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Lacey A, Whyte E, Dillon S, O'Connor S, Burke A, Moran K. Definitions and surveillance methods of running-related injuries: A scoping review. Eur J Sport Sci 2024; 24:950-963. [PMID: 38956793 DOI: 10.1002/ejsc.12123] [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: 12/04/2023] [Revised: 04/12/2024] [Accepted: 04/30/2024] [Indexed: 07/04/2024]
Abstract
Inconsistent and restricted definitions of injury have contributed to limitations in determining injury rates and identifying risk factors for running-related injuries (RRIs). The aim of this scoping review was to investigate the definitions and surveillance methods of RRIs. A systematic electronic search was performed using PubMed, Scopus, SPORTDiscuss, MEDLINE, and Web of Science databases. Included studies were published in English between January 1980 and June 2023 which investigated RRIs in adult running populations, providing a definition for a general RRI. Results were extracted and collated. 204 articles were included. Three primary criteria were used to define RRIs: physical description, effect on training and medical intervention, while three secondary criteria are also associated with definitions: cause/onset of injury, location, and social consequences. Further descriptors and sub-descriptors form these criteria. The use of Boolean operators resulted in nine variations in definitions. Inconsistency is evident among definitions of RRIs. Injury definitions seem to be important for two main reasons: firstly, determining accurate injury rates, and secondly, in research examining risk factors. For the latter, definitions seem to be very limited, only capturing severe injuries and failing to recognise the full development process of RRIs, precluding the identification of conclusive risk factors. A potential two-approach solution is the initial use of a broad definition acting as a gatekeeper for identifying any potential injury, and follow-up with an extensive surveillance tool to capture the specific consequences of the varying severity of RRIs.
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Affiliation(s)
- Aisling Lacey
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
| | - Enda Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Sarah Dillon
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Siobhán O'Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Aoife Burke
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Kieran Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Strømstad K, Skarpaas LS, Haslerud SI, Alve YA, Sandqvist J, Aas RW. Exploring return to work barriers through the lens of model of human occupation. The NOW WHAT project. Scand J Occup Ther 2024; 31:2297732. [PMID: 38242153 DOI: 10.1080/11038128.2023.2297732] [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: 07/04/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The challenges of returning to work after sickness absence demands a wide conceptual understanding of what hinders the employee's work participation. Thus, there is a need to know more about self-perceived barriers for Return to Work (RTW). AIM This study aimed to investigate RTW barriers experienced by employees on long-term sick leave, through the lens of the Model of Human Occupation (MOHO). MATERIAL AND METHODS The study was a large-scale qualitative interview study (n = 85) using semi-structured telephone interviews. Eligible participants had received sick leave benefits for between 6 months and 1.5 years. The data were analysed with quantitative and qualitative content analysis. A deductive approach using the MOHO concepts guided the analysis process. RESULTS The study generated 941 coded meaning units describing barriers for RTW, of which we were able to code 895 within the framework of MOHO. In the person-specific concepts, performance capacity barriers were most often described (n = 303), followed by volitional barriers (n = 165) and barriers related to habituation (n = 66). Barriers related to the environmental components amounted to 361. Barriers in the occupational environment was dominant (n = 214). CONCLUSION Experienced barriers related to both environmental components and person-specific concepts. SIGNIFICANCE The habituational and volitional perspective on barriers can contribute to the identification and communication of performance capacity-related barriers not previously identified.
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Affiliation(s)
- Kine Strømstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Lisebet S Skarpaas
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Sturla I Haslerud
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Yeasir A Alve
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, USA
| | - Jan Sandqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Randi W Aas
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
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Snippen NC, de Vries HJ, Roelen CAM, Brouwer S, Hagedoorn M. The Associations Between Illness Perceptions and Expectations About Return to Work of Workers With Chronic Diseases and Their Significant Others: A Dyadic Analysis. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:189-200. [PMID: 35978150 PMCID: PMC10025207 DOI: 10.1007/s10926-022-10062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
Purpose To examine the associations between illness perceptions and expectations about full return to work (RTW) of workers with chronic diseases and their significant others. Methods This study used cross-sectional data of 94 dyads consisting of workers with chronic diseases and their significant others. We performed dyadic analyses based on the Actor-Partner Interdependence Model (APIM), estimating associations of illness perceptions of the two members of the dyad with their own expectations about the worker's full RTW within six months (actor effect) as well as with the other dyad member's expectations about the worker's RTW (partner effect). Results Illness perceptions of one dyad member were significantly associated with his or her own RTW expectations (actor effect composite illness perceptions score; B = -0.05, p < .001; rd = .37) and with the other dyad member's RTW expectations (partner effect composite illness perceptions score; B = -0.04, p < .001; rd = .35). That is, more negative illness perceptions of one member of the dyad were associated with more negative RTW expectations in both dyad members. For most illness perception domains, we found small to moderate actor and partner effects on RTW expectations (rd range: .23-.44). Conclusions This study suggests that illness perceptions and RTW expectations should be considered at a dyadic level as workers and their significant others influence each other's beliefs. When trying to facilitate adaptive illness perceptions and RTW expectations, involving significant others may be more effective than an individualistic approach targeted at the worker only.
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Affiliation(s)
- N C Snippen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
| | - H J de Vries
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - C A M Roelen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
- Arbo Unie, Nieuwegein, The Netherlands
| | - S Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - M Hagedoorn
- Department of Health Sciences, Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Gershoni T, Pud D, Aviram J, Eisenberg E. Wellness of patients with chronic pain is not only about pain intensity. Pain Pract 2023; 23:145-154. [PMID: 36181347 PMCID: PMC10092262 DOI: 10.1111/papr.13168] [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: 03/15/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients. DESIGN A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T0 ), six (T6 ), and twelve (T12 ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively. RESULTS Participants included 510 patients. All variables were significantly improved from T0 to T6 and T12 . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T0 , T6 , and T12 (related conditions: β0 = 0.55, p < 0.001; β6 = 0.54, p < 0.001; and β12 = 0.51, p < 0.001; pain: β0 = 0.42, p < 0.001; β6 = 0.18, p < 0.001; and β12 = 0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness. CONCLUSION Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.
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Affiliation(s)
- Tamar Gershoni
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Dorit Pud
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Joshua Aviram
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Elon Eisenberg
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Jain R, Rana KB, Meena ML. An integrated multi-criteria decision-making approach for identifying the risk level of musculoskeletal disorders among handheld device users. Soft comput 2023; 27:3283-3293. [PMID: 33551675 PMCID: PMC7856850 DOI: 10.1007/s00500-021-05592-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In work-from-home (WFH) situation due to coronavirus (COVID-19) pandemic, the handheld device (HHD) users work in awkward postures for longer hours because of unavailability of ergonomically designed workstations. This problem results in different type of musculoskeletal disorders (MSDs) among the HHD users. An integrated multi-criteria decision-making approach was offered for identifying the risk level of MSDs among HHD users. A case example implemented the proposed approach in which, firstly, the best-worst method (BWM) technique was used to prioritize and determine the relative importance (weightage) of the risk factors. The weightages of the risk factors further used to rank the seven alternatives (HHD users) using Vlse Kriterijumska Optimizacija Kompromisno Resenje (VIKOR) technique. The outcomes of the BWM investigation showed that the three most significant risk factors responsible for MSDs are duration of working, poor working posture and un-ergonomic design. The outcome of the VIKOR technique exhibited that computer professionals were at the highest risk among all users. The risk factor priority must be used for designing a working strategy for the WFH situation which will help to mitigate the risks of MSDs.
