Intimate partner violence in women with disabilities: perception of healthcare and attitudes of health professionals

Purpose: Intimate partner violence (IPV) is a major social problem and public health issue, but we still have a relatively small amount of data about partner violence in women with disabilities. The main objective of this study was to understand the experiences of women with disabilities who are or have been abused by their partners and to explore the knowledge, views and training requirements of primary care professionals.

Method: Qualitative study using semi-structured interviews with women with disabilities who had experienced IPV (n?=?14), and focus groups with healthcare professionals (n?=?16).

Results: Women with disabilities suffer specific forms of abuse. Because they depend on the people around them to take action, they are subordinate and this can prolong the abuse. The healthcare staff frequently mentioned that it is often difficult to notice that women with disabilities are being abused. Their lack of training about disabilities and gender-based violence makes them less sure of their ability to identify and deal with any possible cases of abuse.

Conclusions: The difficulties described by the women interviewed are broadly speaking the same as those described by the healthcare professionals consulted. A number of suggestions for improvements are provided based on the results found.

• Implications for Rehabilitation

• The rehabilitation of abused disabled women implies that women perceive the health system as a resource to resolve their situation.

• Healthcare professionals should be trained on how to detect, treat and communicate with disabled women who experience partner violence.

• Is needed to establish a comprehensive system of coordination between services involved in caring for abused women and with disabilities.

     

“The complaining women”: health professionals’ perceptions on patients with fibromyalgia in Spain

Purpose: The aim of this study is twofold: (1) to explore health service providers’ perceptions regarding fibromyalgia patients in Spain and (2) to analyze possible consequences of these perceptions in terms of how health service providers construct the disease and treat their patients.

Design: Qualitative study.

Subjects/Patients: Twelve health service providers (eight men, four women) involved in the care of fibromyalgia patients. Providers were from different disciplines and included general practitioners, rheumatologists, occupational doctors, psychologists, psychiatrists, physiotherapists and behavioral specialists from Spain.

Method: We performed individual semistructured interviews, which were recorded and transcribed to conduct a qualitative content analysis supported by Atlas.ti-7.

Results: We identified three categories from the interviews: (1) the fibromyalgia patient prototype: the complaining woman, (2) fibromyalgia is considered a women’s health issue, but male patients are a privileged minority, and (3) health professionals’ attitudes toward fibromyalgia patients: are they really suffering or pretending?

Conclusion: The uncertainty surrounding fibromyalgia together with the fact that those affected are primarily women, seem to influence professional practice in terms of lack of recognition of Fibromyalgia as a severe disease. Increased training of all health professionals is essential to improving the support and attention given to patients suffering from fibromyalgia.

• Implications for rehabilitation

• Fibromyalgia

• ??In order to improve fibromyalgia patients´ attention, health providers should learn how to assist patients without prejudices.

• ??Training programs for health providers should include sensitization about the severity of fibromyalgia.

• ??Health providers should be aware of the existence of stereotypes about women suffering from fibromyalgia.

• ??Fibromyalgia protocols should give skills to health providers to avoid offering a gender-biased attention to patients.

     

High hospital readmission rates for patients aged ≥65 years associated with low socioeconomic status in a Swedish region: a cross-sectional study in primary care

Objective: There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission.

Design: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses.

Setting and subjects: Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014.

Main outcome measure: Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload.

Results: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r?=?0.74; p?r?=?0.73; p?r?=?0.74; p?r?=?0.51; p?r?=??0.40; p?=?0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p?Conclusion: Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged ≥65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities.

• Key Points

• In Sweden, hospital readmission within 30 days among patients aged ≥65 has been used as a measure of quality of primary care for the elderly.

• However, in our study, elderly 30-day readmission was associated with low neighbourhood socioeconomic status.

• A simple survey in one Swedish region showed that the primary health care centres that lacked active strategies for working with aged patients did not have higher hospital readmission rates than those that reported having strategies.

• Interventions aimed at reducing elderly hospital readmissions should therefore also consider the socioeconomic disparities in the elderly.

     

Psychoeducation against depression,anxiety, alexithymia and fibromyalgia: a pilot study in primary care for patients on sick leave

Objectives: Feasibility testing of a psychoeducational method -The Affect School and Script Analyses (ASSA) – in a Swedish primary care setting. Exploring associations between psychological, and medically unexplained physical symptoms (MUPS).

