title: Work performance and pain intensity during exercise. A before-and-after study of a cognitive-behavioural treatment in primary care of young immigrant patients.
abstract: OBJECTIVE
  To explore the efficacy of an exercise programme (EP) in primary care on work performance and pain intensity in young immigrants having pain.
  
  
  METHODS
  Patients on long-term sick leave, aged 20-45 years, categorized by sex and 'high education' (>/=8 years) or 'little education' (0-7 years).
  
  
  METHODS
  The 4-week EP was combined to weekly, patient-doctor, dialogue sessions about pain. Two doctors established the clinical status, explored attitudes to exercise and stationary pain behaviour. The EP included daily sessions of an all-round training (15 exercises on five devices in three rounds) led by a physiotherapist, who neglected dysfunctional behaviours. The target for the training was a good work performance (1.5 points), consisting of endurance during a session (0=one round, 1=two rounds, 2=three rounds) and work behaviour (0=bad, 1=acceptable, 2=good), as well as reduced pain intensity measured on a visual analogue scale. Non-parametric statistics were used to detect significant differences between the before-and-after values.
  
  
  RESULTS
  Forty-four men and 73 women, median education 7 years, participated. Nearly all were immigrants. All had muscular pain; 72% were anxious about the pain and 14% were depressed. At the start, nearly all were negative about exercise but participated anyway and significantly improved their work performance (p<0.001) from very low starting values (in median 0.0). Only the highly educated men reached the target levels. The highly educated persons reported less pain, while some men and women with little education reported more pain. The doctors also noted a significant decline in stationary pain behaviour in all sub-groups.
  
  
  CONCLUSIONS
  A good efficacy regarding work performance and pain intensity was seen only in the highly educated group.
authors.affiliation: Rinkeby Health Centre, Stockholm, Sweden. Monica.Lofvander@klinvet.ki.se
authors.forename: Monica
authors.initials: M
authors.lastname: Löfvander
authors.forename: Alf
authors.initials: A
authors.lastname: Engström
authors.forename: Shiva
authors.initials: S
authors.lastname: Nafezi
mesh_terms: D000328:Adult; D004522:Educational Status; D004641:Emigration and Immigration; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D010146:Pain / Q000503:physiopathology / Q000534:rehabilitation*; D010147:Pain Measurement; D011320:Primary Health Care; D015397:Program Evaluation; D013548:Sweden; D013647:Task Performance and Analysis; D016526:Workload