This cross-sectional study on a random sample of 1,500 ambulance personnel investigated the relationships between self-reported work-related physical and psychosocial factors, worry about work conditions, and musculoskeletal disorders among female and male ambulance personnel. Three different outcomes, complaints, activity limitation, and sick leave, for the neck-shoulder and low-back region, respectively, were chosen. Among the female personnel, physical demands was significantly associated with activity limitation in the neck-shoulder (OR 4.13) and low-back region (OR 2.17), and psychological demands with neck-shoulder (OR 2.37) and low-back (OR 2.28) complaints. Among the male personnel, physical demands was significantly associated with low-back complaints (OR 1.41) and activity limitation (OR 1.62). Psychological demands and lack of social support were significantly associated with neck-shoulder complaints (OR 1.86 and OR 1.58, respectively) and activity limitation (OR 3.46 and OR 1.71) as well as activity limitation due to low-back complaints (OR 2.22 and OR 1.63). Worry about work conditions was independently associated with activity limitation due to low-back complaints among the female (OR 5.28), and to both neck-shoulder and low-back complaints (OR 1.79 and OR 2.04, respectively) and activity limitation (OR 2.32 and OR 1.95) among the male personnel. In conclusion, the association patterns between physical and psychological demands and MSDs suggest opportunities for intervention.

The role of body size has often been neglected in routine tests of muscle strength and movement performance. The aim of the present study was to test the hypothesis that different types of functional movement performance require different normalisations in order to assess muscle strength. Twenty-one right-handed male university students were tested on the following functional movement tasks: vertical jump, standing soccer ball kick, seated medicine ball throw and standing maximal isometric lift. Isokinetic strength of active muscle \, groups was also recorded. The performance of the vertical jump and standing s9ccer ball kick demonstrated stronger relationship with the strength of active muscles normalised for body size, while the performance of the s~ated medicine ball throw and standing maximal

Iisometric lift demonstrated stronger relationship with the non- normalised strength.

It was concluded that the ability of performing functional movements based on overcoming gravitational and/or inertial resistance of subject's own body (such as keeping certain body postures, or various body movements) should be assessed by the tested muscle strength normalised for body size, while the functional performance based on muscle action performed against external objects (e.g. manual material handling, or lifting heavy objects) should be assessed by the non-normalised muscle strength. The obtained f"mdings proved to be in line with our recently proposed classification of muscle strength and functional movement tests based on the role of body size in the re~orded performance.

This study aimed at investigating the relationships between work-related psychosocial factors, worry about work conditions and health complaints (sleeping problems, headache and stomach symptoms) among female and male ambulance personnel. Out of 4000 ambulance personnel in Sweden, 1500 (300 female and 1200 male personnel) were randomly selected. They answered a questionnaire including items on self-reported health complaints, individual characteristics, work-related psychological demands, decision latitude, social support and worry about work conditions. Twenty-five per cent of the female and 20% of the male ambulance personnel reported two or more health complaints sometimes or often. According to the demand-control-support questionnaire, ambulance personnel reported a generally positive psychosocial work environment, although psychological demands were associated with sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Another factor that was significantly associated with health complaints among both genders was worry about work conditions. When worry about work conditions was added to the regression models, this variable took over the role from psychological demands as a predictor for health complaints among the female ambulance personnel. The prevalence of sleeping problems, headache and stomach symptoms were significantly associated with psychological demands among both female and male ambulance personnel. Notably, worry about work conditions seems to be an important risk factor for health complaints. This suggests that worry about work conditions should not be neglected when considering risk factors among ambulance personnel.

Objectives: The aim of the present study was to assess physiological and subjective stress markers during a 24-h ambulance work shift and during the next two work-free days, and relate these parameters to self-reported health complaints. Methods: Twenty-six ambulance personnel were followed during a 24-h work shift and during the next two work-free days with electrocardiogram, cortisol assessments and diary notes. The ambulance personnel also performed tests of autonomic reactivity before and at the end of the work shift. The subjects were categorized into two groups according to their number of health complaints. Results: In general, stress markers did not show differences between the work shift and leisure time. However, a modest deviation in heart rate variability pattern and higher morning cortisol values during work in comparison with work-free days were observed in personnel with many health complaints. Conclusions: Subjective and physiological characteristics of ambulance personnel did not indicate distinctive stress during the 24-h work shift. Relationships between frequent health complaints and specific work-related factors require further prospective studies.