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Affiliation(s)
- Rahul Jain
- Department of Mechanical Engineering, University Teaching Department, Rajasthan Technical University Kota, Rawatbhata Road, Akelgarh, Kota, Rajasthan 324010 India
| | - Kunj Bihari Rana
- Department of Mechanical Engineering, University Teaching Department, Rajasthan Technical University Kota, Rawatbhata Road, Akelgarh, Kota, Rajasthan 324010 India
| | - Makkhan Lal Meena
- Department of Mechanical Engineering, Malaviya National Institute of Technology, JLN Marg, Malaviya Nagar, Jaipur, Rajasthan 302017 India
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Bergman BP, Demou E, Lewsey J, Macdonald E. A comparison of routine and case-managed pathways for recovery from musculoskeletal disorders in people in employment. Disabil Rehabil 2022; 44:4648-4655. [PMID: 33896322 PMCID: PMC7613959 DOI: 10.1080/09638288.2021.1912837] [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: 11/04/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare outcomes in employed people from an enhanced routine management pathway for musculoskeletal disorders within National Health Service Scotland with an existing active case-management system, Working Health Services Scotland. MATERIALS AND METHODS The study comprised a service evaluation using anonymised routinely collected data from all currently employed callers presenting with musculoskeletal disorder to the two services. Baseline demographic and clinical data were collected. EuroQol EQ-5DTM scores at the start and end of treatment were compared for both groups, overall and by age, sex, socio-economic status, and anatomical site, and the impact of mental health status at baseline was evaluated. RESULTS Active case-management resulted in greater improvement than enhanced routine care. Case-managed service users entered the programme earlier in the recovery pathway; there was evidence of spontaneous improvement during the longer waiting time of routine service clients but only if they had good baseline mental health. Those most disadvantaged through mental health co-morbidity showed the greatest benefit. CONCLUSIONS People with musculoskeletal disorders who have poor baseline mental health status derive greatest benefit from active case-management. Case-management therefore contributes to reducing health inequalities and can help to minimise long-term sickness absence. Shorter waiting times contributed to better outcomes in the case-managed service. Implications for RehabilitationMusculoskeletal disorders are a major cause of inability to work.Case-management is effective in helping people with musculoskeletal disorders to return to work.People who have the poorest mental health are likely to gain the greatest benefit from case-management of their musculoskeletal disorders.
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Affiliation(s)
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - James Lewsey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ewan Macdonald
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder. J Clin Med 2021; 11:jcm11010154. [PMID: 35011895 PMCID: PMC8745240 DOI: 10.3390/jcm11010154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.
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Postigo-Martin P, Cantarero-Villanueva I, Lista-Paz A, Castro-Martín E, Arroyo-Morales M, Seco-Calvo J. A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists. J Clin Med 2021; 10:1691. [PMID: 33920035 PMCID: PMC8071011 DOI: 10.3390/jcm10081691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Ana Lista-Paz
- Faculty of Physiotherapy, University of La Coruña, 15006 La Coruña, Spain;
| | - Eduardo Castro-Martín
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
| | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Jesús Seco-Calvo
- Physiotherapy Department, Institute of Biomedicine (IBIOMED), University of Leon, Campus de Vegazana s/n, 24071 Leon, Spain;
- Department of Physiology, Visiting Professor and Researcher of University of the Basque Country, 48940 Leioa, Spain
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Durand MJ, Coutu MF, Berbiche D. Validation of the Work Disability Diagnosis Interview for Musculoskeletal and Mental Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:232-242. [PMID: 32712758 DOI: 10.1007/s10926-020-09916-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose The Work Disability Diagnosis Interview (WoDDI) consists of a semi-structured interview designed to help clinicians systematically identify the factors contributing to a work disability. The aim was to validate two versions of the WoDDI (construct validity, internal consistency, interrater reliability) developed for individuals absent from work due to a musculoskeletal disorder (MSD) or common mental disorder (CMD). Methods A convenience sample of workers absent from work for at least three months due to an MSD or a CMD and enrolled in a rehabilitation program was recruited. To assess interrater reliability for the MSD and CMD versions, six occupational therapists by sub-group scored the WoDDI based on case histories. Results A total of 290 male and female workers (140 MSD, 150 CMD) were recruited. Exploratory factor analysis revealed similar dimensions in both versions, specifically, illness representation, clinical judgment of the complexity of the medical condition, and high level of work demands. It allowed items to be reduced by approximately 20 and 40% respectively for the CMD and MSD versions. Internal consistency (Cronbach's alpha) varied from 0.40 to 0.75 and 0.75 to 0.80 for the CMD and MSD versions respectively, while interrater reliability (Cohen's kappa coefficients) varied from 0.51 to 0.57 and 0.27 to 0.44 for the two versions respectively. Conclusion Despite some limitations, the WoDDI's factors correspond to those in the current scientific literature. The varying results for internal consistency suggest limitations mainly for the CMD version. Interrater reliability was found overall to be fair. The next step will be to revise and retest this version.
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Affiliation(s)
- Marie-José Durand
- Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada.
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada.
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada.
| | - Marie-France Coutu
- Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
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Central Sensitivity Is Associated with Poor Recovery of Pain: Prediction, Cluster, and Decision Tree Analyses. Pain Res Manag 2020; 2020:8844219. [PMID: 33178373 PMCID: PMC7647749 DOI: 10.1155/2020/8844219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
The process of pain recovery varies and can include the recovery, maintenance, or worsening of symptoms. Many cases of patients with pain show a tendency of recovering as predicted; however, some do not. The characteristics of cases that do not fit the prediction of pain recovery remain unclear. We performed cluster and decision tree analyses to reveal the characteristics in cases that do not fit the prediction of pain recovery. A total of 43 patients with musculoskeletal pain (nonoperative: 22 patients, operative: 13 patients) and central pain (brain disease: 5 patients, spinal cord disease: 3 patients) were included in this longitudinal study. Central sensitivity syndrome (CSS) outcome measures (Central Sensitisation Inventory), pain intensity-related outcome measures (Short-Form McGill Pain Questionnaire-2 (SFMPQ-2)), and cognitive-emotional outcome measures (Hospital Anxiety and Depression Scale and Pain Catastrophising Scale-4) of all patients were assessed at baseline and after 1-2 months. Regression analysis was used to calculate pain recovery prediction values. A hierarchical cluster analysis based on the predicted change of SFMPQ-2 and the observed change of SFMPQ-2 was used to extract subgroups that fit and those that do not fit pain recovery prediction. To extract the characteristics of subgroups that do not fit the prediction of pain recovery, a decision tree analysis was performed. The level of significance was set at 5%. In the results of cluster analysis, patients were classified into three subgroups. Cluster 1 was characterised by worse pain intensity from baseline, cluster 2 by pain, having recovered less and mildly than the predicted value, and Cluster 3 by a marked recovery of pain. In the results of the decision tree analysis, the CSI change was extracted as an indicator related to the classification of all clusters. Our findings suggest that the poor improvement of CSS is characteristic in cases that do not fit the prediction of pain recovery.
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Haider T, Dunstan D, Bhullar N. Improving psychologists' adherence to evidence‐based practice guidelines for treating musculoskeletal injuries: A feasibility study. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tahira Haider
- School of Psychology & Behavioural Science, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Debra Dunstan
- School of Psychology & Behavioural Science, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Navjot Bhullar
- School of Psychology & Behavioural Science, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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Haider T, Dunstan DA, Bhullar N. Psychologists’ Application of Clinical Guidelines and Recommended Protocols and Procedures within State Insurance Regulatory Authority Insurance Frameworks: Outcomes for Injured Patients with Musculoskeletal Injuries. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tahira Haider
- School of Behavioural, Cognitive and Social Sciences, University of New England,
| | - Debra A. Dunstan
- School of Behavioural, Cognitive and Social Sciences, University of New England,
| | - Navjot Bhullar
- School of Behavioural, Cognitive and Social Sciences, University of New England,
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Prognostic Factors for Staying at Work for Partially Sick-Listed Workers with Subjective Health Complaints: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197184. [PMID: 33008096 PMCID: PMC7578951 DOI: 10.3390/ijerph17197184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Abstract
Examination of prognostic factors for staying at work for long-term sick-listed workers with subjective health complaints (SHC) who partially work in a paid job, and to evaluate whether these factors are comparable with those of workers with other disorders. We used data of 86 partially sick-listed workers with SHC (57 females, 29 males, mean age 47.1 years) and 433 with other disorders (227 females, 206 males, mean age 50.9 years), from an existing prospective cohort study consisting of 2593 workers aged 18–65 years and registered as sick-listed with different health complaints or disorders for at least 84 weeks in the database of the Dutch Social Security Institute. We performed univariable logistic regression analyses (p ≤ 0.157) for all independent variables with the dependent variable staying at work for the workers with SHC. We then performed multivariable logistic regression analyses with forward selection (p ≤ 0.157) and combined the remaining factors in a final, multivariable model (p ≤ 0.05), which we also used for logistic regression analysis in the workers with other disorders. The following factors were significant prognostic factors for staying at work for workers with SHC: full work disability benefits (odds ratio (OR) 0.07, 95% confidence interval (95% CI) 0.01–0.64), good mental health (OR 1.08, 95% CI 1.02–1.14), positive expectations for staying at work (OR 6.49, 95% CI 2.00–21.09), previous absenteeism for the same health complaint (OR 0.31, 95% CI 0.10–0.96) and good coping strategies (OR 1.13, 95% CI 1.04–1.23). For workers with other disorders, full work disability benefits, good mental health and positive expectations for staying at work were also prognostic factors for staying at work. Individual and policy factors seem to be important for staying at work of sick-listed workers with SHC and those with other disorders alike, but several biopsychosocial factors are particularly important for workers with SHC.
