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Purpose: To explore what patients with rheumatic and musculoskeletal diseases (RMDs) need and receive of follow-up care after specialized rehabilitation, and whether received follow-up is associated with health outcomes after 1 year. Further, to compare these findings with patients' experiences to improve the understanding of how follow-up takes place., Methods: In a mixed methods study, patients received a rehabilitation programme designed to improve the continuity in rehabilitation across care levels. A total of 168 patients completed questionnaires, of which 21 were also interviewed., Results: At discharge, most patients reported needs for follow-up. These needs were largely met within 1 year, mainly resulting from patients' initiatives to re-connect with previous contacts. The degree of received follow-up was not associated with goal attainment, quality of life, or physical function. Factors related to providers (competence, communication skills), context (delays, limited access to care), and patients (motivation, life situation, preferences) seemed to be decisive for the progress of the rehabilitation process over time., Conclusions: The results provide evidence that access to follow-up care is crucial to patients with RMDs. However, it also highlights several factors that may influence its impact. These results can be used to optimise design and implementation of future follow-up interventions.

Purpose: To validate the comprehensive ICF core set for post-acute musculoskeletal conditions from the perspective of patients in a primary care physiotherapy setting., Materials and Methods: A qualitative study was conducted with patients suffering from musculoskeletal problems. A phenomenological approach based on focus groups was used to identify the most relevant aspects related to physical therapy care in their condition. The data were analyzed using a meaning condensation procedure, identifying relevant themes and concepts. The identified concepts were linked to the ICF and compared to the ICF core set for post-acute musculoskeletal conditions., Results: Forty-three patients were included in eight focus groups. A total of 1281 relevant concepts were extracted and related to 156 ICF second-level entities. Entities in the ICF core set for post-acute musculoskeletal conditions were 95.7% confirmed. Eighty-nine additional second-level ICF entities were identified., Conclusions: Entities in the ICF core set for post-acute musculoskeletal conditions are relevant to patients seen in primary care physical therapy units. However, there are areas of functioning related to community health care not covered by this ICF-based tool.IMPLICATIONS OF REHABILITATIONAn ICF-based framework is feasible for the assessment of musculoskeletal conditions.Post-acute musculoskeletal ICF core set was confirmed in patient focus groups.Additional ICF categories emerged for a primary care physical therapy setting.Community features of functioning could be addressed by a tailored ICF core set.

Purpose: To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness., Methods: A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed., Results: Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders ( g  = 1.488, 95% CI = 0.320-2.655, p  = 0.013). Analyses for other intervention types and patient groups were underpowered., Conclusion: Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.

Purpose: To synthesize common or differing perceptions of patients' and clinicians' that influence uptake of online-delivered exercise programmes (ODEPs) for chronic musculoskeletal (MSK) conditions., Methods: Eight databases were searched from inception to April 2023 for studies including (1) patients with and/or clinicians delivering ODEPs for chronic MSK conditions, and (2) synchronous ODEPs, where information is exchanged simultaneously (mode A); asynchronous ODEPs, with at least one synchronous feature (mode B); or no ODEPs, documenting past experiences and/or likelihood of participating in an ODEP (mode C). Critical Appraisal Skills Programme checklists were used to assess study quality. Perceptions of patients' and clinicians' influencing uptake of ODEPs were extracted. Quantitative and qualitative data were synthesised and integrated., Results: Twenty-one studies were included (twelve quantitative, seven qualitative, and two mixed-methods) investigating the perceptions of 1275 patients and 534 clinicians on ODEP mode A ( n  = 7), mode B ( n  = 8), and mode C ( n  = 6). Sixteen of the 23 identified perceptions related to satisfaction, acceptability, usability, and effectiveness were common, with 70% of perceptions facilitating uptake and 30% hindering uptake., Conclusions: Findings highlight the need to promote targeted education for patients and clinicians addressing interconnected perceptions, and to develop evidence-based perception-centred strategies encouraging integrated care and guideline-based management of chronic MSK conditions.

Purpose: To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Arabic language and to examine its measurement properties in patients with lower extremity musculoskeletal disorders., Materials and Methods: The original English version of the PSFS was cross-culturally adapted into modern standard Arabic language following Beaton's guidelines. Patients with lower extremity musculoskeletal disorders ( N  = 116) were recruited to examine the test-retest reliability, measurement error, floor and ceiling effects, and construct validity of the Arabic PSFS. Construct validity was tested by examining eight predefined correlational hypotheses., Results: Participants in the current study indicated that the Arabic PSFS was clear and understandable. The Arabic PSFS had very good test-retest reliability (ICC = 0.86) with no floor or ceiling issues. The standard error of measurement and the minimal detectable change of the Arabic PSFS were 0.64 and 1.49 points respectively indicating acceptable measurement error. The majority of the predefined construct validity hypotheses (75%) were supported by the results justifying the construct validity of the Arabic PSFS., Conclusions: The Arabic PSFS is a comprehensible and easy to use measure. The Arabic PSFS has very good test-retest reliability, acceptable measurement error, and evidence supporting its construct validity as measure of activity limitation in patients with lower extremity musculoskeletal disorders.Implications for rehabilitationRehabilitation specialist can confidently interpret patient's score in the Arabic PSFS to represent the extent of activity limitation.Patients with unchanged clinical status will have similar scores in the Arabic PSFS with repeated administrations of the scale over time.The Arabic PSFS can be used in daily clinical practice and in research studies to measure activity limitation in Arabic-speakers with lower extremity musculoskeletal disorders.The Arabic PSFS enables rehabilitation specialist to quantify activity limitation in a way that is relevant to the culture and life style of Arabic-speakers.

Purpose: A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. Methods: The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Results: Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Conclusion: Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients customarily use to adhere to other activities may inform strategies to promote prescribed home exercise adherence.

Purpose: A screening instrument (0-100 points) to predict return-to-work (RTW) problems was developed. We tested the predictive validity in patients with mental diseases (MD) and musculoskeletal diseases (MSD)., Materials and Methods: A prospective multicenter study with questionnaires at admission and 3 months after rehabilitation was conducted. Patients with MD and MSD were included. The outcome was occurrence of RTW problems during the follow-up. Receiver operating characteristic analyses were performed. Sensitivity, specificity, and predictive values were calculated for each disease group using the threshold of 27 points., Results: There were 401 patients with MD (n = 250) and MSD (n = 151) included in the study, and 31.8% and 46.4% reported RTW problems during the follow-up, respectively. The area under curve was 0.885 (0.838-0.920) and 0.899 (0.841-0.943). The sensitivity rates were 87.1% and 87.5% and the specificity rates were 79.9% and 88.4% for MD and MSD, respectively. The post-test probability of experiencing RTW problems was 78.9% for MD and 77.8% for MSD. Analyses including only employed patients showed similar results., Conclusions: The screening predicts short-term RTW problems after rehabilitation in patients with mental or MSD regardless of employment. The threshold of 27 points was confirmed as reasonable, but alternatives in the range of 20-30 points can also be recommended. Implications for Rehabilitation The SIMBO is a short and economic screening predicting future problems during the return to work (RTW) in patients with mental or musculoskeletal diseases. The SIMBO can be recommended to detect the initial RTW chance at the beginning of the rehabilitation process. This paper implied that there are mainly generic factors predicting the success of an RTW. Based on this it is possible to use one screening for different disease groups.

