Low Back Pain (LBP) is a condition that most people experience at least once in their lifetime and for which many will seek physiotherapeutic intervention. Recently published and internationally recognised clinical guidelines for the management of LBP recommend the use of spinal manual and manipulative therapy techniques alongside exercise, advice, education and pharmaceutical therapies, particularly in the early stages. Other areas of development in the last decade include classification systems, clinical prediction rules (CPR’s), patient-reported outcome measures (PROMS’s) and minimum clinically important difference (MCID) thresholds. Additionally, sympathetic nervous system (SNS) measures of treatment responses are now recognised as providing quantifiable indicators of peripheral, spinal and central effects of manual therapy interventions although research in the lumbar spine is very limited with none providing data on a patient population. The aims of the study were; to determine the reliability and stability of the Biopac System in recording skin conductance (SC) activity levels and calculate the smallest real difference (SRD) statistic; to generate data on the magnitude of SC response to two commonly utilised treatments for LBP; and to observe the changes in a clinical population receiving guideline-endorsed physiotherapy treatment for the management of acute and sub-acute LBP. Furthermore, clinical data analysis sought to identify correlations of SC measures to PROM’s and evaluate the feasibility of using SC responses as a predictive tool for therapeutic outcome. The ability of the Biopac System to reliably record SNS activity was established by using SC measurements with 12 participants on two occasions, one-week apart. Data was recorded within a natural, non-laboratory setting. Results established that SC measurements could be reliably recorded between data sessions with a measurement variability of; ICC=0.99 (p<0.005) with an SRD value of 0.315 μmho’s (4.633%). In conclusion, any SC change above the SRD could be regarded as an SNS change that is independent of any measurement error or variability thus representing a real change ascribable to the intervention under investigation. The pre-clinical investigation compared the magnitude of SC response (SCR) of two, independently administered, specific MT techniques, applied, after randomisation, to the Lumbar 4/5 segment of 50 asymptomatic healthy volunteers. Treatments included; a rotatory lumbar manipulation technique or a repeated McKenzie extension in lying exercise. Findings revealed that both techniques produced statistically significant changes in SNS activity in the lower limbs (> SRD) with manipulative technique SCR’s (76%) that were twice the size of the McKenzie repeated extension in lying exercise (EIL) technique (35.7%)( p=0.0005). Only the manipulation technique had a lasting effect that was carried into the final rest period (p=0.012) but the SNS response was not a side-specific phenomenon (p= 0.76). The final clinical study recruited 60 acute and sub-acute LBP patients (symptoms of up to 12 weeks duration) who received guideline-recommended physiotherapy treatment within a hospital-based musculoskeletal out-patient physiotherapy department. SCRs were recorded throughout all treatment episodes with standardised, validated PROM’s used for comparison of status at inception, mid-point and at discharge. Functional impairment was determined using the Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) with pain intensity evaluated with the Narrative Pain Rating Score (NPRS). A preliminary comparison, between the asymptomatic population and a random selection from the patient population, revealed that patients had treatment SCR’s that were significantly greater (three-fold) than those of the asymptomatic groups (manipulation, p=0.003; EIL exercises p=0.001). Analysis of the patient data indicated that pre-treatment/baseline SC activity levels in the inception data capture point were lower than at discharge (18 µMho’s; p<0.0005) but, conversely, that treatment SC levels were initially high, but diminished in magnitude by discharge (230 to 172 µMho’s; p<0.0005) representing a SCR reduction of 125%. Correlational analyses of change scores of maximum SCR’s to PROM’s, from inception to discharge suggested weak positive correlations of SCR treatment responses to functional disability score improvements (rho 0.278) and pain intensity reductions (rho=0.229) that were significant for function (p=0.033) but not significant for pain (p=0.080). The final analyses indicated that there were trends in the magnitude of response to specific elements of treatment with manipulation having the largest SCR (266%). Further evaluative analysis of SC readings as a predictor, at inception, of functional outcome, at discharge indicated that a critical/cut-off value of 195% may indicate those patients least and most likely to respond positively to MT treatment. Preliminary logistic regression analysis indicated that the 195% SCR value was excellent at identifying poor responders but less successful at identifying good responders, functionally, to treatment. Nonetheless, SCR was a better predictor of outcome than duration of symptoms and patient age. Characteristically, patients achieving the 195% value were most likely to have higher functional disability and pain intensity scores at inception but by discharge had required fewer treatments, had greater overall functional improvement and lower pain intensities than those not achieving this threshold. In conclusion, SC activity levels and SCR’s may be a reliable, stable, alternative and objective measure of LBP patients’ SNS status and changes that occur as a result of symptom abatement throughout a course of physiotherapy treatment. SC readings may (indirectly) reflect the state of dorsal horn (DH) sensitisation and of the central nervous system (CNS) processing system and its facilitatory capacity to activate the descending pain inhibitory system (DPIS). Further research, in patient populations (including chronic LBP patients), is recommended to verify these findings and validate the 195% SCR cut-off point. Definitive RCT’s are indicated to further the understanding of guideline-endorsed physiotherapy treatment (a complex intervention –MRC, 2000) and to determine whether the SNS activity measurements can be used to help classify, predict, and ultimately, direct the care of patients with LBP.

