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Context: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR). Design: Cross-sectional study. Methods: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90--1.00), high (.70--.90), moderate (.50--.70), low (.30--.50), and no correlation (.00--.30). Results: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27). Conclusions: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study explores the profound impact of trauma on oral health through a biopsychosocial lens, emphasizing the necessity of incorporating Trauma-Informed Care (TIC) within dental practice. It addresses the gap in current dental care models by proposing a comprehensive approach that integrates dental and mental health care to enhance treatment outcomes for trauma survivors. Methods: We reviewed literature across disciplines, including psychology, dentistry, and social work, to illustrate how trauma influences oral health. A multidisciplinary model, the Dental-Mental Model with a TIC focus, was proposed, highlighting the need for a community-based team approach in dental practices. Results: Trauma, including Adverse Childhood Experiences (ACEs), significantly affects oral health outcomes, contributing to conditions such as bruxism, Temporomandibular Joint Disorder (TMJD), and periodontal disease. Current healthcare models fail to adequately address the biopsychosocial complexities presented by trauma survivors. The Dental-Mental Model emphasizes early detection, sensitivity training, and adherence to TIC principles, aiming to improve patient trust, reduce dental anxiety, and enhance oral health outcomes. Conclusions: Integrating a trauma-informed, multidisciplinary approach in dental care significantly improves the therapeutic relationship and treatment outcomes for individuals with a history of trauma. This model not only addresses the biopsychosocial factors affecting oral health but also promotes a holistic approach to patient care. Clinical Significance: This study underscores the critical need for trauma-informed practices in dentistry. By adopting a holistic, multidisciplinary approach, dental professionals can offer more compassionate and effective care, ultimately enhancing the oral and overall health of individuals with trauma histories. [ABSTRACT FROM AUTHOR]

Context: End-of-life palliative care aims to provide comprehensive care and can be marked by somatic, psychosocial, and spiritual distresses, requiring interdisciplinary care. However, interdisciplinary care is costly, and palliative care services, similar to all other medical services, are pressurized to be as cost-effective as possible. Objectives: To describe the case complexity of palliative care inpatients, we evaluated possible correlations between complexity and the provision of care and identified complexity subgroups. Methods: Patients (N = 222) hospitalized in a specialist palliative care unit in Switzerland were assessed for biopsychosocial complexity using INTERMED. Based on a chart review, INTERMED scores were determined at admission and at the end of hospitalization or at death. Descriptive statistics and Pearson's correlation coefficients were used to estimate the association between biopsychosocial complexity and the amount and type of care provided. Principal component analysis (PCA) was conducted to explain variance and identify patient subgroups. Results: Almost all patients (98.7%) qualified as complex, as indicated by INTERMED. Provision of care was positively correlated (r = 0.23, p = 0.0008) with INTERMED scores upon admission. The change in the INTERMED score during the stay correlated negatively with the provision of care (r = −0.27, p = 0.0001). PCA performed with two factors explained 49% of the total variance and identified two subgroups that differed in the INTERMED psychosocial-item scores. Conclusion: Inpatients receiving specialist palliative care showed the highest complexity score of all populations assessed to date using INTERMED. Correlations between biopsychosocial complexity and care provided, and between care and decrease in complexity scores can be considered indicators of care efficiency. Patient subgroups with specific requirements (psychosocial burden) suggested that palliative care teams require specialist palliative care collaborators. Key message: Palliative care provision correlates with case complexity and is effective. [ABSTRACT FROM AUTHOR]

Apathy, the deficit of goal-directed behaviour, is well recognised as one of the most debilitating syndromes after moderate-to-severe traumatic brain injury (TBI). However, mechanisms underlying apathy, or at least factors associated with apathy, are sporadically reported. Based on a biopsychosocial framework, this systematic review and meta-analysis synthesised evidence regarding neurobiological, socio-environmental and individual factors associated with apathy. Our searches identified 21 studies satisfying inclusion and exclusion criteria. Results showed that the majority of work has focused on cognitive dysfunction, TBI-related factors, demographic variables and psychological correlates of apathy, while evidence for neural substrates and socio-cultural and premorbid aspects is scant. Overall, the current literature suggests that TBI-related and patient demographic factors did not contribute to apathy after TBI, whereas complex neurocognitive alterations, socio-environmental and cultural factors as well as patients' self-related factors may be important components. The evidence points to the multifaceted interplay of certain biopsychosocial contributors to apathy and suggests future investigations of more complex behavioural traits, cultural elements and pre-injury levels to better characterise the aetiology of this detrimental impairment after TBI. [ABSTRACT FROM AUTHOR]

Objective: Understanding biopsychosocial contributions to a sensitised pain system is a key target of many pain management programs. The 'Protectometer' is a freely available educational tool that guides people with chronic pain to explore their personal threats and reassurances, identifying them as 'DIMs' (danger in me) or 'SIMs' (safety in me), to guide personalised pain management. This study aimed to explore common types of DIMs and SIMs, and examine differences between adults and young people. Materials and Methods: A retrospective qualitative study was conducted. Written DIMs (n = 504) and SIMs (n = 711) were collected from 96 participants with chronic pain (77 adults aged 18–85 years; 19 young people aged 9–17 years) across 15 multidisciplinary pain management groups. DIMs and SIMs were transcribed and analysed using deductive content analysis. Results: Four overarching themes were identified: 'Engaging with the environment', 'In my body', 'My emotional health', and 'Activities and behaviours'. Similarities in SIMs were found, with the greatest proportion of SIMs in the social domain (49% adults; 47% young people). While adult DIMs were fairly evenly spread across the biological (37%), psychological (27%) and social domains (36%), young people's DIMs were predominantly in the psychological (44%) and social (43%) domains. Discussion: These findings provide insights into common threats and reassurances people in pain perceive, and revealed age-related differences in biopsychosocial contributions to pain and pain relief. Findings also highlight the importance of social-based interventions as part of pain management therapies for both adults and young people. [ABSTRACT FROM AUTHOR]

Background: Apathy is a prevalent and debilitating neuropsychiatric symptom among persons living with Alzheimer's disease and related dementias, particularly those residing in long-term care facilities (LTCF). Despite its profound effects on the quality of life for both residents and their caregivers, apathy remains underrecognized and poorly understood in the context of dementia care. Objective: To investigate the prevalence and biopsychosocial characteristics of apathy among newly admitted residents with dementia in Canadian LTCF using an Apathy Index derived from the interRAI Minimum Data Set (MDS) 2.0. Methods: This cross-sectional study analyzed data from newly admitted residents with dementia from various LTCF (N = 97,789) across seven Canadian provinces between 2015 and 2019. Logistic regression analysis was performed to determine the relationship between apathy and multiple variables including sociodemographic and clinical variables. The biopsychosocial model of health was used to guide analysis. Results: The prevalence rate of apathy among the Canadian long-term care residents with Alzheimer's disease and related dementias was 13.1%. Apathy was associated with various variables including male sex, pain, use of psychotropics, high Activity of Daily Living Self-Performance Hierarchy Scale scores, depression, aggression, severe cognitive impairment, and insomnia. Preferences for certain activities such as card games, art and craft, reading, music and exercise were inversely related to apathy while gardening was not. Conclusions: By shedding light on this complex phenomenon within a Canadian context, we recommend that targeted interventions and improved care strategies to enhance the well-being of persons living with dementia should be prioritized in LTCF. [ABSTRACT FROM AUTHOR]