Study Design: Prospective longitudinal study., Objective: To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings., Background: Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported., Methods: Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age ± SD = 36.7 ± 11.1)., Main Outcome Measures: Mobility Activities Measure scales for lower extremity; PF-10; and PSFS., Results: All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively)., Conclusions: The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients' mobility. Implications for rehabilitation All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods. Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale, especially during the first four weeks of treatment. The summary measure also detected a higher percentage of participants with positive change that exceeded the minimal detectable change than the Patient-Specific Functional Scale and the Physical Functioning Scale at the first follow-up period. By demonstrating their consistency and sensitivity to change, the three Mobility Activities Measures scales can now be considered in order to track patients' functional progress. Mobility Activities Measure can be therefore used in patients with musculoskeletal conditions across outpatient rehabilitation settings to provide estimates of change in mobility activities focusing on the lower extremity.

Purpose: To investigate the prevalence, activity limitations and potential risk factors of upper extremity impairments in type 1 diabetes in comparison to controls., Methods: In a cross-sectional population-based study in the southeast of Sweden, patients with type 1 diabetes <35 years at onset, duration ≥20 years, <67 years old and matched controls were invited to answer a questionnaire on upper extremity impairments and activity limitations and to take blood samples., Results: Seven hundred and seventy-three patients (ages 50 ± 10 years, diabetes duration 35 ± 10 years) and 708 controls (ages 54 ± 9 years) were included. Shoulder pain and stiffness, hand paraesthesia and finger impairments were common in patients with a prevalence of 28-48%, which was 2-4-folds higher than in controls. Compared to controls, the patients had more bilateral impairments, often had coexistence of several upper extremity impairments, and in the presence of impairments, reported more pronounced activity limitations. Female gender (1.72 (1.066-2.272), p = 0.014), longer duration (1.046 (1.015-1.077), p = 0.003), higher body mass index (1.08 (1.017-1.147), p = 0.013) and HbA1c (1.029 (1.008-1.05), p = 0.007) were associated with upper extremity impairments., Conclusions: Compared to controls, patients with type 1 diabetes have a high prevalence of upper extremity impairments, often bilateral, which are strongly associated with activity limitations. Recognising these in clinical practise is crucial, and improved preventative, therapeutic and rehabilitative interventions are needed. Implications for rehabilitation Upper extremity impairments affecting the shoulder, hand and fingers are common in patients with type 1 diabetes, the prevalence being 2-4-fold higher compared to non-diabetic persons. Patients with diabetes type 1 with upper extremity impairments have more pronounced limitations in daily activities compared to controls with similar impairments. Recognising upper extremity impairments and activity limitations are important and improved preventive, therapeutic and rehabilitation methods are needed.

Purpose: Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders., Method: This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively., Results: The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders' concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers' diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker's capacities were essential for return-to-work success., Conclusion: These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions. Implications for rehabilitation Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker's capacities, is important for return-to-work success. Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities. Rehabilitation professionals should also be constantly watching for workers' and employers' return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

Background: The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) offers an optional performing arts module. The goal was to examine the psychometric properties of this module in musicians., Methods: This study is a secondary analysis of a randomized controlled trial on the effectiveness of a biopsychosocial intervention to prevent or reduce playing-related disability in conservatory students. Baseline data were used to examine internal consistency and discriminative validity of the performing arts module of the DASH questionnaire. Construct validity was analyzed by hypotheses testing. The performing arts module outcomes were compared to scores from the general DASH questionnaire, pain disability index, Short-Form 36, playing-related musculoskeletal disorder (PRMD) intensity, and pain intensity., Results: Questionnaires completed by 130 conservatory students were analyzed, 55% of the population was female. Median age was 20 years (IQR 4). The performing arts module showed good internal consistency (Cronbach's alpha 0.893). Discriminative validity between students with and without PRMDs was good. Three out of six hypotheses were accepted, indicating moderate construct validity., Conclusions: The performing arts module showed good internal consistency, good discriminative validity and moderate construct validity in a population of conservatory students. Implications for Rehabilitation Musicians suffer frequently from musculoskeletal disorders, mostly in the upper extremity. The Disabilities of the Arm, Shoulder, and Hand questionnaire is a well-known outcome measure, which also includes a performing arts module. This study is the first to explore psychometric properties of the performing arts module. The performing arts module of the Disabilities of the Arm, Shoulder, and Hand questionnaire showed good internal consistency, good discriminative validity, and moderate construct validity.

Purpose: To determine whether there was a difference in the sensitivity to change of the subscales of the Functional Independence Measure and the Assessment of Motor and Process Skills within three different post-acute inpatient rehabilitation populations., Material and Methods: We conducted retrospective chart review of patients consecutively admitted to inpatient rehabilitation units, with both admission and discharge Functional Independence Measure and Assessment of Motor and Process Skills scores. A total of 276 participants were included and categorized into diagnostic groups (orthopedic, oncology, and geriatric). Within group, sensitivity to change was evaluated for the subscales of each measure by calculating the difference in standardized response means (SRM) and 95% confidence intervals (CI)., Results: The Functional Independence Measure motor subscale was more sensitive to change than the Assessment of Motor and Process Skills in the orthopedic and geriatric groups (SRM difference  = 1.53 [95% CI 0.93, 2.3] and 0.65 [95% CI 0.3, 1.02], respectively) but not in the oncology group (SRM difference  = 0.42 [95% CI -0.2, 1.04]). For the cognitive subscales, the Assessment of Motor and Process Skills was more sensitive to change than the Functional Independence Measure in all three groups (SRM difference  = 0.38 [95% CI 004, 0.74], 0.65 [95% CI 0.45, 0.90], and 1.15 [95% CI 0.77, 1.69] for orthopedic, geriatric, and oncology, respectively)., Conclusions: The Functional Independence Measure is a mandated measure for all rehabilitation units in Canada. As the cognitive subscale of the Assessment of Motor and Process Skills is more sensitive to change than the Functional Independence Measure, we recommend also administering the Assessment of Motor and Process Skills to better detect changes in the cognitive aspect of function. Implications for rehabilitation When deciding between the Functional Independence Measure or the Assessment of Motor and Process Skills, it is important to consider whether patients' functional status is expected to change similarly or differently. The difference in sensitivity to change between the subscales of the two outcome measures varies with the characteristics of change (similar or different) in patients' functional status. We recommend using the Assessment of Motor and Process Skills, along with the Functional Independence Measure, for patients who are expected to make similar amounts of change in functional status, as the cognitive subscale of the Assessment of Motor and Process Skills is more sensitive to change and can better detect changes in the cognitive aspect of functioning. For patients whose functional status are expected to change differently (diverse diagnoses), the Functional Independence Measure may be more useful as the motor subscale was more sensitive to change when comparing between rehabilitation populations.

