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A rehabilitation intervention directed to combating the consequences of pain in activities and participation rather than against pain per se might lead to improved working capacity.

Objective: In order to facilitate comparisons of pain rehabilitation programmes in Sweden and to enable audit spirals for single programmes as well as outcome studies, the Swedish Association for Rehabilitation Medicine initiated a national quality registry in 1995. Patients: Referred for rehabilitation due to pain-related disability. Methods: The registry collects standardized self-reports before assessment, after rehabilitation and one year later, covering demographic, educational and psychometric data, pain intensity, physical disability and life satisfaction. Sick leave data are collected from the National Insurance Board before and up to two years after rehabilitation. At each programme unit self-reports are processed into individual assessment profiles relevant to plan rehabilitation. Data are sent annually to the central registry for analysis and compared with "return to work" data. Each unit can compare its results with national means. Results and conclusion: The organization of the registry is described. Data indicating that contextual factors, but not pain characteristics, depression or activity limitations vary between patients referred to different centres, makes comparisons difficult. As of 2007, data from the multidisciplinary assessment of 19,833 patients have been collected. A total of 7289 patients attended a rehabilitation programme, generating two more self-reports. A limitation of the study is a lack of follow-up data from some units.

A multi-modal rehabilitation programme for the chronic suffering attributed to WAD had positive effects according to several aspects of the retrospective evaluations, but according to most of the aspects evaluated prospectively the programme does not appear to have significant benefits.

Objectives: To determine whether coping profile changes after rehabilitation, assessed with the Multidimensional Pain Inventory (MPI), can predict which persons disabled by chronic musculoskeletal pain will be in receipt of sick leave benefits in the long term. Methods: Study of MPI data from 2,784 patients (709 men and 2,075 women) collected from the Swedish Quality Register for Pain Rehabilitation (SQRP) before and at the end of rehabilitation and compared with independent sick leave data for 1 year later. Results: After rehabilitation there was a significantly decreased share of Dysfunctional profiles (DYS) among both men (44% before, 31% after) and women (39% before, 26% after), but an increased share of Adaptive Coper profiles (men 15% before, 24% after, women 14% before, 24% after). The number of patients on full-time sick leave decreased significantly among men (from 57% to 46%) and women (from 57% to 50%). Persons with a DYS profile after rehabilitation had a low probability of having no or parttime sick leave. Conclusion: The number of persons with DYS profiles decreased after rehabilitation. Those with other profiles had less full-time sick leave one year later than those with DYS profiles, indicating that leaving the DYS profile is a positive prognostic sign long-term. Furthermore, the gender differences observed suggest the need to tailor rehabilitative strategies differently for men and women.

Introduction. The main aims of the present study were: (1) to compare aspects of disability (activity preferences and sick leave) and perceived global situation (life satisfaction) in a patient group with chronic whiplash associated disorders (WAD group; N = 32) with a healthy group of subjects (without neck or shoulder pain) randomly recruited from the official census lists (C group; N = 55), (2) to investigate whether the WAD group has a general hyper vigilance with respect to symptoms and (3) to analyse whether symptoms, signs or activity preferences influence aspects of life satisfaction in the WAD group.Methods. All subjects answered a questionnaire that asked them to disclose their symptoms, activity preferences, sick leave, and satisfaction with life. In addition, all subjects underwent a physical examination.Results. Significantly lower levels of activity preferences were noted Ylva Sterner, MD, PhD, Inga-Britt Bränholm, PhD, and Vanja Nyberg, RPT, are affiliated with the For personal use only. as a whole, physical and psychological health was significantly lower in the WAD group. The WAD group had significantly higher prevalence of several neuropsychological and emotional symptoms, but no general hyper vigilance with respect to all symptoms was noted. Both pain related symptoms and neuropsychological symptoms were of significant importance for aspects of disability and life satisfaction in the WAD group.Conclusions. The present study showed that chronic WAD was associated with marked negative consequences with respect to the activity preferences and the perceived global situation.

The aim of the present study was to analyse the effects of gender and age in a population-based sample of clinically healthy subjects on: (1) strength, endurance and perception of fatigue, (2) mean frequency (MNF) of the electromyogram (EMG), and (3) the ability to relax between active contractions (signal amplitude ratio; SAR) of the surface EMG of an isokinetic shoulder forward flexion test. With this aim we have analysed aspects of the validity of MNF as an indicator of fatigue, using peak torque as a criterion variable. The subjects were 27 men and 28 women (age range: 20-60 years), who were obtained by random sample from the official census lists (participation rate: 66%). The peak torque and surface EMG of two portions of the trapezius, deltoid and infraspinatus muscles were recorded throughout 100 repetitive maximal isokinetic shoulder forward flexions. No significant differences in the perception of fatigue and relative endurance levels of peak torque and work were found between males and females. Males were significantly stronger than females and, on average, females produced approximately 60% of the output of the males; 76% after normalisation for body mass. The men had significantly lower MNF endurance levels for three of the investigated muscles. When controlled for age and body mass, the men had a significantly higher MNF of the deltoid muscle than did the females. These differences were only found for the deltoid muscle. Significant correlations existed between the MNF of the four muscles and biomechanical output, indicating criterion validity for the MNF variable with respect to fatigue. There were no significant effects of gender or age on the ability to relax between repetitive contractions (SAR). The higher prevalence of musculoskeletal complaints of the neck-shoulder region in females cannot be explained by a higher intrinsic muscle tension. Age, gender, body mass index and biomechanical output can have significant effects upon MNF. These effects are important considerations in the interpretation of MNF, for instance in ergonomic situations.

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