The aim of the study was to evaluate the effects of individually prescribed physical exercise programmes on development of fatigue during the carrying of a loaded stretcher up and down the stairs. Nineteen ambulance personnel performed the training for 1 year. Testing occurred before and after 1 year of the training. Both the training group (n = 19) and the control group (n = 15) were assessed for physical capacity and lactate concentration in blood and ratings of perceived exertion during carrying a stretcher on the stairs. When comparisons were made between those who had been training three times/week for 1 year and the control group, lactate concentration was significantly decreased. In conclusion, markers of fatigue during stretcher carrying can be reduced by the use of individually prescribed physical exercise programmes.

This literature review gives support for a positive health effect of regular physical exercise matching the physical demands at work and the anatomical origin of disorder:

-specific trunk muscle exercises ca 1–2 times/week can have a positive effect on low back disorders among women/men with heavy vigorous or varied job tasks working in different health care or industrial settings

-specific shoulder-arm and neck exercises ca 1–2 times/week can have a positive effect on neck-shoulder and neck disorders, respectively, among women with light repetitive or monotonous job tasks working in different office settings.

Overall, associations between physical exercise and improvement in related physical performance and musculoskeletal health – disorders were found in those studies which met the criteria of randomized allocation, specified exercises, frequency and duration of the exercise session and documented effect from exercise on the corresponding physical capacity. Minor or major methodological deficiencies are, however, present in many of the intervention studies that impair the assessment as they can lead to an over- as well as an underestimation of the effect of training. Future studies should therefore focus on high methodological quality especially regarding 1) research design, inclusion criteria, allocation to intervention and control group; 2) exercise program, registration of compliance to training and changes of occupational load; 3) high accuracy of the effect measures

The aims of this study were (1) to identify which physical performance tests could best explain the development of fatigue during a simulated ambulance work task, (2) to investigate the effect of height and weight and (3) to investigate in what respects these findings differ between female and male ambulance personnel. Forty-eight male and 17 female ambulance personnel completed a test battery assessing cardio-respiratory capacity, muscular strength and endurance, and co-ordination. The subjects also completed a simulated ambulance work task -- carrying a loaded stretcher. The work task was evaluated by development of fatigue. Univariate and multiple regression analyses were used to investigate to what extent the tests in the test battery were able to explain the variance of developed fatigue. The explained variance was higher for female than for male ambulance personnel (time > 70% of HRpeak: R2 = 0.75 vs 0.10, accumulated lactate: R2 = 0.62 vs 0.42, perceived exertion: R2 = 0.75 vs 0.10). Significant predictors in the models were VO2max, isometric back endurance, one-leg rising, isokinetic knee flexion and shoulder extension strength. Height, but not weight, could further explain the variance. The high physical strain during carrying the loaded stretcher implies the importance of investigating whether improved performance, matching the occupational demands, could decrease the development of fatigue during strenuous tasks.

This study investigates whether physical activity and physical performance in adolescence are positively related to adult bone mineral density (BMD). In 1974, physical activity, endurance, and muscular strength were measured in 204 randomly selected female students, age 16.1 +/- 0.3 year (range 15-17 years). Twenty years later, 36 of the women volunteered to undergo a measurement of their BMD. Women who were members in a sports club in adolescence had significantly higher adult BMD (mean differences of 5% to 17% depending on site) compared with subjects who were not engaged in a sports club. Furthermore, women with persistent weight-bearing activity in adulthood had significantly higher BMD compared with women who had stopped being active or had never been active. The differences ranged between 5% and 19% with the highest difference found in trochanter BMD. Stepwise regression analyses showed that membership in a sports club at baseline was a significant independent predictor of BMD in the total body, lumbar spine, legs, trochanter, and femoral neck, explaining 17-26% of the variation in BMD. Change in body weight was a strong independent predictor of BMD of the total body and arms, explaining 8% of the variation in both sites. In addition, running performance at baseline was an independent predictor of total body BMD, whereas the two-hand lift performance significantly predicted BMD of the total body, legs and trochanter. The hanging leg-lift and handgrip were both significant predictors of arm BMD. In conclusion, membership in a sports club and site-specific physical performance in adolescence together with the change in body weight were significantly associated with adult BMD in premenopausal women

