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  1. Article ; Online: Effects of Inpatient Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy on Sick Leave and Cost of Lost Production: 7-Year Follow-Up of a Randomized Controlled Trial.

    Aasdahl, Lene / Gismervik, Sigmund Østgård / Johnsen, Roar / Vasseljen, Ottar / Bjørnelv, Gudrun M W / Bjørngaard, Johan Håkon / Fimland, Marius Steiro

    Journal of occupational rehabilitation

    2024  

    Abstract: Objectives: Previously, we reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective than outpatient Acceptance and Commitment Therapy (O-ACT) in reducing sickness absence and was cost-effective over a 24- ... ...

    Abstract Objectives: Previously, we reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective than outpatient Acceptance and Commitment Therapy (O-ACT) in reducing sickness absence and was cost-effective over a 24-month period. Here we present 7-years of follow-up on sick leave and the cost of lost production.
    Methods: We randomized individuals aged 18-60, sick-listed due to musculoskeletal or mental health disorders to I-MORE (n = 82) or O-ACT (n = 79). I-MORE, lasting 3.5 weeks, integrated ACT, physical training, and work-related problem-solving. In contrast, O-ACT mainly offered six weekly 2.5 h group sessions of ACT. We measured outcomes using registry data for days on medical benefits and calculated costs of lost production. Our analysis included regression analyses to examine differences in sickness absence days, logistic general estimating equations for repeated events, and generalized linear models to assess differences in costs of lost production.
    Results: Unadjusted regression analyses showed 80 fewer days of sickness absence in the 7-year follow-up for I-MORE compared to O-ACT (95% CI - 264 to 104), with an adjusted difference of 114 fewer days (95% CI - 298 to 71). The difference in costs of production loss in favour of I-MORE was 27,048 euros per participant (95% CI - 35,009 to 89,104).
    Conclusions: I-MORE outperformed O-ACT in reducing sickness absence and production loss costs during seven years of follow-up, but due to a limited sample size the results were unprecise. Considering the potential for substantial societal cost savings from reduced sick leave, there is a need for larger, long-term studies to evaluate return-to-work interventions.
    Language English
    Publishing date 2024-04-28
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1171536-4
    ISSN 1573-3688 ; 1053-0487
    ISSN (online) 1573-3688
    ISSN 1053-0487
    DOI 10.1007/s10926-024-10195-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Acceptance and use of a clinical decision support system in musculoskeletal pain disorders - the SupportPrim project.

    Granviken, Fredrik / Meisingset, Ingebrigt / Vasseljen, Ottar / Bach, Kerstin / Bones, Anita Formo / Klevanger, Nina Elisabeth

    BMC medical informatics and decision making

    2023  Volume 23, Issue 1, Page(s) 293

    Abstract: Background: We have developed a clinical decision support system (CDSS) based on methods from artificial intelligence to support physiotherapists and patients in the decision-making process of managing musculoskeletal (MSK) pain disorders in primary ... ...

    Abstract Background: We have developed a clinical decision support system (CDSS) based on methods from artificial intelligence to support physiotherapists and patients in the decision-making process of managing musculoskeletal (MSK) pain disorders in primary care. The CDSS finds the most similar successful patients from the past to give treatment recommendations for a new patient. Using previous similar patients with successful outcomes to advise treatment moves management of MSK pain patients from one-size fits all recommendations to more individually tailored treatment. This study aimed to summarise the development and explore the acceptance and use of the CDSS for MSK pain patients.
    Methods: This qualitative study was carried out in the Norwegian physiotherapy primary healthcare sector between October and November 2020, ahead of a randomised controlled trial. We included four physiotherapists and three of their patients, in total 12 patients, with musculoskeletal pain in the neck, shoulder, back, hip, knee or complex pain. We conducted semi-structured telephone interviews with all participants. The interviews were analysed using the Framework Method.
    Results: Overall, both the physiotherapists and patients found the system acceptable and usable. Important findings from the analysis of the interviews were that the CDSS was valued as a preparatory and exploratory tool, facilitating the therapeutic relationship. However, the physiotherapists used the system mainly to support their previous and current practice rather than involving patients to a greater extent in decisions and learning from previous successful patients.
    Conclusions: The CDSS was acceptable and usable to both the patients and physiotherapists. However, the system appeared not to considerably influence the physiotherapists' clinical reasoning and choice of treatment based on information from most similar successful patients. This could be due to a smaller than optimal number of previous patients in the CDSS or insufficient clinical implementation. Extensive training of physiotherapists should not be underestimated to build understanding and trust in CDSSs.
    MeSH term(s) Humans ; Artificial Intelligence ; Decision Support Systems, Clinical ; Musculoskeletal Pain/therapy ; Physical Therapy Modalities
    Language English
    Publishing date 2023-12-19
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2046490-3
    ISSN 1472-6947 ; 1472-6947
    ISSN (online) 1472-6947
    ISSN 1472-6947
    DOI 10.1186/s12911-023-02399-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders.

