspectives and experiences of physiotherapists in New Zealand and Sweden toward promoting physically active recreation for adults with chronic neurological conditions. Nine physiotherapists who worked with adults with neurological disability in a range of long-term rehabilitation and community (home) health services were interviewed and the data analysed for themes. The physiotherapists described innovative and resourceful expertise to assist patients to be physically active. However, they perceived a lack of support for their work from within the health system and a lack of knowledge of disability issues within the recreational arena, both of which they perceived hindered their promotion of physical activity for people with neurological disability. Physiotherapists feel unable to fully support health and disability policies for the promotion of physically active recreation for people with neurological conditions, because of perceived constraints from within the recreational arena and their own health systems. If these constraints were addressed, then physiotherapists could be better agents to promote physical activity for people with neurological conditions.

  • 36. Nordin, Catharina
    et al.
    Gard, Gunvor
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Being in an exchange process: experiences of patient participation in multimodal pain rehabilitation2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 6, p. 580-586Article in journal (Refereed)
    Abstract [en]

    Objective: To explore primary healthcare patients' experiences of patients participation in multimodal pain rehabilitation.

    Patients and methods: A total of 17 patients who had completed multimodal rehabilitation for persistent pain were interviewed. The interviews were analysed using qualitative content analysis.

    Results: One theme, Being in an exchange process, and 4 categories emerged. The theme depicted patient participation as a continuous exchange of emotions, thoughts and knowledge. The category Fruitful encounters represented the basic prerequisites for patient participation through dialogue and platforms to meet. Patients' emotional and cognitive resources and restrictions, as well as knowledge gaps, were conditions influencing patient participation in the category Inequality in co-operation. Mutual trust and respect were crucial conditions in patient's personal relationships with the health professionals, forming the category Confidence-inspiring alliance. In the category Competent health professionals, the health professionals' expertise, empathy and personal qualities, were emphasized to favour patient participation.

    Conclusion: Patient participation can be understood as complex and individualized. A confidence-inspiring alliance enables a trusting relationship to be formed between patients and health professionals. Patients emphasized that health professionals need to play an active role in building common ground in the interaction. Understanding each patient's needs in the participation process may favour patient participation.

  • 37.
    Nordström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Grysell, Tomas
    Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students2011In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 11, no 74, p. 7-Article in journal (Refereed)
    Abstract [en]

    Background: One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play.

    Methods: After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains.

    Results: The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience.

    Conclusions: The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.

  • 38.
    Nordström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grysell, Tomas
    The effect of a role-playing exercise on clerkshipstudents’ views of death notification: the Swedish experience2011In: International Journal of Medical Education, ISSN 2042-6372, Vol. 2, p. 24-29Article in journal (Refereed)
    Abstract [en]

    Objectives The purpose of this study was to examine clerkship students' perspective towards delivering death notifications. An additional purpose of the study was to identify the learning needs of students following a role play exercise in delivering death notifications.

    Methods Participants in this study were fourth-year medical students (N=86) ranging in age from 22-43 years with a mean age of 27.1 years. There were 28 women and 58 men. Questionnaires, consisting of open-ended questions and a visual analogue scale (VAS), were administered before and after the "Marathon Death" role play exercise.

    Results Six categories emerged from the analysis of the questionnaire: communication, emotions, self-development, exercise-related, learning opportunities and tools and strategies. Results from the visual analogue scale showed that the majority of students (60%) needed to practice how to deliver difficult messages in death notifications. After taking part in the role-playing activity with video playback, where the students had an opportunity to view, discuss and reenact scenarios, seventy-six out of 78 (97.4%) stated that they had received training in communication skills. The responding students rated the exercise as highly relevant, scoring it a mean of 91 on a VAS scale of 0 to 100 mm.

    Conclusions Students are not competent in the communication skills required for delivering death notifications. A majority of students expressed a need for training in communication skills. The "Marathon Death" role play exercise provides initial training and emotional support for delivering a death notification. However, further empirical studies are required about the effect of the exercise on delivering the notification of death.

  • 39.
    Nordvall Strömberg, Petronella
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Enhanced information regarding exercise training as treatment is needed. An interview study in patients with chronic obstructive pulmonary disease2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 16, p. 1424-1430Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study is to describe thoughts and attitudes of patients with chronic obstructive pulmonary disease (COPD) when talking about exercise training as treatment.

    METHODS: Semi-structured interviews were performed and analyzed with the grounded theory method. Four men and six women were interviewed (ages 66-84 years), with moderate to severe COPD, and no experience of organized exercise training as treatment for COPD.

