Ökad stressrelaterad ohälsa bidrar till ökade sjukskrivningar. Minskade möjligheter att återhämta sig har setts som en orsak till denna ökning. En teknik, som använts för att möjliggöra återhämtning, är en återhämtningsfåtölj med inbyggd mekanisk massage och mental tränings program, vilka kan användas både separat och tillsammans. Effekterna av återhämtningsfåtöljen och dess mekanismer har dock inte studerats vetenskapligt tidigare.
Syfte:
Syftet med denna avhandling var därför att utvärdera psykologiska och fysiologiska effekter av mekanisk massage och mental träning, inbyggda i en återhämtningsfåtölj, både separat och tillsammans.
Metod:
Denna pilotstudie var en randomiserad kontrollerad interventionsstudie där fyra arbetsplatser inom skola, vårdsektorn, bilindustri och tillverkningsindustri i sydvästra Sverige ingick. Arbetstagarna lottades slumpvis till fem olika behandlingsgrupper. En grupp lottades till att använda mekanisk massage i 15 minuter 3 gånger/vecka, en annan grupp lottades till att använda mental träning i 15 minuter 3 gånger/vecka, en tredje grupp lottades till att använda både mekanisk massage och mental träning i 15 minuter 3 gånger/vecka. Två grupper agerade som kontrollgrupper, en pausgrupp som tog 15 minuter paus 3 gånger/vecka och en kontrollgrupp jobbade på som vanligt.
Resultat:
Psykologiska effekter: Resultatet visade att de arbetstagare som fick mekanisk massage hade en signifikant sänkning av sin kroppsliga ångestbenägenhet. Även arbetstagare i den mentala träningsgruppen visade en signifikant tendens till en sänkning av sin kroppsliga ångestbenägenhet. Deltagarna som fick både mekanisk massage och mental träning visade en signifikant sänkning av sin stressmottaglighet de sista fyra och åtta veckorna av studien. Resultatet visade också en signifikant sänkning av stressmottaglighet och avståndstagande för pausgruppen.
Fysiologiska effekter: Resultatet visade att mekanisk massage gav en
signifikant minskning av hjärtfrekvens samt systoliskt och diastoliskt blodtryck. Dessutom resulterade mekanisk massage i en ökning av fingertopptemperaturen. Gruppen som enbart fick mental träning visade en signifikant minskning av fingertoppstemperaturen och en signifikant minskning av hjärtfrekvensen, vid studiens slut jämfört med studiens start. Massage och mental träning tillsammans bidrog till en signifikant ökning av det diastoliska blodtrycket under de sista fyra veckorna av studien. Deltagarna i pausgruppen visade dessutom en högre hjärtfrekvens jämfört med andra grupper efter fyra veckor. Deltagarna i kontrollgruppen, gruppen som fortsatte jobba som vanligt, visade statistiskt signifikanta förbättringar i hjärtfrekvensen och det systoliska blodtrycket.
Slutsats:
Slutsatsen av studien är att arbetare som använde återhämtningsfåtöljen med mekanisk massage eller mentalt träningsprogram, antingen separat eller i kombination i åtta veckor, rapporterade en positiv inverkan på sin ångest- och stresskänslighet. Resultaten visade också positiva effekter på arbetstagarnas blodtryck, puls och fingertoppstemperatur. Effekten var särskild starka för de som endast fick mekanisk massage. Återhämtningsfåtöljen och dess mekanismer kan därför ses som ett hälsofrämjande verktyg på arbetsplatser. Detta kan bidra till att minska arbetsrelaterad stress och antalet sjukskrivningar bland svenska arbetstagare. Resultatets slutsats kan dock inte dras till återhämtningsfåtöljens effekter under en längre period än åtta veckor och visar därför behov av randomiserade kontrollerade longitudinella interventionsstudier studier, som pågår en längre tid än åtta veckor.
Acknowledgements
To be a PhD-student with all its moments, to be a part of a research team and part of this project was, still is, a great honor to me. I have learned so much, about myself and about the world of research. This was only possible by the never ending trust, support and enthusiasm of many persons outside and within the research field.
• First of all I want to acknowledge all the healthy employees and employers who participated in this study and who made this research possible.
I want also thank:
•The Knowledge Foundation, Sweden, (www.kks.se) reference number: 20110142, who funded the study. Promas AB, who provided the armchair with the mechanical massage and Scandinavian International University who provided the mental training program. The study was a co-production project including University of Skövde, School of Health and Education •Professor Anja Huizink for grateful support with the language edition. I will say “thank you so much” and express my appreciation especially to: •School of Health and Welfare at Jönköping University with its very interesting and informative courses which gave me a lot knowledge.
