Maria Sandborgh | Mälardalen University (original) (raw)

Papers by Maria Sandborgh

Research paper thumbnail of Development and psychometric properties of the stressor scale for emergency nurses

International emergency nursing, Jul 3, 2018

Emergency department nurses are exposed to specific stressors and report higher stress levels tha... more Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses. The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated. The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and...

Research paper thumbnail of Implementing a behavioral medicine approach in physiotherapy for patients with musculoskeletal pain: a scoping review

Research paper thumbnail of Alternatives to routinely used physiotherapy interventions for achieving maximum patients’ benefits and minimising therapists’ exposure in treatment of COVID-19 – a commentary

European Journal of Physiotherapy

Research paper thumbnail of Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review

Physiotherapy Theory and Practice

In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy ... more In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

Research paper thumbnail of The complexity of integrating a behavioral medicine approach into physiotherapy clinical practice

Physiotherapy Theory and Practice

Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy ... more Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy is challenging, and studies regarding the determinants are sparse. Thus, the aim of this study was to explore determinants of applying a BM approach in physiotherapy for patients with persistent pain across the micro-, meso-, and macro-levels. Methods: A qualitative multiple-case study design was used. Data were collected from four cases through semi-structured interviews with physiotherapists (PTs), patients, and managers; observations of video-recorded treatment sessions; and reviews of local directives and regulations. Data were analyzed with inductive content analysis and cross-case analysis, followed by mapping to the domains of determinants at the micro-, meso-, and macro-levels within the Implementation of Change Model. Results: Similar determinants were found across the cases. At the micro-level, these determinants concerned the PTs' ambivalence toward a BM approach, a biomedical focus, embarrassment asking about psychosocial factors, BM knowledge, skills for applying the approach, and self-awareness. Others concerned the patients' role expectations of the PT, patients as active or passive agents in the treatment process, patients' focus on biomedical aspects, and confidence in the PT. At the meso-level, support from managers and peers, allocation of time, and expectations from the organization were identified as determinants. No determinants were identified at the macro-level. Conclusion: The complexity of integrating a BM approach into physiotherapy clinical practice arises from multiple determinants functioning as both facilitators and barriers. By selecting strategies to address these determinants, the implementation of a BM approach could be supported.

Research paper thumbnail of Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability

Disability and Rehabilitation

Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when... more Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain. Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size. Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group. Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed. ä IMPLICATIONS FOR REHABILITATION Tailored multifaceted facilitation can support the implementation of an evidence based behavioral medicine approach in physiotherapy. Facilitation can be useful for increasing self-efficacy beliefs for using behavioral medicine approach in physiotherapist's clinical practice. Further research is required to establish strategies that are effective in sustaining behavioral changes.

Research paper thumbnail of Development and psychometric properties of the stressor scale for emergency nurses

International emergency nursing, Jul 3, 2018

Emergency department nurses are exposed to specific stressors and report higher stress levels tha... more Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses. The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated. The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and...

Research paper thumbnail of Is self-efficacy and catastrophizing in pain-related disability mediated by control over pain and ability to decrease pain in whiplash-associated disorders?

Physiotherapy Theory and Practice

Research paper thumbnail of The Relation between the Fear-Avoidance Model and Constructs from the Social Cognitive Theory in Acute WAD

Pain Research and Management

In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disablin... more In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disabling process in whiplash associated disorder (WAD). The aim was to exemplify the possible input from Social Cognitive Theory on the FA model. Specifically the role of functional self-efficacy and perceived responses from a spouse/intimate partner was studied. A cross-sectional and correlational design was used. Data from 64 patients with acute WAD were used. Measures were pain intensity measured with a numerical rating scale, the Pain Disability Index, support, punishing responses, solicitous responses, and distracting responses subscales from the Multidimensional Pain Inventory, the Catastrophizing subscale from the Coping Strategies Questionnaire, the Tampa Scale of Kinesiophobia, and the Self-Efficacy Scale. Bivariate correlational, simple linear regression, and multiple regression analyses were used. In the statistical prediction models high pain intensity indicated high punishing respo...

Research paper thumbnail of Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand

Journal of Cross-Cultural Gerontology, 2016

The aim of this study was to describe factors associated with perceived health and healthy aging ... more The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand's aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors.

Research paper thumbnail of Screening, Targeting, Tailoring, and Implementation in Primary Health Care : An integrated physical therapy and behavioural medicine approach to persons with persistent musculoskeletal pain

... However, Woby and coworkers (2007b) propose a revised fear-avoidance model (Vlaeyen and Linto... more ... However, Woby and coworkers (2007b) propose a revised fear-avoidance model (Vlaeyen and Linton, 2000; Leeuw et al., 2006) incorporating a ... manual, the development of a training program to impart the required skills to the treatment providers, and the de-velopment of a ...

