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Not least tuberculosis caused the growth of many spas. In Denmark, the Society for Physical Therapy and Dietetic was formed in 1902, and in 1921 it changed its name to the Danish Physiatrists Society, later the Danish Society for Physiatrists and Rehabilitation. In the early 1980's the National Board of Health decided, that all specialties should rehabilitate patients within their own area, and the specialty for rehabilitation was abolished. Therefore, all doctors need to have knowledge of the biopsychosocial model and the involvement of other professional groups and sectors.

This article describes the core themes in modern rehabilitation and how it can be used in practice. The purpose of rehabilitation is an independent and meaningful life with the greatest possible functional ability. Rehabilitation goals will always be what matters most to the patient (not what health professionals think matters). The doctor's role includes clarification of biomedical issues, but also highlighting resources and barriers in relation to rehabilitation (including practical, economic and social barriers and resources).

Cardiac rehabilitation is an essential part of treatment for patients with cardiovascular disease. Cardiac rehabilitation is increasingly organized outside hospital in community healthcare services. However, this transition may be challenging. The aim of this study was to examine assumptions and perspectives among healthcare professionals on how facilitators and challenges influence the transition from hospital to community healthcare services for patients in cardiac rehabilitation. The study followed the Interpretive Description methodology and data consisted of participant observations and focus group interviews. The analysis showed that despite structured guidelines aimed to support the collaboration, improvements could be made. Facilitators and challenges could occur in the collaboration between the healthcare professionals, in the collaboration with the patient, or because of the new reality for patients when diagnosed with cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objective: To explore rehabilitees' and professionals' experiences of goal-setting in a context of (un)certainty with a progressive neurodegenerative disease and how they navigate this (un)certainty in Parkinson's disease rehabilitation. Design: A long-term multi-sited ethnographic fieldwork (2019−2020) following 20 rehabilitees and their goals over time and settings. Observation at 30 goal-setting meetings. Participants: Rehabilitees and professionals in Danish Parkinson's disease rehabilitation. Two randomly chosen groups of rehabilitees attending a Parkinson's disease course at a rehabilitation centre participated. Methods: Semi-structured interviews and participant observation. Results: Living with Parkinson's disease holds a certainty that the condition will progress yet an uncertainty regarding the pace and severity, as indicated by the notion (un)certainty. The (un)certainty challenges goal-setting. Reflecting on goal-setting, rehabilitees brought forth existential, economical, and societal considerations. Some expressed an ambivalent view, questioning the value of goal-setting with a progressive condition, yet finding own rehabilitation goals relevant. Others expressed a pragmatic view, attuning goals to fit the situation. Professionals found that the visible and invisible symptoms and the uncertain pace of Parkinson's made goal-setting challenging. They had to strike a balance between mentioning symptoms to come, yet not rendering the future too bleak. Conclusions: Rehabilitees and professionals found that setting goals in a condition that progresses is no easy task. They made use of strategies such as observation, repetition, future-proofing strategies, and attuning goals to navigate the (un)certainty. In goal-setting, to maintain functioning with progressive Parkinson's disease was a viable goal. Participants found they just do the best they can to navigate (un)certainty. [ABSTRACT FROM AUTHOR]

Across rehabilitation fields, rehabilitees and professionals meet to set rehabilitation goals. Portrayed as an ordinary, yet foundational practice in rehabilitation, participants often find goal-setting meetings challenging; ideal and real seem to clash. Based on a long-term fieldwork in Danish Parkinson's disease rehabilitation, we explore goal-setting and its rationale to gain insight into why goal-setting qualifies as challenging. We find that challenges relate to disease, organizational matters and an imbalance in institutional knowledge, but also that different logics, of choice, interdependence, and accountability, entangle and affect goal-setting. A competitive aspect between goal-setting logics appears pivotal to understand the challenges in goal-setting. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to examine the potential of outdoor contexts within community-based rehabilitation to empower people with disabilities in their rehabilitation. Materials and methods: Interpretive description was applied as the methodology in a 5-month ethnographic fieldwork study, and guided by social practice theory. In total, 115 people with disabilities were included for participant observation, of which 15 participants were recruited for individual walking interviews. Results: Analysis revealed four overlapping themes. Firstly, "Revisiting the Outdoors" appeared to be an overarching theme, which created a basis for "Building Autonomy" among the participants. The varied outdoor experiences empowered the participants to take a more active role in their rehabilitation. These experiences afforded unique opportunities for "Connecting with Community" and, finally, "Embodied Learning" – that could be transferred to home and to other everyday contexts. Conclusion: Outdoor contexts within community-based rehabilitation appeared to hold strong potential for connecting people with disabilities to communities. Although barriers exist, we argue that revisiting the outdoors supports collective awareness and action with the capacity to influence community attitudes more broadly. Outdoor contexts within community-based rehabilitation for people with disabilities capitalise on the features of both indoor and outdoor environments with activities that meet shifting individual priorities and needs. Outdoor contexts within community-based rehabilitation offer people with disabilities empowering experiences that are part of the landscape of everyday life and transfer well to home and other environments. Community-based rehabilitation directly involving outdoor contexts and supported by professional skills provides a crucial bridge from individual rehabilitation to community belonging. [ABSTRACT FROM AUTHOR]