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Which Psychological Factors Are Involved in the Onset and/or Persistence of Musculoskeletal Pain? An Umbrella Review of Systematic Reviews and Meta-Analyses of Prospective Cohort Studies. Clin J Pain 2020; 36:626-637. [PMID: 32379072 DOI: 10.1097/ajp.0000000000000838] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to summarize the current status of knowledge about the longitudinal association between vulnerability or protective psychological factors and the onset and/or persistence of musculoskeletal (MSK) pain. METHODS PubMed, CINAHL, PsycINFO, PubPsych, Scopus, Web of Science, gray literature, and manual screening of references were searched from inception to June 15, 2019. Systematic reviews with or without meta-analysis that explored the longitudinal association between psychological factors and the onset and/or persistence of MSK pain were identified. The AMSTAR-2 tool was used to assess the risk of bias. RESULTS Fifty-nine systematic reviews that included 286 original research studies were included, with a total of 249,657 participants (127,370 with MSK pain and 122,287 without MSK pain at baseline). Overall, our results found that exposure to many psychological vulnerability factors such as depression, anxiety, psychological distress, and fear, among others, may increase the risk of the onset and persistence of MSK pain across time. In addition, our results also showed that a range of psychological factors considered to be "protective" such as self-efficacy beliefs, better mental health, active coping strategies, or favorable expectations of recovery may reduce the risk of the onset and persistence of MSK pain. However, all these systematic reviews were evaluated to have critically low confidence based on the AMSTAR-2 tool, indicating that findings from these reviews may be informative, but should be interpreted with caution. DISCUSSION The large number of methodological flaws found across reviews gives rise to a call to action to develop high-quality systematic reviews in this field.
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Dulude E, Coutu MF, Durand MJ. Promoting resilience in work rehabilitation: development of a transdiagnostic intervention. Disabil Rehabil 2020; 43:3652-3662. [PMID: 32228191 DOI: 10.1080/09638288.2020.1744041] [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: 10/24/2022]
Abstract
PURPOSE The aim of this study was to develop an operationalized transdiagnostic resilience-based intervention for workers at risk of long-term work disability. METHODS A sequential mixed method design was used. Expert clinicians (n = 10) first answered a questionnaire including closed and open-ended questions on the clarity, applicability, relevance and exhaustiveness of a preliminary resilience intervention developed from evidenced-informed resilience factors to prompt reflection. Second, proposals from the questionnaire were discussed at a consensus group meeting with the same experts, yielding a final and improved intervention. Third, semi-structured interviews with work-disabled workers (n = 6) explored the intervention's acceptability to them. Thematic analysis of the verbatim was performed. RESULTS Experts identified 15 statements on clarity, applicability, relevance or exhaustiveness in the questionnaire that did not achieve consensus and generated 41 modification proposals. The consensus group adopted 15 modifications. The adapted intervention was well-accepted by the workers who had completed a work rehabilitation program. They perceived the intervention as positive, relevant, coherent, useful and consistent with their values. CONCLUSION A new transdiagnostic resilience intervention in work rehabilitation is available and was on exploratory basis seen acceptable by workers. Next step would be to validate it at a larger scale with more workers and other stakeholders.IMPLICATIONS FOR REHABILITATIONPromoting workers resilience in work rehabilitation fosters a holistic approach in clinical practice.Resilience interventions should be integrated into work rehabilitation programs.A new transdiagnostic resilience intervention designed to complement current work rehabilitation programs is available.
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Affiliation(s)
- Eve Dulude
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
| | - Marie-France Coutu
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
| | - Marie-José Durand
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
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Sullivan N, Hebron C, Vuoskoski P. "Selling" chronic pain: physiotherapists' lived experiences of communicating the diagnosis of chronic nonspecific lower back pain to their patients. Physiother Theory Pract 2019; 37:973-992. [PMID: 31744369 DOI: 10.1080/09593985.2019.1672227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However, no previous studies have explored clinicians' experiences of communicating their understanding of this diagnosis to their patients.Methods: A qualitative research design, using hermeneutic phenomenological methodology, was employed. Five participants were purposively recruited for the research and data collected via semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Emergent, super-ordinate and master themes were developed to help convey the qualitative significant meanings of the lived-through experiences.Findings: Three master themes were identified, with each comprising two sub-themes. These were: 1) Patient-centeredness (1a. Understanding the patient; and 1b. emotional awareness and adaptability); 2) Getting patients "on board" (2a. the "selling" process; and 2b. paternalism and the clinician's perspective); and 3) Dealing with conflict and uncertainty (3a. fear of interpersonal conflict; and 3b. personal doubts and uncertainty).Conclusions: Personal conflicts were identified between clinicians' descriptions of their wishes to "sell" their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients' beliefs. Building a good initial rapport, showing empathy and adapting approaches in response to perceptions of patients' reactions were perceived as strategies to help mitigate the risks of failed communication, but this was something for which participants felt unprepared by their prior training.
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Affiliation(s)
- Nick Sullivan
- Sutton Health & Care Alliance, Physiotherapy Department, St Helier Hospital, Carshalton, UK
| | - Clair Hebron
- Faculty of Health and Social Science, Department of Physiotherapy, University of Brighton, Eastbourne, UK
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences (Physiotherapy), University of Jyväskylä, Jyväskylä, Finland
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Skarpaas LS, Haveraaen LA, Småstuen MC, Shaw WS, Aas RW. Horizontal return to work coordination was more common in RTW programs than the recommended vertical coordination. The Rapid-RTW cohort study. BMC Health Serv Res 2019; 19:759. [PMID: 31655594 PMCID: PMC6815375 DOI: 10.1186/s12913-019-4607-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In return-to-work (RTW) programs, coordinators are often provided in order to integrate services. However, models of coordinating services vary widely internationally, and across different programs, where one distinction is between vertical and horizontal integration (i.e. between levels/institutions, or within one service/level). The aim of this study was therefore to explore and describe if and how a coordinator was provided in RTW-programs, and whether the provision of a coordinator was associated with certain personal or intervention characteristics. METHODS The study was designed as a cohort study following employees participating in a variety of Rapid-RTW-programs in Norway (n = 39). Employees (n = 494) answered a self-administered questionnaire, which was linked to register-data on diagnoses and sickness-absence. Employees who replied yes/no to the question "Did the program provide a person who tailored or coordinated your services?" were included in this analysis. Associations for being provided with a coordinator were tested in adjusted logistic regression models. RESULTS Sixty-nine percent of the employees reported having a coordinator. These coordinators were mainly responsible for coordinating treatment within own programs (i.e. horizontal coordination, 68%). As expected, rehabilitation programs more often provided a coordinator compared to treatment programs (OR 3.87 95% CI 2.42-6.24). The odds for being provided with a coordinator were reduced for each additional year of age of the employee (OR 0.97, 95% CI 0.96-0.99). More professions were involved in programs that provided coordinators, also more contact with other stakeholders like leaders and social insurance services (NAV), but only contact with supervisor remained statistically significant in adjusted analysis (OR 1.69 95% CI 0.31-9.27). The programs with a coordinator more often provided adaptations at the workplace for the individual employee (OR 0.08 95% CI 0.01-0.60). However, these signs of vertical integration were only evident for a limited number of employees. CONCLUSION In this study, seven of ten employees reported to have a coordinator, which was associated with more professions and stakeholder involvement in the RTW-process. Most of these coordinators did not coordinate vertically between the service levels and types of intervention arenas for sick listed employees (i.e. workplace, social security, and health care services), as recommended in earlier research.
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Affiliation(s)
- Lisebet Skeie Skarpaas
- Presenter - Making Sense of Science, Stavanger, Norway. .,Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway.
| | | | | | - William S Shaw
- Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Randi Wågø Aas
- Presenter - Making Sense of Science, Stavanger, Norway.,Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Black O, Sim MR, Collie A, Smith P. Differences Over Time in the Prognostic Effect of Return to Work Self-Efficacy on a Sustained Return to Work. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:660-667. [PMID: 30719610 DOI: 10.1007/s10926-018-09824-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose This study investigated the association between return to work self-efficacy (RTW-SE) and sustained return to work (RTW) at two different time points, over a 12-month period. The primary objective of the study was to examine if the relationship between RTW-SE and a sustained RTW changed over the RTW timeline. Methods This study used survey responses from a longitudinal cohort of n = 410 workers' compensation claimants with either an upper-body musculoskeletal injury or a psychological injury. A path analysis tested the associations between RTW-SE and a sustained RTW at two time-points. A Wald χ2 test compared nested models to determine if the association changed over time. Results RTW-SE measured at time- point 1 (T1) was associated with a sustained RTW at time-point two (T2) (β = 0.24, P < 0.05) but no association was found between RTW-SE at T2 and a sustained RTW at time-point three (T3) (β = 0.017, n.s.). Model comparisons revealed significant differences in the associations between RTW-SE and a sustained RTW, with the relationship being stronger in the early phase of RTW compared to the latter phase (χ2 = 5.002, p = 0.03). Conclusions The results indicate that RTW-SE at 4-6 months post-injury is important for a sustained RTW 6-months later although RTW-SE at 10-12 months post-injury had a negligible association over the same duration. Further research should investigate whether these findings generalize to other populations and what factors other than RTW-SE are associated with RTW in the later stages of the RTW process.
