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Introduction: Despite the importance of a biopsychosocial approach in chronic pain, many physiotherapists still adhere to a biomedical framework.1 To facilitate the adoption of a biopsychosocial view, more insight into barriers and facilitators for using this approach is required. The aim for this study is to map these barriers and facilitators. Methods: A scoping review was performed.2 Eligible studies present data on barriers and facilitators, chronic pain, primary care physiotherapy and a biopsychosocial perspective. Extracted data on barriers and facilitators was discussed and sub grouped in themes following a qualitative content analysis approach, using the Theoretical Domains Framework3 and a micro-meso-macro layout to organise and map the different themes. Results: Twenty-three studies were included. Although analyses are ongoing preliminary results show that on a micro-level barriers and facilitators concern the therapist (knowledge, skills, attitudes, confidence, role clarity, patient perception, etc.), the patient (expectations, etc.) and the patient-therapist relationship. On a meso-level barriers relating to the environmental context (time, treatment-fee, etc.) were identified. Discussion: It appears that a level of saturation was reached, suggesting a complete picture of known barriers and facilitators. There is, however, a large variety in used terminology and unclarity of what a biopsychosocial model entails. The presented overview can be used to inform professionals, researchers and policy-makers when designing strategies for implementation. Process evaluation: The focus in the search strategy was on studies mentioning the biopsychosocial model. This might have resulted in missing studies that implicitly adopted this approach. [ABSTRACT FROM AUTHOR]

Introduction: Despite the importance of a biopsychosocial approach in chronic pain, many physiotherapists still adhere to a biomedical framework. Designing a teaching program that supports obtaining adequate competencies in the participant's context is challenging.1 This study describes the development of a program for learning primary care physiotherapists to use the biopsychosocial model in chronic pain. Methods: Participatory Action Research methodology, including experts in chronic pain, education and co-design as well as the target audience, was used. Information gathered from literature and curricula of EFIC and IASP was combined with interviews and focusgroups with stakeholders. Co-design methods structured by several design-sprints were used to create, iterate and pilot-test choices of content, and design-and educational solutions.2 Data were summarized in a Plan of Requirements. Results: Based on the Plan of Requirements a three-month program was developed containing three days of face-to-face learning, online learning and facilitated learning in the workspace.3 The program challenges participants to move out of their comfort zone, with room for active personal learning and respect for the dynamic nature of skills needed for working with chronic pain. Discussion: The use of a broad range of stakeholders strengthens the consistency, content and validity of the program. Co-design as a method for development is, though rich, difficult to replicate and present in a transparent manner. Next a feasibility study is needed to evaluate the program. Process evaluation: Because of COVID the design-process had to take place online hindering the interaction. However, it also facilitated the possibility for stakeholders to join for a brief consultation. [ABSTRACT FROM AUTHOR]

Background: Collaboration between Speech and Language Therapists (SLTs) and parents is considered best practice for children with developmental disorders. However, such collaborative approach is not yet implemented in therapy for children with developmental language disorders (DLD) in the Netherlands. Improving Dutch SLTs' collaboration with parents requires insight in factors that influence the way SLTs work with parents., Aims: To explore the specific beliefs of Dutch SLTs that influence how they collaborate with parents of children with DLD., Methods and Procedures: We conducted three online focus groups with 17 SLTs using a reflection tool and fictional examples of parents to prompt their thoughts, feelings and actions on specific scenarios. Data were organised using the Theoretical Domains Framework (TDF)., Outcomes and Results: We identified 34 specific beliefs across nine TDF domains on how SLTs collaborate with parents of children with DLD. The results indicate that SLTs hold beliefs on how to support SLTs in collaborating with parents but also conflicting specific beliefs regarding collaborative work with parents. The latter relate to SLTs' perspectives on their professional role and identity, their approach towards parents, and their confidence and competence in working collaboratively with parents., Conclusions and Implications: SLTs hold specific beliefs that potentially hinder them from working collaboratively with parents. Appropriate interventions should be developed by combining implementation science and behaviour change science., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Physical activity levels of children with disabilities are low, as these children and their parents face a wide variety of both personal and environmental barriers. Behavior change techniques support pediatric physical therapists to address these barriers together with parents and children. We developed the What Moves You?! intervention Toolkit (WMY Toolkit) filled with behavioral change tools for use in pediatric physical therapy practice., Objective: To evaluate the feasibility of using the WMY Toolkit in daily pediatric physical therapy practice., Methods: We conducted a feasibility study with a qualitative approach using semi-structured interviews with pediatric physical therapists (n = 11). After one day of training, the pediatric physical therapists used the WMY Toolkit for a period of 9 weeks, when facilitating physical activity in children with disabilities. We analyzed the transcripts using an inductive thematic analysis followed by a deductive analysis using a feasibility framework., Results: For acceptability, pediatric physical therapists found that the toolkit facilitated conversation about physical activity in a creative and playful manner. The working mechanisms identified were in line with the intended working mechanisms during development of the WMY Toolkit, such as focusing on problem solving, self-efficacy and independence. For demand, the pediatric physical therapists mentioned that they were able to use the WMY Toolkit in children with and without disabilities with a broad range of physical activity goals. For implementation, education is important as pediatric physical therapists expressed the need to have sufficient knowledge and to feel confident using the toolkit. For practicality, pediatric physical therapists were positive about the ease of which tools could be adapted for individual children. Some of the design and materials of the toolkit needed attention due to fragility and hygiene., Conclusion: The WMY Toolkit is a promising and innovative way to integrate behavior change techniques into pediatric physical therapy practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sol et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs., Competing Interests: The authors declare no conflicts of interest.