Undersökningar visar att elever med funktionsnedsättning uppger att de trivs sämre i skolan, de upplever ofta högre krav och mer stress från skolarbetet än övriga elever. Arbetsterapi inom skolmiljö riktar sig mot att möjliggöra en stödjande miljö för individen. Syftet med studien var att undersöka och beskriva arbetsterapeuters erfarenheter av arbete i skolan för elever med ADHD och/eller autism. Metoden som författarna använde sig utav var en kvalitativ intervjustudie där deltagarna rekryterades med avsiktligt urval och snöbollsurval. Undersökningen bestod av intervjuer med åtta arbetsterapeuter som arbetar inom skola och habilitering i Sverige. Materialet analyserades enligt kvalitativ innehållsanalys och bygger på arbetsterapeuternas berättelser. Resultatet presenteras i tre kategorier: Utmaningar i skolmiljön, Interventioner samt Skolan som ny arena. Arbetsterapeuterna beskrev utmaningar som målgruppen upplevde i skolmiljö, vilka interventioner som användes samt deras uppfattningar av arbetsterapi i skolan. Slutsatsen är att det finns brist på kunskap om ADHD och autism i omgivningen i skolan. Det finns behov av arbetsterapi i skolan för elever med ADHD och/eller autism. En arbetsterapeut kan med sitt helhetsperspektiv arbeta för att främja aktivitet och delaktighet i skolan. / Studies shows that pupils with disabilities state that they experience a low level of wellbeing in school. Pupils with disabilities often experience higher demands and more stress from school tasks than other pupils. Occupational therapy within school environment is targeted at enabling a supportive environment for the individual. The purpose with this study was to investigate and describe occupational therapist´s experiences of work in school for pupils with ADHD and/or autism. The method that was used by the authors was a qualitative interview study. Participants were recruited by using purposive and snowball sampling. The study consisted of 8 occupational therapists who were working in school and habilitation in Sweden. The material was analyzed by using qualitative content analysis. The results are based on the occupational therapist´s point of view and are presented in three main categories, Challenges in the school environment, Interventions and School as a new arena. The occupational therapists describes challenges in school environment for the pupils, which interventions they were using in their work and their perceptions about occupational therapy in school. The conclusion is that there is a lack of knowledge about ADHD and autism in the surroundings at school. There is a need for occupational therapy in schools for pupils with ADHD and/or autism. An occupational therapist can work with their holistic perspective to promote activity and participation in the school.

