1
|
Gregersen MHM, Nielsen KR, Lynge NH, Heiberg BD, Hartvigsen J, Kawchuk G, Kongsted A. Goal setting in people with low back pain attending an education and exercise program (GLA:D Back) and the impact of demographic factors. BMC Musculoskelet Disord 2024; 25:339. [PMID: 38678259 PMCID: PMC11055288 DOI: 10.1186/s12891-024-07450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Individual goal setting is a fundamental element in self-management supportive interventions, serving to guide actions and enhance motivation for engagement. Despite this, little is known about the goals people with back pain have and to what extent these differ across genders, age groups and geographical location. This study aimed to elucidate this by first describing individual goals set by Danish and Canadian participants in a self-management intervention for people with back pain using the ICF framework; then, determining what proportion of these goals met criteria for being specific, measurable, acceptable, and time bound, and finally, by investigating differences between countries, sexes, and age groups. METHODS In a cross-sectional study conducted August 2018 to June 2020, 394 Danish and 133 Canadian (Alberta Province) participants defined their individual goals of participating in a self-management programme involving patient education and supervised exercises. The goals were linked to the ICF framework. Distribution of goals was compared between countries, sexes, and age groups. RESULTS Goals most often related to the ICF component of 'Activity and Participation'. The most prevalent goals were "Walking" (DK: 20%; CA: 15%) and "Maintaining a body position" (DK: 17%; CA: 22%). Only few goals differed between populations, age and sex. All elements of SMART goal setting were recorded for 88% of Danish and 94% of Alberta participants. CONCLUSIONS People with low back pain attending a self-management programme established goals according to the SMART criteria and focused primarily on activity. Goals were similar across countries and showed few differences across sex and age groups. The high number of different goals points to the need for individualised person-centred care.
Collapse
Affiliation(s)
- Mette H M Gregersen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Kristine R Nielsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Nana H Lynge
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Bibi D Heiberg
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
- Chiropractic Knowledge Hub, Campusvej 55, Odense, Denmark
| | - Greg Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 St NW, Edmonton, AB, Canada
| | - Alice Kongsted
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
- Chiropractic Knowledge Hub, Campusvej 55, Odense, Denmark.
| |
Collapse
|
2
|
Ceulemans D, Moens M, Reneman M, Callens J, De Smedt A, Godderis L, Goudman L, Lavreysen O, Putman K, Van de Velde D. Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis. J Rehabil Med 2024; 56:jrm13454. [PMID: 38226563 PMCID: PMC10802789 DOI: 10.2340/jrm.v56.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. DESIGN A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. METHODS Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. RESULTS Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. CONCLUSION This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.
Collapse
Affiliation(s)
- Dries Ceulemans
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium; STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium.
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Michiel Reneman
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jonas Callens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Ann De Smedt
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Lode Godderis
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium; IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Olivia Lavreysen
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Dominique Van de Velde
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium
| |
Collapse
|
3
|
Feleus A, Wevers L, Schiphof D, Verhoef J, van Hooft S, van Staa A. Content Validition and Psychometric Evaluation of the Self-efficacy and Performance in Self-management Support Instrument for Physiotherapists. Arch Phys Med Rehabil 2024; 105:49-58. [PMID: 37385365 DOI: 10.1016/j.apmr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To develop and psychometrically test the Self-Efficacy and Performance in Self-Management Support instrument for physiotherapists (SEPSS-PT), based on the SEPSS-36, the corresponding instrument for nurses. DESIGN Instrument development including content validation and psychometric evaluation (construct validity, factor structure, and reliability). SETTING Data were collected from literature, expertmeetings, and online questionnaire PARTICIPANTS: Next to a comprehensive literature study, experts (self-management experts (n=2); physiotherapists (n=10); patients (n=6)) and physiotherapists and physiotherapy students (n=334), participated in different stages of the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. A literature study (n=42 reviews) and consultations with physiotherapists and patients identified the specific content for physiotherapy. The Five-A's model and overarching competencies of "supportive partnership attitude", were used to structure the items. Psychometric evaluation of the draft questionnaire (40 items) was tested in a sample of 334 physiotherapists and physiotherapy students from the Netherlands, of whom 33 filled out the questionnaire twice to establish the test-retest reliability. RESULTS Confirmatory factor analyses revealed satisfactory fit indices for both the 6-factor model and hierarchical model, with best fit for the 6-factor model. The questionnaire discriminated between physiotherapists and physiotherapy students, and between physiotherapists who did or did not consider self-management support important. The overall internal consistency (Cronbach's alpha) was high, both for the self-efficacy and the performance items. In most of the subscales, test-retest intra-class correlation coefficients for both overall self-efficacy and performance were good, but in 3 subscales insufficient for performance. CONCLUSION The SEPSS-PT questionnaire is a 40-item, Likert-scaled instrument with good content and construct validity, good internal consistency and reliability, and sufficient test-retest reliability. Future research in a larger and more diverse sample could confirm stability and discriminating power.
Collapse
Affiliation(s)
- Anita Feleus
- Department of Physiotherapy and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
| | - Lotte Wevers
- Department of Physiotherapy and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - John Verhoef
- Department of Physical Therapy & Faculty of Health University of Applied Sciences, Leiden, the Netherlands
| | - Susanne van Hooft
- Department of Nursing and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| |
Collapse
|
4
|
Kafel T, Šuc L, Vidovič M, Smith M. Methods of Goal-Setting in Rehabilitation of Adults with Physical Dysfunctions-A Scoping Review. Occup Ther Health Care 2023:1-30. [PMID: 38157219 DOI: 10.1080/07380577.2023.2294817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
This scoping review utilized the JBI methodology to investigate methods of goal-setting used in the rehabilitation of adults with physical dysfunctions. Electronic databases were searched for articles published in the last 5 years. The inclusion of articles and data extraction were performed by two independent reviewers. Results were presented and synthesized numerically and thematically analyzed. Results suggest that goals should be client-centered and specific and long-term goals, should be complemented with medium and short-term goals. While various goal-setting methods are used in current practice, their full potential is often not realized due to improper implementation. Therefore, there is a need for educating clinicians to improve the goal-setting process and ensure its effectiveness.
