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Objective: To examine patients' use of primary healthcare (PHC) before and after specialized rehabilitation and its relation with self-reported health and functioning., Design: Longitudinal cohort study., Participants: 451 rehabilitation patients., Methods: Register data were used to measure the frequency of visits to the general practitioner (GP) and physiotherapist (PT) in PHC 3 years before and after rehabilitation. Patients reported health (EQ-VAS) and functioning (SF-36) before rehabilitation and at 1 and 3 years after. Data are described for the total study cohort and subgroups with musculoskeletal disease (MSD) and cardiovascular disease (CVD)., Results: There was an increase in GP and PT visits preceding rehabilitation and a gradual decrease thereafter. An exception was GP visits among patients with CVD, with few diagnosis-specific visits before but an increase after. Lower levels of health and functioning tended to be related to more frequent GP and PT visits. An indication of clinically important improvement was found among those with frequent GP visits in the MSD subgroup, and among those with 1-2 GP visits in the CVD subgroup., Conclusions: The diverse relationship between health and functioning, and the use of PHC services at follow-up, may imply that additional factors besides healthcare use explain long-term improvement following rehabilitation.

Objective: To investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation., Design: Prospective cohort., Participants: Patients, across diseases, living in western Norway, accepted for somatic specialized interprofessional rehabilitation (n = 984)., Methods: Physical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling., Results: In the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b = -0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years., Conclusion: Physical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation.

Objective: To assess the effects of adding a workplace intervention to inpatient occupational rehabilitation on return-to-work self-efficacy, and whether changes in return-to-work self-efficacy were associated with future work outcomes., Design: Randomized clinical trial., Subjects: Individuals aged 1860 years, sick-listed 212 months were randomized to multimodal inpatient rehabilitation with (n?=?88) or without (n?=?87) a workplace intervention., Methods: Between-group differences for 4 months follow-up were assessed using linear mixed models. Associations between self-efficacy scores and future sickness absence days during 12 months of follow-up were assessed by linear regression., Results: There were no statistically significant between-group differences in self-efficacy during follow-up. Participants with high or medium self-efficacy scores at the end of rehabilitation had fewer sickness absence days during follow-up compared with participants with low scores. Participants with consistently high scores or an increasing score throughout the programme showed fewer sickness absence days than those with reduced or consistently low scores., Conclusion: Receiving an added workplace intervention did not increase return-to-work self-efficacy more than standard inpatient occupational rehabilitation alone. High scores and a positive development in return-to-work self-efficacy were associated with higher work participation. This suggests that return-to-work self-efficacy could be an important factor to consider in the return-to-work process.

Objective: Physical exercise recommendations become particularly effective when embedded into medical rehabilitation. However, little is known about long-term behaviour maintenance and its effect on sickness absence and subjective employability. The current longitudinal observational study investigated self-reported physical exercise, sickness absence and subjective employability over a period of 8 years., Subjects: A total of 601 (T0) outpatients (mean age 45.14 years; standard deviation 10.73 years, age range 18-65 years) with different orthopaedic disorders were recruited during their 3-week medical rehabilitation in Germany. Of these, 61.7% (n = 371) were female. Follow-ups were carried out at 6 months (T1, n = 495), 12 months (T2, n = 340), 3 years (T3, n = 296) and 8 years (T4, n = 142) after baseline., Methods: Patient characteristics, exercise status, social-cognitive variables, sickness absence and subjective employability were obtained via self-report questionnaires. SPSS hierarchical regression models were used for data analysis, controlling for baseline measures and sociodemographic variables., Results: Physical exercise status 6 months after rehabilitation treatment (T1) predicted sickness absence at 12 months (T2). Inactive people were 3.28 times more likely to be on sick leave at T2. In addition, physical exercise at T1 predicted subjective employability 12 months (T2) and 3 years (T3) later. Those who met the recommendations to be physically active for at least 40 min a week were more likely to feel able to work., Conclusion: Exercise appears to play an important role in reducing sickness absence and subjective employability and should be promoted within and after rehabilitation treatment.

Objective: To determine: (i) the prevalence of opioid-naïve patients discharged on opioids from a musculoskeletal rehabilitation inpatient unit; (ii) the prevalence of opioid use 6 months after discharge; and (iii) the efficacy of the Opioid Risk Tool in identifying long-term opioid use., Design: Prospective study., Participants: Sixty-four opioid-naïve patients who were exposed to opioids during admission and who were discharged on an opioid., Methods: Potentially eligible patients' charts were reviewed. Participants were interviewed during admission to obtain the opioid risk score and contacted 6 months after discharge via a semi-structured telephone interview., Results: Twenty-eight percent of opioid-naïve patients, who were discharged on opioids were still using opioids 6 months after discharge from rehabilitation. There was a trend for higher Opioid Risk Tool scores in those still using opioids than in individuals who were not using opioids at 6 months (p = 0.053)., Conclusion: Patients who are prescribed opioids during a hospital admission should be screened for risk of opioid misuse. This data suggests that the Opioid Risk Tool could identify a patient's potential for becoming a long-term user of opioids.

Study Design: Phenomenological, qualitative investigation. The discord between commonly used outcome measures and patients' self-perceived recovery is problematic in the investigation and rehabilitation of low-back pain-related disorders. To better understand the course and development of this costly and disabling condition, the complex process of patient recovery requires further elucidation., Objective: To explore issues and experiences impacting retrospective, self-appraised recovery., Methods: Semi-structured interviews were conducted with 32 purposively sampled individuals, after which computer-assisted substantive categorization and thematic analysis was performed., Results: Self-appraised status could be determined as "recovered" for 17 respondents, "unsure" for 6, and "not recovered" for 9. Recovery/non-recovery hinged on continued pain-related issues and the perception that injury/trauma made recovery impossible. Individuals who had difficulties relating the recovery construct to their context as well as those who were sceptical of pain-free periods were unable to appraise their status., Conclusion: This investigation confirms that pain is central to the resolution of recurrent low-back pain associated disorders. However, recovery also involves "redefinition" and "readjustment". In the investigation and rehabilitation of ambiguous, regional musculoskeletal disorders, our results provide further sensitizing concepts, derived through naturalistic observation, that are useful in the development of a more comprehensive explanatory framework of patient recovery.

