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BACKGROUND: This qualitative study followed participants enrolled in a return to work (RTW) intervention, aiming to address individual physical, psychological and work-related challenges.OBJECTIVE: To explore cancer survivors' experiences of receiving a tailored RTW intervention initiated parallel with chemotherapy and/or radiotherapy.METHODS: Two semi-structured interviews of eight female cancer survivors in treatment for breast cancer (n = 7) or ovaria cancer (n = 1) were conducted prior or close to their RTW and 3-5 months later. Inspired by Margrit Schreier's inductive analysis coding and identification of themes guided the analysis.RESULTS: Participants expressed satisfaction with the RTW intervention, which helped them to cope during the RTW process. Three themes with corresponding subthemes dominated the participants' experience of the RTW intervention. 1) Social workers made participants feel individually coached, 2) Collaboration with social workers helped over time to manage RTW, and 3) Social workers supported participants to conduct and adjust the RTW plan.CONCLUSION: This study shows how the interaction with social workers were based on mutual trust and sense of being cared for, which seems to have a positive impact on how participants managed their RTW. Future research needs to address the long-term challenges in cancer survivors' RTW.

AimsTo examine the temporal trends and factors associated with national cardiac rehabilitation (CR) referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral.Methods and resultsThis cohort study includes all adult patients alive 120 days from incident heart failure (HF) identified by the Danish Heart Failure Registry (n = 33 257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1 year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex [odds ratio (OR): 0.85; 95% confidence interval: 0.80–0.89], older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs. I (OR: 0.75; 0.60–0.95), left ventricular ejection fraction >40%, and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87–0.97) and all-cause mortality (OR: 0.65; 0.58–0.72).ConclusionAlthough increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients at highest risk of non-referral.

Studies suggest that persistent symptoms after COVID-19 (long COVID) influence functioning and activities of daily living (ADL). However, it is still uncertain how and to what extent. This study aimed to describe patient-reported mental fatigue, ADL problems, ADL ability, sick leave and functional status among patients with long COVID. In this cross-sectional study, 448 patients, ≥18 years old and referred to occupational therapy at a Danish Post-COVID-19 Clinic, were included. Mental fatigue was measured by the Mental Fatigue Scale, ADL problems and ability were measured by the Canadian Occupational Performance Measure, sick leave was self-reported and functional status was evaluated by the Post-COVID-19 Functional Status Scale. Mean age was 46.8 years, 73% of the patients were female, and 75% suffered from moderate to severe mental fatigue. The majority reported difficulties performing productive and leisure activities. The median performance and satisfaction scores were 4.8 and 3, respectively. In total, 56% of the patients were on sick leave, and 94% were referred to rehabilitation. A decrease in functional status was found between pre-COVID-19 and assessment. Conclusively, the patients were highly affected in their everyday life and had distinct rehabilitation needs. Future research is needed to address causalities and rehabilitation for this patient group.

BACKGROUND: Work participation among employees with depression is hampered due to cognitive impairments. Although studies show higher levels of work disability among people with a lower education, highly educated employees may encounter specific challenges in fulfilling their work role due to the cognitive impairments of depression, as they often perform cognitively demanding jobs. There is little knowledge about their challenges and opportunities with regard to work participation. OBJECTIVE: To investigate how highly educated employees with depression manage work participation by focusing on their views on opportunities and challenges in fulfilling their work role. METHODS: Eight individual interviews with highly educated employees with depression were conducted. Transcripts were analysed using qualitative content analysis.RESULTS: The analysis revealed four categories: struggling with acknowledging depression and disclosure; fear of being stigmatised at work; work is a motivator in life; and striving to fulfil the work role at the expense of private life activities. CONCLUSIONS: Highly educated employees with depression need guidance regarding the disclosure of information about health issues and work ability. To successfully manage their work role, they need a clear plan with outlined tasks, demands and goals. Healthcare professionals and workplaces should support them in setting limits with regard to work tasks and working hours. BACKGROUND: Work participation among employees with depression is hampered due to cognitive impairments. Although studies show higher levels of work disability among people with a lower education, highly educated employees may encounter specific challenges in fulfilling their work role due to the cognitive impairments of depression, as they often perform cognitively demanding jobs. There is little knowledge about their challenges and opportunities with regard to work participation. OBJECTIVE: To investigate how highly educated employees with depression manage work participation by focusing on their views on opportunities and challenges in fulfilling their work role. METHODS: Eight individual interviews with highly educated employees with depression were conducted. Transcripts were analysed using qualitative content analysis.RESULTS: The analysis revealed four categories: struggling with acknowledging depression and disclosure; fear of being stigmatised at work; work is a motivator in life; and striving to fulfil the work role at the expense of private life activities. CONCLUSIONS: Highly educated employees with depression need guidance regarding the disclosure of information about health issues and work ability. To successfully manage their work role, they need a clear plan with outlined tasks, demands and goals. Healthcare professionals and workplaces should support them in setting limits with regard to work tasks and working hours.