Collapse
Affiliation(s)
- Tibor Kafel
- School of Health Professions, University of Plymouth, Plymouth, UK
- Department of Occupational Therapy, University Rehabilitation Institute of Republic of Slovenia Soča, Ljubljana, Slovenia
| | - Lea Šuc
- Department of Occupational Therapy, University Rehabilitation Institute of Republic of Slovenia Soča, Ljubljana, Slovenia
| | - Marko Vidovič
- Department of Occupational Therapy, University Rehabilitation Institute of Republic of Slovenia Soča, Ljubljana, Slovenia
| | - Marnie Smith
- School of Health Professions, University of Plymouth, Plymouth, UK
| |
Collapse
|
5
|
Gayton J, Monga A. Goal setting in physiotherapy-led adult musculoskeletal care: A scoping review. Musculoskeletal Care 2023; 21:1315-1340. [PMID: 37641529 DOI: 10.1002/msc.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Goal setting is a key part of rehabilitation across various fields of physiotherapy. It is less clear what evidence exists to underpin its effectiveness and to practically guide its use within musculoskeletal physiotherapy. OBJECTIVES This scoping review provides an overview of current research regarding goal setting in adult physiotherapy-led musculoskeletal care with three aims: 1) to identify and analyse any gaps in the literature, 2) to identify relevant features of goal setting theory and 3) to make recommendations for future research. The principal research question was what does the literature tell us about the role of goal setting for adults over the age of 18 with musculoskeletal pain accessing outpatient physiotherapy services? INCLUSION CRITERIA The population, concept and context framework was used to define the inclusion criteria. Key definitions were adults over the age of 18 with musculoskeletal conditions, goal setting, and physiotherapy-led interventions. METHODS This scoping review followed the guidance set out by the Joanna Briggs Institute Manual for Evidence Synthesis. Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, MEDLINE, American Psychological Association PsycInfo and the Cochrane Database of Systematic Reviews, Protocols and Trials were searched using pre-defined search criteria. Data were extracted from screened full-text articles and presented in basic statistical and narrative form. RESULTS 41 articles were included in the review. Several broad themes and research methods were identified. The nature of the studies suggested that the clinical application of goal setting is complex and the depth of understanding is limited. Most studies suggested that goal setting is feasible and has a positive impact on outcomes. A common finding was a lack of clear definitions regarding goal setting terminology and approaches. Study samples were generally defined by biomedical categories, suggesting a pathoanatomical approach to researching a cognitive construct. Theoretical underpinning was lacking in many studies. No frameworks guiding goal setting in physiotherapy-led musculoskeletal rehabilitation have been identified. CONCLUSIONS Goal setting is a popular tool within musculoskeletal outpatient physiotherapy. Further research is required to clarify its efficacy and provide guidance on its role and application in clinical practice.
Collapse
Affiliation(s)
- Jonathan Gayton
- Advanced Physiotherapy Practitioner, Musculoskeletal Service, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Aastha Monga
- School of Allied Health Professions, Keele University, Keele, UK
| |
Collapse
|
6
|
Soheili S, Letafatkar A, Hosseinzadeh M. The effect of patient-led goal setting approach combined with pain neuroscience education or manual therapy in patients with chronic low back pain: protocol for a parallel-group randomized controlled trial. Trials 2023; 24:573. [PMID: 37684646 PMCID: PMC10485946 DOI: 10.1186/s13063-023-07617-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a multifactorial disorder associated with a high range of physical and psychological burden on the society. Patient-led goal-setting approach has shown potential effects for improving chronic LBP. However, there are few studies investigating its benefits when combined with a supplementary intervention. This paper, therefore, presents a protocol for a randomized control trial (RCT) to study the effect of a patient-led goal-setting approach combined with pain neuroscience education (PNE) or manual therapy (MT) among patients with chronic LBP. METHODS A total of 105 patients suffering from chronic LBP will be recruited via flyers displayed in hospitals and universities, and those meeting the study's criteria will randomly be allocated into a patient-led goal-setting approach with the PNE group, and/or with the MT program group, and/or a control group. The primary outcomes will be the pain intensity and disability. Secondary outcomes include quality of life, depression, anxiety and stress, fear avoidance beliefs, kinesophobia, pain self-efficacy, catastrophic pain, neurophysiology of pain, and central sensitivity. All the outcomes will be recorded at 2 months after receiving the treatment as post-test sessions and after 4 and 12 months as follow-up sessions. The Ethics Committee in Research at Sport Sciences Research Institute of Iran approved the protocol of this trial (IR.SSRC.REC.1400.084). Written, informed consent to participate will be obtained from all participants. All methods will be conducted in accordance with the ethical standards of the Declaration of Helsinki and in accordance with relevant guidelines and regulations. We will disseminate the findings through peer-reviewed publications and conference presentations and send them to the participants. DISCUSSION This trial will demonstrate which supplementary intervention can better improve the impact of a patient-led goal-setting approach to treat LBP. If successful, the results will potentially have implications for athletic trainers, physiotherapists, and health care practitioners. TRIAL REGISTRATION IRCT Iranian Registry of Clinical Trials IRCT20210927052616N1. Registered on November 03, 2021.
