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Various tools for clinical assessment of lumbar mobility in the sagittal plane coexist. Their validity has been called into question in particular because of their fixed distances between their skin markers whatever the height of the subject.To measure the distance between the lower margin of the Postero Superior Iliac Spines (PSIS) and the middle of the L1 spinous process and to analyze the characteristics that influence it. To check whether these new skin marks could be more reliable for developing a new clinical assessment tool for lumbar mobility.The distance between the lower margin of the PSIS and the L1, located by ultrasound, was taken in the standing position and analyzed on 200 participants.The mean PSIS-L1 distance was 13.3 ± 1.8 cm, influenced mainly by standing height. A ratio or the regression line equation, based on the relationship between standing height and PSIS-L1, were highlighted.The actual mode of placement of skin markers for the clinical assessment tools to evaluate lumbar mobility is not valid. The PSIS-L1/standing height ratio or the regression equation are the most effective ways for predicting the location of the upper skin marker (L1) for developing a new tool. [ABSTRACT FROM AUTHOR]

Introduction: In 2013, a study showed low guideline adherence regarding chronic low back pain (CLBP) in physiotherapy students concerning activity and work recommendations (47% and 16%)1. The aim of this study is to investigate if the 2020' physiotherapy students'attitudes and beliefs regarding CLBP and osteoarthritis (OA) and the guideline adherence have changed since 2013, by using the same protocol. Methods: Physiotherapy students in their 2nd and 4th year of education from 6 Belgian and 2 Dutch institutions participated. The attitudes and beliefs regarding CLBP and OA were measured using the Pain attitudes and beliefs scale (BAPS), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and a questionnaire regarding therapeutic exercise and knee OA. A clinical case vignette was used to measure the guideline adherence regarding CLBP. Results: In total, 2738 students participated, 1624 in 2013 and 1114 in 2020. Compared to 2013, students in 2020 scored lower on a biomedical orientation (p < 0.001) and higher on psychosocial orientations (p < 0.001) regarding CLBP and OA. Medium effect size (cohens'd = 0.548) was found on the psychosocial orientation of the PABS, other differences only had small effect sizes. In 2020, 54% provided clinical guidelines' consistent recommendations for activity and 28% for work, which significantly improved compared to 2013. Discussion: A positive shift occurred towards a more biopsychosocial approach between students of 2013 and 2020. However, the improved guideline adherence concerning activity and work recommendations remains low. Process evaluation: Additional clinical case vignette to measure clinical recommendations regarding OA would have strengthen this study. [ABSTRACT FROM AUTHOR]

Introduction: Numerous scientific studies have established the necessity of a biopsychosocial (BPS) approach in the treatment of chronic pain, however, the implementation into clinical practice falls short. The aim of this study is to investigate the effectiveness of a BPS pain educational program for primary healthcare providers (PHCP) on changes in knowledge and attitude, and the guideline adherence. Methods: Within an implementation project of the Belgian Federal Government, a BPS pain educational program was developed based on recent scientific research, and barriers and facilitators formulated by an expert panel. 300 PHCP from various disciplines followed the course which contains two e-learning sessions and two one-day face-to-face trainings. Changes in knowledge and attitudes regarding chronic pain were measured using the KNowledge and Attitudes of Pain (KNAP). Guideline adherence was measured with two clinical case vignettes. Participants were measured pre-course, post-course and at a 6-month follow-up. The satisfaction of participants regarding the training and implementation into practice was measured during the course and at the follow-up. Results: A shift towards the biopsychosocial perspective that is in line with clinical guidelines is expected after completing the chronic pain course. Discussion: The pain course developed in the present study might increase the biopsychosocial perspective and guideline adherence of PHCP. Process evaluation: The selection of adequate evaluation tools to assess multidisciplinary groups was challenging. Furthermore, it remains to be established whether the improvements observed in knowledge and attitude questionnaires and the guideline adherence based on clinical vignettes reflect actual change in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Many clinical guidelines promote a bio-psycho-social framework for the management of low-back pain (LBP) [1-3]. The objective of this study was to examine the current knowledge, attitudes and beliefs of physiotherapists (PTs) about guideline-adherent approach in the management of LBP. Methods: PTs were recruited in 3 regions (French and Dutch speaking part of Belgium and France) using an online platform. Participants filled in the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ) and two clinical vignettes (non-specific and specific LBP). Results: In total 527 PTs participated. 62% of the physiotherapists are uncertain or don't know the guidelines on the management of LBP and only 37% apply them in clinical practice. 63% of the physiotherapists give guidelines inconsistent recommendations about work and 23% for activity. Score of the HC-PAIRS, Back-PAQ, NPQ and clinical vignette on non-specific LBP are significantly correlated with the knowledge of the guidelines (p < 0.001). Discussion: Most PTs report being uncertain or unaware of clinical guidelines for the management of LBP, which is concerning. The beliefs and attitudes of these PTs are less guidelines oriented. Hence it is crucial to develop efficient strategies to enhance best practice and guidelines knowledge among PTs. Process evaluation: These results concern baseline assessment of a large RCT in 2 populations, i.e. PTs and General Practitioners. The preparation of this study was more time consuming than expected (e.g. using different arms in Qualtrics to include 2 different populations, from 3 regions, randomized over 2 interventions). [ABSTRACT FROM AUTHOR]

