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Health promoting factors in people with chronic musculoskeletal pain or with rheumatic diseases: a descriptive and interventional study
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis with a salutogenic approach was to describe health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, and to evaluate the effects of an intervention study with a self-care promoting PBL-program for people with rheumatic diseases having chronic musculoskeletal pain, sleep disturbances and/or fatigue.

 

Methods: This thesis is comprised of four samples: a randomly selected sample from a Swedish general population (study I) and three different samples containing people with rheumatic diseases registered at a hospital for rheumatic diseases in the southwest of Sweden (studies II, III and IV). Study I had a longitudinal cohort design with an eight-year follow-up in a general population. There were 1109 participants without chronic pain and 700 participants with chronic musculoskeletal pain. Study II had a longitudinal cohort design with participants with rheumatic diseases (n=185) 12 months after rehabilitation at a hospital for rheumatic diseases. Study III had a descriptive qualitative design with a phenomenological approach based on a reflective life-world perspective. Twelve participants were interviewed about their experiences about health-promoting self-care. Study IV had a randomised controlled design with post-test six months after the one-year self-care promoting problem-based learning (PBL) program for people with rheumatic diseases. The participants were randomly assigned to the experimental group, 54 participants, or to the control group, 148 participants. Data in studies I, II and IV were analysed with statistics. In study III a Husserlian phenomenological approach based on a reflective life-world perspective was used in the data collection and analysis.

 

Results: Study I: Although participants without chronic musculoskeletal pain reported better health-related quality of life (HRQL) than participants with chronic musculoskeletal pain, similar health factors were found to promote a better HRQL in the eight-year follow-up. The most important factors were feeling rested after sleep and having good sleep structure. Study II: The most important factors promoting better outcome in HRQL 12 months after rehabilitation in participants with rheumatic diseases were having a strong sense of coherence (SOC), feeling rested after sleep, having work capacity, and having good sleep structure. Study III: The meaning of health-promoting self-care as experienced by people with rheumatic diseases was that self-care takes place against a background of continual hope and belief to be able to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three interrelated constituents elucidated the experiences: dialogue, power struggle and choice. Study IV: At the six month follow-up the participants in the experimental group had stronger empowerment after participation in the self-care promoting PBL-program compared with the control group which only got standard care for people with rheumatic diseases. There were no differences in HRQL, self-care ability, SOC, pain, quality of sleep or fatigue between the experimental group and the control group. The participants in the experimental group also stated that they had implemented lifestyle changes which they had not done without the PBL-program.

 

Conclusion: The results of this thesis provide a valuable and useful insight in health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, but also in that people with rheumatic diseases have benefit from taking part in patient education with a self-care promoting PBL-program. These results contribute to evidence supporting the introduction of a more salutogenic approach in rheumatology care and research.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences, Jönköping University , 2011. , 164 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 17
Keyword [en]
Adult, chronic musculoskeletal pain, empowerment, health factors, HRQL, intervention, patient education, problem-based learning, rheumatic diseases, self-care
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-15007ISBN: 978-91-85835-16-4 (print)OAI: oai:DiVA.org:hj-15007DiVA: diva2:416473
Public defence
2011-06-01, Forum Humanum, Hälsohögskolan, Jönköping, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2011-05-16 Created: 2011-05-11 Last updated: 2014-05-20Bibliographically approved
List of papers
1. Health predicting factors in a general population over an eight-year period in subjects with and without chronic musculoskeletal pain
Open this publication in new window or tab >>Health predicting factors in a general population over an eight-year period in subjects with and without chronic musculoskeletal pain
2008 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, Vol. 6, no 1, 98- p.Article in journal (Refereed) Published
Abstract [en]