Background/Objectives: To identify clinical phenotypes of hip osteoarthritis (OA) within a biopsychosocial framework. Methods: A cross-sectional analysis of 143 individuals with hip OA awaiting total hip arthroplasty (THA) was performed. Phenotyping features included sociodemographic and biomedical information, pain-related cognitions and emotions, mental disorders, traumatic experiences, self-efficacy, social support, perceived stress, and somatosensory function. Outcome measures included the hip disability and osteoarthritis outcome score and the numeric pain-rating scale. Decision tree learning was used to select the most important phenotyping features. K-means clustering analyses were performed to identify clinical phenotypes and a decision tree algorithm was trained to classify individuals in the identified clinical phenotypes. Results: Selected phenotyping features associated with pain and disability included a combination of biomedical, psychological, and social variables. Two distinct clinical phenotypes were identified. Individuals within the maladaptive phenotype (34%) reported more comorbidities, less self-efficacy and higher levels of anxiety, depression, pain-related fear-avoidance, and feelings of injustice. No differences were found regarding social support and somatosensory function. Regarding the outcome measures, individuals within the maladaptive phenotype reported higher levels of pain and disability. Finally, based on the Fear-Avoidance Components Scale (FACS) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), individuals could be classified into the clinical phenotypes with 87.8% accuracy. Conclusions: Two clinical phenotypes, an adaptive and a maladaptive phenotype, can be identified in individuals with hip OA using the FACS and HADS-A. The identification of these clinical phenotypes represents a crucial step toward precision medicine, enabling the development of targeted treatment pathways tailored to the distinct biomedical and psychological features of each phenotype. [ABSTRACT FROM AUTHOR]

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article brings together research from the fields of pain science and Alexander Technique (AT) to investigate the mechanisms by which AT helps reduce pain. AT is a cognitive embodiment practice and a method for intentionally altering habitual postural behavior. Studies show that AT helps with various kinds of pain, although the mechanisms of pain reduction are currently not well understood. Advances in pain science may give insight into how this occurs. Modern interventions with efficacy for improving pain and function are consistent with active approaches within kinesiology. They also share similarities with AT and may have common mechanisms such as learning, mind–body engagement, normalization of sensorimotor function, improvement of psychological factors, and self-efficacy, as well as nonspecific treatment effects. AT likely has additional unique mechanisms, including normalization of muscle tone, neuronal excitability, and tissue loading, as well as alterations to body schema, attention redirection, and reduction in overall reactivity. [ABSTRACT FROM AUTHOR]

Background: The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) is a disease-specific, quality of life patient-reported outcome measure (PROM) that is valid and reliable in patients with recurrent lateral patellofemoral instability (LPI). Quality of life encompasses the physical, emotional, and psychological aspects of patient functioning and recovery. Purposes: To concurrently validate the BPII 2.0 to the Tampa Scale for Kinesiophobia (TSK-11), the Pain Catastrophizing Scale (PCS), and the Anterior Cruciate Ligament–Return to Sport after Injury Scale (ACL-RSI) in patients presenting with recurrent LPI and to assess baseline values for the PROMs in patients with LPI. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: A total of 107 consecutive patients with recurrent LPI were assessed between January and October 2021. Patients completed the BPII 2.0, TSK-11, PCS, and ACL-RSI. A Pearson r correlation coefficient was employed to examine relationships between the PROMs. Baseline values, as well as floor and ceiling effects and Cronbach alpha, were assessed for all PROMs. Results: All 107 patients completed the 4 PROMs. Patients included 28 men (26.2%) and 79 women (73.8%), with a mean (SD) age of 25.7 (9.8) years. The mean (SD) age at first dislocation was 14.8 (6.3) years. The TSK-11, PCS, and ACL-RSI were all statistically significantly correlated with the BPII 2.0 (P <.01; 2-tailed), with moderate correlations (r = -0.361-0.628) The R 2 values indicated an overlap of the constructs measured by the PROMs. Conclusion: A statistically significant correlation was evident between the BPII 2.0 and the other PROMs. The BPII 2.0 does not explicitly measure kinesiophobia or pain catastrophizing; however, the significant statistical relationship of the TSK-11 and PCS to the BPII 2.0 suggests that this information is being captured and reflected. [ABSTRACT FROM AUTHOR]

The article "Speciality grand challenge: next steps for coaching? Some existing and emerging issues" by Dave Collins explores the current landscape of coaching science, addressing key issues such as skill development, mental health, and societal expectations. Collins, an experienced coach, offers insights on the future direction of coaching, emphasizing the need for evidence-based initiatives and critical evaluation. The article highlights challenges in coaching, including the need for a more mechanism-driven consideration of skill development and the exploration of active inference approaches. Overall, the paper calls for a more critical approach to coaching research and development, grounded in genuine data and evidence. [Extracted from the article]

Background: Our conventional approach to health care tends to separate patients' health by body system, treating each independently and "efficiently"—e.g., minimal time with a provider, reliance on medications, and little investment to support behavioral and lifestyle improvements. Meanwhile, the United States has the most expensive health care in the world, with some of the worse outcomes. Purpose In this paper, we make the case for transforming health care from a disease-centric approach to a "whole person" model. Research Design: We provide detailed health and health care utilization assumptions for a hypothetical patient, Mrs. M, over her life from age 40 to 80 years under 2 care scenarios: the continuation of conventional care (Version A) and a whole person care approach (Version B). Analysis We developed a set of health care utilization assumptions for each scenario, applied 2023 U.S. dollar (USD) resource prices, and estimated cumulative total health care costs. The price and the health care utilization assumptions for the conventional care scenario were validated using Medical Expenditures Panel Survey (MEPS) data. Results: At age 80, with conventional care, we find Mrs. M increasingly frail and living in a skilled nursing facility, with total cumulative health care costs of $353,155. With whole person care, we find her active and generally healthy at age 80, with total cumulative health care costs of $52,425. Conclusions: Although based on an "imagined" case, the 2 versions of Mrs. M's history illustrate how an investment beginning in early middle age to support a healthy diet, physical activity, and stress management can plausibly lead to improved health and well-being, as well as reduced health care spending. [ABSTRACT FROM AUTHOR]

Background: Aging is a process inherent to the human condition that is characterized by various biological, psychological, and social changes that can lead to certain mental health problems. Objective: This study aimed to understand and characterize how biological, psychological, and social factors influence mental health symptoms and neuropsychological function in the aging process. Methods: A sample consisting of 616 participants (73.8% female) aged between 50 and 90 years, (mean [SD]: 69.6 [17.2] years). Data collection involved a neuropsychological assessment carried out by a psychologist in a clinical interview session and the self-completion of a questionnaire. Results: Regression models revealed that depressive symptoms are explained by anxiety, psychological and environmental quality of life, and sleep habits. Anxiety symptoms are explained by depression, physical quality of life, and sleep habits. Statistically significant differences were identified between participants with and without anxiety in neuropsychological terms at the level of agnosia and praxis. Statistically significant differences were identified between participants with and without depression in neuropsychological terms at the level of memory, language, agnosia and praxis, and executive function (eg, prefrontal tests). Conclusions: Depression and anxiety symptoms are associated and could negatively influence the aging process. Aging should be understood in an ecological way taking into account the action of biological, psychological, social, and environmental factors, as well as the relationship and influence between the different levels and factors. This knowledge is important for diagnosis, for clinical practice, and for the development and definition of public policies to promote healthy aging. [ABSTRACT FROM AUTHOR]