Research paper thumbnail of A pilot study of targeted and tailored treatment strategies in physical therapy for patients with persistent musculoskeletal pain

Research paper thumbnail of Implementation of a tailored cognitive behavioural approach in physical therapy

Research paper thumbnail of Fall-Related Self-efficacy in Instrumental Activities of Daily Living is Associated with Falls in Older Community-Living People

Physical & Occupational Therapy in Geriatrics, 2013

ABSTRACT Introduction: The aim of this study was to identify fall risk factors in community-livin... more ABSTRACT Introduction: The aim of this study was to identify fall risk factors in community-living people 75 years or older. Methods: From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75–101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls. Results: The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93–21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers. Conclusion: Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.

Research paper thumbnail of Musculoskeletal Pain in Primary Health Care: Subgroups Based on Pain Intensity, Disability, Self-Efficacy, and Fear-Avoidance Variables

The Journal of Pain, 2007

The purpose of this study was to identify and describe subgroup profiles based on self-reported p... more The purpose of this study was to identify and describe subgroup profiles based on self-reported pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing in patients with musculoskeletal pain. Two primary health care samples (n ‫؍‬ 215 and n ‫؍‬ 161) were used. Self-report questionnaires were completed at the start of physical therapy treatment. Cluster analysis was used to generate subgroups. Three subgroups were identified in sample 1 and replicated in sample 2. These were labeled "High self-efficacy-Low fear-avoidance," "Low self-efficacy-Low fear-avoidance," and "Low self-efficacy-High fear-avoidance." The subgroups differed significantly in work-status in both samples (P < .001), but not in age, gender, or duration of pain. The results show the presence of subgroups based on pain intensity, disability, self-efficacy, fear of movement/ (re)injury, and catastrophizing. The profile patterns suggest that different management strategies may be relevant in each subgroup. Perspective: This article presents subgroups of patients with musculoskeletal pain with different profiles in pain intensity, disability, and psychosocial variables possible to modify by physical therapy management. The results could potentially aid clinicians in tailoring assessment and treatment approaches to each subgroup.

Research paper thumbnail of The Pain Belief Screening Instrument (PBSI): Predictive validity for disability status in persistent musculoskeletal pain

Disability & Rehabilitation, 2008

To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy... more To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated. Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement. The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lambda = 0.848, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months. The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.

Research paper thumbnail of Implementing behavioural medicine in physiotherapy treatment. Part II: Adherence to treatment protocol

Advances in Physiotherapy, 2010

ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment str... more ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment strategies, based on cognitive–behavioural treatment principles were investigated. The intervention was aimed at patients with persistent musculoskeletal pain in primary healthcare. A preliminary examination indicated low treatment integrity for the tailored treatment. Therefore, the aim in this study was to evaluate physiotherapists&#39; treatment adherence to a treatment tailored to physical, cognitive and behavioural factors of importance for the performance of patients&#39; prioritized activities. Explorative study, Part II. Materials and Methods: Treatment documents for 18 patients, treated by four specially trained physiotherapists, were utilized for assessment of treatment adherence. A treatment integrity measure was developed, tested and used for evaluation of adherence to the treatment protocol. Results: Physiotherapists&#39; adherence to the treatment manual was low concerning treatment components and the overall sequencing of the treatment. Intrapersonal physical and cognitive factors, and situational variations tied to the performance of prioritized activities targeted in treatment, were rarely found or specified in treatment documents. Statements about functional and causal relationships between determinants for activity performance were not documented or unspecified. Conclusion: The physiotherapists&#39; adherence to the treatment protocol was low despite the pre-intervention training programme and supervision during the intervention period.

Research paper thumbnail of Pain belief screening instrument: Development and preliminary validation of a screening instrument for disabling persistent pain

