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The objective of the research was to construct a brief coping questionnaire designed to assess the approach-avoidance dichotomy. A 20-item questionnaire was designed and tested in samples of 206 students and 93 patients. Based on empirical analyses and interviews with patients, 12 items were chosen for the final scale, which was named the Brief Approach/Avoidance Coping Questionnaire (BACQ). BACQ was then tested in a clinical sample of 299 primary care patients. A Cronbach's alpha of 0.68 was found in a primary care sample. In testing concurrent validity, BACQ indexes correlated significantly with relevant COPE sub-scales in a 0.34 to 0.57 range. A factor structure based on a two-factor solution gave one bipolar factor, ranging from active approach to resignation and withdrawal, and a second factor with items indicating diversion. In conclusion, the 12-item BACQ is a brief measure of coping strategies with satisfactory psychometric properties. The instrument is designed to measure a general concept of approach versus avoidance oriented coping, but the findings also point to two sub-dimensions of avoidant coping, resignation/withdrawal and diversion. [ABSTRACT FROM AUTHOR]

Objective: To identify core elements of what patients with chronic low back pain perceive as good clinical communication and interaction with a specialist ('The Good Back-Consultation').Design: Qualitative study including observation of consultations and a subsequent patient interview. Quantitative data were also recorded.Subjects: Thirty-five patients with chronic low back pain referred to a specialist.Methods: Thirty-five consultations were observed with respect to history-taking, clinical examination and interaction between patient and doctor. Patients were subsequently interviewed about how they perceived the consultation. Fourteen specialists with various specialty branches and 35 patients (18 males) participated. For 3 of the specialists a positive effect (return to work) on patients with chronic low back pain had been documented in previous randomized controlled trials. Qualitative data analysis was performed using a template method.Results: Most patients thought that the history-taking and clinical examination had been thorough and satisfactory. Patients emphasized the importance of being given an explanation during the examination of what was being done and found, of receiving understandable information on the causes of the pain, of receiving reassurance, discussing psychosocial issues and discussing what can be done. The most important characteristic of 'The Good Back-Consultation' was that the specialist took the patient seriously.Conclusion: The findings may represent an important potential for enhancing clinical communication with patients. [ABSTRACT FROM AUTHOR]

Objective: To enable measurement of coping in the general Danish population the aims of this study are to 1) describe the translation and cultural adaption of the Danish Brief Approach/Avoidance Coping Questionnaire (BACQ) and 2) investigate the psychometric properties of the Danish BACQ. Design: The BACQ was translated and adapted into Danish, and the psychometric properties tested in two samples of adult Danish citizens: Sample A = 167, used for exploratory factor analysis (EFA), and Sample B = 330 persons, used for confirmatory factor analysis (CFA). Internal consistency was evaluated by Cronbach's Alpha, item-to-rest correlation, and scale-to-scale Pearson correlation. Results: The EFA suggested reasonable fits for both a three-factor and four-factor model, confirmed by the CFA with acceptable goodness-of-fit indices for both models. Using the four-factor-model would require a re-evaluation of the scale. The three-factor model had admissible internal consistency with an overall Cronbach's alpha of 0.66. Individuals with low self-rated health, extreme concern about current health and poor physical fitness, respectively, had lower Approach and higher Diversion and Resignation scores. Conclusion: The psychometric properties showed that the Danish BACQ could be used as a three-factor model. With some limitations, the Danish version had acceptable construct validity, internal consistency, and content validity. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to quantitatively assess the thickness of the thoracolumbar fascia (TLF) and lumbar multifidus muscle through ultrasound imaging in younger-middle aged individuals, both those experiencing chronic low back pain (LBP) and those without LBP. Additionally, the study sought to explore the potential significance of these anatomical structures in relation to clinical and sonographic findings. Method: A cross-sectional study was conducted involving a cohort of 50 participants, divided into two groups: chronic LBP group (Group LBP, n = 30) and a group without LBP (Group control, n = 20). Participants from both groups underwent assessments pertaining to pain characteristics (intensity and quality), functional impairment, and kinesiophobia. The thicknesses of the thoracolumbar fascia and lumbar multifidus muscle were measured using ultrasonography. Results: Among participants with chronic LBP, the thoracolumbar fascia displayed a statistically significant increase in thickness on the left side, whereas the lumbar multifidus muscle exhibited reduced thickness on the left side. Notably, positive correlations were observed between the thickness of the thoracolumbar fascia and scores from the Numerical Rating Scale (NRS) for pain intensity (r = 0.472, p = 0.008) as well as the McGill Pain Questionnaire (MPQ) (r = 0.547, p = 0.002). Moreover, a positive correlation was established between the thickness of the lumbar multifidus muscle and the modified Schober test (r = 0.174, p = 0.040). However, the thickness of the lumbar multifidus muscle demonstrated a negative correlation with age (r = −0.304, p = 0.032). Multiple logistic regression analysis did not identify any significant predictors for the presence of LBP based on demographic or clinical variables. Conclusions: Individuals afflicted with chronic LBP exhibited pronounced thickening of the thoracolumbar fascia and attenuation of the lumbar multifidus muscle in comparison to asymptomatic counterparts. Notably, increased thickness of the thoracolumbar fascia corresponded to heightened pain intensity, while reduction in lumbar multifidus muscle thickness was associated with decreased lumbar flexion ability. These findings underscore the importance of incorporating tailored regimens targeting both fascial and muscular components in the rehabilitation of individuals with LBP. [ABSTRACT FROM AUTHOR]

