Claus Vinther Nielsen

Objective: To identify, organize, and prioritize stakeholder-defined components of rehabilitation to support functioning in everyday life, at home and at work, among people on sick leave due to low back pain. Design: Participatory mixed-methods study using group concept mapping conducted in Denmark. Subjects/patients: Participants with lived experience of low back pain and sickness absence, healthcare and employment professionals, workplace representatives, and researchers. Methods: Stakeholders completed online brainstorming, sorting, and rating, followed by a validation workshop. Multidimensional scaling and cluster analysis were applied. Results: Brainstorming involved 101 participants and generated 190 ideas, synthesized into 125 statements. Sorting and rating data were provided by 23 and 36 participants, respectively. Eleven participants attended the validation workshop. Six clusters consisted of self-management, physical training and activity, workplace involvement, interdisciplinary coordination, individual support, and extended assessment. Thirty-nine statements (31.2%) were rated very important and all clusters received high importance ratings. Conclusion: Stakeholder priorities encompassed physical, psychological, social, and work-related aspects of rehabilitation, consistent with a biopsychosocial perspective. Rehabilitation was conceptualized as a coordinated, adaptive, and person-centred process across sectors and everyday-life contexts. Although represented across clusters, functioning at home did not emerge as a distinct domain and requires further attention in low back pain rehabilitation.

Background: Effective management of low back pain requires a biopsychosocial approach, integrating physical, psychological, social, and occupational elements. Although moderate evidence supports multidisciplinary biopsychosocial rehabilitation and workplace interventions individually, the impact of combining these approaches for employees on sick leave due to low back pain remains unexplored. Objective: This systematic review investigated the effectiveness of biopsychosocial rehabilitation including workplace interventions for employees on sick leave due to low back pain. Methods: Structured literature search were conducted in MEDLINE, EMBASE, CINAHL, PEDro, PsycINFO and supplemented with grey literature. Eligible studies were randomized or non-randomized controlled studies involving employees on partial or full sick leave due to non-specific low back pain in subacute or persistent phases. Two reviewers independently performed screening, data extraction and risk-of-bias assessment. Interventions were described using the TIDieR checklist, and certainty of evidence was graded according to GRADE. Results: Four publications representing three randomized controlled trials with 346 employees included. Evidence quality was low to very low for pain, return to work, and sick leave, but moderate for improvement of disability at 12 months follow-up. Conclusion: Limited available evidence suggests that incorporating workplace interventions into multidisciplinary biopsychosocial rehabilitation may improve long-term disability for employees on sick leave due to low back pain. However, evidence for effects on pain, return to work and sick leave remains low or very low. This review identifies critical gaps in existing interventions and provides practice-based foundation, underscoring the need for further research to optimize rehabilitation for individuals with low back pain.

Background and purpose: Lung cancer patients have an increased risk of adverse employment outcomes. However, limited research exists on the association between socioeconomic position (SEP) and employment status in this cancer group. This study explored the influence of SEP on employment status after a lung cancer diagnosis. Patient/material and methods: This population-based cohort study included all working-age Danish residents diagnosed with lung cancer between 2000 and 2015. Logistic regression analyses were conducted to assess the association between socioeconomic variables (education, income, sick leave, and work status before diagnosis), and working and disability pension 3 years after diagnosis. Results: A total of 1,946 lung cancer patients were included. High income and long education were associated with higher odds of working, odds ratio (OR) = 2.31 (1.65–3.24) and OR = 1.92 (1.15–3.21), respectively, and lower odds of disability pension, OR = 0.19 (0.11–0.33) and OR = 0.30 (0.13–0.70), respectively. Moreover, sick leave and being out of work before diagnosis were associated with lower odds of working, OR = 0.25 (0.13–0.46) and OR = 0.32 (0.24–0.43), respectively, and higher odds of disability pension, OR = 3.73 (2.14–6.50) and OR = 2.88 (2.14–3.87), respectively. Interpretation: Lung cancer patients with low SEP are less likely to be employed and more likely to receive disability benefits. Therefore, rehabilitation to support socioeconomically disadvantaged lung cancer patients is needed.