Aim: To detennine whether repetitive ann work, with a large component of static muscle contraction alters glucose metabolism and insulin sensitivity.

Methad: Euglycemic clamps (2h) were started in ten healthy individuals 15 minutes after 37 minute periods of: 1) repetitive ann work in a simulated occupational setting; 2) dynamic concentric exercise on a cycle ergometer at 60% OfVO2 max and 3) a resting regime as a control. During the experimental periods, blood samples were collected, blood pressure was measured repeatedly and electrocardiogram (ECG) wasrecorded continuously. During the clamps, euglycemia was maintained at 5 mmo1/l and insulin was infused at 56 mU/m2/min for 120 min.

Results: The insulin-mediated glucose disposal rate (M-value) for the steady state period (60- 120 min) of the clamp, tended to be lower following ann work than for both cycling and resting regimes. When dividing the steady state period into 20-minute intervals, the insulin sensitivity index, (ISI) was significantly lower for ann work compared with the resting control situation between 60-80 minutes (p=0.04) and 80-100 minutes (p=0.01) respectively.

Catecholamines increased significantly for ann work and cycling compared with resting regime. .Data from heart rate variability (HRV) me asurements indicated significant sympathetic activation during repetitive ann work test.

Canelusian: The results indicate that repetitive ann work might acutely promote insulin resistance, whereas no such effect on insulin resistance was produced by dynamic concentric exercise.

Many of the existing low back pain (LBP) questionnaires of function and symptoms have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. The present study describes the development of a clinically derived back-specific questionnaire incorporating both a functional limitation and a symptom scale, with a further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aims of the study were to assess the overall reliability and validity of the new questionnaire, named the Profile Fitness Mapping questionnaire (PFM). A total of 193 chronic LBP patients answered the PFM together with five validated criterion questionnaires. For the internal consistency of the questionnaires, the three indices of the PFM had the highest Cronbach's alpha (0.90-0.95) and all items had item-total correlations above 0.2. The correlation coefficients between the PFM and the back-specific criterion questionnaires ranged between 0.61 and 0.83, indicating good concurrent criterion validity. The best discriminative ability between patients with different pain severities was demonstrated by the functional limitation scale of the PFM. Well centered score distribution with no patient's score at the floor or the ceiling level indicates that the PFM has the potential to detect the improvement or worsening of symptoms and functional limitations in chronic LBP patients. Classification according to the International Classification of Functioning, Disability and health (ICF) of WHO revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. The present study suggests that the PFM has a high internal consistency and is a valid indicator of symptoms and functional limitations of LBP patients. It offers the combination of a composite total score and the possibility of evaluations within specific domains of disability. Complementary evaluation of test-retest reliability and responsiveness to change is warranted.

Background: Disability questionnaires for LBP-patients mostlyemanate from health professionals and have a content of differentdomains of disability presented as a single sum score, makingit difficult to derive changes within a specific domain. Thisstudy introduces a new back-specific questionnaire, the ProfileFitness Mapping questionnaire (PFM), which was based on patient’sself-reported characteristics of the LBP. The PFM incorporatesboth a functional limitation and a symptom scale, with furthersubdivision of the symptom scale in separate indices for severityand temporal aspects. The aim of the study was to assess theoverall validity of the PFM.