Collapse
Affiliation(s)
- Sahar Soheili
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Sports Injury and Corrective Exercises, Kharazmi University, Tehran, Iran
| | - Mahdi Hosseinzadeh
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, No. 3, 5Th Alley, Miremad Street, Motahhari Street, Tehran, 1587958711, Iran.
| |
Collapse
|
7
|
Carta G, Costantini G, Garzonio S, Romano D. Investigation of the Relevant Factors in the Complexity of Chronic Low Back Pain Patients With a Physiotherapy Prescription: A Network Analysis Approach Comparing Chronic Pain-Free Individuals and Chronic Patients. Am J Phys Med Rehabil 2023; 102:571-576. [PMID: 36882316 DOI: 10.1097/phm.0000000000002229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is the leading cause of disability worldwide, and several factors have been proposed as potential causes or cofactors. The aim of this study was to explore their direct and indirect relations to understand CLBP and identify relevant rehabilitation targets. METHODS A total of 119 patients with CLBP and 117 chronic pain-free individuals were assessed. A network analysis approach was used to explore the complexity of CLBP by assessing the relations between pain intensity, disability, functionality (physical, social, and psychological), age, body mass index, and education level. RESULTS The network analysis revealed the independence of pain and disability related to CLBP from age, sex, and body mass index. Crucially, pain intensity and disability are directly and strongly connected in chronic pain-free individuals, but not in patients with CLBP. Psychosocial functioning is related to pain intensity and disability indirectly through the mediation of one's general health perception and perceived physical functionality. CONCLUSION Clinicians should pay more attention to perceived physical functionality and psychosocial factors as they are tightly linked to CLBP. Indeed, pain intensity seems a suboptimal rehabilitation target. This study suggests that a biopsychosocial approach is much needed to investigate CLBP, but it also warns against overestimating the direct impact of each potential contributor. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Recognize the relation of pain intensity, disability, and loss of function in patients with CLBP; (2) Determine the impact of the most common biological and psychosocial factors in addressing the assessment of chronic back pain patients; and (3) Enhance confidence in selecting the relevant outcomes for the assessment of patients with CLBP following a multidimensional assessment. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.
Collapse
Affiliation(s)
- Giacomo Carta
- From the Systems Biology of Pain Laboratory, Division of Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria (G. Carta); Department of Rehabilitation, ASST-fbf-Sacco, Milano, Italy (G. Carta); Department of Biological and Clinical Sciences, University of Turin, Turin, Italy (G. Carta); Psychology Department, University of Milano-Bicocca, Milan, Italy (G. Costantini, DR); Department of Rehabilitation, ASST-PINI-CTO, Milano, Italy (SG); and Department of History, Society and Human Studies, University of Salento, Lecce, Italy (DR)
| | | | | | | |
Collapse
|
8
|
Kühn L, Lindert L, Kuper P, Prill R, Choi KE(A. Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: a scoping review. BMC Health Serv Res 2023; 23:193. [PMID: 36823581 PMCID: PMC9949696 DOI: 10.1186/s12913-023-09166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The provision of low-value physiotherapy services in low back pain management is a known but complex phenomenon. Thus, this scoping review aims to systematically map existing research designs and instruments of the field in order to discuss the current state of research methodologies and contextualize results to domains and perspectives of a referred low-value care typology. Ultimately, results will be illustrated and transferred to conditions of the German health care setting as care delivery conditions of physiotherapy in Germany face unique particularities. METHODS The development of this review is guided by the analysis framework of Arksey and O'Malley. A two-stage, audited search strategy was performed in Medline (PubMed), Web of Science, and google scholar. All types of observational studies were included. Identified articles needed to address a pre-determined population, concept, and context framework and had to be published in English or German language. The publication date of included articles was not subject to any limitation. The applied framework to assess the phenomenon of low-value physiotherapy services incorporated three domains (care effectiveness; care efficiency; patient alignment of care) and perspectives (provider; patient; society) of care. RESULTS Thirty-three articles met the inclusion criteria. Seventy-nine percent of articles focused on the appropriateness of physiotherapeutic treatments, followed by education and information (30%), the diagnostic process (15%), and goal-setting practice (12%). Study designs were predominantly cross-sectional (58%). Data sources were mainly survey instruments (67%) of which 50% were self-developed. Most studies addressed the effectiveness domain of care (73%) and the provider perspective (88%). The perspective of patient alignment was assessed by 6% of included articles. None of included articles assessed the society perspective. Four methodical approaches of included articles were rated to be transferrable to Germany. CONCLUSION Identified research on low-value physiotherapy care in low back pain management was widely unidimensional. Most articles focused on the effectiveness domain of care and investigated the provider perspective. Most measures were indirectly and did not monitor low-value care trends over a set period of time. Research on low-value physiotherapy care in secondary care conditions, such as Germany, was scarce. REGISTRATION This review has been registered on open science framework ( https://osf.io/vzq7k https://doi.org/10.17605/OSF.IO/PMF2G ).