Objective: The objective of this scoping review was to identify studies combining the concepts of eHealth and work participation for sick-listed employees across diagnostic groups in health care and workplace contexts. Introduction: There is an increased demand for better health care services and technologies, and eHealth is proposed as a useful tool to improve efficiency and reduce costs. eHealth functions at the intersection of medical informatics, public health, and business, and may be a promising solution for managing the process of return to work among employees on sick leave. Assessment of work outcomes is essential in evaluating the effectiveness of health services, and there is a need to map the research literature on existing eHealth interventions to facilitate work participation. Inclusion criteria: This scoping review considered studies combining two core concepts: eHealth and work participation. It considered studies on eHealth interventions for employees (18 to 65 years of age) on sick leave due to any type of diagnosis or disability, conducted by any stakeholder in workplace or health care contexts and in any country. Empirical data from both quantitative and qualitative studies were included. Methods: Published and unpublished studies from January 1, 2008, to August 21, 2020, written in English were included in this review. The search was conducted in MEDLINE, Scopus, Embase, PsycINFO, WHO clinical registry, and ClinicalTrials.gov. A three-step search strategy was followed. Data extraction was performed by two independent reviewers and undertaken using an extraction tool developed specifically for the scoping review objectives. Results: This review identified 15 studies eligible for inclusion. Four studies delivered the eHealth intervention by telephone, while 10 interventions were web-based. Of the web-based interventions, five had a blended approach, such as website and email support, or website and social media platforms. One study used an app-based intervention. Only eight studies targeted employees sick-listed due to common sick leave diagnoses, such as common mental disorders and musculoskeletal disorders. The workplace context was the target of the eHealth intervention in seven studies, although the intervention was still delivered by health personnel such as therapists or occupational physicians. Collaboration on individual cases between the health professional, employer, and employee to facilitate work participation seemed to be rare. Four studies reported both a theoretical and an empirical base for the intervention used. Conclusions: This review demonstrated that the use of eHealth interventions to facilitate work participation is limited, and there is a need for future studies on the use of eHealth technology for this purpose. Developing eHealth interventions specifically for populations at risk of long-term sick leave, and encouraging collaboration between all relevant stakeholders, may help improve work participation.

To present the process used to develop the low back pain (LBP) assessment tool including evaluation of the initial content validity of the tool. The development process comprised the elements: definition of construct and content, literature search, item generation, needs assessment, piloting, adaptations, design, and technical production. The LBP assessment tool was developed to assess the construct “functioning and disability” as defined by the International Classification of Functioning, Disability and Health (ICF). Involvement of patients and health professionals was essential. The elements were collapsed into five steps. In total, 18 patients and 12 health professionals contributed to the content and the design of the tool. The LBP assessment tool covered all ICF components shared among 63 ICF categories. This study presents the process used to develop the LBP assessment tool, which is the first tool to address all ICF components and integrate biopsychosocial perspectives provided by patients and health professionals in the same tool. Initial evaluation of content validity showed adequate reflection of the construct “functioning and disability”. Further work on the way will evaluate comprehensiveness, acceptability, and degree of implementation of the LBP assessment tool to strengthen its use for clinical practice.Implications for RehabilitationA biopsychosocial and patients-centred approach is a strong foundation for identifying the many relevant aspects related to low back pain (LBP).Responding to a lack of tools to support a biopsychosocial and patients-centred approach the LBP assessment tool was developed using a robust, multi-step process with involvement of patients and health professionals.The LBP assessment tool is a strong candidate for a user-friendly tool to facilitate use of the International Classification of Functioning, Disability and Health in routine clinical practice. A biopsychosocial and patients-centred approach is a strong foundation for identifying the many relevant aspects related to low back pain (LBP). Responding to a lack of tools to support a biopsychosocial and patients-centred approach the LBP assessment tool was developed using a robust, multi-step process with involvement of patients and health professionals. The LBP assessment tool is a strong candidate for a user-friendly tool to facilitate use of the International Classification of Functioning, Disability and Health in routine clinical practice.