Objective: Systematic reviews indicate the effectiveness of multimodal rehabilitation. In Germany this has been shown, in particular, for work-related medical rehabilitation. A recently published guideline on work-related medical rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related medical rehabilitation., Methods: Focus groups were conducted with 7 inpatient orthopaedic rehabilitation teams and examined using qualitative content analysis., Results: Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related medical rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors., Conclusion: The significance of multiprofessional teamwork for successful multimodal rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related medical rehabilitation guideline is indicated.

Objective: To report the theoretical foundation of generic patient-reported outcomes for measuring functioning related to upper extremity musculoskeletal disorders and perform content coverage analysis and content comparison using the International Classification of Functioning, Disability and Health (ICF)., Methods: A literature search was performed to identify commonly used patient-reported outcomes. A comparison of their theoretical foundations and a linking exercise between the measures' meaningful concepts and the ICF and Brief ICF Core Set for Hand Conditions was accomplished based on established rules., Results: Fifteen measures were selected. Multiple theoretical foundations were identified, and only 7 measures were developed based on a known conceptual model. Six measures were chosen for the linking process with 232 meaningful concepts retrieved and linked to 54 ICF categories. No concept was linked to the Body Structures component and two measures stood out for their Activity and Participation coverage. No measure covered all Brief ICF Core Set for Hand Conditions recommended categories., Conclusion: Some heterogeneity was observed with regards to the theoretical foundations on which the identified measures are based. The results of the linking process should help reduce these inconsistencies. They enable easy identification of content coverage and content comparison between measures using a common framework and can be used as a reference when selecting the most appropriate patient-reported outcome measure.

Objective: To investigate whether an interdisciplinary rehabilitation for chronic musculoskeletal disorders is associated with changes in the purchase of prescribed pain medication., Design: Prospective register-based study., Subjects: Employees in the public sector (n = 4,365) who participated in the rehabilitation programme between 1996 and 2009., Methods: The changes in annual purchases of prescribed pain medication were measured for a 9-year exposure window, starting from 4 years before the start date of rehabilitation and ending 5 years after this date., Results: Purchases of prescribed pain medication increased throughout the follow-up in all medication groups. The steepest increase was observed for analgesics, antidepressants, and hypnotics and sedatives. The growth rate of annual purchase, however, slowed significantly following the year of the start of rehabilitation for analgesics (annual growth rate (rate ratio) before and after rehabilitation 1.27 and 1.04, respectively, difference in trend p < 0.001); antidepressants (rate ratio 1.17 and 1.09, p = 0.005); and muscle relaxants (rate ratio 1.31 and 1.01, p < 0.001). For anxiolytics, and hypnotics and sedatives, no differences were observed in the trends of annual purchase before and after rehabilitation., Conclusion: Rehabilitation was associated with a slowing increase in purchases of prescribed pain medication amongst rehabilitants. This may be a reflection of the positive effect that rehabilitation has on the need for pain medication.

Objective: To identify which factors best explain non-adherence to home rehabilitation exercises (HRE) for patients with musculoskeletal injuries., Design: Cross-sectional study., Methods: Participants (n = 87) aged 17-91 years completed questionnaires measuring demographic and injury-related information, self-efficacy, personality, health locus of control, patient-practitioner relationship, optimism, health value and adherence to HRE. In addition, each participant's attending physiotherapist assessed the participant's adherence and effort during the appointment., Results: A hierarchical regression with 3 steps (step 1: disposition; step 2: cognitive factors; step 3: patient-practitioner relationship) and adherence to HRE as the dependent variable was conducted. The factors in step 3 were the most significant and explained 16% (p < 0.001) of the variance in adherence to HRE. In addition, a high score for patient neuroticism was found to correlate with poor adherence to HRE., Conclusion: These preliminary results suggest that the patient-practitioner relationship is the best predictor of adherence to HRE, and that improving patient perception of the clinician's productivity, communication of information and trust during consultations may improve adherence to HRE.

Objective: To evaluate the measurement properties of the Wheelchair Use Confidence Scale for manual wheelchair users version 2.1 (WheelCon-M 2.1)., Design: Cohort study., Participants: Volunteer sample of 83 community-dwelling, experienced manual wheelchair users., Methods: Participants completed the WheelCon-M 2.1 twice to assess retest reliability. Validity was assessed by evaluating hypothesized relationships between the WheelCon-M 2.1 and relevant variables. Responsiveness was assessed using the standard error of measurement (SEM) and smallest real difference (SRD)., Results: The median (interquartile range) WheelCon-M 2.1 score was 84.6 (71.3-92.0) of a possible 0-100. The one-week retest intraclass correlation coefficient was 0.84 with 95% bias-corrected and accelerated confidence intervals of 0.77-0.90. Cronbach's alpha was 0.92. Correlations ranging from rs = -0.19 (p = 0.780) to rs = 0.58 (p < 0.001) were found between the WheelCon-M 2.1 and other relevant outcome measures with all correlations being statistically significant except for age (p = 0.780) and social support (p = 0.057). A statistically significant difference was not found between the sexes (p = 0.140). The SEM and SRM were 5.9 and 16.4, respectively., Conclusions: WheelCon-M 2.1 has high internal consistency, strong retest reliability, and support for concurrent validity, construct validity and responsiveness. This new test holds promise as a clinical and research tool.

Objectives: To systematically investigate current scientific evidence about the effectiveness of multidisciplinary team rehabilitation for different health problems., Data Sources: A comprehensive literature search was conducted in Cochrane, Medline, DARE, Embase, and Cinahl databases, and research from existing systematic reviews was critically appraised and summarized., Study Selection: Using the search terms "rehabilitation", "multidisciplinary teams" or "team care", references were identified for existing studies published after 2000 that examined multidisciplinary rehabilitation team care for adults, without restrictions in terms of study population or outcomes. The most recent reviews examining a study population were selected., Data Extraction: Two reviewers independently extracted information about study populations, sample sizes, study designs, rehabilitation settings, the team, interventions, and findings., Data Synthesis: A total of 14 reviews were included to summarize the findings of 12 different study populations. Evidence was found to support improved functioning following multidisciplinary rehabilitation team care for 10 of 12 different study population: elderly people, elderly people with hip fracture, homeless people with mental illness, adults with multiple sclerosis, stroke, acquired brain injury, chronic arthropathy, chronic pain, low back pain, and fibromyalgia. Whereas evidence was not found for adults with amyetrophic lateral schlerosis, and neck and shoulder pain., Conclusion: Although these studies included heterogeneous patient groups the overall conclusion was that multidisciplinary rehabilitation team care effectively improves rehabilitation intervention. However, further research in this area is needed.