Objective: To compare return to work (RTW) rates among patients with low back pain (LBP) and different job relations randomized to brief or multidisciplinary intervention. Design: A randomized controlled trial with 1-year follow-up. Setting: Silkeborg Regional Hospital, Denmark. Subjects: Four hundred seventy-six participants were divided into two groups concerning job relations: strong (influence on job and no fear of losing it) or weak (no influence on job and/or fear of losing it), and afterwards randomized to brief or multidisciplinary intervention. Interventions: Brief intervention included examination and advice by a rheumatologist and a physiotherapist. Multidisciplinary intervention included brief intervention plus coaching by a case manager making a plan for RTW with the patient. Main measures: Primary outcome was 1-year RTW rate. Secondary outcomes included pain intensity (LBP rating scale), disability (Roland Morris disability scale), and psychological measures (Common Mental Disorder Questionnaire, Major Depression Inventory, and EQ-5D-3L). Results: Mean (SD) age was 43.1 (9.8) years. Among 272 participants with strong job relations, RTW was achieved for 104/137 (76%) receiving brief intervention compared to 89/135 (66%) receiving multidisciplinary intervention, hazard ratio 0.73 (CI: 0.55–0.96). Corresponding results for 204 participants with weak job relations were 69/102 (68%) in both interventions, hazard ratio 1.07 (CI: 0.77–1.49). For patients with strong job relations, depressive symptoms and quality of life were more improved after brief intervention. Conclusion: Brief intervention resulted in higher RTW rates than multidisciplinary intervention for employees with strong job relations. There were no differences in RTW rates between interventions for employees with weak job relations. [ABSTRACT FROM AUTHOR]

This systematic review sheds light on the link between community-based rehabilitation (CBR) approaches and outdoor settings. The aim was to examine and synthesise qualitative knowledge on people with disabilities' and professionals' experiences and perceptions regarding facilitators and barriers to CBR approaches in outdoor settings. The Interpretive Description methodology guided the interpretive synthesis. Nine articles met the inclusion criteria. The synthesis revealed four themes: Ability to Overcome Challenges, Outdoor Adaptive Activities, Inclusive Social Communities and Culture of Reciprocal Interaction. The link between CBR approaches and outdoor settings seemed to empower participation opportunities and social inclusion of people with disabilities, which stimulated equality among all people involved. However, to transfer potential benefits into society, beyond the formalised programme contexts, more focus is needed on creation of inclusive environments. These inclusive environments entail cultural as well as physical changes together with political commitment. People with disabilities are often restricted by physical barriers and misconceptions about their abilities when they attempt to participate in the community. This systematic review found that rehabilitation based in the community with focus on outdoor adaptive activities, gave people with disabilities an opportunity to learn how to overcome challenges of everyday living. Outdoor adaptive activities serve as a social gathering point, where people of all abilities can share experiences and be equally included in social communities. Professionals play a key role to ensure safety and provide social support, but they express a lack of experience and shared direction on what this approach to rehabilitation involves. This study recommends that inclusive environments and political commitment are necessary for a cultural development towards more equality in relations between all people in society. [ABSTRACT FROM AUTHOR]

Contemporary practice has started to rethink use of outdoor and community environments for advancing comprehensive rehabilitation outcomes. The aim is to examine health professionals' experiences and perceptions of providing rehabilitation in outdoor community settings. The purpose is to use these experiences to generate practice-based knowledge in using the outdoors as a means to guide community-based rehabilitation. The Interpretive Description methodology was accompanied by social practice theory. Fieldwork was conducted utilizing participant observation, photovoice, and focus-group interviews. Included were 27 health professionals. The analysis revealed how "naturalistic learning opportunities" offered health professionals strategies to empower activity and participation levels and yet invoked "rehabilitation setting tensions." A continuum was engaged in the theme "navigating a middle ground," representing an integrated environment approach; rehabilitation in conventional indoor and outdoor community settings. Development of a sustainable concept for outdoor community-based rehabilitation involves strengthening health professionals' competencies and skills for providing outdoor and community work. [ABSTRACT FROM AUTHOR]