To evaluate comprehensiveness and acceptability of the patient-reported outcome instrument (PRO-LBP) and the clinician-reported outcome instrument (ClinRO-LBP) included in the low back pain (LBP) assessment tool. Second, to assess degree of implementation after three months. Feasibility-testing, training of health professionals, field-testing, and a feedback meeting was undertaken. Field-testing provided data to evaluate comprehensiveness, acceptability, and degree of implementation. Feasibility-testing and training of health professionals revealed that the LBP assessment tool was usable and ready for field-testing. In total, 152 patients participated in the field-testing of whom 95% considered the PRO-LBP comprehensive and 59% found it acceptable. Health professionals found the ClinRO-LBP comprehensive and acceptable. The feedback meeting revealed that the LBP assessment tool broadened the health professionals’ approach to functioning and facilitated a consultation based on the patient perspective. The degree of implementation reached 79%. The PRO-LBP and the ClinRO-LBP covered key concepts of LBP and were found acceptable by patients and health professionals. Despite the reduced degree of implementation after three months the LBP assessment tool allowed the health professionals to apply a biopsychosocial and patient-centred approach. Future research should investigate whether the LBP assessment can enhance patient-centred care.Implications for rehabilitationThe low back pain (LBP) assessment tool is the first evidence-based tangible tool to cover biopsychosocial aspects related to LBP as defined by the International Classification of Functioning, Disability and Health (ICF).The LBP assessment tool allowed health professionals to apply a biopsychosocial and patients-centred approach and has the potential to be used in rehabilitation planning.Awareness to continuous facilitation and training of health professionals is important to facilitate and maintain implementation of new procedures into routine clinical practice. The low back pain (LBP) assessment tool is the first evidence-based tangible tool to cover biopsychosocial aspects related to LBP as defined by the International Classification of Functioning, Disability and Health (ICF). The LBP assessment tool allowed health professionals to apply a biopsychosocial and patients-centred approach and has the potential to be used in rehabilitation planning. Awareness to continuous facilitation and training of health professionals is important to facilitate and maintain implementation of new procedures into routine clinical practice.

Across rehabilitation fields, rehabilitees and professionals meet to set rehabilitation goals. Portrayed as an ordinary, yet foundational practice in rehabilitation, participants often find goal-setting meetings challenging; ideal and real seem to clash. Based on a long-term fieldwork in Danish Parkinson's disease rehabilitation, we explore goal-setting and its rationale to gain insight into why goal-setting qualifies as challenging. We find that challenges relate to disease, organizational matters and an imbalance in institutional knowledge, but also that different logics, of choice, interdependence, and accountability, entangle and affect goal-setting. A competitive aspect between goal-setting logics appears pivotal to understand the challenges in goal-setting.