Design: Pilot study.

Setting: Three Swedish primary care centers serving 20,000 people.

Intervention: 8 weekly 2-hour sessions with a 5–7 participant group led by two instructors - followed by 10 individual hour-long sessions.

Subjects: Thirty-six patients, 29 women (81%), on sick-leave due to depression, anxiety, or fibromyalgia.

Outcome measures: Feasibility in terms of participation rates and expected improvements of psychological symptoms and MUPS, assessed by self-report instruments pre-, one-week post-, and 18 months post-intervention. Regression coefficients between psychological symptoms and MUPS.

Results: The entire 26-hour psychoeducational intervention was completed by 30 patients (83%), and 33 patients (92%) completed the 16-hour Affect School. One-week post-intervention median test score changes were significantly favorable for 27 respondents, with p?Conclusions: A psychoeducational method previously untested in primary care for mostly women patients on sick-leave due to depression, anxiety, or fibromyalgia had?>80% participation rates, and clear improvements of self-assessed psychological symptoms and MUPS. The ASSA intervention thus showed adequate feasibility in a Swedish primary care setting.

• Key Points

• ?A pilot study of a psychoeducational intervention – The Affect School and Script Analyses (ASSA) – was performed in primary care

• ??The intervention showed feasibility for patients on sick-leave due to depression, anxiety, or fibromyalgia

• ??92% completed the 8 weeks/16?hours Affect School and 83% completed the entire 26-hour ASSA intervention

• ??9 of 11 self-reported measures improved significantly one-week post intervention

• ??7 of 11 self-reported measures improved significantly 18 months post-intervention

     

The profiles of health care utilization among a non-depressed population and patients with depressive symptoms with and without clinical depression

Abstract

Objective: To examine health service (HS) utilization profiles among a non-depressive population and patients with depressive symptoms (DS) with and without clinical depression.

Design, subjects and setting: The study population was based on primary care patients with DS scoring ≥10 in the 21-item Beck Depression Inventory (BDI) and who were at least 35 years old and had been referred to depression nurse case managers (n?=?705). Their psychiatric diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (M.I.N.I.). Of these patients, 447 had clinical depression. The number of patients with DS without clinical depression was 258. The control group consisted of a random sample of 414 residents with a BDI score < 10. Use of HS (visits and phone calls to a doctor and a nurse) was based on patient records.

Main outcome measures: Number of visits and calls to physicians and nurses.

Results: Patients with DS regardless of their depression diagnosis used primary health care (PHC) services three times more than the controls (p?<?0.001). In the secondary care, the differences were smaller but significant. Of the controls, 70% had 0–4 HS contacts per year whereas a majority of the patients having DS had more than 5 contacts per year. The number of contacts correlated with the BDI from a score of 0 to 10 but not as clearly in the higher scores.

Conclusion: Depressive symptoms, both with or without clinical depression, are associated with increased HS use, especially in PHC. This study suggests that even mild depressive symptoms are associated with an increased use of HS.

• KEY POINTS

• We analyzed the health service (HS) use among primary health care patients screened for depression and non-depressive population.

• Screen positive patients without clinical depression used as much HS as those having clinical depression.

• Regardless of depression diagnosis, screen positive patients visited a GP and nurse three times more often than the control population.

• In the screen negative control population, milder depressive symptoms were correlated with the use of HS.

• Primary health care was responsible for most of the HS use among patients having depressive symptoms.

     

On surmounting the barriers to HPV vaccination: we can do better

The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention’s (CDC) Healthy People 2020 target of 80% coverage. Parents’ willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a “bundle” along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action.

• Key messages

• ??Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative.

• ??According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer.

• ??First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males.

• ??It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence.

• ??Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s.

• ??The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.