Background and Objectives: Although Interdisciplinary Multimodal Pain Treatment (IMPT) programmes share a biopsychosocial approach to increase the wellbeing of patients with chronic pain, substantial variation in content and duration have been reported. In addition, it is unclear to what extent any favourable health outcomes are maintained over time. Therefore, our first aim was to identify and analyse the change over time of patient-related outcome measures in cohorts of patients who participated in IMPT programmes. Our second aim was to acquire insight into the heterogeneity of IMPT programmes., Databases and Data Treatment: The study protocol was registered in Prospero under CRD42018076093. We searched Medline, Embase, PsycInfo and Cinahl from inception to May 2020. All study selection, data extraction and risk of bias assessments were independently performed by two researchers. Study cohorts were eligible if they included adult patients with chronic primary musculoskeletal pain for at least 3 months. We assessed the change over time, by calculating pre-post, post-follow-up and pre-follow-up contrasts for seven different patient-reported outcome domains. To explore the variability between the IMPT programmes, we summarized the patient characteristics and treatment programmes using the intervention description and replication checklist., Results: The majority of the 72 included patient cohorts significantly improved during treatment. Importantly, this improvement was generally maintained at follow-up. In line with our expectations and with previous studies, we observed substantial methodological and statistical heterogeneity., Conclusions: This study shows that participation in an IMPT programme is associated with considerable improvements in wellbeing that are generally maintained at follow-up. The current study also found substantial heterogeneity in dose and treatment content, which suggests different viewpoints on how to optimally design an IMPT programme., Significance: The current study provides insight into the different existing approaches regarding the dose and content of IMPT programs. This analysis contributes to an increased understanding of the various approaches by which a biopsychosocial perspective on chronic pain can be translated to treatment programs. Furthermore, despite theoretical and empirical assertions regarding the difficulty to maintain newly learned health behaviors over time, the longitudinal analysis of health outcomes did not find a relapse pattern for patients who participated in IMPT programs., (© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.)

Background: Many intervention development projects fail to bridge the gap from basic research to clinical practice. Instead of theory-based approaches to intervention development, co-design prioritizes the end users' perspective as well as continuous collaboration between stakeholders, designers, and researchers throughout the project. This alternative approach to the development of interventions is expected to promote the adaptation to existing treatment activities and to be responsive to the requirements of end users., Objective: The first objective was to provide an overview of all activities that were employed during the course of a research project to develop a relapse prevention intervention for interdisciplinary pain treatment programs. The second objective was to examine how co-design may contribute to stakeholder involvement, generation of relevant insights and ideas, and incorporation of stakeholder input into the intervention design., Methods: We performed an embedded single case study and used the double diamond model to describe the process of intervention development. Using all available data sources, we also performed deductive content analysis to reflect on this process., Results: By critically reviewing the value and function of a co-design project with respect to idea generation, stakeholder involvement, and incorporation of stakeholder input into the intervention design, we demonstrated how co-design shaped the transition from ideas, via concepts, to a prototype for a relapse prevention intervention., Conclusions: Structural use of co-design throughout the project resulted in many different participating stakeholders and stimulating design activities. As a consequence, the majority of the components of the final prototype can be traced back to the information that stakeholders provided during the project. Although this illustrates how co-design facilitates the integration of contextual information into the intervention design, further experimental testing is required to evaluate to what extent this approach ultimately leads to improved usability as well as patient outcomes in the context of clinical practice., (©Stefan Elbers, Christa van Gessel, Reint Jan Renes, Remko van der Lugt, Harriët Wittink, Sander Hermsen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.01.2021.)

