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The article aims at inspiring young researchers in the field, which is achieved through keynote lectures and meet-the- expert sessions from pain experts in the field, but also endorses possibilities to start new collaborations with researchers as well as clinicians in order to close the gap between science and clinical practice.

Background Evidence for effectiveness of transcutaneous electrical nerve stimulation ( TENS) is still inconclusive. As heterogeneity of chronic pain patients might be an important factor for this lack of efficacy, identifying factors for a successful long-term outcome is of great importance. Methods A prospective study was performed to identify variables with potential predictive value for 2 outcome measures on long term (6 months); (1) continuation of TENS, and (2) a minimally clinical important pain reduction of ≥ 33%. At baseline, a set of risk factors including pain-related variables, psychological factors, and disability was measured. Results In a multiple logistic regression analysis, higher patient's expectations, neuropathic pain, no severe pain (< 80 mm visual analogue scale [ VAS]) were independently related to long-term continuation of TENS. For the outcome 'minimally clinical important pain reduction,' the multiple logistic regression analysis indicated that no multisited pain (> 2 pain locations) and intermittent pain were positively and independently associated with a minimally clinical important pain reduction of ≥ 33%. Conclusion The results showed that factors associated with a successful outcome in the long term are dependent on definition of successful outcome. [ABSTRACT FROM AUTHOR]

Background and Objective: Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain, and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist training programs, and process‐related factors (practical implementation). Methods: We searched in scientific databases and reference lists. Randomized controlled trials (RCTs) evaluating primary care physiotherapist‐led BPS interventions in adults (≥18 years) with nonspecific CLBP (≥12 weeks) were included. Results: Our search resulted in 943 references; 7 RCTs were included (1,426 participants). Results show moderate‐quality evidence (3 trials; 991 participants) that a BPS intervention is more effective than education/advice for reducing disability and pain in the short, medium, and long term. Low‐quality evidence (4 trials; 435 participants) was found for no difference with physical activity treatments. Conclusions: BPS interventions seem more effective than education/advice and were found to be as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapists participate in training programs with extensive support prior and during delivery (manual, supervision, and informative resources). [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Although the importance of psychosocial factors has been highlighted in many studies in patients with chronic low back pain (CLBP), there is a lack of research examining the role of illness perceptions in explaining functional disability and physical activity in patients with CLBP. Aim: The aim of the study was to explore the value of illness perceptions in explaining functional disability and physical activity in patients with CLBP. Methods: Eighty‐four participants with CLBP (of > 3 months' duration) completed a battery of questionnaires investigating psychosocial factors (Pain Catastrophizing Scale [PCS], Illness Perceptions Questionnaire Revised [IPQ‐R], and 36‐Item Short Form mental health scale [SF‐36_MH]) and perceived pain intensity (visual analog scale [VAS]), as well as the Oswestry Disability Index (ODI) and Baecke questionnaire. The latter 2 were entered separately as dependent variables in a regression analysis. Results: The combined variables (VAS, PCS, SF‐36_MH, IPQ‐R) accounted for 62% of the variance in functional disability (ODI). Adding the results of the IPQ‐R to the scores of the other 3 variables (VAS, PCS, SF‐36_MH) significantly increased the explained variance of ODI scores in CLBP patients, yielding 18% additional information (P < 0.01). Only 5% of the variance in the Baecke questionnaire was explained by combining the 4 variables. None of the single variables alone made a significant contribution to R². Conclusions: Illness perceptions are an important factor for explaining functional disability, but not for explaining habitual physical activity in CLBP patients. [ABSTRACT FROM AUTHOR]

Background Content validity, the proper reflection of the concept to be measured, is yet unknown for the Credibility and Expectancy Questionnaire ( CEQ). It is frequently used in pain rehabilitation because treatment expectancy is influential on the outcome. Objective To test and improve the content validity of the CEQ in a sample of patients with chronic pain in different phases of their treatment. Methods A qualitative observational study design using the Three-Step Test-Interview method was used. Therein, data collection, analyses, and adaptations occur iteratively. Results Seventeen patients with chronic pain in different stages of treatment participated through convenience sampling from the mother sample of a randomized controlled trial. The main study parameter is content validity, which is defined as (1) interpretations and responses of the participants and (2) the identification of response problems operationalized, and resulting in changes in the CEQ. For patients waiting for treatment, the written instruction of the CEQ allowed different interpretations. After changing the instructions, the CEQ became an easy-to-understand and content-valid questionnaire. For patients who had already undergone treatment, changes regarding time frame and recall period were necessary to overcome interpretation and response problems to the CEQ. Discussion After small changes, the CEQ appeared to be a content-valid measurement instrument for patients waiting for treatment. However, for patients who had already undergone treatment, the content validity of the CEQ was less, and considerable changes were necessary. [ABSTRACT FROM AUTHOR]

Purpose The aims of this study were, first, to determine the percentage of adolescents with chronic pain/fatigue successfully treated with rehabilitation treatment for chronic pain/fatigue and, second, to identify predictors for a successful rehabilitation treatment. Methods Treatment success is scored based on a combination of predefined clinically relevant changes in 4 outcome measures: level of pain/fatigue, school absence, physical functioning, and psychosocial functioning. A forward stepwise logistic regression analysis with treatment success as a dependent variable is performed to identify predictors for successful treatment. Results A total of 172 adolescents (mean age 16.2 [ SD = 2.5]; 85.5% girls) participated. Almost half (49.6%) of the adolescents had a successful treatment. The explained variance for the complete model explaining treatment success was 49% ( R2 = 0.487). Patients with a higher level of pain/fatigue and a passive coping style pretreatment improved most, and these factors could thus be indicated as predictors for successful treatment. Also, gender significantly contributed to the prediction, in favor of boys. Conclusions Regarding the first aim, using predefined treatment success based on clinically relevant changes, half of the participants had a successful treatment. Concerning the second aim, adolescents with a high level of pain/fatigue and those with a high passive coping style pretreatment have a better ability to change their functioning during treatment. Boys benefit more than girls. [ABSTRACT FROM AUTHOR]