     

Maternal factors and the emotional and behavioural functioning of adolescents with chronic health conditions

Purpose: This study investigated the association between mothers’ mental health and education and the emotional and behavioural functioning of adolescents with chronic health conditions over time. Methods: Data were drawn from an ongoing study. Study participants (N?=?363) were recruited through eight children’s rehabilitation centres. Logistic regression models were estimated. Results: There were significantly reduced odds that girls would display clinical signs of hyperactivity/inattention one year later compared to boys when a maternal mental health condition was present (OR?=?0.10; p?p?p?Conclusions: Findings support a link between maternal factors and emotional and behavioural functioning in adolescents with chronic conditions. A holistic and family-centred approach to assessment and service delivery is indicated.

• Implications for Rehabilitation

• When conducting clinical assessments, service providers should consider associations between maternal education and mental health and the emotional and behavioural functioning of adolescents with chronic health conditions.

• A holistic and family-centred approach to assessment and service delivery is indicated to ensure adolescents with chronic conditions and their families receive support for interrelated needs.

     

Maternal body mass index in pregnancy and offspring physical and psychosocial functioning in older age: findings from the Helsinki Birth Cohort Study (HBCS)

Introduction: Maternal obesity is associated with several adverse long-term health outcomes in the offspring. In this study, we examined the association between maternal body mass index (BMI) and offspring physical and psychosocial functioning in late adulthood. Methods: The study included 1759 men and women born during 1934–1944 and belonging to the Helsinki Birth Cohort Study. Data on maternal weight and height in late pregnancy and on offspring birth weight were retrieved from hospital birth records. Physical and psychosocial functioning was assessed using the Short Form 36 scale. Results: Maternal BMI was positively associated with poorer physical and psychosocial functioning among men, but not among women. This association was not mediated by birth weight. Discussion: The present study emphasizes the importance of preventing overweight and obesity among women of childbearing age.

• Key messages

• Maternal BMI is known to be associated with adverse health outcomes among adult offspring.

• We found that higher maternal BMI was associated with poorer physical and psychosocial functioning among male offspring in late adulthood.

• The association between maternal BMI and offspring physical and psychosocial functioning was not mediated by birth weight.

     

Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth

Abstract

Purpose: To explore how women experience living with long-term pregnancy-related pelvic girdle pain.

Materials and methods: Nine women with persistent pregnancy-related pelvic girdle pain of 2–13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28–42 years of age and had given birth to 2–3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis.

Results: The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance.

Conclusion: The participants’ narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

• IMPLICATIONS FOR REHABILITATION

• Chronic pregnancy-related pelvic girdle pain

• ??Pregnancy-related pelvic girdle pain impairs women’s capacity to perform meaningful activities of daily life for many years after pregnancy.

• ??The participants’ narratives highlighted that the pain interfered with their sense of identity.

• ??It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

     

Glucocorticoid sensitivity and inflammatory status of peripheral blood mononuclear cells in patients with coronary artery disease

Objective: Mechanisms behind sustained inflammation in patients with coronary artery disease (CAD) are not clarified but hypothalamus-pituitary-adrenal (HPA) axis dysfunction may have a role. Here, we investigated whether inflammatory status of peripheral blood mononuclear cells (PBMCs) was associated with altered glucocorticoid sensitivity in CAD patients.

Methods: In 55 CAD patients and 30 controls, mRNA levels of GR-α, GR-β, NF-κB, IκBα, MMP-9 and TIMP-1 were measured in PBMCs. Suppressive effects of dexamethasone on GR-α, GR-β, NF-κB, IκBα, MMP-9 and TIMP-1 mRNA levels were assessed in PBMCs ex vivo. Salivary cortisol was repeatedly measured over 3 days.

Results: GR-α mRNA levels were higher in CAD patients than in controls, 0.50 (0.38–0.59) versus 0.26 (0.18–0.37), p?p?p?p?Conclusions: PBMCs from CAD patients displayed an inflammatory gene expression profile. This was not explained by reduced glucocorticoid sensitivity. Instead, inflammation was associated with increased expression of GR-α mRNA, suggesting a hypocortisolemic state.

• Key messages

• ??Peripheral blood mononuclear cells from patients with coronary artery disease (CAD) display an inflammatory gene expression profile.

• ??This inflammatory state cannot be explained by reduced glucocorticoid sensitivity in CAD patients.

• ??Instead, the inflammatory gene expression profile is associated with upregulated levels of glucocorticoid receptor-α mRNA, suggesting a hypocortisolemic state.

