Swedish research exchange (2009) (work rehab etc) Aylward, White, C. Black, etc

[Dolphin]

I thought some people might find this of interest given, for example, welfare reform in the UK:

http://web.archive.org/web/20101129...dents/articles/swedish-research-exchange.html

Swedish research exchange

10 March 2009

(From left to right) Dr Bob Grove, Professor Dame Carol Black, Professor Mansel Aylward, Dr Debbie Cohen, Professor Gordon Waddell and Professor Peter White

University research helping to remove the barriers people face when returning to work has been shared with policy makers at a leading conference in Stockholm.

Professor Mansel Aylward CB, Director of the Centre for Psychosocial and Disability Research in the School of Psychology, headed a British team of academics to the first conference of the new Social Council of Sweden at the Ministry of Health and Social Affairs in Stockholm.

Professor Aylward, Dr Debbie Cohen and Professor Gordon Waddell outlined key pieces of University research helping to explain and address the obstacles people face in the UK when returning to work.

In his keynote address, Professor Aylward chronicled the development of "Pathways to Work" in the UK and drew upon research undertaken by his team at Cardiff which further explored obstacles to return to work and interventions to address them..

Professor Aylward said: "The first conference of the new Social Council of Sweden, at the invitation of the Swedish Government, was an opportunity to share our research knowledge with academics, researchers, healthcare professionals and senior government advisors, officials and politicians - including Sweden's Secretary for Health and Social Affairs, Bettina Kashefi , on what works.

"We hope our presentations will provide the scientific and research knowledge to inform the Swedish Government's plans for Welfare reform."

The Conference was also addressed by other key UK academics. Dr Bob Grove of The Sainsbury Centre, King's College London gave an update on the evaluation of the `Pathways to Work' project;

Professor Peter White of Bart's and the London School of Medicine discussed Symptoms Defined Illness and their handling in occupational rehabilitation and Professor Dame Carol Black,

UK National Director for Health, Work and Well-being, outlined the findings of a review of the health of Britain's working age population: Working for a healthier tomorrow.

Professor Aylward and his team from Cardiff also spent a day at the Karolinska Institute. Meeting with Professor Alexanderson, who chairs the Swedish Social, it was an opportunity to explore joint research opportunities. Professor Aylward added: "The visit to the Karolinska Institute allowed us to discuss and set out the basis for collaboration between the Karolinska Institute and Cardiff University. We hope this will lead to joint research in the area of health and work."
Related links

Centre for Psychosocial and Disability Research
Department for Work and Pensions

 

[Dolphin]

Peter White presentation

All sorts of grand claims in this e.g. full recovery.

The details of the Ross review are at: http://forums.phoenixrising.me/show...yndrome-a-focus-on-function-(Ross-et-al-2004) - not particular impressive at all.

http://www.sou.gov.se/socialaradet/omarbetet/konferenser.htm
http://www.sou.gov.se/socialarad/pdf/Peter Whites presentation.pdf

What helps occupational rehabilitation when the doctor cannot explain the symptoms?

Peter White

Agenda

Symptom defined illnesses (SDIs)

The example of chronic fatigue syndrome

Biopsychosocial management is best

Prevention is even better

Symptom defined illnesses

Tension headaches,

Atypical facial and chest pains

Fibromyalgia (chronic widespread pain)

Other chronic pain disorders

Irritable bowel syndrome

Multiple chemical sensitivity

Chronic (postviral) fatigue syndrome (ME)

How common is CFS?
0.2 - 2.6 % population or primary care
Risk (OR) of depressive illness with
chronic physical disorders
CFS 7.2
Fibromyalgia 3.4
Peptic ulcers 2.8
COPD 2.7
Migraine 2.6
Back pain 2.3
Cancer 2.3
MS 2.3

UK costs of CFS

118,000 on incapacity benefit

19,000 on disability living allowance

+ Cost of medical and social care

+ Loss of employment

Outcome is poor without treatment

Systematic review of longitudinal studies
5 % (range 0 - 31) recovered by follow up
39 % (range 8 - 63) some improvement
Cairns R, Hotopf M, Occup Med 2005

Use the biopsychosocial model

The biopsychosocial model "takes into account the patient, the social content in which he lives and ... the physician role and the health care system."

George Engel, 1977

Management is biopsychosocial

Biological
e.g. medication, physical rehabilitation

Psychological
e.g. CBT

Social

Remove the barriers to recovery -

Relationships .. at work or home

Iatrogenic .. bad healthcare advice

Benefit gap .. financial incentives

The lost art of rehabilitation

We have forgotten not only how to rehabilitate patients, but that we need to do so for the patient to make a full recovery.

Graded exercise therapy for CFS

Exercise = "an activity requiring physical effort"

Percentage improved with GET

Percentage improved with CBT

But do these treatments help patients return to work?

"Only cognitive behavior therapy, rehabilitation, and exercise therapy interventions were associated with restoring the ability to work."

- Even without occupation as the aim.

Systematic review: SD Ross et al, Arch Intern
Med 2004

Predictions of non-response to GET

High psychological distress

Membership of a self-help group

Sickness benefit

R Bentall et al, 2002

Social risks
"If you have to prove you are ill, you can't get well." (N Hadler, 1996)

"ME is an incurable disease." (UK doctor, 2008)

Does the BPS approach work?

CFS
Low back pain
IBS
Depressive illness
(Cardiac disease)
(DM)

Preventing SDIs

Patients with infectious mononucleosis

Brief rehabilitation, with graded return to
activities

Compared to leaflet

By 6 months, 26% had abnormal fatigue after rehab, compared to 50% of controls.
B Candy et al, 2004