Introduction: Education is strongly advocated as a key component of treatment for mild traumatic brain injury (mTBI) in clinical guidelines. However, there is mixed evidence on the benefit of education. This study aimed to evaluate a new education resource for mTBI. CLARITY is a freely available animated video based on a biopsychosocial conceptualization of mTBI, explaining the complex psychological, environmental and biological mechanisms behind symptoms and recovery.1 Methods: 24 adults with a history of mTBI participated in this mixed method study to examine prior experience of mTBI education and to evaluate CLARITY. Following viewing of the education video participants’ were invited to engage in a semi-structured interview and to share their perceptions of it via an online anonymous questionnaire. Results: Thematic analysis of semi-structured interviews revealed one overarching theme: education is the foundation of recovery. Participants emphasised the critical role of coherent education in facilitating understanding, engagement in rehabilitation, and positive expectations during recovery. However, the first subtheme was that existing foundations are weak. Participants’ previous education was often limited in scope, inconsistent, and delivered in inaccessible ways. The second subtheme was that new foundations are stronger. Participants responded positively to CLARITY, highlighting its explanatory biopsychosocial approach, focus on mental health factors and accessible delivery methods as key strengths. Questionnaire responses revealed favourable endorsement of CLARITY’s utility, comprehensibility and accessibility. Discussion: Recommendations for minor refinements to CLARITY were provided and made, as well as for its use in health care services. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate what concerns people with acute low back pain (LBP) and explore whether demographic and clinical factors were associated with having concerns about LBP. DESIGN: Mixed-methods study. METHODS: We included participants aged ≥18 years with acute LBP (LBP≤6 weeks). We collected demographic and clinical characteristics via an online survey and asked one open-ended question to elicit participants' concerns about their LBP. We investigated concerns about LBP using inductive content analysis. Using multivariable logistic regression, we explored associations between demographic and clinical characteristics and having concerns about LBP. RESULTS: We included 2025 participants, a majority of whom (n = 1200, 59.3%) reported having at least 1 concern about their LBP. There were 34 unique concerns, which mapped to 5 themes: causes of LBP (n = 393, 19.4%), future consequences of LBP (n = 390, 19.3%), psychosocial consequences of LBP (n = 287, 14.2%), physical consequences of LBP (n = 210, 10.4%), and health consequences of LBP (n = 84, 4.2%). Demographic and clinical characteristics were associated with having concerns about LBP: participants with university education, having previously received advice for LBP, with higher LBP intensity, interference, and higher anxiety symptoms were more likely to have concerns about their LBP. CONCLUSION: Most people with acute LBP had at least 1 concern about their LBP, more commonly centered around the causes of and the future consequences of LBP. [ABSTRACT FROM AUTHOR]

This study evaluated Spanish physiotherapists' orientations toward biopsychosocial and biomedical approaches in chronic pain management through a cross-sectional survey of 447 registered professionals. Validated questionnaires assessed knowledge, attitudes, and beliefs. Multivariate analysis of covariance (MANCOVA) identified influential factors and ordinal regression determined the frequency of biopsychosocial application. Content analysis of open-ended responses explored barriers to biopsychosocial implementation. Over 50% of physiotherapists favored the biopsychosocial model, influenced by interdisciplinary work settings, advanced pain knowledge, and specific training. Comprehensive pain knowledge significantly impacted both biomedical and biopsychosocial orientations inversely. The biomedical approach was more prevalent among those with lower education levels and less pain knowledge, particularly at the beginning or over 20 years into their careers. Despite the theoretical preference for biopsychosocial among Spanish physiotherapists, practical application was infrequent, with only 9.8% always using it and 40.7% frequently. Self-reported confidence and skills were crucial determinants of biopsychosocial implementation frequency. Significant barriers included inadequate psychological skills (63.6%), coordination challenges (47.6%), time constraints (43.6%), patient misconceptions (34.2%), and systemic issues. These findings align with international research, highlighting the need to bridge the gap between theoretical knowledge and clinical practice. Addressing these challenges through targeted training and systemic reforms is crucial for improving chronic pain management globally. [ABSTRACT FROM AUTHOR]

Introduction: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. Aim: To explore the process of preparing discharge for patients with COPD in a hospital setting. Method: Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. Results: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co‐creating, hesitating and socialising. The co‐creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. Conclusion: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co‐creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes. [ABSTRACT FROM AUTHOR]

Chronic pain rehabilitation helps to reduce pain and restore valued life roles. Patients may have more positive outcomes when they perceive rehabilitation to be personally meaningful. This study examined associations between self-reported, personally meaningful rehabilitation and well-being. A pilot study was conducted using an online survey of people with chronic pain and experiences of rehabilitation. The PROMIS Pain Interference Short Form 8a and The Flourishing Scale were used to explore well-being. A modified self-report measure, the Meaningfulness in Rehabilitation Scale, was pilot-tested for construct validity and used in the survey. Of the 48 participants (81% female; 19% male), most attended a generalist therapy practice (62%) once per week (33%) or once per fortnight (29%). No statistically significant relationship was found between self-reported meaningfulness in rehabilitation and pain interference or other patient and therapy characteristics (duration of chronic pain category, type of therapy practice, resolution of rehabilitation category, and frequency of appointments). The nonparametric analysis identified a statistically significant moderate positive correlation between self-reported meaningfulness in rehabilitation and the flourishing aspect of well-being. This raises important questions and suggests that patients' perception of rehabilitation as meaningful warrants further research. This pilot study provides valuable guidance to inform a larger investigation. [ABSTRACT FROM AUTHOR]

Objectives: Although psychological distress in palliative patients has at least an equal or greater impact on the quality of life compared to physical or spiritual distress, there is limited research on contextual factors associated with psychosocial intervention accessibility and relevance. This is the first published study to explore patients' views on psychosocial intervention delivery medium preferences, key biopsychosocial target domains, and well-being priorities during the palliative and end-of-life (EOL) phases.Methods: Eighty-one palliative patients from a Specialist Palliative Care Service completed a questionnaire, which collected quantitative and qualitative data on preferred mediums for receiving psychosocial interventions, priority biopsychosocial target domains, and well-being priorities during the palliative and EOL phases.Results: Results showed that an individual in-person was the most preferred medium for receiving psychosocial interventions. Improving quality of life, distressing emotions, and adjusting to the palliative care context were the 3 most frequently endorsed biopsychosocial target domains. Valued living and comfortable living were the key priority well-being themes for the palliative phase, whereas being surrounded by loved ones and comfortable and dignified dying were the priority well-being themes for the EOL phase.Significance Of Results: Findings highlight psychosocial interventions as an essential part of a holistic approach to patient-centered care throughout both the palliative and the EOL phases. Results can inform the refinement of existing and the development of new psychosocial interventions, particularly those that target emotional distress, adjustment, and quality of life. Furthermore, in-person treatment delivery remains essential in an evolving digital world. [ABSTRACT FROM AUTHOR]