    Aasdahl, Lene / Fimland, Marius Steiro / Bjørnelv, Gudrun M W / Gismervik, Sigmund Østgård / Johnsen, Roar / Vasseljen, Ottar / Halsteinli, Vidar

    Journal of occupational rehabilitation

    2023  Volume 33, Issue 3, Page(s) 463–472

    Abstract: Purpose: To evaluate the cost-effectiveness and cost-benefit of inpatient multimodal occupational rehabilitation (I-MORE) compared to outpatient acceptance and commitment therapy (O-ACT) for individuals sick listed due to musculoskeletal- or common ... ...

    Abstract Purpose: To evaluate the cost-effectiveness and cost-benefit of inpatient multimodal occupational rehabilitation (I-MORE) compared to outpatient acceptance and commitment therapy (O-ACT) for individuals sick listed due to musculoskeletal- or common mental disorders during two-years of follow-up.
    Methods: We conducted an economic evaluation with a societal perspective alongside a randomized controlled trial with 24 months follow-up. Individuals sick listed 2 to 12 months were randomized to I-MORE (n = 85) or O-ACT (n = 79). The outcome was number of working days. Healthcare use and sick leave data were obtained by registry data.
    Results: Total healthcare costs during the 24 months was 12,057 euros (95% CI 9,181 to 14,933) higher for I-MORE compared to O-ACT, while the difference in production loss was 14,725 euros (95% CI -1,925 to 31,375) in favour of I-MORE. A difference of 43 (95% CI -6 to 92) workdays, in favour of I-MORE, gave an incremental cost-effectiveness ratio of 278 euros for one workday, less than the cost of one day production (339 euros). Net societal benefit was 2,667 euros during two years of follow-up.
    Conclusion: Despite considerable intervention costs, the lower production loss resulted in I-MORE being cost-effective when compared to O-ACT. Based on economic arguments, I-MORE should be implemented as a treatment alternative for individuals on long-term sick leave. However, more research on subgroup effects and further follow-up of participants' permanent disability pension awards are warranted.
    MeSH term(s) Humans ; Cost-Benefit Analysis ; Acceptance and Commitment Therapy ; Inpatients ; Outpatients ; Return to Work ; Mental Disorders/rehabilitation ; Sick Leave
    Language English
    Publishing date 2023-03-23
    Publishing country Netherlands
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1171536-4
    ISSN 1573-3688 ; 1053-0487
    ISSN (online) 1573-3688
    ISSN 1053-0487
    DOI 10.1007/s10926-022-10085-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Rigid head-neck responses to unpredictable perturbations in patients with long standing neck pain does not change with treatment.

    Stensdotter, Ann-Katrin / Stavdahl, Øyvind / Vasseljen, Ottar / Meisingset, Ingebrigt

    PloS one

    2020  Volume 15, Issue 8, Page(s) e0237860

    Abstract: In a previous study we have shown that patients with long standing non-specific neck-pain display more rigid neck movement behavior than controls in response to unpredictable perturbations. In the present study we investigated head/neck motor control in ... ...

