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Purpose: To investigate the experiences the target group had with physical activity as a physiotherapy intervention. Design, material and method: Six qualitative interviews were analyzed by Kirsti Malteruds´ principles of systematic text condensation (STC). This study was based on the biopsychosocial model of understanding (BPSS). Findings: Four categories described what the training group led to. 1) To change focus contributed to stop negative thoughts. The experience of being tired in a new way resulted in a calmer everyday life. 2) To have continuous routines created predictability, and the experience of being expected made attending manageable. 3) To be a part of a community gave a feeling of affiliation, even though exclusion was felt occasionally. 4) An experience of victory created a belief in facing, and managing other challenges in life. Conclusion: The findings gave an understanding of physical activity as an important impact in the patients’ lives (biologically, psychologically and socially). Physiotherapists can be an important part in the process of further developing the treatment for a group in need of a closer follow-up offer.

Introduction: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain and fatigue condition. Despite extensive research, there is currently no known therapy leading to a cure for FMS. Although studies have reported that some patients can regain their health, little is known about their personal process of becoming well.Objevtive: This study aimed to explore women's narratives about the process of recovering from FMS.Methods: The empirical material consists of qualitative interviews of eight Norwegian women who all have previously had, but do not have FMS any more. Inspired by a narrative approach we analyzed their experiences of becoming better with a focus on recovery as a meaning-making process.Results: The findings revealed a recovery process consisting of two intertwined narratives that are mutually nurturing each other. The first narrative telling moments of prompting changes refers to events during the recovery process where women understood themselves and their suffering in new ways and thereby enabled them to act in new ways or take further action. The second narrative a mundane process of rebuilding a tolerable daily life refers to a lasting, mundane everyday process of exploration how they initially should act to avoid becoming worse and, later, to promote improvement.Conclusion: Our findings show how the women explain their recovery in terms of overcoming fear of movement, making sense of their symptoms and becoming more active in everyday life. The close analysis reveals a recovery narrative portraying a complex and ambiguous process consisting of small dramas about the efforts trying to rebuild a meaningful life.

Introduction: In 2020, a new national guideline for the bachelor’s degree in physiotherapy will be introduced. In addition, new guidelines for all health and social education (RETHOS) will be introduced. These guidelines emphasize that bachelor candidates should have knowledge of social and health challenges such as neglect of care, violence, substance abuse and socio-economic problems. Main part: The article describes how physiotherapists can better meet the health challenges of people who are in active substance (ab)use, based in theories of recovery, pedagogy related to health and social awareness. Studies show that people with a drug addiction often have extensive and complex health issues that physiotherapists have good knowledge about, and which are conditions in which physical therapy is indicated. Nevertheless, a Norwegian survey of living conditions shows that physiotherapy is not used by people with poor health and accompanying low social capital. Physiotherapists should strive to be better equipped to meet and get involved with these clients by providing their professional competence to people who neither know how to ask for help, nor what they need help for. Moreover, the authors argue that the approach towards these clients should start as a social process based in social and physical interaction rather than based in a relatively rigid structure of functional and physical examinations, testing and assessments. Conclusion: An important message in this article is how recovery can be understood as a nonlinear process that starts with establishing a respectful reciprocal arena of interaction on the user’s premises where the person concerned explores how meaning can be created in his/her own life through curiosity, trial and error, and dialogue, and that physiotherapy can contribute in this process. The authors are nuancing how a recovery perspective can assist the physiotherapists in acquiring better strategies towards people with drug addiction challenges, and thus suggest how the new guidelines can be implemented.

The objective of this study was to conduct a fidelity evaluation of a motivational interviewing (MI) intervention delivered by social insurance caseworkers, in a three-arm randomized controlled trial (RCT) for improving return to work for people on sick leave with musculoskeletal disorders. The caseworkers received six days of MI training, including an intervention manual prior to the trial onset, as well as supervision throughout the trial. The caseworkers recorded 21 MI sessions at regular intervals during the trial. An independent MI analysis center scored the recordings using the MI treatment integrity code (MITI 4). In addition, three experienced MI trainers assessed the adherence to the MI intervention manual on a 1–4 Likert scale and MI competence. Total MITI 4 mean scores were at beginning proficiency levels for two components (global technical, mean 3.0, SD 0.6 and the reflections/questions ratio, mean 1.1, SD 0.2) and under beginning proficiency for two components (global relational, mean 3.2, SD 0.7 and complex question, mean 34.0, SD 21.2). The MI trainers’ assessment showed similar results. The mean adherence score for the MI sessions was 2.96 (SD 0.9). Despite delivering a thorough course and supervision package, most of the caseworkers did not reach proficiency levels of good MI competence during the study. The fidelity evaluation showed that a large amount of training, supervision and practice is needed for caseworkers to become competent MI providers. When planning to implement MI, it is important that thorough consideration is given regarding the resources and the time needed to train caseworkers to provide MI in a social insurance setting.