     

Relevance of nerve conduction velocity in the assessment of balance performance in older adults with diabetes mellitus

Purpose This study investigated the relationship between peripheral nerve conduction velocity (NCV) and balance performance in older adults with diabetes. Methods Twenty older adults with diabetes were recruited to evaluate the NCV of their lower limbs and balance performance. The balance assessments comprised the timed up and go (TUG) test, Berg balance scale (BBS), unipedal stance test (UST), multidirectional reach test (MDRT), maximum step length (MSL) test and quiet standing with eyes open and closed. The relationship between NCV and balance performance was evaluated by Pearson’s correlation coefficients, and the balance performances of the diabetic patients with and without peripheral neuropathy were compared by using Mann–Whitney U tests. Results The NCV in the lower limbs exhibited a moderate to strong correlation with most of the balance tests including the TUG (r?=??0.435 to??0.520, p?r?=?0.406–0.554, p?r?=?0.409–0.647, p?P?p?p?p?p?p?Conclusion Our findings revealed that a decline in peripheral nerve conduction in the lower limb is not only an indication of nerve dysfunction, but may also be related to the impairment of balance performance in patients with diabetes.

• Implications for Rehabilitation

• Nerve conduction velocity in the lower limbs of diabetic older adults showed moderate to strong correlations with most of the results of balance tests, which are commonly used in clinics.

• Decline in nerve conduction velocity of the lower limbs may be related to the impairment of balance control in patients with diabetes.

• Diabetic older adults with peripheral neuropathy exhibited greater postural instability than those without peripheral neuropathy.

     

Cancer patients’ use of primary care out-of-hours services: a cross-sectional study in Norway

Objective: To investigate how cancer patients in Norway use primary care out-of-hours (OOH) services and describe different contact types and procedures.

Design: A retrospective cross-sectional registry study using a billing registry data source.

Setting: Norwegian primary care OOH services in 2014.

Subjects: All patients’ contacts in OOH services in 2014. Cancer patients were identified by ICPC-2 diagnosis.

Main outcome measures: Frequency of cancer patients’ contacts with OOH services, contact types, diagnoses, procedures, and socio-demographic characteristics.

Results: In total, 5752 cancer patients had 20,220 contacts (1% of all) in OOH services. Half of the contacts were cancer related. Cancer in the digestive (22.9%) and respiratory (18.0%) systems were most frequent; and infection/fever (21.8%) and pain (13.6%) most frequent additional diagnoses. A total of 4170 patients had at least one cancer-related direct contact; of these, 64.5% had only one contact during the year. Cancer patients had more home visits and more physicians’ contact with municipal nursing services than other patients, but fewer consultations (p?p?Conclusion: There was no indication of overuse of OOH services by cancer patients in Norway, which could indicate good quality of cancer care in general.

• KEY POINTS

• Many are concerned about unnecessary use of emergency medical services for non-urgent conditions.

• ??There was no indication of overuse of out-of-hours services by cancer patients in Norway.

• ??Cancer patients had relatively more home visits, physician’s contact with the municipal nursing service, and weekend contacts than other patients.

• ??Cancer patients in the least central municipalities had relatively more contacts with out-of-hours services than those in more central municipalities.

     

The relationship of severe health disorders with bone loss,grip strength,and mobility in postmenopausal women – a 15-year follow-up study

Purpose: To investigate the relationships of severe health disorders (SHD) with bone loss, grip strength (GS) and mobility in postmenopausal women. Method: The study sample consisted of 2227 Finnish women (mean age 53.2) from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) cohort. Postal inquiries and clinical measurements were completed during the 15-year follow-up at 5-year intervals between 1989 and 2004. Femoral neck bone mineral density (BMD) and GS were measured. Life-style factors and mobility were obtained via postal inquiries. Work disability pension according to the ICD-9 was an indicator of a SHD. Results: At the baseline 242 women had SHD, 506 got late SHD during 1989–1995, whereas 1479 women had none until 1996. The women with baseline SHD had higher annual bone loss (0.44%) than those without SHD (0.34%) (p?Conclusion: Effects of SHDs on BMD, GS, and mobility are disease-specific. Thus, rehabilitation should be encouraged in postmenopausal women with SHD, especially in case of diseases of respiratory and nervous system.