    RESULTS: The analysis resulted in one core category, unknown territory, and three categories, good for those who can, but not for me; fear of future; and mastering. Exercise training as treatment was perceived by the participants as something unknown. It was also described as important for others but not for them. Their perceptions were that they could not perform exercise training, and did not have the knowledge of what or how to perform exercise that was good for them.

    CONCLUSIONS: Patients with COPD, with no previous experience of exercise training as treatment for their disease, describe exercise training as something unknown and unimportant for them. The results provide important knowledge for healthcare professionals regarding how to educate patients with COPD about the content and benefits of exercise training as treatment. Implications for Rehabilitation Exercise training is effective for patients with chronic obstructive pulmonary disease (COPD) with regard to dyspnea, physical capacity, health-related quality of life, and health care use. Patients with COPD perceive a lack of information regarding exercise training as treatment. The information and the presentation of exercise training as treatment might be of importance to get better adherence to this treatment.

  • 40.
    Norlund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Personal Resources and Support When Regaining the Ability to Work: An Interview Study with Exhaustion Disorder Patients2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 2, p. 270-279Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of the study was to explore experiences and thoughts in the process of returning to work in employed patients with Exhaustion Disorder. Methods Twelve patients with Exhaustion Disorder (burnout) who had been referred to a Stress Rehabilitation Clinic were interviewed. All patients were employed but a majority was on full or part-time sick leave. Grounded Theory was used as the qualitative method. Results A core category, regaining the ability to work, was developed. Alongside, two categories, internal resources and the external support system, were experienced as being important to the process. The internal resources were expressed through three key features (sub-categories), perceived validation, insights and adaptive coping abilities. The external support system was diverse and described by the sub-categories practical/structural and/or emotional support. Four external support actors were identified; the workplace, health care, the Social Insurance Agency, and the union. The supervisor was described as the most important external actor. Conclusions Internal and external resources are intertwined in the process of regaining the ability to work. The internal resources and external support can directly increase the probability to regain the ability to work. Moreover, these resources can affect each other and thus indirectly have an effect on the process.

  • 41.
    Olofsson, Lena
    et al.
    Department of Occupational Therapy and Physiotherapy, Östersund Hospital, Östersund, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sö derman, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    From loss towards restoration: Experiences from anterior cruciate ligament injury2010In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 1, p. 50-57Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to illuminate anterior cruciate ligament (ACL)-reconstructed athletes’ experience of their injury, rehabilitation and recovery. Seven persons, aged 19–57 years, were interviewed on one occasion in autumn 2004, between 10 and 31 months after the ACL reconstruction. They were selected to reach a maximum variation sample according to gender, age, activity level, time between injury and ACL reconstruction and time between surgery and the interview. The analyses were carried out using the Grounded Theory method of constant comparison. One core category “From loss towards restored belief in one's ability” and three categories emerged. The core category represents the process starting when the informants were injured. The process contained phases that interacted with each other but more importantly were drawn out over a long period, especially the mental recovery. The informants used different procedures to manage situations that arose and strived towards restored belief in their ability. This study illuminates the complexity of the recovery process. The patients’ belief in their own ability took a long time to restore. It is important for physiotherapists to understand what patients with ACL injuries need while waiting for surgery. The process of rehabilitation can further equip people with the means to manage problems that can arise and help to strengthen their belief in their ability, as well as helping them with physical training.

  • 42.
    Sandell, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Frykman, M
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Chesky, K
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Playing-related musculoskeletal disorders and stress-related problems among percussionists2009In: Medical problems of performing artists, ISSN 0885-1158, E-ISSN 1938-2766, Vol. 24, no 4, p. 175-180Article in journal (Refereed)
    Abstract [en]

    This cross-sectional study examined the prevalence of self-reported playing-related musculoskeletal disorders (PRMDs) and stress-related health problems among percussionists. Data for the present study were extracted from the University of North Texas Musician Health Survey (UNT-MHS) data set. Subjects (n = 279) were included if they identified auxiliary percussion (i.e., tambourine, triangle, bells, rattle, wood block), drum set, marimba, steel drum, timpani, vibraphone, xylophone, or other percussion as their primary instrument. Prevalence rates for PRMDs and stress-related health problems were determined for the total percussion group and for separate instrument categories. Of the total group, 77% reported one or more PRMDs. The keyboard percussionists (marimba, vibraphone, xylophone, and steel drum) reported the significantly highest prevalence (89%), followed by auxiliary and other percussionists (79%) and membranophone percussionists, including drum set and timpani (74%). The highest region-specific prevalence of PRMDs for the whole group was found in the bilateral hand and low back regions. Stress due to work environment was considered moderate to high by 75% of the respondents. Regarding stress-related health problems, percussionists reported primarily problems with fatigue, depression, and stage fright. The overall findings of this study show that PRMDs and stress-related health problems are a major concern for percussionists and warrant further research.