Purpose The aim of this study was to explore embodiment as a meaning-making experience in the daily life of Norwegian adults living with joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT). The work of Drew Leder and his distinction between bodily dis- and dys-appearance contributes to the description and analysis of individuals' bodily experiences of living with this chronic illness. Methods An explorative and qualitative design was applied to in-depth interviews with seven participants. The theoretical framework was phenomenological, and the method of analysis was thematic, involving descriptive and interpretative approaches. Results Participants' bodily experiences were closely connected to a timeline viewing their illness in the past, the present and from future perspectives. The following central themes emerged from the data: (a) visible to invisible signs of a former body; (b) standing up and falling down of a present body; and (b) future thoughts of an inner and outer body. Conclusions The study found that living with JHS/EDS-HT revealed complex experiences of having flexible bodies and restricted lives. Our findings also showed a meaning-making process of embodied experiences that evolved over time, as well as a sliding transition from social to personal dys-appearance. In the course of time, a bodily disruptions in social interactions comes to the fore, with invisible symptoms such as pain and fatigue. Individual bodily suffering determines the existence of hope or hopelessness regarding recovery from this condition.

Purpose: To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on sick leave with musculoskeletal disorders participating in a randomised controlled trial. The research questions concerned how the SVAI was delivered, the content of the SVAI and the physiotherapists’ experiences from delivering the SVAI. Methods: We used qualitative and quantitative data from 148 intervention logs documenting the follow-up provided to each participant, recordings of 18 intervention sessions and minutes from 20 meetings with the physiotherapists. The log data were analysed with descriptive statistics. A qualitative content analysis was performed of the recordings, and we identified facilitators and barriers for implementation from the minutes. Results: Of 170 participants randomised to the SVAI 152 (89%) received the intervention and 148 logs were completed. According to the logs, 131 participants received the correct number of sessions (all by telephone) and 146 action plans were developed. The physiotherapists did not attend any workplace meetings but contacted stakeholders in 37 cases. The main themes from the recorded sessions were: ‘symptom burden’, ‘managing symptoms’, ‘relations with the workplace’ and ‘fear of not being able to manage work’. The physiotherapists felt they were able to build rapport with most participants. However, case management was hindered by the restricted number of sessions permitted according to the protocol. Conclusion: Overall, the SVAI was delivered in accordance with the protocol and is therefore likely to be implementable in primary care if it is effective in reducing sick leave. Open access funding provided by OsloMet - Oslo Metropolitan University. This study was funded by The Research Council of Norway, The Norwegian Labour and Welfare Administration (NAV), Oslo Metropolitan University and The Norwegian Fund for Post-Graduate Training in Physiotherapy.

Purpose The aim of this study was to evaluate potential barriers and facilitators for implementing motivational interviewing (MI) as a return to work (RTW) intervention in a Norwegian social insurance setting. Methods A mixed-methods process evaluation was conducted alongside a randomized controlled trial involving MI sessions delivered by social insurance caseworkers. The study was guided by the Reach, Efectiveness, Adoption, Implementation, and Maintenance framework using focus groups with the caseworkers. MI fdelity was evaluated through audio-recordings of MI sessions and questionnaires to sick-listed participants. Results Lack of co-worker and managerial support, time and place for practicing to further develop MI skills, and a high workload made the MI intervention challenging for the caseworkers. The MI method was experienced as useful, but difcult to master. MI fdelity results showed technical global scores over the threshold for “beginning profciency” whereas the relational global score was under the threshold. The sick-listed workers reported being satisfed with the MI sessions. Conclusions Despite caseworker motivation for learning and using MI in early follow-up sessions, MI was hard to master and use in practice. Several barriers and facilitators were identifed; these should be addressed before implementing MI in a social insurance setting. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/

Musculoskeletal disorders (MSD) are the largest contributor to disability worldwide. In addition to burdening individuals, there are large socioeconomic costs involved. MSD accounts for a considerable use of health services, and for the greatest proportion of lost productivity in the workplace. In Norway, MSD are the most common cause of sickness absence and represent the largest health challenge for workers in terms of prevalence and cost measured in worse health and disability in addition to sickness absence. The study was founded by the Research Council of Norway (280431/GE).