This article analyses attempts to enact complexity in postgenomic experimentations using the case of epigenetic research on biomarkers of psychosocial stress. Enacting complexity in this research means dissecting multiple so-called biosocial processes of health differentiation in the face of stressful experiences. To characterize enactments of biosocial complexity, the article develops the concepts of complexity work and complexification. The former emphasizes the social, technical, and material work that goes into the production of mixed biological and social representations of stress in epigenetics. The latter underlines how complexity can be assembled differently across distinct configurations of experimental work. Specifically, complexification can be defined as producing, stabilizing, and normalizing novel experimental systems that are supposed to improve techno-scientific enactments of complexity. In the case of epigenetics, complexification entails a reconfiguration of postgenomic experimental systems in ways that some actors deem 'better' at enacting health as a biosocial process. This study of complexity work and complexification shows that biosocial complexity is hardly a univocal enterprise in epigenetics. Consequently, the article calls for abandoning analysis of these research practices using clear-cut dichotomies of reductionism vs. holism, as well as simplicity vs. complexity. More broadly, the article suggests the relevance of a sociology of complexification for STS approaches to complexity in scientific practices. Complementing the existing focus on complexity as instrumental rhetoric in contemporary sciences, complexification directs analytical attention to the pragmatic opportunities that alternative (biosocial) complexities offer to collective, societal, and political thinking about science in society. [ABSTRACT FROM AUTHOR]

This study aimed to explore added value of mcoach app and activity bracelet in 12-month cardiac rehabilitation on changes in rehabilitee's biopsychosocial functioning: cardiorespiratory fitness, depressive symptoms and social quality of life compared to similar rehabilitation without remote technology. Additionally, the study explored the factors explaining changes of biopsychosocial functioning. Six groups of coronary rehabilitees were cluster-randomised to experimental (n = 30) or control group (n = 29). Parametric and nonparametric statistical analyses and linear regression analyses were used. No differences between the groups regarding changes in VO2max (p = 0.474), DEPS (p = 0.315) or social quality of life (p = 0.592) were observed. Positive changes in the whole study population in VO2max were explained with shorter time from last cardiac operation and higher light activity at the baseline (R2 = 0.309). Smaller increase in DEPS was explained with positive changes in different aspects of social quality of life (R2 = 0.562). Remote technology had no added value for rehabilitation, but the results confirmed the importance of early rehabilitation, maintenance of socially meaningful life and the use of biopsychosocial and multidisciplinary approaches. Research defining the needs and types of technology, their timing, to whom and to what extent the remote technology would be most beneficial, is still needed. [ABSTRACT FROM AUTHOR]

The aim of our study is to inform the development of a rehabilitation program of care from the perspectives of those suffering from degenerative cervical radiculopathy (DCR). We conducted a qualitative study, purposefully recruiting individuals with DCR. Transcripts from virtual semi-structured interviews were iteratively analyzed using interpretative phenomenological methods. Eleven participants were recruited and depicted their ideal rehabilitation program of care. Participants described the importance of a patient centered-approach, health care providers who were validating, reassuring and attentive, easier access to health services, a supportive and collaborative team environment, and receiving peer support. Furthermore, participants expressed that they would expect the program of care to result in their symptoms being less intense and intermittent. In consideration of the participant perspectives, the ideal rehabilitation program of care can be conceptualized by the enactive-biopsychosocial model, which provides a theoretical framework for developing and implementing the program of care. We obtained valuable information from individuals living with DCR regarding their preferences and expectations of a rehabilitation program of care. The participant descriptions will provide the groundwork for its development to meet patient needs and expectations. Future research to guide implementation will also be explored. The lives of those suffering from cervical radiculopathy are significantly impacted. Incorporating patient perspectives in the development of care plans can lead to the inclusion of interventions considered patient-centered and may improve implementation, adherence, and outcomes. Participants described their preferences and expectations of a rehabilitation program of care that may assist in its future development to meet patient needs and expectations. From participants' perspectives, the ideal rehabilitation program of care would be framed by the enactive-biopsychosocial model, thus providing a theoretical context for its development and implementation. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods: We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings: We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion: Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem. [ABSTRACT FROM AUTHOR]

The undergraduate physiotherapy program at the University of the Witwatersrand, South Africa, aims to respond to global and national health needs across levels of care, with a focus on primary care. Ideally, contemporary health professionals' education focuses on a holistic approach that extends beyond addressing a patient's medical diagnosis. In South Africa, however, this approach also needs to address the country's colonial past by emphasizing decolonialization and social justice. Within this context, novel competencies are required to serve South Africans consistent with comprehensive health and disability frameworks based on the biopsychosocial approach such as the International Classification of Functioning, Disability and Health. As physiotherapy educators at the University of the Witwatersrand, we describe the rationale for the current public health and community physiotherapy curriculum in the context of decolonialization and social justice and provide an overview of the curriculum. Narrative approach. Our curriculum is an example of a response to the 21st-century health needs of the South African population and the specific global and universal policies, philosophies, and principles that influence healthcare professionals and their service delivery. This curriculum prepares physiotherapy students to practice holistically, be responsive to health needs and contribute to decolonialization initiatives. Other programs may benefit from our experience. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate quality of life (QoL) in middle-aged adults living alone and identify comprehensive biological, psychological, interpersonal, and contextual factors related to QoL using the dynamic biopsychosocial model. As a secondary analysis, this study used data from the 2017 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency. Methods: Among the total 228,381 respondents, 10,639 middle-aged individuals aged 40–64 years from single-person households (5,036 men and 5,603 women) were included in the analysis. QoL was measured using the EuroQoL-5 Dimension (EQ-5D). The EQ-5D descriptive statistics were provided according to biological, psychological, interpersonal, and contextual factors. Considering the data structure of the multistage stratified cluster sampling method, a complex samples general linear model statistic was used to identify the predictors of QoL. Results: QoL was lower in those who had undesirable psychological status (e.g., more depressive symptoms, poor subjective health, and higher perceived stress), less engagement in social networking (less frequent contact with friends and less frequent participation in social activities such as religious activities, friendship gathering, and leisure), and lower physical, behavioral, and socioeconomic factors. Conclusions: This study's findings indicate that psychological and interpersonal factors should be addressed and prioritized to improve the QoL of middle-aged adults living alone. By providing many opportunities for easily accessible social activities that meet the needs and interests of this demographic, their QoL can be improved through strengthening social support. [ABSTRACT FROM AUTHOR]

Disability acceptance is one of the most significant constructs in the psychosocial adaptation process. Although prior research has examined the relationship among different biopsychosocial factors, disability acceptance, and quality of life (QoL), limited study focused on entering a series of biopsychosocial factors simultaneously into analysis to reflect live experience of individuals with disabilities. This study aimed to examine the role of acceptance regarding the relationship between a series of biopsychosocial factors (i.e., general health, physical functioning, pain, anxiety, depression, stress, loneliness, stigma, sense of community, and neighborhood problems) and QoL based on Livneh's psychosocial adaptation model to inform psychosocial interventions. A total of 430 participants with disabilities completed an online survey consisting of instruments measuring target variables. Exploratory and confirmatory factor analyses indicated a three-factor structure for selected biopsychosocial factors (i.e., psychological difficulties, physical status, and community issues). Structural equation modeling results showed that the proposed model indicated a fair model fit after respecification. Effect analyses showed that disability acceptance directly affected QoL and partially mediated the relationship between physical status and QoL and psychological difficulties and QoL. In addition, loneliness has been found to significantly and directly predict QoL in the respecified model. The model demonstrated that disability acceptance and loneliness have a significant impact on QoL. [ABSTRACT FROM AUTHOR]