Introduction and aim. Cognitive impairments after acquired brain injury (ABI) or concussion significantly affect work capacity. While hypnotic suggestion has shown promise in improving working memory and work ability, studies on its long-term effects on labor market attachment and cognition are lacking. The aim of this study was to estimate the long-term effect of hypnotic suggestion on labor market attachment, cognition, and functioning following acquired brain injury or concussion. Material and methods. A randomized controlled trial (RCT) was conducted at a municipal vocational rehabilitation center in Denmark, among 87 patients aged 18 to 62 years who experienced ABI or concussion at least 6 months prior to the first therapy session. The study group were randomized according to the applied intervention: usual care (n=28), hypnosis (n=30) or mindfulness (n=29). Participants underwent baseline and 6-month follow-up assessments involving The Danish Register for Evaluation of Marginalization (DREAM), The Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV), Impact on Participation and Autonomy questionnaire (IPA), The Working Memory Questionnaire and Trial Making Test related to working memory and functioning, assessing three dimensions: short-term storage, attention, and executive control. Results. The primary outcome was the average number of weeks employed during the 12–24-month period post-inclusion. The mean number of weeks employed was 32.71 (SD: 22.31) in the usual care group, 35.97 (SD: 21.58) in the hypnosis group, and 32.90 (SD: 22.44) in the mindfulness group. All intervention groups had exhibited a working memory score of around 90, which improved to a range of 91 to 95 at the 6-month follow-up. No significant differences were found between the groups. Conclusion. Brief hypnotic treatment at a municipal vocational rehabilitation center for people with ABI and concussion showed no significant advantage over mindfulness or usual care in labor market attachment, cognition, or family functioning. However, participants in the hypnosis group demonstrated improved social functioning at the 6-month follow-up compared to usual care.

Much in life is imagined: hoped for, dreamed about, or dreaded, as we engage with potential futures. Parkinson’s disease is a progressive and neuro-degenerative disease, currently incurable. During long-term fieldwork among Danish rehabilitees with Parkinson’s disease, rehabilitees’ mentioning of hope and images of the future gradually inspired attention to an imaginary dimension in rehabilitation. We explore haunting images and hope among rehabilitees as examples of the imaginary in rehabilitation, but also as windows into how rehabilitees orientate themselves towards an uncertain future. We show how rehabilitees’ imaginations of the future resemble hauntings instigating an urge to ‘do something’ to avoid their actualisation; to insist on living in the now, keeping up training, and partaking in clinical trials. This urge translates into rehabilitation practices, where rehabilitees and professionals work with both hope and rehabilitation goals to maximise the present and postpone the future. We emphasise that hope is a complex phenomenon; it is multiple and has a certain elasticity. A person can carry multiple hopes at once; hope can be agentic, co-created and worked with, located, or be an existential stance.

Background: Patient reported outcomes (PROs) are being used frequently in clinical practice. PROs often serve several purposes, such as increasing patient involvement, assessing health status, and monitoring and improving the quality-of-care at an aggregated level. However, the lack of representative PRO-data may have implications for all these purposes. This study aims to assess the association of non-administration of (not sending an electronic invite to PRO) and non-response to (not responding to PRO) electronically administered PROs with social inequality in a primary healthcare cancer rehabilitation setting. Furthermore, it examines whether the workflows surrounding PRO have an impact on non-administration and non-response. Methods: This is a cross sectional study using routinely collected data from electronic health records and registers including cancer survivors (CSs) over 18 years booked for an initial consultation in a primary healthcare cancer rehabilitation setting using PROs for systematic health status assessment. During the study period two different PRO platforms were used, each associated with different workflows. Non-administration and non-response rates were calculated for sociodemographic characteristics for each PRO platform. Crude and adjusted odds ratios were calculated using univariate and multivariate logistic regression. Results: In total, 1868 (platform 1) and 1446 (platform 2) CSCSs were booked for an initial consultation. Of these, 233 (12.5%) (platform 1) and 283 (19.6%) (platform 2) were not sent a PRO (non-administration). Among those who received a PRO, 157 (9.6%) on platform 1 and 140 (12.0%) on platform 2 did not respond (non-response). Non-administration of and non-response to PROs were significantly associated with lower socioeconomic status. Moreover, the workflows surrounding PROs seem to have an impact on non-inclusion in and non-response to PROs. Conclusions: Non-administration of and non-response to PROs in clinical practice is associated with determinants of social inequality. Clinical workflows and the PRO platforms used may potentially worsen this inequality. It is important to consider these implications when using PROs at both the individual and aggregated levels. A key aspect of implementing PROs in clinical practice is the ongoing focus on representativeness, including a focus on monitoring PRO administration and response.