There is a high prevalence of child sexual abuse (CSA) in India and the UK (Laccino, 2014). However, there is a lack of research on culturally-specific aspects of psychotherapy offered to child and adolescent survivors of CSA in both these countries. Therapeutic interventions with sexually abused children raise complex concerns due to the heterogeneity based on the developmental stage of children; varied impact, presenting difficulties and needs; and characteristics of abuse, age, gender, ethnicity and cultural factors. Numerous therapeutic interventions for CSA have been documented, with varying theoretical constructs, structure, content and outcome (Reavey & Warner, 2001), ranging from cognitive behavioural, psychoanalytic, humanistic and feminist paradigm (Misurell, Springer, & Tryon, 2011). Most of these approaches do not provide sufficient guides to therapy (Reavey & Warner, 2001). Few of these are widely studied and clinically accepted, while most lack empirical evidence. Although existing studies conclude that therapy is better than no treatment, there is lack of consensus on treatment characteristics important in child and adolescent sexual abuse therapy (Hetzel-Riggin, Brausch, & Montgomery, 2007). Further, little is known about culturally-specific holistic and coherent responses to CSA. A Constructivist Grounded Theory (Charmaz, 2006) study was conducted to investigate therapeutic approaches practiced by professionals in India and the UK with child and adolescent survivors of CSA, and to understand the factors that govern the choice of an approach or model adopted. In-depth, semi-structured interviews were undertaken with 32 professionals (16 each in India and the UK) from different settings including statutory, voluntary and private sector. NVIVO 10 was used for data management and analysis of the digitally recorded and transcribed interviews. Although there is a growing emphasis on evidence-based therapies, with most empirical studies focussing on traditional forms of psychotherapy, the actual practice of the professionals interviewed reflected a more fluid, flexible, multi-modal, ecological and integrative approach to CSA-therapy. The findings indicate that the therapeutic interventions progress through four different phases, based on the goals identified by professionals. The goals in turn are influenced by the socio-cultural context, structural factors, and/or trauma understanding of the professionals. Four phases identified in the study are: 1. Social Action Framework, with the goal to identify silenced and invisible children, particularly in a culture of silence and suppression in India; 2. Stabilisation and Resilience Building Framework, found to be practiced in India and the UK, with the goal to ensure safety and build the foundation for ensuing phase of therapy; 3. CSA-Trauma Resolution Framework, where the goal is to uncover the sexual abuse details to facilitate recovery and reintegrate the traumatised child, more visible in therapeutic practice in the UK; and 4. Maintenance and Relapse Prevention Framework, with the goal to prevent relapse and protect from revictimisation and future developmental difficulties. These phases may be mutually exclusive, follow a linear trajectory, or there may be a back and forth movement from one phase to the other. These four phases were integrated to construct a culturally relevant, ecological-based theoretical model of CSA therapy with child and adolescent survivors.

Challenges like adversity and traumatic experiences can be especially stressful for children since they may not have fully developed certain skills and are often dependent on the support and guidance of adults. The medium of play is a powerful tool and can be used to enhance children to meet challenges better. It is mostly their preferred medium of interaction and allows them to process experiences playfully.The aim of this systematic literature review was to examine existing play therapy interventions that promote intrinsic characteristics of resilience in children. A search for scholarly articles has been carried out in 7 databases, resulting in ten articles included in the analysis. Play therapy interventions explicitly targeting resilience could not be found, as well as play therapy interventions targeting problem-solving abilities and adaptability of children. Interventions that targeted intrinsic characteristics of resilience were Child-Centered-Play-Therapy, Sandplay therapy, and Theraplay. The play therapy interventions were mostly effective but varied in their effect sizes. Results indicate that children with disabilities need a more directed form of play therapy. The field of play therapy interventions supporting explicitly intrinsic characteristics of resilience is a multi-factorial, dynamic, and complex construct that stands in its beginnings of research. Limitations of the study and further research are discussed.

Research has shown that exercise has the potential to improve couple relationships. This study contributes to current literature by examining the associations between exercise, its duration, and its intensity and daily clinical couple interactions. Participants were 22 married couples in a treatment-as-usual setting who completed daily diaries about daily behaviors and marital interactions. Multilevel models were run, and results showed that wives who exercised were more likely to report a negative interaction with their husband that day. When wives exercised longer, both they and their husbands were more likely to report positive interactions that day. Interestingly, if husbands exercised longer on a given day, their wives were less likely to report positive interactions and there was no association between husbands' perception of interactions and their own exercise duration. Finally, we found that when wives exercised more intensely, both she and her husband were less likely to report positive marital interactions. These results have implications for clinicians working with couples in therapy.

Syftet med litteraturstudien var att systematiskt granska studier och sammanställa arbetsterapeutiska interventioners effekt på hjärntrötthet till följd av multipel skleros. Datainsamling gjordes i databaserna PubMed, CINAHL, MEDLINE och Scopus via Luleå Tekniska Universitet under perioden februari till mars 2022. Sökningen resulterade i att totalt nio kvantitativa artiklar inkluderades i litteraturstudien. Resultatet redovisas i tre kategorier;Gruppbaserade interventioner som bygger på Fatigue Management av Packer et al. (1995),Individuella interventioner som bygger på Fatigue Management av Packer et al. (1995) samt Andra arbetsterapeutiska gruppinterventioner. Effekten av de arbetsterapeutiska interventionerna varierade, däremot uppmättes till största del positiva effekter på olika aspekter av hjärntröttheten hos deltagarna. Slutsatsen är att det finns ett behov av fortsatt utveckling avbedömningsinstrument och att studier med större antal deltagare och utökad uppföljning behövs, för att kunna stärka det vetenskapliga underlaget gällande arbetsterapeutiska interventioners effekt på hjärntrötthet till följd av multipel skleros. / The purpose of the literature study was to systematically review studies and compile effects of occupational therapy interventions on fatigue due to multiple sclerosis. Data collection was done in the databases PubMed, CINAHL, MEDLINE and Scopus via Luleå University ofTechnology during the period February to March 2022. The search resulted in a total of nine quantitative articles being included in the literature study. The results are reported in three categories; Group-based interventions based on Fatigue Management by Packer et al. (1995),Individual interventions based on Fatigue Management by Packer et al. (1995) and Otheroccupational therapy group interventions. The effect of the occupational therapy interventionsvaried, however, for the most part positive effects were measured on different aspects of fatiguein the participants. The authors' conclusion is that there is a need for continued development ofassessment instruments and that studies with a larger number of participants and increasedfollow-up are needed, in order to be able to strengthen the scientific basis regarding the effectof occupational therapy interventions on fatigue due to multiple sclerosis.

