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  • 1.
    Eskilsson, Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Stressrehabilitering, Västerbottens läns landsting.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Sturesson, Marine
    Västerbottens läns landsting.
    Ståhlnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Metodstöd ADA+: ArbetsplatsDialog för Arbetsåtergång : planering, uppföljning och stöd2017Book (Other academic)
  • 2.
    Sturesson, Marine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Primärvårdens arbete med sjukskrivna – patientmötet, bedömningar och samverkan2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The ability to work can be reduced if a person has health problems which may lead to periods of sick leave. In Sweden sickness certification is issued by physicians. Many general practitioners (GPs) find sickness certification to be problematic. Some studies indicate that collaboration with other health care professions could be beneficial. The aim of the thesis was to provide knowledge on how the work with the sick leave process in primary health care can be improved and how occupational therapists’ (OT) assessment could be used prior to the decision on sick leave and rehabilitation. Initially seven focus groups were held, four with OTs and three with physicians. The discussions in the focus gropes were analysed by qualitative content analysis. An intervention project was initiated, where four health care centres in northern Sweden tested a working approach where sick listed patients were offered a supplementary assessment of activity and work-related problems by an OT. Data on sick leave, sickness certificates and patient questionnaires were collected from intervention health care centres (IHCC) and other health care centres (OHCC). Interviews were conducted with patients, GPs and OTs. The quality of the information in the collected sickness certificates was evaluated. Average values of sick leave were compared between the IHCCs and the OHCCs in the county. The interviews with sick listed patients were analysed by qualitative content analysis. In order to analyse the implementation of the intervention the Consolidated Framework for Implementation Research, CFIR, was used. An overall theme and four categories emerged from the focus groups. The theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirmed the complex structure of work ability: the person, the context of life, the work, and the society. No significant differences between IHCCs and OHCCs in data on sick leave or the mandatory information in the certificates were found. Thirty-four percent of the collected sickness certificates did not contain all requested information. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was significantly more often prescribed for male patients than for female. Two themes revealed that highlight important areas for persons on sick leave in their healthcare encounters. The theme ‘Trust in the relationship’ contains categories describing the patients’ feelings of participation, being believed, confirmed, and listened to. The second theme ‘Structure and balance’ contains the participants’ views on important factors that could facilitate the return-to-work process such as a structured plan and support to balance activity. The analysis with CFIR clarified that coaching and education for all the users are crucial to get fidelity when new interventions are tested as well as involvement by the clinical department manager. The work with sick leave issues in primary health care can be improved by developing cooperation with several different professionals. To achieve an increased cooperation new working approaches are required. These working approaches must be anchored in management and requires an applied implementation strategy. More focus on the quality of encounters with healthcare professionals can also improve the sick leave process in primary health care centres. The healthcare encounters must build on a mutual trust and sick-listed persons’ return to work can be facilitated by providing a clear structure in the process and support in occupational balance. For issuing sickness certification further education about the descriptions of functioning and the tasks included in the patient’s work is needed. A better gender awareness in the health care encounters is also necessary.

  • 3.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Bränholm, Inga-Britt
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Life satisfaction in subjects with chronic obstructive pulmonary disease2000In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 14, no 2, p. 77-82Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine the levels of life satisfaction for patients with chronic obstructive disease (COPD) and to explore the relationships between life satisfaction, lung function, walking distance test/exercise capacity and quality of life. STUDY DESIGN: The population comprised 91 patients with COPD, 28 patients with COPD using long term oxygen therapy (LTOT) and a reference group (R) of 150 healthy individuals. Before the study, a number of the COPD patients had been tested with regard to spirometry, walking distance and quality of life using the Chronic Respiratory Disease Questionnaire (CRQ). All subjects filled in an eight-item checklist on levels of life satisfaction. RESULTS: Significantly lower levels of satisfaction were reported by both patient groups than the R group for satisfaction with life as a whole and satisfaction derived from vocational/occupational situation, sexual life and ADL, and by the LTOT group, furthermore, also with family life. Only 10% of the patients were satisfied with their health. The LTOT group reported significantly lower levels of satisfaction than the COPD group for life as a whole, satisfaction with their vocational/occupational situation, leisure, ADL situation and their satisfaction with family life and partnership relation. Factor analyses demonstrated different patterns between the R group and the patient group. No correlation was found between satisfaction with life as a whole and lung function parameters whereas three of the CRQ dimensions; emotional function, fatigue and mastery correlateded significicantly with satisfaction with life as a whole and several of the domains. No relationships was found between satisfaction with life as a whole or any of the domains and the CRQ dimension dyspnea. CONCLUSIONS: The low levels of satisfaction with life as a whole, in addition to low levels of satisfaction with several domains, indicate that the majority of the patients had not managed to cope successfully with the consequences of their impairment. More attention must, thus, be given to these patients in the rehabilitation work.

  • 4.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Edlund, Curt
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Falkdal, Annie H.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Swedish Association of Local Authorities and Regions, Stockholm, Sweden.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Healthcare encounters and return to work: a qualitative study on sick-listed patients' experiences2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 4, p. 464-475Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sickness absence is a complex phenomenon affected by aspects other than disease. One important factor that can affect sick leave is the individual's experience of healthcare encounters. It is therefore essential to consider the quality of the encounter with health professionals and its impact on the patient's rehabilitation and return to work.

    AIM: The aim was to explore how sick-listed patients in Sweden perceive their contact with healthcare professionals in primary healthcare and to analyse what they view as crucial components for returning to work.

    METHODS: A qualitative approach was used. Data were collected by semi-structured telephonic interviews with patients who were or had been on sick leave. The transcribed interview text was analysed according to qualitative content analysis.

    FINDINGS: The analysis revealed two themes that highlight important areas for persons on sick leave in their healthcare encounters. The theme 'Trust in the relationship' contains categories describing the patients' feelings of participation, and of being believed, confirmed, and listened to, and also dedication on the part of healthcare providers. Healthcare encounters that were characterised by professionalism, knowledge, continuity, and a holistic approach seemed to create trust. The theme 'Structure and balance' contains the participants' views on important factors that could support the return-to-work process. All participants stated the importance of follow-up and a plan for rehabilitation. Sick leave itself can make a person passive, and participants in this study asked for support to balance activity, exercise, and work demands, which could facilitate their return to work.

    CONCLUSION: Healthcare professionals can facilitate sick-listed persons' rehabilitation back to work by providing a clear structure in the process and support in occupational balance. The healthcare encounters must build on a mutual trust.

  • 5.
    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.

  • 6.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hörnqvist Bylund, Sonya
    Edlund, Curt
    Hansen Falkdal, Annie
    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.
    Collaboration in work ability assessment for sick-listed persons in primary health careManuscript (preprint) (Other academic)
  • 7.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hörnqvist Bylund, Sonya
    Edlund, Curt
    Hansen Falkdal, Annie
    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.
    Quality in sickness certificates in a Swedish social security system perspective2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 8, p. 841-847Article in journal (Refereed)
    Abstract [en]

    AIM: In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate.

    METHODS: An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden.

    RESULTS: Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found.

    CONCLUSION: Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters.

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