Purpose: The purpose of this study is to psychometrically test the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions., Materials and Methods: One thousand and two hundred people with ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic upper limb disorders; or Primary Sjögren's syndrome completed the Evaluation of Daily Activity Questionnaire, Health Assessment Questionnaire and Short-Form Health Survey v2. We examined internal construct validity using Rasch analysis, internal consistency, concurrent validity with the Health Assessment Questionnaire and Short-Form Health Survey v2. Participants repeated the Evaluation of Daily Activity Questionnaire to assess test-retest reliability., Results: The 12 domains satisfied Rasch model expectations for fit, local dependency, unidimensionality and invariance by age and gender, in each musculoskeletal condition. Internal consistency was consistent with individual use (Cronbach's α > 0.90); concurrent validity was strong (Health Assessment Questionnaire: r s  = 0.60-0.92; Short-Form Health Survey v2 Physical Function: r s  = -0.61 to -0.91) and test-retest reliability excellent (Intra-Class Correlation Coefficient(2,1) = 0.77-0.96)., Conclusion: The Evaluation of Daily Activity Questionnaire satisfied Rasch model requirements for construct validity and has good reliability and validity in each MSC. The Evaluation of Daily Activity Questionnaire can be used as a measure of everyday activity in practice and research with people with musculoskeletal conditions. Implications for rehabilitation The Evaluation of Daily Activity Questionnaire evaluates users' ability to perform common daily activities (in 12 domains) that were identified as problematic by people with seven musculoskeletal conditions (i.e., osteoarthritis, systemic lupus, ankylosing spondylitis, chronic pain, chronic upper limb conditions, systemic sclerosis, Sjogren's syndrome). Most patients considered the Evaluation of Daily Activity Questionnaire was the right length and would be helpful for discussing everyday problems with an occupational therapist. The 12 domains have good reliability and validity and can be combined into two components: Self-Care and Mobility. The Evaluation of Daily Activity Questionnaire is suitable for use both in clinical practice and research and a User Manual is available for therapists and researchers.

Purpose: Problems with access to outpatient physiotherapy services have been reported in publicly funded healthcare systems worldwide. A few studies have reported management strategies aimed at reducing extensive waiting lists, but their association with waiting times is not fully understood. The purpose of this study was to document access to public outpatient physiotherapy services for persons with musculoskeletal disorders in hospitals and explore organizational factors associated with waiting time., Methods: We surveyed outpatient physiotherapy services in publicly funded hospitals in the province of Quebec (Canada)., Results: A total of 97 sites responded (99%) to the survey. The median waiting time was more than six months for 41% of outpatient physiotherapy services. The waiting time management strategies most frequently used were attendance and cancelation policies (99.0%) and referral prioritization (95.9%). Based on multivariate analyses, the use of a prioritization process with an initial evaluation and intervention was associated with shorter waiting times (p = 0.008)., Conclusions: Our findings provide evidence that a large number of persons wait a long time for publicly funded physiotherapy services in Quebec. Based on our results, implementation of a prioritization process with an initial evaluation and intervention could help improve timely access to outpatient physiotherapy services. Implications for Rehabilitation Access to publicly funded outpatient physiotherapy services is limited by long waiting times in a great proportion of Quebec's hospitals. The use of a specific prioritization process that combines an evaluation and an intervention could possibly help improve timely access to services. Policy-makers, managers, and other stakeholders should work together to address the issue of limited access to publicly funded outpatient physiotherapy services.

Purpose: The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire is a patient reported outcome measure for evaluating upper limb function in people with musculoskeletal conditions. While the DASH has good psychometric properties when used with people with musculoskeletal conditions, it has not been tested with adults after stroke., Methods: Data for n = 61 adults following stroke (aged 32-93 years, 44% male) were analyzed to test validity and reliability of the DASH for use with a stroke population. Data included demographic and clinical attributes, DASH scores (baseline and four weeks later) and Patient Rated Wrist Evaluation (PRWE) measures., Results: Internal consistency was good (Cronbach alpha 0.92, SEM 6.65). Factor analysis and Rasch modeling suggested that the questionnaire comprised three subscales: pain, impact and function. Concurrent validity between the DASH and PRWE (Spearman's Rho r s  =   0.41) was moderate. The scale was perceived by clinicians to be useful, quick and simple to administer. The DASH had low four-week test-retest reliability (ICC 0.56 [95% Cl 0.05-0.79])., Conclusions: The DASH is considered to have acceptable validity when used with adults following stroke. Test-retest reliability was low but further research is needed to establish whether this is a result of condition-related change or the stability of the measure. Implications for Rehabilitation The DASH questionnaire examines upper limb function in task performance and appears to be a useful tool, which is simple to administer in the clinical setting with adults following stroke. Upper limb function post stroke can be meaningfully assessed using the DASH as it has good internal consistency and moderate concurrent validity. Rasch analysis and factor analysis suggests that the tool appears to consist of three subscales: pain, impact and function. The total score of the DASH may be less meaningful than the totals of these subscales. The test-retest reliability of the DASH requires further research; over a four-week period DASH stability was poor in a group of people with moderate to severe upper limb impairment.