In recent years, the importance of holistic care in individuals with systemic lupus erythematosus (SLE) has been emphasized, and therefore a measurement tool that evaluates biopsychosocial impact is needed. This study was conducted to determine the validity, reliability, and responsiveness of the Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) in individuals with SLE. Lupus Quality of Life (LupusQoL), Short Form-36 (SF-36), Health Assessment Questionnaire (HAQ), and Hospital Anxiety and Depression Scale (HADS) were used for the validity. For reliability, evaluations were repeated at 1 -week intervals and for responsiveness, the same scales were re-administered at 3-month intervals to 30 patients. BETY-BQ showed moderate to high correlations with LupusQoL subparameters (rho = −0.522 to −0.718, p < 0.001), moderate to very high correlations with SF-36 subparameters (r = −0.826 to rho = 0.594, p < 0.001), high correlations with HAQ and HADS-D (rho = 0.735, p < 0.001; rho = 0.622, p < 0.001, respectively) and a moderate correlation with HADS-A (rho = 0.571, p < 0.001). In the test-retest method the correlation between the responses was very high (r = 0.989, p < 0.001). The intraclass correlation coefficient (r = 0.944, p < 0.001) and Cronbach's alpha value were found to be excellent (0.952). BETY-BQ showed moderate correlations with LupusQoL subparameters (the body image r = −0.443, p = 0.014; planning rho = −0.529, p = 0.003; fatigue r = −0.484, p = 0.007; intimate relationships rho = −0.421, p = 0.02), SF-36 social function subparameter (rho = −0.427, p = 0.019) and anxiety and depression subparameter of HADS (rho = 0.418, p = 0.021; r = 0.507, p = 0.004, respectively). BETY-BQ which was found as a valid, reliable, and responsive scale in individuals with SLE, was presented to healthcare professionals for use in clinical and research studies as a scale that can be preferred in the evaluation of biopsychosocial status of individuals with SLE. [ABSTRACT FROM AUTHOR]

Communicating effectively, including the ability to negotiate, has been claimed to be key competencies in interprofessional practice. However, these day-to-day contributions to interprofessional teamwork are not yet sufficiently understood. The aim of this article is to explore the day-to-day interprofessional negotiations in biopsychosocial pain rehabilitation. A qualitative design with an ethnographic approach was applied to the overall study. Participant observation of interprofessional encounters and clinical encounters in a pain rehabilitation ward was undertaken in 2016 for a period of 19 weeks. Intermittent interviews with 12 professionals were conducted. Data were analyzed in an abductive process using thematic analysis. We present the results as two themes: 1) Silent conflicting interests in the office, and 2) Silent dissatisfaction with meetings. The study showed that the team members had opportunities to negotiate in interprofessional offices and meetings, while they perceived insufficient time for discussion, and their individual work being interrupted by each other in the offices. They did not discuss their dissatisfaction, but silently bargained on how to spend time together. Professionals can contribute to teamwork through silent bargains that can promote a low level of conflict and thereby preserve a good workflow. [ABSTRACT FROM AUTHOR]

Objective: Many women are affected by pelvic floor disorders, such as stress urinary incontinence and pelvic organ prolapse. In recent years, these disorders have been treated with transvaginal mesh implant surgeries involving the vaginal insertion of woven netting. We explored women's experiences of transvaginal mesh implant surgery through a biopsychosocial lens. Design: We analysed women's submissions to an Australian Parliament Senate Inquiry on transvaginal mesh implant surgery using thematic analysis. Main Outcome Methods: One-hundred and fifty-three publicly available submissions detailing women's experiences of transvaginal mesh implant surgery to an Australian Parliament Senate Inquiry were analysed. Adverse and positive accounts were eligible for inclusion. Results: We generated nine themes in three categories relating to the Biopsychosocial Model: Physical Health - comprising three themes; Psychological Health - comprising two themes; and Social Wellbeing - comprising four themes. Physical, psychological and social experiences interacted, resulting in reduced quality of life for women. Conclusion: Most women who made submissions to an Australian government inquiry about transvaginal mesh implant surgery described devastating impacts on physical, psychological, and social wellbeing. We provide recommendations to guide psychologists in assisting women with adverse transvaginal mesh-related outcomes. Further research should explore women's long-term experiences of the various transvaginal mesh procedures. [ABSTRACT FROM AUTHOR]

Women's health is a vast and complex field, encompassing diverse experiences and challenges throughout the pregnancy lifecycle. Despite advanced medical facilities in the United States, pregnancy-related mortality rates remain higher than in other countries, with alarming disparities affecting minority populations. This article explores the multifaceted landscape of infertility, focusing on women in heterosexual partnerships pursuing in vitro fertilization (IVF). In exploring the biological, psychological, and social dimensions of women's health in the context of IVF, this article employs the biopsychosocial model as a systemic framework to comprehend the comprehensive nature of the IVF process. It delves into the challenges faced by individuals and couples, emphasizing the vital role of mental health services in promoting overall wellbeing. [ABSTRACT FROM AUTHOR]

SUMMARY: Multiaxial classification system development (organising important and relevant clinical factors under multiple headings or 'axes') has a long history stretching back to the 1940s. The World Health Organization supported the development of a multiaxial system of classification for children from the 1960s and in the 1990s produced a comprehensive multiaxial system which could be used with ICD-10. Using the multiaxial approach provides for an atheoretical framework that can integrate factors from within the child and the environmental influences on the child. This article presents a variety of ways in which the ICD-10 multiaxial framework can be extended from its classic usage to provide clinicians with valuable tools to assist in a biopsychosocial clinical assessment. Using the multiaxial system in an extended format allows a more comprehensive diagnosis and planning of treatments and is helpful in the training and teaching of juniors. It is also useful in evaluating responses to medication when it is combined with a chronological analysis and can provide other useful ways of integrating information relevant to understanding clinical cases. [ABSTRACT FROM AUTHOR]

Background and Objectives Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Nonpharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different nonpharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis. Research Design and Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions. Results Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences −0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity. Discussion and Implications Nonpharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults. [ABSTRACT FROM AUTHOR]