Background: In the context of neck pain, neck muscle activity adapts through diverse regional coordination modifications during tasks. Although patterns of cervical flexor muscle impairment are well-documented, patterns in the cervical extensor muscles are less clear, hindering assessment and treatment. Despite studies revealing adaptations in the cervical extensor muscles, outcome measure heterogeneity complicates interpretation, particularly between superficial and deep muscles. To address this, we conducted a systematic review comparing neck extensor muscle activity between symptomatic and asymptomatic groups during tasks, aiming to inform clinical practice., Objectives: To compare the cervical extensor muscle activity during neck tasks between symptomatic and asymptomatic groups, using complementary examination tools., Methods: Up to January 2024, experimental studies assessing cervical extensor muscle activity during neck tasks in adults with idiopathic or traumatic neck pain, or cervicogenic headache compared to healthy controls were included. Study selection involved 2 blinded reviewers. Electronic databases (Medline, Scopus, and Embase), reference lists, and relevant reviews were screened. Data extraction focused on the results of the between-group motor activity comparisons. Critical appraisal used the JBI appraisal checklist for analytical cross-sectional studies., Results: Twenty-three studies met the inclusion criteria, involving 932 participants and reporting 170 comparative assessments of 8 muscle groups, encompassing 4 main motor activity outcomes: recruitment, timing, fatigue, and directional activation. Significant differences were noted for motor recruitment in 51 % of comparisons, for timing in 35 %, and fatigue in 33 %, with consistent differences in directional activation. Impaired activity in individuals with neck pain compared to those without was found in 47 % of comparisons for superficial muscles and 65 % for deep muscles., Conclusions: Motor activity adaptations during neck tasks appear to be unpredictable in individuals with neck pain, with a tendency for change in the deep cervical extensor muscles. Further high-quality studies are needed to confirm these findings, considering various contraction parameters, multiple muscle analyses, and several motor activity outcomes., Trial Registration: PROSPERO International Prospective Register of Systematic Review CRD42022285864., Competing Interests: Declaration of competing interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

People with fibromyalgia syndrome (FMS) may have difficulty attending rehabilitation sessions. We investigated the feasibility (adherence and satisfaction) of implementing an 8-week home-based somatosensory, entirely remote, self-training programme using the TrainPain smartphone app in people with FMS. The secondary aim was to evaluate the effect on pain symptoms. The training was performed 15 min/day, 7 days/week for 8 weeks. Participants identified the number of vibrations emitted by vibrotactile pods positioned on the most painful site and the contralateral side of the body. They completed the Brief Pain Inventory before, during (4 weeks), and at the end of the 8-week programme. At 8 weeks, they also rated satisfaction and the overall perceived change. The app recorded session completion. Of the 34 individuals recruited, 29 (mean, age 46 [SD] 9 years; 27 women; median duration of symptoms 7 [5;10] years) completed all assessments. Participants completed 75% of sessions and rated the programme easy-to-use and enjoyable, 94% would recommend the programme, and 38% reported a very strong improvement at 8 weeks. Pain intensity reduced from pre to post (effect size 0.77), as did interference (effect size 0.7 to 1.17). This treatment could be a useful addition to a multidisciplinary, multicomponent approach to FMS.

