Health Services Research and Rehabilitation Research
The goal of clinical social medicine and rehabilitation is to maintain and develop optimum functional capacity in patients – despite disease, perceived illness, and physical, psychological, or social weakening. Interventions, which are based on the individual’s entire life situation and decisions, are provided as a coordinated, coherent, and knowledge-based effort.
At the section of clinical social medicine and rehabilitation, our research areas include the implementation, monitoring, and assessment of rehabilitation interventions from municipal and regional authorities, which are offered to persons with chronic conditions, somatic and mental diseases, and disabilities. The groups covered are children, adults, and elderly people with a Danish or other ethnic background. We seek to answer questions like:
- How do we create a coherent rehabilitation trajectory from hospital, to general practice (GP), to municipal authority?
- How do we assess the need for, and the efficacy of, rehabilitation efforts?
- How do we help patients to keep working, even while they are ill?
- What is the best rehabilitative intervention targeted to the individual?
A significant proportion of the section’s research activities revolve around the Regional Back Centre Silkeborg – Research unit for patients on sick leave. This unit was established in 2004, and it has since been run with financing from hospitals, a number of municipal authorities, and the Central Denmark Region (and the County of Aarhus, prior to 2007).
Regional and international collaboration
Working closely with the university departments of social medicine in Trondheim, Tromsø, and Oslo, we have established a Danish–Norwegian network in the field: Norsk–Dansk Trygde og Socialmedicinsk Netværk. The unit currently has six PhD students, all of whom are working with the consequences of illness for young people’s functional capabilities in the workplace and elsewhere.
Our research-based work is done in close collaboration with a wide range of clinical departments at AU Health, and with a number of municipalities in the Central Denmark Region. Municipal cooperation includes counselling from physicians, psychologists, and social-service professionals. From the perspective of the individual citizen, our primary task is to coordinate the efforts of GPs, hospitals, municipalities, and workplaces.
The goal is that over the next few years we will develop useful tools that enable us to identify rehabilitation needs, and to differentiate the interventions for specific target groups at specific stages during the course of their disease.
Projects
1. Working with the Regional Back Centre Silkeborg – Research unit for patients on sick leave, we have conducted a randomized controlled study (covering four municipalities in the mid-Jutland region) of a hospital-based, coordinated intervention for patients on sick leave who are diagnosed with unspecified disorders in the lower back, and neck/shoulder pain. The factors studied to assess their significance include social situation, mental illnesses, and functional impairments.
2. In a randomized study (Bodily distress syndrome, BDS, in the extensive Danish ReturnToWork ervention) focusing on persons with BDS on sick leave, we examine whether a new municipally coordinated, interdisciplinary intervention can improve their return-to-work prognosis. The study is being carried out in cooperation with the National Centre for the Working Environment.
3. In the Norwegian–Danish network, a PhD project seeks to clarify the development from 2000 to 2010 of sickness absence among young people. Comparing Danish and Norwegian data and conditions, the project has special focus on employees of municipal care programmes for the elderly in the Municipality of Aarhus.
4. Another PhD project is studying the income situations of patients treated for haematological cancer in Denmark, shedding light on links between income situation and selected clinical, socioeconomic, and demographic factors such as anxiety, depression, and fatigue.
5. Two PhD projects are part of a national Danish network (CE -Spine) involving several hospitals in the Central Denmark Region, and studying whether cognitive interventions and/or coordinator counselling prior to lumbar surgery can result in better restitution and returning to work. Both projects include health-care economy analyses.
6. An upcoming qualitative PhD examines why men diagnosed with cancer have a lower participation rate in municipal rehabilitation programmes.
Milestones
The research section, with its interdisciplinary staff, has effectively existed for 4½ years. Since its inception the unit has:
- Hosted and assisted in the preparation and successful defence of 3 PhD dissertations
- Taken on a further 6 graduates in our PhD programme (projects currently under way)
- Grown to a total staff of 20, including 4 senior researchers
Established the Regional Back Centre Silkeborg – Research unit for patients on sick leave in 2004. The research is funded by an affiliation agreement between the Central Denmark Region and Aarhus University, which will provide DKK 8 m over a period of 4½ years (running until the end of 2012), and also by grants from TrygFonden and the Working Environment Research Fund. The latter has contributed DKK 5 million, which has been allocated to several projects in this context.
Methods
Our research is multidisciplinary and seeks to combine:
- quantitative analyses (RCT, observational/epidemiological, and biostatistical)
- qualitative analyses (anthropological field observation, phenomenological/hermeneutic and other)
- data from all available sources: questionnaires (validated questions and scales), public registers and databases, clinical observations/paraclinical data, and interviews.