Objective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjects with musculoskeletal or mental disorders. Factors associated with return-to-work were also analysed., Design: A prospective cohort study., Methods: A total of 699 newly sick-listed patients responded to a questionnaire on sociodemographics, measures of health, functioning, work ability, self-efficacy, social support, work conditions, and expectations. The 3-month follow-up questionnaire included patients' self-reported measures of return-to-work, work ability and type of interventions. The most frequent International Classification of Diseases-10 diagnoses for patients' musculoskeletal disorders were dorsopathies (M50-54) and soft tissue disorders (M70-79), and for patients with mental disorders, depression (F32-39) and stress reactions (F43)., Results: Patients with mental disorders who received combined interventions returned to work to a higher degree than those who received only clinical intervention. The prevalence of work-related interventions was higher for those who were younger and more highly educated. For patients with musculoskeletal disorders better health, work ability and positive expectations of return-to-work were associated with return-to-work. However, combined interventions did not affect return-to-work in this group., Conclusion: Receiving combined interventions increased the probability of return-to-work for patients with mental disorders, but not for patients with musculoskeletal disorders. Better health, positive expectations of return-to-work and better work ability were associated with return-to-work for patients with musculoskeletal disorders.

Musculoskeletal ultrasound has gained a significant place in the diagnosis and management of various musculoskeletal disorders due to its several advantages (being convenient, inexpensive, non-invasive, repeatable, providing dynamic imaging and not requiring any exposure to radiation). It has also become a valuable tool in the daily clinical practice of physical and rehabilitation medicine physicians; the musculoskeletal ultrasound probe having become synonymous with the physician's stethoscope. In this paper, aside from drawing attention to this growing issue in the agenda of PRM physicians, we will touch upon its basic technical features and certain aspects as regards muscle, tendon, ligament, nerve, joint lesions and ultrasound guided interventions.

Objective: The aim of this study was to clarify the association of fear of movement and physical activity among patients with chronic musculoskeletal pain., Methods: The sample comprised 93 patients participating in a multidisciplinary pain management programme. The purpose of the programme was to regain overall functioning by means of physical and functional exercises, education and personal pain management training. Tampa Scale of Kinesio-phobia and Leisure Time Physical Activity questionnaires were completed at baseline, and at 6-month and 12-month follow-ups., Results: At baseline, low and medium kinesiophobia groups showed more leisure-time physical activity than did the high kinesiophobia group (p = 0.024). At a 6-month follow-up the high kinesiophobia group had increased their physical activity index to the level of the low and medium kinesiophobia groups and maintained that change to 12-month follow-up. The effect sizes of the change in the physical activity index and pain intensity at the 12-month follow-up were both moderate (0.56) in the high kinesiophobia group., Conclusion: The change in physical activity and kinesiophobia was associated with the level of baseline kinesiophobia. Multidisciplinary rehabilitation seems to produce favourable effects in terms of physical activity and pain among the high kinesiophobia patients.

Objective: Interest in the use of musculoskeletal ultrasonography in the field of Physical Medicine and Rehabilitation has increased significantly over recent years. In order to determine to what extent this growing interest among Physical and Rehabilitation Medicine physicians is resulting in publications, we reviewed the trend in publications by physiatrists on musculoskeletal ultrasonography., Methods: We searched retrospectively for all papers indexed in Science Citation Index-Expanded and Index Medicus in which "rehabilitation medicine" was addressed as at least one of the authors' affiliations (up to 2011). All papers were examined individually for the authors' affiliations, document types, publication years, countries, and journal categories., Results: A total of 171 papers was included in the study. After 2004, there appears to be a significant amount of increase in the number of publications. USA, Turkey, Taiwan and South Korea were the leading countries in which physiatrists carry out research and publish papers on musculoskeletal ultrasonography. The top 5 journal categories in which these papers were published were: Rehabilitation (44.3%), Orthopaedics (14.1%), Radiology (10.7%), Neurology (8.1%) and Rheumatology (6.7%)., Conclusion: The number of scientific publications by physiatrists about musculoskeletal ultrasonography is increasing in parallel with the interest regarding its routine use in Physical Medicine and Rehabilitation clinics.

Objectives: To examine the relevance and completeness of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Sets for patients in post-acute rehabilitation facilities., Design: Multi-centre cohort study., Patients: A total of 165 patients (46% female; mean age 67.5 years) from post-acute rehabilitation facilities in 2 Austrian and 7 German hospitals., Methods: Data on functioning were collected using the respective comprehensive post-acute ICF Core Sets. Data was extracted from patients' medical record sheets and interviews with health professionals and patients., Results: Most of the categories of the comprehensive ICF Core Sets describing impairments, limitations or restrictions occurred in a considerable proportion of the study population. The most outstanding limitations and restrictions of the patients were problems with sleep and blood vessel functions, walking and moving and self-care. Twenty-six aspects of functioning not previously covered by the comprehensive ICF Core Sets were ranked as relevant., Conclusion: Most categories of the comprehensive ICF Core Set for patients in post-acute rehabilitation facilities were confirmed. No significant gaps in the established set could be identified.

Objective: To identify candidate categories for brief International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in the acute hospital., Design: Prospective multi-centre cohort study., Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in acute hospitals., Methods: Functioning and contextual factors were coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables., Results: A total of 391 patients were included in the study (91 neurological, 109 cardiopulmonary, 191 musculoskeletal), mean age 63.4 years, 50.1% female. Selection yielded 33 cate-gories for neurological, 31 for cardiopulmonary, and 30 for musculoskeletal., Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the ICF cate-gories most relevant for the practical assessment and monitoring of functioning in patients with acute neurological, cardiopulmonary, and musculoskeletal conditions.