Introduction: Empathy refers to the ability to understand the emotions of others and to show this understanding. It plays a crucial role in the healthcare professions and should be developed during training. The aim of this study was to compare the empathy levels of students from different sections of health sciences enrolled in their final year at the University of Liège., Materials and Methods: Students in their final year of Medicine, Psychology and Physiotherapy at ULiège were asked to complete the Jefferson Scale of Empathy (HPS version), two numerical scales (0-10) relating to empathy (importance and self-assessment, respectively) and some demographic questions., Results: In total, 292 subjects (103 students in Physiotherapy, 99 in Medicine and 90 in Psychology) took part in the study. Empathy scores were significantly higher for Psychology students (118.7 ± 9.60) than for Medicine (109.9 ± 13.4) and Physiotherapy (109.5 ± 12.6) students. The importance of empathy in the practice of the profession was estimated at 8.96 ± 1.18 and the average level of self-perceived empathy was 7.85 ± 1.12., Conclusion: This study suggests that Psychology students are more empathetic than Medicine and Physiotherapy students. Students generally consider themselves to be empathetic and believe that this concept is important in professional practice.

This Anaphylaxis Manifesto calls on communities to prioritise 10 practical actions to improve the lives of people at risk of serious allergic reactions. The Global Allergy and Asthma European Network and the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) compiled patient-centric priorities. We used qualitative consensus methods, research evidence and feedback from over 200 patient groups, stakeholder organisations and healthcare professionals. We encourage healthcare, education and food organisations to collaborate with people at risk of serious allergic reactions to tackle safety, anxiety and financial burdens for individuals and societies. Key priorities for prevention include awareness-raising campaigns for the public and professionals, school and workplace initiatives and mandatory precautionary allergen labels on food. Priorities for improving immediate and long-term management include educating healthcare professionals, patients and schools about when and how to use adrenaline, funding two approved adrenaline devices for everyone at risk, and facilitating access to allergy specialists. Integrated care pathways should include clinical and non-clinical management options such as individualised risk assessment and quality of life assessment, self-management plans, dietetic and psychosocial support and peer support. Organisations around the world are committing to work together towards these priorities., (© 2024 The Author(s). Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Abstract: Advancements in clinical science have shown the necessity for a paradigm shift away from a biomedical toward a biopsychosocial approach. Yet, the translation from clinical science into clinical practice is challenging. The aim of this study was to assess the short-term and mid-term changes in pain knowledge and attitudes and guideline-adherent recommendations of healthcare professionals (HCP) by means of an interdisciplinary training program (ITP) about chronic pain. Belgian HCPs, with a priority for medical doctors, physiotherapists, occupational therapists, nurses, psychologists, and pharmacists in primary care, participated in the ITP, which contained 2 e-learning modules and two 7-hour workshops provided in small interdisciplinary groups in 5 cities. The objective of ITP was to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioral approach into clinical practice. Primary outcomes were changes in knowledge and attitudes about pain and guideline-adherent recommendations for continuation of physical activity, sports, and work; avoiding bed rest; and not supporting opioid usage measured through 2 clinical vignettes. They were measured before, immediately after, and 6 months after the ITP. Changes were analyzed using (generalized) linear mixed models. A total of 405 HCPs participated. The knowledge and attitudes about pain scores improved at post-training (Δ = 9.04, 95% confidence interval 7.72-10.36) and at 6-month follow-up (Δ = 7.16, 95% confidence interval 5.73-8.59). After the training program, HCPs provided significantly more recommendations in accordance with clinical guidelines. Thus, an ITP can improve the biopsychosocial perspective of chronic pain management among HCPs in the short-term and mid-term., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.)