Rationale: Despite cardiac rehabilitation and medical treatment being integrated parts of the pathway of patients with cardiovascular disease, as well as the well‐establish positive effect, cardiac rehabilitation remains underutilised. In recent years, cardiac rehabilitation has increasingly been moved from the hospitals to the community healthcare services. This transition may be challenging for patients with cardiovascular disease. Aim: To investigate reflections and perspectives of patients opting out of cardiac rehabilitation in community healthcare services to improve participation and adherence to cardiac rehabilitation in the future. Results: A total of eight patients opting out of cardiac rehabilitation participated in individual interviews. Opting out of cardiac rehabilitation is defined as never enroled or did not complete cardiac rehabilitation. The Interpretive Description methodology was used in the analysis where two themes and six subthemes were identified: (1) ‘Structural and organisational factors’ with three subthemes; Being a patient in the healthcare system, Enroling into CR when it is meaningful, and Getting back to work is vital, and (2) ‘Patients' internal factors’ with three subthemes; Feeling a desire to regain control, Seeing yourself as recovered, and Being aware of own needs. The analysis indicates that patients' decision to opt out of CR was multidimensional and based on a combination of factors. Conclusion: Ensuring that the healthcare professionals in the community have sufficient information regarding the patient and a clear communication plan between the healthcare professionals and the patient may reduce the transition causing confusion and frustrations for patients. Incorporating a vocational element in CR and ensuring that employers understand the importance of CR may hamper returning to work as a challenge to CR. Ensuring timely CR referral and enrolment and a transition coordinator may reduce the challenge of patients not viewing CR as meaningful. However, further studies are needed to fully understand how CR could become meaningful for patients opting out of CR.

Background and purpose: There is a growing need for rehabilitation services beyond hospitals. This study aims to describe challenges faced by cancer survivors (CSs) referred for rehabilitation in primary healthcare, employing standardized scales measuring health-related quality of life (HRQOL) and open-ended questions. Furthermore, the study explores the applicability of patient-reported outcomes (PROs) in comprehensively understanding challenges encountered by CSs. Material and methods: This cross-sectional study involves CSs referred for cancer rehabilitation in a primary healthcare setting, including those participating in PROs as a part of routine practice. HRQOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The International Classification of Functioning, Disability and Health (ICF) framed the analysis of responses to open-ended questions ‘what concerns you the most?’ and ‘what matters to you?’ Results: FACT-G showed the lowest scores for functional well-being (14.4) and emotional well-being (16.6), with higher scores for physical well-being (18.9) and social/family well-being (21.1). Responses to open-ended questions unveiled worries about everyday life and how cancer will impact family well-being presently and in the future. Furthermore, CSs reported a need to maintain normality and proactively address the challenges posed by the disease. Interpretation: CSs referred for rehabilitation in primary healthcare experience comprehensive challenges necessitating a holistic rehabilitation approach. This includes interventions supporting CSs in dealing with uncertainty, regaining a sense of control, and addressing family well-being concerns. When using PROs for need assessment, the combination of validated HRQOL scales and open-ended questions is crucial for an in-depth understanding of CSs’ challenges.

Background. Despite existing evidence on the efficacy of cardiac rehabilitation (CR), programs are underutilized. Factors affecting referral and enrolment in hospital‐based CR were identified; however, research into factors affecting referral and enrolment in community‐based CR is lacking. Aim. The purpose of this scoping review is to identify and synthesize facilitators and challenges in the transition of patient care from hospital to community healthcare services and how they influence CR referral and enrolment. Method. PubMed, Embase, CINAHL, Scopus, ProQuest, and Web of Science databases were searched for relevant publications. The data were analysed using thematic analysis by Braun and Clarke. The study followed the PRISMA extension for scoping reviews and the Joanna Briggs Institute’s model. Result. In total, 36 studies were included in this analysis. The results show that facilitators and challenges for referral and enrolment in CR form a complex interaction. Factors influencing referral and enrolment may be setting‐dependent or ‐independent. However, each setting may influence the entire transition. Conclusion. The patient decision‐making process regarding CR may begin in the hospital, indicating that this period is the right time to encourage CR enrolment. To support patient transition, healthcare professionals at hospitals require knowledge of CR and the ability to prioritize patient support. Offering an initial meeting at a local site may decrease patient prejudice and facilitate enrolment.

Social inequity in healthcare persists even in countries with universal healthcare. The Social Health Bridge-Building Programme aims to reduce healthcare inequities. This paper provides a detailed description of the programme. The Template for Intervention Description and Replication (TIDieR) was used to structure the description. The programme theory was outlined using elements from the British Medical Research Council’s framework, including identifying barriers to healthcare, synthesising evidence, describing the theoretical framework, creating a logic model, and engaging stakeholders. In the Social Health Bridge-Building Programme, student volunteers accompany individuals to healthcare appointments and provide social support before, during, and after the visit. The programme is rooted in a recovery-oriented approach, emphasising personal resources and hope. The programme finds support in constructs within the health literacy framework. Student volunteers serve as health literacy mediators, supporting individuals in navigating the healthcare system while gaining knowledge and skills. This equips students for their forthcoming roles as healthcare professionals, and potentially empowers them to develop and implement egalitarian initiatives within the healthcare system, including initiatives that promote organisational health literacy responsiveness. The Social Health Bridge-Building Programme is a promising initiative that aims to improve equity in healthcare by addressing individual, social, and systemic barriers to healthcare. The programme’s description will guide forthcoming evaluations of its impact.