Objectives
The overall objective of the project is to examine measures that can promote participation and acquire a better understanding of goal-setting processes in various forms of rehabilitation, so that effective rehabilitation strategies can be developed.
The project will critically evaluate the literature and the knowledge base for interventions that aim to facilitate participation for people with chronic functional problems. Furthermore, the project will shed light on how goal setting by individuals on sick leave due to musculoskeletal disorders is discussed and negotiated through the rehabilitation program at NAV's follow-up initiative; and the type of knowledge the participants will bring into the meetings. The focus is on the relationship between work and health, and also how this relationship manifests itself among actors with different points of view from different arenas and service levels.
Background
Rehabilitation is based on collaboration between the service users and the health and social service providers, and should support the users' goals of being able to participate in different arenas of the society. Nevertheless, there is a lack of knowledge on the effects of interventions and how we can integrate goals and goal setting processes in an effective way for people with musculoskeletal disorders, who seek different types of services at different levels. People with musculoskeletal disorders often require both health and social services, but the liaison between these services is often inadequate. It is therefore important to understand the measures that can reduce the gap between health and social services, and gain insight into the communication between governmental vocational programs and health services.
Method
Systematic literature review of randomized goal-oriented studies and meta-epistemological analysis of qualitative goal-based studies was carried out. In addition, interviews were conducted between the involved parties; and the meetings between individuals on sick leave due to musculoskeletal disorders and the professionals at NAV's sick leave follow-up program were analyzed using qualitative methods.
The data material was analyzed in the light of central sociological, linguistic and philosophical perspectives in order to describe how objectives were formulated. There has been a focus on how different understandings and forms of knowledge were brought into the meetings and how the power dynamics could influence the goal setting process. The analyzes of the goal-setting process have drawn on concepts such as symbolic capital and symbolic power which expose how the right of decision and categorization is linked to special statuses or positions. It has examined how the interplay between knowledge and power relations can determine what can be formulated linguistically and appear as an accepted truth. As an continuation of this thinking, theoretical understandings have been developed on how different forms of governance and self-governance are used at the individual level as well as in a larger perspective such as in corporate governance.
Public Involvement
CHARM's service user representative panel
Result
The literature review has uncovered major methodological shortcomings in the randomized studies that focused on improving participation. The qualitative studies under review also tended to quantify and categorize rather than to provide a deeper understanding and in-depth knowledge.
The analyzes of the NAV meetings showed that the persons on sick leave, their employers, NAV employees and doctors had completely different views and understandings of the meetings. This dissonance of viewpoints made it hard to predict the outcomes of the meetings. However, the outcomes seemed to be most influenced by participants who were active during the meetings.
Conclusion
It is important to develop better quantitative instruments and increase the understanding of the processes involved in goal-based rehabilitation. This is especially true when different professionals are involved and vocational enablement is the goal.
Financing
- Research Council of Norway through CHARM (Research Centre for Habilitation and Rehabilitation Models and Services)
- Cooperation
- Oslo University Hospitals (OUS)
- University of Oslo, Institute of Health and Society (Helsam), Faculty of Medicine
- OsloMet, Faculty of Health Sciences
- Norwegian Rheumatism Association (NRRK)
- International Research Institute of Stavanger (IRIS)
Postdoktor
One postdoctoral research fellow, Truls I. Juritzen, is employed to work on this project
Results:
- One or the Many: Quantified Subjectivity and Aggregated Uniqueness in Qualitative Rehabilitation Research. Qualitative Health Research, Oct 16, 2016 1049732316668297, DOI: 10.1177/1049732316668297. Juritzen T, Soberg HL, Røe C, Saebu M, Engen G, Bliksvaer T, Engebretsen E.
- A Systematic Review of Rehabilitation Interventions Aimed at Improving Participation in Life Domains for Young Adults with Disabilities, Int J Phys Med Rehabil 4:324. doi:10.4172/2329-9096.1000324, Engen G, Saebu M, Juritzen TI, Bliksvaer T, Engebretsen E, Soberg HL, Roe C.
- Goal Setting in Rehabilitation; A Systematic Synthesis of Clinical Practice Described in Randomized Controlled Trials, Ann Rheum Dis 2016;75:1288 doi:10.1136/annrheumdis-2016-eular.3509. Sand-Svartrud AL, Smedslund G, Soberg HL, Engen G, Kjeken I.
- Kritiske perspektiver i helsefagene: Utdanning, yrkespraksis og forskning, Feiring M, Juritzen TI, Knutsen IR, Larsen K, Adrian SW, Brottveit G, Brænd JA; Egede-Nissen V, Femdal I; Heiaas I; Hindhede AL; Højbjerg K; Olesen SG; Solvang PK; Tanggaard L. Kapittel 4: "Frihet og selvstyring – NAVs dialogmøter som styringsteknologi", Juritzen TI. 2017 Jun 23. Open Access, Epub ISBN-13 (15) 9788202570095.