Objective of this narrative review is to elucidate the complex relationship among dietary habits, sarcopenia, and gut microbiota composition, with an eye toward enhancing patient management and outcomes. Given the burgeoning interest in the influence of diet on CMP, a detailed examination of the current literature is warranted. Nutritional intake is a critical determinant of the gut microbiota profile, which, in turn, is linked to musculature integrity and performance, potentially leading to sarcopenia. The development of sarcopenia can aggravate CMP owing to diminished muscular strength and functionality. Additionally, disruptions in the gut microbiota may directly modulate nociception, intensifying CMP manifestations. Thus, nutritional optimization emerges as a viable approach to CMP management. Emphasizing a diet conducive to a healthy gut microbiome could forestall or mitigate sarcopenia, thereby attenuating CMP intensity. Nevertheless, the domain calls for further empirical exploration to unravel the nuances of these interactions and to forge efficacious dietary strategies for individuals with CMP. Beyond mere analgesia, comprehensive patient care for CMP requires acknowledgment of the complex and multifactorial nature of pain and its foundational elements. Embracing an integrative treatment model allows healthcare practitioners to promise better patient prognoses, enriched life quality, and a decrease in the sustained healthcare costs associated with CMP. Plain Language Summary: Chronic musculoskeletal pain (CMP) is long-lasting pain in the bones, muscles, and joints, and it's a common problem affecting over 1.7 billion people worldwide. This kind of pain can really disrupt someone's daily life, making it hard to do everyday things and causing a lot of stress. This review is like a deep dive into how eating habits, muscle loss, and the tiny organisms living in our guts all connect to this pain. As we are becoming more curious about how food affects CMP, it's important to look closely at what we already know. What we eat can change the tiny bugs in our guts, which has a big impact on our muscles. If our muscles get weak and shrink (a condition called sarcopenia), it can make CMP worse because weak muscles cannot support our bodies well. Also, if the balance of bugs in our gut is off, it might even make us feel pain more intensely. So, changing what we eat might be a good way to tackle CMP. Eating foods that keep our gut bugs happy might help prevent muscle loss and reduce pain. But we still need to do more research to understand this better and to figure out the best foods to eat for this purpose. Treating CMP is not just about getting rid of the pain; it's about looking at the whole picture and all the things that contribute to the pain. By considering everything — from our diet to our muscles to our gut bugs — doctors can help improve the lives of people with CMP, making them more comfortable and possibly reducing medical costs in the long run. [ABSTRACT FROM AUTHOR]

Bondage/discipline, Dominance/submission, and Sadism/Masochism (BDSM) have gained increased attention and discussion in recent years. This prevalence is accompanied by a shift in perceptions of BDSM, including the declassification of sadomasochism as a paraphilic disorder. Evolutionary psychology offers a unique perspective of why some individuals are interested in BDSM and why some prefer certain elements of BDSM over others (e.g., dominance versus submission). In this paper, we examine BDSM from an evolutionary standpoint, examining biopsychosocial factors that underlie the BDSM interests and practice. We articulate this perspective via an exploration of: proximate processes, such as the role of childhood experiences, sexual conditioning, and physiological factors; as well as ultimate explanations for power play and pain play dimensions of BDSM, highlighting the potential adaptive advantages of each. While BDSM may not be adaptive in itself, we examine the literature of sex differences in BDSM role preferences and argue that these preferences may stem from the extreme forms of behaviors which enhance reproductive success. In the realm of pain play, we explore the intersection of pain and pleasure from both physiological and psychological perspectives, highlighting the crucial role of psychological and play partner factors in modulating the experience of pain. Finally, we encourage future research in social sciences to utilize evolutionary frameworks to further explore the subject and help alleviate the mystification surrounding BDSM. This multifaceted exploration of BDSM provides valuable insights for clinicians, kink-identified individuals, and scholars seeking to understand the evolutionary perspectives of human sexual behavior and preferences. [ABSTRACT FROM AUTHOR]

The Occupational Therapy department at the University of the Pacific sought to custom-design the occupational therapy foundations course for entry-level occupational therapy doctorate (OTD) students. The first and second authors are occupational therapists with extensive experience in clinical practice as well as academia; the third author is an occupational scientist with broad experience in teaching both graduate and undergraduate professionals. Together they were recruited to design and co-teach the course. The course is consistent with the biopsychosocial philosophy that is the foundation for the curriculum design in the program and the overarching goal was to provide a broad lens on the centrality of occupation in human life. The course was offered for the first time during the spring 2021 term and included thirty-seven first year OTD students. Several assessment methods were used to evaluate students' learning and understanding of the course content. A summative course assessment survey with comments was used at the end of the course. This article describes the model of the course design and the student feedback. This approach for designing a new course with integrated perspectives will be helpful to OTD programs seeking to equip entry-level occupational therapists for the complex work of today's healthcare system. The authors will describe the course design, fit with the curriculum, implementation, and student feedback. The authors hope that sharing this course design will contribute toward informing OT education and meeting the needs of healthcare through the use of integrated professional perspectives. [ABSTRACT FROM AUTHOR]

To examine the applicability and process of change of Cognitive Functional Therapy (CFT) in the management of pain and disability in people with knee osteoarthritis who were offered knee replacement surgery and had risk factors for poor response to surgery. Single-case experimental design with a mixed-methods, repeated measures approach was used to investigate the process of change through CFT in four participants. Qualitative interviews investigated beliefs, behaviours and coping responses, and self-reported measures assessed pain, disability, psychological factors, and function at 25 timepoints. Study registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619001491156). Qualitative data indicate that CFT promoted helpful changes in all participants, with two responses observed. One reflected a clear shift to a biopsychosocial conceptualisation of osteoarthritis, behavioural re-engagement and the view that a knee replacement was no longer necessary. The other response reflected a mixed conceptualisation with dissonant beliefs about osteoarthritis and its management. Psychological and social factors were identified as potential treatment barriers. Overall, quantitative measures supported the qualitative findings. The process of change varies between and within individuals over time. Psychological and social barriers to treatment have implications for future intervention studies for the management of knee osteoarthritis. Cognitive Functional Therapy is applicable in the management of knee osteoarthritis. Reconceptualisation of osteoarthritis reflected a helpful change. Psychological and social factors emerged as barriers to recovery. [ABSTRACT FROM AUTHOR]

Despite research advances and urgent calls by national and global health organizations, clinical outcomes for millions of people suffering with chronic pain remain poor. We suggest bringing the lens of complexity science to this problem, conceptualizing chronic pain as an emergent property of a complex biopsychosocial system. We frame pain-related physiology, neuroscience, developmental psychology, learning, and epigenetics as components and minisystems that interact together and with changing socioenvironmental conditions, as an overarching complex system that gives rise to the emergent phenomenon of chronic pain. We postulate that the behavior of complex systems may help to explain persistence of chronic pain despite current treatments. From this perspective, chronic pain may benefit from therapies that can be both disruptive and adaptive at higher orders within the complex system. We explore psychedelic-assisted therapies and how these may overlap with and complement mindfulness-based approaches to this end. Both mindfulness and psychedelic therapies have been shown to have transdiagnostic value, due in part to disruptive effects on rigid cognitive, emotional, and behavioral patterns as well their ability to promote neuroplasticity. Psychedelic therapies may hold unique promise for the management of chronic pain. [ABSTRACT FROM AUTHOR]