    Abstract In a previous study we have shown that patients with long standing non-specific neck-pain display more rigid neck movement behavior than controls in response to unpredictable perturbations. In the present study we investigated head/neck motor control in patients with neck-pain during a course of physiotherapy intervention and the associations with pain, neck disability and kinesiophobia. In this longitudinal observational study, 72 patients with non-specific neck-pain were exposed to unpredictable horizontal rotations by means of an actuated chair in three conditions; with a visual reference, and without vision with and without a cognitive task before first consultation with physiotherapist, after 2 weeks and 2 months of intervention. The neck movements were analyzed in the frequency domain to cover voluntarily and reflex controlled responses. Questionnaires encompassed Neck Disability Index, Tampa Scale of Kinesiophobia, and the Numerical Rating Scale for current pain. The results showed that the response pattern for the amplitudes of movement between head and trunk across frequencies did not change over time, whereas some changes in timing were found for some frequencies. Pain, neck disability, and kinesiophobia improved after intervention, but were not significantly associated with neck movement responses to perturbations across time or condition. Although physiotherapy intervention improved self-reported function, the rigid responses to unpredictable perturbations remained unchanged. This indicates altered function in reflex mediated control mechanisms, i.e., the vestibulocollic and the cervicocollic reflex systems that control the head in space and on the trunk. Future research should further investigate pain related changes in reflex systems and whether alterations in these systems are modifiable.
    MeSH term(s) Adolescent ; Adult ; Aged ; Cognition ; Female ; Head/physiopathology ; Humans ; Male ; Middle Aged ; Motor Activity ; Neck/physiopathology ; Neck Pain/physiopathology ; Neck Pain/therapy ; Treatment Outcome ; Vision, Ocular ; Young Adult
    Language English
    Publishing date 2020-08-24
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0237860
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes.

    Aasdahl, Lene / Granviken, Fredrik / Meisingset, Ingebrigt / Woodhouse, Astrid / Evensen, Kari Anne I / Vasseljen, Ottar

    BMC musculoskeletal disorders

    2021  Volume 22, Issue 1, Page(s) 455

    Abstract: Background: There are large variations in symptoms and prognostic factors among patients sharing the same musculoskeletal (MSK) diagnosis, making traditional diagnostic labelling not very helpful in informing treatment or prognosis. Recently, we ... ...

    Abstract Background: There are large variations in symptoms and prognostic factors among patients sharing the same musculoskeletal (MSK) diagnosis, making traditional diagnostic labelling not very helpful in informing treatment or prognosis. Recently, we identified five MSK phenotypes across common MSK pain locations through latent class analysis (LCA). The aim of this study was to explore the one-year recovery trajectories for pain and functional limitations in the phenotypes and describe these in relation to the course of traditional diagnostic MSK groups.
    Methods: We conducted a longitudinal observational study of 147 patients with neck, back, shoulder or complex pain in primary health care physiotherapy. Data on pain intensity and function were collected at baseline (week 0) and 1, 2, 3, 4, 6, 8, 12, 26 and 52 weeks of follow up using web-based questionnaires and mobile text messages. Recovery trajectories were described separately for the traditional diagnostic MSK groups based on pain location and the same patients categorized in phenotype groups based on prognostic factors shared among the MSK diagnostic groups.
    Results: There was a general improvement in function throughout the year of follow-up for the MSK groups, while there was a more modest decrease for pain intensity. The MSK diagnoses were dispersed across all five phenotypes, where the phenotypes showed clearly different trajectories for recovery and course of symptoms over 12 months follow-up. This variation was not captured by the single trajectory for site specific MSK diagnoses.
    Conclusion: Prognostic subgrouping revealed more diverse patterns in pain and function recovery over 1 year than observed in the same patients classified by traditional diagnostic groups and may better reflect the diversity in recovery of common MSK disorders.
    MeSH term(s) Humans ; Musculoskeletal Pain/diagnosis ; Musculoskeletal Pain/epidemiology ; Phenotype ; Physical Therapy Modalities ; Primary Health Care ; Prognosis
    Language English
    Publishing date 2021-05-19
    Publishing country England
    Document type Journal Article ; Observational Study
    ISSN 1471-2474
    ISSN (online) 1471-2474
    DOI 10.1186/s12891-021-04332-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Correction to: Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes.

    Aasdahl, Lene / Granviken, Fredrik / Meisingset, Ingebrigt / Woodhouse, Astrid / Evensen, Kari Anne I / Vasseljen, Ottar

    BMC musculoskeletal disorders

    2021  Volume 22, Issue 1, Page(s) 586

    Language English
    Publishing date 2021-06-25
    Publishing country England
    Document type Published Erratum
    ISSN 1471-2474
    ISSN (online) 1471-2474
    DOI 10.1186/s12891-021-04428-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Two-Year Follow-Up of a Randomized Clinical Trial of Inpatient Multimodal Occupational Rehabilitation Vs Outpatient Acceptance and Commitment Therapy for Sick Listed Workers with Musculoskeletal or Common Mental Disorders.