Purpose: The aim was to translate and cross-culturally adapt the Lower Extremity Functional Scale (LEFS) into Arabic language and to examine its measurement properties in patients with musculoskeletal disorders of the lower extremity., Methods: Standard forward and backward translation followed by expert committee review, then preliminary testing was carried out to produce the final Arabic version of LEFS (LEFS-Ar). The test-retest reliability, measurement error, internal consistency and construct validity of the LEFS-Ar were examined in patients with musculoskeletal disorders of the lower extremity (N = 116)., Results: The LEFS-Ar had excellent test-retest reliability (ICC2,1 = 0.96). LEFS-Ar standard error of measurement was 3.5 points while the minimal detectable change MDC95 was 9.8 points. LEFS-Ar showed excellent internal consistency with Cronbach's alpha of 0.95. Parallel analysis and factor analysis showed that LEFS-Ar measures one underlying factor with all items loading heavily on this single factor. LEFS-Ar showed significant positive correlation with patient's global assessment of function (r = 0.59) and that patients recovering from surgery reported lower LEFS-Ar score compared to patients with no surgery further supporting the construct validity of the LEFS-Ar., Conclusion: LEFS-Ar has excellent internal consistency, test-retest reliability with relatively small measurement error and is a valid measure of activity limitation due to lower extremity musculoskeletal disorders. All these measurement properties of the LEFS-Ar suggest the clinical usefulness of this measure., Implications for Rehabilitation: The Arabic Lower Extremity Functional Scale (LEFS-Ar) is a reliable and valid measure of activity limitation due to lower extremity musculoskeletal disorders with relatively small measurement error. LEFS-Ar can be used in daily clinical practice and for research purposes to quantify activity limitation in Arabic-speaking individuals with lower extremity musculoskeletal disorders.

Purpose: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders., Method: Semi-structured interviews were performed with 39 women and 30 men, (aged 22-63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis., Results: These people experienced health as "having resources and opportunities to lead the life one wants". Three categories, "a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life", illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on "being ill" and "being well" and what makes the difference. Five aspects influenced the dynamics of their health experiences: "body and soul, prognosis, character of symptoms, physical and social activity, and emotional state". Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want., Conclusions: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies., Implications for Rehabilitation: Musculoskeletal disorders (MSDs) are difficult to cure and actions to alleviate suffering are of most importance to increase wellbeing and thereby work ability. Research on lay perspectives can contribute towards a deepened understanding of the health experiences of the affected, and thereby the development of the goals and activities of rehabilitation. Our models, that present the view of health and aspects important for achieving wellness among people with MSDs, can contribute in the development of multimodal rehabilitation. The results can also be useful as a base in the evaluation of clinical practice.

Purpose: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions., Methods: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised., Results: Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling "normal", motivation and optimism, redefining self and escapism from everyday boundaries., Conclusions: Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions., Implications for Rehabilitation: Individuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity. It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity. Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered. Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual's barriers to physical activity. A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.

Purpose: The aim of this study was to investigate, from the perspective of society, the costs of sick leave and rehabilitation of recently sick-listed workers with musculoskeletal disorders (MSD) or mental disorders (MD)., Methods: In a prospective cohort study, 812 sick-listed workers with MSD (518) or MD (294) were included. Data on consumption of health care and production loss were collected over six months from an administrative casebook system of the health care provider. Production loss was estimated based on the number of sick-leave days. Societal costs were based on the human capital approach., Results: The mean costs of production loss per person were EUR 5978 (MSD) and EUR 6381 (MD). Health care interventions accounted for 9.3% (MSD) and 8.2% (MD) of the costs of production loss. Corresponding figures for rehabilitation activities were 3.7% (MSD) and 3.1% (MD). Health care interventions were received by about 95% in both diagnostic groups. For nearly half of the cohort, no rehabilitation intervention at all was provided., Conclusions: Costs associated with sick leave were dominated by production loss. Resources invested in rehabilitation were small. By increasing investment in early rehabilitation, costs to society and the individual might be reduced., Implications for Rehabilitation: Resources invested in rehabilitation for sick-listed with musculoskeletal and mental disorders in Sweden are very small in comparison with the costs of production loss. For policy makers, there may be much to gain through investments into improved rehabilitation processes for return to work. Health care professionals need to develop rehabilitative activities aiming for return to work, rather than symptoms treatment only.

Purpose: The Lower Extremity Functional Scale (LEFS) is a widely used questionnaire to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It also can be used to monitor the patient over time and to evaluate the effectiveness of an intervention. Nevertheless there is no Spanish version of the LEFS, so the aim of this study was the translation and cross-cultural adaption of the Spanish version of the LEFS and to evaluate its psychometrics properties., Methods: The questionnaire was cross cultural adapted into Spanish. The psychometric properties tested in the Spanish version of the LEFS were: internal consistency, test-retest reliability, constructs validity, discriminative validity, responsiveness, concurrent validity and floor and ceiling effects in 132 participants seeking for treatment due to lower extremity dysfunction., Results: The Spanish version of the LEFS had high internal consistency (Cronbach's α=0.989), test-retest reliability (ICC=0.998, 95% CI: 0.996-0.999) and presented a high correlation with the SF-36 (36-Item Short-Form Health Survey) especially with the physical function and pain subscales. The construct validity showed a single factor that account for 84.95% of the variance. The standard error of measurement of the Spanish version of the LEFS was 0.88 scale points (95% CI) and the minimal detectable change was 2.18 scale points (95% CI). The sample, collected from five Spanish physical therapy centers, was divided in groups (acute, sub-acute and chronic subjects). Within group changes showed a significant improvement on the LEFS score (p<0.001) and effect sizes were large in all conditions. The LEFS allowed to distingue between acute and not acute conditions; for this criterion ROC curve was performed at baseline (area under the curve [AUC]=0.95). There was no floor or ceiling effects., Conclusions: The Spanish version of the LEFS has been shown to be a valid and reliable tool to assess musculoskeletal dysfunction in the lower extremity that could be used with Spanish speaker population. Implications for Rehabilitation Cross-cultural adaptation of a self-reported questionnaire to evaluate musculoskeletal lower extremity disorders in the Spanish population. To provide Spanish clinicians and physiotherapists a useful tool to assess the lower extremity function. To provide Spanish researchers a valid tool for research on lower extremity function: patient's improvement due to treatment, compare results obtained between populations, treatment.

Purpose: To investigate whether patients are prescribed rehabilitation early in a new sick leave period, and whether this prescription is associated with sex, age, diagnosis, description of functioning and affiliation of certifying physician., Method: A cross-sectional study using data from sickness certificates issued during a total sick leave period, collected consecutively during 2 weeks in 2007 in Östergötland County, Sweden. Rehabilitation prescribed in the first certificate or within 28 days after the start of sick leave was defined as early rehabilitation., Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). The mean duration of sick leave was 94 days (SD 139), longest for MD patients. Early rehabilitation was prescribed in 27% of all certificates and in 45% of certificates for MSD and MD diagnoses. Logistic regression analysis indicated that prescription of early rehabilitation was associated with certificates issued for MSD and MD, youngest patients, and certificates issued by primary health care physicians. The final model explained 29% of variation in the prescription of early rehabilitation., Conclusions: There is a modest prescription of early rehabilitation in sickness certificates, based on younger age and MSD or MD diagnosis. This indicates that patients' rehabilitation needs may not have been identified., Implications for Rehabilitation: Sickness certificates are the decision basis for entitlement to sickness benefits and return to work (RTW) measures conveyed between the health care, the social insurance office and employers. Sickness certificates were found to provide modest information about early rehabilitation and RTW measures, indicating that patients' rehabilitation needs may not have been identified. As a communication tool, this scarce information might have implications for the patient regarding RTW measures or work modifications.