Purpose: The aim was to examine the potential of outdoor contexts within community-based rehabilitation to empower people with disabilities in their rehabilitation.Materials and methods: Interpretive description was applied as the methodology in a 5-month ethnographic fieldwork study, and guided by social practice theory. In total, 115 people with disabilities were included for participant observation, of which 15 participants were recruited for individual walking interviews.Results: Analysis revealed four overlapping themes. Firstly, "Revisiting the Outdoors" appeared to be an overarching theme, which created a basis for "Building Autonomy" among the participants. The varied outdoor experiences empowered the participants to take a more active role in their rehabilitation. These experiences afforded unique opportunities for "Connecting with Community" and, finally, "Embodied Learning" - that could be transferred to home and to other everyday contexts.Conclusion: Outdoor contexts within community-based rehabilitation appeared to hold strong potential for connecting people with disabilities to communities. Although barriers exist, we argue that revisiting the outdoors supports collective awareness and action with the capacity to influence community attitudes more broadly.IMPLICATIONS FOR REHABILITATIONOutdoor contexts within community-based rehabilitation for people with disabilities capitalise on the features of both indoor and outdoor environments with activities that meet shifting individual priorities and needs.Outdoor contexts within community-based rehabilitation offer people with disabilities empowering experiences that are part of the landscape of everyday life and transfer well to home and other environments.Community-based rehabilitation directly involving outdoor contexts and supported by professional skills provides a crucial bridge from individual rehabilitation to community belonging.

INTRODUCTION: Resuming work during or after cancer treatment has become an important target in cancer rehabilitation.PURPOSE: The aim was in a controlled trial to study the return to work (RTW) effect of an early, individually tailored vocational rehabilitation intervention targeted to improve readiness for RTW in cancer survivors.MATERIAL AND METHODS: Participants diagnosed with breast, cervix, ovary, testicular, colon-rectal, and head-and-neck cancers as well as being employed were allocated to a vocational rehabilitation intervention provided by municipal social workers (n = 83) or to usual municipal RTW management (n = 264). The intervention contained three elements: motivational communication inspired by Acceptance and Commitment Therapy by which RTW barriers were addressed, municipal cancer rehabilitation and finally employer and workplace contact. RTW effect was assessed as relative cumulative incidence proportions (RCIP) in the control and intervention group within 52 weeks of follow-up, estimated from the week where treatment ended at the hospital. RCIP was interpreted and reported as relative risk (RR) with 95% confidence intervals (CI) adjusted for gender, age cancer diagnosis, education, comorbidity, and sick leave weeks.RESULTS: Across cancer diagnoses 69 (83.1%) and 215 (81.4%) returned to work in the intervention and control group, respectively. No statistical effect was seen (RR 1.08 (95% CI 0.98-1.19)). Repeating the analyses solely for participants with breast cancer (n = 290) showed a significant effect of the intervention (RR 1.12 (95% CI 1.01-1.23)).CONCLUSION: More than 80% returned to work in both groups. However, no statistical difference in RTW effect was seen across cancer diagnoses within one year from being exposed to an early, individually tailored vocational rehabilitation intervention compared with usual municipal RTW management.TRIAL REGISTRATION NUMBER: ISRCTN50753764.

The demand for rehabilitation has increased, and evidence is rapidly growing; however, a rehabilitative health strategy receives less attention than treatment. Knowledge of what is being researched, who are the target groups and who contributes to rehabilitation research is deficient. We did not find any reviews mapping rehabilitation research regarding the research questions. The objective was to identify and synthesize existing scientific evidence on rehabilitation research published by Danish institutions between 2001 and 2021. The research questions to be explored were: Among which study groups has rehabilitation research been published?. Which types of studies on rehabilitation have been published?. Which institutions have been involved in rehabilitation research?MethodsThe process was guided according to the Joanna Briggs Institute's (JBI's) scoping review methodology. Four databases were searched. All types of peer-reviewed studies on any target group and rehabilitation setting, with any affiliation to a Danish institution, were eligible to be included. Studies referring to population and the type of design were categorized. Institutions were counted as Danish first authorship.ResultsThe search revealed 3,100 studies, and following screening 1,779 were included. A total of 24 broad study groups were identified, mostly diagnosis-based health conditions. Musculoskeletal, cancer, and cardiac had 342, 228, and 174 studies, respectively. A total of 1,545 had a Danish first authorship, most of the Danish publications came from hospitals (56.6%) and universities (28.4%). The publication trend showed an almost linear development, with a 10–15% increase during the period.ConclusionFollowing screening 1,779 studies were included involving 24 broad study groups. Most categories were diagnosis-based; musculoskeletal, cancer, and cardiac health conditions encompassed most studies. All study designs were represented, and 1/10 were secondary studies. The majority (87%) of studies had a Danish first authorship. The majority of first affiliations were among hospitals followed by universities. A few municipalities were presented although they are yet to have research responsibility. Publication trends showed an increase primarily from 2013.Systematic Review Registrationhttps://osf.io/, identifier [10.17605/OSF.IO/2AENX].