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Affiliation(s)
- Oliver Black
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne/Burwood, Australia.
- Department of Management, Deakin University, Burwood, Australia.
| | - Malcolm R Sim
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne/Burwood, Australia
| | - Alexander Collie
- Insurance Work and Health Group, Monash University, Melbourne/Burwood, Australia
| | - Peter Smith
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne/Burwood, Australia
- Institute for Work & Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Othman R, Jayakaran P, Tumilty S, Swain N, Mani R. Predictive relationship between psychological, social, physical activity, and sleep measures and somatosensory function in individuals with musculoskeletal pain: a systematic review and meta-analysis protocol. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1648715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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20
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Samoborec S, Ayton D, Ruseckaite R, Evans SM. Biopsychosocial barriers affecting recovery after a minor transport-related injury: A qualitative study from Victoria. Health Expect 2019; 22:1003-1012. [PMID: 31155834 PMCID: PMC6803416 DOI: 10.1111/hex.12907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of the study was to understand the recovery phenomena and to explore participants' perspectives on the biopsychosocial facilitators and barriers affecting their recovery after a minor transport injury. Methods A qualitative method was used involving semi‐structured interviews with 23 participants who sustained a minor transport injury. Interviews and analysis were guided by the biopsychosocial model (BPS) of health. The outcomes were themes capturing biopsychosocial barriers to, and personal experiences of, recovery using a previously defined framework. Results The themes indicate that recovery is a multifaceted phenomenon affected by comorbidities such as chronic pain, depression and anxiety. A range of subsequent complexities such as the inability to self‐care and undertaking daily domestic duties, and incapacity to participate in recreational activities were major barriers to recovery. These barriers were found to be an on‐going source of frustration, dissatisfaction and a perceived cause of depressive symptomatology in many participants. Most participants reported mixed feelings of the care received. Other common issues raised included a lack of understanding of the assessment time, regular follow‐up, guidance and on‐going support. Conclusion This study revealed that recovery after a minor transport‐related injury was a challenging, complex, demanding and a long‐term process for the individuals in this study. Findings from this limited cohort suggested that, for participants to return to their pre‐accident health status, a more coordinated approach to information and care delivery may be required.
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Affiliation(s)
- Stella Samoborec
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan M Evans
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Keene DJ, Schlüssel MM, Thompson J, Hagan DA, Williams MA, Byrne C, Goodacre S, Cooke M, Gwilym S, Hormbrey P, Bostock J, Haywood K, Wilson D, Collins GS, Lamb SE. Prognostic models for identifying risk of poor outcome in people with acute ankle sprains: the SPRAINED development and external validation study. Health Technol Assess 2019; 22:1-112. [PMID: 30474592 DOI: 10.3310/hta22640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Ankle sprains are very common injuries. Although recovery can occur within weeks, around one-third of patients have longer-term problems. OBJECTIVES To develop and externally validate a prognostic model for identifying people at increased risk of poor outcome after an acute ankle sprain. DESIGN Development of a prognostic model in a clinical trial cohort data set and external validation in a prospective cohort study. SETTING Emergency departments (EDs) in the UK. PARTICIPANTS Adults with an acute ankle sprain (within 7 days of injury). SAMPLE SIZE There were 584 clinical trial participants in the development data set and 682 recruited for the external validation study. PREDICTORS Candidate predictor variables were chosen based on availability in the clinical data set, clinical consensus, face validity, a systematic review of the literature, data quality and plausibility of predictiveness of the outcomes. MAIN OUTCOME MEASURES Models were developed to predict two composite outcomes representing poor outcome. Outcome 1 was the presence of at least one of the following symptoms at 9 months after injury: persistent pain, functional difficulty or lack of confidence. Outcome 2 included the same symptoms as outcome 1, with the addition of recurrence of injury. Rates of poor outcome in the external data set were lower than in the development data set, 7% versus 20% for outcome 1 and 16% versus 24% for outcome 2. ANALYSIS Multiple imputation was used to handle missing data. Logistic regression models, together with multivariable fractional polynomials, were used to select variables and identify transformations of continuous predictors that best predicted the outcome based on a nominal alpha of 0.157, chosen to minimise overfitting. Predictive accuracy was evaluated by assessing model discrimination (c-statistic) and calibration (flexible calibration plot). RESULTS (1) Performance of the prognostic models in development data set - the combined c-statistic for the outcome 1 model across the 50 imputed data sets was 0.74 [95% confidence interval (CI) 0.70 to 0.79], with good model calibration across the imputed data sets. The combined c-statistic for the outcome 2 model across the 50 imputed data sets was 0.70 (95% CI 0.65 to 0.74), with good model calibration across the imputed data sets. Updating these models, which used baseline data collected at the ED, with an additional variable at 4 weeks post injury (pain when bearing weight on the ankle) improved the discriminatory ability (c-statistic 0.77, 95% CI 0.73 to 0.82, for outcome 1 and 0.75, 95% CI 0.71 to 0.80, for outcome 2) and calibration of both models. (2) Performance of the models in the external data set - the combined c-statistic for the outcome 1 model across the 50 imputed data sets was 0.73 (95% CI 0.66 to 0.79), with a calibration plot intercept of -0.91 (95% CI -0.98 to 0.44) and slope of 1.13 (95% CI 0.76 to 1.50). The combined c-statistic for the outcome 2 model across the 50 imputed data sets was 0.63 (95% CI 0.58 to 0.69), with a calibration plot intercept of -0.25 (95% CI -0.27 to 0.11) and slope of 1.03 (95% CI 0.65 to 1.42). The updated models with the additional pain variable at 4 weeks had improved discriminatory ability over the baseline models but not better calibration. CONCLUSIONS The SPRAINED (Synthesising a clinical Prognostic Rule for Ankle Injuries in the Emergency Department) prognostic models performed reasonably well, and showed benefit compared with not using any model; therefore, the models may assist clinical decision-making when managing and advising ankle sprain patients in the ED setting. The models use predictors that are simple to obtain. LIMITATIONS The data used were from a randomised controlled trial and so were not originally intended to fulfil the aim of developing prognostic models. However, the data set was the best available, including data on the symptoms and clinical events of interest. FUTURE WORK Further model refinement, including recalibration or identifying additional predictors, may be required. The effect of implementing and using either model in clinical practice, in terms of acceptability and uptake by clinicians and on patient outcomes, should be investigated. TRIAL REGISTRATION Current Controlled Trials ISRCTN12726986. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 64. See the NIHR Journals Library website for further project information. Funding was also recieved from the NIHR Collaboration for Leadership in Applied Health Research, Care Oxford at Oxford Health NHS Foundation Trust, NIHR Biomedical Research Centre, Oxford, and the NIHR Fellowship programme.