Objective: To examine the cost-effectiveness of case manager–assisted rehabilitation as an add-on to usual physical rehabilitation after lumbar spinal fusion, given the lack of any clinical benefits found on analysing the clinical data. Design: Economic evaluation alongside a randomized controlled trial with two-year follow-up. Setting: Patients from the outpatient clinics of a university hospital and a general hospital. Subjects: A total of 82 lumbar spinal fusion patients. Interventions: Patients were randomized one-to-one to case manager–assisted rehabilitation programme as an add-on to usual physical rehabilitation or to usual physical rehabilitation. Main measures: Oswestry Disability Index and EuroQol 5-dimension. Danish preference weights were used to estimate quality-adjusted life years. Costs were estimated from micro costing and national registries. Multiple imputation was used to handle missing data. Costs and effects were presented with means (95% confidence interval (CI)). The incremental net benefit was estimated for a range of hypothetical values of willingness to pay per gain in effects. Results: No impact of case manager–assisted rehabilitation on the Oswestry Disability Index or estimate quality-adjusted life years was observed. Intervention cost was Euros 3984 (3468; 4499), which was outweighed by average reductions in inpatient resource use and sickness leave. A cost reduction of Euros 1716 (–16,651; 20,084) was found in the case manager group. Overall, the probability for the case manager–assisted rehabilitation programme being cost-effective did not exceed a probability of 56%, regardless of willingness to pay. Sensitivity analysis did not change the conclusion. Conclusion: This case manager–assisted rehabilitation programme was unlikely to be cost-effective. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of a case manager–assisted rehabilitation programme as an add-on to usual physical rehabilitation in patients undergoing lumbar spinal fusion. Design: A randomized controlled trial with a two-year follow-up. Settings: Outpatient clinics of a university hospital and a general hospital. Subjects: In total, 82 patients undergoing lumbar spinal fusion. Interventions: The patients were randomized one-to-one to case manager–assisted rehabilitation (case manager group) or no case manager–assisted rehabilitation (control group). Both groups received usual physical rehabilitation. The case manager–assisted rehabilitation programme included a preoperative meeting with a case manager to determine a rehabilitation plan, postsurgical meetings, phone meetings, and voluntary workplace visits or roundtable meetings. Main measures: Primary outcome was the Oswestry Disability Index. Secondary outcomes were back pain, leg pain, and return to work. Results: Of the 41 patients in the case manager group, 49% were men, with the mean age of 46.1 (±8.7 years). In the control group, 51% were male, with the mean age of 47.4 (±8.9 years). No statistically significant between-group differences were found regarding any outcomes. An overall group effect of 4.1 points (95% confidence interval (CI): –1.8; 9.9) was found on the Oswestry Disability Index, favouring the control group. After two years, the relative risk of return to work was 1.18 (95% CI: 0.8; 1.7), favouring the case manager group. Conclusion: The case manager–assisted rehabilitation programme had no effect on the patients' functional disability or back and leg pain compared to usual physical rehabilitation. The study lacked power to evaluate the impact on return to work. [ABSTRACT FROM AUTHOR]

Objective: There is strong evidence that medication adherence and lifestyle changes are essential in patients undergoing secondary cardiovascular disease prevention. Cardiac rehabilitation (CR) increases medication adherence and improves lifestyle changes. Patients with cardiac diseases and a low educational level and patients with little social support are less responsive to improve medication adherence and to adapt lifestyle changes. The aim of the present study was to investigate the long-term effects of a socially differentiated CR intervention on medication adherence as well as changes in biological and lifestyle risk factors at two- five- and ten-year follow-up. Design: A prospective cohort study. Setting: The cardiac ward at Aarhus University Hospital, Denmark. Intervention: A socially differentiated CR intervention in addition to the standard CR program. Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N = 379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network. Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status. Results: No significant long-term effect of the intervention was found. Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status. The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors. Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking. General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status. [ABSTRACT FROM AUTHOR]

Purpose To assess effects of an inpatient multicomponent occupational rehabilitation program compared to less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders. Methods Randomized clinical trial with parallel groups. Participants were individuals 18–60 years old on sick-leave for 2–12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2, identified in a national register. The inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy (ACT), physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Both programs were group based. Primary outcome was cumulated number of sickness absence days at 6 and 12 months follow-up. Secondary outcome was time until sustainable return to work. Results 168 individuals were randomized to the inpatient program (n = 92) or the outpatient program (n = 76). We found no statistically significant difference between the programs in median number of sickness absence days at 6 and 12 months follow-up. In the outpatient program 57% of the participants achieved sustainable return to work (median time 7 months), in the inpatient program 49% (log rank, p = 0.167). The hazard ratio for sustainable return to work was 0.74 (95% CI 0.48–1.32, p = 0.165), in favor of the outpatient program. Conclusions This study provided no support that the more comprehensive 4 + 4 days inpatient multicomponent occupational rehabilitation program reduced sickness absence compared to the outpatient rehabilitation program. [ABSTRACT FROM AUTHOR]

Background:There is a lack of evidence-based knowledge about the effectiveness of home-based OT for older adults aimed at improving occupational performance by practicing activities and tasks. Aim:This review synthesizes and discusses evidence for the effectiveness of occupation-focused and occupation-based OT for older adults at home. Material and methods:Peer-reviewed quantitative papers were included. Participants: ≥ 60-year-old adults with functional limitations. Intervention: OT aiming at improving occupational performance, primarily through the practice of activities and tasks. Outcome: Occupational performance. Context: Home. Three reviewers critically appraised 13 of 995 detected papers. Extracted data were presented and summarized descriptively. Results:Eight high-quality papers showed that occupation-focused and occupation-based OT using cognitive, behavioral and environmental strategies may significantly improve occupational performance in older, home-dwelling adults with physical health problems. Maintaining achieved improvements was a consistent challenge. Conclusions and significance:Evidence suggests that older adults’ occupational performance can be significantly improved through low-intensity occupation-focused and occupation-based intervention. It is recommended to develop and test high-intensity OT programs and maintenance programs. [ABSTRACT FROM PUBLISHER]