Background The experience of physical activity is influenced by social relations and gendered roles. Group-based lifestyle interventions are considered effective in promoting physical activity, yet the experiences of being active with others are unknown among individuals with severe obesity. Purpose To explore how individuals with severe obesity experience being with others during physical activity. Methods A qualitative hermeneutic phenomenological study of repeated single-gender focus group interviews was conducted with adults living with severe obesity during group-based lifestyle intervention. Results Three themes were developed: 1) 'Enjoying safety, kinship and belonging among peers'; 2) 'Feeling like a failure is shameful: A sense of aversion'; and 3) 'Striving to feel at home in physical activity: Needing distance from others.' The themes were drawn into an overall meaning 'Achieving wellbeing may always be a challenge: not feeling at home in the group or in body.' Conclusion Intersubjective and spatial dimensions of experiences are central and influence how individuals with severe obesity can feel wellbeing and 'at home' in physical activity. Physiotherapists should be aware of the individuals' vulnerability regarding feelings of failure, aversion, and shame as well as awareness of gendered norms and roles.

Aim: To understand healthcare providers’ experiences with video recording of patient consultations. Background: Video recordings have been recognised to be an effective method to evaluate in situ interactions in clinical practice. The video recordings are often conducted by researchers, but active involvement of healthcare providers into the process of recording is evolving. Still, little is known of how video recordings by healthcare providers may influence daily clinical practice and potentials for direct use to guide practice development. Methods: A qualitative design was used, conducting two focus group interviews including 12 healthcare providers representing eight different healthcare services who provide municipal cardiac rehabilitation. Interpretive description was used as the methodological framework, and symbolic interactionism served as the theoretical lens. Findings: Three themes were identified reflecting healthcare providers’ experiences with video recording of patient consultations: ‘Concerns of compromising primary work tasks’, ‘Exposing professional and personal skills’ and ‘A new learning dimension’. Overall, the three themes represent the process of video recording own practices attached to patient consultations and the personal investment attached to the video data. Also, how the recordings may provide new insights for practice development in terms of individual and team-based performance in patient consultations. Conclusion: Video recordings by healthcaref providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice.

Aims: This study aimed to compare health-related quality of life (HRQOL) among cancer survivors and controls in the Danish population, with special attention given to the impact of low educational attainment. Comparisons were made at population level and for subgroups stratified by education. Furthermore, comparisons were made for all cancer diagnoses combined and for the 14 most prevalent cancer sites and ‘other cancer sites’. Finally, the importance of time since initial diagnosis was examined. Methods: HRQOL was measured using the physical component score (PCS) and mental component score (MCS) of the 12-item Short-Form Health Survey version 2 in a population-based survey. By linking data with the Danish Cancer Registry, 11,166 cancer survivors and 151,117 individuals with no history of cancer were identified. Results: HRQOL was reduced in cancer survivors for all cancers combined and most cancer sites. Differences were found at population level and stratified by educational attainment. PCS was reduced to a similar extent in the three educational groups, whereas MCS was reduced slightly more in the low than in the high educational attainment group. HRQOL increased with time since initial diagnosis during the first years. Conclusions: Cancer survivors had lower HRQOL than controls, and HRQOL was lower in the low than in the high educational attainment group. However, low educational attainment did not widen the gap in HRQOL following a cancer diagnosis. Despite this, the combined effect of low educational attainment and a cancer diagnosis markedly reduced HRQOL in some cancer survivors. The study identified groups of cancer survivors with low HRQOL who may have unmet rehabilitation needs.

Background Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA). Method A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed. Result Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05). Conclusion This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes.