    Aasdahl, Lene / Vasseljen, Ottar / Gismervik, Sigmund Østgård / Johnsen, Roar / Fimland, Marius Steiro

    Journal of occupational rehabilitation

    2021  Volume 31, Issue 4, Page(s) 721–728

    Abstract: Purpose There is a lack of results on long-term effects of return to work interventions. We previously reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective in reducing sickness absence and facilitating ... ...

    Abstract Purpose There is a lack of results on long-term effects of return to work interventions. We previously reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective in reducing sickness absence and facilitating return to work (RTW) at 12 months follow-up compared to an outpatient program that consisted mainly of Acceptance and Commitment Therapy (O-ACT). We now report the 2-year outcome data. Methods A randomized clinical trial with parallel groups. Participants were 18-60 years old, sick listed with musculoskeletal, common mental or general/unspecified disorders. I-MORE lasted 3.5 weeks and consisted of ACT, physical training and work-related problem solving. O-ACT consisted mainly of 6 weekly sessions (2.5 h. each) of ACT in groups. Outcomes were cumulated number of days on medical benefits and time until sustainable RTW (1 month without medical benefits) during 2-years of follow-up, measured by registry data. Results For the 166 randomized participants, the median number of days on medical benefits was 159 (IQR 59-342) for I-MORE vs 249 days (IQR 103-379; Mann-Whitney U test, p = 0.07), for O-ACT. At 2 years, 40% in I-MORE received long-term benefits (work assessment allowance) vs 51% in O-ACT. The crude hazard ratio (HR) for sustainable RTW was 1.59 (95% CI 1.04-2.42, p = 0.03) and the adjusted HR 1.77 (95% CI 1.14-2.75, p = 0.01), in favor of I-MORE. Conclusions The 2-year outcomes show that I-MORE had long-term positive effects on increasing work participation for individuals sick listed with musculoskeletal and mental disorders. Further follow-up and economic evaluations should be performed.
    MeSH term(s) Acceptance and Commitment Therapy ; Adolescent ; Adult ; Follow-Up Studies ; Humans ; Inpatients ; Mental Disorders ; Middle Aged ; Outpatients ; Sick Leave ; Young Adult
    Language English
    Publishing date 2021-03-25
    Publishing country Netherlands
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1171536-4
    ISSN 1573-3688 ; 1053-0487
    ISSN (online) 1573-3688
    ISSN 1053-0487
    DOI 10.1007/s10926-021-09969-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Physiotherapy interventions improve tennis elbow with superior long-term outcomes to corticosteroid injections.

    Vasseljen, Ottar

    The Australian journal of physiotherapy

    2007  Volume 53, Issue 1, Page(s) 61

    Language English
    Publishing date 2007-02-20
    Publishing country Australia
    Document type Comment ; Journal Article
    ZDB-ID 605885-1
    ISSN 0004-9514
    ISSN 0004-9514
    DOI 10.1016/s0004-9514(07)70063-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Home exercises and supervised exercises are similarly effective for people with subacromial impingement: a randomised trial.

    Granviken, Fredrik / Vasseljen, Ottar

    Journal of physiotherapy

    2015  Volume 61, Issue 3, Page(s) 135–141

    Abstract: Question: Are there different effects of home exercises and supervised exercises on pain and disability for people with subacromial impingement?: Design: Randomised trial with two treatment arms, concealed allocation, blinded assessment of some ... ...