Purpose: The aim was to culturally translate and validate the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower extremity musculoskeletal disorders (n = 304)., Method: This is a prospective methodological study. After a standard forward-backward translation, psychometric properties were assessed in terms of test-retest reliability, internal consistency, construct validity, dimensionality, and ceiling or floor effects., Results: The acceptable level of intraclass correlation coefficient >0.70 and Cronbach's alpha coefficient >0.70 was obtained for the Persian LEFS. Correlations between Persian LEFS and Short-Form 36 Health Survey (SF-36) subscales of Physical Health component (rs range = 0.38-0.78) were higher than correlations between Persian LEFS and SF-36 subscales of Mental Health component (rs range = 0.15-0.39). A corrected item--total correlation of >0.40 (Spearman's rho) was obtained for all items of the Persian LEFS. Horn's parallel analysis detected a total of two factors. No ceiling or floor effects were detected for the Persian LEFS., Conclusions: The Persian version of the LEFS is a reliable and valid instrument that can be used to measure functional status in Persian-speaking patients with different musculoskeletal disorders of the lower extremity. Implications for Rehabilitation The Persian lower extremity functional scale (LEFS) is a reliable, internally consistent and valid instrument, with no ceiling or floor effects, to determine functional status of heterogeneous patients with musculoskeletal disorders of the lower extremity. The Persian version of the LEFS can be used in clinical and research settings to measure function in Iranian patients with different musculoskeletal disorders of the lower extremity.

Purpose: This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs)., Methods: A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles., Results: Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status., Conclusions: The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability., Implications for Rehabilitation: Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.

Purpose: Health care practice guidelines require physiotherapists to include patients in goal-setting. However, not much is known about how this process is accomplished in practice. The purpose of this study is to analyse patient-physiotherapist consultations and to identify how physiotherapists enquire about goals and how patients respond to these enquiries., Method: 37 consenting patients and their physiotherapist from outpatient physiotherapy practice settings were videotaped. Conversation analysis was used to transcribe and analyse the data., Results: In 11 cases, physiotherapists enquire explicitly about goals. Patients' responses indicate that problems can arise when therapists' questions treat it as expected that the patient has a goal already in mind, and has sufficient understanding about "physiotherapy-relevant" goals. Patients' difficulties with stating a goal are related to patients' knowledge to propose a goal and whether they treat consultations as one in which it is appropriate to claim knowledge about goals., Conclusions: Goal-setting is not a straightforward process. Practices that entail asking patients to state their goals neither take into consideration the fact that patients may not know what an achievable goal is nor do they consider so-called social reasons for patients not to make claims to their physiotherapist about what the goals should be. Implications for Rehabilitation Patients respond to explicit goal enquiries using an open question with delayed responses indicating some communication problem. Goal-setting should not be treated as a predetermined process, but as negotiated in consultations. Goal-setting is a complex interaction in which participants manage knowledge about goals.

Purpose: Occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The aim of this study was to evaluate the prognostic value of various short-term rehabilitation outcome parameters on early retirement in Germany., Method: In a prospective multi-centre cohort study of self-rated patient status, physician chosen therapy goals and attainment were measured by means of standardized questionnaires at the beginning and end of medical rehabilitation. Information with regard to disability was collected by self-report over a 5-year follow-up period., Results: We included 1268 MSD patients aged 45-57 who underwent a 3-week, multidisciplinary, in-patient rehabilitation programme in 10 rehabilitation centres in Southern Germany between January and December 2001. During follow-up (mean duration: 3.9 years) 117 (9%) patients received a disability pension. After adjustment for sex, age and patient outcomes, risk for early retirement was significantly increased for patients with only partial success with respect for the therapy goals pain reduction (HR 1.95), improvement in spine motility (HR 1.6) and improvement of muscle strength (HR 2.3). Patients who did not have the therapy goal were at the same risk as patients with full goal achievement., Conclusions: Clinicians' rating of short-term therapy outcome might be of prognostic relevance of MSD patients' long-term employment status.

Purpose: To assess internal consistency and construct validity of the French version of the Revised Illness Perception Questionnaire adapted for Work Disability (IPQR-WD)., Method: A cross sectional study was conducted in rehabilitation centers and private clinics in the Montreal region of Canada, involving 43 men and women, French speaking, absent from work between 3 months and a year due to musculoskeletal disorders. The 9 dimension IPQR-WD and the following eight-related instruments for construct validity were administered: Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Psychological Distress Index (PDI-14), Pain Disability Index (PDI), Self-Efficacy for Return to Work Scale (SERWS), Pain Beliefs and Perceptions Inventory (PBPI), Implicit Models of Illness Questionnaire (IMIQ) and a Visual Analog Scale for pain intensity (VAS)., Results: Calculations of Cronbach's α (from 0.58 to 0.87) revealed satisfactory internal consistency of the IPQR-WD dimensions. Multiple regression analyses were performed with each IPQR-WD dimension and significant independent variables. Final models explained a good proportion of the variance (adjusted r(2) = 0.33-0.70) for each dimension, except for the Cyclical timeline dimension for which associations became non-significant after adjusting for gender, age and length of sick leave. The SERWS and the VAS were not significantly associated to any of the IPQR-WD dimensions., Conclusions: Moderate to strong correlations were found with six-related instruments which support the multidimensional nature of the IPQR-WD and its unique contribution as one simple questionnaire that can assess representations related to work disability. [Box: see text].

Purpose: The aim of this study is to determine differences in self-reported work ability, work conditions, health and function between ICD-10 groups with musculoskeletal disorders (MSD), mental disorders (MDs) and MSD + MD and to determine which variables are associated with sick leave., Method: A cross-sectional study of 210 employees was conducted at an occupational health service unit. Physiotherapists and physicians classified the employees' health problems according to ICD-10 and the employees answered a questionnaire with questions on demographic variables, health, functioning, work ability and work conditions., Results: Forty-four per cent of the employees had MSD, 22% had MD and 34% had a MSD + MD. The group on sick leave had worse results for all health and work measures. Belonging to the MD group, belonging to the MSD + MD group, having poor work ability and functioning were associated with being on sick leave. The value for the model explaining being on sick leave was 0.63 (Nagelkerke R²)., Conclusions: Having a diagnosis of MD based on a professional opinion and having poor work ability and functioning based on self-reports are associated with being on sick leave. The results suggest that self-reported data could be used to complement the expert-based diagnosis.