The relationship between Emotional Intelligence (EI) and lifestyle choices during the COVID-19 pandemic is obscure and not very well understood. To clarify the mechanisms underlying this relationship, we proposed to test the hypothesis that different coping styles (avoidant and approach) have an indirect effect on the association between EI and many types of lifestyle habits. A cross-sectional study was conducted between December 2020 and January 2021. Our target sample consisted of Lebanese adults from the general population. In path analysis, approach coping mediated the association between EI and different lifestyle habits (rest, nutrition, general physical conditions), but not exercise. Furthermore, avoidant coping did mediate the association between EI and general physical conditions, but not between EI and other lifestyle choices (namely rest, exercise, and nutrition). To conclude, individuals with high EI, and that are users of approach coping strategies to deal with stressors, have increased rest time, healthy nutrition and general physical conditions. This cautiously implies that fostering approach coping may help improve the positive effects of EI on healthy lifestyles during crises such as this pandemic. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes. [ABSTRACT FROM AUTHOR]

In recent years, the number of athletes who aim to return to competition after childbirth has increased. However, few international reports have investigated complications during pregnancy, and changes in physical function after childbirth in many athletes. To conduct a retrospective investigation of medical problems during pregnancy, and postpartum, in female athletes who aim to return to competition after childbirth, and to identify the barriers and facilitators for their return. A voluntary web-based survey was aimed at former female athletes who became pregnant with their first child and gave birth during their active sports career. The survey items included respondent background, their exercise activities during and after childbirth, perinatal complications, mode of delivery, symptoms and physical function after childbirth. The participants were divided into a vaginal delivery group and a cesarean section group. Three hundred and twenty-eight (29.1 ± 5.1 years old) former athletes were included in the analysis, and about half reported undertaking exercise during pregnancy. The most common perinatal complication was anemia (27.4%). The appearance of any symptoms after childbirth, including low back pain (44.2%) and urinary incontinence (39.9%), was reported by 80.5%. The rate of urinary incontinence may be higher in the vaginal delivery than in the cesarean section group (p = 0.05). The most common physical decline after childbirth was in muscular strength, followed by speed and endurance. Addressing pregnancy-associated anemia and managing low back pain is critical for athletes aiming to return to competition after childbirth. Additionally, interventions to reduce the risk for and treat urinary incontinence are important. In addition, in order to return to competition after childbirth, it is important to strengthen muscles, especially the lower limbs and trunk, as well as to create a training program that takes into account the sport/events. [ABSTRACT FROM AUTHOR]

Examines the management of coronary heart disease (CHD) risk in general practice. Effects of lifestyle intervention on men with high risk for CHD; Comparison between a patient-centered, self-directive intervention and conventional care; Response of patients to intervention emphasizing patient responsibility and self-determination.

To evaluate the prevalence of low back pain (LBP) among physiotherapy students during the COVID-19 lockdown in the State of Israel. One hundred and sixty four physiotherapy students from all four-year student levels were invited to participate. One hundred and thirty-seven students (83.5%) were recruited in the study with 79 females (57.7%) and 58 males (42.3%). We used a structured anonymous questionnaire that sought standard information on age, height, weight, sports activity and low back pain (LBP) prevalence during three periods. No significant differences were noted in the prevalence of LBP between the lockdown period compared to 12-month period in all four-year levels. More so, our findings showed that LBP prevalence among physiotherapy students was greater during the 12-month period compared to the lifetime period. This study indicates that COVID-19 lockdown has no negative impact on the prevalence of LBP among physiotherapy students. [ABSTRACT FROM AUTHOR]

Globally, musculoskeletal lumbopelvic pain (LPP) predominates among women. This high predominance of LPP is attributed to the complex interaction of biomechanical, psychological, and social factors among women. The deleterious effect of LPP has increased the likelihood of LPP-care seeking among women. The need for care seeking is influenced by a person's perception, beliefs, and attitude toward pain; which in turn, is framed by his/her culture and community. Thus, this qualitative research aimed to seek insights into LPP-care seeking behaviors among women from Indian cultural background. Semi-structured interviews were administered among 18 women living in urban as well as semi-urban areas of North India. Analysis of interview scripts lead to generation of three themes: LPP-care seeking behavior, non-adherence to LPP rehabilitation and barriers to LPP rehabilitation. LPP-care seeking behavior was influenced by unawareness about physiotherapy (PT), self-help practices and beliefs about LPP. We also found that lack or incomplete knowledge incite false assumptions, resulted in non-adherence in LPP rehabilitation. In addition, unsupportive family, lack of time, and difficulty in memorizing LPP exercises were the cultural, work, and old age-related barriers to LPP-care seeking, respectively. [ABSTRACT FROM AUTHOR]