    Abstract Question: Are there different effects of home exercises and supervised exercises on pain and disability for people with subacromial impingement?
    Design: Randomised trial with two treatment arms, concealed allocation, blinded assessment of some outcomes, and intention-to-treat analysis.
    Participants: Forty-six patients with subacromial impingement were recruited from an interdisciplinary outpatient clinic of physical medicine and rehabilitation at a university hospital in Norway.
    Intervention: The home exercise group had one supervised exercise treatment followed by exercises at home for 6 weeks. The supervised exercise group had up to 10 supervised exercise treatments in addition to home exercises for 6 weeks.
    Outcome measures: The primary outcome was the Shoulder Pain and Disability Index (SPADI). Secondary outcome variables were: average pain during the past week, the Fear Avoidance Beliefs Questionnaire, participant satisfaction with treatment, active range of motion, work status and clinical shoulder tests. Pain was assessed weekly and all outcomes were assessed at 6 weeks. Participants were free to seek ongoing treatment of their choice until 26 weeks, when the SPADI was assessed again.
    Results: While both groups improved considerably, the groups did not differ significantly on the SPADI after the intervention at 6 weeks (0 points, 95% CI -14 to 14) or when followed up at 26 weeks (-2 points, 95% CI -21 to 17). There were no between-group differences for pain at any time. The remaining outcomes also did not differ significantly, except for the clinical tests of shoulder impingement. In the supervised exercise group, 11 out of 23 participants had two or more positive tests, compared to 18 out of 21 in the home exercise group.
    Conclusion: Supervision of more than the first session of a 6-week exercise regimen did not cause significant differences in pain and disability in people with subacromial impingement.
    Trial registration: NCT01257113.
    MeSH term(s) Aged ; Aged, 80 and over ; Disability Evaluation ; Exercise Therapy/methods ; Female ; Humans ; Male ; Middle Aged ; Pain Measurement ; Self Care/methods ; Shoulder Impingement Syndrome/rehabilitation ; Treatment Outcome
    Language English
    Publishing date 2015-07
    Publishing country Netherlands
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2543915-7
    ISSN 1836-9561 ; 1836-9553 ; 0004-9514
    ISSN (online) 1836-9561
    ISSN 1836-9553 ; 0004-9514
    DOI 10.1016/j.jphys.2015.05.014
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  10. Article ; Online: SupportPrim-a computerized clinical decision support system for stratified care for patients with musculoskeletal pain complaints in general practice: study protocol for a randomized controlled trial.

    Lervik, Lars Christian Naterstad / Vasseljen, Ottar / Austad, Bjarne / Bach, Kerstin / Bones, Anita Formo / Granviken, Fredrik / Hill, Jonathan C / Jørgensen, Pål / Øien, Torbjørn / Veites, Paola Marin / Van der Windt, Danielle A / Meisingset, Ingebrigt

    Trials

    2023  Volume 24, Issue 1, Page(s) 267

    Abstract: Background: Musculoskeletal disorders represented 149 million years lived with disability world-wide in 2019 and are the main cause of years lived with disability worldwide. Current treatment recommendations are based on "one-size fits all" principle, ... ...

    Abstract Background: Musculoskeletal disorders represented 149 million years lived with disability world-wide in 2019 and are the main cause of years lived with disability worldwide. Current treatment recommendations are based on "one-size fits all" principle, which does not take into account the large degree of biopsychosocial heterogeneity in this group of patients. To compensate for this, we developed a stratified care computerized clinical decision support system for general practice based on patient biopsychosocial phenotypes; furthermore, we added personalized treatment recommendations based on specific patient factors to the system. In this study protocol, we describe the randomized controlled trial for evaluating the effectiveness of computerized clinical decision support system for stratified care for patients with common musculoskeletal pain complaints in general practice. The aim of this study is to test the effect of a computerized clinical decision support system for stratified care in general practice on subjective patient outcome variables compared to current care.
    Methods: We will perform a cluster-randomized controlled trial with 44 general practitioners including 748 patients seeking their general practitioner due to pain in the neck, back, shoulder, hip, knee, or multisite. The intervention group will use the computerized clinical decision support system, while the control group will provide current care for their patients. The primary outcomes assessed at 3 months are global perceived effect and clinically important improvement in function measured by the Patient-Specific Function Scale (PSFS), while secondary outcomes include change in pain intensity measured by the Numeric Rating Scale (0-10), health-related quality of life (EQ-5D), general musculoskeletal health (MSK-HQ), number of treatments, use of painkillers, sick-leave grading and duration, referral to secondary care, and use of imaging.
    Discussion: The use of biopsychosocial profile to stratify patients and implement it in a computerized clinical decision support system for general practitioners is a novel method of providing decision support for this patient group. The study aim to recruit patients from May 2022 to March 2023, and the first results from the study will be available late 2023.
    Trial registration: The trial is registered in ISRCTN 11th of May 2022: 14,067,965.
    MeSH term(s) Humans ; Decision Support Systems, Clinical ; Quality of Life ; Musculoskeletal Pain/therapy ; General Practice ; General Practitioners ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2023-04-11
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-023-07272-6
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