Objective: To examine the relevance and completeness of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Sets for patients with rehabilitation needs in acute hospital care., Design: Multi-centre cohort study., Patients: A total of 391 patients (50.1% female, mean age 63.4 years) from 4 university hospitals in Austria, Germany and Switzerland and one Austrian general hospital., Methods: Data on functioning were collected using the respective comprehensive acute ICF Core Sets. Data were extracted from patients' medical record sheets and interviews with health professionals and patients., Results: Most of the categories of the comprehensive ICF Core Sets describing impairments, limitations or restrictions occurred in a considerable proportion of the study population. The most outstanding limitations and restrictions of the patients were problems with sleep and blood vessel functions, walking and moving and self-care. Thirty-eight aspects of functioning not previously covered by the comprehensive ICF Core Sets were ranked as relevant., Conclusion: Categories of the comprehensive ICF Core Sets for the acute hospital situation were confirmed. Some additional categories not covered by the Set in its present version emerged from the interviews, and should be considered for inclusion in a finalized version.

Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in early post-acute rehabilitation facilities., Design: Prospective multi-centre cohort study., Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in early post-acute rehabilitation facilities., Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables., Results: A total of 165 patients were included in the study (67 neurological, 37 cardiopulmonary, 61 musculoskeletal), mean age 67.5 years, 46.1% female. Selection yielded 38 cate-gories for neurological, 32 for cardiopulmonary, and 31 for musculoskeletal., Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the assessment and monitoring of functioning in patients undergoing early post-acute rehabilitation for neurological, cardiopulmonary, and musculoskeletal conditions.

Objective: To describe the empirical processes used to (i) validate the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Sets, and (ii) develop brief ICF Core Sets from the ICF Categories of these more comprehensive ICF Core Sets., Design: Prospective multi-centre cohort study., Patients: PATIENTS receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in acute hospitals or early post-acute rehabilitation facilities., Methods: Functioning was coded using the ICF. For validation, absolute and relative frequencies (prevalences) of impairment, limitation or restriction were reported at admission and end-point (discharge or 6 weeks after admission). Aspects not covered were extracted and translated into the best corresponding ICF category. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables., Conclusion: We present an algorithm to identify candidate categories for brief ICF Core Sets extracted from the comprehensive acute and post-acute ICF Core Sets.

Purpose: To analyse differences between males and females in expectations about rehabilitation outcome., Design: cross-sectional study., Setting: a general rehabilitation centre., Patients: n = 616, mean age 44 years, with chronic musculoskeletal pain, referred for multidisciplinary pain rehabilitation. All eligible patients in the period January 2005 to September 2009 were sent a questionnaire prior to or during the first two weeks of the treatment; the response was 630 out of 1105 (57%), of whom 14 patients did not give permission to use their data for research purposes., Main Outcome Measure: odds ratios., Results: Odds ratios for 21 items from a list of 25 expectations were not significant, odds ratios for 3 expectations were lower than 2 and odds ratio for 1 expectation was 4.0. Male patients were more likely than female patients to expect that the treatment would enable them to cope better with being a spouse and that the cause of their pain would be found. Female patients were more likely than male patients to expect that the treatment would enable them to better accept the fact that they could no longer do what they were able to do in the past, and that they would have fewer problems with household activities., Conclusion: There were no gender differences in pre-treatment expectations for 21 of 25 possible expectations, small differences for 3 expectations and a strong, clinically important difference for 1 expectation: female patients were more likely than male patients to expect that they would have fewer problems with household activities.

Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and clinical measurement of functioning in older patients in early post-acute rehabilitation facilities., Design: Prospective multi-centre cohort study., Patients: Older patients receiving rehabilitation interventions in early post-acute rehabilitation facilities., Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables., Results: A total of 209 patients were included in the study, mean age 80.4 years, 67.0% female. Selection yielded a total of 29 categories for the functioning part and 9 categories for the contextual part of the ICF., Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the clinical assessment and monitoring of functioning in older patients undergoing early post-acute rehabilitation.

Objective: To examine the relevance and completeness of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for patients in geriatric post-acute rehabilitation facilities., Design: Multi-centre cohort study., Patients: A total of 209 patients (67% female, mean age 80.4 years) in geriatric wards of 2 Austrian and 3 German hospitals., Methods: Data on functioning were collected using the respective comprehensive ICF Core Set. Data were extracted from patients' medical record sheets and interviews with health professionals and patients., Results: Most of the categories of the comprehensive ICF Core Set describing impairments, limitations or restrictions occurred in a considerable proportion of the study population. The most outstanding limitations and restrictions of the patients were problems with walking and moving around, and difficulties with self-care. Fourteen aspects of functioning not previously covered by the comprehensive ICF Core Set were reported as relevant., Conclusion: Most categories of the comprehensive ICF Core Set could be confirmed. Limitations in categories of intellectual and seeing functions appeared less frequently than might have been expected for a population of older hospitalized people. Some additional categories not covered by the present version of the comprehensive ICF Core Set emerged from the interviews and should be considered for inclusion in the final version.

Objective: To conduct a systematic review of the psychometric evidence relating to presenteeism scales in workers with musculoskeletal disorders., Methods: A structured search was conducted in 3 databases (MEDLINE, CINAHL, Embase) for articles published between 1966 and 2010. Sixteen articles met eligibility criteria. Pairs of raters used structured tools to analyse these articles through critical appraisal and data extraction. Descriptive synthesis of the psychometric evidence was then performed., Results: Methodological quality ratings of 56% of the studies reviewed reached a level of 75% or higher. Seven presenteeism scales were evaluated. Overall, presenteeism scales demonstrated acceptable validity content, were moderately to highly correlated (r > 0.50) to each other and to work- and disease-oriented constructs, and were able to differentiate between different populations and disability levels (p < 0.05). Limited evidence exists on the reliability and responsiveness of presenteeism scales, as reliability had only been evaluated for two scales and responsiveness in two studies., Conclusion: None of the identified scales demonstrated satisfactory results for all evaluated psychometric properties. For most scales, data regarding properties such as reliability and responsiveness were insufficient. Therefore, there is no substantial evidence to recommend one questionnaire over the others based solely on psychometric properties.

