<p>The background to the thesis is the high rate for sickness absence in Sweden since the end of the 1990s. In an international perspective, the Swedish sickness absence appears exceptionally high. This can appear paradoxical bearing in mind the high standard of living and the high average length of life in Sweden, and there is much to indicate that complex causal correlations are involved.</p><p>The overall aim of the thesis is to study and analyse the return to work or transition to disability pension, for persons on long-term sick leave from their own perspective. The focus of the thesis is the individual in a social context.</p><p>The theoretical frame of reference is within medical sociology and is about sickness concepts and models and on medicalisation. The concept of work capacity is also taken up based on the concepts of disability and impairment.</p><p>The empirical material consists of four studies. Two of these are qualitative interview studies with women. One of them (I) is about Greek women who have been granted Swedish disability pension. The aim of this study is to find explanations why such a large number of Greek women have become disability pensioners in Sweden. The analysis indicated some important factors: the doctors, the family and the social insurance system. The women had unclear psychosomatic complaints, which had been medicalised. The other qualitative study (IV) concerned women who after sick leave and rehabilitation succeeded in returning to work. It was seen to be strong and stubborn women who had to struggle to get back to working life. They had also been well taken care of in rehabilitation.</p><p>The other two studies (II and III) are quantitative, prospective cohort studies with persons on sick leave with unspecified back and neck complaints. One main aim of one study (III) was to investigate the importance of motivation for rehabilitation and return to work. Two specially designed forms were used. It was seen, among other things that the forecasts of the person on sick leave on return to work coincided quite well with a follow-up two years later. One important result was that those who had undergone rehabilitation measures had returned to work to a much lesser extent than those who had not.</p><p>Overall, the results showed the importance of listening to the individual and taking their own assessments of obstacles and possibilities in the rehabilitation process into consideration. The results in study III indicated that rehabilitation had not been sufficiently effective and in many cases did not lead to a return to work.</p>

The background to the thesis is the high rate for sickness absence in Sweden since the end of the 1990s. In an international perspective, the Swedish sickness absence appears exceptionally high. This can appear paradoxical bearing in mind the high standard of living and the high average length of life in Sweden, and there is much to indicate that complex causal correlations are involved. The overall aim of the thesis is to study and analyse the return to work or transition to disability pension, for persons on long-term sick leave from their own perspective. The focus of the thesis is the individual in a social context. The theoretical frame of reference is within medical sociology and is about sickness concepts and models and on medicalisation. The concept of work capacity is also taken up based on the concepts of disability and impairment. The empirical material consists of four studies. Two of these are qualitative interview studies with women. One of them (I) is about Greek women who have been granted Swedish disability pension. The aim of this study is to find explanations why such a large number of Greek women have become disability pensioners in Sweden. The analysis indicated some important factors: the doctors, the family and the social insurance system. The women had unclear psychosomatic complaints, which had been medicalised. The other qualitative study (IV) concerned women who after sick leave and rehabilitation succeeded in returning to work. It was seen to be strong and stubborn women who had to struggle to get back to working life. They had also been well taken care of in rehabilitation. The other two studies (II and III) are quantitative, prospective cohort studies with persons on sick leave with unspecified back and neck complaints. One main aim of one study (III) was to investigate the importance of motivation for rehabilitation and return to work. Two specially designed forms were used. It was seen, among other things that the forecasts of the person on sick leave on return to work coincided quite well with a follow-up two years later. One important result was that those who had undergone rehabilitation measures had returned to work to a much lesser extent than those who had not. Overall, the results showed the importance of listening to the individual and taking their own assessments of obstacles and possibilities in the rehabilitation process into consideration. The results in study III indicated that rehabilitation had not been sufficiently effective and in many cases did not lead to a return to work.