Collapse
Affiliation(s)
- Lukas Kühn
- Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany. .,Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
| | - Lara Lindert
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany
| | - Paulina Kuper
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany
| | - Robert Prill
- grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816 Neuruppin, Germany ,grid.473452.3Center of Orthopaedics and Traumatology, Universtiy Hospital Brandenburg/Havel, Brandenburg Medical School, Neuruppin, Germany
| | - Kyung-Eun (Anna) Choi
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany ,grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816 Neuruppin, Germany ,grid.465811.f0000 0004 4904 7440Health Services Research, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstraße 124, 3500 Krems-Stein, Austria
| |
Collapse
|
9
|
Mullen N, Ashby S, Haskins R, Osmotherly P. The perceptions of individuals with musculoskeletal disorders towards prognosis: An exploratory qualitative study. Musculoskeletal Care 2022. [PMID: 36567482 DOI: 10.1002/msc.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/27/2022]
Abstract
QUESTION(S) How do individuals living with musculoskeletal disorders perceive the concept of prognosis? DESIGN Exploratory phenomenological study. PARTICIPANTS Individuals aged 18 years or older currently experiencing a musculoskeletal disorder. DATA ANALYSIS Single semi-structured one-on-one interviews were conducted. Data was analysed using inductive coding and thematic analysis. RESULTS Five themes were identified. First, participants defined prognosis as the likely outcome associated with their diagnosis. Their prognosis was often associated with outcomes related to pain, tissue health, and function. Second, participants perceived pain as having a negative impact on their prognosis by limiting their function and having a psychological impact. Third, participants held biomedical views in that tissue health was perceived as a cause for their pain and that tissue healing was essential for pain cessation. It was also difficult for participants to distinguish between pain related to tissue damage, and pain that was not. Fourth, participants use their ability to complete leisure and functional activities to determine the success of their recovery. Finally, participants perceived receiving individual prognoses for pain, tissue health, and function that may be simultaneously occurring as both important and beneficial. CONCLUSION Overall, participants viewed receiving prognostic information as important and beneficial. When constructing their views on prognosis participants perceived that pain, tissue health, and functional ability could all impact upon prognosis, whilst having a prognosis of their own. Physiotherapists should consider conceptualising and discussing prognosis in terms of pain, tissue health, and function when managing musculoskeletal disorders.
Collapse
Affiliation(s)
- Nicholas Mullen
- School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Samantha Ashby
- School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Robin Haskins
- John Hunter Hospital Outpatient Service, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Peter Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
10
|
Hovey RB, Pavate V, Vigouroux M. Lives Penciled in, the Reality of Chronic Health Conditions and Trauma: Reflexivity, Health, and Shadowed Identities. FRONTIERS IN PAIN RESEARCH 2022; 3:903724. [PMID: 35812018 PMCID: PMC9257251 DOI: 10.3389/fpain.2022.903724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
When living with chronic health conditions or experiences of trauma our lives can become perpetually penciled in. The use of the penciled-in metaphor means to arrange our time tentatively: a date, an appointment, a meeting, seeing a movie, or attending a class. In our technologically-driven world of electronic calendars where everything is entered electronically, the utility of the pencil and hand-written agendas have all but vanished. However, for the purpose of this article, the pencil provides a metaphoric common ground to learn about the totality of the disruption experienced by living with chronic health conditions and their residual trauma. The pencil is touchable, tangible and as a researcher and a person who lives with challenging health concerns, metaphors help me to create an understanding of the chaos of living a life in pain with cancer. This article is a person-centered account of the process of reflexive coping and self-processing of pain by a pain researcher and educator. This article focuses on the metaphor of penciled-in lives to provide a qualitative account of experiences of pain from chronic health issues and the trauma both physical and emotional it causes. This act of reflexivity becomes a personal examination of life. It reveals to me my beliefs, decisions, and practices before and during my hermeneutic journey and how these may have prejudiced my thinking and behaviors.
Collapse
Affiliation(s)
- Richard Bruce Hovey
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, QC, Canada
- *Correspondence: Richard Bruce Hovey
| | - Veeresh Pavate
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, QC, Canada
| | - Marie Vigouroux
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, QC, Canada
- Department of Pediatric Anesthesia, Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children's Hospital, Montreal, QC, Canada
| |
Collapse
|
11
|
Ashe MC, Azim FT, Ariza‐Vega P, Burns J, Clemson L, Grover S, Hoppmann CA, Langford D, Fleig L, Burton E. Determinants of implementing reablement into research or practice: A concept mapping study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1949. [DOI: 10.1002/pri.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/04/2022] [Accepted: 03/26/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Maureen C. Ashe
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
| | - Farah Tabassum Azim
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
| | | | - Jane Burns
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
- Department of Physical Therapy The University of British Columbia Vancouver British Columbia Canada
| | - Lindy Clemson
- Sydney School of Health Sciences The University of Sydney Sydney New South Wales Australia
| | - Sanya Grover
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
| | - Christiane A. Hoppmann
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
- Department of Psychology The University of British Columbia Vancouver British Columbia Canada
| | - Dolores Langford
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
- Department of Physical Therapy The University of British Columbia Vancouver British Columbia Canada
| | - Lena Fleig
- Department of Psychology Medical School Berlin Berlin Germany
| | - Elissa Burton
- Curtin School of Allied Health Curtin University Perth Western Australia Australia
- enAble Institute Curtin University Perth Western Australia Australia
| |
Collapse
|
12
|
Rogers CJ, Hackney ME, Zubkoff L, Echt KV. The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review. Pain Manag 2022; 12:653-664. [PMID: 35350847 DOI: 10.2217/pmt-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic low back pain (cLBP) impacts millions of adults annually. Several nonsurgical interventions are recommended for treating this condition, however, limited literature exists regarding the impact patient-led goals may have on outcomes in the treatment of cLBP. The purpose of this narrative review is to identify gaps and synthesize literature examining the associations of patient-led goals combined with care for cLBP. A total of 12 studies were reviewed and findings were synthesized. Patient-led goal setting may serve as an effective intervention for adults with cLBP. Current outcome measures may not align with patient-led goals. Further investigation is required to understand patient-led goals with ancillary treatments and specific age groups, such as adults over age 65.