•Bengt Fridlund, Kajsa Linnarsson, Jan Mårtensson and Karolina Boberg who guided and helped me through my doctoral studies, which was so helpfully for me.
field and for always taking time for me. You gave me also the possibility to express my feelings when I´ve got angry or sad or something else. So releasing! Thank you Linda.
Anette and Linda, from the start to the end of my education, you have followed me and were on my side whenever I needed you. You supported me and helped me through this incredible tough doctoral studies with all your heart. I am really proud of you both and I am so glad that you both have been my supervisors. THANK YOU SO MUCH 💐
•Senior Lecturer Ulrika Lindmark, thank you for wanting to be my co- supervisor. In a moment of doubt you came in and completed our research team in a wonderful way.
•Senior Lecturer Mikael Harlén, thank you for your structured way to lead me through this education. It was a big help for me to sometimes see the light in the dark. Professor Kerstin Uvnäs-Moberg, it was actually you who initiated this project. Without you I wouldn´t be here. Thank you for all the experiences I made because of you!
I also want thank:
• My boss Annelie Amigelius for all support and trust in me.
•My colleagues from both the unit for public health sciences and for nursing sciences at University of Skövde thank you for joyful moments, fruitful conversations, hearty laugher, hugs and times of recovery with help of cakes and (the more healthier way) fruits :0). I am very glad for being your colleague!
•Everybody who surrounding me in my private field and who participated of my research and being a PhD-student experiences in different ways such as friends, family, neighbors and other PhD-students.
And most importantly:
•Special thanks to my sweet, little girl Liv , the most valuable treasure in my life. I love you more than you can imagine .
References
Andersson, K., Tornkvist, L., & Wandell, P. (2009). Tactile massage within the primary health care setting. Complementary Therapies in Clinical
Practice, 15(3), 158-160. doi: 10.1016/j.ctcp.2008.10.007.
Antonovsky, A. (1987). Unraveling the mystery of health : how people manage stress and stay well. San Francisco, California: Jossey-Bass.
Arbetsmiljöverket (2016). Arbetsorsakade besvär 2016, Work-Related
Disorders 2016. Arbetsmiljöstatistik Rapport 2016:3
ISSN 1652-1110.
Billhult, A. & Gunnarsson, R. (2012). Kvantitativ studiedesign och stickprov. In: Henricson (red). Vetenskaplig teori och metod – från idé till examination
inom omvårdnad. Studentlitteratur.
Dhand, R., & Sohal, H. (2006). Good sleep, bad sleep! The role of daytime naps in healthy adults. Current Opinion in Pulmonary Medicine, 12(6), 379- 382. doi: 10.1097/01.mcp.0000245703.92311.d0.
Dimsdale, J. E. (2008). Psychological stress and cardiovascular disease.
Journal of the American College of Cardiology, 51(13), 1237-1246. doi:
10.1016/j.jacc.2007.12.024.
Ejlertsson, L., Heijbel, B., Ejlertsson, G., & Andersson, I. (2014). Salutogena
arbetsfaktorer för friska medarbetare - en enkätstudie inom primärvården.
Kristianstad University Press.
Eriksson, M. & Lindström, B. (2008). A salutogenic interpretation of the Ottawa Charter. Health promotion International, 23 (2):190-199. doi:
Forbes (2013). The causes and costs of absenteeism in the workplace. Available at: https://www.forbes.com/sites/investopedia/2013/07/10/the- causes-and-costs-of-absenteeism-in-the-workplace.
Frass, M., Strassl, R. P., Friehs, H., Mullner, M., Kundi, M., & Kaye, A. D. (2012). Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review.
Ochsner Journal, 12(1), 45-56.
Försäkringskassan. (2015). Stress vanligaste orsaken till sjukskrivning.
Pressmeddelande. Available from:
https://www.forsakringskassan.se/wps/wcm/connect/4ab827ab-5977-420b- a9e79bc74aadd11f/pm_+sjukfall_med_+psykiska_diagnoser.pdf?MOD=AJ PERES.
Geurts, S. A. & Sonnentag, S. (2006). Recovery as an explanatory mechanism in the relation between acute stress reactions and chronic health impairment.
Scandinavian Journal of Work, Environment and Health, 32(6), 482-492.
Gustavsson, J. P., Bergman, H., Edman, G., Ekselius, L., von Knorring, L., & Linder, J. (2000). Swedish universities Scales of Personality (SSP): construction, internal consistency and normative data. Acta Psychiatrica et
Scandinavica, 102(3), 217-225.
Handlin, L., Muller, J. & Ekström, A. (2017). Promotion health of Swedish workers by complementary methods - example of a study design of a longitudinal randomized controlled intervention study. Medical Research Archives, 2017, 5(8), 1-13.
