Posterutställningen

Presentatör: Maria Isik, fysioterapeut, Ronna Rehab, Södertälje

Bakgrund: Långvarig smärta är en vanlig orsak till att människor söker vård och är vanligare hos kvinnor än hos män, i synnerhet hos invandrarkvinnor. Trots att andlighet/religion utgör en viktig del för en holistisk och patientcentrerad vård glöms denna dimension ofta bort. Fysioterapeuter och andra professioner kan behöva en tydligare förståelse för denna dimensions effekter på hälsa och hälsobeteende.

Syfte: Syftet med denna studie var att beskriva hur kristna invandrarkvinnor från Mellanöstern med långvarig smärta upplever sin hälsa i relation till sin andliga tro samt betydelsen av att fysioterapeuten bemöter andlighet.

Metod: Data samlades in genom semistrukturerade intervjuer med åtta kvinnor. Analysen genomfördes med hjälp av kvalitativ innehållsanalys enligt Graneheim och Lundman (2004)

Resultat: Två teman framkom: 1) Andlighet – en läkande kraft och Vårdmöte med värdighet och respekt. Kvinnornas upplevelse av sin hälsa utgår från en stark tro på Gud som har en viktig och central roll i deras liv och som påverkar hälsan positivt på olika nivåer och hjälper kvinnorna att hantera smärta. Resultatet visar även att fysioterapeuten har en viktig uppgift i att identifiera och möta eventuella andliga behov vid rehabilitering. För att kunna göra detta krävs en viss förförståelse men också ett genuint intresse och lyhördhet hos fysioterapeuten.

Slutsats: Andlig/religiös kompetens behövs för att kunna utföra individanpassad vård i vårt mångkulturella samhälle och bör integreras mer i fysioterapeututbildningen för att ge en ökad kunskap och förståelse. Dessutom bör fysioterapeuten själv ha reflekterat kring egna värderingar och sin egen trosuppfattning för att bättre kunna bemöta patienters andliga behov.

Presentatörer: Lenka Katila, Annica Rhodin, PhD, Rolf Karlsten, PhD.

Dept. of surgical sciences, Uppsala University

Bakground: Opioid agonist therapy (OAT) is used for the treatment av opioid use disorder(OUD) of chronic pain patients(CPP) with iatrogenic OUD. Ongoing study “Substitution therapy of opioid treated patients with iatrogenic addiction development” studies the structure of patients and treatment results of all patients included in the OAT during the last 30 years. Drug induced mortality in OAT was identified to be 42% previously ( Bech et al,2019).

Aim: The aim of this communication is to identify reasons of treatment´s termination of OAT for pain patients with iatrogenic OUD.

Method: Observation study. All CPP accepted for OAT since 1993 were identified through journal notes and a previous study database. Data considering the reason of termination of treatment and cause of death were analyzed descriptively.

Results: In total, 232 persons (48,7% female) were identified. More than one third, (37%) of patients, are still treated. Another one third (31%) completed OAT  treatment due to opioid tapering  or dose minimizing with referral to general practitioner or pain clinic. In total, there were only 18 patients who died (8%) and of those majority died in. somatic diseases (73%), mainly cardiovascular diseases (45%). Overdose was ascertained only in 1 case (5%) and suicide in 1 case (5%) in contrast with usual outcome  in OAT programs.

Conclusion: Cardiovascular diseases are the most prevalent causes of death in çhronic pain patients in OAT program of OUD. OAT with methadone or buprenorphine is mostly terminated because of the total tapering or dose minimizing.

Presentatör: PhD student Alicia Böthun, Department of Clinical Oral Physiology, Umeå University

Background: Orofacial pain is common in the general population and has been reported in connection to whiplash trauma. However, studies on the relationship between orofacial pain and whiplash trauma, have mainly been cross-sectional or questionnaire studies.

Aim:

1. To evaluate clinical signs in the jaw and neck regions after whiplash trauma
2. To explore predictive factors for development and maintenance of jaw pain

Method: The baseline cohort consisted of 292 individuals;176 cases with a whiplash trauma

after a car accident and 116 controls. One month after trauma, the participants answered questionnaires and had a clinical examination. After two years 223 individuals (76%) returned. Exclusion criteria were neck fracture for cases and previous neck trauma for controls. Outcome measures: I) pain on palpation of jaw- and neck muscles, II) jaw pain.

Mixed models and logistic regression analyses was used.

Results: Cases and women were at higher risk for pain on palpation of jaw- (OR:7.7;CI:2.7–22.5 and OR:3.2; CI:1.3–7.6) and neck muscles (OR:12.7; CI:3.9–42.0 and OR:2.9;CI:1.2–7.2). No time effect was seen. Whiplash trauma did not increase odds for jaw pain over a two-year period (OR:1.97; CI:0.53-7.38). Physical symptoms (OR:8.56; CI:1.08-67.67) increased the odds for jaw pain after two years.

Conclusion: Development of jaw pain are probably not related to the trauma itself, but dependent on physical symptoms and a general mechanism behind widespread pain. The results highlight the importance of having a biopsychosocial perspective on pain development and early examinations and interventions could potentially prevent development of chronic pain.

Presentatörer:
Sofia Wagner, PT, M.Sc., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Annika Bring, PT, Ph.D., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Pernilla Åsenlöf, PT, Ph.D., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.

