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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, 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.

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  • 5.
    Andersdotter Sandström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context2023In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2212950Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important.

    Objective: The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder.

    Method: A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison.

    Results: The analysis of the data was developed into the core category ‘trying to integrate physical activity into daily life in a sustainable way’, and three categories: ‘acceptance of being good enough’, ‘learning physical activity by doing’ and ‘advocation for physical activity in rehabilitation’. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was ‘good enough’ in terms of dose and intensity of physical activity, and how to listen to the body’s signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested.

    Conclusion: Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.

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  • 6.
    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.

  • 7.
    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.

  • 8.
    Einarsson, Sandra
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    Johansson, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Kautto, Ethel
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    Lindberg, Veronica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Ljusbäck, Ann Margreth
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Rydén, Petra
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    Salander Ulander, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Thinking and re-thinking: a qualitative study of university teachers' perspectives on the development process for a new online interprofessional education curriculum in a Swedish higher education institution2023In: Nordic Studies in Education, ISSN 1891-5914, E-ISSN 1891-5949, Vol. 43, no 3, p. 225-240Article in journal (Refereed)
    Abstract [en]

    The objective was to reflect on the experience of working collaboratively across education programmes, departments, and faculties from the perspective of university teachers at a higher education institution. Nine teachers from five programmes working together to develop a new curriculum for interprofessional education (IPE) participated in a focus group discussion. Data were analysed using thematic analysis. Findings suggest that teacher experiences can be understood in terms of teamwork processes valued from both professional and IPE experiential variations within the group. Since findings illustrate pedagogical collaboration across department and faculty boundaries, they can inspire teachers who are planning a similar process.

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  • 9.
    Eliasson, Kristina
    et al.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Dahlgren, Gunilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Hellman, Therese
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Svartengren, Magnus
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Nyman, Teresia
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Lewis, Charlotte A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ergonomists’ experiences of executing occupational health surveillance for workers exposed to hand-intensive work: a qualitative exploration2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 1223Article in journal (Refereed)
    Abstract [en]

    Background: In order to reduce work-related upper limb disorders, the Swedish Work Environment Authority introduced an occupational health surveillance targeting hand-intensive work. A process model, aimed at supporting the employers as well as the occupational health service provider (i.e., ergonomist) in the work process with the occupational health surveillance, was developed. The objective of this qualitative study was to explore ergonomists’ experiences of the execution of occupational health surveillance for hand-intensive work when following the novel process model as well as factors influencing the execution.

    Methods: Semi-structured individual interviews were conducted with ten ergonomists on one occasion regarding their experience of following the work process. Qualitative content analysis with an inductive approach was used for analyzing the data.

    Results: The ergonomists’ experiences were summarized in one theme “A joint roadmap supporting a participatory process” and two categories “Clear structure provided by the components” and “The process influenced by collaboration and context”. The ergonomists valued being guided by the systematics of the model, which provided structure and clarity in their work. Factors affecting the execution were related to communication deficiencies and uncertainties regarding expectations between different roles and functions (e.g., ergonomists and contact person, lack of information to workers). Additional factors, for instance, companies’ routines and the ergonomist’s intra-organizational support, such as access to IT-resources, could also affect the process.

    Conclusions: The findings reveal that this process model facilitates the ergonomists’ work and cooperation with a client company. However, the process model needs to be developed and accompanied by a guideline with information related to the process, including e.g., description of a start-up meeting and of the roles/functions of the involved parties.

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  • 10.
    Eskilsson, Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Ek Malmer, Elin
    Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden..
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
    Malmberg Gavelin, Hanna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder2020In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 61, no 3, p. 361-368Article in journal (Refereed)
    Abstract [en]

    It is important to understand how people with exhaustion disorder (ED) perceive interventions aiming to facilitate cognitive functioning. Therefore, the overall aim of this study was to explore experiences from persons with ED after participating in a 12-week intervention of either computerized cognitive training or aerobic training. Both interventions were performed in addition to a multimodal rehabilitation programme. Thirteen participants, 11 women and 2 men, were interviewed about pros and cons with participating in the training. The interviews were analysed with Qualitative Content Analysis. The analyses resulted in the theme hopeful struggling for health and the categories support, motivation and sensations. It was hard work recovering from ED. Support from others who are in the same situation, family members, and technology and routines for the training were strongly emphasized as beneficial for recovery. Timing, i.e., matching activities to the rehabilitation programme, getting feedback and perceiving joy in the training were important for motivation. Participants in both interventions experienced positive sensations with improved memory performance, everyday life functioning and increased faith in the prospect of recovery. However, it is important to consider various aspects of support and motivation in both computerized cognitive training and aerobic training to enable participants to pursue their participation.