Hanssen, B., Grimsgaard, S., Launso, L., Fonnebo, V., Falkenberg, T., & Rasmussen, N. K. (2005). Use of complementary and alternative medicine in the Scandinavian countries. Scandinavian Journal of Primary Health Care,
23(1), 57-62.
Hausmann, A. C., & Kleinert, C. (2014). Berufliche Segregation auf dem
Arbeitsmarkt - Männer -und Frauendomänen kaum verändert. IAB-
Hayashi, M., Watanabe, M., & Hori, T. (1999). The effects of a 20 min nap in the mid-afternoon on mood, performance and EEG activity. Clinical
Neurophysiology, 110(2), 272-279.
Heale, R. & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidense Based Nursing, 18(3):66-7. doi: 10.1136/eb-2015-102129. Helgesson, G. (2006). Forskningsetik för medicinare och naturvetare. Studentlitteratur.
Hodgins, M. (2012). The Workplace Setting Introduction to Part III Workplaces as a Setting for Health Promotion. In: Scriven, A. & Hodgins, M. (Eds.), Health Promotion Settings - Principles and Practice.
Jansen, N. W., Kant, I. J., & van den Brandt, P. A. (2002). Need for recovery in the working population: description and associations with fatigue and psychological distress. International Journal of Behavioral Medicine, 9(4), 322-340.
Jansen, N. W. H., Kant, I. J., van Amelsvoort, L. G. P. M., Nijhuis, F.J. N. & van den Brandt, A. (2003). Need for recovery from work: Evaluating short- term effects of working hours, patterns and schedules. Ergonomics, 46(7): 664-680.
Jonas, W., Nissen, E., Ransjo-Arvidson, A. B., Matthiesen, A. S., & Uvnäs- Moberg, K. (2008). Influence of oxytocin or epidural analgesia on personality profile in breastfeeding women: a comparative study. Archives of Womens
Mental Health, 11(5-6), 335-345. doi: 10.1007/s00737-008-0027-4.
Kang, M. G., Koh, S. B., Cha, B. S., Park, J. K., Baik, S. K., & Chang, S. J. (2005). Job stress and cardiovascular risk factors in male workers. Preventive
Representatives. Institute of Work, Health & Organizations. Protecting worker´s health series No.3.
Lindberg, P., Vingård, E., Josephson, M. & Alfredsson, L. (2005). Retaining to ability to work – associated factors at work. European Journal of Public
Health, 16(5): 470-475.
LoBiondo-Wood, G. & Haber, J. (Ed.) (1998). Nursing Research Methods,
Critical Appraisal, and Utilization. Missouri. Fourth Edition.
Lundberg, U. (2005). Stress hormones in health and illness: The roles of work and gender. Psychoneuroendocrinology, 30, 1017-1021. doi: 10.1016/j.psyneuen.2005.03.014.
Lundberg, U., Dohns, I. E., Melin, B., Sandsjö, L., Palmerud, G., Kadefors, R., … Parr, D. (1999). Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. Journal of
Occupation Health Psychologyl, 4(3), 245-255.
McCambridge, J., Witton, J., & Elbourne, D. R. (2014). Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. Journal of Clinical Epidemiology, 67(3), 267-277. doi: 10.1016/j.jclinepi.2013.08.015.
Mino, Y., Babazono, A., Tsuda, T., & Yasuda, N. (2006). Can stress management at the workplace prevent depression? A randomized controlled trial. Psychotherapy and Psychosomatics, 75(3), 177-182. doi: 10.1159/000091775.
Morrison, V., & Bennett, P. (2006). An introduction to health psychology. Harlow, England; Pearson Education.
Naidoo, J., & Wills, J. (2004). Health Promotion. Foundations for practice. Second edition Edinburgh; Elsevier.
Nilsson, P., Andersson, I.H., Ejlertsson, G. & Troein, M. (2012). Workplace health resources based on sense of coherence theory. International Journal of
Workplace Health Management, 5(3): 156-167
study within the northern Sweden MONICA Project. Multinational Monitoring of Trends and Determinants of Cardiovascular Disease. Journal
of Interne Medicine, 250(3), 225-233.
Nissen, E., Gustavsson, P., Widstrom, A. M., & Uvnas-Moberg, K. (1998). Oxytocin, prolactin, milk production and their relationship with personality traits in women after vaginal delivery or Cesarean section. Journal of
Psychosomatic Obstetricts and Gynaecology, 19(1), 49-58.
Ortet, G., Ignacio, M., Llerena, I., Torrubia, R. (2002). The Underlying Traits of the Karolinska Scales of Personality (KSP). European Journal of
Psychological Assessment. 18(2), 139-148.
