Nanna Rolving

Objectives. We aimed to develop a booklet for people with low back pain (LBP) and their healthcare professionals (HCPs), which provides coherent, evidence-based patient education to support helpful pain-related behaviours tailored to individual needs.Methods. People with LBP, HCPs, educators, researchers, and a visual artist were included in a co-design process. Booklet content was developed in an iterative approach comprising three surveys and three in-person workshops. First, HCPs contributed suggestions for educational content in a survey. These were then organised into themes, drafted as text paragraphs and metaphors, and refined through three workshops and two subsequent survey rounds involving all stakeholder groups. Illustrations were sketched during workshops and discussed in surveys.Results. Three overarching themes were agreed on: (1) creating an alliance (HCPs and people with LBP working collaboratively), (2) explaining LBP, and (3) managing LBP. The booklet included these themes by combining suggestions for factual explanations, metaphors, and practical strategies for facilitating a collaborative approach to patient education. In the final survey, the texts for all of 17 outlined messages were endorsed by more than 90% (n = 27) respondents. Of 11 proposed metaphors for explaining LBP, one was excluded due to lack of consensus.Conclusions. We developed a booklet for people with LBP and for HCPs in a co-design process. The content covers topics previously identified as important for LBP education, while the booklet emphasises individualised education delivered through interaction and dialogue rather than generic information transfer. Future research should explore the booklet’s usefulness for supporting people with LBP in managing their condition, and a tailored implementation plan should be developed.Practice implications. The booklet “When Your Back Hurts – A Guide to Back Pain” is available as a source of current information about LBP meant to support an individualised clinical dialogue.

Background and Purpose: In patients undergoing lumbar spinal fusion, a randomised controlled trial examined the effect of an early cognitive behavioural rehabilitation intervention designed to reduce sedentary behaviour. The intervention consisted of graded activity and pain education (GAPE). The objective of this qualitative study was to explore participants' experiences with GAPE following the three‐month intervention period. Methods: This study employed an interpretive qualitative design. Participants were purposefully recruited 3 months post‐surgery. Semi‐structured individual interviews were conducted, and data were analysed using a Template Analysis approach by a research group adopting an intermediate epistemological stance. Results: A total of 11 participants were included. Based on the data, a final template was developed comprising four themes and associated subthemes: (1) An angel in the house post‐surgery , (2) Embodied experiences and regaining control , (3) Master in my own house , and (4) Bridging personalised rehabilitation across settings . The study showed that GAPE provided meaningful support during the early post‐surgical period after lumbar spinal fusion. Important factors included individually formulated goals, a strong therapeutic alliance, appropriate timing, and graded activity. These components helped participants understand their bodies and pain, thereby enhancing their safety and bodily confidence. Trusting relationships with physiotherapists and home‐based sessions made rehabilitation both manageable and personally meaningful. Discussion: Overall, GAPE supported participants' early recovery after lumbar spinal fusion by combining personalised goals, trusting therapeutic relationships, and home‐based, graded activity, thereby enhancing bodily confidence and making rehabilitation manageable and meaningful. Strengths of the study include participant diversity and a reflexive, multidisciplinary research team, which strengthened data richness and transparency. However, the overrepresentation of highly educated participants and researcher involvement in intervention development may limit generalisability and introduce potential bias.

Patients who survive critical illness and intensive care unit (ICU) admission often experience long-lasting physical, psychological, and cognitive impairments. Cognitive impairments are common and may persist well beyond ICU discharge. Few structured interventions address these impairments across the care continuum, from the ICU to post-discharge recovery. This gap informed the development of a stakeholder-driven cognitive rehabilitation intervention. The aim was to develop a cognitive rehabilitation intervention for critically ill patients that bridges the period from ICU admission to post-discharge recovery. The intervention was developed using a multiphase process guided by the 2021 Medical Research Council (MRC) framework for complex interventions and reported in line with the GUIDED and TIDieR checklists. Stakeholder input was gathered through: (1) a workshop (n = 11) to identify end-user needs; (2) a three-round Delphi process (n = 39) to prioritise interventions using a seven-point Likert scale; and (3) expert consultations to refine selected components. Qualitative data from the workshop and open-ended Delphi responses were analysed thematically, while quantitative analysis identified consensus, defined a priori as ≥80% agreement on importance. The process generated a range of proposed interventions, including both novel and established elements. Interventions reaching stakeholder consensus were further reviewed by experts for clinical relevance and feasibility. Two prototype interventions were selected: (1) a Mindfulness-based intervention and (2) a Brain Training intervention. This study outlines a stakeholder-informed process for developing a cognitive rehabilitation intervention tailored to ICU patients across the care continuum. The co-design approach improved contextual fit and clinical applicability. These findings support the planned feasibility evaluation of the proposed interventions. The overall research study received ethics approval, while formal ethics committee approval was not required for the workshop and Delphi activities under Danish legislation (osf.io/5a4xq).