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Affiliation(s)
- David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael M Schlüssel
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jacqueline Thompson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daryl A Hagan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mark A Williams
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Christopher Byrne
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matthew Cooke
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Philip Hormbrey
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - David Wilson
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gary S Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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Soberg HL, Engebretsen KB, Juel NG, Roe Y, Brox JI. Associations between shoulder pain and functioning on the ICF checklist and the disabilities of the arm, shoulder, and hand scale – a cross-sectional study. Disabil Rehabil 2019; 42:3084-3091. [DOI: 10.1080/09638288.2019.1584252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Helene L. Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kaia B. Engebretsen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
| | - Niels G. Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
| | - Yngve Roe
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jens I. Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Harari D, Casarotto RA. Effectiveness of a multifaceted intervention to manage musculoskeletal disorders in workers of a medium-sized company. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2019; 27:247-257. [DOI: 10.1080/10803548.2019.1575052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Denise Harari
- Department of Physiotherapy, Communication Science & Disorders and Occupational Therapy, University of Sao Paulo, Brazil
| | - Raquel Aparecida Casarotto
- Department of Physiotherapy, Communication Science & Disorders and Occupational Therapy, University of Sao Paulo, Brazil
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Skarpaas LS, Haveraaen LA, Småstuen MC, Shaw WS, Aas RW. The association between having a coordinator and return to work: the rapid-return-to-work cohort study. BMJ Open 2019; 9:e024597. [PMID: 30782911 PMCID: PMC6398742 DOI: 10.1136/bmjopen-2018-024597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess if the reported provision of a coordinator was associated with time to first return to work (RTW) and first full RTW among sick-listed employees who participated in different rapid-RTW programmes in Norway. DESIGN The study was designed as a cohort study. SETTING Rapid-RTW programmes financed by the regional health authority in hospitals and Norwegian Labour and Welfare Administration in Norway. PARTICIPANTS The sample included employees on full-time sick leave (n=326) who participated in rapid-RTW programmes (n=43), who provided information about the coordination of the services they received. The median age was 46 years (minimum-maximum 21-67) and 71% were female. The most common reported diagnoses were musculoskeletal (57%) and mental health disorders (14%). INTERVENTIONS The employees received different types of individually tailored RTW programmes all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%). PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes were measured as time to first RTW (graded and 100%) and first full RTW (100%). RESULTS Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80 to 176) days vs 61 (43 to 79) days for first RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full RTW, there was no statistically significant difference between employees provided with a coordinator versus those who were not. CONCLUSIONS The model of coordination, provided in the Norwegian rapid-RTW programmes was not associated with a more rapid RTW for sick-listed employees. Rethinking how RTW coordination should be organised could be wise in future programme development.
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Affiliation(s)
- Lisebet Skeie Skarpaas
- Presenter - Making Sense of Science, Stavanger, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | | | | | - William S Shaw
- Division of Occupational & Environmental Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Randi Wågø Aas
- Presenter - Making Sense of Science, Stavanger, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Tseli E, Boersma K, Stålnacke BM, Enthoven P, Gerdle B, Äng BO, Grooten WJ. Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Clin J Pain 2019; 35:148-173. [PMID: 30371517 PMCID: PMC6343958 DOI: 10.1097/ajp.0000000000000669] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR). MATERIALS AND METHODS Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE). DISCUSSION While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
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Affiliation(s)
- Elena Tseli
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet
| | - Katja Boersma
- School of Law, Psychology and Social Work, Örebro University, Örebro
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå
| | | | - Björn Gerdle
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping
| | - Björn O. Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet
- School of Education, Health and Social Studies, Dalarna University
- Center for Clinical Research Dalarna,Uppsala University, Falun, Sweden
| | - Wilhelmus J.A. Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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26
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Nordström K, Ekhammar A, Larsson MEH. Physiotherapist-guided Free Movement Dance for patients with persistent pain is empowering in everyday living. A qualitative study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1536893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Annika Ekhammar
- Rehabilitation Clinic, Primary Health Care, Närhälsan Eriksberg Rehabilitation Clinic, Gothenburg, Sweden
| | - Maria EH Larsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
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27
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Bravo C, Skjaerven LH, Guitard Sein-Echaluce L, Catalan-Matamoros D. Experiences from group basic body awareness therapy by patients suffering from fibromyalgia: A qualitative study. Physiother Theory Pract 2018; 36:933-945. [PMID: 30247934 DOI: 10.1080/09593985.2018.1517286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to obtain a deeper understanding of how patients with fibromyalgia experienced movement awareness through a basic body awareness therapy group treatment program. A total of 19 participants with fibromyalgia diagnosis were interviewed individually and in groups. Data collection was done from three sources: (1) interviews from the Basic Body Awareness Rating Scale (BARS) part 2 at baseline, at end of treatment, as well as at 12 and 24 weeks follow up; (2) focus group discussions that took place at the end of each session, and at the end of treatment; and (3) an in-depth focus group. Giorgi's method was followed for data construction and analysis. The researchers conducted 57 individual interviews, 10 focus groups, and one in-depth focus group. The findings revealed the following categories: "creating a new relation to self"; "change the pattern of body awareness"; "being in a group"; and "experiencing physical capacity", showing influences among them. Body awareness seems to have an impact in the therapeutic process in patients suffering from fibromyalgia.
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Affiliation(s)
- Cristina Bravo
- Department of Nursing and Physiotherapy, University of Lleida , Lleida, Spain
| | - Liv H Skjaerven
- Department of Physiotherapy, Faculty of Health and Social Sciences, Bergen University College , Bergen, Norway
| | | | - Daniel Catalan-Matamoros
- Research Group CTS 451 "Health Sciences", University of Almeria , Almeria, Spain.,Science/Health Communication. University Carlos III of Madrid , Madrid, Spain
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28
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Stevens ML, Boyle E, Hartvigsen J, Mansell G, Søgaard K, Jørgensen MB, Holtermann A, Rasmussen CDN. Mechanisms for reducing low back pain: a mediation analysis of a multifaceted intervention in workers in elderly care. Int Arch Occup Environ Health 2018; 92:49-58. [PMID: 30173369 DOI: 10.1007/s00420-018-1350-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/28/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive-behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. METHODS This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. RESULTS There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [β = - 0.63, 95% CI (1.23, 0.03); β = - 1.03, 95% CI (- 1.70, - 0.34)] and the use of assistive devices [β = - 0.55, 95% CI (- 1.04, - 0.05)], but not on perceived muscle strength [β = - 0.18, 95% CI (- 0.50, 0.13)] or physical exertion [β = - 0.05, 95% CI (- 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [β = 0.14, 95% CI (0.04, 0.23)]. CONCLUSIONS A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP.
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Affiliation(s)
- Matthew L Stevens
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, PO Box M179, Missenden Rd, Sydney, NSW, 2050, Australia.
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Gemma Mansell
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Marie B Jørgensen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Andreas Holtermann
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
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Cochrane A, Higgins NM, Rothwell C, Ashton J, Breen R, Corcoran O, FitzGerald O, Gallagher P, Desmond D. Work Outcomes in Patients Who Stay at Work Despite Musculoskeletal Pain. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:559-567. [PMID: 29236203 DOI: 10.1007/s10926-017-9748-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose To assess self-reported work impacts and associations between psychosocial risk factors and work impairment amongst workers seeking care for musculoskeletal pain while continuing to work. Methods Patients were recruited from Musculoskeletal Assessment Clinics at 5 hospitals across Ireland. Participants completed questionnaires including assessments of work impairment (Work Productivity and Activity Impairment Questionnaire), work ability (single item from the Work Ability Index) and work performance (Work Role Functioning Questionnaire; WRFQ). Logistic and hierarchical regressions were conducted to analyse the relation between psychosocial variables and work outcomes. Results 155 participants (53.5% female; mean age = 46.50 years) who were working at the time of assessment completed the questionnaires. Absenteeism was low, yet 62.6% were classified as functioning poorly according to the WRFQ; 52.3% reported having poor work ability. Logistic regression analyses indicated that higher work role functioning was associated with higher pain self-efficacy (OR 1.51); better work ability was associated with older age (OR 1.063) and lower functional restriction (OR 0.93); greater absenteeism was associated with lower pain self-efficacy (OR 0.65) and poorer work expectancy (OR 1.18). Multiple regression analysis indicated that greater presenteeism was associated with higher pain intensity (β = 0.259) and lower pain self-efficacy (β = - 0.385). Conclusions While individuals continue to work with musculoskeletal pain, their work performance can be adversely affected. Interventions that target mutable factors, such as pain self-efficacy, may help reduce the likelihood of work impairment.
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Affiliation(s)
- Andy Cochrane
- Department of Psychology, Maynooth University, Co Kildare, Ireland.
| | - Niamh M Higgins
- Department of Psychology, Anglia Ruskin University, Cambridge, UK
| | - Conor Rothwell
- Department of Psychology, Maynooth University, Co Kildare, Ireland
| | | | - Roisin Breen
- Royal College of Physicians in Ireland, Dublin, Ireland
| | - Oriel Corcoran
- Rheumatology Services, University Hospital Waterford, Waterford, Ireland
| | - Oliver FitzGerald
- School of Medicine, St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Deirdre Desmond
- Department of Psychology, Maynooth University, Co Kildare, Ireland
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Hawken T, Turner-Cobb J, Barnett J. Coping and adjustment in caregivers: A systematic review. Health Psychol Open 2018; 5:2055102918810659. [PMID: 30450216 PMCID: PMC6236498 DOI: 10.1177/2055102918810659] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This systematic review assessed coping and adjustment in caregivers of all ages to provide a synthesis of existing literature in the context of methodological approaches and underlying theory. Four databases were searched. Reference lists, citations and experts were consulted. In total, 27 studies (13 quantitative and 14 qualitative) were included. Coping factors associated with adjustment (problem- versus emotion-focussed coping and cognitive strategies) and psychosocial factors associated with physiological adjustment (trait anxiety, coping style and social support) were identified. Results raised methodological issues. Future research requires physiological adjustment measures and longitudinal assessment of the long-term impact of childhood caregiving. Findings inform future caregiver research and interventions.