Background Despite proven benefits of cardiac rehabilitation (CR), adherence to CR remains suboptimal. This trial aimed to assess the impact of the patient education ‘Learning and Coping Strategies’ (LC) on patient adherence to an eight-week CR program. Methods 825 patients with ischaemic heart disease or heart failure were open label randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. Both arms received same amount of training and education hours. LC consisted of individual clarifying interviews, participation of experienced patients as co-educators, situational, reflective and inductive teaching. The control arm received structured deductive teaching. The primary outcomes were patient adherence to at least 75% of the exercise training or education sessions. We tested for subgroup effects on the primary outcomes using interaction terms. The primary outcomes were compared across arms using logistic regression. Results More patients in the LC arm adhered to at least 75% of the exercise training sessions than control (80% versus 73%, adjusted odds ratio (OR):1.48; 95% CI:1.07 to 2.05, P = 0.018) and 75% of education sessions (79% versus 70%, adjusted OR:1.61, 1.17 to 2.22, P = 0.003). Some evidence of larger effects of LC on adherence was seen for patients with heart failure, low education and household income. Conclusions Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education. Patients with heart failure, low levels of education and household income appear to benefit most from this adherence promoting intervention. Trial registration www.clinicaltrials.gov identifier NCT01668394 [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. PURPOSE: The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. METHODS: We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. RESULTS: Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they "awaited the result of surgery", and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. CONCLUSION: The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of rehabilitation may have encouraged beneficial pain coping behavior by altering patients' pain perception and coping behavior, thereby reducing adverse effects of pain. [ABSTRACT FROM AUTHOR]

Objective: To understand hearing behaviors of adults seeking help for the first time through the application of two models of health behavior change: the transtheoretical model and the health belief model. Design: The relationships between attitudes and beliefs were examined relative to hearing-aid uptake and outcomes six months later. Study sample: One hundred and sixty adults completed the University of Rhode Island change assessment (targeting the transtheoretical model), and the hearing beliefs questionnaire (targeting the health belief model), as well as the hearing handicap inventory and the psychosocial impact of hearing loss scale, within two months of an initial hearing assessment. Six months later, participants completed these same questionnaires, while those who had taken up hearing aids also completed hearing-aid outcome questionnaires. Results: (1) Attitudes and beliefs were associated with future hearing-aid uptake, and were effective at modeling this behavior; (2) attitudes and beliefs changed following behavior change, and (3) attitudes and beliefs following behavior change were better predictors of hearing-aid outcomes than pre-behavior change attitudes and beliefs. Conclusion: A counseling-based intervention targeting the attitudes and beliefs assessed by the transtheoretical model and the health belief model has the potential to increase uptake of hearing health care. [ABSTRACT FROM AUTHOR]

Background: Catastrophic thinking and fear-avoidance belief are negatively influencing severe acute pain following surgery causing delayed ambulation and discharge. We aimed to examine if a preoperative intervention of cognitive-behavioural therapy (CBT) could influence the early postsurgical outcome following lumbar spinal fusion surgery (LSF).Methods: Ninety patients undergoing LSF due to degenerative spinal disorders were randomly allocated to either the CBT group or the control group. Both groups received surgery and postoperative rehabilitation. In addition, the CBT group received a preoperative intervention focussed on pain coping using a CBT approach. Primary outcome was back pain during the first week (0-10 scale). Secondary outcomes were mobility, analgesic consumption, and length of hospitalisation. Data were retrieved using self-report questionnaires, assessments made by physical therapists and from medical records.Results: No difference between the groups' self-reported back pain (p = 0.76) was detected. Independent mobility was reached by a significantly larger number of patients in the CBT group than the control group during the first three postoperative days. Analgesic consumption tended to be lower in the CBT group, whereas length of hospitalisation was unaffected by the CBT intervention.Conclusion: Participation in a preoperative CBT intervention appeared to facilitate mobility in the acute postoperative phase, despite equally high levels of self-reported acute postsurgical pain in the two groups, and a slightly lower intake of rescue analgesics in the CBT group. This may reflect an overall improved ability to cope with pain following participation in the preoperative CBT intervention.Trial Registration: The study was approved by the Danish Protection Agency (2011-41-5899) and the Ethics Committee of the Central Denmark Region (M-20110047). The trial was registered in Current Controlled Trials ( ISRCTN42281022 ). [ABSTRACT FROM AUTHOR]