  • 11.
    Eskilsson, Therese
    et al.
    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.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Sturesson, Marine
    Region Västerbotten.
    Elwér, Sofia
    Region Västerbotten.
    Lewis, Charlotte
    Region Västerbotten.
    Malmberg Gavelin, Hanna
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nording, Sofia
    Region Västerbotten.
    Arbetsplatsdialog AD-A: metodstöd för arbetsgivare vid ohälsa och sjukfrånvaro2019Book (Other academic)
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  • 12.
    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.

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  • 13.
    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)
  • 14.
    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)
  • 15.
    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.

  • 16.
    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)
  • 17.
    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)
  • 18.
    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, 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.

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  • 19.
    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, 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.

  • 20.
    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

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  • 21.
    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.

  • 22.
    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)
  • 23.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Söderman, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lundqvist, Mari
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Retrospective experiences of individuals two decades after anterior cruciate ligament injury: a process of re-orientation towards acceptance2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 21, p. 6267-6276Article in journal (Refereed)
    Abstract [en]

    Purpose: Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury.

    Methods: Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20–29 years ago.

    Results: A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying.

    Conclusion: ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.

    IMPLICATIONS FOR REHABILITATION

    More than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight. Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight. Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour. ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.

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  • 24.
    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.

  • 25. 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

  • 26.
    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, 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.

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  • 27.
    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, 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.

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  • 28.
    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. Umeå University, Faculty of Medicine, Department of Nursing.
    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, Professional 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.

  • 29.
    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, 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.

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  • 30.
    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.

  • 31.
    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. 

  • 32.
    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)
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  • 33.
    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.

  • 34.
    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, 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.

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  • 35.
    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.

  • 36.
    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, 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.

  • 37.
    Ilgunas, Aurelia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häggman-Henrikson, Birgitta
    Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Lobbezoo, Frank
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Visscher, Corine M.
    Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Durham, Justin
    School of Dental Sciences, Newcastle University, Newcastle, UK; Newcastle Hospitals’ NHS Foundation Trust, Newcastle, UK.
    Lövgren, Anna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Patients' experiences of temporomandibular disorders and related treatment2023In: BMC Oral Health, E-ISSN 1472-6831, Vol. 23, no 1, article id 653Article in journal (Refereed)
    Abstract [en]

    Background: Temporomandibular disorders (TMD) are common and therefore managed by dentists on a daily basis. However, patients with TMD consistently go undetected and therefore untreated in dentistry. The reasons for these shortcomings have not been fully explored, specifically with regard to patients’ perspectives. Therefore, this study aimed to explore patients’ experiences of TMD and related treatment, with special focus on the experiences of having TMD, factors related to seeking care, and perspectives on received treatment.

    Methods: Purposive sampling was used to recruit adult patients at the Public Dental Health services (PDHS) in the Region of Västerbotten, Sweden, during 2019. Individual semi-structured interviews were conducted and analysed using Qualitative Content Analysis. Sixteen patients were interviewed (ten women and six men, 20–65 years). The interviews probed the patients’ perspectives of having TMD, seeking care, and receiving treatment. All participants were also examined according to the Diagnostic Criteria for TMD (DC/TMD) and qualified for at least one DC/TMD diagnosis.

    Results: The data analysis led to the main theme Seeking care when the situation becomes untenable, but dental care fails to meet all needs. The patients expressed worry and social discomfort because of the symptoms but still strived to have an as normal daily life as possible. However, severe symptoms and associated consequences compelled them to seek professional help. Experiences of distrust together with challenges to access the PDHS were identified and related to the patients’ unfulfilled expectations.

    Conclusions: Patients’ reported experiences indicate that receiving timely and appropriate care is more of an unfulfilled expectation than the current state of management of patients with TMD in dentistry.

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  • 38.