Methods and Results: Chronic LBP-patients (n=193) answered thePFM and four validated back-specific criterion questionnaires.The correlation coefficients between the PFM and the criterionquestionnaires showed good concurrent criterion validity (0.61– 0.83). The best discriminative ability between patientswith different pain severity was demonstrated by the functionallimitation scale of the PFM. Classification according to theICF revealed a high degree of homogeneous item content of thesymptom scale to the domain of impairments, and of the functionallimitation scale to the domain of activity limitations. Wellcentered score distribution indicates that the PFM has the potentialto detect improvement or worsening of symptoms and functionallimitations in chronic LBP-patients.

Conclusion: The results of the study signify that the PFM isa valid indicator of symptoms and functional limitations ofLBP-patients. It provides the combination of a composite totalscore and the possibility of evaluations within specific domainsof disability.

BACKGROUND: Disability questionnaires for LBP-patients mostly emanate from health professionals and have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. This study introduces a new back-specific questionnaire, the Profile Fitness Mapping questionnaire (PFM), which was based on patient’s self-reported characteristics of the LBP. The PFM incorporates both a functional limitation and a symptom scale, with further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aim of the study was to assess the overall validity of the PFM.

METHODS AND RESULTS: Chronic LBP-patients (n=193) answered the PFM and four validated back-specific criterion questionnaires. The correlation coefficients between the PFM and the criterion questionnaires showed good concurrent criterion validity (0.61 – 0.83). The best discriminative ability between patients with different pain severity was demonstrated by the functional limitation scale of the PFM. Classification according to the ICF revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. Well centered score distribution indicates that the PFM has the potential to detect improvement or worsening of symptoms and functional limitations in chronic LBP-patients.

CONCLUSION: The results of the study signify that the PFM is a valid indicator of symptoms and functional limitations of LBP-patients. It provides the combination of a composite total score and the possibility of evaluations within specific domains of disability.

Purpose: To assess overall reliability and validity of a neck-specific questionnaire, the Profile Fitness Mapping neck questionnaire (ProFitMap-neck), on three chronic neck pain groups. Method: Participating groups were as follows: whiplash associated disorders, inpatient care (IP-WAD, n = 127); nonspecific neck pain, inpatient care (IP-NS, n = 83) and nonspecific neck pain subjects (non-IP-NS, n  = 104). All groups answered the ProFitMap-neck and the SF-36, whereas non-IP-NS also answered the Neck Disability Index (NDI) and the Functional Self-Efficacy Scale (SES). Internal consistency, test–retest reliability and components of convergent construct, face and content validity were determined for the ProFitMap-neck. Results: The ProFitMap-neck showed good internal consistency in all three groups, and ICC test–retest reliability (0.80–0.91). Good correlation (0.66–0.78) and highest agreement was reached with NDI. According to the International Classification of Functioning, Disability and Health, the symptom scale of the ProFitMap-neck was mainly classified to the domain of impairments–body functions, and the functional limitation scale to the activity limitation domain. Conclusion: The results indicate that the ProFitMap-neck is valid for measuring symptoms and functional limitations in people with chronic neck pain. The combination of a composite total score of symptoms and function as well as separate scores of each domain makes ProFitMap-neck suitable for research as well as in clinical practice.

Implications for Rehabilitation

• The ProFitMap-neck can be used as a valid self-assessment tool for measuring symptoms and functional limitations in people belonging to the most prevalent categories of neck pain.

• The combination of the symptom and functional limitation questionnaire scores in a total score can be used for an overall clinical judgment.

Objective: The aim of the present study was to compare autonomic activity, pressure-pain thresholds, and subjective assessments of health and behavior between patients with stress-related illnesses and healthy control subjects. Methods: Twenty sick-listed patients with stress-related disorders and 20 age- and gender-matched healthy subjects performed tests of autonomic regulation and algometric tests, and completed questionnaires about physical and mental health and behavioral patterns. Results: Patients exhibited higher autonomic reactivity to cognitive and physical laboratory tasks (p<0.05), and had lower pressure-pain thresholds in the shoulders and lower back than healthy control subjects (p<0.05). Furthermore, the patients rated considerably poorer health and health behavior than the control subjects (p<0.05). Conclusions: The results indicate an engagement of the autonomic nervous system in stress-related illnesses. Furthermore, they show that patients with stress-related illnesses experience strong symptoms of musculoskeletal pain, and it is therefore recommended that assessments of musculoskeletal pain be incorporated in the clinical examinations and the rehabilitation of patients with stress-related illnesses.

The aim of the present study was to examine the effects of cognitive behavioral group treatment and physical activity for patients with stress-related illnesses. Sixty patients were randomly allocated to one of three groups, so that each group contained twenty patients. Group A received cognitive behavioral group treatment, group B participated in physical activity, and group C constituted a control group thus receiving no treatment during the course of the study. Measurements of autonomic activity, pain sensitivity, and subjective health assessments were performed before and after a 10-week intervention period, consisting of two gatherings per week for the cognitive behavioral treatment group, and two exercise sessions per week for the physical activity group. Each of the two treatment groups assembled at 1.5, 3, and 6 months after the intervention, and follow-up measurements on all participants were performed at 6 and 12 months after the intervention. For comparison, measurements were performed at one occasion on healthy subjects of the same age and gender distribution as the patients. Patients exhibited higher autonomic reactivity to cognitive and physical laboratory tasks (p<0.05), had lower pressure-pain thresholds in the shoulders and lower back (p<0.05), and rated poorer health than healthy subjects (p<0.01). No overall effect of cognitive behavioral group treatment or physical activity was found on autonomic activity (p>0.06) or pressure-pain thresholds (p>0.71), although patients who received cognitive behavioral group treatment reported improved health (p<0.05). The results suggest little difference in effect of cognitive behavioral group treatment and physical activity on patients with stress-related illnesses

OBJECTIVE: To evaluate the effects of a cognitive behavioural training programme and a physical activity programme for patients with stress-related illnesses. DESIGN: In a randomized controlled study, patients were allocated randomly to 1 of 3 groups, where group 1 participated in a cognitive behavioural training programme, group 2 participated in a physical activity programme, and group 3, the control group, was offered usual care for the course of the study. SUBJECTS: A total of 75 patients participated in the study. They had been on sick leave for at least 50% of the time for between 1 month and 2 years due to stress-related illnesses. METHODS: Measurements of autonomic activity, pressure-pain thresholds and subjective ratings of health and behaviour were made before and after a 10-week intervention period, and at 6 and 12 months after the intervention. RESULTS: Minor differences in autonomic activity and pressure-pain thresholds were found between the groups immediately after the intervention. At the 6- and 12-month follow-up assessments, the differences were no longer present. Patients in the cognitive behavioural training group improved their ratings of general health compared with the physical activity group throughout the study. CONCLUSION: The study showed little difference in the effect of cognitive behavioural training and physical activity, compared with usual care, for patients with stress-related illnesses.

Level of stress and muskuloskeletal complaints was studied in t wo metal- industry workplaces. Measurements were obtained twice with a 6-month inteIVa!. Level of stress was measured by the Job Stress Survey (Spieiberger & Vagg, 1999). Level of muskuloskeletal complaints was measured by 5-point rating scales. Results showed that the JSS sca!e values, as weil as the muskuloskeletal ratings, were quite stable over the six-month inteIVal. The three JSS scales showed high reliability. The two factories differed with respect to the patteffi of scale values, but these patteros remained over the six months, suggesting that the JSS instrument reflects major stress structures in the factory , rather than occasional changes in production.

Occupational stress and muskuloskeletal complaints was studied in t wo metal-industry workplaces. Measurements were obtained twice with a 6-month interval. Occupational stress was measured by the lob Stress Survey (SpieIberger & Vagg, 1999) and muskuloskeletal complaints was measured by 5-point rating scales. Results showed that the lSS scale values, as weIl as the musculoskeletal pain ratings, were quite stable over the six-month interval. The three lSS scales showed high reliability. The t wo factories differed with respect to the pattern of scale values, but the se patterns remained over the six months, suggesting that the lSS instrument reflects major stress structures in the factory , rather than occasional changes in production.