Objective: To compare return to work (RTW) rates among patients with low back pain (LBP) and different job relations randomized to brief or multidisciplinary intervention. Design: A randomized controlled trial with 1-year follow-up. Setting: Silkeborg Regional Hospital, Denmark. Subjects: Four hundred seventy-six participants were divided into two groups concerning job relations: strong (influence on job and no fear of losing it) or weak (no influence on job and/or fear of losing it), and afterwards randomized to brief or multidisciplinary intervention. Interventions: Brief intervention included examination and advice by a rheumatologist and a physiotherapist. Multidisciplinary intervention included brief intervention plus coaching by a case manager making a plan for RTW with the patient. Main measures: Primary outcome was 1-year RTW rate. Secondary outcomes included pain intensity (LBP rating scale), disability (Roland Morris disability scale), and psychological measures (Common Mental Disorder Questionnaire, Major Depression Inventory, and EQ-5D-3L). Results: Mean (SD) age was 43.1 (9.8) years. Among 272 participants with strong job relations, RTW was achieved for 104/137 (76%) receiving brief intervention compared to 89/135 (66%) receiving multidisciplinary intervention, hazard ratio 0.73 (CI: 0.55–0.96). Corresponding results for 204 participants with weak job relations were 69/102 (68%) in both interventions, hazard ratio 1.07 (CI: 0.77–1.49). For patients with strong job relations, depressive symptoms and quality of life were more improved after brief intervention. Conclusion: Brief intervention resulted in higher RTW rates than multidisciplinary intervention for employees with strong job relations. There were no differences in RTW rates between interventions for employees with weak job relations.

Aims To present an overview of reviews of interventions for the prevention of diabetes in women after gestational diabetes mellitus (GDM) with the overall aim of gaining information in order to establish local interventions. Methods Six databases were searched for quantitative, qualitative or mixed‐methods systematic reviews. All types of interventions or screening programmes were eligible. The outcomes were effectiveness of reducing diabetes incidence, encouraging healthy behavioural changes and enhancing women's perceptions of their increased risks of developing type 2 diabetes following GDM. Results Eighteen reviews were included: three on screening programmes and seven on participation and risk perceptions. Interventions promoting physical activity, healthy diet, breastfeeding and antidiabetic medicine reported significantly decreased incidence of postpartum diabetes, up to 34% reduction after any breastfeeding compared to none. Effects were larger if the intervention began early after birth and lasted longer. Participation in screening rose up to 40% with face‐to‐face recruitment in a GDM healthcare setting. Interventions were mainly based in healthcare settings and involved up to nine health professions, councillors and peer educators, mostly dieticians. Women reported a lack of postpartum care and demonstrated a low knowledge of risk factors for developing type 2 diabetes. Typical barriers to participation were lack of awareness of increased risk and low levels of support from family. Conclusions Lifestyle interventions or pharmacological treatment postpartum was effective in decreasing diabetes incidence following GDM. Women's knowledge of the risk of diabetes and importance of physical activity was insufficient. Early face‐to‐face recruitment increased participation in screening. Programmes aimed at women following a diagnosis of GDM ought to provide professional and social support, promote screening, breastfeeding, knowledge of risk factors, be long‐lasting and offered early after birth, preferably by face‐to‐face recruitment., One in two women with gestational diabetes develops diabetes within 10 years. This overview explored effectiveness and determinants for participation in programmes. Conclusions: Preventive programmes should inform women about risk factors and include physical activity, healthy diet and promotion of breastfeeding. Early recruitment is important to rely on motivational factors.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines. Purpose The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral. Methods All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients. Results Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF Conclusions Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.

Introduction Gestational diabetes mellitus (GDM) is a common complication in pregnancy and constitutes a public health problem due to the risk of developing diabetes and other diseases. Most women face barriers in complying with preventive programs. This study aimed to explore motivational factors for lifestyle changes among women with a history of GDM and their suggestions for preventive programs. Methods This study used a qualitative approach in six focus group interviews with a total of 32 women. The selection criteria were time since onset of GDM, including women diagnosed with GDM, six months and five years after GDM, diagnosed and not diagnosed with diabetes. Inductive analysis was performed. Results The women reacted with anxiety about their GDM diagnosis and experienced persistent concerns about the consequences of GDM. They were highly motivated to take preventive initiatives, but faced major adherence challenges. The demotivating factors were lack of time and resources, too little family involvement, lack of knowledge and social norms that may obstruct healthy eating. A powerful motivational factor for complying with preventive strategies was the well‐being of their children and partners. Conclusions Preventive initiatives should be rooted in the women's perception of GDM/diabetes and based on their experiences with barriers and motivational factors. The well‐being and the quality of life within the family are dominant motivational factors which offer powerful potentials for supporting the women's coping capability. Further, there is a need to be responsiveness to the women and their families even a long time after the onset of GDM., Even a long time after GDM the women are worried about the health consequences of the diagnosis and all though motivated to take preventive actions they experience barriers to adhere to the recommended lifestyle changes. To better overcome such barriers the women's recommend preventive initiatives to be rooted at the core of their everyday life and to include their families. It is important to pay attention to the women for a long time after the GDM diagnosis and to base preventive programs within the women's perspectives of GDM/diabetes and preventive initiatives.