Background: Cognitive impairment is common after critical illness, yet structured cognitive rehabilitation is rarely integrated into routine intensive care practice. ICU CogHab is a stakeholder‐ and theory‐informed intervention comprising two components: Mindfulness and Brain Training, developed to support recovery from intensive care to 6‐month follow‐up. Aim: To evaluate the feasibility of the ICU CogHab intervention, focussing on acceptability and fidelity among ICU patients and nurses. Study Design: A multi‐method feasibility evaluation was conducted alongside a pragmatic, five‐arm randomised controlled feasibility trial in four Danish ICUs. Data were collected using patient and nurse surveys and semi‐structured interviews. Acceptability was explored in terms of three domains: affective attitude, burden and perceived effectiveness. Fidelity was assessed in relation to adherence and dose, with participant responsiveness and quality of delivery examined within adherence. Quantitative data were analysed descriptively, and qualitative data were analysed using deductive content analysis. Results: Thirty‐one patients contributed with survey data and nine participated in interviews. In addition, 53 nurses contributed with 194 session‐based surveys and seven interviews, informing evaluation of delivery during ICU admission. Both components were generally perceived as relevant and appropriate by patients and nurses. Patients described the components as meaningful and supportive. Fidelity varied across settings and over time, with adherence and dose influenced by clinical condition, fatigue, patient readiness and competing rehabilitation demands, meaning that intervention use often required adaptation in timing and duration across recovery phases. Nurses reported contextual barriers to delivery, including high workload and competing clinical priorities. Conclusion: The ICU CogHab intervention components demonstrated overall acceptability across ICU and post‐discharge phases. Variation in fidelity reflected the patient condition, clinical context and competing demands, providing direction for further refinement before larger‐scale evaluation. Relevance to Clinical Practice: Cognitive rehabilitation may be acceptable and feasible to introduce within intensive care pathways but delivery may require flexible timing, integration into routine care and support across the ICU‐to‐home transition.

Objectives: Implementing motivational self-management support in low back pain care remains challenging due to barriers including health care providers’ limited confidence in addressing behavioral aspects of pain, people with low back pain’s expectations, and time constraints. To promote person-centered low back pain care, this project engaged people with low back pain, health care providers, and researchers in a co-design process to develop a dialogue tool aimed at supporting motivational conversations and facilitating self-management.Methods: Guided by Design Thinking principles, we conducted a co-design process informed by self-determination theory and structured around the 5A’s model for behavior change (Assess, Advise, Agree, Assist, Arrange). The process included fieldwork, workshops, prototype development, and iterative refinements. To inform refinements, acceptability, appropriateness, and feasibility of the dialogue tool were evaluated through surveys (n = 9 health care providers) and in semi-structured interviews with health care providers (n = 6) and people with low back pain (n = 4).Results: The final product was an analog tool comprising 7 dialogue sheets and 5 information postcards aligned with the 5A’s components. Both health care providers and people with low back pain found the prototype tool acceptable and feasible for structuring person-centered conversations about pain and self-management. The most frequently used elements were those to support a person-centered assessment of pain complexity (Assess) and to provide options for managing pain (Assist). Barriers included lack of experience and need of supplementary training in use of the dialogue tool.Conclusions: Using a co-design process, we developed an analog dialogue tool to facilitate a person-centered approach to support self-management of low back pain. Effects of the tool and strategies for implementation are still to be tested.Practice implications: The dialogue tool may support structured, person-centered conversations about pain beliefs, factors affecting pain, and self-management strategies linked to meaningful goals and activities.