Objective: To operationalize items based on categories of the International Classification of Functioning, Disability and Health (ICF) relevant to patient problems that are addressed by physiotherapeutic interventions in the acute hospital, and to test the reliability of these items when applied by physiotherapists., Methods: A selection of 124 ICF categories was operation-alized in a formal decision-making and consensus process. The reliability of the newly operationalized item list was tested with a cross-sectional study with repeated measurements., Results: The item writing process resulted in 94 dichotomous and 30 polytomous items. Data were collected in a convenience sample of 28 patients with neurological, musculoske-letal, cardiopulmonary, or internal organ conditions, requiring physical therapy in an acute hospital. Fifty-six percent of the polytomous and 68% of the dichotomous items had a raw agreement of 0.7 or above, whereas 36% of all polytomous and 34% of all dichotomous items had a kappa coefficient of 0.7 and above., Conclusion: The study supports that the ICF is adaptable to professional and setting-specific needs of physiotherapists. Further research towards the development of reliable instruments for physiotherapists based on the ICF seems justified. :

Objective: To identify goals of older patients in geriatric rehabilitation and to measure their improvement in overall functioning., Design: A prospective multi-centre cohort study., Methods: A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning from patients' and health professionals' perspectives. Patients' goals were linked to the International Classification of Functioning, Disability and Health (ICF). Using a residualized change score, we identified patients who improved more than statistically expected., Results: A total of 209 patients gave 476 statements. Of these, 346 (72.7%) statements were linked to 58 different ICF categories. More than 90% of the ICF categories were part of the comprehensive geriatric ICF Core Set. "Walking", "getting rid of pain", "autonomy" and "returning home" were the most frequently reported goals. Multivariable analysis identified shorter length of inpatient stay and goal attainment to be significant predictors for an improvement in overall functioning from the patients' perspective., Conclusion: The ICF can be used to identify and structure patients' goals in geriatric rehabilitation. The association between goal attainment and improved overall functioning underlines the necessity of considering the patients' perspective in the rehabilitation process.

Objective: To explore ambulatory outpatient experiences and perceptions in post-acute care settings and how these experiences may have led to perceived gaps in continuity of rehabilitation care., Subjects: Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries, who had had more than 10 physiotherapy treatment sessions., Methods: Qualitative study using a modified grounded theory approach. Data collection was carried out through 9 focus groups. Each group was recorded, transcribed literally and analyzed thematically., Results: Participants described 3 main themes in continuity; relational, informational, and management continuity. Several factors that led to gaps in the 3 types of continuity were described. The relevant factors for relational continuity were: consistency of the multi-professional rehabilitation team; and an established provider-patient relationship. Factors for informational continuity were: transfer of information among providers; and accumulated knowledge regarding patients' disability experiences. Factors for management continuity included: consistency of care among rehabilitation providers; flexibility of the team in adapting care to functional changes; and involvement of the team in achieving patient collaboration., Conclusion: This study provides evidence of gaps in different types of continuity of care within the post-acute rehabilitation services in ambulatory settings. Outpatients often perceive their experiences of rehabilitation care as non-connected or non-coherent over time.

Objective: To identify goals of patients with rehabilitation needs in the acute hospital setting using the International Classification of Functioning, Disability and Health (ICF), to examine association of goal achievement with improvement in overall functioning, and to examine whether ICF Core Sets for the acute hospital cover patients goals., Design: Multi-centre cohort study., Patients: A total of 397 patients (50% female, mean age 63 years) from 5 hospitals in Austria, Switzerland and Germany., Methods: A semi-structured questionnaire was used to assess patient goals and goal achievement. Overall functioning from the patients' and health professionals' perspective was assessed on a numerical rating scale. Improvement in functioning was calculated using a residualized gain score. Association between goal achievement and improvement in overall functioning was assessed with logistic regression., Results: A total of 397 patients reported achievement of at least 1 goal. Eighty-eight percent of the goals were translated into categories of the ICF. Logistic regression analyses revealed significant association between goal achievement and overall functioning., Conclusion: The ICF might be useful to identify and structure patient's goals in acute hospital care. The association between goal achievement and improved functioning underlines that it is essential to involve the patient in the process of planning rehabilitation interventions in acute hospitals.

Objective: Timely goal setting in close collaboration with the patient is essential to successful rehabilitation. We therefore sought to identify goals of patients in early post-acute rehabilitation as predictors of improved functioning., Design: We conducted a prospective multi-centre cohort study in 5 early post-acute rehabilitation facilities., Patients: Patients with musculoskeletal, cardiopulmonary and neurological conditions were recruited between May 2005 and August 2008., Methods: A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning. Patients' goals were coded according to the International Classification of Functioning, Disability and Health (ICF). By means of a mixed effects model we examined the association between goal attainment and improved functioning., Results: A total of 116 patients gave 546 statements, of which 426 were linked to 74 ICF categories, which were assigned to the existing comprehensive post-acute ICF Core Sets. Improvements in walking, recreation and leisure, pain, and transfer were the most frequently reported goals. In multivariable analysis patients' goal attainment was not a predictor for improved overall functioning., Conclusion: The ICF can be used to identify and structure patients' goals. Patients' perspective should be considered in the rehabilitation process.

Background: Physical therapists often assess patient independence through observation; however, it is not known if therapists make these judgments reliably. We have developed a standardized method to assess a patient's ability to perform his or her treatment program independently., Objectives: To develop a standardized assessment of patient independence in performance of a treatment program and examine the intra- and inter-rater reliability decisions made by two physical therapists., Design: Test-retest., Methods: An assessment of patient independence in performance was developed. Standardized patient scenarios were used to assess the intra- and inter-tester reliability of two physical therapists. Percentage of agreement (%) and kappa's coefficient (k and k(w)) indexed rater reliability., Results: Intra-rater reliability of therapist 1 was as follows: knowledge: % = 95, k = 0.90; performance: % = 95, k(w) = 0.82. Intra-rater reliability of therapist 2 was as follows: knowledge: % = 85, k = 0.68; performance: % = 94, k(w) = 0.80. Inter-rater reliability for knowledge was % = 91 and k = 0.79 and for performance was % = 91 and k(w) = 0.72., Conclusion: Trained therapists displayed substantial to excellent intra-rater reliability and substantial inter-rater reliability in assessing a patient's independence in a treatment program. :