Purpose There is limited knowledge about motivational interviewing (MI) for people on sick leave with musculoskeletal disorders. Hence, our objective was to investigate what research on MI as a method to facilitate return to work for individuals who are on sick leave due to musculoskeletal disorders exists, and what are the results of the research? Methods We systematically searched MEDLINE, PsycINFO, EMBASE, Cochrane Library, CINAHL, Web of Science, Sociological Abstracts, Epistemonikos, SveMed + and DARE & HTA (covering 1983 to August 2019). We also searched the MINT bulletin and relevant web pages. Eligibility criteria: empirical studies investigating MI and return to work for people with musculoskeletal disorders. Two authors independently screened the records, critically appraised the studies and charted the data using a data extraction form. Results The searches identified 1264 records of which two studies were included. One randomized controlled trial (RCT) found no effect of MI on return to work for disability pensioner with back pain (n = 89, high risk of bias), while a cluster RCT found that MI increased return to work for claimants with chronic musculoskeletal disorders (n = 728, low risk of bias). Conclusions This mapping review identified a huge gap in research on MI to increase return to work for individuals with musculoskeletal disorders. Registration Current Research Information System in Norway, project id: 635823 (https://app.cristin.no/projects/show.jsf?id=635823).

Background: Fibromyalgia (FM) is characterized by chronic, widespread musculoskeletal pain, extensive fatigue and an array of other symptoms. Cure is not expected, and patients have to learn to live with the illness. During the last years several studies have examined how it is like to live with FM from a patient’s point of view. These findings may help physiotherapists to better understand the challenges faced by patients. Objective: To describe what it is like for patients to live with FM and discuss how this may inform physiotherapy practice. Design: A systematic literature search of qualitative studies up till May 2016 was conducted, and 93 papers were read. The focus was on patients’ experiences of symptoms and how they managed everyday life. Results: Incomprehensible, unpredictable symptoms of FM intrude and disturb everyday life. The body is constantly monitored by patients on a day-to-day basis according to fluctuations in pain and energy levels, and habits and routines of daily life are adapted to these shifts. With other words, the connection between body, self and daily life is ruptured. In contrast, those having recovered from FM had found out what they could tolerate during a day and spent long time in rebuiding a life worth living. Conclusion: The present paper presents an argument that living with FM calls for a rather complex personal healing process that should be recognized and supported by physiotherapists. The final version of this research has been published in Physical Therapy Reviews. © 2017 Taylor & Francis

Background: The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs’ experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Method: A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs’ experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. Results : Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs’ experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 sub-categories that formed three overarching main themes of work experiences: 1) individualizing one’s professional approach within the clinical encounter; 2) managing one’s emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs’ work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one’s own emotions. Conclusion: Few qualitative studies highlighted HCPs’ general working experiences, as they mainly focused on the patients’ experiences or HCPs’ experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs’ work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support.

Fibromyalgia syndrome (FMS), a chronic musculoskeletal pain condition, is often accompanied by fatigue. In this study, inspired by narrative approaches to health and illness, we explore how women who have regained their health after FMS describe tiredness along a storyline from before they fell ill, through their illness, recovery process, and present-day health. The data derive from qualitative interviews with eight Norwegian women who previously suffered from FMS but who no longer had the condition at the time of interview. We undertook a narrative analysis to understand the complexity of the stories about tiredness and fatigue and on this basis identified a storyline based on four sub-narratives: 1) Alarming but ignored tiredness (before illness); 2) paralyzing fatigue (during illness); 3) making sense of fatigue (recovery process); and 4) integrating tiredness into life (today). The findings highlight participants' different understandings and meanings of tiredness and fatigue and the ways in which these link past, present, and future. Significantly, a clear distinction between tiredness and fatigue was not always found. Overall, the storyline that emerges from the narratives is about balancing tiredness/fatigue with everyday life, and how this unfolds in different ways across the span of FMS, from falling ill to recovering and regaining health.