• Implications for Rehabilitation

• Osteoporosis, muscle strength and co-morbidity

• Women with severe health disorders (SHD) leading to work disability have impaired musculoskeletal health.

• Active monitoring of the musculoskeletal health is advised for those with SHD.

• Women with SHD may benefit from rehabilitative treatment in order to avoid complications of musculoskeletal impairments.

     

Qualitative perspectives on aquatic exercise initiation and satisfaction among persons with multiple sclerosis

Purpose: To identify the individual and social experiences underlying the initiation and satisfaction with aquatic exercise among persons with MS.

Methods: A convenience sample (n?=?45) of persons aged?≥18 with MS who had engaged in water-based exercise within the previous six months completed a 60–90?min semi-structured telephone interview regarding their aquatic exercise experiences.

Results: An aquatic exercise history was not a prerequisite for the adoption of aquatic exercise. Rather, participants described aquatic exercise routines as stemming from recognition of a decline in physical function combined with encouragement and invitations to join aquatic programs. Despite regular visits, health care providers were not a common source of information regarding the feasibility of aquatic exercise. Participants’ aquatic activities included MS-specific and generalized aquatics courses, with class satisfaction resting on the instructor, class “fit” and a feeling of acceptance.

Conclusion: Communication regarding local aquatic opportunities is critical for ensuring aquatics engagement among persons with MS. Providers could play a stronger role in emphasizing the feasibility and benefits of aquatic programs. In addition, persons with MS should be encouraged to try local MS and more generalized aquatic programs in order to identify a program matching their social and physical goals.

• Implications for Rehabilitation

• Directed communication regarding aquatic opportunities is essential to prompting the initiation of aquatic exercise

• Both MS-specific and general aquatics classes can provide positive exercise experiences for persons with MS

• A history of regular exercise or aquatic experiences is not a prerequisite for the initiation of aquatic exercise among persons with MS

• Health care provider visits may represent missed opportunities for promoting aquatics; providers should consider the suitability of aquatics for all patients with MS, regardless of the patient’s exercise history.

     

Fatigue in the mothers of children with cerebral palsy

Purpose: To evaluate fatigue in the mothers of children with cerebral palsy (CP), and to determine its associations with clinical parameters of CP, depression and quality of life (QoL). Method: Ninety children (50 girls and 40 boys) with spastic CP and their mothers were included. Control group comprised mothers of healthy children. Gross motor function classification system (GMFCS) was used for determining functional status. Spasticity was evaluated by using modified Ashworth scale. Fatigue symptom inventory (FSI) was used for assessing maternal fatigue, Nottingham health profile (NHP) for maternal QoL, and Beck Depression Scale (BDS) for maternal depression. Results: Mothers of children with CP scored significantly higher in all FSI subgroups (intensity of fatigue, duration of fatigue and interference with QoL), all NHP subgroups and BDS (p?p?< 0.01). No association was found between FSI and clinical parameters of children with CP including age, gender, type of CP, tonus and functional impairment (p?>?0.05). Conclusions: Our findings indicate that fatigue levels of mothers with CP children are higher than those with healthy children and associated with depression and deterioration in QoL in terms of physical, social and emotional functioning. This should be considered while designing a family centred rehabilitation programme for children with CP.

• Implications for Rehabilitation

• Caring for a child with cerebral palsy has psychological, social and financial impacts on familiesand is associated with increased levels of fatigue among mothers.

• The capacity of current programs and services needs to be strengthened to accommodate theneeds of children with CP and their mothers in order to reduce fatigue of mothers.

• New programs need to be developed to provide psychosocial support for the mothers andto reduce their fatigue as they continue to care for their children.

• Provision of assistive technology devices (particularly suitable wheelchairs) will be useful inreduction of fatigue levels of mothers.

     

Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems: results of a two-year follow-up study

Abstract

Purpose: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. Methods: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n?=?88) and of conventional case management (n?=?80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. Results: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference?=?58 days; p?<?0.01) and year two (mean difference?=?36 days; p?=?0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p?=?0.02). Conclusion: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management.

• Implications for Rehabilitation

• Evidence for effective return-to-work (RTW) interventions for people with mental health problems is limited, as most research to date has been done in the context of musculoskeletal disorders.