Journal of Rehabilitation Medicine, 2007

To develop and test the ability of a screening instrument to identify subgroups among primary hea... more To develop and test the ability of a screening instrument to identify subgroups among primary healthcare patients with musculoskeletal pain. The Pain Belief Screening Instrument covers pain intensity, disability, self-efficacy, fear avoidance and catastrophizing. Design: Cross-sectional, correlational and comparative study. Subjects: Patients in primary healthcare (n 1 = 215; n 2 = 93) with a pain duration of 4 weeks or more were included. Methods: Items for the Pain Belief Screening Instrument were derived from principal component analyses of: the Self-efficacy Scale, the Tampa Scale of Kinesiophobia and the Catastrophizing subscale in the Coping Strategies Questionnaire. Cluster solutions of scores on the screening instrument and the original instruments were cross-tabulated. The reliability of items in the Pain Belief Screening Instrument was examined. Results: The screening instrument identified 2 groups: highor low-risk profile for pain-related disability. Validity was inbetween moderate and substantial (κ = 0.61, p < 0.001). The reliability of each item in the Pain Belief Screening Instrument in relation to the corresponding item in the original instruments was moderate to high (r s 0.50-0.80, p < 0.01). Conclusion: The screening instrument fairly well replicated subgroups identified by the original instruments. The reliability of items in the screening instrument was acceptable. Further testing of predictive validity for a primary healthcare population is needed.

Research paper thumbnail of Implementing behavioural medicine in physiotherapy treatment. Part II: Adherence to treatment protocol

Advances in Physiotherapy, Feb 25, 2010

ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment str... more ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment strategies, based on cognitive–behavioural treatment principles were investigated. The intervention was aimed at patients with persistent musculoskeletal pain in primary healthcare. A preliminary examination indicated low treatment integrity for the tailored treatment. Therefore, the aim in this study was to evaluate physiotherapists&#39; treatment adherence to a treatment tailored to physical, cognitive and behavioural factors of importance for the performance of patients&#39; prioritized activities. Explorative study, Part II. Materials and Methods: Treatment documents for 18 patients, treated by four specially trained physiotherapists, were utilized for assessment of treatment adherence. A treatment integrity measure was developed, tested and used for evaluation of adherence to the treatment protocol. Results: Physiotherapists&#39; adherence to the treatment manual was low concerning treatment components and the overall sequencing of the treatment. Intrapersonal physical and cognitive factors, and situational variations tied to the performance of prioritized activities targeted in treatment, were rarely found or specified in treatment documents. Statements about functional and causal relationships between determinants for activity performance were not documented or unspecified. Conclusion: The physiotherapists&#39; adherence to the treatment protocol was low despite the pre-intervention training programme and supervision during the intervention period.

Research paper thumbnail of Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods

Implementation Science

Background In a quasi-experimental study, facilitation was used to support implementation of the ... more Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists...

Research paper thumbnail of Development and psychometric properties of the stressor scale for emergency nurses

International emergency nursing, Jul 3, 2018

Emergency department nurses are exposed to specific stressors and report higher stress levels tha... more Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses. The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated. The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and...

Research paper thumbnail of Implementing a behavioral medicine approach in physiotherapy for patients with musculoskeletal pain: a scoping review

Research paper thumbnail of Alternatives to routinely used physiotherapy interventions for achieving maximum patients’ benefits and minimising therapists’ exposure in treatment of COVID-19 – a commentary

European Journal of Physiotherapy

Research paper thumbnail of Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review

Physiotherapy Theory and Practice

In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy ... more In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

Research paper thumbnail of The complexity of integrating a behavioral medicine approach into physiotherapy clinical practice

Physiotherapy Theory and Practice

Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy ... more Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy is challenging, and studies regarding the determinants are sparse. Thus, the aim of this study was to explore determinants of applying a BM approach in physiotherapy for patients with persistent pain across the micro-, meso-, and macro-levels. Methods: A qualitative multiple-case study design was used. Data were collected from four cases through semi-structured interviews with physiotherapists (PTs), patients, and managers; observations of video-recorded treatment sessions; and reviews of local directives and regulations. Data were analyzed with inductive content analysis and cross-case analysis, followed by mapping to the domains of determinants at the micro-, meso-, and macro-levels within the Implementation of Change Model. Results: Similar determinants were found across the cases. At the micro-level, these determinants concerned the PTs' ambivalence toward a BM approach, a biomedical focus, embarrassment asking about psychosocial factors, BM knowledge, skills for applying the approach, and self-awareness. Others concerned the patients' role expectations of the PT, patients as active or passive agents in the treatment process, patients' focus on biomedical aspects, and confidence in the PT. At the meso-level, support from managers and peers, allocation of time, and expectations from the organization were identified as determinants. No determinants were identified at the macro-level. Conclusion: The complexity of integrating a BM approach into physiotherapy clinical practice arises from multiple determinants functioning as both facilitators and barriers. By selecting strategies to address these determinants, the implementation of a BM approach could be supported.