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31
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Torstensen TA, Grooten WJA, Østerås H, Heijne A, Harms-Ringdahl K, Äng BO. How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomised controlled trial in Sweden and Norway: the SWENOR Study. BMJ Open 2018; 8:e018471. [PMID: 29730615 PMCID: PMC5942416 DOI: 10.1136/bmjopen-2017-018471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA. METHODS AND ANALYSIS This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment. ETHICS AND DISSEMINATION This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT02024126; Pre-results.
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Affiliation(s)
- Tom Arild Torstensen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Wilhelmus J A Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Håvard Østerås
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Annette Heijne
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Harms-Ringdahl
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Olov Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
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32
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Reis F, Guimarães F, Nogueira LC, Meziat-Filho N, Sanchez TA, Wideman T. Association between pain drawing and psychological factors in musculoskeletal chronic pain: A systematic review. Physiother Theory Pract 2018; 35:533-542. [PMID: 29659315 DOI: 10.1080/09593985.2018.1455122] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND It has been speculated that there is an association between pain area and psychological factors in chronic musculoskeletal pain conditions; however, this relation is not well established. PURPOSE To investigate the association between pain distribution and psychological factors in chronic musculoskeletal pain conditions. STUDY DESIGN Systematic review. METHODS We searched the following databases using optimized search strategies: MEDLINE, PsycINFO, Scopus, Web of Science and Cochrane. Studies were included if they investigated the relation between pain area using a pain drawing (PD) and psychological factors measured by any consistent available method. RESULTS Eleven articles were included. A total of 1301 participants with different musculoskeletal pain conditions, including low back pain, whiplash-associated disorders and fibromyalgia took part in the studies. In three studies, the correlation between pain area and depression was weak (r = 0.15, p = N/A; r = 0.26, p < 0.05; r = 0.25, p = 0.01). Depression seemed to be a risk factor for pain in more body areas in one study (relative risk = 6.09, 95% CI = 1.1-33.5; p < 0.05). The relation between pain area and other psychological factors such as anxiety, kinesiophobia, catastrophizing, memory disturbances and concentration difficulties was also reported. CONCLUSIONS A definitive answer on the relation of psychological factors and pain area is not available; the findings suggest that only depression might have a weak relation with pain area. Future studies that investigate sensory, psychological, emotional, cognitive and behavioral aspects, and also more accurate methods of PD assessment, are needed.
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Affiliation(s)
- Felipe Reis
- a Department of Physiotherapy , Instituto Federal do Rio de Janeiro (IFRJ) , Rio de Janeiro , Brazil.,b Postgraduation Progam, Clinical Medicine Department , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Fernanda Guimarães
- a Department of Physiotherapy , Instituto Federal do Rio de Janeiro (IFRJ) , Rio de Janeiro , Brazil
| | - Leandro Calazans Nogueira
- a Department of Physiotherapy , Instituto Federal do Rio de Janeiro (IFRJ) , Rio de Janeiro , Brazil.,c Postgraduation Progam in Rehabilitation Sciences , Centro Universitário Augusto Motta (UNISUAM) , Rio de Janeiro , Brazil
| | - Ney Meziat-Filho
- c Postgraduation Progam in Rehabilitation Sciences , Centro Universitário Augusto Motta (UNISUAM) , Rio de Janeiro , Brazil
| | - Tiago A Sanchez
- d Department of Radiology , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Timothy Wideman
- e Physical Therapy Department , McGill University , Montreal , Canada
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33
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[The impact of catastrophizing on the effect of depression on pain and functional ability : A longitudinal mediator analysis]. Schmerz 2018; 31:159-166. [PMID: 27858219 DOI: 10.1007/s00482-016-0172-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND While the association between pain and depression is well proven, little is known about the mechanisms influencing this relationship. The cognitive distortion of catastrophizing plays a significant role in several concepts of both diseases. OBJECTIVE The aim of the study was to analyze the role of catastrophizing on the effect of depression on pain and functional ability. MATERIAL AND METHODS Participants were recruited from 11 outpatient rehabilitation centers in Germany at the beginning of orthopedic rehabilitation aftercare. Perceived functional ability (spinal function sort), pain intensity (rating scales) and physical functioning (36-item Short-Form Health Survey, SF-36) were assessed as dependent variables at the beginning of the aftercare (T1) as well as 6 months later (T2). The independent variable depression (Patient Health Questionnaire and Mental Health Index of the SF-36) as well as the mediator catastrophizing (Coping Strategies Questionnaire) were measured at T1. Pathway models were used to analyze the direct and indirect proportions of the total effect of an independent variable on a dependent variable and the role of catastrophizing as a mediator of this association. RESULTS A total of 241 patients were included in the analyses. Depression had a significant total effect on pain as well as functional capacity. Catastrophizing mediated substantial proportions of these effects (42.9-87.1%). CONCLUSION Catastrophizing mediates the relationship between depression and pain as well as functional capacity; therefore, the reduction of catastrophizing thoughts and attitudes should be a focus in rehabilitation programs.
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Crocce Carlotto PA, Moraes Cruz R, Guilland R, Ruppel da Rocha RE, Dalagasperina P, Ornellas Ariño D. Riscos Psicossociais Relacionados ao Trabalho: perspectivas teóricas e conceituais. REVISTA INTERAMERICANA DE PSICOLOGÍA OCUPACIONAL 2018. [DOI: 10.21772/ripo.v37n1a04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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35
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Tseli E, Grooten WJA, Stålnacke BM, Boersma K, Enthoven P, Gerdle B, Äng BO. Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis. Syst Rev 2017; 6:199. [PMID: 29020989 PMCID: PMC5637325 DOI: 10.1186/s13643-017-0598-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain. METHODS We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation. DISCUSSION The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016025339.
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Affiliation(s)
- Elena Tseli
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, 141 83, Huddinge, Sweden.
| | - Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, 141 83, Huddinge, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Department of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Paul Enthoven
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Olov Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, 141 83, Huddinge, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Corbière M, Negrini A, Durand MJ, St-Arnaud L, Briand C, Fassier JB, Loisel P, Lachance JP. Development of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES) and Validation with Workers Suffering from a Common Mental Disorder or Musculoskeletal Disorder. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:329-341. [PMID: 27562583 DOI: 10.1007/s10926-016-9661-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Introduction Common mental disorders (CMDs) and musculoskeletal disorders (MSDs) lead the list of causes for work absence in several countries. Current research is starting to look at workers on sick leave as a single population, regardless of the nature of the disease or accident. The purpose of this study is to report the validation of the Return to Work Obstacles and Self-Efficacy Scale (ROSES) for people with MSDs and CMDs, based on the disability paradigm. Methods From a prospective design, the ROSES' reliability and validity were investigated in a Canadian sample of workers on sick leave due to MSDs (n = 206) and CMDs (n = 157). Results Exploratory and confirmatory factor analyses revealed that 46 items spread out on 10 conceptual dimensions (e.g., Fears of a relapse, Job demands, Difficult relation with the immediate supervisor), with satisfactory alpha coefficients and test-retest reliability for all subscales. Finally, several dimensions of ROSES also predict the participant's RTW within 6 months for MSDs (e.g., job demands), and CMDs (e.g., difficult relation with the immediate supervisor), even when adjusted by several variables (e.g., age, severity of symptoms). Apart from the job demands dimension, when the ROSES dimension is more external to the individual, only the perception of obstacles remains significant to predict RTW whereas it is the opposite result when the dimension is more internal (e.g., fears of a relapse). Conclusion The ROSES demonstrated satisfactory results regarding its validity and reliability with people having MSDs or CMDs, at the time of the return-to-work process.