Background: Balance assessment scales are important clinical tests to identify balance impairments. Chronic pain (> 3 months) is associated with impaired dynamic balance; however, very few balance assessment scales are psychometrically evaluated for the population.

Aim: To evaluate the construct validity and internal consistency of the Mini-BESTest for individuals with chronic pain in specialized pain care.

Methods: 180 individuals with chronic pain (> 3 months) were included. For construct validity, five alternative factor structures were evaluated using a confirmatory factor analysis. A priori hypotheses about convergent validity with the 10-meter walk test, and divergent validity with the Brief Pain Inventory (BPI): pain intensity, the Tampa Scale of Kinesiophobia-11 (TSK-11), and the Pain Catastrophizing Scale (PCS-SW) were tested. Internal consistency was evaluated for the best fitting model.

Results: A one-factor model with added covariance via the modification indices showed adequate fit. In line with our hypotheses, Mini-BESTest showed convergent validity (r_s = >.70) with the 10-meter walk test, and divergent validity (r_s = <.50) with BPI pain intensity, TSK-11, and PCS-SW. Internal consistency for the one-factor model was good (α = 0.92).

Conclusion: Our study supported the construct validity and internal consistency of the Mini-BESTest for measuring balance in individuals with chronic pain in specialized pain care. The one-factor model showed an adequate fit. In comparison, models with subscales did not reach convergence, or showed high correlations between subscales, implying that Mini-BESTest is measuring one construct in this sample. We, therefore, propose using the total score, instead of subscale scores, for individuals with chronic pain.

Presentatörer: Ulrika Nyström¹, Kajsa Lidström Holmqvist²

1. Leg arbetsterapeut, Medicine master i arbetsterapi, Smärtrehab, VO Neuro och rehabiliteringsmedicin, Universitetssjukhuset i Örebro
2. Leg arbetsterapeut, Docent, VO Neuro och rehabiliteringsmedicin, Universitetssjukhuset i Örebro, Universitetssjukvårdens forskningscentrum, Fakulteten för medicin och hälsa, Örebro universitet

Bakgrund: I smärtrehabiliteringsprogram är arbetsterapeutens fokus ett hållbart och förbättrat, eller bibehållet, aktivitetstutförande i vardagen. Kunskapen om hur deltagare i smärtrehabiliteringsprogram upplever vilken påverkan det har för deras aktivitetsutförande i vardagen är dock bristfällig. Ökad kunskap kan bidra till att utveckla och förbättra en personcentrerad smärtrehabilitering och ge patienterna bästa möjliga förutsättningar att på ett sätt som är hållbart över tid kunna utföra meningsfulla aktiviteter i vardagen.

Syfte: Att beskriva deltagarnas upplevelser av aktivitetsutförande efter deltagande i smärtrehabiliteringsprogram.

Metod: Metoden hade en kvalitativ ansats där åtta personer intervjuades med semistrukturerade frågor. Data analyserades med kvalitativ innehållsanalys.

Resultat: Ett huvudtema och tre kategorier med underliggande kategorier identifierades. Huvudtemat, Tilltro till egen aktivitetsförmåga för en inre resa mot acceptans, beskriver deltagarnas process mot ett bättre vardagsfungerande. Olika aspekter av detta beskrivs i kategorierna: Förutsättningar för förändring, Implementering i vardagen och En förändrad vardag.

Slutsats: Deltagarna upplevde ett förbättrat och förändrat aktivitetsutförande efter deltagande i smärtrehabiliteringsprogram. Det visar att åtgärder med fokus på aktivitetsutförande i vardagen är en betydelsefull del i behandling av långvarig smärta.

Presentatörer:

Axel Kutschke^1,2,3, Bilsan Ahmad⁴, Birgitta Häggman-Henrikson^2,5, Anders Wänman⁵, Justin Durham^6,7, Anna Lövgren⁵

¹ Department of Clinical Oral Physiology, Folktandvården Gävleborg AB, Gävle, Sweden
² Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
³ Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden
⁴ Medai.ai GmbH, Frankfurt/Main, Germany
⁵ Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
⁶ School of Dental Sciences, Newcastle University, Newcastle, UK
⁷ Newcastle Hospitals’ NHS Foundation Trust, Newcastle, UK

Background: Psychosocial screening is an important part of the assessment of patients with chronic pain. Currently, extensive analogue questionnaires are used to assess the degree of such comorbidity. Digital alternatives for questionnaires may be cost-effective and resource-saving if well-accepted by patients.

Aim: To evaluate how patients perceive digital psychosocial screening in dentistry.

Method: Using a qualitative approach, individual semi-structured interviews were conducted with a purposive sample of adult patients (n=16) recruited from orofacial pain specialist dental clinics in Umeå and Gävle. In preparation for the study, pilot-testing of the software had been conducted. All patients completed first the analogue and then the digital version of the questionnaires before the interviews. A flexible topic guide and a mind map were used to allow a structured but evolving open-ended approach to the interviews. The interviews were transcribed and analysed with Qualitative Content Analysis.

Results:

The preliminary analysis of patients’ experience revealed two categories:

• Perceptions about health shape patients’ initial expectations of dental care; but with deeper understanding, patients value the incorporation of a holistic approach that includes psychosocial factors.
• Digital screening is perceived as a reliable, meaningful and environmentally sustainable method.

Conclusion: In general, patients appreciate a holistic approach in dentistry and understand the value of psychosocial screening as part of this. From the patients’ perspective, digital psychosocial screening is well accepted and can be introduced into daily dental practice.