Aims: The starting point of this study was the experience of great problems with persons on long-term sick leave in the county of Västerbotten. In order to illuminate the situation we designed a study of the actors most involved who dealt with persons on long-term sick leave. These actors were the medical doctors; the employers: the social insurance officials; and members of the board of social insurance and persons reporting on the cases to the board. One aim was to describe and analyse the situation for persons on sick leave. Another aim was to describe and analyse the perception of the role the different actors played when dealing with persons on long-term sick leave. The third aim was to describe and analyse the different actors' views of each other, and of the co-operation around the persons on long-term sick leave. Method and material: Interviews with persons on sick leave, employers, social insurance officials and medical doctors. Questionnaires were sent to persons on sick leave, doctors and the members of the board of social insurance and those reporting on the cases. The interviews were audio- taped and transcribed word by word. Coding and analysis of collected data was done simultaneously by performing new interviews, using an adjusted form of grounded theory with the purpose of trying to find patterns and contexts. The aim was to describe the subjective experiences of how the actors look upon their situation and their way of coping with it. Results: The interviews with the employers showed great differences in attitudes and ways of treating employees, which also led to different models for dealing with work environment, sickness absence and rehabilitation. We divided the employers into five different "ideal types". Two of them could be described as "well-functioning" with regard to rehabilitation, and three of them as "less well-functioning". A high degree of flexibility characterises the successful employer, and he also takes good care of his personnel. The good employer also co-operates with other actors. The employers that are not well-functioning are not engaged in making adjustments, and have little confidence in their staff; the unions within their field are weak. Interviews with medical doctors revealed that they felt lonely, and that the demands were frustrating to them. They also had feelings of losing the locus of control. The doctors showed lack of knowledge of the labour market and the social insurance legislation, which made their work harder. They experienced that their lack of time made sickness periods longer. Among the results from the interviews with social insurance officials can be mentioned that they had good knowledge about laws, but sometimes it was difficult to use their knowledge and methods due to lack of flexibility. They experienced feelings of loneliness and had great difficulty in making decisions. Co-operation with partners often did not work out - the officials did not demand so much of their co-actors. The results of the questionnaire directed towards the members of the board of social insurance and those who reported on the cases did not show statistically significant differences between the three counties. The members of the board had almost the same proposals for decision as those who reported on the cases. There were no significant differences between men and women in decision-making. As a whole the members of the board seemed to be skilled in their knowledge of how to use the social insurance legislation. The results of the interviews with persons on sick leave showed that those persons had difficulties in asking for help and support. They felt such loyalty to their employers that they did not ask for adjustments of working places when needed. At the same time they were disappointed that the employers were not sufficiently involved in making it possible to come back to work again. More than half of the respondents had not received enough support from the employers, the medical doctors or the social insurance officials. Most of them felt frustrated, with little or no hope for the future. The results of the questionnaire to persons on long-term sick leave showed that women took a greater responsibility for their own rehabilitation, while the employers showed an earlier interest in sick male employees than in sick female employees. The employers were also keener to adjust the working places for men than for women. Despite those factors, women more often met their employers than men did, and they also had a more positive attitude to social insurance officials and doctors than men had. People with longer education took greater responsibility for their rehabilitation than those with shorter education. Compared to older people, younger persons were more optimistic about their future health and work, and also expressed that work was not so stressful. / digitalisering@umu

OBJECTIVE: The aim of this study was to analyse how people who return to the labour market after long-term sickness absenteeism and subsequent job loss differ in employability, work ability, health, educational level, age, and gender, compared to those who do not. PARTICIPANTS: The cohort consisted of 191 individuals, 20 men and 171 women, whose employment was terminated because they had not been able to return to their regular work after taking a long-term sick leave and rehabilitation measures. METHODS: This study is based on a postal questionnaire sent out to a cohort of previous employees in a Swedish municipality in 2008. RESULTS: At the time of the survey, 39% of the respondents had returned to the labour market and the remaining 61% had not. Return to the labour market after a long-term sick leave was positively associated with male gender, young age, and work ability, i.e. the ability to work with respect to health and work-related demands. Employability, educational level, and health were not significantly associated with a return to the labour market. CONCLUSIONS: In the discourse on employability, work ability is often neglected even though it is a central aspect of an individual's ability to obtain new employment.