Collapse
Affiliation(s)
- Casey J Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA
| | - Madeleine E Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Lisa Zubkoff
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Katharina V Echt
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| |
Collapse
|
13
|
Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies. Musculoskelet Sci Pract 2021; 56:102433. [PMID: 34416557 DOI: 10.1016/j.msksp.2021.102433] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Self-management strategies are considered a necessary component of chronic musculoskeletal pain management to address ongoing symptoms and challenges. However uptake of self-management can be impeded by a number of factors. OBJECTIVES The aim of this study was to explore common impeding and facilitating factors of self-management strategies from the patient perspective. METHODS An electronic search was performed between 2009 to May 2020 for the following databases: MEDLINE, AMED, PsychINFO, Cochrane Library, PubMed, CINAHL, PEDro, and Google Scholar. The search terms included peer-reviewed qualitative or mixed-method studies investigating the perspective of chronic musculoskeletal pain patients in regards to the use of self-management strategies. Study rigor and bias was assessed using the CASP (Critical Appraisal Skills Programme) questionnaire specific to qualitative studies. Qualitative data was coded using a three-stage thematic synthesis process. Confidence in findings was assessed using CERQual (The Confidence in the Evidence from Review of Qualitative Research). RESULTS Twenty-seven studies were included with 487 participants. Six major themes were identified and divided into external and internal influencing factors. The external influencing factors were made up of the following three themes: health care practitioner role, supportive environment, accessibility. While the three internal influencing themes were: physical factors, knowledge and understanding, and psychological factors. CONCLUSION Learning to self-manage for patients in chronic pain required ongoing support either from healthcare practitioners or from social circles. To further assist the self-management process practitioners can improve self-efficacy through increasing patient knowledge of chronic pain, utilising goal setting and finding ways an individual can access ongoing support, either from the practitioner or through group programs.
Collapse
|
14
|
Enthoven P, Eddeborn F, Abbott A, Schröder K, Fors M, Öberg B. Patients' experiences of the BetterBack model of care for low back pain in primary care - a qualitative interview study. Int J Qual Stud Health Well-being 2021; 16:1861719. [PMID: 33393455 PMCID: PMC7782354 DOI: 10.1080/17482631.2020.1861719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: The aim of this study was to describe patient experiences of received primary care for low back pain (LBP) according to the BetterBack Model of Care (MoC) with a focus on illness beliefs and self-management enablement. Methods: Individual interviews were conducted with 15 adults 4–14 months after receiving treatment according to the BetterBack MoC for LBP in primary care in Sweden. Data were analysed using content analysis. Results: When analysing the data, the following theme emerged; “Participant understanding of their treatment for low back pain and self-management strategies—a matter of support systems”, comprising the following categories: “Knowledge translation”, “Interaction and dialogue”, “The health care professional support” and “Form organization”. Participants experienced that they had better knowledge about their LBP and received tools to better manage their health condition. The participants expressed good communication with the treating physiotherapist and provided suggestions to further improve the treatment of LBP. Conclusions: Participants experienced that they had gained new knowledge about their health problems and after the treatment they had the tools to handle their back problems. This suggests that the BetterBack MoC may be used as a basis for a support system to provide valuable tools for self-management for patients with low back pain.
Collapse
Affiliation(s)
- Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Fredrik Eddeborn
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Rehab West, Region Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Karin Schröder
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Maria Fors
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| |
Collapse
|
15
|
Hansen LS, Præstegaard J, Lehn-Christiansen S. Patient-centeredness in Physiotherapy - A literature mapping review. Physiother Theory Pract 2021; 38:1843-1856. [PMID: 34096445 DOI: 10.1080/09593985.2021.1923095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and purpose: Research on patient-centeredness within physiotherapy points to a need for clarification about what the concept entails in science and practice and how research positions itself within health care. Thus, the aim is to systematically map the characteristics of research on patient-centeredness in physiotherapy and critically discuss the dominant understandings within. Methods: A systematic research mapping was carried out, based on searches in leading bibliographic databases. Four categories were selected in order to characterize the research field: focus, design, theoretical approach and inherent logic. Findings: Of 5,324 studies, 101 were included in the final mapping, pointing to a limited amount of research. The papers included were published in 47 different journals. Two major research foci emerges: one testing or developing technologies (tools) to promote patient-centeredness and one exploring patients' or professionals' experiences related to physiotherapy practice. Most papers reported on empirical research and there seems to be a dearth of conceptual papers. The theoretical approaches applied were mainly psychological, pedagogical and biomedical. The papers included were divided into equal amounts of studies carried out within inherent logics of causality and complexity. Conclusion: The mapping suggests an incipient awareness of patient-centeredness within the research field of physiotherapy. Empirical studies dominate the field, whereas conceptual and critical papers seem in need of wider acknowledgment. The research field is divided into two mutually disconnected trends: one concerned with understanding the complexity of clinical practice and patients' experiences of treatment and illness, and another trend concerned with solving "the problem" of patient involvement.
Collapse
Affiliation(s)
- Louise Søgaard Hansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University Roskilde, Denmark
| | - Jeanette Præstegaard
- Centre for Nutrition and Rehabilitation, Department of Physiotherapy, University College Absalon, Roskilde, Denmark
| | - Sine Lehn-Christiansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University Roskilde, Denmark
| |
Collapse
|
16
|
Goudman L, De Smedt A, Linderoth B, Eldabe S, Witkam R, Henssen D, Moens M. Identifying goals in patients with chronic pain: A European survey. Eur J Pain 2021; 25:1959-1970. [PMID: 34048121 DOI: 10.1002/ejp.1814] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic pain is a major healthcare issue that often requires an interdisciplinary treatment approach. Defining relevant treatment goals is one of the crucial steps in creating successful rehabilitation schemes. Therefore, the first aim was to explore goals that patients suffering from chronic pain aim to achieve. The second aim was to translate those goals into measurable functional outcome variables which can be used to measure treatment success. METHODS An online survey was developed and spread through local pain alliances in six European countries. Participants, patients suffering from chronic pain, were asked to report their most important goals, combined with a rank to denote the importance of each goal. For the highest ranked goals, participants were asked to decompose their goal into functional postures and the number of minutes per posture to achieve this goal. RESULTS We approached 1,494 persons, of which 487 effectively completed this survey. The highest ranked goals were taking part in family and social activities (72.55%), pain reduction (91.18%) and household tasks (68.14%). Obtaining pain reduction was most often ranked first (55.75%), followed by improving sleep (12.25%) and taking part in family or social activities (11.00%). For all goals, walking was a crucial component. CONCLUSIONS The goals of chronic pain patients are in line with previously explored expectations, denoting the importance of achieving pain relief combined with improvements on the level of activities and participation. This survey indicates that rehabilitation programs should definitely focus on improving walking ability, due to its importance in underpinning overall goal achievement. SIGNIFICANCE Goals and expectations of chronic pain patients are in line with each other. Obtaining pain relief remains the highest ranked goal, however, goals on the level of activities and participation were also highly ranked. Walking seems to be the overall crucial component for goal achievement.