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Affiliation(s)
- Marc Corbière
- Department of Education and Pedagogy, Career Counseling, Université du Québec à Montréal, Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), 1205, Rue Saint-Denis, Montréal, QC, H2X 3R9, Canada.
| | - Alessia Negrini
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du travail (IRSST), 505 Boulevard de Maisonneuve Ouest, Montréal, QC, H3A 3C2, Canada
| | - Marie-José Durand
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), School of Rehabilitation, Université de Sherbrooke, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada
| | - Louise St-Arnaud
- Faculty of Education, Centre de Recherche et d'Intervention sur l'Éducation et la Vie au Travail (CRIEVAT), Université Laval, 2320 Rue des Bibliothèques, Québec, QC, G1V 0A6, Canada
| | - Catherine Briand
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, 7077, Avenue du Parc, Montréal, QC, H3C 3J7, Canada
| | - Jean-Baptiste Fassier
- Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE), Hospices Civils de Lyon, Université Claude Bernard Lyon 18, Avenue Rockefeller, 69673, Lyon Cedex 08, France
| | - Patrick Loisel
- Division of Occupational and Environmental Health, Dalla Lana Faculty of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Jean-Philippe Lachance
- School of Rehabilitation, Université de Sherbrooke, CR-IUSMM, 150 Place Charles Le Moyne, Bureau 200, Longueuil, QC, J4K 0A8, Canada
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Oliveras I, Losilla JM, Vives J. Methodological quality is underrated in systematic reviews and meta-analyses in health psychology. J Clin Epidemiol 2017; 86:59-70. [DOI: 10.1016/j.jclinepi.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/09/2016] [Accepted: 05/02/2017] [Indexed: 01/09/2023]
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Björnsdóttir SV, Triebel J, Arnljótsdóttir M, Tómasson G, Valdimarsdóttir UA. Long-lasting improvements in health-related quality of life among women with chronic pain, following multidisciplinary rehabilitation. Disabil Rehabil 2017; 40:1764-1772. [DOI: 10.1080/09638288.2017.1312565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sigrún Vala Björnsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
| | - Jan Triebel
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
- Department of Orthopaedic Surgery, Akademiska, University Hospital Uppsala, Sweden
| | | | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Streibelt M, Bethge M, Gross T, Herrmann K, Ustaoglu F, Reichel C. Predictive Validity of a Screening Instrument for the Risk of Non-Return to Work in Patients With Internal Diseases. Arch Phys Med Rehabil 2017; 98:989-996.e1. [PMID: 28137474 DOI: 10.1016/j.apmr.2016.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the predictive validity of the SIMBO (Screening-Instrument zur Feststellung des Bedarfs an medizinisch-beruflich orientierten Maßnahmen in der medizinischen Rehabilitation [Screening Instrument for the Access to Work-Related Multimodal Rehabilitation]; total score ranges from 0 to 100 points) in patients with internal diseases in a rehabilitation setting. DESIGN Prospective multicenter study. SETTING Inpatient rehabilitation centers. PARTICIPANTS Patients (N=1366) aged 18 to 65 years with internal diseases. INTERVENTIONS Multimodal rehabilitation programs. MAIN OUTCOME MEASURES The primary outcome was occurrence of a critical return-to-work (RTW) event during the follow-up period. Receiver operating characteristic analyses were performed. Sensitivity, specificity, and positive predictive values were calculated for each disease group using the cutoff score of 27 points. RESULTS A total of 1366 patients with neoplasms (n=203); endocrine, nutritional, and metabolic diseases (n=355); and diseases of the circulatory (n=470), respiratory (n=255), and digestive (n=83) systems were included. Between 9.9% and 40.6% of the patients reported critical RTW events during the 3-month follow-up period. The area under the curve was between .849 (.754-.923) and .903 (.846-.959). Sensitivity and specificity ranged from 65.6% to 92.9% and from 80.4% to 89.9%, respectively. The positive predictive values were between 40.4% and 77.8%. CONCLUSIONS The risk score SIMBO predicts short-term RTW problems after rehabilitation in patients with internal diseases. The cutoff of 27 points was confirmed as a reasonable threshold.
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Affiliation(s)
- Marco Streibelt
- Department of Rehabilitation, German Federal Pension Insurance, Berlin, Germany.
| | - Matthias Bethge
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Thomas Gross
- Rehabilitation Center Schömberg, Schömberg, Germany
| | - Klaus Herrmann
- Rehabilitation Center Bad Kissingen, Bad Kissingen, Germany
| | | | - Christoph Reichel
- Rehabilitation Center Bad Brückenau, Bad Brückenau, Germany; Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
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40
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Gerdle B, Molander P, Stenberg G, Stålnacke BM, Enthoven P. Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres. BMC Musculoskelet Disord 2016; 17:490. [PMID: 27887616 PMCID: PMC5124266 DOI: 10.1186/s12891-016-1346-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients with chronic pain, the heterogeneity of clinical presentations makes it difficult to identify patients who would benefit from multimodal rehabilitation programs (MMRP). Yet, there is limited knowledge regarding the predictors of MMRP's outcomes. This study identifies predictors of outcome of MMRPs at a 12-month follow-up (FU-12) based on data from the Swedish Quality Registry for Pain Rehabilitation (SQRP). METHODS Patients with chronic pain from two clinical departments in Sweden completed the SQRP questionnaires-background, pain characteristics, psychological symptoms, function, activity/participation, health and quality of life-on three occasions: 1) during their first visit; 2) immediately after the completion of their MMRP; and 3) 12 months after completing the MMRP (n = 227). During the FU-12, the patients also retrospectively reported their global impressions of any changes in their perception of pain and their ability to handle their life situation in general. RESULTS Significant improvements were found for pain, psychological symptoms, activity/participation, health, and quality of life aspects with low/medium strong effects. A general pattern was observed from the analyses of the changes from baseline to FU-12; the largest improvements in outcomes were significantly associated with poor situations according to their respective baseline scores. Although significant regressors of the investigated outcomes were found, the significant predictors were weak and explained a minor part of the variation in outcomes (15-25%). At the FU-12, 53.6% of the patients reported that their pain had decreased and 80.1% reported that their life situation in general had improved. These improvements were associated with high education, low pain intensity, high health level, and work importance (only pain perception). The explained variations were low (9-11%). CONCLUSIONS Representing patients in real-world clinical settings, this study confirmed systematic reviews that outcomes of MMRP are associated with broad positive effects. A mix of background and baseline variables influenced the outcomes investigated, but the explained variations in outcomes were low. There is still a need to develop standardized and relatively simple outcomes that can be used to evaluate MMRP in trials, in clinical evaluations at group level, and for individual patients.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Peter Molander
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gunilla Stenberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Britt-Marie Stålnacke
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Paul Enthoven
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
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Dwyer CP, Durand H, MacNeela P, Reynolds B, Hamm RM, Main CJ, O'Connor LL, Conneely S, Taheny D, Slattery BW, O'Neill C, NicGabhainn S, Murphy AW, Kropmans T, McGuire BE. Effectiveness of a biopsychosocial e-learning intervention on the clinical judgements of medical students and GP trainees regarding future risk of disability in patients with chronic lower back pain: study protocol for a randomised controlled trial. BMJ Open 2016; 6:e010407. [PMID: 27231000 PMCID: PMC4885315 DOI: 10.1136/bmjopen-2015-010407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chronic lower back pain (CLBP) is a major healthcare problem with wide ranging effects. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions that identify biopsychosocial barriers to recovery have been observed to lead to successfully reduced pain-related work absences and increased return to work for individuals with CLBP. Modern conceptualisations of pain adopt a biopsychosocial approach, such as the flags approach. Biopsychosocial perspectives have been applied to judgements about future adjustment, recovery from pain and risk of long-term disability; and provide a helpful model for understanding the importance of contextual interactions between psychosocial and biological variables in the experience of pain. Medical students and general practitioner (GP) trainees are important groups to target with education about biopsychosocial conceptualisations of pain and related clinical implications. AIM The current study will compare the effects of an e-learning intervention that focuses on a biopsychosocial model of pain, on the clinical judgements of medical students and trainees. METHODS AND ANALYSIS Medical student and GP trainee participants will be randomised to 1 of 2 study conditions: (1) a 20 min e-learning intervention focused on the fundamentals of the flags approach to clinical judgement-making regarding risk of future pain-related disability; compared with a (2) wait-list control group on judgement accuracy and weighting (ie, primary outcomes); flags approach knowledge, attitudes and beliefs towards pain, judgement speed and empathy (ie, secondary outcomes). Participants will be assessed at preintervention and postintervention. ETHICS AND DISSEMINATION The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee. The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN53670726; Pre-results.