Background: Lumbosacral radicular pain diagnosis remains challenging. Diffusion tensor imaging (DTI) and diffusion weighted imaging (DWI) have potential to quantitatively evaluate symptomatic nerve root, which may facilitate diagnosis., Purpose: To determine the ability of DTI and DWI metrics, namely fractional anisotropy (FA) and apparent diffusion coefficient (ADC), to discriminate between healthy and symptomatic lumbosacral nerve roots, to evaluate the association between FA and ADC values and patient symptoms, and to determine FA and ADC reliability., Study Type: Systematic review., Subjects: Eight hundred twelve patients with radicular pain with or without radiculopathy caused by musculoskeletal-related compression or inflammation of a single, unilateral lumbosacral nerve root and 244 healthy controls from 29 studies., Field Strength/sequence: Diffusion weighted echo planar imaging sequence at 1.5 T or 3 T., Assessment: An extensive systematic review of the literature was conducted in Embase, Scopus, and Medline databases. FA and ADC values in symptomatic and contralateral lumbosacral nerve roots were extracted and summarized, together with intra- and inter-rater agreements. Where available, associations between DWI or DTI parameters and patient symptoms or symptom duration were extracted., Statistical Tests: The main results of the included studies are summarized. No additional statistical analyses were performed., Results: The DTI studies systematically found significant differences in FA values between the symptomatic and contralateral lumbosacral nerve root of patients suffering from radicular pain with or without radiculopathy. In contrast, identification of the symptomatic nerve root with ADC values was inconsistent for both DTI and DWI studies. FA values were moderately to strongly correlated with several symptoms (eg, disability, nerve dysfunction, and symptom duration). The inter- and intra-rater reliability of DTI parameters were moderate to excellent. The methodological quality of included studies was very heterogeneous., Data Conclusion: This systematic review showed that DTI was a reliable and discriminative imaging technique for the assessment of symptomatic lumbosacral nerve root, which more consistently identified the symptomatic nerve root than DWI. Further studies of high quality are needed to confirm these results., Evidence Level: N/A TECHNICAL EFFICACY: Stage 2., (© 2024 International Society for Magnetic Resonance in Medicine.)

Objective: This longitudinal pilot study aimed to evaluate the feasibility, safety and potential benefits of Platelet-Rich Plasma injections into the lumbar intervertebral discs in patients with low back pain and degenerative intervertebral monodiscopathy, assessing potential efficacy on disability., Design: Longitudinal pilot study., Methods: Six participants with chronic low back pain and lumbar degenerative intervertebral disc (monodiscopathy) disease underwent 1 Platelet-Rich Plasma injection, with a 1-year follow-up. Platelet-Rich Plasma injections were administered into the lumbar intervertebral disc, and outcomes were measured using the Roland Morris Disability Questionnaire, numeric rating scale for pain, Tampa scale for kinesiophobia and lumbar flexion range. Magnetic resonance imaging analysis assessed disc changes., Results: No adverse events were reported. At the end of the 1-year follow-up, half of the patients showed significant improvements in disability scores at 1 year, while 3 of the 6 patients had no change. Magnetic resonance imaging revealed no significant disc changes., Conclusion: Platelet-Rich Plasma injections show promise for some patients with low back pain and degenerative intervertebral discopathy patients. However, caution is warranted due to study limitations, including small sample size and lack of a control group. Further research is needed to define Platelet-Rich Plasma therapy protocols., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s).)

