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Balancing intrusive illness: the experiences of people with musculoskeletal problems
University of Gävle, Centre for Musculoskeletal Research.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to explore and describe the health experiences of men and women with musculoskeletal problems. The specific aims of the four papers were: (I) to explore the experience of illness and wellness among ambulance personnel with musculoskeletal symptoms; (II) to explore the experience of illness and wellness among female health care personnel with musculoskeletal symptoms; (III) to explore the experience of bodily illness among people with musculoskeletal problems in the neck-shoulder region, and; (IV) to investigate the symptoms described by people with non-specific neck-shoulder problems, to investigate the method of development of neck-shoulder questionnaires that assesses pain and other symptoms, to analyse the content and items of these questionnaires, and to compare the findings.

The overall findings show that the occupationally active men and women with MSDs were “striving for balance” (I-II), that the disease course of chronic neck-shoulder disorders was characterised by “uncontrollable fluctuations” (III), and that most neck-shoulder questionnaires had a low correspondence to the variety of symptoms experienced during this course (IV). In the process of striving for balance (I-II), the informants’ health experiences were not a state of either wellness or illness, but of both, in varying degrees at different times. The balancing started when illness became too intrusive, and was a process of minimising the impact of illness by accepting and handling it, while attaining and maintaining wellness to feel well enough. When striving for balance, the interviewees kept on working to continue being nurtured at the same time as they made different efforts directed at minimising the impact of their illness. For both men and women, illness was characterised by disembodiment, vulnerability, and exhaustion. The illness experiences were counterbalanced by wellness, where some differences could be recognised between the men and the women. Study III further explored the experiences of bodily illness, focusing on people with chronic musculoskeletal disorders in the neck-shoulder region. The course of the disorder was described as characterised by uncontrollable fluctuations, and it usually developed from insidious symptoms to a state of constant discomfort. The participants experienced calmer periods during the course, but intermittent events of increasing illness were always lying in wait, with periodic moments of consuming intensity. In the interviews included in study IV a variety of symptoms were expressed, which indicated a bodily, mental, and emotional engagement, which included more general and more severe symptoms than are usually related to neck-shoulder disorders. Few of the questionnaires were developed using the experiences of the affected. Taken as a whole, did the questionnaires cover many of the symptoms of the interviewees, but each individual questionnaire only included a few. The fluctuations and nuances of symptoms were rarely considered. The correspondence between individual questionnaires and the experiences of those affected was most often low. This thesis reveals other aspects of health than just bodily experiences as important among occupationally active people with MSDs. It also provides a description of the disease course, and an indication of possibilities for improvement of neck-shoulder questionnaires

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2007. , 54 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1106
Keyword [en]
musculoskeletal problems, health experiences, illness, wellness, grounded theory, content analysis, balancing, disease course, uncontrollable fluctuations, symptoms
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:hig:diva-2741ISBN: 978-91-7264-335-2 (print)OAI: oai:DiVA.org:hig-2741DiVA: diva2:119403
Public defence
(English)
Opponent
Supervisors
Available from: 2008-05-27 Created: 2008-05-27 Last updated: 2011-09-27Bibliographically approved
List of papers
1. Striking a balance - health experiences of male ambulance personnel with musculoskeletal symptoms: a grounded theory
Open this publication in new window or tab >>Striking a balance - health experiences of male ambulance personnel with musculoskeletal symptoms: a grounded theory
2007 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 5, 770-779 p.Article in journal (Refereed) Published
Abstract [en]

Background: Musculoskeletal disorders (MSD) are a dominant cause to long-term sick leave and early retirement. Some occupational groups are more affected than others and ambulance personnel are among them. Despite a vast amount of research, only a small part focuses the experiences of the affected.

Objectives: The aim of the study was to explore the experience of illness and wellness in ambulance personnel with musculoskeletal symptoms.

Design: An emerging design was used in accordance with Grounded Theory.

Participants: Informants in the study were ten men with musculoskeletal symptoms, working as ambulance personnel at an ambulance station located in a mid-sized city in Sweden.

Methods: Narrative interviews were performed, parallel to a constant comparative analysis.

Results: The study resulted in a model, which describes the experience of illness and wellness as characterised by an effort to strike a balance. Wellness through nurturing appeared parallel to encountering illness as an experience and a threat. Accepting and handling illness was of importance to maintaining wellness, and wellness through nurturing was the motivation for accepting and handling illness.

Conclusions: Enhancing the understanding of wellness and illness makes it possible to avoid undermining the meaningfulness that support accepting and handling illness, and by understanding different aspects of illness prevention can become facilitated. This is of importance as other aspects than solely physical have shown to be similarly important in the development of MSD.

Keyword
Adaptation, Psychological, Adult, Ambulances, Attitude of Health Personnel, Attitude to Health, Burnout, Professional etiology psychology, Emergency Medical Technicians psychology, Humans, Job Satisfaction, Male, Men psychology, Middle Aged, Models Psychological, Musculoskeletal Diseases etiology prevention control psychology, Narration, Nursing Methodology Research, Occupational Diseases etiology prevention control psychology, Questionnaires, Retirement, Self Care methods psychology, Self Concept, Sick Leave, Sick Role, Sweden
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:hig:diva-2739 (URN)10.1016/j.ijnurstu.2006.02.007 (DOI)000247990000013 ()16600239 (PubMedID)2-s2.0-34250013627 (Scopus ID)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2016-10-30Bibliographically approved
2. Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems.
Open this publication in new window or tab >>Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems.
2007 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 8, 1379-1390 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration. OBJECTIVES: The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms. DESIGN: A qualitative grounded theory approach guided the study in data collection and analysis. SETTINGS: Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals. PARTICIPANTS: Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages. METHODS: A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons. RESULTS: The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness. CONCLUSION: This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.