<p>Flera studier har pekat på viktiga faktorer för att hälsa och återgång till yrkeslivet ska vara möjliga men hur detta i praktiken ska ske och vilka rehabiliteringsåtgärder som är mest effektiva är otillräckligt belagt. Studien har genom intervjuer med sju kvinnor med stressrelaterade störningar granskat hur en tillfriskningsprocess kan upplevas och vad som upplevs som meningsfull hjälp i samband med den. Deras tillfriskning har inneburit en kamp och ett starkt personligt engagemang. Beslutsamhet och målinriktning var förutsättningar för att få ta del av rehabiliteringsåtgärder. Kvinnorna i studien har upplevt ett stort personligt ansvarstagande för sin tillfriskning men de har också betonat vikten av bekräftelse från en förstående omgivning. En stor besvikelse har uttryckts gentemot Försäkringskassan och i vissa fall arbetsgivare för bristande förståelse, stöd och hjälp. Genom bland annat kampandan har kvinnorna utvecklat sin självkännedom och sin livssituation.</p> / <p>Several studies have identified factors associated with the promotion of health and return to work. But knowledge is insufficient of how this is practically done and which rehabilitation methods are most effective. This study aimed to shed light on women’s experiences of their rehabilitation process and also experiences of meaningful support associated with the process. Interviews were done with seven women with stress-related disorders whose recovery involved great efforts and a great deal of personal responsibility. The respondents’ determination was a condition for receiving the needed rehabilitation measures. They also emphasized the importance of social support and an empathetic attitude from others. Respondents expressed disappointment with the way The Swedish Social Insurance Agency and employers have handled and treated them. Through the struggles women in this study have endured, they’ve achieved personal growth and the awareness needed to change their situation of life.</p>

Flera studier har pekat på viktiga faktorer för att hälsa och återgång till yrkeslivet ska vara möjliga men hur detta i praktiken ska ske och vilka rehabiliteringsåtgärder som är mest effektiva är otillräckligt belagt. Studien har genom intervjuer med sju kvinnor med stressrelaterade störningar granskat hur en tillfriskningsprocess kan upplevas och vad som upplevs som meningsfull hjälp i samband med den. Deras tillfriskning har inneburit en kamp och ett starkt personligt engagemang. Beslutsamhet och målinriktning var förutsättningar för att få ta del av rehabiliteringsåtgärder. Kvinnorna i studien har upplevt ett stort personligt ansvarstagande för sin tillfriskning men de har också betonat vikten av bekräftelse från en förstående omgivning. En stor besvikelse har uttryckts gentemot Försäkringskassan och i vissa fall arbetsgivare för bristande förståelse, stöd och hjälp. Genom bland annat kampandan har kvinnorna utvecklat sin självkännedom och sin livssituation. / Several studies have identified factors associated with the promotion of health and return to work. But knowledge is insufficient of how this is practically done and which rehabilitation methods are most effective. This study aimed to shed light on women’s experiences of their rehabilitation process and also experiences of meaningful support associated with the process. Interviews were done with seven women with stress-related disorders whose recovery involved great efforts and a great deal of personal responsibility. The respondents’ determination was a condition for receiving the needed rehabilitation measures. They also emphasized the importance of social support and an empathetic attitude from others. Respondents expressed disappointment with the way The Swedish Social Insurance Agency and employers have handled and treated them. Through the struggles women in this study have endured, they’ve achieved personal growth and the awareness needed to change their situation of life.