Informal caregiving is crucial to the sustainability of health and social care systems globally. With ageing populations and a rising prevalence of acute and chronic health conditions, the need for informal care is growing, making it important to understand what motivates individuals to care and to continue caring. This paper reports findings of a systematic review which examined determinants of motivations and willingness to provide informal care. A systematic search was conducted using six electronic databases and a wide range of additional sources. 105 qualitative studies published before August 2019 were included with 103 of them reporting on personal and relational motivations, and the contextual factors underpinning these. Grounded theory-based, thematic synthesis was applied to synthesise the literature. This meta-synthesis reports on findings from across the world spanning three decades, with data from over 2500 caregivers across a range of health conditions. This paper presents the relational, personal and contextual themes. It highlights the significance of reciprocity, affection, family values and caregiving obligations. Personal characteristics, finding meaning, illness perceptions, situational and temporal aspects of caregiving are also identified as important in shaping motivations and willingness to care and to continue caring. Implications for theory, research, policy and practice are discussed. [ABSTRACT FROM AUTHOR]

To evaluate the long-term effects of a multilevel community intervention to improve the quality of prescription practice of potentially addictive medications (PAMs). We conducted a retrospective study, using anonymized data from the Norwegian prescription registry. Based on an initiative from the GPs in Molde Municipality in Norway, a multilevel community intervention was initiated by the municipal chief physician in 2018. The intervention targeted GPs, patients, and the public. We retrieved prescription data from 26 of 36 GPs. By using the standardized defined daily dose (DDD), we compared prescription of three groups of PAMs from before the intervention (2017) throughout the intervention in 2018, and through 2020 to determine long-term effects. Three years after the intervention, the GPs in our study sample prescribed 26% less opioids, 38% less benzodiazepines, and 16% less z-hypnotics. Overall prescription of PAMs decreased by 27%. The number of individuals receiving at least 90 DDD of benzodiazepines and z-hypnotics were reduced from 9 to 7 and 34 to 24 per 1000, respectively. Also, the number of individuals receiving two and three PAMs concomitantly were reduced. Addressing prescription practice among GPs in a community as a joint intervention, combined with addressing patients and the public may be a feasible method to obtain long-term reduction of PAM prescriptions. Non-therapeutic prescriptions of potentially addictive medications (PAMs) are both a public health concern and a frequent challenge in general practice. A multilevel community intervention, targeting general practitioners, patients, and the public, led to 27% reduction in prescription of PAMs. Both the number of daily users and concomitant use of several PAMs were reduced. The reduction in prescription persisted for three years. [ABSTRACT FROM AUTHOR]

Pelvic girdle dysfunction is a common musculoskeletal disorder among pregnant women. It is a disabling condition affecting the ability of a pregnant woman to perform her daily functional activities. The scope of digital health in delivering rehabilitation services is growing exponentially, especially in the present COVID −19 pandemic crisis. A 29-year-old primigravida, at 32 weeks of gestation with severe pelvic girdle pain during bed transitions, sought physiotherapy consultation via video call, as she expressed difficulty in accessing Physiotherapy services due to the present pandemic crisis. Physiotherapy consultation was provided in 4 weekly sessions using a real-time video-based telerehabilitation program and the patient performed unsupervised exercise sessions for 30 minutes for 5 days per week for 4 weeks. The plan of care included muscle energy techniques, pelvic cloth belt, strengthening, stabilization exercises and stretching. The patient completed four sessions including evaluation and treatment and there was a reduction of pain scores for bed transitions from NPRS 8/10 during session one to NPRS 0/10 during session four. The Pelvic girdle dysfunction questionnaire showed a decrease in percentage scores from 54.6 to 4 at the end of physiotherapy sessions. Telerehabilitation was successfully used to manage a pregnant woman with pelvic girdle dysfunction. [ABSTRACT FROM AUTHOR]

Factors causing and sustaining long-lasting musculoskeletal pain differ between patients, but must be identified in order to target treatment. During physiotherapy, there are multiple factors influencing the treatment outcome. The focus in the present study was to grasp patients' experiences of how social burdens influence the development and persistence of symptoms of muscle pain, and how the relationship with the physiotherapist influences the process of change during Norwegian Psychomotor Physiotherapy. A phenomenological, descriptive, and retrospective design was chosen. Data were collected through focus-group interviews. Eleven patients participated. They ranged in age from 34 to 67 years. The analysis was inspired by Giorgi's phenomenological method. The results identified a general, overarching structure; "Caring for others and developing self-care" and the two interwoven themes "Emerging awareness of overload" and "Receiving care from the physiotherapist." These themes describe the essence of the experiences from the treatment process. To be recognized by the physiotherapist, both through the hands-on treatment and verbal communication, appears to be crucial for patients to develop an awareness of the factors causing and sustaining their pain problems. This awareness seemed necessary for the process of change to take place and for the patients to take more responsibility for their own care. [ABSTRACT FROM AUTHOR]