Background: Although interdisciplinary multimodal pain treatment (IMPT) programs are widely regarded as treatment of choice for patients with chronic pain, there are signs that many patients are unable to maintain their treatment gains in the long term. To facilitate the maintenance of positive treatment outcomes over time, we developed two relapse prevention strategies., Objective: The main objective of this study was to explore the feasibility of these strategies within the context of IMPT programs., Methods: We performed a feasibility study using 3 workbook prototypes containing either one or both strategies. For a period of 6 months, the workbooks were made available in two IMPT facilities. Qualitative data were collected through a focus group and semistructured interviews. We performed a thematic analysis using a deductive approach with (1) applicability to the treatment program, (2) acceptability of the workbook content, and (3) form, as predefined themes., Results: The final dataset consisted of transcripts from a focus group with health care providers and 11 telephone interviews and 2 additional in-depth interviews with patients. In general, the intervention was perceived as useful, easy to use, and in line with the treatment program. The data also include suggestions to further improve the use of both strategies, including more specific implementation guidelines, revised goal-setting procedure, and development of a mobile health version. However, several factors, including a high dropout rate and small sample size, impact the external validity of our findings., Conclusions: This study should be regarded as a first step in the process of transforming the prototype workbook into an effective intervention for clinical practice. Although these initial results indicate a favorable evaluation of both behavior regulation strategies within the workbook, this study encountered multiple barriers regarding implementation and data collection that limit the generalizability of these results. Future research efforts should specifically address the fidelity of HCPs and patients and should include clear procedures regarding recruitment and use of both relapse prevention strategies during treatment., (©Stefan Elbers, Jan Pool, Harriët Wittink, Albère Köke, Rob Smeets. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 11.12.2020.)

Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies., Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users., Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses., Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients., Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice., Trial Registration: Netherlands Trial Register NL8076; https://www.trialregister.nl/trial/8076., International Registered Report Identifier (irrid): DERR1-10.2196/18632., (©Stefan Elbers, Jan Pool, Harriët Wittink, Albère Köke, Else Scheffer, Rob Smeets. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 18.08.2020.)

Local and medium range order in the glass system 50Ag2O-50[(B2O3)x-(P2O5)(1-x)] (x=0, 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6) have been investigated by high-resolution solid state nuclear magnetic resonance (NMR) techniques. The detailed local site distribution has been derived from deconvolution analysis of the 11B and 31P magic-angle spinning (MAS) NMR signals. Quantitative information regarding the extent of boron-oxygen-phosphorus connectivity has been obtained on the basis of 11B[31P} and 31P{11B} rotational echo double resonance experiments. Incorporation of borate into silver metaphosphate glasses produces four-coordinate BO4/2- sites, which crosslink the metaphosphate chains, resulting in a significant increase in the glass transition temperature. Furthermore, the presence of borate favors the disproportionation of P(2) chain-like units into P(1) and P(3) sites, an effect not observed in binary alkali phosphate glasses. Finally, borate incorporation beyond x=0.3 results in the formation of neutral BO3/2 units, indicating some net charge transfer from the borate to the phosphate network former species. This latter result corresponds to the general metal ion scavenging effect observed for phosphate species in other mixed network former glass systems. In the present system, the effect is relatively moderate, however, suggesting that anionic BO4/2- groups are stabilized by the interaction with the phosphate groups.

Modern solid state nuclear magnetic resonance presents new powerful opportunities for the elucidation of medium range order in glasses in the sub-nanometer region. In contrast to standard chemical shift spectroscopy, the strategy presented here is based on the precise measurement and quantitative analysis of internuclear magnetic dipole-dipole interactions, which can be related to distance information in a straightforward manner. The review discusses the most commonly employed experimental techniques, producing dipolar coupling information in both homo- and heteronuclear spin systems. The approach is particularly powerful in combination with magic-angle sample spinning, producing site-resolved dipolar coupling information. We present new applications to oxide-based network glasses, permitting network connectivities and spatial cation distributions to be elucidated.

Time-resolved infrared spectroscopic studies have been used to characterize the reactive intermediate CH3C(O)Co(CO)2PPh3 (ICo), which is relevant to the mechanism of the catalysis of alkene hydroformylation by the phosphine-modified cobalt carbonyls. Step-scan FTIR and (variable) single-frequency time-resolved infrared detection on the microsecond time scale were used to record the spectrum of ICo and to demonstrate that the principal photoproduct of the subsequent reaction of this species at PCO = 1 atm is the methyl cobalt complex CH3Co(CO)3PPh3 (MCo). At higher PCO the trapping of ICo with CO to re-form CH3C(O)Co(CO)3PPh3 (ACo) (rate = kCO[CO][ICo]) was shown to become competitive with the rate of acetyl-to-cobalt methyl migration to give MCo (rate = kM[ICo]). Activation parameters for the competing pathways in benzene were determined to be delta H++CO = 57 +/- 04 kJ mol-1, delta S++CO = -91 +/- 12 J mol-1 K-1 and delta H++M = 40 +/- 2 kJ mol-1, delta S++M = -19 +/- 5 J mol-1 K-1. The effects of varying the solvent on the competitive reactions of ICo were also explored, and the mechanistic implications of these results are discussed.