We assessed the test-retest reliability and discriminative ability of a somatosensory temporal discrimination (SSTD) assessment tool for fibromyalgia syndrome (FMS) and determined if pain-related variables were associated with SSTD performance. Twenty-five women with FMS and twenty-five asymptomatic women were assessed during two sessions 7 to 10 days apart. The proportion of correct responses (range 0-100) was calculated. Sociodemographic information was collected for both groups. The participants with FMS also completed the widespread pain index and the Brief Pain Inventory. Test-retest reliability was verified by calculating intraclass correlation coefficients. Discriminative ability was verified by a between-group comparison of scores using a t -test. Associations between SSTD score and pain variables were tested using Pearson or Spearman correlation coefficients. The test-retest reliability of the SSTD score was excellent (ICC > 0.9, CI: 0.79-0.96) for the asymptomatic group and good for the FMS group (ICC: 0.81, 95% CI: 0.62-0.91). The median (Q1-Q3) test session SSTD score differed significantly between the FMS 84.1 (71-88) and the asymptomatic 91.6 (83.4-96.1) groups ( p < 0.001). Only pain duration was associated with the SSTD score. In conclusion, the new SSTD test seems reliable for people with FMS and is discriminative. Further studies should examine its sensitivity to change and correlations with other SSTD tests.

Background: Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain., Methods: This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders., Results: The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals' possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; 'capability', 'opportunity', and 'motivation'. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice., Conclusion: We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs., (© 2024. The Author(s).)

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes., Competing Interests: Declaration of interests BM received consultation fees from Haleon, GSK, and Grünenthal, and honoraria from Haleon, GSK, Grünenthal, Krka, Mundipharma, and Viatris, is the past president of the European Pain Federation and program director of the Belgian Interuniversity Course in Pain Management. AC received payment for work as group tutor for the course in Clinimetrics (EpidM, Amsterdam, Netherlands). JN and the Vrije Universiteit Brussel received lecturing or teaching fees from various professional associations and educational organisations. EKo received royalties for textbook chapters from Liber and Studentlitteratur, payment for a lecture from Eli Lilly, and is a member of the scientific board of the Swedish Rheumatism Association. PH received travel support from the German Osteopathic Society, the Icelandic Physiotherapy Association, and the Finish Musculoskeletal Medicine Society. All other authors declared no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work., Objectives: To assess the differences in physical therapy students' attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020., Methods: In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity, and work., Results: In 2013, 927 second-year and 695 fourth-year students; in 2020, 695 second-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations., Conclusions: Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low., (Copyright © 2024 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To review the use (dosage parameters and combination with other therapeutic interventions) of cervical extensor muscle exercises and their effect on pain, disability (primary outcomes), range of motion, endurance and strength (secondary outcomes) in people with neck pain., Data Sources: An extensive literature search was conducted through MEDLINE (Ovid), Scopus (Elsevier) and Physiotherapy Evidence Database (PEDro) up to May 2023. The reference lists of all included studies and relevant reviews were screened for additional studies., Review Methods: Randomised controlled trials reporting the use of cervical extensor muscle exercises (alone or combined) applied to adults with idiopathic or traumatic neck pain were included. Study selection, data extraction and critical appraisal (PEDro assessment scale) were performed by two blinded reviewers. Data extraction included dosage parameters, other modalities combined with these exercises and outcomes., Results: Thirty-five randomised controlled trails (eight of which were complementary analyses) with 2409 participants fulfilled the inclusion criteria. Twenty-six were of moderate to high quality. In most studies, cervical extensor muscle exercises were combined with various other therapeutic modalities and applied at different dosages. Only two studies (one high and one low quality) specifically assessed their effectiveness. The high-quality study showed significant improvements in neck pain and disability, pressure point threshold and neck mobility after both low load and high load training for 6 weeks., Conclusion: The results suggest cervical extensor muscle exercises may reduce neck pain and disability; however firm conclusions cannot be drawn because of the few studies that addressed this question and the heterogeneity of the dosage parameters., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objective: The primary aim of this pilot study was to test the feasibility and acceptability of a prototype of a novel digital system enabling somatosensory training at home by means of a gamified mobile application in patients with chronic pain. The secondary aims were to test the effect size of the intervention on clinical outcomes to power a subsequent randomized controlled trial. Materials and Methods: We conducted a pilot randomized controlled trial in patients with fibromyalgia. This was an 8-week crossover study, which included a 4-week somatosensory training phase (daily use with the novel digital system) and a 4-week control phase (no use of this new system) in a random order. Feasibility was tested by objectively measuring the adherence and retention rates. Acceptability and changes in pain and disability were measured through data from subjective questionnaires. Results: Thirty-five patients completed the study. The satisfaction questionnaire indicated high training enjoyment, ease of use for daily training and interest to continue to use the intervention after the study. The adherence (93%) and retention (94%) rates were high. The effect sizes were moderate for pain intensity (0.57). Conclusion: The novel gamified technology for remotely delivered somatosensory training is feasible in a group of patients with fibromyalgia, and results in high engagement, satisfaction, and adherence. A subsequent clinical trial with the final version of the technology platform, including a longer training with more sensory training tasks and a bigger sample size is necessary.