Functional neurological disorder (FND) is a neuropsychiatric disorder that manifests in a broad array of functional motor, sensory, or cognitive symptoms, which arise from complex interactions between brain, mind, body, and context. Children with FND make up 10%–20% of presentations to neurology services in children's hospitals and up to 20% of adolescents admitted to hospital for the management of intractable seizures. The current review focuses on the neurobiology of pediatric FND. The authors present an overview of the small but growing body of research pertaining to the biological, emotion-processing, cognitive, mental health, physical health, and social system levels. Emerging research suggests that pediatric FND is underpinned by aberrant changes within and between neuron-glial (brain) networks, with a variety of factors – on multiple system levels – contributing to brain network changes. In pediatric practice, adverse childhood experiences (ACEs) are commonly reported, and activation or dysregulation of stress-system components is a frequent finding. Our growing understanding of the neurobiology of pediatric FND has yielded important flow-on effects for assessing and diagnosing FND, for developing targeted treatment interventions, and for improving the treatment outcomes of children and adolescents with FND. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to synthesise the evidence of older persons' experiences of frailty. Background: The world's population is ageing with those aged over 60 years expected to total 2 billion by 2050. Although not exclusive to ageing, there is a higher prevalence of frailty in older adults, with corresponding demand for related healthcare. While definitions of frailty are debated, there is emerging consensus that sole reliance on biomedical conceptualisations is inadequate to capture the complex needs of older persons living with frailty. In addition, the voices of older persons have largely been excluded from frailty discourses. There is a consequent need for an expanded approach. Methods: A meta‐synthesis was conducted of the literature on older persons' experiences of frailty. CINAHL, Medline, Embase and ASSIA databases were systematically searched up to January 2024. Reference lists of retrieved sources and grey literature were also searched. Studies were independently evaluated for inclusion by two reviewers using predetermined inclusion criteria. Included studies were quality appraised using a standardised tool, and extracted data were thematically analysed and synthesised. Results: Eight hundred and thirteen studies were identified as potentially relevant. Following title and abstract review, 52 studies were selected for full‐text review. Thirty‐four studies were subsequently excluded as they did not address the systematic review question, leaving 17 included in the final review. An additional two studies were identified via grey literature sources. Older persons' experiences of frailty were synthesised with reference to three themes: (i) living with frailty: a multidimensional experience; (ii) living with frailty: acceptability and associations; and (iii) living with frailty: resisting and adapting and losing control. Conclusions: Older persons' experiences of frailty revealed a resistance to the biomedical use of the term generally used in clinical practice. Instead, a more nuanced and multidimensional understanding of frailty was identified in the experiences of older persons. Implications for Practice: Health and social care personnel should therefore consider an expanded approach in practice that incorporates the perspective of older people who strive to maintain independence and control when living with frailty. Doing so may enhance shared understanding and person‐centred care planning between older persons and professionals. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe whether certain occupations were over- or underrepresented and to compare biopsychosocial functioning by types of occupation and employment status among adults seeking orofacial pain (OFP) treatment. The authors extracted self-reported employment status, occupation, and biopsychosocial functioning from initial appointment records of 444 treatment-seeking adults at a university-affiliated OFP clinic. The authors categorized occupations in major and minor occupational groups according to the 2018 Standard Occupational Classification. The authors compared proportions between their sample and the corresponding state level, using a ratio and 95% CI (1.00 = equal representation in sample vs state, < 1.00 = underrepresentation, > 1.00 = overrepresentation). Among major occupational categories, health care practitioners and technical occupations were the most common in the study sample (22.4%) and the second most overrepresented (ratio, 3.20; 95% CI, 2.59 to 3.97) after the arts, design, entertainment, sports, and media occupations (ratio, 3.95; 95% CI, 2.15 to 7.26). Among minor occupational categories, teachers and instructors were the most common in the study sample (11.2%) and the most overrepresented (ratio, 90.71; 95% CI, 65.67 to 125.30), followed by managers (ratio, 43.87; 95% CI, 29.61 to 64.99) and photographers (ratio, 40.89; 95% CI, 10.23 to 163.4). No differences were observed in biopsychosocial functioning between major occupational categories. However, those not working due to health reasons or disability had worse biopsychosocial functioning (insomnia, anxiety and depression, life satisfaction, sleep health, pain intensity, pain-related interference; all P <.034) than those who were employed. Several occupations are strongly over- and underrepresented among adults seeking OFP treatment. Differences were not explained by biopsychosocial functioning. Future research should attempt to identify and address the underlying mechanisms of association between occupation and seeking care for OFP. [ABSTRACT FROM AUTHOR]

Objectives: Sexual satisfaction is an important aspect of quality of life. Chronic pain, depression and anxiety, and relational problems correspond with higher risk for sexual difficulties. Less is known about how risk factors for sexual dysfunction and other problems--such as medical conditions, pain severity, and medication side effects--affect the sexual satisfaction of people with chronic pain. Using a biopsychosocial framework, this study explored factors related to sexual satisfaction among patients presenting for evaluation of chronic pain. Methods: Researchers used a hierarchical multiple regression analysis to model potential predictors of sexual satisfaction. Variables analyzed were demographic features, medical history, average pain severity, depressed mood, anxiety, and perceived significant other support. Data collection involved administration of retrospective questionnaires and chart review. The sample included male and female participants (N = 134) presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Results: Medical history (i.e., medical conditions, surgical history, and medications) and clinical self-report variables (i.e., pain severity, depressed mood, anxiety, and perceived significant other support) were associated with sexual satisfaction. In this sample, antidepressant use and higher pain severity were unique predictors of lower sexual satisfaction. Married marital status and higher levels of perceived significant other support were predictive of greater sexual satisfaction. Discussion: Findings highlight the importance of understanding the unique impact of biopsychosocial variables on the sexual satisfaction of patients presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Further exploration of protective factors that account for sexual satisfaction among individuals with chronic pain may help inform screening, referrals, and treatment. [ABSTRACT FROM AUTHOR]

Contemporary pain literature increasingly acknowledges the need of a multidimensional approach to pain, which accounts for its complex biological, psychological and social components. This is reflected in the recently revised definition of the International Association for the Study of Pain (IASP) and some contemporary philosophical positions. This paper addresses the need to offer a theoretical approach that integrates the biopsychosocial and qualitative multidimensionality of pain by developing the "social grounding view of pain". My focus is on seeking a multidimensional philosophical approach that accounts not only for its complex biological and psychological aspects but also and specifically does justice to its social dimension. I draw from some of the most recent multidimensional theoretical and methodological approaches that attempt to account for the social component of pain, including enactivism and interpretative phenomenological analysis (IPA), to propose the advancement of the social grounding view, which has a particular focus on socially shared linguistic concepts in relation to the meaning and modulation of pain. More specifically, the social grounding view is based on the argument that the meaning of the experience of pain is determined in part by socially shareable linguistic concepts habitually associated with pain. I test this view against empirical cases drawn from pain neuroscience education (PNE) and try to demonstrate how the modification of the linguistic concepts of pain could be used effectively to modulate its experience. [ABSTRACT FROM AUTHOR]

Background: Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. Aim: To develop a multidimensional international palliative care goals model in dementia for use in practice. Design: International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. Setting/participants: Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. Results: Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss−person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. Conclusion: A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research. [ABSTRACT FROM AUTHOR]

Debilitating fatigue is common in people living with kidney disease and often persists after a kidney transplant. Current understanding of fatigue is centered around pathophysiological processes. Little is known about the role of cognitive and behavioral factors. The aim of this study was to evaluate the contribution of these factors to fatigue among kidney transplant recipients (KTRs). A cross-sectional study of 174 adult KTRs who completed online measures of fatigue, distress, illness perceptions, and cognitive and behavioral responses to fatigue. Sociodemographic and illness-related information was also collected. 63.2% of KTRs experienced clinically significant fatigue. Sociodemographic and clinical factors explained 16.1% and 31.2% of the variance in the fatigue severity and fatigue impairment, respectively, increasing by 28% and 26.8% after adding distress. In adjusted models, all the cognitive and behavioral factors except for illness perceptions were positively associated with increased fatigue-related impairment, but not severity. Embarrassment avoidance emerged as a key cognition. In conclusion, fatigue is common following kidney transplantation and associated with distress and cognitive and behavioral responses to symptoms, particularly embarrassment avoidance. Given the commonality and impact of fatigue in KTRs, treatment is a clinical need. Psychological interventions targeting distress and specific beliefs and behaviors related to fatigue may be beneficial. [ABSTRACT FROM AUTHOR]