Purpose: The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person's actual working situation 1, 5 and 10 years after a rehabilitation period., Methods: This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline., Results: Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories., Conclusions: The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person's needs and facilitating RTW.

Purpose: To propose the joint use of the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) and to illustrate this proposal using musculoskeletal (MSK) conditions., Method: In light of the MSK conditions as classified in the ICD, categories from existing ICF core sets for MSK conditions were pooled to specify functioning. Another approach was to consider other categories from measures or instruments already linked in the literature., Results: ICF Categories have been pooled from six core sets for MSK conditions, two specific care settings, one MSK clinical trial setting and eight instrument linkage papers., Conclusions: The ICD-ICF joint use would be able to capture the impact of a health condition by taking into account the disease and functioning status which would facilitate clinical care. Therefore, there is reasonable ground to demonstrate the operational linkage and complementary role of the ICD and the ICF in the context of the ICD revision.

Purpose: The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago., Methods: This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups., Results: In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups., Conclusions: Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.

Purpose: The application of the margin of manoeuvre (MM) concept in work rehabilitation is new. It allows for variations in both health status and work demands, and the interaction between the two, to be taken into account. The objective of this exploratory study was to document the relationship between the presence of an MM in the workplace and the return to work (RTW), after a long-term absence., Methods: This study used the data collected during an earlier study that sought to identify the dimensions and indicators of the MM. The data were analysed on three levels, and the convergences and divergences in the MM indicators and dimensions in relation to the RTW were grouped accordingly., Results: Eleven workers and five clinicians participated in this study. The results support the proposition that the presence of a sufficient MM in the workplace is associated with RTW of individuals at the end of a rehabilitation programme despite a long-term absence (n = 6), and conversely, that its absence would appear to be associated with a non-return to work (n = 4)., Conclusions: A better understanding of this concept will help further the development of a tool to assist clinicians in their task of assessing a worker's capacity to return to a given job.

Purpose: The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden., Methods: An experimental group comprising 89 patients from two primary health care units received individualised treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine. All participants completed questionnaires measuring pain, sick leave, quality of life, health care utilisation, drug consumption and psychosocial factors at baseline and at 3-year follow-up., Results: After 3 years, utilisation of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The control group showed a trend of having a higher risk of high consumption after 3 years compared to the intervention group. There was no significant difference between the two groups concerning remaining variables such as function, catastrophising and pain., Conclusion: Both groups demonstrated considerable improvement over the course of 3 years. The experimental group had lower health care utilisation and a reduced risk of using large amounts of medication at the 3-year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain.

Purpose: The purpose of this critical review is to describe the available theoretical models for understanding the gender issues in prolonged work disability related to persistent musculoskeletal (MSK) pain., Method: A critical literature review was conducted in medicine, health sciences, and social sciences databases (MEDLINE, CINHAL, PsychINFO and SOCINDEX) using specific keywords. After screening titles and abstracts, followed by methodological quality assessment, a total of 55 references were retained for content analysis., Results: Gender issues in disability related to persistent MSK pain show that men and women may experience pain and rehabilitation process in different ways. Three main themes were exftracted and further described: (1) the experience of distrust; (2) the self-identity process; and (3) the domestic strain. Each of these themes has a specific and potentially different impact on men and women, and we report that experiential differences may strongly impact the rehabilitation process and outcomes such as return to work., Conclusions: This critical review provides insight into gender issues in the process of rehabilitation and outcomes such as return to work. We suggest that work and family considerations are the two most important issues in the rehabilitation process and that differences between men and women are likely to occur.

Purpose: The overall aim of this study was to estimate the possible mediating role of self-efficacy, catastrophic thinking and fear of movement and (re)injury between pain intensity and pain-related disability in two samples of acute pain patients, i.e. patients with musculoskeletal injuries and patients with whiplash injury., Method: A cross sectional design with data-collection after an acute injury was used. Subjects were recruited at an emergency department. Sixty-four patients with acute whiplash associated disorders (WAD) and 74 patients with musculoskeletal injury completed the questionnaires., Results: Self-efficacy was found to be a mediator between pain intensity and pain-related disability in the WAD group, whereas fear of movement and (re)injury appeared as mediator in the musculoskeletal-injury group. The strength of association between variables was weaker in the musculoskeletal-injury group compared to the WAD group., Conclusions: It is important to assess fear of movement beliefs in patients with musculoskeletal injuries. Similarly, patients with acute WAD expressing low self-efficacy beliefs should be identified. An early detection of these beliefs may improve management at the acute phase and possibly reduce risks for slow improvements.

Purpose: To assess quality of life (QoL) in two groups of patients with long-term musculoskeletal pain with and without psychiatric co-morbidity and to compare them with a reference group of normative controls. The patients in both study groups were sick-listed full or part time for 3 months or more., Method: The patients were recruited from a company health service and consulting psychiatry. A generic QoL questionnaire, the SF-36, was used to assess QoL. Each group was compared with age- and gender-matched normative controls., Results: Both groups reported a pronounced impairment of QoL (p < 0.001) compared with their age- and gender-matched populations. The greatest impairment was seen among the patients referred for psychiatric assessment (n = 30). The patients in the company health service (n = 42) reported significantly higher QoL with regard to the dimensions mental health (p < 0.028), social functioning (p < 0.034) and role emotional (p < 0.040) compared with the patients referred for psychiatric assessment., Conclusion: Patients with long-term pain in the company health care and patients with psychiatric co-morbidity, sick-listed full or part-time reported severely impaired QoL with regard both to physical, social and mental dimensions. Psychiatric co-morbidity reported even more pronounced impairment of emotional, social and mental dimensions of QoL which might indicate dysfunctional coping strategies.