Objective: Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self-evaluative processes, as conceptualized in the process model of self-stigma, and implications for other health-related outcomes, remain to be clarified. Design and Methods: In a representative general population sample of N = 1158 overweight and obese individuals, the impact of core self-evaluation as a mediator between weight bias internalization and mental and global health outcomes as well as between weight bias internalization and health care utilization, was examined using structural equation modeling. Results: In overweight and obese individuals, greater weight bias internalization predicted lower core self-evaluation, which in turn predicted greater depression and anxiety, lower global health, and greater health care utilization. These mediational associations were largely stable in subsample analyses and after controlling for sociodemographic variables. Conclusions: The results show that overweight and obese individuals with internalized weight bias are at risk for impaired health, especially if they experience low core self-evaluation, making them a group with which to target for interventions to reduce self-stigma. Weight bias internalization did not represent a barrier to health care utilization, but predicted greater health care utilization in association with greater health impairments.

Syfte: Att beskriva och kartlägga arbetsterapeutiska interventioner för vuxna med ME/CFS och betydelsen för aktivitetsbalans. Metod: För att besvara syftet så utfördes en litteraturöversikt som inkluderar kvalitativa studier, kvantitativa studier och litteraturstudier, totalt åtta studier. Resultat: Arbetsterapeutiska interventioner har många fördelar som visar att arbetsterapi som används i rehabilitering har betydelse för vuxna med ME/CFS i det dagliga livet på olika sätt. Att aktiviteter skulle delas upp i relation till klientens aktivitetsnivåer och energinivåer synliggjordes. Individuell intervention som Pacing strategier och Gruppintervention som Gruppbaserad self-managementprogram kan användas som arbetsterapeutiska verktyg för diagnosgruppen ME/CFS och har betydelse för aktivitetsbalans. Det framkommer att kortsiktiga individuella interventioner kan vara kan vara effektiva och att Gruppbaserad self-managementprogram visar inga långvariga effekter. Slutsats: Uppsatsen visar fördelar att tillämpa Pacing som copingstrategi inom arbetsterapi för klienter med ME/CFS. Pacing strategier kan vara ett betydelsefullt arbetsterapeutiskt verktyg eftersom klienterna behöver strategier till att bespara sina energinivåer för meningsfulla aktiviteter. Pacing strategier visar ge goda effekter och beskrivs vara den säkraste intervention för klienter med ME/CFS. Pacing möjliggör för klienterna att uppnå aktivitetsbalans i vardagen. Arbetsterapeutisk gruppintervention som Gruppbaserad self-managementprogram kan vara en del av den arbetsterapeutiska rehabiliteringen av klienter med ME/CFS. Gruppbaserade self-managementprogram är funktionellt inom primärvården, vilket uppskattades av klienterna eftersom det möjliggör klientträffar med andra med samma diagnos. Genom gruppinterventionen har klienterna lärt sig att använda Copingstrategier och arbeta med sin acceptans. Gruppinterventionen resulterade att klienter lärde sig att undvika överansträngning, lärde sig att förändra levnadsvanor, energibesparing vilket kan stödja klienterna. Resultatet visar att efter genomförd gruppintervention är det betydelsefullt för klienter att hålla kontakten och skapa nätverk mellan klienterna. Arbetsterapi och arbetsterapeuten har betydelse för rehabiliteringen av klienter med ME/CFS och för deras aktivitetsbalans i dagliga livet. Det är viktigt att ta hänsyn till klientens uppfattningar, värderingar och synpunkter i relation till klientens diagnos. Ett dåligt bemötande och omhändertagande i hälso-och sjukvården kan påverka rehabiliteringen negativt. Det är betydelsefullt att arbetsterapeuten respekterar och har kunskapen om diagnosens pendlande symtom i samband med rehabiliteringsinsatser och interventioner. Det finns ett behov och efterfrågan om vidare forskning inom området, eftersom det är ett begränsat område gällande arbetsterapi och arbetsterapeutens betydelse i rehabilitering för klienter med ME/CFS som kan främja aktivitetsbalans.