Study Design. A randomized clinical trial including 90 patients. Objective. To examine the effect of a preoperative cognitivebehavioral intervention (CBT) for patients undergoing lumbar spinal fusion (LSF) surgery. Summary of Background Data. Few published studies have looked at the potential of rehabilitation to improve outcomes after LSF. Rehabilitation programs using CBT are recommended. Furthermore, initiating interventions preoperatively seems beneficial, but only limited data exist in the field of spine surgery. Methods. Patients with degenerative disc disease or spondylolisthesis undergoing LSF were randomized to usual care (control group) or preoperative CBT and usual care (CBT group). Primary outcome was change in Oswestry Disability Index from baseline to 1-year follow-up. Secondary outcomes were catastrophizing, fear avoidance belief, work status, and back and leg pain. Results. At 1-year follow-up, there was no statistically significant difference between the CBT group and the control group in Oswestry Disability Index score ( P = 0.082). However, the CBT group had achieved a significant reduction of - 15 points ( -26; -4) already at 3 months (between group difference P = 0.003), and this reduction was maintained throughout the year. There were no differences between groups at 1-year follow-up with regard to any of the secondary outcomes. Conclusion. Participating in a preoperative CBT intervention in addition to usual care did not produce better outcomes at 1-year follow-up for patients undergoing LSF. Although the reduction in disability was achieved much faster in the CBT group, resulting in a significant difference between groups already 3 months after surgery, it did not translate into a faster return to work. Our findings support the need for further research into the use of targeted rehabilitation interventions among patients with elevated levels of catastrophizing and fear avoidance beliefs. [ABSTRACT FROM AUTHOR]

Background The ideal rehabilitation strategy following lumbar spinal fusion surgery has not yet been established. This paper is a study protocol, describing the rationale behind and the details of a cognitive-behavioural rehabilitation intervention for lumbar spinal fusion patients based on the best available evidence. Predictors of poor outcome following spine surgery have been identified to provide targets for the intervention, and the components of the intervention were structured in accordance with the cognitive-behavioural model. The study aims to compare the clinical and economical effectiveness of a cognitive-behavioural rehabilitation strategy to that of usual care for patients undergoing lumbar spinal fusion surgery. Methods/Design The study is a randomized clinical trial including 96 patients scheduled for lumbar spinal fusion surgery due to degenerative disease or spondylolisthesis. Patients were recruited in the period October 2011 to July 2013, and the follow-up period is one year from date of surgery. Patients are allocated on a 1:2 ratio (control : intervention) to either treatment as usual (control group), which implies surgery and the standard postoperative rehabilitation, or in addition to this, a patient education focusing on pain behaviour and pain coping (intervention group). It takes place in a hospital setting, and consists of six group-based sessions, managed by a multidisciplinary team of health professionals. The primary outcomes are disability (Oswestry Disability Index) and sick leave, while secondary outcomes include coping (Coping Strategies Questionnaire), fear-avoidance belief (Fear Avoidance Belief Questionnaire), pain (Low Back Pain Rating Scale, pain index), mobility during hospitalization (Cumulated Ambulation Score), generic health-related quality of life (EQ-5D) and resource use. Outcomes are measured using self report questionnaires, medical records and national registers. Discussion It is expected that the intervention can provide better functional outcome, less pain and earlier return to work after lumbar spinal fusion surgery. By combining knowledge and evidence from different knowledge areas, the project aims to provide new knowledge that can create greater consistency in patient treatment. We expect that the results can make a significant contribution to development of guidelines for good rehabilitation of patients undergoing lumbal spinal fusion. Trial registration Current Controlled Trials ISRCTN42281022. [ABSTRACT FROM AUTHOR]

Background: The uptake and use of hearing aids is low compared to the prevalence of hearing impairment. People who seek help and take part in a hearing aid rehabilitation process participate actively in this process in several ways. Purpose: In order to gain more knowledge on the challenges of hearing help-seeking and hearing aid use, this qualitative study sought to understand the ways that people with hearing impairment describe themselves as active participants throughout the hearing aid rehabilitation process. Research Design: In this qualitative interview study we examined the hearing rehabilitation process from the perspective of the hearing impaired. In this article we describe how the qualitative interview material was interpreted by a pragmatic qualitative thematic analysis. The analysis described in this article focused on the efforts, initiatives, actions, and participation the study participants described that they had engaged in during their rehabilitation. Study Sample: Interviews were conducted with people with hearing impairment in Australia, Denmark, the United Kingdom, and the United States. The 34 interview participants were distributed equally between the sites, just as men and women were almost equally represented (56% women). The average age of the participants was 64. All participants had a hearing impairment in at least one ear. The participants were recruited to represent a range of experiences with hearing help-seeking and rehabilitation. Data Collection and Analysis: With each participant one qualitative semistructured interview ranging between 1 and 2 hr was carried out. The interviews were transcribed verbatim, read through several times, and themes were identified, defined, and reviewed by an iterative process. Results: From this thematic focus a concept called "client labor" has emerged. Client labor contains nine subthemes divided into three overarching groups: cognitive labor, emotional labor, and physical labor. The participants' experiences and meaning-making related to these conceptual types of efforts is described. Conclusions: The study findings have implications for the clinical encounter between people with hearing impairment and hearing health-care professionals. We suggest that a patient-centered approach that bears in mind the client's active participation could help toward improving clinical dispensing, fitting, and counseling practices with the end goal to increase hearing aid benefit and satisfaction. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the effect of early initiation of rehabilitation after instrumented lumbar spinal fusion. The study randomly assigned patients with degenerative disc diseases undergoing instrumented lumbar spinal fusion to initiate their rehabilitation 6 weeks or 12 weeks after the procedure. It showed no difference in the study patients according to return to work 1 year postsurgery.

The aim of the study is to gain insight into the user's perspective on user involvement in mental health rehabilitation. The study was designed as a field study lasting 15 months in two supported housing schemes. An ethnographic approach by James Spradley was employed, involving participant observation, informal conversations, and individual- and group-interview. A phenomenological-hermeneutic approach inspired by Paul Ricoeur's theory on text interpretation was used, including theories of situated learning. The results of the study show that the users experienced their involvement in rehabilitation to be associated with learning processes in interaction with residents as well as professionals. Learning took place via legitimate peripheral participation, via support from and negotiations with professionals and support from peer residents. Both opportunities for and limitations for learning were experienced. The transferability of knowledge and skills to life in a community was questioned, as limited access to participation was experienced. [ABSTRACT FROM PUBLISHER]

Objective: This study investigated the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation. Design: Individual semi-structured interviews were completed. Study sample: In total, 34 adults with hearing impairment in four countries (Australia, Denmark, UK, and USA) participated. Participants had a range of experience with hearing help-seeking and rehabilitation, from never having sought help to being satisfied hearing-aid users. Results: Qualitative content analysis identified four main categories ('perceiving my hearing impairment', 'seeking hearing help', 'using my hearing aids', and 'perspectives and knowledge') and, at the next level, 25 categories. This article reports on the densest categories: they are described, exemplified with interview quotes, and discussed. Conclusions: People largely described hearing help-seeking and rehabilitation in the context of their daily lives. Adults with hearing impairment rarely described clinical encounters towards hearing help-seeking and rehabilitation as a connected process. They portrayed interactions with clinicians as isolated events rather than chronologically-ordered steps relating to a common goal. Clinical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background and Aims: Denmark offers COPD rehabilitation to enable patients to tackle the consequences of COPD, but only a minority of the patients complete these programs. To increase the completion rate, an follow-up study was performed, to characterize COPD patients and to identify potential differences between those who complete and those who do not complete rehabilitation or do not even get a rehabilitation offer in daily clinical routine. Methods: In- and out COPD-patients who participated in baseline tests were compared in terms of completion of rehabilitation, drop-out, and no rehabilitation offer. We obtained data on basic characteristics, co-morbidity, lung-function (FEV1), dyspnea (MRC), six-minute walkg-distance (6MWD), and quality of life (SF36). Results: The source population counted 521 COPD patients of whom 256 were excluded (diagnosis withdrawn, death, moved away, long-term oxygen, severe illness). Patients who completed rehabilitation had a 15% longer 6MWD than patients not offered rehabilitation and a 10% longer 6MWD than drop-outs despite a significant lower subjective perception of physical function among completers than in the two other groups. Patients not offered rehabilitation had a slightly better lung function than the other two groups. This suggests that lower physical performance with the same (drop-outs) or even higher (not offered) lung function indicates a lower chance of completion. Conclusion: COPD patients who could potentially benefit most from completing rehabilitation seem to be deselected. A mere 9% completed rehabilitation within the study period and 23% ever completed. This demonstrates that the political target that 60% of COPD patients should be offered rehabilitation is still far away. Please cite this paper as: Bjoernshave B, Korsgaard J, Jensen C and Nielsen CV. Participation in pulmonary rehabilitation in routine clinical practice. Clin Respir J 2011; 5: 235-244. [ABSTRACT FROM AUTHOR]

Objectives: This descriptive summary of the literature provides an overview of the available studies (published between January 1980 and January 2009) on correlates of help-seeking behavior for hearing loss, hearing-aid uptake, hearing-aid use, and satisfaction with the device. Methods: Publications were identified by structured searches in Pubmed and Cinahl and by inspecting the reference lists of relevant articles. The articles covered different stages that a person with hearing impairment may go through: prior to hearing aid fitting, the period covering the fitting and the period post hearing aid fitting. Inclusion of articles occurred according to strict inclusion and exclusion criteria. Data were extracted by two independent researchers. Thirty-nine papers were included that identified 31 factors examined in relation to the four outcome measures. These covered personal factors (e.g., source of motivation, expectation, attitude), demographic factors (e.g., age, gender) and external factors (e.g., cost, counseling). Only two studies covered the actual fitting process. There was only one factor positively affecting all four outcome variables. This was self-reported hearing disability. The vast majority of studies showed no relationship of age and gender with any of the outcome domains. Discussion and conclusion: Whereas research of the last 28 years yielded valuable information regarding relevant and irrelevant factors in hearing aid health care, there are still many relevant issues that have never been investigated in controlled studies. These are discussed. [ABSTRACT FROM PUBLISHER]