Collapse
Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.,STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Jette, Belgium
| | - Ann De Smedt
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.,STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bengt Linderoth
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sam Eldabe
- Pain Clinic, The James Cook University Hospital, Middlesbrough, UK
| | - Richard Witkam
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Unit of Functional Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan Henssen
- Unit of Functional Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.,STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Jette, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
| |
Collapse
|
17
|
Amundsen O, Vøllestad NK, Meisingset I, Robinson HS. Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice. BMC Musculoskelet Disord 2021; 22:182. [PMID: 33583404 PMCID: PMC7882069 DOI: 10.1186/s12891-021-04048-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Goal setting is linked to person-centred care and is a core component in physiotherapy, but the associations between goal classes, patient characteristics and outcome measures for musculoskeletal disorders has not been investigated. The study’s purpose was to examine 1) how goals used in clinical practice for patients with musculoskeletal disorders (MSD) are distributed in classes based on ICF, 2) if goal classes were associated with patient characteristics and 3) whether goal classes were associated with treatment outcome. Methods Data analysis from a longitudinal observational study (N = 2591). Goals were classified in symptom, function/structure, activity/participation and non-classifiable. Associations between patient characteristics and goal classes were examined using x2 and one-way ANOVA. Association between goal classes and outcomes were examined using multiple logistic and linear regression models. Outcomes are reported at 3 months or end of treatment if prior to 3 months. Results There was a high variability in goals used for patients with MSD. 17% had symptom goals, 32.3% function/structure, 43.4% activity/participation and 7.4% non-classifiable goals. We found significant associations between goal classes and age, gender, severity, region of pain/diagnosis and emotional distress (all p < .001). Activity/participation goals were associated with better outcomes on GPE (OR 1.80, 95% CI 1.23–2.66). Non-classifiable goal was associated with poorer outcomes on pain intensity (B .87, 95% CI .32–1.43). Conclusion There is an association between goal classes and patient characteristics. Including activity/participation in the main goal was associated with better outcomes for GPE and having a non-classifiable goal was associated with poorer outcomes for pain intensity. Trial registration The project is approved by the Regional committee for Medical and Health Research Ethics in Norway (REC no. 2013/2030). https://clinicaltrials.gov/ct2/show/NCT03626389.
Collapse
Affiliation(s)
- Olav Amundsen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, P. O box 1130 Blindern, 0318, Oslo, Norway.
| | - Nina Køpke Vøllestad
- Institute of Health and Society, Faculty of Medicine, University of Oslo, P. O box 1130 Blindern, 0318, Oslo, Norway
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Stendal Robinson
- Institute of Health and Society, Faculty of Medicine, University of Oslo, P. O box 1130 Blindern, 0318, Oslo, Norway
| |
Collapse
|
18
|
Abstract
STUDY DESIGN Observational cross-sectional study. OBJECTIVE To analyze the association between low back pain and biomedical beliefs in physiotherapy students of the first and last year. SUMMARY OF BACKGROUND DATA There is a hypothesis that the presence of low back pain may be a risk factor for biomedical beliefs in physiotherapy academics. METHODS Three hundred sixty-five students of first and last year of the physiotherapy course from three universities in city of Fortaleza completed a questionnaire with sociodemographic factors and a Pain Attitude and Beliefs Scale used to determine the orientation (biopsychosocial or biomedical approach) of practitioners to the management of people with low back pain. RESULTS The mean age of participants was 23.57 ± 4.77 years, with a predominance of females (80.27%, n = 239). Approximately 23.84% reported low back pain, 18.9% had undergone imaging tests at the site, and 36.71% reported that family members with low back pain also underwent these examinations. The means of the biopsychosocial subscale of the Pain Attitude and Belief Scale corresponded to 20.19 and 20.63 in the first and last year academics, respectively, whereas the biomedical subscale corresponded to 32.10 and 32.73 in the first and last year academics, respectively. There was no statistical difference between the scores of the first and last year students. Linear regression analyses showed that low back pain was associated with lower levels of biomedical beliefs in the students of the last year (beta coefficient = -2.17, 95% confidence interval = -3.95 to -0.3, P = 0.02). We did not find association between low back pain and levels of biomedical beliefs in academics of both years and with academics of the first year. Also, we did not find association between low back pain and levels of biopsychosocial beliefs. CONCLUSION First and last year physical therapy students did not present a difference between biomedical and biopsychosocial beliefs. Although biomedical beliefs were prevalent in both groups, the academics of the last year who had low back pain presented lower levels of biomedical beliefs than the academics of the last year without low back symptoms. LEVEL OF EVIDENCE 4.
