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1.  A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial 
Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited.
The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups.
140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress.
By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen’s d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen’s d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up.
The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention.
Trial Registration NCT01236209; (Archived by WebCite at
PMCID: PMC3636011  PMID: 23538392
Internet-based personalized feedback; widespread chronic pain; fibromyalgia; pain management; eHealth; smartphone; Internet; cognitive therapy; catastrophization
2.  Changes in health-related quality of life in people with morbid obesity attending a learning and mastery course. A longitudinal study with 12-months follow-up 
Severe obesity is a complex condition that is associated with a wide range of serious health complications and reduced health-related quality of life (HRQoL). In addition to physiological factors, activity and participation, environmental factors, and personal factors are related to an individual’s overall quality of life HRQoL. In Norway, a course based on cognitive behavioral principles is offered to people seeking medical treatment for weight management. The aim is to assist participants to achieve a healthier lifestyle and thereby improve their HRQoL. We therefore investigated changes in HRQoL in participants after they attended this learning and mastery course, and explored how well sociodemographic variables, paid work, social support, personal factors, and surgery predicted HRQoL at 12-month follow-up.
A single-group longitudinal study was conducted. Data were collected by self-reported questionnaires. This article reports on those who had completed the questionnaire at the 12-month (n = 69) follow-up. HRQoL was assessed with the EQ-5D. Other standardized instruments measured employment, social support, self-efficacy, and surgery.
At the 12-month follow-up, participants scored higher on all dimensions of the EQ-5D and on the EQ-VAS. Generalized linear model showed that having paid work, and social support were statistically significant predictors of HRQoL at the 12-month follow-up. Sex, self-efficacy, and surgery were not statistically significant associated with HRQoL.
Participation in paid work, and receiving social support from persons with whom they had a close relationship were strongly related to HRQoL in obese people 12 months after participating in a learning and mastery course.
Trial registration
The study is registered in Clinical Trials: NCT01336725.
PMCID: PMC3462106  PMID: 22901031
Obesity; Health-related quality of life; Social support; Patient education; Bariatric surgery
3.  Volunteering in dementia care – a Norwegian phenomenological study 
The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for health care services. It is assumed that volunteers will strengthen community health care services more in the future than they do today.
The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia.
Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method.
Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the health care professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role.
In order to promote volunteering in a caring context, mutual trust and freedom should be emphasized. Being conscious of important volunteer characteristics like their experiences, knowledge, and caring behavior, as well as a focus on the staff showing appreciation and providing feedback, may be the difference between success and failure.
PMCID: PMC3292403  PMID: 22396627
activity; early stage dementia; phenomenology; voluntary work
4.  Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based intervention 
This pretrial study aimed to develop and test the usability of a four-week Internet intervention delivered by a Web-enabled mobile phone to support self-management of chronic widespread pain.
The intervention included daily online entries and individualized written feedback, grounded in a mindfulness-based cognitive behavioral approach. The participants registered activities, emotions and pain cognitions three times daily using the mobile device. The therapist had immediate access to this information through a secure Web site. The situational information was used to formulate and send a personalized text message to the participant with the aim of stimulating effective self-management of the current situation. Six women participated and evaluated the experience.
The intervention was rated as supportive, meaningful and user-friendly by the majority of the women. The response rate to the daily registration entries was high and technical problems were few.
The results indicate a feasible intervention. Web-applications are fast becoming standard features of mobile phones and interventions of this kind can therefore be more available than before.
Trial registration number NCT01236209
PMCID: PMC3050782  PMID: 21352516
5.  Personal factors associated with health-related quality of life in persons with morbid obesity on treatment waiting lists in Norway 
Quality of Life Research  2011;20(8):1187-1196.
To explore relationships of socio-demographic variables, health behaviours, environmental characteristics and personal factors, with physical and mental health variables in persons with morbid obesity, and to compare their health-related quality of life (HRQoL) scores with scores from the general population.
A cross-sectional correlation study design was used. Data were collected by self-reported questionnaire from adult patients within the first 2 days of commencement of a mandatory educational course. Of 185 course attendees, 142 (76.8%) volunteered to participate in the study. Valid responses on all items were recorded for 128 participants. HRQoL was measured with the Short Form 12v2 from which physical (PCS) and mental component summary (MCS) scores were computed. Other standardized instruments measured regular physical activity, social support, self-esteem, sense of coherence, self-efficacy and coping style.
Respondents scored lower on all the HRQoL sub-domains compared with norms. Linear regression analyses showed that personal factors that included self-esteem, self-efficacy, sense of coherence and coping style explained 3.6% of the variance in PCS scores and 41.6% in MCS scores.
Personal factors such as self-esteem, sense of coherence and a high approaching coping style are strongly related to mental health in obese persons.
PMCID: PMC3178016  PMID: 21336658
Obesity; Health-related quality of life; Personal factors; Coping; Self-esteem; Sense of coherence; Patient education
6.  Observed communication skills: how do they relate to the consultation content? A nation-wide study of graduate medical students seeing a standardized patient for a first-time consultation in a general practice setting 
In this study, we wanted to investigate the relationship between background variables, communication skills, and the bio-psychosocial content of a medical consultation in a general practice setting with a standardized patient.
Final-year medical school students (N = 111) carried out a consultation with an actor playing the role of a patient with a specific somatic complaint, psychosocial stressors, and concerns about cancer. Based on videotapes, communication skills and consultation content were scored separately.
The mean level of overall communication skills had a significant impact upon the counts of psychosocial issues, the patient's concerns about cancer, and the information and planning parts of the consultation content being addressed. Gender and age had no influence upon the relationship between communication skills and consultation content.
Communication skills seem to be important for final-year students' competence in addressing sensitive psychosocial issues and patients' concerns as well as informing and planning with patients being representative for a fairly complex case in general practice. This result should be considered in the design and incorporation of communication skills training as part of the curriculum of medical schools.
PMCID: PMC2213643  PMID: 17996053

Results 1-6 (6)