To investigate outcome measurement tools for the validation of teleaudiology hearing aid rehabilitation services for adults. A search strategy was developed to identify tools used to evaluate standard and teleaudiology hearing aid rehabilitation services for adults. A seven-domain hearing-health-care service model for validation was defined and used to analyse the applicability and suitability of patient- and service-centred tools. This model and the applicability and suitability criteria were based on the literature, the International Classification of Functioning (ICF) framework, and gold standard professional practice guidelines, which together formed the validation framework used in this study. Eighteen tools were identified and assessed against the validation framework. These tools were found to primarily assess aspects in the patient communication domain and rarely in the domain of service provision. All the included tools had some applicable items for teleaudiology hearing aid services; three tools were judged as suitable and four partially suitable for validating these services. Although there is a set of suitable tools available to validate teleaudiology hearing aid rehabilitation services, none of them cover all the seven domains of the validation model used by this review and few are focussed on a specific domain. Further improvement and/or development of new tools to comprehensively validate these services is still necessary. At this stage, this still limits clinical audiology practice research, especially in teleaudiology. Outcome measurement tools are crucial for assessing the validity of hearing rehabilitation services. Findings of this study inform clinicians and researchers on how and what to assess and use to evaluate teleaudiology and standard hearing aid rehabilitation services. The use of the proposed validation framework may facilitate the standardisation of validation of both face-to-face and remotely delivered audiology rehabilitation services and improve consistency of methodology and reported real-world outcomes across studies and thus, the evidence. [ABSTRACT FROM AUTHOR]

There is limited research on the relationship between commonly used outcome measures, pain duration and work status. The objective of this study was to examine this relationship in different groups of patients with low back pain (LBP). This is a multicentre cross-sectional study. Patients with LBP (n = 141) between 18 and 65 years were divided into groups according to pain duration and work status and compared: acute (<6 weeks), subacute (6–12 weeks), chronic (>12 weeks), on sick leave versus working. Outcome measures: pain intensity, function, lumbar mobility, fear avoidance beliefs and mental distress. No differences were found in outcomes in relation to symptom duration, except for lumbar mobility in the acute group (−1.1 cm, p = 0.007), and distress in the chronic group (0.2 points, p = 0.004). Patients on sick leave had overall significantly worse outcomes versus patients working. Fear avoidance had the strongest association with sick leave measured with correlation analysis (r = −0.42). Fear avoidance, pain intensity and function discriminated best between those on sick leave versus those working. Pain, function and fear avoidance beliefs did not differ in patients with different durations of LBP, but lumbar mobility and distress did. Patients on sick leave had worse symptoms, and fear, pain and function were associated to sick leave. [ABSTRACT FROM AUTHOR]

Background: The Pain Attitudes and Beliefs Scale (PABS) for physiotherapists aims to differentiate between clinicians' biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain (LBP). Objective: To study the content validity of the Norwegian PABS by following international guidelines: exploring its relevance, comprehensibility and comprehensiveness. Methods: Cognitive interviews were performed using the Three-Step Test Interview, consisting of think-aloud techniques, retrospective probing and in-depth interviews. Eleven Norwegian physiotherapists with a diversity of professional backgrounds participated. Results: The participants encountered little difficulty in completing the PABS. All items were deemed relevant and important but five items had ambiguous formulations which can easily be handled. The biomedical subscale appeared to be a comprehensive representation of biomedical treatment orientation. The biopsychosocial subscale was found to lack items concerning cognitive behavioral aspects of LBP management, such as patient education, therapeutic alliance, shared decision making and graded exposure. Conclusions: This study provides empirical evidence that the Norwegian version of the PABS-PT is relevant and comprehensible, provided some minor adjustments. The biopsychosocial subscale, however, lacks comprehensiveness, as it is not able to capture important aspects of contemporary biopsychosocial best practice care. Measurement of biopsychosocial treatment orientation may therefore be incomplete. [ABSTRACT FROM AUTHOR]

The physician-patient relationship is important and essential to the delivery of effective healthcare. The current study examined a measure of this relationship, which we call the physician-patient working alliance (PPWA). We examined it from both perspectives of the medical dyad, simultaneously, which to date has not been done. Data were analyzed via the Actor Partner Interdependence Model to account for the possibility of interdependence in the ratings provided by each member of the dyad. The sample consisted of sixty-eight physician-patient dyads. Patients' ratings of the PPWA were significantly associated with their ratings of adherence to, and satisfaction with treatment. Physicians' ratings of the PPWA were significantly associated with their ratings of patient adherence and to their own satisfaction with treatment. Significant "partner" effects were uncovered, in that physicians' ratings of the PPWA were significantly associated with patients' ratings of adherence. Significant zero-order correlations were also observed for physician-rated outcome; particularly, significant correlations with patient-rated and physician-rated adherence. We conclude that the PPWA is a significant factor in patients' and physicians' ratings of adherence and satisfaction. This study also provides initial evidence that the PPWA is a dyadic phenomenon (e.g., the perception of the strength of the PPWA in one member of the medical dyad impacts the other member's perception) and that both parts of the medical dyad should be considered in future research and in clinical practice. [ABSTRACT FROM AUTHOR]

In this study, we investigated how women struggling with long-term pelvic girdle pain after giving birth experienced and coped in their daily life. We conducted individual interviews with 9 women with pain between 3 and 26 years after giving birth. We found that pelvic girdle pain results in significant challenges, influencing women's relationships with their children, partners and wider network. The pain demands careful planning and time for rest, influences women's ability to work, and creates feelings of isolation and shame. The informants connect the lack of formal diagnostic criteria for the condition to the low level of societal recognition. [ABSTRACT FROM AUTHOR]

To synthesize evidence on the effectiveness of mass media campaigns for the management of LBP on beliefs of the general public and health care providers, LBP-related disability, health utilization, and LBP clinical outcomes. Five electronic databases were searched from inception to December 17, 2019. Any studies evaluating the effectiveness of mass media campaigns for LBP were eligible. Primary outcome was general public LBP beliefs, while secondary outcomes included health care provider beliefs as well as LBP-related disability, health utilization, and clinical outcomes. The search resulted in 4,164 unique records, of which 18 studies were included. These 18 studies predominantly used quasi-experimental methods to evaluate seven LBP mass media campaigns conducted in seven countries. All studies evaluating LBP beliefs in the general public detected positive effects. Health care provider beliefs also consistently improved. Results for behavioural outcomes (disability behaviour and health utilization) were mixed and appeared dependent on campaign characteristics and local context. Mass media campaigns for LBP appear effective for improving beliefs of the general public and health care providers. Prospero CRD42018116797 Mass media campaigns about low back pain (LBP) appear effective for improving beliefs of the general public and health care providers, aligning beliefs with current evidence and self-management principles. Rehabilitation professionals should be aware of and seek to support public education initiatives in their communities related to LBP and other disabling health conditions. Rehabilitation professionals can highlight and reinforce campaign messages when providing education and reassurance to individual patients. Several campaign resources (i.e., posters, pamphlets, electronic resources, etc.) are available for rehabilitation professionals to use in their efforts to reduce disability related to LBP. [ABSTRACT FROM AUTHOR]

Increasingly, people turn to online sources for health information, creating human-non-human relationalities. Health websites are considered accessible in scope and convenience but can have limited capacity to accommodate complexities. There are concerns about who gets to 'assemble' with these resources, and who is excluded. Guided by Ahmed's socio-political theories of emotions, we questioned our feelings as we intra-acted with a consumer information website about back pain (MyBackPain). This encouraged us to approach resource evaluation in a way that alters conventional rational/cognitive judgement processes. Our inquiry was 'supra-disciplinary' involving public health, sociology, allied health and consumer collaborators. Specifically, we considered relationality – the feelings circulating between bodies/objects and implicated in MyBackPain's affective practices; impressions – the marks, images or beliefs MyBackPain makes on bodies/objects; and directionality – how these intra-actions pushed in some directions and away from others. Although Ahmed would likely not consider herself 'post-humanist', we argue that her socio-political theories of how objects and emotions entangle are of great interest to furthering critical post-human understandings of health. Rather than threatening decision-making, we suggest that feelings (and their affects) are central to it. The article demonstrates the productive potential of critical post-human inquiry in identifying/countering 'othering' possibilities, and catalysing a 'nomadic shift' towards new human-non-human formations. [ABSTRACT FROM AUTHOR]

To explore Nordic patients' ranking of the importance of different aspects of general practice. Patients ranked the importance of 47 statements reflecting five quality domains: communication, involvement, accessibility, continuity, and comprehensiveness. Nordic general practice. Patients ≥18 years in general practitioners waiting rooms. Items rated as important or very important by ≥ 90% in all countries were identified. Associations with patient characteristics were analysed by logistic regression. 209 Danish, 175 Norwegian, 129 Finnish, 112 Swedish and 82 Icelandic patients responded. Ten statements were ranked as important or very important by ≥90% in each country. Six pertained to communication, three to patient involvement and one to the comprehensiveness of care. No items regarding accessibility or continuity exceeded the 90% limit. The item most frequently rated as very important was 'I understand what the GP explains". Female patients were more likely to value personal treatment (OR = 2.9; 95%CI 1.5–5.5) and receiving instructions if things went wrong (1.7; 1.2–2.2). Older patients >65 years put less emphasis than those <35 on whether the GP takes them seriously (0.4; 0.3–0.5) and on the importance of instructions (0.5; 0.4–0.7). Patients with chronic diseases were less concerned (0.6; 0.4–0.8) with receiving instructions, but valued strongly that a GP knows when to refer (2.2; 1.5–3.3). Patients in all countries assigned high value to good communication. Availability was deemed important but came secondary to good communication. Organisational framework for general practice must allow for acceptable communication quality as well as availability. In order to identify relevant service areas for quality improvement in primary care, we aimed to increase knowledge of patient ranked importance of different dimensions of care. Nordic primary care patients valued good communication and involvement in decisions higher than accessibility to care. A singular focus on the access of care when developing services may not be in accordance with patient preferences. [ABSTRACT FROM AUTHOR]

Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However, no previous studies have explored clinicians' experiences of communicating their understanding of this diagnosis to their patients. Methods: A qualitative research design, using hermeneutic phenomenological methodology, was employed. Five participants were purposively recruited for the research and data collected via semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Emergent, super-ordinate and master themes were developed to help convey the qualitative significant meanings of the lived-through experiences. Findings: Three master themes were identified, with each comprising two sub-themes. These were: 1) Patient-centeredness (1a. Understanding the patient; and 1b. emotional awareness and adaptability); 2) Getting patients "on board" (2a. the "selling" process; and 2b. paternalism and the clinician's perspective); and 3) Dealing with conflict and uncertainty (3a. fear of interpersonal conflict; and 3b. personal doubts and uncertainty). Conclusions: Personal conflicts were identified between clinicians' descriptions of their wishes to "sell" their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients' beliefs. Building a good initial rapport, showing empathy and adapting approaches in response to perceptions of patients' reactions were perceived as strategies to help mitigate the risks of failed communication, but this was something for which participants felt unprepared by their prior training. [ABSTRACT FROM AUTHOR]

This study aimed to explore and compare the perceptions of patients and primary healthcare professionals regarding the management of chronic low back pain. Qualitative study using 26 semi-structured individual interviews, and one discussion group, carried out in primary care in Lleida, Spain. Patients and primary healthcare professionals both had assumptions pertaining to: (1) the diagnosis and meaning of chronic low back pain, (2) expectations regarding treatment for pain reduction, and (3) communication between primary healthcare professionals and patients with chronic low back pain. Results suggest a mutual dissatisfaction with the diagnosis of chronic low back pain and a lack of understanding between primary healthcare professionals and patients. Some contradictions between them were also noted: the patients wanted quick solutions to reduce their pain, but the primary healthcare professionals required an accurate etiology to prescribe treatment, and the patients did not always follow the primary healthcare professionals' recommendations. Diagnosing and treating chronic low back pain is compromised due to differing expectations and the communication barriers that exist between healthcare professionals and their patients. Primary healthcare professionals should be aware of the power of their explanations and recommendations to patients. Primary healthcare professionals should negotiate treatments with patients and adapt them to their individual needs, according to a Patient-Centered approach and the biopsychosocial model of pain. Primary healthcare professionals should explain to patients the underlying mechanisms and multifactorial nature of chronic low back pain. Primary healthcare professional-patient communication needs to be improved to help patients to better understand their chronic condition. The healthcare professionals in Spain should be more trained into the (bio)psychosocial model of long-term pain, stop searching for non-evident pathologies and change their biomedical beliefs. [ABSTRACT FROM AUTHOR]

Adolescent female victims of sexual assault must often disclose their victimization to trusted adults to seek positive physical and mental health outcomes; however, adolescent girls face unique barriers to disclosure, and they are less likely to disclose compared to adult women. Media interventions could be useful in motivating adolescent girls to feel more efficacious about disclosing sexual assaults. Self-efficacious messages in media that model disclosure behavior could motivate adolescent girls to feel more confident disclosing information about an assault and seeking positive health outcomes. This study used quasi-experimental methods to test the effect of a YouTube vlog containing a self-efficacy message about sexual assault disclosure. Results indicate that exposure to the self-efficacious message leads to higher sexual assault disclosure efficacy among adolescent girls who identify with self-efficacious media characters (B = -.0867, SE = .059, 95% CI [-.2318, -.0033]), albeit indirectly through perceived discrimination of sexual assault victims and approach coping behaviors. Appropriate interventions targeting disclosure of sexual assault by adolescent girls could include a more holistic view of disclosure and use new mediums like YouTube vlogs to deliver self-efficacious messages. [ABSTRACT FROM AUTHOR]

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Chronic pain is the leading cause of disability worldwide due to both a high prevalence and the associated health burden. Mass media campaigns can educate the public, promote evidence-based healthcare messages, and positively influence health behaviours. To evaluate the literature on mass media campaigns focusing on adults with chronic pain management to inform the design of future campaigns. A scoping review including literature from seven databases was undertaken. A narrative synthesis approach was used to identify the key features of all campaigns and gaps in knowledge. Twenty-five articles evaluating 11 mass media campaigns for pain management, targeting the public and/or healthcare providers were included. Most of the campaigns were on back pain from high-income, Western countries and were shown to produce small to moderate improvements in public beliefs and minimal positive change on public or provider behaviour. The key elements from campaigns include careful consideration for developing and testing key messages with a target audience. Both high and low-cost campaigns had produced similar improvements in campaign awareness. The use of social media as a mode of dissemination was relatively unexplored. Mass media campaigns on pain management may lead to positive changes in public and healthcare providers' beliefs and minimal effect on changing behaviours. Social media may have considerable potential as a low cost, high reach modality. Future pain campaigns conducted in other contexts (e.g. low and middle-income countries) and targeted populations (e.g. culturally and linguistically diverse communities) are needed. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study was to identify how low-income older women with disabilities perceive pain, pain management, and communication with healthcare providers. We interviewed 26 low-income women (average age 75 years; SD 7.0), eliciting the following overarching themes: "Invisibility of Pain: Unnoticed or Undetected," "Escalating Pain Leads to Help Seeking," "Communication with Healthcare Providers and Outcomes," "Pain Management Facilitates Function and Accomplishment," and "The Intersection of Pain, Disability, and Depressive Symptoms." Study findings support the ways in which behavior changes from pain can impede pain management. [ABSTRACT FROM AUTHOR]

Sacroiliac joint (SIJ) pain has been identified as a primary or contributing source of pain in patients with low back pain. The Laslett cluster of SIJ pain provocation tests has the strongest evidence for noninvasive clinical testing. The purpose of this report was to describe the impact of physical therapy treatments for a patient postpartum with SIJ pain who satisfied the Laslett cluster. Specifically, the goal was to assess the impact of progressive pelvic floor muscle exercise and manual therapy. The Modified Oswestry Low Back Pain Disability Questionnaire (MODI) was the primary outcome measure used in this case. In addition, the Numeric Pain Rating Scale (NRPS) and Global Rating of Change (GROC) were used as secondary outcome measures. In this case report, the patient responded to the combined interventions with decreases in MODI, NRPS and GROC. Further research is warranted to develop stronger evidence to identify specific interventions for the treatment of SIJ pain. [ABSTRACT FROM AUTHOR]

Person-centred care (PCC) for people living with HIV (PLWH) is a global goal for WHO and the UNAIDS strategy. We aimed to develop a novel person-centred intervention for community providers, test the feasibility of participant recruitment and retention, intervention delivery and to establish acceptability. Findings from qualitative interviews with PLWH and healthcare professionals were mapped onto a PCC theory in an expert intervention development workshop. A parallel feasibility cluster randomised controlled trial (cRCT) was conducted. We randomly assigned clusters (1:1) either to intervention or to standard care. The primary outcome was trial recruitment and retention. We screened 83 PLWH, enrolled 60 with 30 allocated to each arm. Recruitment and retention rates were 87% and 97%, respectively. Potential effect size achieved at final timepoint: a measure of person-centred outcomes [0.7 (95% CI 0.17–1.23) p < 0.001]; MOSHIV [0.7 (95% CI 0.17–1.23) p < 0.001]; Patient Experience Questionnaire [0.8 (95% CI 0.27–1.31) p < 0.001]; CARE Measure [1.0 (95% CI 0.45–1.55) p < 0.001], POSITIVE OUTCOMES [0.7 (95% CI 0.17–1.23) p < 0.001]. Post-trial interviews revealed general acceptability of the intervention. The results confirm the feasibility and justify a definitive cRCT of the enhanced care intervention to improve person-centred outcomes for PLWH. Trial registration number ISRCTN13630241. [ABSTRACT FROM AUTHOR]

This work is based on data from a qualitative research study of multiply body modified individuals in the greater San Francisco Bay Area. Participant narratives produced emergent findings of significant life stress, and traumatic events, in the lives of multiply body modified individual. The following publication provides original data regarding the domains of post-traumatic growth as expressed by multiply body modified individuals in their life narrative. Of the five domains (new paths, personal strength, appreciation, increased spirituality, and closer relationships) the most frequent that was reflected in their body modification was an increased sense of personal strength. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to translate and culturally adapt The Pelvic Girdle Questionnaire to Swedish, and to evaluate the construct and discriminative validity. Materials and methods: A translation and cultural adaptation process was performed according to international guidelines. Pilot tests were conducted among 16 women during pregnancy and post-partum. Analysis of the construct and discriminative validity of the Swedish version of the Pelvic Girdle Questionnaire was performed in a sample of 177 pregnant women suffering from pain in the lumbo-pelvic area. Participants completed the Pelvic Girdle Questionnaire along with Oswestry Disability Index, numeric rating scales for pain intensity and for pelvic girdle pain concerns. Results: The Swedish version of the Pelvic Girdle Questionnaire showed high internal consistency with Cronbach's alphas between 0.82 and 0.96, good convergent validity with high correlations with the Oswestry Disability Index and the pain intensity numeric rating scale, whereas moderate correlation was shown between the concerns numeric rating scale and the other instruments as hypothesized. Receiver operating characteristic curves showed good discriminatory capacity for women in need of treatment. Conclusions: The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability. It has good construct and discriminative validity for measurements of consequences of pregnancy-related pelvic girdle pain among Swedish speaking women. Pregnancy-related pelvic girdle pain may be disabling and long-lasting, however treatable when identified. The Pelvic Girdle Questionnaire is the only condition-specific, reliability tested and validated questionnaire for pelvic girdle pain. The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability, good construct validity for pelvic girdle pain among Swedish speaking women, and shows good discriminative capacity for women in need of treatment. [ABSTRACT FROM AUTHOR]

Islam constitutes the world's second largest religious group. In the United Kingdom (UK), Islam is the second largest religion after Christianity; the largest group of Muslims in the UK is of Pakistani heritage. This qualitative practice-based research study used Interpretative Phenomenological Analysis to explore the experiences of six second-generation Pakistani Muslim men (SGPMM) who had completed cognitive-behavioural therapy (CBT) in the UK. Three superordinate themes were generated: "Pre-CBT difficulties," "The process of CBT," and "The interaction between CBT and Islam." This paper elaborates the second theme, "The process of CBT," as the researchers believe it offers the strongest implications for clinical practice and research. This theme captures participants' thoughts and feelings about the process of their therapy, and further consists of four sub-themes: "Experience of therapeutic dialogue: Guide or conversation?" "Experience of matching: Tailor or taboo?" "Benefits of CBT: Simple tools, big impact, enlightenment", and "Limitations of CBT: Problems with language." These findings seek to inform counselling psychologists and services working with SGPMM, to contribute meaningfully to existing research literature, and to encourage future research. [ABSTRACT FROM AUTHOR]