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Affiliation(s)
- Christopher P Dwyer
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Hannah Durand
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Pádraig MacNeela
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Bronagh Reynolds
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Robert M Hamm
- Department of Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christopher J Main
- Department of Behavioural Medicine, Keele University, Staffordshire, England
| | - Laura L O'Connor
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Sinéad Conneely
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Darragh Taheny
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Brian W Slattery
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Ciaran O'Neill
- Discipline of Economics, National University of Ireland, Galway, Ireland
| | - Saoirse NicGabhainn
- Discipline of Health Promotion, National University of Ireland, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Thomas Kropmans
- Discipline of Medical Informatics and Education, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
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Howe CQ, Robinson JP, Sullivan MD. Psychiatric and psychological perspectives on chronic pain. Phys Med Rehabil Clin N Am 2016; 26:283-300. [PMID: 25952065 DOI: 10.1016/j.pmr.2014.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic pain patients often have psychiatric disorders that negatively influence their responses to treatment. Also, many of them have dysfunctional beliefs and coping strategies, even if they do not meet DSM-5 criteria for a psychiatric disorder. Physiatrists should have a low threshold for referring both groups of patients for mental health services. This article describes psychiatric disorders that are highly prevalent among pain patients and also describes psychological processes that contribute to poor coping by the patients. Finally, it discusses factors that a physiatrist should consider in deciding whether to refer patients to psychiatrists versus psychologists.
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Affiliation(s)
- Catherine Q Howe
- Physical Medicine & Rehabilitation, University of Washington, Seattle, WA, USA
| | - James P Robinson
- Physical Medicine & Rehabilitation, University of Washington, Seattle, WA, USA.
| | - Mark D Sullivan
- Physical Medicine & Rehabilitation, University of Washington, Seattle, WA, USA
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Valentin GH, Pilegaard MS, Vaegter HB, Rosendal M, Ørtenblad L, Væggemose U, Christensen R. Prognostic factors for disability and sick leave in patients with subacute non-malignant pain: a systematic review of cohort studies. BMJ Open 2016; 6:e007616. [PMID: 26739716 PMCID: PMC4716223 DOI: 10.1136/bmjopen-2015-007616] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients. SETTING General practice and other primary care facilities. PARTICIPANTS Adults (>18 years) with a subacute (≤ 3-month) non-malignant pain condition. Eligibility criteria were cohort studies investigating the prediction of disability or long-term sick leave in adults with a subacute pain condition in a primary care setting. 19 studies were included, referring to a total of 6266 patients suffering from pain in the head, neck, back and shoulders. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was long-term disability (>3 months) due to a pain condition. The secondary outcome was sick leave, defined as 'absence from work' or 'return-to-work'. RESULTS PubMed, EMBASE, CINAHL and PEDro databases were searched from 16 January 2003 to 16 January 2014. The quality of evidence was presented according to the GRADE WG recommendations. Several factors were found to be associated with disability at follow-up for at least two different pain symptoms. However, owing to insufficient studies, no generic risk factors for sick leave were identified. CONCLUSIONS Multiple site pain, high pain severity, older age, baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites. There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain, indicating that these factors may not play as large a role as expected in developing disability due to a pain condition. Quality of evidence was moderate, low or very low, implying that confidence in the results is limited. Large prospective prognostic factor studies are needed with sufficient study populations and transparent reporting of all factors examined. TRIAL REGISTRATION NUMBER CRD42014008914.
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Affiliation(s)
- Gitte H Valentin
- Department of Central Denmark Region, Health Technology Assessment and Health Services Research, CFK-Public Health and Quality Improvement, Aarhus, Denmark
| | - Marc S Pilegaard
- Department of Public Health, Research Initiative for Activity Studies and Occupational Therapy, General Practice, University of Southern Denmark, Odense, Denmark
| | - Henrik B Vaegter
- Pain Research Group, Pain Centre South, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Odense, Odense, Denmark
| | | | - Lisbeth Ørtenblad
- Department of Central Denmark Region, Health Technology Assessment and Health Services Research, CFK-Public Health and Quality Improvement, Aarhus, Denmark
| | - Ulla Væggemose
- Department of Central Denmark Region, Health Technology Assessment and Health Services Research, CFK-Public Health and Quality Improvement, Aarhus, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
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Rasmussen CDN, Holtermann A, Bay H, Søgaard K, Birk Jørgensen M. A multifaceted workplace intervention for low back pain in nurses' aides: a pragmatic stepped wedge cluster randomised controlled trial. Pain 2015; 156:1786-1794. [PMID: 25993549 PMCID: PMC4617291 DOI: 10.1097/j.pain.0000000000000234] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/25/2022]
Abstract
This study established the effectiveness of a workplace multifaceted intervention consisting of participatory ergonomics, physical training, and cognitive-behavioural training (CBT) for low back pain (LBP). Between November 2012 and May 2014, we conducted a pragmatic stepped wedge cluster randomised controlled trial with 594 workers from eldercare workplaces (nursing homes and home care) randomised to 4 successive time periods, 3 months apart. The intervention lasted 12 weeks and consisted of 19 sessions in total (physical training [12 sessions], CBT [2 sessions], and participatory ergonomics [5 sessions]). Low back pain was the outcome and was measured as days, intensity (worst pain on a 0-10 numeric rank scale), and bothersomeness (days) by monthly text messages. Linear mixed models were used to estimate the intervention effect. Analyses were performed according to intention to treat, including all eligible randomised participants, and were adjusted for baseline values of the outcome. The linear mixed models yielded significant effects on LBP days of -0.8 (95% confidence interval [CI], -1.19 to -0.38), LBP intensity of -0.4 (95% CI, -0.60 to -0.26), and bothersomeness days of -0.5 (95% CI, -0.85 to -0.13) after the intervention compared with the control group. This study shows that a multifaceted intervention consisting of participatory ergonomics, physical training, and CBT can reduce LBP among workers in eldercare. Thus, multifaceted interventions may be relevant for improving LBP in a working population.
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Affiliation(s)
- Charlotte Diana Nørregaard Rasmussen
- National Research Centre for the Working Environment, Copenhagen Ø, Denmark
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen Ø, Denmark
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Hans Bay
- National Research Centre for the Working Environment, Copenhagen Ø, Denmark
| | - Karen Søgaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Björnsdóttir SV, Arnljótsdóttir M, Tómasson G, Triebel J, Valdimarsdóttir UA. Health-related quality of life improvements among women with chronic pain: comparison of two multidisciplinary interventions. Disabil Rehabil 2015; 38:828-36. [DOI: 10.3109/09638288.2015.1061609] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Physiotherapists' assessment of patients' psychosocial status: Are we standing on thin ice? A qualitative descriptive study. ACTA ACUST UNITED AC 2015; 20:328-34. [DOI: 10.1016/j.math.2014.10.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/25/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022]
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Prang KH, Newnam S, Berecki-Gisolf J. The impact of family and work-related social support on musculoskeletal injury outcomes: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:207-219. [PMID: 24846079 DOI: 10.1007/s10926-014-9523-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Social support has been identified as a key factor in facilitating better health outcomes following injury. However, there is limited research on the role of social support in recovery from musculoskeletal injury (MSI), the leading cause of morbidity and disability in the world. The aim of this study is to review the extent to which family and work-related social support (e.g. co-workers, supervisors) has been identified as a factor in the outcomes (physical, psychological, economic) of individuals with MSI. METHODS Eight online databases were searched for observational studies reporting findings on family and work-related social support in populations with MSI. Data extraction, quality assessment and a systematic critical synthesis were carried out on included studies. RESULTS Fourteen relevant articles were identified. The majority of the studies focused on social support from co-workers or supervisors (n = 11), while three studies focused on social support from the family. Overall, the evidence for the relation between work-related support and MSI outcomes was inconclusive. Similarly, there was limited and inconclusive evidence to demonstrate a relationship between family support and MSI outcomes. CONCLUSIONS The results of this review are inconclusive. Further research is needed to understand the role of social support in rehabilitation efforts following MSI. Recommendations for future research are provided.
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Affiliation(s)
- Khic-Houy Prang
- Monash Injury Research Institute, Monash University, Building 70, Monash University Clayton Campus, Wellington Road, Clayton, VIC, 3800, Australia,
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Johansson AC, Öhrvik J, Söderlund A. Associations among pain, disability and psychosocial factors and the predictive value of expectations on returning to work in patients who undergo lumbar disc surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:296-303. [DOI: 10.1007/s00586-015-3820-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/15/2015] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
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Smith PM, Berecki-Gisolf J. Age, occupational demands and the risk of serious work injury. Occup Med (Lond) 2014; 64:571-6. [DOI: 10.1093/occmed/kqu125] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chan C, Ackermann B. Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians. Front Psychol 2014; 5:706. [PMID: 25071671 PMCID: PMC4086404 DOI: 10.3389/fpsyg.2014.00706] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/19/2014] [Indexed: 12/26/2022] Open
Abstract
Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.
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Affiliation(s)
- Cliffton Chan
- Discipline of Biomedical Science, Sydney Medical School, The University of Sydney Sydney, NSW, Australia
| | - Bronwen Ackermann
- Discipline of Biomedical Science, Sydney Medical School, The University of Sydney Sydney, NSW, Australia
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