Objective: To examine how financial compensation affects the outcome of vocational rehabilitation. Design: A registry-based follow-up study. Subjects: A total of 1397 rehabilitees discharged from the 5 local rehabilitation agencies in Aarhus County, Denmark from 1 July 2000 to 31 December 2001. Methods: At submission demographic data was obtained as well as data on financial compensation, i.e. compensation for industrial injury, indemnity for off-duty injury and application for disability pension. Rehabilitation outcomes were recorded at discharge. Renouncing further attempts at rehabilitation was defined as a negative outcome; education, further rehabilitation or return-to-work on normal or less demanding terms were defined as a positive outcome. Rehabilitees with and without financial compensation were compared. Results: Rehabilitees with involvement of financial compensation had an increased risk of a negative outcome compared with those without involvement of financial compensation. Adjustment for potential confounders did not change the association between financial compensation and negative outcome. The risk of a negative outcome rose with increasing age, with less than 1 year of labour market experience and with rented housing. Previous occupation as a skilled worker reduced the risk. Conclusion: Financial compensation was associated with an increased risk of a negative vocational rehabilitation outcome. [ABSTRACT FROM AUTHOR]

Background: Internet use within health care contexts offers the possibility to provide both health information and peer support. Internet Support Groups (ISGs) for patients may offer advantages, which are not found in face-to-face support. In patients undergoing lumbar spine fusion (LSF), ISGs could have a particular potential, as peer support on the web might bridge the decreased satisfaction with social life and social isolation found within these patients. ISGs might in this way contribute to increasing the functioning and overall health-related quality of life. However, LSF patients may generally belong to a group of citizens not prone to internet and online peer support. However, our knowledge of how LSF patients use ISGs is limited.Objective: The aim of this study was to describe the characteristics of users of an ISG and thematically explore the content of ISG interactions in Danish patients undergoing instrumented LSF because of degenerative spine disorders.Methods: Participants were recruited from a randomized controlled trial and included in a prospective cohort with a mixed methods design. Sociodemographic characteristics and information on psychological well-being (symptoms of anxiety and depression) were obtained at baseline and 1 to 5 weeks before surgery. Usage of the ISG was registered from baseline until 3 months after surgery. All posts and comments were collected, and content analysis was performed.Results: A total of 48 participants comprised the study population, with a mean age of 53 years (range 29-77). Of the participants, 54% (26/48) were female, 85% (41/48) were cohabitating, 69% (33/48) were unemployed, and the majority (69% [33/48]) had secondary education. Approximately one-third of the participants had symptoms of depression (35%, 17/48) and anxiety (29%, 14/48). Overall, 90% (43/48) of the participants accessed the ISG. No correlations were found between sociodemographic characteristics and access to the ISG. Women were more prone to be active users, contributing with posts (P=.04). Finally, active users contributing with posts or comments had viewed more pages, whereas passive users, users without posts or comments, had more interactions with the ISG (P<.001). The ISG contained 180 conversation threads, generating 354 comments. The 180 conversation threads in the ISG were constituted by 671 independent dialogue sequences. On the basis of those 671 dialogue sequences, 7 thematic categories emerged.Conclusions: Sociodemographic characteristics were not predictors of ISG use in this study, and active use was found to be gender dependent. Content of interactions on the ISG emerged within 7 thematic categories and focused on social recognition, experience of pain or use of pain medication, experience of physical activity or physical rehabilitation, expression of psychosocial well-being, advising on and exploring the ISG, and employment, which seemed to correspond well with the prevalent occurrence of symptoms of anxiety and depression. [ABSTRACT FROM AUTHOR]

Hip fracture (HF) incidents can severely restrict the activity and well-being of older people. While participation in activities may be related to lived experiences of meaningfulness, the aim of this study was to explore facilitators and barriers for being active as experienced by older people during the first six months after HF. The study used a phenomenological-hermeneutic methodology informed by the philosophies of Heidegger and Gadamer. Two men and 11 women with reduced functioning prior to the HF were interviewed 2 weeks (n=13) and again 6 months (n=11) after discharge. Referring to own pre-understanding including a theoretical framework of well-being, a method of meaning condensation was applied to structure the data. A deeper understanding was gradually achieved through a movement between the parts and the wholes. Two themes emerged: (1) "Inner dialogue and actions" with the sub-themes "Inner driving forces" and "Inner limitations"; (2) "Struggling and Striving" with the sub-themes "Building relationships" and "Considering complications and conditions". We conclude that facilitators for older people to experience well-being while being active involve meaningful relationships with other people, a sense of own identity and being at peace and may be influenced by relationships with staff, physical surroundings, public health services, and health problems. [ABSTRACT FROM AUTHOR]