Die vorliegende Literatursichtung belegt, gerade im Lichte neuen Störungswissens und für neue diagnostische Kategorien, die Notwendigkeit, die Wirksamkeit bestehender Therapieformen zu erhöhen und/oder neue Behandlungen für Essstörungen, speziell für Bulimia Nervosa und Binge Eating-Störung, zu entwickeln. Ein wesentlicher Erkenntnisgewinn wird zudem von einer systematischen Analyse des therapeutischen Prozesses sowie von Moderatoren und Mediatoren erwartet. Darüber hinaus stellen die Dissemination evidenzbasierter Therapiemethoden in die Praxis und eine Überprüfung gestufter Behandlungsmodelle wichtige Aufgaben zukünftiger Forschung dar. / The consideration of existing literature, especially in light of new knowledge of eating disorders and new diagnostic categories, highlights the necessity to increase the efficacy of current forms of therapy, and to develop novel therapies for eating disorders. This pertains, in particular, to bulimia nervosa and binge eating disorder. A considerable gain in knowledge is to be expected from a systematic analysis of the therapeutic process as well as the moderators and mediators. Furthermore, dissemination of evidence-based treatment methods in practical settings and an examination of stepped care models are important avenues of future research.

Die Adipositas geht im Erwachsenenalter oft mit psychischer Komorbidität einher, die den Gewichtsreduktionserfolg beeinflussen und eine Behandlung indizieren kann, die von Standardprogrammen der multimodalen Adipositasverhaltenstherapie (AVT) nicht abgedeckt wird. Dieser Artikel diskutiert am Beispiel der häufig komorbiden Binge-Eating-Störung (BES) aktuelle Forschungsergebnisse zu Ätiologie und Intervention bei Komorbidität mit dem Ziel, Implikationen für die weitere Forschung und Behandlung abzuleiten. Weil die Kognitive Verhaltenstherapie (KVT), die am besten belegte Therapieform für Erwachsene mit BES, der AVT bei der Reduktion der Essstörungssymptomatik überlegen war, bei der Gewichtsreduktion nur tendenziell und ausschließlich kurzfristig unterlegen, sollte sich die weitere Interventionsentwicklung auf graduelle Anpassungen der KVT zur Verbesserung der Gewichtsreduktion bei Patienten mit Adipositas und BED konzentrieren. Hierfür kommen mit dem Ziel einer geringfügigen Gewichtsreduktion einzelne adaptierte AVT-Interventionen in Betracht, während sich gleichzeitige oder sequentielle Kombinationen dieser beiden Therapieformen nicht eindeutig bewährt haben. Interventionen, die auf aktuellen Forschungsergebnissen für die Komorbidität beider Störungsbilder fußen, könnten individualisiert einbezogen werden, um die Wirksamkeit für Essstörungssymptomatik und Körpergewicht zu erhöhen. Neue digitale Behandlungsmodalitäten könnten den Transfer in den Lebensalltag und die Nachhaltigkeit der Effekte fördern. Diese Modifikationen hin zu einer adaptiven KVT für Erwachsene mit Adipositas und BES, basierend auf einem patientengerechten Therapierationale, bedürfen der Absicherung durch weitere experimentelle Therapieforschung. / Obesity often co-occurs with mental comorbidity in adults, likely impacting weight loss success and indicating treatment that is not covered by standard behavioral weight loss (BWL) treatment. Using the example of binge-eating disorder (BED) as a frequent comorbid condition, this article discusses current research on etiology and intervention in case of comorbidity, in order to derive implications for research and treatment. Cognitive-behavioral therapy (CBT), the most well-established treatment for adults with BED, was more efficacious than BWL in improving binge-eating symptomatology in patients with obesity and BED, while tending to show lower weight loss effects in the short term only. Therefore, further intervention development should focus on gradual adaptations of CBT for improving weight loss. These interventions could be adapted from BWL and aim at a slight weight loss. Parallel or sequential combinations of these treatments have not consistently demonstrated improved treatment effects. Interventions based on current research could be included on an individual basis, in order to enhance efficacy for eating disorder symptomatology and body weight. New digital treatment modalities could support the transfer into daily life and boost the long-term maintenance of therapeutic gains. These modifications regarding adaptive CBT for adults with obesity and BED should be based on an individual treatment rationale and require further research in an experimental therapeutics framework.