• A complex, multidisciplinary intervention, detached from the workplace, does not appear to improve the stability of RTW and may actually lead to more sickness absence days and less self-support when compared to conventional case management of sickness absence beneficiaries in Denmark.

• A stronger focus on cooperation with social insurance officers and employers may produce better results.

     

The effect of word prediction settings (frequency of use) on text input speed in persons with cervical spinal cord injury: a prospective study

Purpose: To determine whether activation of the frequency of use and automatic learning parameters of word prediction software has an impact on text input speed.

Methods: Forty-five participants with cervical spinal cord injury between C4 and C8 Asia A or B accepted to participate to this study. Participants were separated in two groups: a high lesion group for participants with lesion level is at or above C5 Asia AIS A or B and a low lesion group for participants with lesion is between C6 and C8 Asia AIS A or B. A single evaluation session was carried out for each participant. Text input speed was evaluated during three copying tasks:

??without word prediction software (WITHOUT condition)

??with automatic learning of words and frequency of use deactivated (NOT_ACTIV condition)

??with automatic learning of words and frequency of use activated (ACTIV condition)

Results: Text input speed was significantly higher in the WITHOUT than the NOT_ACTIV (pp?=?0.02) for participants with low lesions. Text input speed was significantly higher in the ACTIV than in the NOT_ACTIV (p?=?0.002) or WITHOUT (p?Conclusions: Use of word prediction software with the activation of frequency of use and automatic learning increased text input speed in participants with high-level tetraplegia. For participants with low-level tetraplegia, the use of word prediction software with frequency of use and automatic learning activated only decreased the number of errors.

• Implications in rehabilitation

• Access to technology can be difficult for persons with disabilities such as cervical spinal cord injury (SCI). Several methods have been developed to increase text input speed such as word prediction software.This study show that parameter of word prediction software (frequency of use) affected text input speed in persons with cervical SCI and differed according to the level of the lesion.

• ??For persons with high-level lesion, our results suggest that this parameter must be activated so that text input speed is increased.

• ??For persons with low lesion group, this parameter must be activated so that the numbers of errors are decreased.

• ??In all cases, the activation of the parameter of frequency of use is essential in order to improve the efficiency of the word prediction software.

• ??Health-related professionals should use these results in their clinical practice for better results and therefore better patients ‘satisfaction.

     

Within-session responses to high-intensity interval training in spinal cord injury

Aim: Completion of high-intensity interval training (HIIT) increases maximal oxygen uptake and health status, yet its feasibility in persons with spinal cord injury is unknown.

Purpose: To compare changes in cardiorespiratory and metabolic variables between two interval training regimes and moderate intensity exercise.

Method: Nine adults with spinal cord injury (duration?=?6.8?±?6.2?year) initially underwent determination of peak oxygen uptake. During subsequent sessions, they completed moderate intensity exercise, HIIT, or sprint interval training. Oxygen uptake, heart rate, and blood lactate concentration were measured.

Results: Oxygen uptake and heart rate increased (p?p?>?0.05) to moderate intensity exercise. Peak oxygen uptake and heart rate were higher (p?Conclusions: Despite a higher intensity and peak cardiorespiratory strain, all participants preferred interval training versus moderate exercise. Examining long-term efficacy and feasibility of interval training in this population is merited, considering that exercise intensity is recognized as the most important variable factor of exercise programming to optimize maximal oxygen uptake.

• Implications for Rehabilitation

• Spinal cord injury (SCI) reduces locomotion which impairs voluntary physical activity, typically resulting in a reduction in peak oxygen uptake and enhanced chronic disease risk.

• In various able-bodied populations, completion of high-intensity interval training (HIIT) has been consistently reported to improve cardiorespiratory fitness and other health-related outcomes, although its efficacy in persons with SCI is poorly understood.

• Data from this study in 9 men and women with SCI show similar changes in oxygen uptake and heart in response to HIIT compared to a prolonged bout of aerobic exercise, although peak values were higher in response to HIIT.

• Due to the higher peak metabolic strain induced by HIIT as well as universal preference for this modality versus aerobic exercise as reported in this study, further work testing utility of HIIT in this population is merited.