  • 43.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Annchristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dolling, Ann
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    “Nature's effect on my mind”: patients’ qualitative experiences of a forest-based rehabilitation programme2015In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, no 3, p. 607-614Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate the personal experiences and perceived effects on mind from visits to forest environments in a subset of patients with severe exhaustion disorder (ED), who participated in a randomized controlled trial for evaluation of forest-based rehabilitation.

    Participants: A subsample of 19 patients with diagnosed ED, who completed the three-month forest-based rehabilitation programme in the ForRest project, was interviewed. Method: The forest-based rehabilitation consisted of repeated forest visits with the main objective of spending time in rest and solitude in a chosen forest setting. Semi-structured interviews were carried out and analysed using Grounded Theory.

    Result: A core category and five subcategories were set up to describe the patients’ experiences and development during the forest-based rehabilitation. As patients mostly reported that they strove to achieve peace of mind during the forest visits, Striving for serenity was chosen to be the core category. At first the patients were frustrated when left alone with their own thoughts in an unfamiliar forest environment. They gradually became familiar with the forest environments and also found their favourite places where they experienced peace of mind. They were then able to rest and begin reflective thinking about their life situation, which led to ambitions to change it.The preferred forest environments were characterised by openness, light and a good view, and were felt to be undemanding, peaceful and stimulating.

    Conclusion: Visits to the forest provided favourite places for rest, were experienced as restorative, seemed to improved reflection and may have contributed to starting the coping process for these patients. However, forest visits, as the only treatment option, are not sufficient as rehabilitation from severe and long-term ED. We suggest that forest visits should be integrated with cognitive behavioural therapy to further improve the recovery and enhance coping in daily life for these patients.

  • 44.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Sveriges lantbruksuniversitet.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dolling, Ann
    Sveriges lantbruksuniversitet.
    "Nature's effect on my mind". Patients' experiences of nature based rehabilitation: a qualitative inquiry.2015In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, no 3, p. 607-14Article in journal (Refereed)
  • 45.
    Stenberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "Getting confirmation": gender in expectations and experiences of healthcare for neck or back patients2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 2, p. 163-171Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore, from a gender perspective, patients' expectations prior to seeking healthcare for neck or back pain, and their subsequent experiences of the care and rehabilitation they received.

    Methods: Thematized interviews with 12 patients, 7 women and 5 men, using open-ended questions, were analysed according to grounded theory. Each patient was interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later.

    Results: Analysis resulted in 5 categories: "To be taken seriously", "Getting an explanation", "To be invited to participate", "To be assessed and treated individually", and "To be taken care of in a trustworthy environment", which were linked by a core category "Getting confirmation". Two ideal types were identified: the "Confident" type, characterized by self-confidence and pride, and the "Ambiguous" type, characterized by disparagement and shame. The categories were partly perceived in different ways from the two ideal types. The ideal types were not defined by sex; however, more men were found to be of the "Confident" type and more women of the "Ambiguous" type.

    Conclusion: Gender appears to affect expectations and experiences, in addition to how patients view and express their problems. Healthcare professionals should take this into account in consultations.

  • 46.
    Stenberg, Gunilla
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    'I am afraid to make the damage worse': fear of engaging in physical activity among patients with neck or back pain : a gender perspective2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, p. 146-154Article in journal (Refereed)
    Abstract [en]

    Rationale: Neck and back pain are major public health problems in Western societies and cause considerable disability and health service use. Swedish women report more severe neck and back pain compared with Swedish men. Most studies on the aetiology of gender differences in pain deal with biological mechanisms, and less with the role of psychological and sociocultural factors. 'Pain beliefsis a sociocultural factor and can be expressed in different ways among women and men. It is important to know what pain beliefs are held by neck and back pain patients, especially when medical guidelines recommend that back pain patients stay physically active.

    Aim: Exploring pain beliefs in relation to physical activity among neck and back pain patients consulting primary health care.

    Method: Twelve patients (seven women, five men) consulting primary health care for an initial episode of neck or back pain were interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later. The interviews covered patient experiences of neck or back pain, consequences, strategies and treatment experiences. The interviews were analysed with qualitative content analysis from a gender perspective.