Research paper thumbnail of Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability

Disability and Rehabilitation

Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when... more Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain. Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size. Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group. Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed. ä IMPLICATIONS FOR REHABILITATION Tailored multifaceted facilitation can support the implementation of an evidence based behavioral medicine approach in physiotherapy. Facilitation can be useful for increasing self-efficacy beliefs for using behavioral medicine approach in physiotherapist's clinical practice. Further research is required to establish strategies that are effective in sustaining behavioral changes.

Research paper thumbnail of Development and psychometric properties of the stressor scale for emergency nurses

International emergency nursing, Jul 3, 2018

Emergency department nurses are exposed to specific stressors and report higher stress levels tha... more Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses. The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated. The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and...

Research paper thumbnail of Is self-efficacy and catastrophizing in pain-related disability mediated by control over pain and ability to decrease pain in whiplash-associated disorders?

Physiotherapy Theory and Practice

Research paper thumbnail of The Relation between the Fear-Avoidance Model and Constructs from the Social Cognitive Theory in Acute WAD

Pain Research and Management

In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disablin... more In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disabling process in whiplash associated disorder (WAD). The aim was to exemplify the possible input from Social Cognitive Theory on the FA model. Specifically the role of functional self-efficacy and perceived responses from a spouse/intimate partner was studied. A cross-sectional and correlational design was used. Data from 64 patients with acute WAD were used. Measures were pain intensity measured with a numerical rating scale, the Pain Disability Index, support, punishing responses, solicitous responses, and distracting responses subscales from the Multidimensional Pain Inventory, the Catastrophizing subscale from the Coping Strategies Questionnaire, the Tampa Scale of Kinesiophobia, and the Self-Efficacy Scale. Bivariate correlational, simple linear regression, and multiple regression analyses were used. In the statistical prediction models high pain intensity indicated high punishing respo...

Research paper thumbnail of Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand

Journal of Cross-Cultural Gerontology, 2016

The aim of this study was to describe factors associated with perceived health and healthy aging ... more The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand's aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors.

Research paper thumbnail of Screening, Targeting, Tailoring, and Implementation in Primary Health Care : An integrated physical therapy and behavioural medicine approach to persons with persistent musculoskeletal pain

... However, Woby and coworkers (2007b) propose a revised fear-avoidance model (Vlaeyen and Linto... more ... However, Woby and coworkers (2007b) propose a revised fear-avoidance model (Vlaeyen and Linton, 2000; Leeuw et al., 2006) incorporating a ... manual, the development of a training program to impart the required skills to the treatment providers, and the de-velopment of a ...

Research paper thumbnail of A pilot study of targeted and tailored treatment strategies in physical therapy for patients with persistent musculoskeletal pain

Research paper thumbnail of Implementation of a tailored cognitive behavioural approach in physical therapy

Research paper thumbnail of Fall-Related Self-efficacy in Instrumental Activities of Daily Living is Associated with Falls in Older Community-Living People

Physical & Occupational Therapy in Geriatrics, 2013

ABSTRACT Introduction: The aim of this study was to identify fall risk factors in community-livin... more ABSTRACT Introduction: The aim of this study was to identify fall risk factors in community-living people 75 years or older. Methods: From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75–101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls. Results: The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93–21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers. Conclusion: Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.

Research paper thumbnail of Musculoskeletal Pain in Primary Health Care: Subgroups Based on Pain Intensity, Disability, Self-Efficacy, and Fear-Avoidance Variables

The Journal of Pain, 2007

The purpose of this study was to identify and describe subgroup profiles based on self-reported p... more The purpose of this study was to identify and describe subgroup profiles based on self-reported pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing in patients with musculoskeletal pain. Two primary health care samples (n ‫؍‬ 215 and n ‫؍‬ 161) were used. Self-report questionnaires were completed at the start of physical therapy treatment. Cluster analysis was used to generate subgroups. Three subgroups were identified in sample 1 and replicated in sample 2. These were labeled "High self-efficacy-Low fear-avoidance," "Low self-efficacy-Low fear-avoidance," and "Low self-efficacy-High fear-avoidance." The subgroups differed significantly in work-status in both samples (P < .001), but not in age, gender, or duration of pain. The results show the presence of subgroups based on pain intensity, disability, self-efficacy, fear of movement/ (re)injury, and catastrophizing. The profile patterns suggest that different management strategies may be relevant in each subgroup. Perspective: This article presents subgroups of patients with musculoskeletal pain with different profiles in pain intensity, disability, and psychosocial variables possible to modify by physical therapy management. The results could potentially aid clinicians in tailoring assessment and treatment approaches to each subgroup.