Objective: To examine the validity of the PainMatcher in chronic pain., Design: Comparison of parallel pain estimates from visual analogue scales with electrical stimulus magnitude matching., Patients: Thirty-one patients with chronic musculoskeletal pain., Methods: Twice a day ongoing pain was rated on a standard 100-mm visual analogue scale, and thereafter magnitude matching was performed using a PainMatcher. The sensory threshold to electrical stimulation was tested twice on separate occasions., Results: In 438 observations visual analogue scale ranged from 3 to 95 (median 41) mm, and PainMatcher magnitudes from 2.67 to 27.67 (median 6.67; mean 7.78) steps. There was little correlation between visual analogue scale and magnitude data (r = 0.29; p < 0.0001). The mean sensory threshold was 3.67 steps, indicating that the PainMatcher, on average, stimulated at 2.1 times the perception threshold at matching point., Conclusion: Electrical magnitude matching of chronic pain intensity elicited limited activation of nerve fibres at 2.0-2.2 times sensory threshold, indicating that the induced pain was evoked by coarse nociceptive Adelta fibres. While the visual analogue scale estimates covered the whole range of the instrument, the PainMatcher readings utilized only a small part of the instrument range and, importantly, had little or no relation to the visual analogue scale estimates. The validity of the PainMatcher procedure is doubtful.

The aim of this review is to describe aspects of vocational rehabilitation relevant for a physician aiming to become a specialist in physical and rehabilitation medicine (PRM). The review discusses the epidemiology of incapacity for work, the major patient groups in vocational rehabilitation (musculoskeletal and psychiatric diagnoses comprise approximately 50-70% of the patients), the influence of different kinds of environmental and individual risk factors on work resumption (such as the legal framework, application of the law, resources for rehabilitation and its effectiveness, the degree of co-operation between vocational rehabilitation agencies, economic factors/labour market situation, medical and personal factors). The review describes different models of vocational rehabilitation, the effectiveness of various vocational rehabilitation programmes on work resumption or sick leave (where strong evidence is reported for multi-modal rehabilitation programmes for patients with long-lasting musculoskeletal pain). Finally, there are sections about the PRM physician's history-taking in vocational rehabilitation (using the International Classification of Functioning, Disability and Health (ICF)), and report writing with a structure where ICF body functions and activity limitations are reported separately.

Objectives: Workers who carry out modified work during sick leave due to musculoskeletal complaints seem to return to full-capacity work earlier than colleagues not given modified work. This study evaluates whether modified work during sick leave also influences the recurrence of a new episode of sick leave., Methods: Questionnaires on physical and psychosocial workload, musculoskeletal complaints, general health and sick leave were sent to 137 workers on sick leave for 2-6 weeks due to musculoskeletal complaints, shortly after full return to work, and 12 months after the first day of sick leave., Results: Approximately 45% of the participants experienced a recurrence of musculoskeletal sick leave within 12 months after the start of the initial sick leave. Subjects who performed modified work during initial sick leave reported significantly less recurrence than those who had started immediately at full capacity. Musculoskeletal sick leave prior to the start of the study also predicted the recurrence of sick leave. Many workers reported residual health problems at the time of return to work, which in turn influenced recurrence of musculoskeletal sickness absence., Conclusion: This study suggests that, although full recovery of musculoskeletal complaints was not established at the time of return to work, workers who had performed modified work had a lower risk of recurrence of musculoskeletal sick leave than those who had returned directly to full duties.

Objectives: The number of people in Western countries on long-term sick-leave and disability pension due to musculoskeletal complaints and psychological health problems is increasing. The main objective of this study was to examine whether fear-avoidance beliefs, illness perceptions, subjective health complaints, and coping are prognostic factors for return to work after multidisciplinary vocational rehabilitation, and to assess the relative importance and inter-relationship of these factors., Methods: A prospective cohort study with a 1-year follow-up period was performed. A total of 135 individuals on long-term sick-leave (87 women, mean age 45 years) participated in a 4-week inpatient multidisciplinary vocational rehabilitation programme. The participants had been out of work for an average of 10.5 months., Results: Fear-avoidance beliefs about work was the most important risk factor for not returning to work, both at 3 months (odds ratio (OR) 3.8; confidence interval (CI) 1.30-11.32) and 1 year (OR 9.5; CI 2.40-37.53) after the intervention. Forty-eight percent of the variance in fear-avoidance beliefs was explained by subjective health complaints, illness perceptions and education. Coping explained only 1% of the variance., Conclusion: These findings indicate that interventions for these patients should target fear of returning to work and illness perceptions about subjective health complaints.

Objective: To characterize the mental and physical functioning of subjects admitted to Beitostølen Healthsports Centre, and evaluate whether functioning was improved during rehabilitation., Material and Methods: A total of 228 subjects admitted for rehabilitation completed the Medical Outcome Study Short Form 12 (SF-12) on admission and on discharge after approximately 4 weeks. A total of 174 subjects also completed SF-12 3 months after discharge. The physical and mental sum scores and the scores for the 8 subscales of SF-12 were calculated. In a stepwise backward multiple regression model, demographic and medical factors influencing improvement during rehabilitation were explored., Results: Physical, as well as mental, functioning was reduced on admission. Bodily pain and emotional factors represented the most dominant components. Both physical and mental functioning improved during the stay, and the improvement in physical functioning remained stable 3 months after discharge. The improvement in physical functioning was greatest for those subjects living in urban areas and having a painful musculoskeletal diagnosis. The improvement in mental functioning was greatest for females., Conclusion: This approach to rehabilitation appears to be effective for improving physical functioning in the relevant group of individuals. However, carefully controlled studies with longer follow-up periods are required.

Objective: This article reviewed the literature to clarify the physiological effects and benefits of, and misconceptions about, stretches used to reduce musculoskeletal disorders., Methods: Nine databases were reviewed to identify studies exploring the effectiveness of stretching to prevent work-related musculoskeletal disorders. Included studies were reviewed and their methodological quality was assessed using the PEDro scale., Results: The physiological effects of stretches may contribute to reducing discomfort and pain. However, if other measures are not in place to remediate their causes, stretches may suppress awareness of risks, resulting in more debilitating injuries. If inadequately performed, stretches may also cause or aggravate injuries. Careful analysis and stretching program design are required before implementing stretches. Seven studies evaluating the effectiveness of stretching to prevent musculoskeletal disorders in different occupations were identified and reviewed., Conclusion: The studies provided mixed findings, but demonstrated some beneficial effect of stretching in preventing work-related musculoskeletal disorders. However, due to the relatively low methodological quality of the studies available in the literature, future studies are necessary for a definite response. Future studies should minimize threats to internal and external validity, have control groups, use appropriate follow-up periods, and present a more detailed description of the interventions and worker population.