Objective: To evaluate the effect of adding a lay-tutor to the educational sessions of a back school programme for patients with subacute low back pain. Methods: Patients with subacute low back pain were randomized to a 10-week programme comprising 10 h education and 20 h physical exercise led by a former patient as lay-tutor, or a programme led by a physiotherapist. In the intervention group, former patients served as lay-tutors in the educational sessions, teaching in conjunction with physiotherapists. In the control group, 2 physiotherapists led the entire educational programme. Disability, back pain, leg pain and health status were evaluated blindly at 3 and 24 months. Results: Eighty-seven patients with subacute low back pain referred for treatment at 6 selected physiotherapy clinics were allocated to either an intervention group (n = 42) or a control group (n = 45). No statistically significant difference was found between the 2 groups. Both groups of patients showed a statistically significant improvement in health and pain measurements from the start of the study to the 3- and 24-month follow-up. Conclusion: No short-or long-term effect was found of adding a lay-tutor to the educational sessions of a back school programme for patients with subacute low back pain with regards to functional activity, back pain, leg pain or general health. The main limitations are that the potential effect of including lay-tutors in the educational part of a back school programme as an intervention in itself has to be tested, and the programme has to be tested as a complete protocol. Also, no specific testing has been performed to confirm the ideal number of sessions in the programme.

Aims: To study the associations between and timing of psychosocial and physical work factors and health status on sick leave among Danish pregnant employees. Methods: A total of 910 pregnant women completed a questionnaire in gestational weeks 12 (baseline) and 27 (follow-up). Information about psychosocial and physical work factors and health status was obtained at baseline. Associations with sick leave ⩾14 days were estimated using logistic regression. Further, the impact of timing and duration of exposure on sick leave were examined. Results: A total of 133 women (14.6%) reported ⩾14 days of sick leave at follow-up (27 weeks of gestation). Work-related risk factors for sick leave were high work pace, low influence, low recognition, low job satisfaction, conflict in work−family balance, standing/walking, heavy lifting, and shift work/night shift. Health-related risk factors were burnout, stress, possibility of depression, low work ability, previous sick leave, and poor self-rated health. Being exposed to work-related risk factors during the first 27 weeks of pregnancy or at follow-up increased the risk of sick leave compared with those not exposed at any time or only exposed at baseline. Poor health status increased the risk if women were exposed in the first 27 weeks of pregnancy; however, high possibility of depression was also a risk factor when experienced in early pregnancy. Conclusions: Psychosocial and physical work-related risk factors and poor health status were associated with more sick leave in pregnant employees. Early adjustment of work-related risk factors at the workplace is needed to reduce sick leave.

The objectives were to assess the short- and long-term effect of the patient education strategy ‘Learning and Coping’ (LC) in cardiac rehabilitation (CR) on health-related quality of life, patient education impact, cardiac risk factors and lifestyle. In total, 825 patients hospitalized with ischaemic heart disease or heart failure were randomized to either LC-CR or standard CR at three Danish hospitals. Teaching approach in LC-CR was situational, inductive and reflective, with experienced patients as co-educators and supplemental interviews. Teaching approach in standard CR was structured and deductive. Outcomes were assessed immediately after CR, and after 3 months (short term), and after 3 years (long term). Between-arm differences in favour of LC-CR were SF-12 ‘role emotional’ (3.7, 95% CI: 0.6–6.8) and MDI depression score (0.9, 0.1–1.8) immediately after CR, exercise capacity (4 W, 1–9) at 3 months and SF-12 ‘role physical’ (4.6, 0.1–9.0) (long term). Between-arm differences in favour of controls were waist circumference (−1.7 cm, −2.3 to −1.0) immediately after CR and HeiQ domain ‘Constructive attitudes and approaches’ (0.11, 0.04–0.18), triglycerides (−0.12 mmol/l, −0.21 to −0.02), systolic blood pressure (−3.12 mmHg, −5.66 to −0.58) at 3 months. Adding LC strategies to CR provides inconsistent short-term results but improves ‘role physical’ long term.

