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