Objective: To investigate the degree of kinesiophobia in patients with chronic pain, to examine differences in kinesiophobia and other pain-related characteristics between men and women, and to examine differences in pain-related characteristics between patients with high and low levels of kinesiophobia., Design: Postal survey., Subjects/patients: Eighty-eight men and 173 women with chronic musculoskeletal pain., Methods: Patients completed questionnaires covering background data, pain variables, disability and psychological characteristics. The Swedish version of Tampa Scale for Kinesiophobia (TSK-SV) was used to measure kinesiophobia., Results: Kinesiophobia (TSK-SV score >37) was found in 56% of patients, with men having a higher frequency (72%) than women (48%). Pain intensity was correlated with TSK-SV score in both men and women. No correlations were found between kinesiophobia and age, pain duration or probable depression/anxiety. Women with high kinesiophobia tended to be younger, had more pain and showed more tiredness, disability, stress, interference and life dissatisfaction compared with women with low kinesiophobia. These differences were not seen in men., Conclusion: The results indicate differences between men and women with chronic pain. The use of the TSK-SV questionnaire might assist therapists to identify patients whose fear of movement may negatively impact their rehabilitation. There is some evidence to suggest that optimal cut-off scores may differ between male and female patients.

Objective: To predict the discharge destination of rehabilitation patients using signal detection analysis., Design: Cross-sectional and follow-up studies., Subject: The subjects were 324 patients discharged from a hospital in Fukuoka, Japan, between April 2005 and March 2006 and 313 patients discharged from the same hospital between 1 April and 31 October 2006., Methods: The discharge destinations of the 324 patients were predicted using signal detection analysis. As a validation study, 7 variables identified in the first analysis were used to categorize 313 patients, organized retrospectively into 8 groups, and to calculate the home discharge rate in each group., Results: A patient's activities with respect to daily living, key person preference, dementia, age, route taken to hospitalization, residence before hospitalization, and gender were significant predictors of his or her discharge destination. Signal detection analysis established 8 subgroups, with 17.9-99.1% of the patients returning home after discharge. As a validation study, the actual and expected rates in the 8 subgroups were compared, and no significant difference was observed between the rates in any subgroup., Conclusion: Signal detection analysis is a useful technique for predicting the discharge destination of rehabilitation patients.

Objective: The aim of this study was to evaluate the economic consequences of an 8-week multiprofessional rehabilitation programme for patients with persistent pain., Subjects: A group of 67 patients following the programme and a comparison group of 322 patients., Methods: The effect on return to work was estimated using 3 different methods: (i) a matched sample approach; (ii) regression analysis; and (iii) propensity score matching. The economic benefit of the programme was estimated as a reduction in production losses due to sick-leave. This benefit was compared with the actual cost of the programme., Results: The benefit of the programme was estimated to be euro3,799-7,515 per treated patient and year. The total cost of the programme was estimated to be euro5,406 per patient. Based on these figures the total cost of the programme, including costs for patients remaining on sick-leave, had been recovered when the successfully rehabilitated patients had worked for 9-17 months. Any additional work after that yielded net economic benefits., Conclusion: Since other studies indicate that a large proportion of the patients working after one year also work after 3 and 6 years, we conclude that this multiprofessional rehabilitation programme for patients with persistent pain most likely generates substantial net economic gains.

Objective: To report the results from a prospective, cognitive-behavioural team-based, individually geared, low-intensity, rehabilitation programme, randomly assigned to care-seekers in primary care physiotherapy with new pain-related sick leave, and to examine a possible reduction in social security expenditure., Methods: A total of 194 care-seekers were included in a stepwise procedure from November 2000 to February 2002. Control group n = 381., Results: The median number of days of sick leave in the intervention group was 22 during the first 6-month period. After 180 days 5.2% were still on sick leave and after 360 days 4.2%. The comparable figures in the control group were 30 days, 9.7% and 7.2%, respectively. Reductions in social security expenditure were statistically significant from the fourth month. As predicted, clinically relevant subgroups contributed differently to this reduction, both early and later on. The overall problem for one-third of the subgroups was insufficient co-ordination from the employer and the social security executive., Conclusion: It was possible to reduce the social security expenditure in this setting. The intervention costs were balanced out during the first year. A large potential for further cost reductions was identified in increased implementation of workplace-based return-to-work interventions.

Objective: Development of an adaptive, International Classification of Functioning, Disability and Health (ICF)-oriented patient questionnaire on mobility and self-care based on an item response theory model (MOSES questionnaire)., Methods: Using item reconstruction rules, items were developed for the ICF chapters "mobility", "self-care" and "domestic life". The resulting instrument, together with other instruments (SF-36, Short Musculoskeletal Function Assessment Questionnaire (SMFA), MacNew, Functional Independence Measure (FIM), Barthel) was presented to 549 patients with musculoskeletal disease, 212 patients with cardiac disease and 258 neurological rehabilitation patients in rehabilitation clinics in Germany., Results: The MOSES questionnaire includes 58 items on 12 scales and fulfills the requirements of the 1-parameter item response theory model (Rasch model). The results indicate good reliability and high construct validity and sensitivity to change of the instrument. In the construction and selection of items, ICF contents that include complex processes of evaluation, and which presuppose skills that are not acquired prior to the individual learning process, were omitted due to a lack of unidimensionality., Conclusion: The successful implementation of the concept of applying rules to ICF categories in formulating the items of a patient questionnaire showed that the goal of a theory-driven measurement of activities using the ICF is feasible. The results of the project also raise questions as to the homogeneity of the contents of some ICF categories.