The aim of the study was to explore the methods used in horticultural therapy gardens in rehabilitating people suffering from fatigue syndrome. Nine horticultural therapy gardens were contacted of wich three chose to participate. Using case study as method e-mail interviews was carried out with the participants about their establishment and what kind of theories they based their methods upon. The material collected from the interviews was complemented with additional data from the establishments web pages and information pamphlets. Collected data was processed trough content analysis and then formed as background for the development of a program theory for horticultural therapy. The results show some variations in how the different establishments practice horticultural therapy and how they assess and follow up their work. The program theory of horticultural therapy contains gardening and residing in the garden, conversational therapy, autogenic exercise and stress managment. These activities are expected to lead to a higher degree of self perception, a reevaluation of one´s conceptions and higher self esteem. Through these activities the participants are given an increased ability to handle their lives, which in turn is thought to make it possible for them to return to work or studies. The abcense of clearly defined goals with the rehabilitation makes it difficult to determine how effective it is in bringing people with fatigue syndrome back to work. / Syftet med studien var att undersöka hur trädgårdsrehabilitering tillämpas av några verksamheter för att göra en jämförelse i syfte att påvisa likheter och skillnader. Nio verksamheter kontaktades varav tre valde att delta. En fallstudie utfördes där de tre verksamhetsansvariga intervjuades via e-post om sina verksamheters organisation och grundfilosofi samt hur verksamheten utväderades och följdes upp. Som komplement till intervjuerna granskades även verksamheternas presentationer av sig själva på hemsidor och i broschyrer. Resultatet ger en bild av hur tre verksamheter som bedriver trädgårdsrehabilitering för utmattningsdrabbade är utformade, samt i vilken utsträckning de gör utvärderinga och uppföljningar. Gemensamma inslag i rehabiliteringen var trädgårdsvistelse/aktiviteter, hantverksaktiviteter, samtal, stresshantering och avslappningsövningar. Utvärderingar och uppföljningar skedde i varierande grad och med olika mätinstrument. Som en del i att försöka tydliggöra de tänkta verkningsmekanismerna i trädgårdsrehabiliteringen och ge en översiktlig bild av metoden, utformades även en programteori. Den utgår från verksamheternas metoder samt vetenskaplig evidens inom området. Programteorin visar hur de tänkta aktiviteterna förväntas leda fram till slutresultatet. Den, för trädgårdsrehabilitering, utformade programteorin innehåller vistelse i trädgård och trädgårdsarbete, samtalsterapi, avslappningsövningar och stresshantering. Aktiviteterna förväntas leda till en ökad självinsikt, ett ändrat förhållningssätt och en bättre självkänsla, och genom det en ökad förmåga att hantera sin livssituation. Detta antas ge de förutsättningar som behövs för att kunna återgå till arbetsliv eller studier, alternativt fortsätta rehabiliteringen med arbetsträning. Avsaknaden av tydliga, mätbara mål med rehabiliteringen gör det svårt att värdera hur effektiv rehabiliteringsformen egentligen är på att återinföra utmattningsdrabbade i arbetslivet.

Bakgrund.Ländryggssmärta förekommer hos piloter och kan eventuellt vara en anledning till framtida långtidssjukskrivningar. Möjliga påverkande faktorer är antal yrkesverksamma år och träningsvanor. Det finns få antal studier gjorda på kommersiellt flygande piloter.  Syfte.Att kartlägga förekomsten av ländryggssmärta hos piloter inom kommersiell luftfart samt undersöka risken för långtidssjukskrivning. Vidare kartlägga skillnader i förekomst av ländryggssmärta hos piloter som arbetat &lt;10 respektive &gt;10 år samt att undersöka sambandet mellan ländryggssmärta och självskattad träningsvana. Metod.En tvärsnittsstudie genomfördes med webbenkät. Enkäten bestod av ett antal inledande egendesignade frågor och därefter följde Örebroformuläret kortversion av Steven Linton. Resultat.Antalet deltagare i studien var 73 respondenter vilket motsvarar en svarsfrekvens på 30 %. Totalt 57.5 % av de 73 respondenterna angav sig ha ländryggssmärta, av dessa hade majoriteten besvärats av smärtan i över ett år. Resultaten visade på att de piloter som hade ländryggssmärta inte hade en ökad risk för långtidssjukskrivning men att det fanns en skillnad i förekomst av ländryggssmärta hos de som arbetat över respektive under tio år (p=0.017). Korrelationen mellan träningsvanor och förekomst av ländryggssmärta var inte statistiskt signifikanta (r=0.03), (p=0.80). Konklusion.Prevalensen av ospecifik ländryggssmärta hos kommersiellt flygande piloter var hög och föreföll att öka med antalet yrkesverksamma år. Ytterligare forskning behöver undersöka vilka faktorer som bidrar till den höga förekomsten av ospecifik ländryggssmärta. / Background.Low back pain is common among commercial flying pilots and may possibly be a reason for future long- term sick leave. Possible influencing factors are the number of working years and exercise habits. There are few studies researching commercial flying pilots. Purpose.To describe the prevalence of low back pain among commercial flying pilots and to investigate the risk of long- term sick leave. Furthermore, identify differences in the incidence of low back pain among pilots who has worked &lt;10 compared to &gt;10 years, as well as to investigate the correlation between low back pain and self-assessed exercise habits. Method.A cross-sectional study was conducted with a web survey. The survey initially consisted of self-designed questions followed by “Örebroformuläret kortversion” by Steven Linton. Results.The study contained 73 respondents, which corresponded to a response rate of 30%. A total of 57.5% of the 73 respondents indicated that they had low back pain, of which the majority had been suffering for over a year.  The results showed that the pilots who had low back pain had no risk of long-term sick leave. There was a difference in the incidence of low back pain in those who worked over compared to under ten years (p=0.017). The correlation between exercise habits and the incidence of low back pain was not statistically significant (r=0.03), (p=0.08). Conclusion.The prevalence of nonspecific low back pain in commercial flying pilots was high and seemed to increase with the number of working years. Further research needs to investigate which factors contribute to the high incidence of nonspecific low back pain.