Research paper thumbnail of The Pain Belief Screening Instrument (PBSI): Predictive validity for disability status in persistent musculoskeletal pain

Disability & Rehabilitation, 2008

To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy... more To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated. Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement. The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lambda = 0.848, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months. The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.

Research paper thumbnail of Implementing behavioural medicine in physiotherapy treatment. Part II: Adherence to treatment protocol

Advances in Physiotherapy, 2010

ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment str... more ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment strategies, based on cognitive–behavioural treatment principles were investigated. The intervention was aimed at patients with persistent musculoskeletal pain in primary healthcare. A preliminary examination indicated low treatment integrity for the tailored treatment. Therefore, the aim in this study was to evaluate physiotherapists&#39; treatment adherence to a treatment tailored to physical, cognitive and behavioural factors of importance for the performance of patients&#39; prioritized activities. Explorative study, Part II. Materials and Methods: Treatment documents for 18 patients, treated by four specially trained physiotherapists, were utilized for assessment of treatment adherence. A treatment integrity measure was developed, tested and used for evaluation of adherence to the treatment protocol. Results: Physiotherapists&#39; adherence to the treatment manual was low concerning treatment components and the overall sequencing of the treatment. Intrapersonal physical and cognitive factors, and situational variations tied to the performance of prioritized activities targeted in treatment, were rarely found or specified in treatment documents. Statements about functional and causal relationships between determinants for activity performance were not documented or unspecified. Conclusion: The physiotherapists&#39; adherence to the treatment protocol was low despite the pre-intervention training programme and supervision during the intervention period.

Research paper thumbnail of Pain belief screening instrument: Development and preliminary validation of a screening instrument for disabling persistent pain

Journal of Rehabilitation Medicine, 2007

To develop and test the ability of a screening instrument to identify subgroups among primary hea... more To develop and test the ability of a screening instrument to identify subgroups among primary healthcare patients with musculoskeletal pain. The Pain Belief Screening Instrument covers pain intensity, disability, self-efficacy, fear avoidance and catastrophizing. Design: Cross-sectional, correlational and comparative study. Subjects: Patients in primary healthcare (n 1 = 215; n 2 = 93) with a pain duration of 4 weeks or more were included. Methods: Items for the Pain Belief Screening Instrument were derived from principal component analyses of: the Self-efficacy Scale, the Tampa Scale of Kinesiophobia and the Catastrophizing subscale in the Coping Strategies Questionnaire. Cluster solutions of scores on the screening instrument and the original instruments were cross-tabulated. The reliability of items in the Pain Belief Screening Instrument was examined. Results: The screening instrument identified 2 groups: highor low-risk profile for pain-related disability. Validity was inbetween moderate and substantial (κ = 0.61, p < 0.001). The reliability of each item in the Pain Belief Screening Instrument in relation to the corresponding item in the original instruments was moderate to high (r s 0.50-0.80, p < 0.01). Conclusion: The screening instrument fairly well replicated subgroups identified by the original instruments. The reliability of items in the screening instrument was acceptable. Further testing of predictive validity for a primary healthcare population is needed.

Research paper thumbnail of Implementing behavioural medicine in physiotherapy treatment. Part II: Adherence to treatment protocol

Advances in Physiotherapy, Feb 25, 2010

ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment str... more ABSTRACT Abstract Objectives: In a controlled clinical trial, targeted and tailored treatment strategies, based on cognitive–behavioural treatment principles were investigated. The intervention was aimed at patients with persistent musculoskeletal pain in primary healthcare. A preliminary examination indicated low treatment integrity for the tailored treatment. Therefore, the aim in this study was to evaluate physiotherapists&#39; treatment adherence to a treatment tailored to physical, cognitive and behavioural factors of importance for the performance of patients&#39; prioritized activities. Explorative study, Part II. Materials and Methods: Treatment documents for 18 patients, treated by four specially trained physiotherapists, were utilized for assessment of treatment adherence. A treatment integrity measure was developed, tested and used for evaluation of adherence to the treatment protocol. Results: Physiotherapists&#39; adherence to the treatment manual was low concerning treatment components and the overall sequencing of the treatment. Intrapersonal physical and cognitive factors, and situational variations tied to the performance of prioritized activities targeted in treatment, were rarely found or specified in treatment documents. Statements about functional and causal relationships between determinants for activity performance were not documented or unspecified. Conclusion: The physiotherapists&#39; adherence to the treatment protocol was low despite the pre-intervention training programme and supervision during the intervention period.

Research paper thumbnail of Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods

Implementation Science

Background In a quasi-experimental study, facilitation was used to support implementation of the ... more Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists...