Gunilla Brattberg

This study is a long-term follow-up of a previously published study that used the internet in the rehabilitation of people on long-term sick leave owing to chronic pain and/or burnout. The follow-up was to assess the effects over time of this kind of rehabilitation. The goals of the first study were to improve the participants' health and work capacity. Sixty people were randomly assigned to either a treatment or a waiting-list group. A 20-week rehabilitation programme based on 19 films on different themes was supplemented with written material and a dialogue over the internet. Fifty participants, 25 in each group, were followed up for 1 year after programme completion. They were administered the same questionnaire (SF-36, HAD, Stress Barometer) that they had taken immediately before (pre) and after (post) the rehabilitation programme. No significant differences were found regarding stress and health between the treatment and waiting-list groups at the time of the 12-month follow-up. Significant group differences were, however, seen in work capacity (number of hours worked per week): 52% of the participants in the treatment group reported an increased work capacity, compared with only 13% in the waiting-list group (P=0.005). Rehabilitation of people on long-term sick leave, which is carried out over the internet seems to complement other rehabilitation programmes as well.

Objective: To analyse the extent to which traumatic life events, post‐traumatic stress disorder (PTSD) and the neuropsychiatric disorder attention deficit hyperactivity disorder (ADHD) can be contributors associated with burnout and the long‐term sick leave that results from it.Subjects: Sixty‐two individuals on long‐term sick leave due to stress‐related poor health and burnout, and 83 working individuals were screened for the presence of traumatic life events, PTSD and ADHD. Potential background factors involved in burnout were analysed using a multiple logistic regression.Results: Fifty‐two per cent of those on long‐term sick leave were judged to have PTSD and 24 per cent to have ADHD. The number of suspected/possible cases was even higher—71 per cent and 56 per cent, respectively. Nineteen per cent were judged to have both PTSD and ADHD; 56 per cent were judged to have PTSD and/or ADHD. PTSD, ADHD and traumatic life events in the form of sexual assault and severe human suffering were all strongly associated with both burnout and long‐term sick leave.Conclusions: Since ADHD is almost never discussed and PTSD rarely so in the occupational rehabilitation of individuals with burnout, these results should act as a warning signal. Further studies are needed, however, including clinical examinations in order to establish with certainty if PTSD and ADHD can predict burnout followed by long‐term sick leave. Copyright © 2006 John Wiley & Sons, Ltd.

This study investigates utilization of the Internet in the rehabilitation of people on long-term sick leave with chronic pain and/or burnout. Fifty-five people were randomly assigned to two groups: a treatment group (n = 27) that participated in a rehabilitation course over the Internet and a waiting list group (n = 28). The goals were to improve participants' health and increase quality of life, and, for those who were not on permanent disability pensions, to increase work capacity, if possible. A 20-week program, based on 19 films on different themes, was supplemented with written material and a Socratic dialogue over the Internet. Upon completion of the rehabilitation course, statistically significant improvements were observed in the treatment group in comparison to the waiting list group, for variables such as depression, pain, vitality, social function, performance problems involving work or other activities due to physical illness and the presence of stress symptoms. Thirteen of 23 individuals (57%) also increased their work capacity. The number needed to treat regarding recovering from anxiety and depression was 2. For increased work capacity, the number needed to treat was 3. Rehabilitation of people on long-term sick leave carried out over the Internet is a good complement to other rehabilitation programs.

The Stress Barometer, which includes stress symptoms, stress types, relationship stress and time stress, was developed as an easy‐to‐use instrument which provides a visual representation of the stress an individual is experiencing. The purpose of this study was to assess the reliability, validity and usefulness of the Stress Barometer. Reliability was tested using a test–retest procedure on 23 pain patients on long‐term sick leave. To assess validity, the results of the instrument were compared to the results of the SF‐36 Health Survey, the Hospital Anxiety and Depression Scale and the Shirom–Melamed Burnout Questionnaire administered to 112 pain and/or emotional exhaustion syndrome patients on long‐term sick leave. Fifty directors who participated in a management leadership course focusing on stress also completed and evaluated the instrument. Reliability was high for most of the subscales included. The results of the validity test showed that the Stress Barometer correlates with the respondents' perceived experience of a variety of health aspects such as anxiety, depression as well as different aspects of burnout/emotional exhaustion. The Stress Barometer is quick to complete and it offers immediate feedback. The study demonstrates that the Stress Barometer is also usable and useworthy. Copyright © 2006 John Wiley & Sons, Ltd.

Design. In a longitudinal study, 335 children ages 8, 11 and 14, first studied in 1989 were followed‐up on two occasions in 1991 and 2002. The subjects filled in questionnaires on pain, the first two times in school, the last as a postal survey.Purposes. To determine if headache and back pain during the school years were transitory or if they grew into pain problems in adulthood; to determine predictors of pain.Results. In the 2002 study, 59% of the women and 39% of the men reported pain at 21, 24 and 27 years. A total of 68 (52 women, 16 men) or 20% of the subjects reported pain symptoms in all three studies. The cumulative incidence rate for the presence of pain in the cohort studied was 31% for 1989–2002 and 43% for 1991–2002. Four of the 10 individuals with pain also reported signs of stress. Three predictors were found: reported back pain in 8–14‐year‐olds (ppConclusions. Since pain reports in childhood and early adolescence seem to be associated with the report of pain in early adulthood, more attention should be given to the way ill‐health is managed in adolescence in this vulnerable group.

The physician-patient encounter is time-constrained, and there may be little time to ask questions and identify problem areas in patients. Persons who experience aches, pains and other symptoms are sometimes confused in their crisis. The health barometer is a diagnostic aid that shows which areas to emphasize in the explorative conversation with patients. It is easy to use and it reflects the general, emotional, mental and social health of the patient when tested against the SF-36 health survey.