Background: Survivors of critical illness frequently experience persistent cognitive impairment. However, structured cognitive rehabilitation interventions remain limited within intensive care pathways. While physical rehabilitation has received increasing attention, evidence guiding cognitive rehabilitation in intensive care unit (ICU) populations is sparse, and the feasibility of study procedures must be established before large‐scale evaluation. Aim: To assess the feasibility of conducting a multi‐arm randomised controlled trial evaluating a cognitive rehabilitation intervention (ICU CogHab) for ICU survivors. Study Design: A pragmatic, five‐arm randomised feasibility study was conducted across four ICUs at two Danish university hospitals. Feasibility outcomes included screening and recruitment, randomisation procedures, retention through 6‐month follow‐up and completion of patient‐reported and performance‐based outcome measures. Data were analysed descriptively to summarise feasibility parameters and outcome variability. Results: Of 1679 patients screened, 115 met eligibility criteria and 83 were randomised. Recruitment was lower than anticipated, and retention at 6 months was 40%. Clinical data obtained from medical records were largely complete, whereas cognitive and patient‐reported outcomes were more difficult to complete at ICU discharge. Outcome measures demonstrated substantial variability. Conclusion: This study shows that screening and randomisation procedures for a cognitive rehabilitation intervention are feasible within routine ICU practice. Retention and data completeness, particularly after hospital discharge, represent key challenges requiring refinement before further evaluation. Relevance to Clinical Practice: Cognitive rehabilitation can be introduced within routine ICU workflows. However, the timing of assessments, follow‐up procedures and integration into clinical practice require optimisation. These findings inform pragmatic adaptations to support future evaluation and implementation of cognitive rehabilitation for ICU survivors. Trial Registration: The study was prospectively registered on the Open Science Framework ( https://osf.io/b57fv/overview )

Globally, low back pain (LBP) is the leading cause of years lived with disability. Clear communication between patients and health professionals is essenti

Purpose This scoping review study aimed to provide a comprehensive overview of the literature on collaboration between sickness benefit offices and general practice in return to work (RTW) processes, to map existing research, and to identify facilitators and barriers to successful collaboration. Methods This review adhered to established scoping review methodologies. A systematic search of peer-reviewed literature was conducted across six databases. Two researchers independently performed screening and data extraction. Facilitators and barriers were thematically analysed, and tentative findings were discussed with a reference group. Results The search yielded 8477 unique studies, of which 22 met the inclusion criteria. The findings revealed persistent challenges over the past two decades. Most studies used qualitative methods, and the majority were conducted in a Scandinavian context. Written communication was the predominant collaborative activity reported in the studies. Barriers were more frequently identified than facilitators. Commonly reported barriers to successful collaboration included stereotyping, differing priorities, and an over-reliance on written communication. Facilitators included face-to-face meetings and high-quality written communication. Although facilitators have not been extensively studied, our findings emphasize the interconnection between barriers and facilitators, indicating that facilitators can provide strategies to address these barriers. Furthermore, we observed a lack of consensus in the literature regarding key concepts, such as’collaboration’. Discussion Based on the findings, we recommend that future research focus on achieving conceptual clarity and examining the underlying conditions that influence the potential for collaboration between general practice and sickness benefits offices in RTW processes.

Objective Patient-reported outcome measures are essential for assessing health-related quality of life (HRQoL) in both research and clinical practice. The Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire is a disease-specific instrument designed to measure HRQoL in patients with pulmonary embolism (PE). This study aimed to evaluate the psychometric properties of the Danish electronic version of the PEmb-QoL questionnaire. Design Psychometric validation study. Setting Eligible patients received a digital mail 6 months after their diagnosis, with an invitation to complete an online questionnaire. A subset of patients completed a second time 7–10 days following the initial completion. Participants Adult patients diagnosed with PE in Denmark between March 2022 and May 2023 were included in the study. Main outcome measure The main outcome measure was the PEmb-QoL summary score. Validation procedures included assessments of targeting, internal reliability (IR), test–retest reliability, differential item functioning (DIF) and concurrent validity. Results The study included 1017 patients. The Danish PEmb-QoL demonstrated robust IR (IR=0.95 for the total score) and adequate test–retest reliability for most domains (relative G-coefficients>0.7). However, DIF analysis revealed subgroup differences for some items, particularly those related to daily activity limitations and pain. Targeting analysis indicated moderate alignment between latent score distributions and item response distributions, with ceiling effects noted in several domains. The PEmb-QoL exhibited strong correlations with the Post-Venous Thromboembolism Functional Status Scale (r=0.82) and EuroQol-5 Domain (r=0.73), and moderate correlations with Generalised Anxiety Disorder Questionnaire (r=0.47) and Patient Health Questionnaire (r=0.57), confirming its concurrent validity. Conclusion While some items in the PEmb-QoL instrument performed inadequately on DIF and targeting, the expected overall score and the concurrent validity did not seem to be compromised by these issues. Thus, it is likely that a reduced version of the electronic Danish PEmb-QoL will possess suitable psychometric properties for measuring HRQoL in patients with PE.