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AbstractPurposeMaterials and methodsResultsConclusionsInterdisciplinary multimodal pain treatment (IMPT) offers long-term benefits for patients with chronic musculoskeletal pain (CMP). Many patients, despite reporting a clinically relevant decrease of the self-reported Pain Disability Index (PDI), do not achieve such change for the 6-minutes walking test (6MWT). The objective is to identify factors that are associated with no clinically meaningful improvement on the 6MWT in patients with CMP who reported a clinically important improvement on disability (PDI) after 10-weeks of IMPT.Nine hundred and eighty-three patients reporting a clinically important change on the PDI (primary outcome) after IMPT were included. Logistic regression analysis was used to identify baseline and change scores of physiological and psychologic factors independently associated with a clinically important improvement on the 6MWT.Three hundred (32%) patients achieved a clinically important change on the 6MWT. A higher increase of the heart rate (HR) during the 6MWT at post-treatment compared to the HR increase at pre-treatment increases the probability of achieving a clinically relevant change on the 6MWT. Higher self-reported working capacity and anxiety at baseline resulted in a lower probability of achieving a clinically relevant increase of the metres walked.None of the other factors targeted by IMPT contributed significantly to the final model. These results question the feasibility of the 6MWT as a secondary outcome measure as it merely seems to measure patient’s behaviour (performance) and not capacity. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment.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.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.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.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.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]

To develop and explore underlying dimensions of the Self-Regulation Assessment (SeRA) and psychometric features of potential components. Further, to identify associations between the SeRA and disability-management self-efficacy, type of diagnosis, and type of rehabilitation. Based on a previously developed model of self-regulation, expert and patient opinions, and cognitive interviews, a list of 22 items on self-regulation (the SeRA) was constructed. The SeRA was included in a cross-sectional survey among a multi-diagnostic group of 563 former rehabilitation patients. Exploratory analyses were conducted. Respondents had a mean age of 56.5 (SD 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. Four components were found within the SeRA, labelled as "insight into own health condition," "insight into own capabilities," "apply self-regulation," and "organization of help." Cronbach's alpha was high (total scale: 0.93, subscales: range 0.85–0.89). Only scores on the first subscale showed a ceiling effect. Subscale three showed the highest correlation with a self-efficacy measure. Small differences in SeRA total scores (range 71.6–78.1) were found between different diagnostic groups. The SeRA is a new self-regulation measure with four subscales. Further research is needed to establish the validity and reliability of the SeRA. The Self-Regulation Assessment (SeRA) was developed to provide a comprehensive measurement of self-regulation among rehabilitation populations. The SeRA could potentially be used to identify persons with self-regulation problems at the start of rehabilitation treatment and measure outcomes of rehabilitation for self-regulation. The SeRA could potentially be used to help analyse outcomes of rehabilitation practice as well as evaluate interventions on self-regulation. [ABSTRACT FROM AUTHOR]

Generic self-management programs aim to facilitate behavioural adjustment and therefore have considerable potential for patients with chronic musculoskeletal pain. Our main objective was to collect and synthesize all data on the effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain in terms of physical function, self-efficacy, pain intensity and physical activity. Our secondary objective was to describe the content of these interventions, by means of classification according to the Behaviour Change Technique Taxonomy. We searched PubMed, CENTRAL, Embase and Psycinfo for eligible studies. Study selection, data extraction and risk of bias were assessed by two researchers independently. Meta-analyses were only performed if the studies were sufficiently homogeneous and GRADE was used to determine the quality of evidence. We identified 20 randomized controlled trials that compared a self-management intervention to any type of control group. For post-intervention results, there was moderate quality evidence of a statistically significant but clinically unimportant effect for physical function and pain intensity, both favouring the self-management group. At follow-up, there was moderate quality evidence of a small clinically insignificant effect for self-efficacy, favouring the self-management group. All other comparisons did not indicate an effect. Classification of the behaviour change techniques showed large heterogeneity across studies. These results indicate that generic self-management interventions have a marginal benefit for patients with chronic musculoskeletal pain in the short-term for physical function and pain intensity and for self-efficacy in the long-term, and vary considerably with respect to intervention content.Significance: This study contributes to a growing body of evidence that generic self-management interventions have limited effectiveness for patients with chronic musculoskeletal pain. Furthermore, this study has identified substantial differences in both content and delivery mode across self-management interventions. [ABSTRACT FROM AUTHOR]

Introduction: Due to COVID-19 related interrupted healthcare, alternative remote treatment strategies have been implemented.1 The objectives of this study are to investigate (1) whether remote rehabilitation for patients with chronic musculoskeletal pain has equivalent outcomes as conventional, on-site treatment, and (2) whether on-site treatment before and during the pandemic have equivalent outcomes. Methods: Using clinical data from Centre for Integral Rehabilitation (CIR, the Netherlands),2 a retrospective observational equivalence study was conducted. Five groups of participants were formed, following outpatient, interdisciplinary treatment for ten weeks. For objective 1, participants who followed =50% of the treatment remotely during the first lockdown are compared to two groups treated on-site directly before and after the lockdown. For objective 2, participants treated on-site before the pandemic (2019) are compared to two groups treated on-site (2020 and 2021). Based on the Dutch Dataset Pain Rehabilitation, outcome measures included digital questionnaires regarding various relevant domains, with the Pain Disability Index as primary outcome measure. Change scores were compared using linear regression. Results: No results have been reported yet. It is hypothesized that partial remote rehabilitation has equivalent outcomes as conventional treatment, coherent with earlier findings.3 Preliminary results may be available before May 2022. Discussion: The major strength is the combination of two objectives in one study. The group of interest receiving only partial remote treatment is a limitation. Process evaluation: It was challenging to form groups retrospectively due to changing COVID-19 lockdown measures and considering similarity on factors other than type of treatment and pandemic status. [ABSTRACT FROM AUTHOR]