Background: To evaluate the burden of overuse injuries, the Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems (OSTRC-H2) was developed in English in 2013., Purpose: To translate and culturally adapt the OSTRC-H2 into French and investigate the reliability and validity of this new version., Study Design: Cohort study (diagnosis); Level of evidence, 3., Methods: The OSTRC-H2 was translated from English to French according to international guidelines. A total of 80 elite athletes were then invited to complete the OSTRC-H2 weekly for 3 months. Potential ceiling effects, construct validity, and reliability were investigated. Convergent validity was measured using Pearson correlations for continuous items and kappa coefficients for binary items; internal consistency was measured using the Cronbach alpha coefficient; and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Separate analyses were performed on the entire cohort of athletes (population 1 [P1]) and on athletes who reported a health problem during the follow-up (P2)., Results: A total of 80 elite athletes took part in this study. The response rate was very high, with 909 of 960 questionnaires returned (95%). The mean weekly prevalence of health problems was 19.6% during the follow-up period. Nineteen participants reported a health problem during the follow-up (P2). The OSTRC-H2 showed very good test-retest reliability for both populations (ICC, 0.85 [95% CI, 0.77-0.90] for P1; ICC, 0.90 [95% CI, 0.68-0.98] for P2). Internal consistency was very good for P2 (Cronbach α = .94). The OSTRC-H2 demonstrated high concordance with the visual analog scale of symptom intensity ( r = 0.52; P < .05), and low concordance with the overtraining questions from the Questionnaire de la Société Française de Médecine du Sport (κ from -0.01 to 0.12; P > .05)., Conclusion: The French version of the OSTRC-H2 was found to be valid and reliable when applied to French-speaking elite athletes., Competing Interests: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. The present study was approved by the Ethics Committee of the University of Liège (ref 2020/390)., (© The Author(s) 2023.)

Background: While pain is influenced by multiple factors including psychosocial factors, previous research has shown that physiotherapists still favour a biomedical approach., Purpose: To evaluate: (1) how physiotherapists explain the patient's chronic non-specific low back pain (LBP); (2) whether physiotherapists use one or multiple influencing factors, and (3) whether these factors are framed in a biopsychosocial or biomedical approach., Materials and Methods: This exploratory qualitative study uses a vignette depicting chronic non-specific LBP and employs a flexible framework analysis. Physiotherapists were asked to mention contributing factors to the pain based on this vignette. Five themes were predefined ("Beliefs", "Previous experiences", "Emotions", "Patients behaviour", "Contextual factors") and explored., Results: Physiotherapists use very brief explanations when reporting contributing factors to chronic pain (median 13 words). Out of 670 physiotherapists, only 40% mentioned more than two different themes and 2/3rds did not see any link between the patients' misbeliefs and pain. Only a quarter of the participants mentioned the patient's worries about pain and movement, which is considered to be an important influencing factor., Conclusion: The lack of a multifactorial approach and the persistent biomedical beliefs suggest that it remains a challenge for physiotherapists to fully integrate the biopsychosocial framework into their management of chronic LBP.