BACKGROUND: Validation studies have not been able to confirm the stage-specific understanding as operationalised in the readiness for return to work (RRTW) questionnaire.OBJECTIVE: To explore retrospectively how working female cancer survivors experienced the process of becoming ready to RTW during and beyond participation in an occupational rehabilitation intervention and thereby expand the understanding of the RRTW construct.METHODS: A qualitative research design was employed. Thirteen female cancer survivors were included for semi-structured interviews one to two years after they had completed active treatment and returned to work. The RRTW construct guided data generation and analysis. Content analysis was performed in four analytical steps that combined a concept-driven and a data-driven analytic strategy.RESULTS: Three themes were identified; "To have and then lose the safety net", "Realise a changed life situation", "Strive to balance work and everyday life". In a time span of approximately one to two years (from receiving treatment, being enrolled in an intervention and to gradually returning to work); the identified themes were interdependent of each other as one theme gradually evolved to the next theme in the process of engaging in sustained work participation.CONCLUSIONS: The present study points towards continuous development of the RRTW construct and whether the addition of a preparedness dimension would improve validity.

Purpose: To examine perceived aspects of importance among young adults with ADHD to participate and engage in occupational activities, and to explain how support from occupational specialists can assist them to deal with executive impairments. Materials and Methods: Individual interviews with eight young adults with attention-deficit/hyperactivity disorder. The interview guide was based on assumptions derived from the literature regarding executive functioning and issues related to participation in occupational activities, alongside the needs for social support. Interview transcripts were analysed using qualitative content analysis. Results: Four categories emerged from the analysed interviews: (1) Being involved in an occupational environment fulfils a need for social contact, (2) Occupational activities must be clear and within interest (3) Self-confidence and daily routines are prerequisites for occupational participation (4) Having a lifeline providing continuous support is important Conclusions: Routines, interest and structure in everyday life are important to engage in occupational activities. There is a need for continuous support from a trusted person to establish and maintain healthy daily routines. Occupational specialists can be a vital resource, as they possess specific knowledge on the possibilities for occupation, and additionally, they can fulfil the young adults’ needs for continuous support. There is a need for studies questioning how some young adults with ADHD fulfil their work role despite executive impairments. Focusing on executive functioning can be a valuable supplement to the focus on specific diagnoses in research and practice. Purpose: To examine perceived aspects of importance among young adults with ADHD to participate and engage in occupational activities, and to explain how support from occupational specialists can assist them to deal with executive impairments. Materials and Methods: Individual interviews with eight young adults with attention-deficit/hyperactivity disorder. The interview guide was based on assumptions derived from the literature regarding executive functioning and issues related to participation in occupational activities, alongside the needs for social support. Interview transcripts were analysed using qualitative content analysis. Results: Four categories emerged from the analysed interviews: (1) Being involved in an occupational environment fulfils a need for social contact, (2) Occupational activities must be clear and within interest (3) Self-confidence and daily routines are prerequisites for occupational participation (4) Having a lifeline providing continuous support is important Conclusions: Routines, interest and structure in everyday life are important to engage in occupational activities. There is a need for continuous support from a trusted person to establish and maintain healthy daily routines. Occupational specialists can be a vital resource, as they possess specific knowledge on the possibilities for occupation, and additionally, they can fulfil the young adults’ needs for continuous support. There is a need for studies questioning how some young adults with ADHD fulfil their work role despite executive impairments. Focusing on executive functioning can be a valuable supplement to the focus on specific diagnoses in research and practice.