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: Chronic pain rehabilitation aims at increasing patients' functioning. However, conversations between patients and practitioners about pain-related disabilities that patients experience can be challenging. This study explores patients' and practitioners' talk about pain-related disability during admission interviews. Methods: Nine admission interviews were audio recorded. Participants were nine patients with chronic musculoskeletal pain and six practitioners. Recordings were transcribed and analysed taking a discursive psychology perspective. Discursive psychology focuses on how participants in interaction construct social realities through language and examines the social functions of such constructions1. We examined patients' and practitioners' constructions of patient's (in)ability to engage in daily life activities. Results: Patients construct themselves as willing but physically unable to engage in certain activities. Such constructions of mind/body distinctions function as an interactional resource to build up the authenticity of the patient's pain and disabilities. Practitioners, however, challenge patient's body-oriented accounts, for example by constructing patient's inability as insufficiently accounted for. Their constructions reveal that they orient to the potential delicacy of their communication practices. Discussion: Various studies have addressed that the lack of a clear biomedical explanation for chronic pain may threaten patients' credibility2. This study is the first to provide insight into how this dilemma is dealt with by patients and practitioners as they interact. Discussion: Various studies have addressed that the lack of a clear biomedical explanation for chronic pain may threaten patients' credibility2. This study is the first to provide insight into how this dilemma is dealt with by patients and practitioners as they interact. Process evaluation: Detailed interaction analyses such as conducted for this study are time consuming. Therefore, the analysis was limited to admission interviews. It would be worthwhile for future research to look into patients' and practitioners' constructions of disability in other interactional contexts. [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]

Musculoskeletal complaints are highly prevalent in clarinetists and are related to high arm load while playing. It is hypothesized that postural exercise therapy may be used to adapt muscle activity patterns while playing and thus contribute to better sound quality The goal of the present study was to investigate the relationship between body posture, muscle activity, and sound quality in clarinetists while playing the instrument in two different postures, their habitual sitting posture (control, CO) vs an experimental sitting posture (EXP) based on Mensen-dieck postural exercise therapy, method Samama. Twenty healthy professional and student clarinet players, aged 18-60 years, were included in this cross-sectional study. Participants played a 60-second musical excerpt in CO, followed by instruction on the EXP body posture, and then played in the EXP condition. Two-dimensional goniometrie analysis was used to calculate body posture; muscle activity was measured bilaterally using surface electromyography. In EXP, a significantly smaller low thoracic angle, smaller high thoracic angle, and larger pelvic tilt angle (all p<0.001) were found. EMG results indicated that the left and right erector spinae L3 and left and right lower trapezius were more active in EXP compared to CO, whereas left upper trapezius and right brachioradialis were less active in EXP than CO. Most participants experienced better sound quality in EXP, whereas blinded experts found no consistent pattern between body posture and sound quality. To conclude, it seems that postural exercise therapy may change muscle activity patterns. By increasing stability, a decrease in activity of the upper extremity muscles can be induced. [ABSTRACT FROM AUTHOR]

Introduction: Numerous variables are associated with the physical activity level (PAL) and health-related quality of life (HRQOL) in various populations with chronic pain and fatigue. This study aims to identify transdiagnostic and disease-specific determinants of HRQOL and PAL in two distinct patient groups experiencing chronic pain and fatigue: patients with chronic fatigue syndrome (CFS) and multiple osteochondromas (MO). Methods: Data on sociodemographic, symptomatology, psychosocial variables, HRQOL and the PAL of patients with MO (n = 342) were collected at OLVG Amsterdam through a survey. The same data was collected at Vrije Universiteit Brussel of patients with CFS (n = 103). Determinants of HRQOL and PAL are explored with multiple linear regression models. Results: Preliminary results showed that both groups have a significantly lower HRQOL and PAL (p = 0.001) than the general population. PAL is expected to be positively associated with HRQOL in both groups. Pain and fatigue intensity and depression are hypothesized to be negatively associated with HRQOL and the PAL. The level of catastrophizing is lower in patients with MO; catastrophizing is hypothesized to be negatively associated with the PAL and HRQOL in patients with CFS, but not MO. Discussion: These results are expected to assist research and clinical practice in the development of evidence-based interventions aimed at maximizing HRQOL for patients with CFS and/or MO. Process evaluation: Explanatory variables are not measured with the same measurement instruments in both groups and require recoding. We need to compare associated variables between patient groups, dummy coding for the chronic condition seems the most appropriate procedure. [ABSTRACT FROM AUTHOR]