Purpose: The aim of this study was to assess the usability of a modified Astrand bicycle test in subjects with musculoskeletal pain disorder (MSPD) and healthy controls., Methods: In a random cross-over design, 31 subjects with a MSPD who have been referred to rehabilitation medicine and 33 healthy subjects matched for age, gender, height and body weight, performed an Astrand bicycle test and a modified test with a time interval of 7 days. Drop-out rates, VO2max values (in mL/kg lean body mass (LBM) min(-1)), intraclass correlation coefficients (ICCs) and critical difference (Bland-Altman plots) for both tests within each group of subjects were compared., Results: The drop-out rate in both tests for the MSPD group was comparable, and mainly caused by pain, fatigue or breathlessness. Compared with the modified version, the Astrand test showed higher VO2max-scores: 4.83 mL/kg LBM min(-1) (9.96%) in the MSPD group and 3.5 mL/kg LBM min(-1) (5.57%) in the healthy group. ICCs were 0.79 and 0.87 and the limits of agreement were 8.5 mL/kg LBM min(-1) (15.9%) and 10.2 mL/kg LBM min(-1) (18.1%), respectively., Conclusion: The usability of the modified test is acceptable, as well as in healthy individuals as subjects suffering from MSPD being referred to rehabilitation medicine. However, a slight under estimation of VO2max with the modified test has to be taken into account.

Purpose: To analyze why some responded positively to rehabilitation and why some did not., Method: Sixty participants with musculoskeletal disorders, mainly neck and back pain participated in a 7-week rehabilitation programme which was based on a combination of theoretical and practical education and physical activities. Before and after the programme and 6, 12 and 24 months after completion of the programme all participants were evaluated with the Disability Rating Index (DRI) and Pain Intensity Rating on a Visual analogue scale (VAS)., Results: In the participants who had full-time sick leave from the start of the programme to the 2-year follow-up (Group I) self-experienced physical disability and pain ratings were high and showed no decrease and were maintained up until the 2-year follow-up. For the participants who had part-time sick leave or no sick leave (Group II) physical disability and pain ratings were initially lower than in Group I and decreased gradually, (p < 0.01) and (p < 0.05), respectively throughout the 2-year follow-up period., Conclusion: Participants in Group I did not benefit from the rehabilitation programme and did not show improvement in their physical disability and pain rating. Group II showed decreased physical disability and pain rating. The decrease was gradual and was maintained up until the 2-year follow-up period. These results may indicate that persons with musculoskeletal pain with severe disability and pain require other rehabilitation programmes than those with moderate symptoms. This research has highlighted the need for development of such programmes.

Purpose: Musculoskeletal disorders evolve into long-term work disabilities in--10% of work-injury cases. From a prevention perspective, screening for predictive factors and obstacles associated with long-term work disability appear to offer a promising avenue for work rehabilitation. However, knowledge of the factors at play during the chronic phase remains limited. This study aims to explore the presence of a relationship between the predictive factors and obstacles identified at the time of admission to an interdisciplinary work rehabilitation programme and return to work upon completion of the programme, in individuals with a long-term work disability., Method: A descriptive correlational study involving 222 individuals assessed using the Work Disability Diagnostic Interview and who participated in the PREVICAP work rehabilitation programme., Results: The general model accurately predicts the work status of 77% of the participants. Seven to nine factors were found to be associated with return to work in each model produced (3). Those factors were mainly psychosocial and work-related in nature and differ according to gender. Unexpectedly, certain obstacles observed at the time of admission to the programme appear to have a protective effect and thus promote participants' return to work., Conclusion: The results obtained support the hypothesis that screening for predictive factors and obstacles at the time of admission of a work rehabilitation programme for individuals with a long-term work disability allows for more effective intervention regarding these factors, and in all likelihood, promotes return to work.

Purpose: To describe reasons for not starting and to determine expectations and perceived value of multidisciplinary treatment among referred patients, sick-listed due to upper extremity musculoskeletal disorders, Method: Twenty-six randomly chosen referred patients who did not start the treatment were interviewed by telephone to identify their reasons for not starting and 24 randomly chosen patients who participated in the treatment were interviewed face-to-face to explore their expectations and experiences of multidisciplinary treatment., Results: Reasons for not starting the treatment are mainly intrinsic to the treatment. The most important reason was that the treatment was thought to be too psychological in nature. Most treated patients had no prior expectations but saw it as a last resort for their complaints. The psychological (cognitive-behavioural) component was perceived as the most useful part that acquired the ability to cope with their complaints and developed an increased self-awareness. Most treated patients are satisfied, although some said the treatment did not meet their expectations, because their complaints had not disappeared., Conclusion: The most important reason for not starting the treatment was the assumption that the treatment is too psychological in nature, while in treated patients the psychological sessions were perceived as most useful treatment component.

Purpose: To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated., Method: Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement., Results: The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks' lambda = 0.848, p < 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months., Conclusion: The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.

Purpose: To describe the outcome of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain., Study Design: exploratory retrospective cohort study. The study sample consisted of a cohort of 70 children and adolescents (age: 8-21 years) with chronic musculoskeletal pain who completed a 3-month inpatient multidisciplinary pain management program. The program consisted of graded physical exercises, graded activities and counseling of the children and their parents. Assessed were motor and social activities, pain intensity, global assessment of physical functioning and psychosocial well-being (by patient and physician), understanding of the pain process and reduction of medical consumption. Assessments were performed at pre-admission, day of admission, day of discharge and at three months after discharge. Data collection took place over a 10-year period., Results: Compared to admission, at discharge there were significant improvements in motor performances, school attendance, reduction of pain scores, understanding of the chronic pain process and reduction of medical consumption. Results remained stable at follow-up after three months., Conclusion: The results of this study indicate that a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain may be effective.

Purpose: The aim of this study was to evaluate the 2-year outcome of a multidisciplinary rehabilitation programme for working-age people, regarding sick leave and mental health., Method: The test persons consisted of 40 women and 20 men (mean age 46.8 +/- SD 7.9) with musculoskeletal disorders, mainly neck and back pain. The rehabilitation programme was individually adapted and consisted of physical activity in several forms, relaxation, theoretical and practical education and individual guidance. Before, during and after the programme all participants were evaluated with the Global Self-Efficacy Index, Hospital Anxiety and Depression Scale, and stress test., Results: At the 2-year follow-up full-time sick leave had decreased by 37% (p < 0.0001) in the women, and by 25% (p < 0.05) in the men. Both women and men showed an increased quality of life (QoL) and decreased anxiety, depression and self-experienced stress at the 2-year follow-up compared with the start of the rehabilitation programme., Conclusions: The most important conclusion was that the effects of the rehabilitation programme persisted for up to 2 years. At 2 years the majority of the participants were still physically active, their QoL was increased, and most participants had returned to work.