Low back pain and its chronification are among the most common causes of disabilities worldwide. This is why multiple interventions and treatment approaches have been investigated around this pathology in recent years. Currently, the evidence is increasingly leaning towards treating chronic low back pain with a treatment based on the patient's centered biopsychosocial model. This case report presents the evaluation and treatment of a 43-year-old woman with chronic low back pain using a multimodal physiotherapy based on a biobehavioral approach. In the physiotherapy intervention, the patient's pain characteristics and somatosensory, motor-functional, and affective-cognitive states were first evaluated. Subsequently, a multimodal treatment including therapeutic exercise, pain neuroscience education, and orthopedic manual and physical therapies was applied for a total of 14 sessions over a period of 9 weeks. Finally, a post-intervention evaluation and at the one-month follow-up were carried out, in which it was observed that the treatment had significantly improved the patient's symptomatology and their general state. This case suggests that a multimodal physiotherapy treatment based on a biobehavioral approach is an effective option to improve pain symptoms and somatosensory, motor-functional, and affective-cognitive aspects in the reported patient; therefore, a treatment of these characteristics may be an option for patients with chronic low back pain. [ABSTRACT FROM AUTHOR]

Physiotherapists trained to deliver biopsychosocial interventions for complex musculoskeletal pain problems often report difficulties in confidence and competency at the end of training. Cognitive Functional Therapy (CFT) is an individualized biopsychosocial intervention and understanding the facilitators and barriers to training in CFT will help inform future training programs. This study aimed to explore physiotherapists' and trainers' perceptions of the process of developing competency in CFT. A cross-sectional qualitative design using interviews of 18 physiotherapists and two trainers investigated training in CFT for persistent LBP via reflexive thematic analysis. Physiotherapists reported undergoing a complex behavior change process during training. Four themes emerged: 1) Pre-training factors; 2) Behavior change process; 3) Physiotherapy culture and context; and 4) Confident competence and beyond. Key components included graduated practice exposure linked to experiential learning with feedback and clear competency guidelines. Pre-training and contextual factors were facilitators or barriers depending on the individual. Physiotherapists supported ongoing learning, even after competency was achieved. This study provides insight into the processes of change during progress toward competency in CFT. It highlights facilitators and barriers to competency including physiotherapy culture and the clinical environment. The study also describes important educational components, including experiential learning and clinical integration, which may be used to inform future post-graduate training. [ABSTRACT FROM AUTHOR]

Background: Despite increasing studies on mental health among immigrants, there are limited studies using nationally representative samples to examine immigrants' mental health and its potential biopsychosocial contributing factors, especially during the COVID-19 pandemic. We explored and estimated the influence of life satisfaction, social/emotional support, and other biopsychosocial factors on self-reported anxiety/depression symptoms among a nationally representative sample of first-generation immigrants in the U.S. Methods: We conducted a secondary data analysis using the 2021 National Health Interview Survey among first-generation adults aged ≥ 18 years (n = 4295). We applied survey weights and developed multivariable logistic regression model to evaluate the study objective. Results: The prevalence of daily, weekly, or monthly anxiety/depression symptoms was 10.22% in the first-generation immigrant population. There were 2.04% daily, 3.27% weekly, and 4.91% monthly anxiety/depression among the population: about 8.20%, 9.94%, and 9.60% experienced anxiety symptoms, whereas 2.49%, 3.54%, and 5.34% experienced depression symptoms daily, weekly, and monthly, respectively. The first-generation population aged 26–49 years were less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18–25. Females (versus males) were more likely to experience anxiety/depression daily, weekly, or monthly. Those who identified as gay/lesbian had higher odds of experiencing anxiety/depression daily, weekly, or monthly compared to heterosexual persons. Relative to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds, while other/multi-racial/ethnic groups were more likely to experience anxiety/depression daily, weekly, or monthly. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes/rarely or using healthcare within the past one/two years was associated with experiencing anxiety/depression daily, weekly, or monthly. Conclusions: The findings reveal significant burden of anxiety and depression among first-generation population in the U.S., with higher risks among subgroups like young adults, females, sexual minorities, and non-Hispanic White and other/multi-racial individuals. Additionally, individuals with lower life satisfaction scores, limited social/emotional support, or healthcare utilization in the past one or two years present increased risk. These findings highlight the need for personalized mental health screening and interventions for first-generation individuals in the U.S. based on their diversity and health-related risks. [ABSTRACT FROM AUTHOR]

Background/Aims: In studies exploring the effectiveness of physical therapy treatment for painful musculoskeletal conditions, interventions appear to improve patient-reported outcomes. The interventions adopt different approaches, but there is a lack of agreement about which approach is most effective. Thus, research is needed to look at the potential influence of other variables present, such as common factors. Common factors are elements present across different treatments, which are necessary conditions for forming a therapeutic alliance and providing patient-centred care. While there is a positive relationship between common factors and patient outcomes noted in physical therapy, the mechanism through which these factors influence patient outcomes is less understood. The aim of this study was to explore participants' perceptions of the influence of common factors on physical therapy outcomes. Methods: Interviews were undertaken with seven individuals participating in physical therapy. The contextual model provided the framework to move beyond defining common factors to discussing how these elements contribute to the therapeutic changes seen in physical therapy. Results: Participants discussed how the therapeutic relationship is influenced by perceived trust and credibility, enhanced by goal setting, and individualised care. When these common factors are present, the potential for engaging in the work of physical therapy and enacting healthy behaviours and actions by patients were enhanced. Conclusions: By understanding common factors in physical therapy, a more complete view of the effects of interventions may be possible. Implications for practice: This study sheds light on the clinical impact of common factors in physical therapy, highlighting the pivotal role of therapeutic relationships built on trust, credibility, and individualized care. Recognizing and integrating these common factors into practice may enhance patient engagement and foster better therapeutic outcomes in musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

Background: Neck pain is a prevalent and disabling condition. Conservative management of this condition has shown only moderate effects. A solution to improve treatment effectiveness is to sub‐group patients into a classification system (CS) that allows for more personalised care. However, current stratification methods have only shown short‐term efficacy for pain. Given the limitations of these tools, it is pertinent to understand how these CSs are composed to be able to propose alternative patient management solutions. Objective: To identify and examine the different components of classification systems specific to patients with neck‐related conditions. Method: A systematic literature search was performed on 3 databases (PubMed, Scopus and CINAHL). Only systematic reviews, with or without meta‐analysis, and scoping reviews reporting CS with associated treatment for neck pain were included. Bias evaluation was performed through risk of bias in systematic review tools. Results: From the search strategy, 741 citations were retrieved, and seven studies were included. From these studies, 37 CS with associated treatments were extracted. Mobilisations showed that 64% were constructed using physical findings, 61% of CS were guided by symptom modulation, 25% used results of self‐reported questionnaire, 14% used individual characteristics, 14% incorporated cognitive findings, 8% used neurological findings, 3% used results of medical diagnostic test, and 3% incorporated environmental findings. Fear‐avoidance beliefs was the only cognitive parameter considered among CS. Conclusion: This study shows that existing classification systems for neck pain are limited and lack coverage of all potential drivers of pain and disability. The lack of recognition of psychosocial and pain neuroscience parameters may partly explain the limited effectiveness of these tools. [ABSTRACT FROM AUTHOR]