Objective: To develop and test the ability of a screening instrument to identify subgroups among primary healthcare patients with musculoskeletal pain. The Pain Belief Screening Instrument covers pain intensity, disability, self-efficacy, fear avoidance and catastrophizing., Design: Cross-sectional, correlational and comparative study., Subjects: Patients in primary healthcare (n1 = 215; n2 = 93) with a pain duration of 4 weeks or more were included., Methods: Items for the Pain Belief Screening Instrument were derived from principal component analyses of: the Self-efficacy Scale, the Tampa Scale of Kinesiophobia and the Catastrophizing subscale in the Coping Strategies Questionnaire. Cluster solutions of scores on the screening instrument and the original instruments were cross-tabulated. The reliability of items in the Pain Belief Screening Instrument was examined., Results: The screening instrument identified 2 groups: high- or low-risk profile for pain-related disability. Validity was in-between moderate and substantial (kappa = 0.61, p < 0.001). The reliability of each item in the Pain Belief Screening Instrument in relation to the corresponding item in the original instruments was moderate to high (rs 0.50-0.80, p < 0.01)., Conclusion: The screening instrument fairly well replicated subgroups identified by the original instruments. The reliability of items in the screening instrument was acceptable. Further testing of predictive validity for a primary healthcare population is needed..

Objective: To examine the association between socioeconomic position and coping strategies in musculoskeletal pain., Design and Subjects: Cross-sectional study of a random sample of 40- and 50-year-old Danes, participation rate 69%, n=7,125. The study included 1,287 persons who reported functional limitations due to musculoskeletal pain., Methods: Data was collected by postal questionnaires and scales were developed on problem-solving coping and avoidant coping, based on a range of preliminary studies. Multivariate logistic regression analyses was used to study the correlation with socioeconomic position, measured by occupational social class., Results: Among women, there was no correlation between social class and avoidant coping, but a significant decrease in the use of problem-solving coping by decreasing social class, adjusted odds ratio (OR) = 2.64 (95% confidence interval (CI) 1.31-5.32) in social class V vs social classes I + II. Among men, there was no correlation between social class and problem-solving coping, but a significant increase in the use of avoidant coping with decreasing social class, adjusted OR = 3.31 (95% CI 1.75-6.25) in V vs I + II., Conclusion: It is important for clinicians who advise and support patients in their response to musculoskeletal pain to be aware of socioeconomic differences in coping strategies. Gender differences in the association between socioeconomic factors and coping should be further investigated.

Objectives: To describe the occurrence of kinesiophobia and to investigate the association between kinesiphobia and pain variables, physical exercise measures and psychological characteristics in patients with musculoskeletal pain., Design: A prospective descriptive study involving 2 selected physiotherapy departments within a primary healthcare setting in the south-west of Sweden., Patients: Included were 140 of 369 (38%) consecutive patients (aged between 18 and 65 years) with musculoskeletal pain., Methods: Questionnaires including background data, pain variables, physical exercise measures and psychological characteristics were sent to the patients prior to their appointment with the physiotherapist. A simple and a multiple logistic regression model were performed to identify associations among the variables where kinesiophobia was defined as the dependent variable., Results: A high degree of kinesiophobia and psychological distress were observed in approximately 50% of the responders. According to the simple logistic regression analysis the factors that seemed to be associated with kinesiophobia were interference, disability, pain severity, pain intensity, life control, affective distress, depressed mood and solicitous response. The multiple logistic regression analysis showed no significant associations., Conclusion: Kinesiophobia is a commonly seen factor among patients with musculoskeletal pain, which ought to be taken into consideration when designing and performing rehabilitation programmes.

Objective: To identify predictive factors for work capacity in patients with musculoskeletal disorders., Design: A descriptive, evaluative, quantitative study., Subjects/patients: The study was based on 385 patients who participated in a rehabilitation programme., Methods: Patients were divided into 2 groups depending on their ability to work. The groups were compared with each other with regard to sociodemographic factors, diagnoses, disability pension and number of sick days. The patient's level of exercise habits, ability to undertake activities, physical capacity, pain and quality of life were compared further using logistic regression analysis., Results: Predictive factors for work capacity, such as ability to undertake activities, quality of life and fitness on exercise, were identified as important independent factors. Other well-known factors, i.e. gender, age, education, pain and earlier sickness certification periods, were also identified. Factors that were not significantly different between the groups were employment status, profession, diagnosis and levels of exercise habits., Conclusion: Identifying predictors for ability to return to work is an essential task for deciding on suitable individual rehabilitation. This study identified new predictive factors, such as ability to undertake activities, quality of life and fitness on exercise.

Objective: To determine which individual and work-related factors are associated with performing modified work and to evaluate the influence of modified work on the duration of sick leave and health-related outcomes among employees with musculoskeletal complaints., Study Design: A prospective study with 12 months follow-up., Methods: In this prospective study a total of 164 employees on sick leave for 2-6 weeks due to musculoskeletal complaints completed 2 questionnaires. At baseline we gathered information about individual characteristics, physical and psychosocial workload, and disease specific and general health. The follow-up questionnaire, sent to respondents who returned to their original job on full duty, collected information about having performed modified work, and disease-specific and general health., Results: Employees were less likely to perform modified work when their regular work was characterized by frequent lifting and their relationship with colleagues was less than good. Employees were more likely to return to modified work when they had a better mental health, had prolonged periods of standing in their regular job and had less skill discretion. Duration of sick leave was influenced by chronicity of complaints and disability, but not by modified work., Conclusion: Modified work, as the only advice given by a occupational health physician, did not influence the total duration of sick leave nor the improvement in health during sick leave for employees on sick leave due to musculoskeletal complaints.

Objective: This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained. DESIGN, METHODS AND SUBJECTS: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison., Results: One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over one's employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively., Conclusion: The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment.

Recent neuroscientific evidence has revealed that the adult brain is capable of substantial plastic change in such areas as the primary somatosensory cortex that were formerly thought to be modifiable only during early experience. These findings have implications for our understanding of chronic pain. Functional reorganisation in both the somatosensory and the motor system was observed in neuropathic and musculoskeletal pain. In patients with chronic low back pain and fibromyalgia the amount of reorganisational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes cortical reorganisation is correlated with the amount of pain. These central alterations may be viewed as pain memories that influence the processing of both painful and nonpainful input to the somatosensory system as well as its effects on the motor system. Cortical plasticity related to chronic pain can be modified by behavioural interventions that provide feedback to the brain areas that were altered by somatosensory pain memories or by pharmacological agents that prevent or reverse maladaptive memory formation.