Intramuscular injection of Botulinum toxin to produce reduction of focal muscle overactivity, and localized muscle spasm, has been utilized therapeutically for almost two decades. Muscle overactivity in neurologically normal muscle, where an imbalance exists between a relatively overactive muscle and its less active synergist or antagonist, can inhibit control of the antagonist producing a functional muscle imbalance. This brief review provides an overview of the role of muscle imbalance in sports-related pain and dysfunction, and outlines the potential for intramuscular injection of Botulinum toxin to be used as an adjunct to specific muscle re-education and functional rehabilitation in this patient group. A comprehensive understanding of normal movement and the requirements of the sporting activity are essential to allow accurate diagnosis of abnormal motor patterns and to re-educate more appropriate movement strategies. Therapeutic management of co-impairments may include stretching of tight soft tissues, specific re-education aimed at isolation of the non-dominant weak muscles and improvement in their activation, 'unlearning' of faulty motor patterns, and eventual progression onto functional exercises to anticipate gradual return to sporting activity. Intramuscular injection of Botulinum toxin, in carefully selected cases, provides short term reduction of focal muscle overactivity, and may facilitate activation of relatively 'inhibited' muscles and assist the restoration of more appropriate motor patterns.

Purpose: To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on 'resting disability pension'., Method: Qualitative analyses of interviews with 17 individuals going back to work., Results: Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality., Conclusion: Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.

Purpose: To report on the development of a program to treat and rehabilitate children with chronic orthopaedic disabilities in the sub-Saharan African context incorporating orthopaedic reconstructive surgery within community-based rehabilitation (CBR) programs., Method: Practice of rehabilitation descriptive report., Results: In a six-year period between 1996 and 2002, a comprehensive project addressing the rehabilitative and orthopaedic surgery needs of children with motor impairments was established in Uganda. Using the principles of CBR, more than 5000 children annually were assisted with 875 receiving orthopaedic reconstructive surgery. CBR proved a powerful tool in creating awareness and facilitating access to care amongst rural populations living in the circumstances of extreme poverty. By networking the services of several non-governmental development organizations, government agencies, service providers and community groups, a large number of children could be reached in an integrated way. The 'recipe for success' of rehabilitation required access to and integration of all of the following ingredients: CBR, a transportation system, rehabilitation hostels, physiotherapy, orthopaedic surgery, and orthopaedic appliance technology., Conclusions: CBR played a vital role in ensuring access to rehabilitative care and the success of orthopaedic reconstructive surgery.

Purpose: To assess whether and to what extent cognitive status affects functional gain in mobility and extended activities of daily living (ADL) in patients admitted to a geriatric day hospital., Methods: During 2003, 135 older patients admitted to a rehabilitation day hospital were evaluated by the Mini Mental State Examination (MMSE) and the Cognitive Functional Independence Measure (FIM). On admission and at discharge, they were assessed by the Nottingham Extended ADL Index (NEAI) and the Timed Get Up and Go test (TUG)., Results: Orthopedic and stroke patients achieved significant functional gain in mobility regardless of their cognitive status. Nevertheless, cognitively intact stroke patients achieved higher admission and discharge NEAI scores, manifesting greater absolute functional gain than cognitively impaired patients. The patients' ability to extract their rehabilitation potential was significantly better., Conclusions: Cognitively impaired patients can improve in mobility and performance of extended ADL during day hospital rehabilitation. Evaluation of the patients' cognitive status may enable the multidisciplinary team to develop suitable individual programs and better allocate resources. Cognitively intact stroke patients may benefit from extended rehabilitation treatment compared to impaired stroke patients as they are more capable of utilizing their potential to achieve independence in daily tasks.

Purpose: There has been a recent development of the work physical therapy area in Brazil. The relationship between work physical therapy and rehabilitation ergonomics needs to be highlighted to avoid segregation and fragmentation of these complementary fields. For these reasons, the purpose of this article was to review and clarify the scope of the areas of work physical therapy and rehabilitation ergonomics., Method: The available literature discussing the roles of the areas of interest was critically reviewed., Results: Both areas are concerned with workers' health and safety and they complement each other., Conclusions: Work physical therapy can be considered as rehabilitation ergonomics practiced by physical therapists with their specific interests. Hopefully, this paper will contribute to further interaction between the areas of work physical therapy and rehabilitation ergonomics not only in Brazil but worldwide. This may contribute to improved occupational disability prevention and rehabilitation.

Purpose: There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up., Method: The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status., Results: Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation., Conclusions: These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.

Aims: The aim of the present study is to identify self-rated health predictors of return to work (RTW) within the study population as a whole as well as in three subgroups, namely musculoskeletal complaints, other physical health complaints, and psychological complaints., Methods: The study was based on a sample of 862 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. Cox proportional hazards regression analyses were used to identify determinants of RTW., Results: For the study population as a whole type of complaint, earlier sickness absence, subjective severity of complaints and several RAND-36 subscales were predictive of RTW. Furthermore, the RAND-36 subscales physical functioning, physical role limitations, mental health, and health change were predictive of RTW among employees with musculoskeletal complaints. For employees with other physical health problems subjective severity of complaints and the RAND-36 subscales physical and social functioning, general health perception, and health change were associated with RTW. Finally, with regard to the group with psychological complaints the RAND-36 subscales mental health and general health perception predicted RTW., Conclusion: Several aspects of self-rated health predict RTW for employees on long-term sickness absence. Variables related to functional status predict RTW for employees with physical complaints in contrast to psychological problems.

Purpose: The purpose of this study was to describe the development of the Motivation for Change Questionnaire (MCQ) and to test its intra-patient reliability on musculoskeletal pain patients in interdisciplinary rehabilitation as a basis for use in rehabilitation planning., Method: The MCQ questionnaire was developed from a literature search in the Medline, Cinahl and Psychlit databases concerning motivating factors for change in the life and work situation. Questions covering these factors were developed (item generation). Factor analysis of the questions implied a reduction of the number of questions (item reduction). Inter-item correlation was assessed on the baseline administration of the questionnaire by calculating Cronbach's alpha. When testing the structure of the scales, it was shown that the MCQ questionnaire could be described in two scales, one scale relating to motivation for change in the life situation and the other focusing on motivation for change in the work situation and in total 49 questions., Results: The test -- retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals were calculated. One question was excluded due to the threshold limit of > 0.5. Seven scales relating to the life situation were accepted by the analysis: social support, mastery in life, challenges in life, control in life, values, self-efficacy and self-confidence. Six scales relating to the work situation were also accepted: co-worker support, supervisory support, challenges in work, job control, interaction and job-satisfaction., Conclusions: The MCQ questionnaire with 48 questions is reliable for use on musculoskeletal pain patients in interdisciplinary rehabilitation. It can be used to identify each individual's motivating factors for change in life and work situation as a basis for motivational work within rehabilitation and/or to measure within-subject changes in motivation over time. The validity and the responsiveness of the MCQ, need to be studied.