ABSTRACT: BACKGROUND: Many factors are proposed to be associated with health-related quality of life. Knowledge of health factors associated to development of a good health-related quality of life could be of use in clinical practice and public health work. The aim of this study was to investigate the associations between suggested health factors and health-related quality of life at baseline and in an eight-year follow up in subjects with and without chronic musculoskeletal pain in a cohort from a general population. METHODS: The study was designed as a longitudinal study in a Swedish general population (N=1 849) with a postal questionnaire at baseline 1995 and at follow up 2003. Subjects were divided into two groups, according to their response about chronic musculoskeletal pain at baseline. Health-related quality of life was assessed by the SF-36 together with suggested health factors. The associations between SF-36 subscales and suggested health factors were estimated by OR and 95 % CI calculated by multivariable logistic regressions, with adjustment for all health factors, age, sex and baseline SF-36 values. RESULTS: Although subjects without chronic musculoskeletal pain reported better health-related quality of life than subjects with chronic pain, similar health factors were found to be associated to higher scores in SF-36 at baseline and predicted a better outcome in the eight-year follow up. The most consistent finding was a better health outcome in the eight-year follow up for subjects that were feeling rested after sleep. Other factors that in some aspects predicted a better outcome were belonging to higher socioeconomic group, being a native Swede, having emotional support, having good sleep structure, never being or being a former smoker, and regularly drinking alcohol. CONCLUSIONS: The most important health factor in subjects with and without chronic musculoskeletal pain was feeling rested after sleep, but also emotional support, sleep structure, smoking and alcoholic habits appears to be important components. These health factors could be important to address in clinical work with painful musculoskeletal disorders. Since several health factors are common in both subjects with and without pain there could be a common strategy to be formed in public health programmes.

Identifiers
urn:nbn:se:hj:diva-6937 (URN)10.1186/1477-7525-6-98 (DOI)19014459 (PubMedID)
Available from: 2008-12-12 Created: 2008-12-09 Last updated: 2011-05-16Bibliographically approved
2. Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study
Open this publication in new window or tab >>Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study
2011 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, Vol. 12, no 102, -13 p.Article in journal (Refereed) Published
Abstract [en]

Background: Rheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases.

Methods: A longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions.

Results: Factors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure.

Conclusions: This study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-15003 (URN)10.1186/1471-2474-12-102 (DOI)
Available from: 2011-05-11 Created: 2011-05-11 Last updated: 2012-07-31Bibliographically approved
3. Experiences of health-promoting self-care in people living with rheumatic diseases
Open this publication in new window or tab >>Experiences of health-promoting self-care in people living with rheumatic diseases
Show others...
2011 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 6, 1264-1272 p.Article in journal (Refereed) Published
Abstract [en]

Aim This paper is a report of a study which explores and describes the meaning of the phenomenon health-promoting self-care as experienced by people living with rheumatic diseases.

Background People with rheumatic diseases estimate health status as low and health belief and health status influence the self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases.

Method The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases.

Findings The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated the experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues within the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized.

Conclusion In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices.

Keyword
Adults, health promoting self-care, nursing, phenomenology, rheumatic diseases, self-care
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-15006 (URN)10.1111/j.1365-2648.2010.05585.x (DOI)
Available from: 2011-05-11 Created: 2011-05-11 Last updated: 2012-01-23Bibliographically approved
4. Effects of a self-care promoting problem-based learning program as reported by people with rheumatic diseases: a randomized controlled pilot study
Open this publication in new window or tab >>Effects of a self-care promoting problem-based learning program as reported by people with rheumatic diseases: a randomized controlled pilot study
Show others...
2011 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134Article in journal (Refereed) Submitted
Abstract [en]

Objective: The aim of this pilot study was to evaluate the effects of a self-care promoting problem-based learning (PBL) program for people with rheumatic diseases, in terms of health-related quality of life (HRQL), empowerment and self-care ability at a six month follow-up.

Methods: A randomized controlled design was selected with pre-test, one-week and six months post-test after the one-year PBL-program. The participants were randomly assigned to either the experimental group (n=54) or the control group (n=148). The differences were analyzed by t-test and Pearson Chi-square.

Results: The participants in the experimental group had stronger empowerment after participation in the PBL-program compared with the control group. There were no differences in HRQL, self-care ability, sense of coherence, pain, quality of sleep or fatigue between the groups. The participants in the experimental group stated they had implemented lifestyle changes they had not done without the PBL-program.

Conclusion: The present self-care promoting PBL-program enabled people with rheumatic diseases to improve their empowerment but not their HRQL and self-care ability compared with the control group.

Practice Implications: It is important to continue to develop PBL in patient education in order to find the very best way to use this pedagogical model in rheumatology care. 

Keyword
Rheumatic diseases, self-care, empowerment, problem-based learning, patient education
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-15004 (URN)
Available from: 2011-05-11 Created: 2011-05-11 Last updated: 2012-07-31Bibliographically approved

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