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Aysun Damci,1,2 Janneke GJ Hoeijmakers,1,2 Marlies den Hollander,3– 5 Catharina G Faber,1,2 Sophie Waardenburg,6,7 Charlotte CM van Laake-Geelen,3– 5 Albère JA Köke,3,4 Jeanine AMCF Verbunt3– 5 1MHeNS, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, 6200 MD, The Netherlands; 2Department of Neurology, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands; 3Care and Public Health Research Institute, Maastricht university, Maastricht, 6200 MD, The Netherlands; 4Department of Rehabilitation Medicine, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands; 5Adelante Zorggroep, Center of Rehabilitation Medicine, Hoensbroek, 6432 CC, The Netherlands; 6Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, 6229 HX, The Netherlands; 7Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, 6229 HX, The NetherlandsCorrespondence: Aysun Damci, Department of Neurology, Maastricht University Medical Centre+, P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands, Tel +31-43-3877059, Fax +31-43-3877055, Email aysun.damci@mumc.nlPurpose: Small fiber neuropathy (SFN) is characterized by neuropathic pain, associated with decreased quality of life (QOL). It remains unclear which psychosocial factors play a role in SFN. The experience sampling method (ESM) allows a profound understanding of the real-time fluctuations in reaction to events. The main goal of this study was to increase knowledge of the interrelationships between pain intensity, physical activity, and psychosocial factors in patients with SFN in daily practice over time.Patients and Methods: A prospective observational ESM study with the PsyMate© application (smart-eHealth GmbH, Luxembourg) was conducted at the Adelante location of Maastricht University Medical Center+ in the Netherlands. Participants with idiopathic SFN, older than 18 years, with an indication for rehabilitation, were included. Pain intensity, fatigue, positive and negative affect, physical activity, avoidance behavior, and pain catastrophic thoughts were incorporated into the ESM questions. Participants received 10 beep signals per day followed by the above-mentioned questions, for consecutive 7 days. The results were analyzed with linear mixed-effect models.Results: Twenty-one participants were included with a mean age of 48.24 (SD ± 13.89) years, of whom 76.2% were female. More pain (now) resulted in more physical activity (later) (a) and more physical activity (now) resulted in more pain (later) (b). The first association (a) is influenced by pain catastrophic thoughts and fatigue, and the second (b) by an increase in affective states and a lower level of avoidance behavior.Conclusion: In idiopathic SFN, pain intensity, and physical activity showed a 2-sided association, influenced by catastrophic thoughts, fatigue, affective states, and avoidance behavior.Keywords: chronic pain, rehabilitation therapy, biopsychosocial factors, small fiber neuropathy

Anita Stevens,1,2 Albine Moser,1,2 Albère Köke,1,3,4 Trudy van der Weijden,2 Anna Beurskens1,2 1Faculty of Health, Zuyd University of Applied Sciences, Heerlen, 2Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, 3Adelante Centre of Research in Rehabilitation, Hoensbroek, 4Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care. Keywords: goal setting, patient-specific instruments, client-centered care, patient participation

Abstract Background Patients with chronic fatigue syndrome experience extreme fatigue, which often leads to substantial limitations of occupational, educational, social and personal activities. Currently, there is no consensus regarding the treatment. Patients try many different therapies to overcome their fatigue. Although there is no consensus, cognitive behavioural therapy is seen as one of the most effective treatments. Little is known about multidisciplinary rehabilitation treatment, a combination of cognitive behavioural therapy with principles of mindfulness, gradual increase of activities, body awareness therapy and pacing. The difference in effectiveness and cost-effectiveness between multidisciplinary rehabilitation treatment and cognitive behavioural therapy is as yet unknown. The FatiGo (Fatigue-Go) trial aims to compare the effects of both treatment approaches in outpatient rehabilitation on fatigue severity and quality of life in patients with chronic fatigue syndrome. Methods One hundred twenty patients who meet the criteria of chronic fatigue syndrome, fulfil the inclusion criteria and sign the informed consent form will be recruited. Both treatments take 6 months to complete. The outcome will be assessed at 6 and 12 months after the start of treatment. Two weeks after the start of treatment, expectancy and credibility will be measured, and patients will be asked to write down their personal goals and score their current performance on these goals on a visual analogue scale. At 6 and 14 weeks after the start of treatment, the primary outcome and three potential mediators—self-efficacy, causal attributions and present-centred attention-awareness—will be measured. Primary outcomes are fatigue severity and quality of life. Secondary outcomes are physical activity, psychological symptoms, self-efficacy, causal attributions, impact of disease on emotional and physical functioning, present-centred attention-awareness, life satisfaction, patient personal goals, self-rated improvement and economic costs. The primary analysis will be based on intention to treat, and longitudinal analysis of covariance will be used to compare treatments. Discussion The results of the trial will provide information on the effects of cognitive behavioural therapy and multidisciplinary rehabilitation treatment at 6 and 12 months follow-up, mediators of the outcome, cost-effectiveness, cost-utility, and the influence of treatment expectancy and credibility on the effectiveness of both treatments in patients with chronic fatigue syndrome. Trial registration Current Controlled Trials ISRCTN77567702.

Abstract Background The education and activation program (EAP) is a newly developed intervention to prevent the development of chronic shoulder complaints (SCs). Trained general practitioners (GPs) administer the EAP. The EAP addresses inadequate cognitions and maladaptive behavior related to the SCs. The effect of the EAP is evaluated in a randomized clinical trial. The aim of the present study is to use videotaped consultations to study (1) the performance of trained GPs administering the EAP and (2) the presence of key features of the EAP already embedded in usual care (UC). Methods Five trained GPs were videotaped while treating a standardized patient with EAP. Additionally, five GPs administering UC were videotaped. Two blinded observers evaluated the videotapes in relation to key features of the EAP which were scored on the EAP checklist. Results The mean total score on the EAP checklist was 4.7 (SD = 2.9) for the UC group and 7.1 (SD = 2.1) for the EAP group. Neither group reached a score higher than 8, which was considered to reflect an acceptable number of key EAP features. Conclusion Our comparison of the presence of key features of EAP shows that the UC and EAP groups differed less than was expected. GPs in the UC group performed above expectation, with a mean total score of 4.7. Moreover, the low number of key features present in the EAP group may very well have led to a reduced effectiveness of the EAP. The results of this study can be used to optimize the training of GPs using the EAP.

Abstract Background About half of all newly presented episodes of shoulder complaints (SC) in general practice are reported to last for at least six months. Early interventions aimed at the psychological and social determinants of SC are not common in general practice, although such interventions might prevent the development of chronic SC. The Education and Activation Programme (EAP) consists of an educational part and a time-contingent activation part. The aim of the EAP is to provide patients with the proper cognitions by means of education, and to stimulate adequate behaviour through advice on activities of daily living. Design The article describes the design of a randomised clinical trial (RCT) to evaluate the effectiveness and cost-effectiveness of an EAP in addition to usual care, compared to usual care only, in the prevention of chronic SC after six months. It also describes the analysis of the cost and effect balance. Patients suffering from SC for less than three months are recruited in general practice and through open recruitment. A trained general practitioner or a trained therapist administers the EAP. Primary outcome measures are patient-perceived recovery, measured by self-assessment on a seven-point scale, and functional limitations in activities of daily living. Questionnaires are used to study baseline measures, prognostic measures, process measures and outcome measures. Discussion The inclusion of patients in the study lasted until December 31st 2003. Data collection is to end in June 2004.

Purpose: To describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment. Materials and Methods: Data were gathered during routine clinical practice during a 3-year period (2019–2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates. Results: Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain. Conclusions: At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients. IMPLICATIONS FOR REHABILITATION: Chronic musculoskeletal pain can be very disabling and impacting participation and quality of life. Often several psychosocial factors contribute to the maintenance of pain and its evolving consequences. In this study, a 61 hours highly individualized interdisciplinary multimodal pain treatment resulted in significant improvements with moderate to very large effect sizes for all important domains like pain, fatigue, disability, work capacity, and quality of life. Care providers as well as health insurers should acknowledge the interdisciplinary multimodal pain programme as an effective treatment in their clinical decision making. [ABSTRACT FROM AUTHOR]

Access to pain education for healthcare professionals is an International Association for the Study of Pain's key recommendation to improve pain care. The content of preregistration and undergraduate physical therapy pain curricula, however, is highly variable. This study aimed to develop a list, by consensus, of essential pain-related topics for the undergraduate physical therapy curriculum. A modified Delphi study was conducted in four rounds, including a Delphi Panel (N = 22) consisting of in pain experienced lecturers of preregistration undergraduate physical therapy of Universities of Applied Sciences in the Netherlands, and five Validation Panels. Round 1: topics were provided by the Delphi Panel, postgraduate pain educators, and a literature search. Rounds 2–4: the Delphi Panel rated the topics and commented. All topics were analyzed in terms of importance and degree of consensus. Validation Panels rated the outcome of Round 2. The Delphi Panel rated 257, 146, and 90 topics in Rounds 2, 3, and 4, respectively. This resulted in 71 topics judged as "not important," 97 as "important," and 89 as "highly important." In total, 63 topics were rated as "highly important" by the Delphi Panel and Validation Panels. A list was developed and can serve as a foundation for the development of comprehensive physical therapy pain curricula. [ABSTRACT FROM AUTHOR]