Study Design: A cost-effectiveness analysis conducted alongside a randomized clinical trial.Objective: To assess the cost-effectiveness of a preoperative cognitive-behavioral therapy (CBT) intervention compared to usual care for patients undergoing lumbar spinal fusion surgery (LSF).Summary Of Background Data: The clinical effectiveness of a preoperative CBT intervention for patients undergoing LSF has been investigated in a randomized clinical trial. Economic evaluation is however essential for decision makers to make informed choices regarding allocation of scarce resources.Methods: 90 patients undergoing LSF were randomly allocated to usual care (control group) or usual care plus a preoperative CBT intervention (CBT group). Outcome parameters included quality-adjusted life years (QALY), based on the EQ-5D, and pain-related disability, based on the Oswestry disability index (ODI). Health care use and productivity loss were estimated from national registers.Results: One year after LSF the estimated QALY was significantly better for the CBT group with 0.710 (95% CI 0.670; 0.749) versus 0.636 (95% CI 0.5573; 0.687). For the ODI, the CBT group reported significantly larger disability reductions at 3 months (P = 0.003) and 6 months (P = 0.047), but not at 1 year (P = 0.082). There was no difference in the overall costs of the two groups (-€89 (95% CI -12,080; 11,902)), leading to a 70% probability of the CBT intervention being cost-effective at a willingness-to-pay of €40,000 for one additional QALY. For an additional gain of 15 ODI points the probability was 90% at a threshold of €10,000. These results remained largely unaffected by relevant sensitivity analyses, confirming the robustness of findings.Conclusion: Preoperative CBT appears to be more effective and cost neutral when considering the overall health care sector and labor market perspective, supporting the implementation of preoperative CBT in the course of treatment for LSF surgery in a Danish context. [ABSTRACT FROM AUTHOR]

Study Design. Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up. Objective. To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery. Summary of Background Data. In a previously reported randomized controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendations, it seems relevant to address the societal perspective including return to work, quality of life, and costs. Methods. A cost-effectiveness analysis and a cost-utility analysis were conducted. Eighty-two patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylo[isthesis (grade I or II) were randomized to an identical protocol of 4 sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training. Outcome parameters included functional disability (Oswestry Disability Index) and quality-adjusted life years. Health care and productivity costs were estimated from national registries and reported in euros. Costs and effects were transformed into net benefit. Bootstrapping was used to estimate 95% confidence intervals (95% CI). Results. The fast-track strategy tended to be costlier by 6869 (95% CI, -4640 to 18,378) while at the same time leading to significantly poorer outcomes of functional disability by -9 points (95% CI, -18 to -3) and a tendency for a reduced gain in quality-adjusted life years by -0.04 (95% CI, -0.13 to 0.01). The overall probability for the fast-track strategy being cost-effective does not reach 10% at conventional thresholds for cost-effectiveness. Conclusion. Initiating rehabilitation at 6 weeks as opposed to 12 weeks after surgery is on average more costly and less effective. The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice. [ABSTRACT FROM AUTHOR]

Background: Health behavior theories can provide an understanding of hearing health behaviors and, more importantly, can be used to develop theoretically based strategies to change these health behaviors. Purpose: To develop a theory-based brief intervention to increase help-seeking for adult hearing loss and to conduct a pilot study to evaluate its feasibility, effectiveness, and impact on hearing beliefs and behaviors. Research Design: An intervention was designed that could be easily administered by a health-care provider who does not have expertise in audiology--such as a primary care physician, community nurse, or social worker. The intervention aims to alter perceived benefit, severity, cues to action, and self-efficacy for seeking help by providing experiential/affective messaging and simultaneously providing intrinsic motivation for the recipient to seek hearing help. To first determine whether this intervention changed beliefs and increased help-seeking behavior, this study was conducted in a hearing research laboratory setting. Study Sample: A total of 101 adults aged 50-89 yr were recruited within 6 months of having attended an appointment at a primary care clinic at the VA Portland Health Care System. All were sent a letter inviting them to participate in a study if they had trouble with their hearing but had not had a scheduled hearing test or worn hearing aids in the prior 5 yr and also had functional oral and written English. Data from 87 individuals were available for analysis. Intervention: The intervention is designed for use in any health-care setting in which a health-care provider can facilitate a conversation about hearing. On arrival at a health-care facility, recipients are provided with nine emotionally evocative color photographs to prompt reflection on ways in which hearing difficulties impact them. A discussion with a health-care provider (facilitator) follows, during which recipients may identify the negative impacts of their hearing loss. If the recipient identifies negative impacts, the facilitator suggests that he or she consider having a hearing test and provides a list of local hearinghealth professionals. Data Collection and Analysis: Participants completed baseline questionnaires assessing hearing beliefs and attitudes. They were then randomly assigned either to the group receiving the study intervention or to a control group. Six months after study enrollment, participants reported whether they had sought help for their hearing and completed a second set of questionnaires. Results: Twelve of 41 individuals (29.3%) in the intervention group and 7 of 46 individuals (15.2%) in the control group sought help within the 6-month follow-up period. A χ² test showed these numbers did not differ significantly; however, the odds ratio of having had a hearing test were 2.3 times greater for those who received the intervention than for those who did not. Conclusions: Despite not reaching statistical significance, the odds ratio suggests that the theory-based brief intervention is worthy of additional examination. We intend to work with health-care providers to conduct a larger study to investigate whether the intervention has value in the real world. [ABSTRACT FROM AUTHOR]