he present study assesses and evaluates the psychometric properties of a Swedish version of the Job Stress Survey (JSS; Spielberger, 1991; Spielberger & Vagg, 1999). This instrument is constructed to measure generic sources of occupational stress encountered by employees in a wide variety of work settings, settings that often result in psychological strain. The JSS was administered to metal assembly industry workers and medical service personnel in northern Sweden (n= 1186). The exploratory factor analysis showed that there is a high similarity between the present Swedish version and the original American version. Internal reliabilities of the scales, as well as test-retest reliabilities were shown to be high, and concurrent validity, as examined by comparisons with the Perceived Stress Questionnaire Index (Levenstein et al., 1993) was found to be satisfactory. The consistency of these findings is discussed with particular focus on groups of employees, gender, and cross-cultural evaluations.

Musculotendinous tenderness was evaluated in ambulance personnel, and their working load was studied by means of biomechanical analysis of the standard loading and unloading the `stretcher+patient' in and from the vehicle. Swedish and Japanese subjects were tested. The medical examination demonstrated increased tenderness of selected muscles active in work related movement tasks, as well as in spinous processes in both populations. However, a number ofparticular tests suggested higher Ievel of tenderness in the Swedish, as compared with the Japanese personnel. Biomechanical analysis of working tasks demonstrated similar forces, but higher LS-SI, hip and shoulder torques acting in Swedish personnel. This difference appears to be caused by the differences in stretcher construction. Specifically, the Swedish stretcher requires separate lifting of each stretcher side starting from a squat body position, while the Japanese system requires only pushing the stretcher in and pulling it out from the vehicle. We conclude that differences in working technique imposed by available working equipment could contribute to the observed differences in muscle tenderness especially around the shoulders between the two tested populations. However, further studies are needed to elaborate working load and muscle activity while performing standard tasks of ambulance personnel, as well as to explore other possible causes of increased musculotendinous tenderness. Keywords: Ambulance, Muculoskeletal disorders, Muscle tenderness, Spinous process, Biomechanical analyses

The present study aimed at comparing participants with and without self reported musculoskeletal pain in a normal population with regard to performance on a range of tests for episodic memory, semantic memory, and other cognitive functions and to see if expected differences interacted with age. The results showed that participants with pain performed worse on a range of tasks as compared to participants without pain, and that these differences occurred regardless of age. The most robust effects of pain were displayed on tests for vocabulary and construction ability as these were the only effects that remained significant after controlling for years of education and reported depression in separate analyses. When depression and education were controlled for in the same analysis, even these effects were eliminated, suggesting interplay between pain, depressive status, and educational level in the negative effects on cognitive functioning.

The aim of this study was to investigate physical activity levels and factors related to physical activity among 16-year old girls and boys in secondary school practical and theoretical programs. An additional aim was to identify factors contributing to differences in physical activity patterns between the educational programs. Sixteen-year old students in the first year of secondary school in Sweden (n = 585) were systematically selected and 93% agreed to complete a questionnaire. Compared with students in theoretical programs, those in practical programs spent less time and energy per day in physical activity. Girls in practical programs were the least physically active, and boys in theoretical programs the most physically active students. Statistical analysis showed that, among students in practical programs, the influence of educational program on physical activit y level was explained by lower socio-econornic level, less parental support, lower perceived health level, and negative attitudes towards outdoor physical activities. These data suggest that promotion of physical activity should focus on students, especially girls, in practical programs. Because the difference in physical activity levels between educational programs was partly an effect of less positive parental influence, school-based programs may be especially influential in increasing physical activity levels among secondary school students.

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.

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.

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.

This study explored experiences of illness, wellness and work environment of male ambulance personnel with musculoskeletal symptoms. A Grounded theory approach was applied with interviews with ten ambulance men parallel to analysis. Illness was experienced as threefold, with experiences of getting too vulnerable/hardened and getting worn-out beside experiences of bodily illness. Wellness was closely connected to their identity as both individuals and ambulance workers. To create stability and make sense of their illness experiences, the men performed an inner reasoning about extenuating circumstances to make illness acceptable; they also consciously worked out a strategy for handling their problems.