Osha.Europa.eu (2014). Calculating the cost of work-related stress and
psychosocial risks. European risk observatory literature review. Available on:
http://osha.europa.eu/sv/tools-and-publication/literature_review/calculating- the-costs-of-work-related-stress-and-psychosocial-risks.
Pallant, J. (2013). SPSS Survival Manual A step by step guide to data analysis
using IBM SPSS. Open University Press.
Pellmer, K., Wramner, B. & Wramner, H. (2012). Grundläggande
Folkhälsovetenskap. Liber.
Pettigrew, A. C., King, M. O., McGee, K., & Rudolph, C. (2004). Complementary therapy use by women's health clinic clients. Alternative
Therapies in Health and Medicine, 10(6), 50-55.
Polit, D & Beck, C. (2017). Nursing Research. Generating and Assessing Evidence for Nursing practice. Wolters Kluwer. Tenth Edition.
Ruotsalainen, J., Verbeek, J., Mariné, A. & and Serra, C. (2015). Preventing
occupational stress in healthcare workers. Online Publication.
Ryding E. L., Wirfelt E., Wängborg I. B., Sjögren B. & Edman G. (2007). Personality and fear of childbirth. Acta Obstetricia et Gynecologica
Scandinavica, 86(7):814-20.
Sandman, L. & Kjellström, S. (2013). Etikboken. Etik för för vårdande yrken. Studentlitteratur.
Smith R. E. (1993). Psychology. West Publishing Company.
Sohlberg, P., & Sohlberg, B.-M. (2006). Kunskapens former: vetenskapsteori
och forskningsmetod. Liber.
Taft Marcus, M. & Liehr, P. (1998). Qualitative Approaches to research. In.LoBiondo-Wood, G. & Haber, J. (Ed.) (1998). Nursing Research Methods,
Critical Appraisal, and Utilization. Missouri. Fourth Edition.
Takahashi, M., Fukuda, H., & Arito, H. (1998). Brief naps during post-lunch rest: effects on alertness, performance, and autonomic balance. European
Journal of Applied Physiology and Occupational Physiology, 78(2), 93-98.
doi: 10.1007/s004210050392.
Tones, K. & Green, J. (2010). Health promotion: planning and strategies. Sage Publications, London.
Tucker, P., Folkard, S., & Macdonald, I. (2003). Rest breaks and accident risk.
Lancet, 361(9358), 680. doi: 10.1016/S0140-6736(03)12566-4.
Uneståhl, L.-E. & Hellertz, P. (2001). Personal growth by Mental Training: VEJE International Publication.
Uneståhl, L.-E., & Bundzen, P. (1996). Integrated mental-training - neuro- biochemical mechanismus and psychophysical consequencies. Hypnos,
XXIII(3), 148-158.
Uneståhl, L.-E., Bundzen, P., Gavrilova, E., & Isakov, V. (2004). The effects of integrated mental training on stress and psychosomatic health. Hypnos,
Uvnäs-Moberg, K. (1998). Oxytocin may mediate the benefits of positive social interaction and emotions. Psychoneuroendocrinology, 23(8), 819-835. Uvnäs-Moberg, K. (2009). Närhetens hormone: oxytocinets roll i relationer. Natur & Kultur.
Uvnäs-Moberg K., Handlin L., Petersson M. (2015). Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation. Frontiers in psychology.5:1-16. doi:10.3389/fpsyg.2014.01529. WHO (1986). Ottawa Charter for Health Promotion, 1986. Available at: http://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charte r.pdf?ua=1.
WHO (1995). Global Strategy on Occupational Health for all. The way to health at work. Recommendation of the Second Meeting of the WHO Collaborating Centres in Occupational Health 11-14 October 1994 Bejing, China. Geneva.
WHO (2009). Milestones in Health promotion. Statements from Global Conferences.
WHO.int. Constitution of WHO: Principles. Available from: http://www.who.int/about/mission/en/ , 20180403.
Wiklund, I., Norman, M., Uvnäs-Moberg, K., Ransjö-Arvidson, A. B., Andolf, E. (2009) Epidural analgesia: breast-feeding success and related
factors. Midwifery, 25(2):e31-8. Epub 2007 Nov 5.
WMA.net (2018). Declaration of Helsinki - Ethical Principles for Medical
Zullino, D. F., Krenz, S., Fresard, E., Cancela, E., & Khazaal, Y. (2005). Local back massage with an automated massage chair: general muscle and psychophysiologic relaxing properties. Journal of Alternative and
Complementary Medicine, 11(6), 1103-1106. doi: 10.1089/acm.2005.11.11.