Background Little is known about the extent to which improvements in various problem areas are attained after multidisciplinary rehabilitation program in patients with chronic musculoskeletal pain ( CMP). Aim To describe the pre- and postcontents of problems in functioning from the Canadian Occupational Performance Measure ( COPM) in terms of the International Classification of Functioning, Disability and Health ( ICF) in CMP patients following a 15-week rehabilitation program. Methods In all patients admitted to a rehabilitation program, the COPM was administered at admission and discharge. The problems identified at admission were linked to ICF chapters using an established linking procedure. Changes of COPM Performance/Satisfaction scores (1-10; low-high) with 95% confidence intervals ( CIs) were calculated, and effect sizes ( ESs) were computed. Results In total, 165 patients were included with a mean age of 44.1 ( SD 12.9) years; among them, 143 (87%) were women. At admission, totally 801 problems were identified and linked to 706 unique ICF categories: 83 (12%) were related to the ICF component 'Body Functions' and 621 (88%) to 'Activities and Participation'. ICF chapters 'd4 Mobility' (124, 18%) and 'd9 Community social and civic life' (143, 20%) were most frequently identified. The median changes of the COPM total scores for Performance and Satisfaction were 2.1 (95% CI 1.9 to 2.3, ES: 1.75) and 3.2 (95% CI 2.9 to 3.4, ES: 2.38). Conclusion A 15-week multidisciplinary treatment program showed that most problems were seen within chapters Mobility and Community life of the ICF. The program led to significant improvements of patient reported problems, the magnitude of which was similar for all different problem areas. [ABSTRACT FROM AUTHOR]

Objective To describe the development and content of a clinical framework for mirror therapy ( MT) in patients with phantom limb pain ( PLP) following amputation. Methods Based on an a priori formulated theoretical model, 3 sources of data collection were used to develop the clinical framework. First, a review of the literature took place on important clinical aspects and the evidence on the effectiveness of MT in patients with phantom limb pain. In addition, questionnaires and semi-structured interviews were used to analyze clinical experiences and preferences of physical and occupational therapists and patients suffering from PLP regarding the application of MT. All data were finally clustered into main and subcategories and were used to complement and refine the theoretical model. Results For every main category of the a priori formulated theoretical model, several subcategories emerged from the literature search, patient, and therapist interviews. Based on these categories, we developed a clinical flowchart that incorporates the main and subcategories in a logical way according to the phases in methodical intervention defined by the Royal Dutch Society for Physical Therapy. In addition, we developed a comprehensive booklet that illustrates the individual steps of the clinical flowchart. Conclusions In this study, a structured clinical framework for the application of MT in patients with PLP was developed. This framework is currently being tested for its effectiveness in a multicenter randomized controlled trial. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to evaluate whether patients with fibromyalgia FM need more oxygen and more time to complete a walking and stair-climbing task than healthy volunteers and perceive the performance of these tasks as more strenuous. Furthermore, it was evaluated whether a less efficient performance is more pronounced in patients reporting a higher level of fear of movement. Methods Thirty patients with FM and 30 matched healthy volunteers completed a 500-meter walking and a stair-climbing task (60 steps) while wearing a mobile gas analyzing unit. Mean and total oxygen consumption and time needed to complete each task were recorded. After both tasks, a Borg score was used to measure perceived exertion. Fear of movement was measured with the Tampa Scale for Kinesiophobia. Results Patients with FM needed more time to complete the walking and stair-climbing task and reported higher levels of exertion compared to healthy volunteers. However, the total oxygen consumption for performing both tasks was not different. In patients with FM, a higher level of fear of movement was associated with a higher perceived exertion after the walking task. Interestingly, a higher somatic focus is related to a lower mean oxygen consumption needed to perform the stair-climbing task. Conclusion In conclusion, patients with FM perceive a walking and stair-climbing task as more strenuous than healthy controls, even though they walked slower and no differences in total O2 consumption during completion of both tasks were found. [ABSTRACT FROM AUTHOR]

Objective Chronic noncancer pain influences patient's quality of life and their ability to cope. Pain relieving medication and other specific treatments commonly integrated in biopsychosocial rehabilitation demonstrate modest benefits in pain relief and improved functioning of individuals. Spiritual care, covering the fourth dimension provides insight, inspires hope and purpose, and is thought to mediate mental and physical health for patients. This study explores the need for its inclusion in interdisciplinary pain rehabilitation and describes the requirements and test environment for evaluation. Methods Outcomes of spiritual care and interdisciplinary pain rehabilitation in follow-up studies of randomized controlled trials contained in systematic reviews were summarized. Pubmed, Cochrane, and Psyc INFO were searched, citation tracking was applied, articles of follow-up studies therein were located. Literature was searched for insights pertaining to requirements for an assessment of including this fourth dimension. Results No systematic reviews for spiritual care were identified. Five systematic reviews of biopsychosocial rehabilitation containing 14 studies describing long-term outcomes were retrieved. The importance of coping in maintaining long-term outcomes was empirically illustrated. The required test environment is provided by a structured multidimensional care pathway separating spirituality from well-being and mental health, with measures of treatment outcome installed enabling a comparison with benchmarks. Conclusions Active coping seems beneficial for maintaining positive long-term outcomes of interdisciplinary pain rehabilitation Spiritual care may be conducive to active coping. Further research is warranted to explore the additive value of this spiritual care in the context of a multidimensional care pathway. [ABSTRACT FROM AUTHOR]