Keyword
Chronic illness, Musculoskeletal problems, Nurses, Occupational health, Qualitative research
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:hig:diva-2740 (URN)10.1016/j.ijnurstu.2006.07.009 (DOI)000250591100012 ()16973167 (PubMedID)2-s2.0-34548864113 (Scopus ID)
Available from: 2008-05-19 Created: 2008-05-19 Last updated: 2016-10-28Bibliographically approved
3. When the body makes itself heard: the experience of bodily illness among people with neck-shoulder problems
Open this publication in new window or tab >>When the body makes itself heard: the experience of bodily illness among people with neck-shoulder problems
2008 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 10, no 2, 85-94 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore the experience of bodily illness among people with musculoskeletal disorders (MSDs) in the neck/shoulder region. The study had a grounded theory approach, with constant comparisons and simultaneous data collection and analysis. Initially, parts of interviews about health experiences related to MSDs previously performed among men and women with musculoskeletal symptoms in the neck/shoulder and/or back were analysed. Next, complementary semi-structured interviews among men and women with neck/shoulder problems were performed, focusing on the experience of bodily illness, until saturation was reached. The results describe the experiences of bodily illness among people with MSDs in the neck/shoulder region as being characterized by uncontrollable fluctuations. The experiences are presented as a model of the disease course as experienced by the affected. The process usually developed from a beginning with insidious symptoms to a state of constant discomfort. Along the line of this development, periods of intermittent events of increasing illness occurred with peaks of consuming intensity. A variety of different symptoms was present during the process, which are presented in this paper. An increased knowledge of the disease course can be useful in prevention and treatment as communication about the disorder can be more specific.

Keyword
Bodily illness; Disease course; Experience; Fluctuations; Grounded theory; Inside perspective; Neck/shoulder disorders; Process; Qualitative method; Symptoms
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:hig:diva-1900 (URN)10.1080/14038190701760627 (DOI)2-s2.0-45949089052 (Scopus ID)
Available from: 2008-05-29 Created: 2008-05-29 Last updated: 2016-10-28Bibliographically approved
4. How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from the disorders?: A content analysis of questionnaires and interviews
Open this publication in new window or tab >>How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from the disorders?: A content analysis of questionnaires and interviews
2009 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, no 1, 30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous research has indicated neck-shoulder disorders to have a fluctuating course incorporating a variety of symptoms. These findings awoke our interest to make a comparison between symptoms experienced by people affected with the disorder and the content of questionnaires that assess pain and other symptoms in neck-shoulder disorders. Thus the aims of this study were: -to explore the symptoms experienced by people with non-specific neck-shoulder problems, as well as experiences of nuances and temporal variations (fluctuations) of symptoms; -to investigate which sources were used in the development of ten questionnaires for assessing pain and other symptoms in the neck-shoulder; -to analyse the item content of the questionnaires; -to analyse the correspondence between the item content of the questionnaires and the symptoms described by the informants. METHODS: Content analysis of interviews with 40 people with non-specific neck-shoulder pain, and 10 questionnaires used to assess pain and other symptoms in neck-shoulder disorders. RESULTS: The interviews revealed a variety of symptoms indicating a bodily, mental/cognitive, and emotional engagement, and more general and severe symptoms than are usually considered in neck-shoulder questionnaires. Taking all questionnaires together many of the symptoms were considered, but most questionnaires only included a few of them. The informants were able to distinguish fluctuation of symptoms, and a variety of different qualities which were not usually considered in the questionnaires. Only two questionnaires had made use of the opinions of affected people in the development. CONCLUSIONS: Few of the questionnaires had made use of the experiences of affected people in the development. The correspondence between the symptoms expressed by the affected and the content of the questionnaires was low. A variety of symptoms were expressed by the interviewees, and the participants were also able to distinguish nuances and fluctuations of symptoms. The present study points to the importance of other aspects than just pain and physical functioning as clinical trial outcome measures related to neck-shoulder disorders. To develop a condition-specific questionnaire, it is important to decide on the specific symptoms for the condition. Using the experiences of those affected, in combination with relevant research and professional knowledge, can enhance the validity of the questionnaires.

Keyword
adult; article; clinical article; clinical feature; cognition; comparative study; content analysis; correspondence analysis; disease severity; female; functional status; human; interview; male; mental disease; musculoskeletal disease; neck malformation; neck shoulder disorder; pain assessment; questionnaire; seasonal variation; validity; disability; health status; health survey; hospitalization; information processing; joint characteristics and functions; lifestyle; middle aged; neck pain; pathophysiology; psychological aspect; shoulder pain
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:hig:diva-4021 (URN)10.1186/1471-2474-10-30 (DOI)000265850300001 ()19272142 (PubMedID)2-s2.0-65349153105 (Scopus ID)
Available from: 2009-03-27 Created: 2009-03-27 Last updated: 2016-10-27Bibliographically approved

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