Collapse
|
19
|
Szwimer R, Widjaja M, Ingelmo P, Hovey RB. A Phenomenological Exploration of the Personal Implications of Female Adolescents Living With Chronic Pain. J Pediatr Health Care 2020; 34:470-477. [PMID: 32861426 DOI: 10.1016/j.pedhc.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Chronic pain (CP) negatively impacts everyday previously taken-for-granted activities resulting in considerable psychosocial stress for the individual. Qualitative research in pediatric CP is limited despite the considerable influence CP has on the process of establishing one's personal identity during these formative years and invites the opportunity to understand how CP affects these young individuals from their perspective. The objective of the study was to inquire into the experiences of female adolescents living with CP in order to enhance our understanding of how CP affects their personal lives. METHOD We used an interpretive phenomenological approach; two researchers interviewed eight female patients of the Montreal Children's Hospital Chronic Pain Management Clinic (aged 14-17 years) for one session each. RESULTS Self-reported factors that improved these female adolescents' personal life included having engaging hobbies, accepting the incurability of CP, and envisioning a fulfilling future. DISCUSSION The findings from this study suggest a need to orient CP-related services around goals and interests that female adolescents living with CP set for themselves in order to improve their perceived quality of life.
Collapse
|
20
|
Hoorntje A, Waterval-Witjes S, Koenraadt KL, Kuijer PPF, Blankevoort L, Kerkhoffs GM, van Geenen RC. Goal Attainment Scaling Rehabilitation Improves Satisfaction with Work Activities for Younger Working Patients After Knee Arthroplasty: Results from the Randomized Controlled ACTION Trial. J Bone Joint Surg Am 2020; 102:1445-1453. [PMID: 32453116 PMCID: PMC7508269 DOI: 10.2106/jbjs.19.01471] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knee arthroplasty (KA) is increasingly performed in relatively young, active patients. This heterogeneous patient population often has high expectations, including work resumption and performance of knee-demanding leisure-time activities. Goal attainment scaling (GAS) may personalize rehabilitation by using patient-specific, activity-oriented rehabilitation goals. Since unmet expectations are a leading cause of dissatisfaction after KA, personalized rehabilitation may improve patient satisfaction. We hypothesized that, compared with standard rehabilitation, GAS-based rehabilitation would result in younger, active patients having higher satisfaction regarding activities after KA. METHODS We performed a single-center randomized controlled trial. Eligible patients were <65 years of age, working outside the home, and scheduled to undergo unicompartmental or total KA. The required sample size was 120 patients. Using GAS, patients developed personal activity goals with a physiotherapist preoperatively. These goals were used to monitor patients' goal attainment and provide goal-specific feedback during postoperative outpatient rehabilitation. Standard rehabilitation consisted of regular outpatient physiotherapy visits. The primary outcome measures were visual analogue scale (VAS) scores (scale of 0 to 100) for satisfaction regarding activities of daily living and work and leisure-time activities 1 year postoperatively, which were analyzed using generalized estimating equation models. RESULTS Patient satisfaction with work activities was significantly higher in the GAS group (β = 10.7 points, 98% confidence interval [CI] = 2.0 to 19.4 points) than in the control group. Patient satisfaction with activities of daily living and leisure-time activities did not differ between groups. We found no differences in VAS satisfaction scores between unicompartmental KA and total KA. CONCLUSIONS Personalized, goal-specific rehabilitation using GAS resulted in higher patient satisfaction with work activities, compared with standard rehabilitation, 1 year after KA. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands,Email address for A. Hoorntje:
| | - Suzanne Waterval-Witjes
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands,Personalized Knee Care, Maastricht, the Netherlands
| | - Koen L.M. Koenraadt
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - P. Paul F.M. Kuijer
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Rutger C.I. van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| |
Collapse
|
21
|
Magalhães Franchi U, Luiz Carregaro R, Paula de Souza L, Augusto Penha A, Padula RS. Occupational health and ergonomics physiotherapists in Brazil: investigation of the socio-demographic profile and professional practices. Physiother Theory Pract 2019; 37:1466-1473. [PMID: 31847664 DOI: 10.1080/09593985.2019.1703228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Occupational health and ergonomics (OHE) has been recognized as a Physiotherapy specialty in 15 countries; however, a lack of studies that provide profiles of OHE Physiotherapists (PTs) and their professional practices.Objective: To provides a profile of the OHE PTs in Brazil, identify and audit their current professional practices based on the Conselho Federal de Fisioterapia e Terapia Ocupacional (COFFITO) guidelines for this specialty.Method: This was a cross-sectional study. The participants were legally registered with the Regional Council of Physiotherapy and Occupational Therapy (CREFITO) in Brazil. An invitation to participate in the survey was sent to the members of the Association of Physiotherapists in Occupational Health and Ergonomics (ABRAFIT) and PTs recognized for their contributions to the OHE field. The participants were contacted through e-mail, Facebook posts, and LinkedIn messages. The questionnaire was distributed through the SurveyMonkey platform.Results: A total of 153 (86%) OHE PTs returned the survey. The mean age was 35.6 (SD 6.8) years, mean time in the OHE field was 8.5 (SD 5.6) years, the majority are women (61.5%). The OHE PTs were company employees or service providers. The OHE PTs reported satisfaction with their professional performance (74.8%). The OHE PTs' most frequent interventions include biomechanical exposure assessments, ergonomic workplace analysis, and occupational health management.Conclusion: The OHE PTs in Brazil are predominantly women with professional experience who earn higher salaries than other PTs specialties. The OHE PTs based on their audited practices within the COFFITO guidelines focus on ergonomic workplace analysis and biomechanical exposure assessment.