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition. Although studies have reported that some patients can become healthy again, little is known about what they tell about their lives after having FMS. In this study, we interviewed eight Norwegian women who had all recovered from FMS about their experiences when ill and subsequently being healthy. Inspired by narrative methods, we then conducted a thematic narrative analysis. The findings indicate that although women reported that life was better than before, they also reported investing considerable effort in remaining healthy. When ill, they struggled to maintain the routines of everyday life. Being healthy again, they put great effort into avoiding illness through diet, exercise, and relaxation. In conclusion, remaining healthy requires ongoing hard work to maintain the body, as well as profound changes in everyday life. At the same time, the narratives show continuity in the informants’ self-presentation as hard-working women.

Oppgaven belyser kvinners erfaringer rundt det å få, og det å ha diagnosen bekkenløsning sett i lys av dominerende diskurser knyttet til kjønn,kropp og sykdom. Undersøkelsen er forankret i en kvalitativ metodetradisjon, og forskningsmaterialet består av dybdeintervjuer av seks kvinner med diagnosen bekkenløsning. Teoretiske perspektiver og begreper er dannet på grunnlag av prosess og metode. Første og fremst vises det hvordan bekkenløsning hovedsakelig er blitt tolket og forstått i et biomedisinsk sykdomsparadigme. Videre rettes søkelyset mot noen historiske og kulturelle sider rundt kvinner, graviditet og sykdom. Kjernen her er å få frem aspekter ved hvordan kvinner, graviditet og sykelighet har blitt håndtert og forstått sett i lys av medisinen og vitenskapens utvikling. Dette forfølges med noen sentrale begreper hos Simone de Beauvoir og Judith Butler og deres feministiske teorier om kjønn og kropp. Sist utdypes begrepene normalitet, risiko og skam som kaster lys over noen aspekter ved å være gravid i det moderne. Analysen fremstilles i tre kapitler: ”Bekkenløsning- fra smerter i graviditeten til en diagnose”, ”Forestillinger om bekkenløsningskvinnen” og ”Kvinner med bekkenløsning i et likestilt familieliv og i møtet med et moderne arbeidsliv”. Resultatene viser at kvinnene opplever stor usikkerhet rundt bekkenplagene, og at deres forståelse av seg selv som syk veves sammen med en biomedisinsk forståelse hva ’sykdom er’ og hvordan ’sykdom gjøres’. For det andre viser funnene hvordan bekkenløsning henger sammen med hvordan graviditet og kropp blir gjort til et domene for både valg av livsstil og som prosjekt. Det kommer tydelig frem hvordan gravide kvinner på ingen måte slipper unna dominerende kroppsdiskurser i det moderne. Sist viser funnene hvordan kvinnene med bekkenløsning i et moderne arbeidsliv både stritter imot stempelet som svak og syk, og i det lengste strever med å fremstå som en normal og fullverdig arbeidstaker. Oppgaven ønsker samlet sett å fremheve hvordan bekkenløsning ikke bare kan ses som en isolert hendelse i kvinnens kropp, men også som en del av det å være kvinne i det moderne.

Background Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition without any known curative treatment. Although studies have reported that some patients can become healthy again, little is known about what they tell about their lives after having recovered from FMS. Objectives What do women say about their everyday lives in the past having FMS and presently being healthy again? Methods Eight Norwegian women previously fulfilling the ACR-1990 criteria, but who now do not have FMS any more were interviewed about their experiences when ill and presently being healthy again. The study had a narrative approach with a thematic interview guide following a time line; everyday-life before, during and after FMS. The analysis was guided by understanding a narrative as a sequence of events with a beginning, middle and an end whereas the meaning of the story, the plot, weaves together the events into a whole, and a thematic, narrative analysis was conducted. Results The informants lived in rural and urban areas in different parts of Norway. Their age varied from 34 to 59 years. They differed in social and professional backgrounds and educational levels. All were employed, three of them part-time. The narratives about the past as ill was a story about “a struggling for survival” which constitutes a great effort invested in maintaining everyday life, as well as a struggling to understand what was wrong with them and obtain recognition for the reality of their affliction. Although everyday life presently has been restored and reassumed its content and meaning, the narratives about here and now describes how the women invest a considerable effort in remaining healthy. They are avoiding becoming ill again by exercises, diets and relaxation, and by watching their bodies for symptoms so they can take necessary preventive precautions. The narratives also describe how they have established daily routines and regimens for themselves to promote their health. Conclusions Remaining healthy from FMS requires ongoing hard bodily work. The plot linking the narratives about past as ill and present as healthy is a presentation of hard working women. Although FMS has retreated, it is there in the background and a strong reminder of something they do not wish to have back. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4386