<p>Vocational rehabilitation is an ongoing issue that directly or indirectly affects everyone at a workplace. In recent years, laws and rules have changed. The 1st July 2008 changes were made in the General Insurance Act (SFS 1962:381). These changes have meant that there is now a so-called rehabilitation chain.  The rehabilitation chain contains time frames for when sick people will have their ability to work tested against their normal work or to other jobs. If a person is considered having enough capacity to be able to work he or she will lose their entitlement to sick pay.</p><p>The aim of our study is to investigate managers’ perceptions of the new rehabilitation chain, with a focus on vocational rehabilitation of long-term sick to get them back to work.</p><p>The method used was qualitative and data collection was done through nine semi-structured interviews. The results showed that the managers we interviewed believe that their primary responsibility in the rehabilitation work is to be the link between sick leave and workplace. The managers generally think that the introduction of the rehabilitation chain is a good thing. It has become clearer with what to do when an employee becomes ill and the timeframes provides a degree of security as the managers know when different things will happen. Our results also show that managers believe that cooperation with external actors such as social insurance has become easier since the rehabilitation chain was introduced. Some believe that the timeframes may be too tight and they are worried that the individual is forgotten in the process. The conclusion of our study was that there has been a need for a more active and transparent process of rehabilitation and this need has been met by the rehabilitation chain. Although the managers think that the rehabilitation work has become clearer, there is some disagreement in the way of working with sick leave. Some managers say for example that they are still doing so-called rehabilitation investigations, although it shifted responsibility from themselves to the Social Insurance Agency.</p>

Vocational rehabilitation is an ongoing issue that directly or indirectly affects everyone at a workplace. In recent years, laws and rules have changed. The 1st July 2008 changes were made in the General Insurance Act (SFS 1962:381). These changes have meant that there is now a so-called rehabilitation chain.  The rehabilitation chain contains time frames for when sick people will have their ability to work tested against their normal work or to other jobs. If a person is considered having enough capacity to be able to work he or she will lose their entitlement to sick pay. The aim of our study is to investigate managers’ perceptions of the new rehabilitation chain, with a focus on vocational rehabilitation of long-term sick to get them back to work. The method used was qualitative and data collection was done through nine semi-structured interviews. The results showed that the managers we interviewed believe that their primary responsibility in the rehabilitation work is to be the link between sick leave and workplace. The managers generally think that the introduction of the rehabilitation chain is a good thing. It has become clearer with what to do when an employee becomes ill and the timeframes provides a degree of security as the managers know when different things will happen. Our results also show that managers believe that cooperation with external actors such as social insurance has become easier since the rehabilitation chain was introduced. Some believe that the timeframes may be too tight and they are worried that the individual is forgotten in the process. The conclusion of our study was that there has been a need for a more active and transparent process of rehabilitation and this need has been met by the rehabilitation chain. Although the managers think that the rehabilitation work has become clearer, there is some disagreement in the way of working with sick leave. Some managers say for example that they are still doing so-called rehabilitation investigations, although it shifted responsibility from themselves to the Social Insurance Agency.