Collapse
Affiliation(s)
- Uerley Magalhães Franchi
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Rodrigo Luiz Carregaro
- Master Program in Rehabilitation Sciences, School of Physical Therapy, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasilia, DF, Brazil
| | - Leticia Paula de Souza
- Deparment of Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Arquimedes Augusto Penha
- Physiotherapist, President of the Occupational Physiotherapy Association (ABRAFIT), Curitiba, SP, Brazil
| | - Rosimeire Simprini Padula
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil.,Deparment of Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| |
Collapse
|
22
|
Goudman L, Bruzzo A, Sande J, Moens M. Goal Identification Before Spinal Cord Stimulation: A Qualitative Exploration in Potential Candidates. Pain Pract 2019; 20:247-254. [DOI: 10.1111/papr.12845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery Universitair Ziekenhuis Brussel Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy Faculty of Physical Education & Physiotherapy Vrije Universiteit Brussel BrusselsBelgium
| | | | | | - Maarten Moens
- Department of Neurosurgery Universitair Ziekenhuis Brussel Brussels Belgium
- Department of Radiology Universitair Ziekenhuis Brussel BrusselsBelgium
- Center for Neurosciences Vrije Universiteit Brussel Brussels Belgium
| |
Collapse
|
23
|
Man I, Kumar S, Jones M, Edwards I. An exploration of psychosocial practice within private practice musculoskeletal physiotherapy: A cross-sectional survey. Musculoskelet Sci Pract 2019; 43:58-63. [PMID: 31260932 DOI: 10.1016/j.msksp.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/01/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with pain associated with musculoskeletal disorders often seek treatment from physiotherapists, necessitating these practitioners' competence to practice within the biopsychosocial framework. Qualitative research suggests musculoskeletal physiotherapists may not have adequate proficiency in psychosocial practice to assess and address psychosocial factors effectively. OBJECTIVE To collect quantitative self-report data via an online survey from a large cross section of Australian musculoskeletal physiotherapists regarding their psychosocial practice. METHODS The study involved an iterative survey development process followed by the conduct of this survey. A provisional survey named the 'Triple P Questionnaire' was developed, informed by the knowledge and experience of the research team. This Questionnaire was piloted by experts (n = 6) to provide feedback on the instrument. Changes were made to the survey based on this feedback. The finalised Triple P Questionnaire was distributed to Australian musculoskeletal physiotherapists. RESULTS 181 participants completed the full survey. Not all demographic characteristics were representative of the population. Most participants indicated that they 'agree' to most statements posed in the questionnaire including confidence, routine practice of specific psychosocial skills and barriers. Some questions presented a majority response of 'disagree' or a spread of responses, indicating some evidence-practice gaps, including the use of questionnaires, and explicit assessment of psychological factors. Inferential statistics revealed no significant correlations between demographic characteristics and psychosocial practice. CONCLUSION The Triple P Questionnaire identified musculoskeletal physiotherapists' general confidence in their psychosocial practice but highlights some apparent inconsistencies in reported practice and areas where confidence is not as strong, reflecting possible evidence practice gaps.
Collapse
Affiliation(s)
- Isabella Man
- School of Health Sciences, University of South Australia, City East Campus, 108 North Terrace, Adelaide, SA, 5001, Australia.
| | - Saravana Kumar
- School of Health Sciences, University of South Australia, City East Campus, 108 North Terrace, Adelaide, SA, 5001, Australia.
| | - Mark Jones
- School of Health Sciences, University of South Australia, City East Campus, 108 North Terrace, Adelaide, SA, 5001, Australia.
| | - Ian Edwards
- School of Health Sciences, University of South Australia, City East Campus, 108 North Terrace, Adelaide, SA, 5001, Australia.
| |
Collapse
|
24
|
Gardner T, Refshauge K, McAuley J, Hübscher M, Goodall S, Smith L. Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial. Br J Sports Med 2019; 53:1424-1431. [PMID: 30808666 DOI: 10.1136/bjsports-2018-100080] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND One model of care that has not been tested for chronic low back pain (LBP) is patient-led goal setting. We aimed to compare the clinical effectiveness and healthcare use of a patient-led goal setting approach (intervention) with simple advice to exercise (control) over 12 months. METHODS An assessor-blinded randomised controlled trial. Intervention was education combined with patient-led goal setting compared with a control group receiving a standardised exercise programme. The primary outcomes were back pain disability and pain intensity. Secondary outcomes were quality of life, kinesiophobia, self-efficacy, depression, anxiety and stress. Outcomes and healthcare use were assessed immediately post-treatment (2 months) and after 4 and 12 months. Analysis was by intention to treat. RESULTS Seventy-five patients were randomly assigned to either the intervention (n=37) or the control (n=38) group. Using linear mixed model analyses, adjusted mean changes in primary outcomes of disability and pain intensity were greater in the intervention group than in the control group (disability post-treatment: p<0.05). These differences were clinically meaningful. Mean differences in all secondary measures were greater in the intervention group than in the control group (p<0.05). There was no difference in healthcare use between groups over 12 months. CONCLUSION A patient-led goal setting intervention was significantly more effective than advice to exercise for improving outcomes in disability, pain intensity, quality of life, self-efficacy and kinesiophobia in chronic LBP. These improvements were maintained at 12 months. Smaller effects were seen in measures of depression, anxiety and stress. TRIAL REGISTRATION NUMBER ACTRN12614000830695.
Collapse
Affiliation(s)
- Tania Gardner
- Department of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
| | - Kathryn Refshauge
- Department of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - James McAuley
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research & Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Lorraine Smith
- Department of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
25
|
Lennox Thompson B, Gage J, Kirk R. Living well with chronic pain: a classical grounded theory. Disabil Rehabil 2019; 42:1141-1152. [DOI: 10.1080/09638288.2018.1517195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Bronwyn Lennox Thompson
- Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jeffrey Gage
- College of Nursing, California Baptist University, Riverside, CA, USA
| | - Ray Kirk
- UC Health, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|