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The majority of patients following musculoskeletal rehabilitation are taking painkillers. However, apart from one recent observational study, there is a lack of data. The use of analgesics, particularly opioids, is associated with higher scores for pain, anxiety, depression, catastrophizing and disability, as well as poorer results in functional tests. Prescribing analgesic treatment with precise objectives (improving pain and function) should also include identifying psychosocial factors associated with a poor prognosis. Regular reassessment of the treatment should make it possible to limit side-effects and the risk of misuse and help patients to engage in an active rehabilitation programme and resume regular physical activity., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Health, illness and treatment representations have been described as key factors for return to work. The Revised Illness Perception Questionnaire (IPQ-R) is a quantitative tool available to assess these factors. However, an adaptation is necessary before its use with workers on prolonged work disability presenting musculoskeletal disorders (MSD)., Methods: Two distinct phases were carried out, firstly, by adapting the IPQ-R for a population of workers in prolonged work disability related to an MSD and, secondly, by conducting a pre-test on the adapted questionnaire to assess item clarity. PHASE 1: The Technique for Research of Information by the Animation of a Group of Experts (TRIAGE) was selected to proceed with the adaptation. TRIAGE is an inductive and structured method aiming at the attainment of group consensus. Consensus was obtained in two steps: for the individual production, each expert had to judge the pertinence of the questioned elements and suggested new elements if needed; for the group production, all suggestions submitted were sorted according to TRIAGE systematic procedure, in order to retain the most pertinent ones by group consensus. Analysis was done simultaneously to data collection, by the attainment of group consensus. The group of experts consisted of six clinicians and two researchers. For the clinicians, selection criteria consisted of: being an occupational therapist or a psychologist and working for at least 2 years in a vocational rehabilitation setting for workers in prolonged work disability; for the researchers, being affiliated to a university and to have pursued a least one research project regarding prolonged work disability following MSD and development/validation of assessment tools. As a result of the adaptation process eight items were excluded because they were not considered pertinent by the experts. The label "illness" was changed for "current health condition" and 26 new items have been added to the questionnaire to better account for the work disability. The adapted questionnaire appears to present good content validity. PHASE 2: The assessment tool was then pre-tested using a widely known method for trans-cultural adaptation of questionnaires. This method adds a 7-point scale following each item in order to assess item clarity. When the questionnaire is filled, questions are asked to the respondent about items with low rating (4 or less on 7) in order to identify potential ambiguities. Inclusion criteria for the respondents consisted of: being between 18 and 64 of age, having more than 3 months of absence from work related to an MSD and being admitted in a rehabilitation program. Workers absent from work for more than a year, unable to understand and/or read French, suffering from an MSD related to a specific pathology, or presenting major psychiatric problems as indicated in their medical record were excluded. Nine workers were recruited using convenience sampling. Average clarity rating was above 4 for each item, suggesting that the adapted questionnaire was clear. Characteristics of participants seem to be representative of the target population., Conclusion: A questionnaire was adapted in order to better assess the representations of workers in a situation of work disability following an MSD. The rigorous process used in this study ensures the quality of the adaptation, but a validation study must be conducted before the implementation of the questionnaire in clinic and research., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Active therapies are well-accepted during a rehabilitation process or for the treatment of pain. However they may often cause additional pain that can reduce patient compliance. Mechanisms that control the effect of pain on muscle strength are so far poorly understood. It is of prime importance for the clinician to assess the impact of pain during rehabilitation, and especially the soreness induced by the therapies. Although this problem is recognized, it is often minimized by therapists. If the point of view of the patients is usually pretty close from the one of the therapist, it may differ on some points and this may lead to misunderstandings. In order to adjust the treatment and explanations, it is necessary to have a good assessment of the impact of pain on the lives of the patients. This is compulsory in order to get a better adhesion to the treatment.

Introduction: Self-efficacy with regard to work capacity is one of the determinants of return to work among workers with musculoskeletal disorders (MSDs). To our knowledge, the self-administered questionnaire named Echelle de mesure du sentiment d'efficacité personnelle is the only work-specific scale available in French; however its psychometric properties have not been extensively studied., Purpose: To estimate the internal consistency and factorial structure of the scale., Methods: The questionnaire has been administered to 36 workers in prolonged work disability due to a musculoskeletal injury during the chronic pain phase., Results: Internal consistency is satisfactory (Cronbach's alpha: 0.925). Factor analysis reveals a one-dimensional structure that explains 65.5% of the variance., Practice Implications: The results support the use of the scale for clinical practice and research. However, the evaluation of self-efficacy concerning work capacity still requires triangulation with other observations to increase conclusion accuracy.

Introduction: The aim of the Physical and Rehabilitation Medicine (PRM) day hospital's short-stay program is to propose a one- or two-day medical and psychosocial assessment to patients with disabilities. The day hospital is run by an interprofessional team, using interdisciplinary cooperation and a hospital/community network., Objectives: To describe a tool for assessing patient satisfaction and to present the results of our survey., Patients and Methods: A self-administered questionnaire about patient satisfaction was created and given to patients coming to the PRM day hospital. The questionnaire included 27 multiple-choice questions, two visual analogic scales, and one free-response question. The survey was conducted over two months. For the 603 annual day hospital sessions, 143 questionnaires on 143 sessions were filled out., Results: Patients found the questionnaire easy to use, but a few needed help to fill it out. It permitted us to highlight the places where the short-stay program performed unsatisfactorily., Conclusions: The self-administered questionnaire seems to be appropriate for assessing patient satisfaction. The highest scores helped to emphasize where the program was functioning correctly, and the lowest scores allowed us to identify the points that needed to be improved., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

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The Orthopaedic and Arthritic Hospital is a specialty institution dedicated to the provision of elective reconstructive orthopaedic surgery and rehabilitation to individuals with musculoskeletal disorders. This facility is the largest volume joint replacement centre in Canada, performing over 1,000 hip and knee replacement/revision procedures annually. In 1995, the hospital established a Functional Independence Training (FIT) program--a seven-day reactivation program for patients following primary joint replacement. The program aims to promote early independence, improve functional level and return patients to normal activity as quickly and cost-effectively as possible. The program has received positive patient feedback and has demonstrated the potential to save the health care system approximately $479,655 annually through the reduction of 1,453 acute and rehabilitation hospital inpatient days, based on the hospital's annual primary joint replacement caseload.