The majority of non-specific low back pain has a favourable evolution within a short period of time but in some cases the pain becomes persistent or recurrent. These chronic forms are responsible for most of the social and economic burden of low back pain. The crucial role of psycho-social factors in the chronicisation of low back pain justifies a thorough bio-psycho-social assessment. An active semi-intensive ambulatory multidisciplinary programme (Spine Unit Center) that complies with international and national recommendations (KCE and INAMI) has demonstrated its effectiveness in chronic low back pain in terms of algo-functional, physical and psycho-social components. In contrast to intensive programmes requiring hospitalisation, this outpatient treatment allows the patient to remain in his/her social and professional network. The active participation and motivation of the patient are essential for the success of the treatment. The multidisciplinary team will help the patient to define his/her functional objectives and to manage, via the psychologist, emotional aspects. The programme includes therapeutic education and physical reconditioning sessions including progressive aerobic training, group exercises, and individualised and progressive strengthening of the trunk muscles. The introduction of physical activity at home will be encouraged in order to sustain the changes in the patient's behaviour.

Background: Clinical practice guidelines promote bio-psychosocial management of patients suffering from low back pain (LBP). The objective of this study was to examine the current knowledge, attitudes and beliefs of physiotherapists about a guideline-adherent approach to LBP and to assess the ability of physiotherapists to recognise signs of a specific LBP in a clinical vignette., Methods: Physiotherapists were recruited to participate in an online study. They were asked to indicate whether they were familiar with evidence-based guidelines and then to fill in the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), as well as questions related to two clinical vignettes., Results: In total, 527 physiotherapists participated in this study. Only 38% reported being familiar with guidelines for the management of LBP. Sixty-three percent of the physiotherapists gave guideline-inconsistent recommendations regarding work. Only half of the physiotherapists recognised the signs of a specific LBP., Conclusions: The high proportion of physiotherapists unfamiliar with guidelines and demonstrating attitudes and beliefs not in line with evidence-based management of LBP is concerning. It is crucial to develop efficient strategies to enhance knowledge of guidelines among physiotherapists and increase their implementation in clinical practice.

Background: Resisted training of the trunk muscles improves outcomes in chronic low back pain (CLBP). The Itensic b-effect machine was designed to provide resisted training through posterior translation of the pelvis in a seated, forward-tilted position, in contrast with traditional machines that involve extension of the trunk., Objective: To study the effectiveness of lumbopelvic training on the Itensic b-effect machine in individuals with CLBP., Methods: Participants were allocated to 4 weeks of either progressive Itensic (I) training in addition to an education/exercise (EE) program (I+EE group, n= 23) or the education/exercise program alone (EE group, n= 22)., Primary Outcome: Roland Morris Disability Questionnaire (RMDQ)., Secondary Outcomes: pain (0-10 numeric rating scale), trunk extensor endurance (Sorensen test), motor control (thoraco-lumbar dissociation test) and mobility (finger-to-floor test)., Results: RMDQ score improved more in the I+EE group than in the EE group (with a between-group difference at the pos-test). Pain and mobility improved in the I+EE group only, motor control improved in both groups with no between-group difference and the Sorensen test did not improve significantly in either group., Conclusions: Resisted posterior pelvic translation using the Itensic machine in addition to an education/exercise program improved disability, pain and mobility more than the education/exercise program alone.

Food allergy affects approximately 2-4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA 2 LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy., (© 2022 Published by Elsevier Inc. on behalf of World Allergy Organization.)

Purpose: To translate and validate the Identification of Functional Ankle Instability (IdFAI) into French., Methods: The IdFAI was translated according to international recommendations. Discriminative power, floor and ceiling effects, construct validity (including confirmatory factorial analysis (CFA)), internal consistency and test-retest reliability were measured. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were also calculated., Results: 160 participants were included. The IdFAI-F showed a very good test-retest reliability (ICC = 0.95). The SEM was 1.37 and the MDC was 3.79. The internal consistency was moderate (Cronbach's alpha coefficient = 0.68). The correlation between the IdFAI and the Cumberland Ankle Instability Tool (CAIT) was high (r = -0.75, p < 0.001). No floor, nor ceiling effects were observed. The CFA analyses did not confirm the factor structure proposed by the authors of the original English version., Conclusions: The IdFAI-F is a valid and reliable tool to accurately identify and measure chronic ankle instability in research and clinical settings for French-speaking individuals., (Copyright © 2022 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)