    Result: One theme 'Fear of hurting the fragile body' was expressed by all neck or back pain patients. Five categories were identified 'The mechanical body', 'Messages about activity', 'Earlier experiences of pain and activity', 'To be a good citizen' and 'Support to be active' supported or undermined beliefs about pain and physical activity. Gender expressions occurred in the categories 'Messages about activity', 'To be a good citizen' and 'Support to be active'.

    Conclusions: Neck or back pain patients in the study saw the body as fragile and were afraid of hurting it. Notions of gender had an impact on the given advice about activity and on how patients perceived the message about staying active.

  • 47.
    Stenberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundquist, Anders
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Patterns of reported problems in women and men with back and neck pain: similarities and differences2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 7, p. 668-675Article in journal (Refereed)
    Abstract [en]

    Objective: To examine similarities and differences in problem areas reported by women and men who seek physiotherapy for back or neck pain. Methods: Principal component analysis (PCA) was used to analyse questionnaire data including demographics, pain, domestic work, stress, health status, physical disability, psychosocial and physical workload, kinesiophobia and self-efficacy. Most of the questions were recruited from a number of scales, e.g. EuroQol (EQ-5D), Neck Disability Index (NDI), Oswestry Disability Questionnaire (ODQ), Tampa Scale for Kinesiophobia, and Functional-Efficacy-Scale. Results: A total of 118 patients (84 women, 34 men) completed the questionnaire. Men and women scored similarly on physical disability, functional self-efficacy and kinesiophobia, but women scored higher on stress reactions and pain intensity. PCA showed that questions about physical disability and functional self-efficacy comprised the first component and explained most of the variance in this patient group. Questions about stress and social support at work constituted the second component. Questions about domestic workload and pain comprised the third component. Gender differences were found in the second and third components. Conclusion: In general, women and men answered questions similarly, but there were differences: more women reported stress, pain and low support at work and more men reported a lower domestic workload.

  • 48.
    Stenberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundquist, Anders
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Similarities and differences: patterns of reported problems and ICF classification in women and men with back or neck pain seeking physiotherapy treatmentManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: The primary aim of this study was to examine similarities and differences in problem areas reported by women and men who seek physiotherapy treatment for back or neck pain. A second aim was to evaluate the appropriateness of ICF classification in relation to gender.

    Methods: Principal component analysis (PCA) and partial least squares of latent structures (PLS) were used to analyse questionnaire data including background data, questions about pain, domestic work, stress, EQ-5D, Neck Disability Index (NDI), Oswestry Disability Questionnaire (ODQ), psychosocial and physical workload, Tampa Scale and Functional Self-Efficacy Scale.

    Results: One hundred and eighteen patients (84 women and 34 men) completed the questionnaire. Men and women scored similarly on the NDI, ODQ, Functional Self Efficacy, and Tampa Scale, but women rated higher on stress reactions. PCA showed that questions from the NDI, ODQ and Functional Self-Efficacy Scale explained most of the variance in this patient group. Questions about stress and social support at work constituted the second component. Questions about domestic workload and pain comprised the third component. Gender differences were found in the two last components.

    Conclusion: Further investigation of the impact of gender on neck and back pain in different cultures is important.

  • 49. Stråhle-Öberg, Lena
    et al.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Parents' experience of pain in children with cerebral palsy and multiple disabilites. An interview study2009In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, no 3, p. 137-144Article in journal (Refereed)
  • 50.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Edlund, Curt
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Falkdal, Annie Hansen
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians2013In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 45, no 1, p. 117-128Article in journal (Refereed)
    Abstract [en]

    The concept of work ability is not clearly defined although it has a central place in vocational rehabilitation. Several health professions are involved in assessing work ability, physicians and occupational therapists are two of these. OBJECTIVE: The purpose of this study was to explore occupational therapist and physician views about work ability and experiences in assessing work ability. PARTICIPANTS: Fourteen physicians and 23 occupational therapists participated in seven focus group discussions that were audio taped and transcribed verbatim. METHODS: Qualitative content analysis was used. Each author performed an individual preliminary analysis. These analyses were later discussed and refined in the research team and a workshop. The final categorization resulted in one theme, four categories and 13 sub-categories. RESULTS: The overall theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirm the complex structure of work ability: the person, the context of life, the work, and the society. Physicians expressed greater difficulty in assessing work ability than occupational therapists did, because they have fewer instruments to access this concept. CONCLUSIONS: Assessment of work ability requires team cooperation with several different professionals. Cooperation could increase accuracy in issuing sickness certification and strengthens the ability of identifying individual requirements for rehabilitation.

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