Non-pharmacological means are being developed to enhance cognitive abilities in drug abusers. This study evaluated virtual reality (VR) as an intervention tool for enhancing cognitive and vocational outcomes in 90 young ketamine users (KU) randomly assigned to a treatment group (virtual reality group, VRG; tutor-administered group, TAG) or wait-listed control group (CG). Two training programmes with similar content but different delivery modes (VR-based and manual-based) were applied using a virtual boutique as a training scenario. Outcome assessments comprised the Digit Vigilance Test, Rivermead Behavioural Memory Test, Wisconsin Cart Sorting Test, work-site test and self-efficacy pre- and post-test and during 3- and 6-month follow-ups. The VRG exhibited significant improvements in attention and improvements in memory that were maintained after 3 months. Both the VRG and TAG exhibited significantly improved vocational skills after training which were maintained during follow-up, and improved self-efficacy. VR-based cognitive training might target cognitive problems in KU. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a knowledge translation exercise by sharing knowledge from a scoping review, describing physiotherapists' attitudes toward and beliefs about chronic pain, and to gain perspectives on these findings from physiotherapists working with this clientele. Method: We conducted three focus groups with a total of 14 outpatient physiotherapists working in public hospitals. We first showed a video (reflecting an encounter between a clinician and a person living with chronic pain) created based on themes that emerged from a scoping review we conducted, followed by a discussion about attitudes and beliefs toward chronic pain. The sessions were audio-taped and transcripts were analyzed through descriptive and thematic analysis. Results: The consultations reinforced three core themes related to physiotherapists' attitudes toward and beliefs about chronic pain: 1) the development of chronic pain; 2) the relationship to disability and the legitimacy of chronic pain; and 3) physiotherapists' ability to manage psychological aspects of their patient's pain. Conclusion: Physiotherapists in our sample appear unsure of how to interpret severe pain within the context of minimal objective findings. Physiotherapists may benefit from training on how to assess and treat psychosocial factors associated with pain. [ABSTRACT FROM AUTHOR]

Objective: Explore the perceptions of patients and health care professionals about patients' ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs). Design: Cross-sectional questionnaire study of participants in planned consultations. Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden. Subjects: Pairs of patients and GPs (n = 156), patients and DNs (n = 73), and patients and PTs (n = 69). Main outcome measures: Multiple-choice questions about patients' ICE and satisfaction. Results: Approximately 75% of patients and GPs reported that patients' thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation. Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were. Patient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making. In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation. Health care professionals thought patients' experiences were more negative than they were. This discrepancy was observed in responses to questions about patients' concerns, expectations and satisfaction. [ABSTRACT FROM AUTHOR]

Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patients with a recent acute coronary syndrome. State gratitude for one's health 2 weeks post-event was associated with increased physical activity (measured via accelerometer) 6 months later, controlling for relevant demographic, social, medical and psychological factors (β = 340.9; 95% confidence interval = 53.4–628.4; p =.020). Gratitude for one's life was associated with increased self-reported medical adherence at 6 months on the maximally adjusted model (β =.60; 95% confidence interval =.16–1.04; p =.008); no gratitude items were associated with rehospitalizations. In contrast, dispositional gratitude, measured by the Gratitude Questionnaire-6, was less dynamic and responsive to change over the 6-month period and was not associated with physical activity. [ABSTRACT FROM AUTHOR]

Objectives: To assess the attitudes and beliefs of physiotherapists (PTs) regarding the management of chronic LBP and to investigate the factors which influence them. Methods: A cross-sectional study conducted in the French Loire Valley region by a questionnaire sent to the private PTs between June and September 2014. Demographic data and modalities of practices were collected in association with the Pain Attitudes and Beliefs Scale (PABS) which is a specific self-administered questionnaire designed to assess the "biomedical" or "behavioral" (i.e., biopsychosocial) management orientation of PTs toward chronic LBP. Results: One hundred and sixty-eight of the 704 PTs entirely completed the questionnaire (63% of men, 58% >40 years of age) of whom 15 were involved in a LBP care network. A higher biomechanical score was observed with a higher age and lower with full-time employment, less than 20 years of length of practice and a recent LBP-specific training (p < 0.005). Belonging to a LBP care network was associated with a lower biomedical score (p < 0.01) and a higher biopsychosocial score (p < 0.005). Conclusions: Belonging to a LBP care network, which implies closer collaboration with multidisciplinary rehabilitation teams, was the most significant factor associated with higher biopsychosocial beliefs in PTs toward chronic LBP management. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence and severity of subjective health complaints and describe illness perception in a population of Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type. Method: This study was a postal survey with a questionnaire battery on demographic data, subjective health complaints inventory, and illness perception. A total of 110 individuals diagnosed with Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type from two specialized hospitals in Norway were offered participation. Further, 140 gender- and age-matched healthy controls from statistics Norway representing the general population were sent the questionnaire for reference. Results: Overall response rate was 30.4% (n = 76), with 44.5% (n = 49) in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type and 19.3% (n = 27) in controls. Subjective health complaints were significantly higher in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type - than in the controls (32.06 vs. 11.08; p < 0.001). Further the brief illness perception questionnaire indicated that the adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type had low understanding of their illness and symptoms (understanding, mean: 3.93, SD 2.88), and reported to have moderate personal and treatment control over their illness. Conclusion: Adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported higher frequency and severity of subjective health complaints than the matched controls from the general adult population in Norway. Furthermore, Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported low understanding of their illness and associated symptoms, and moderate belief that their illness can be kept under control through self-management or treatment. This may indicate one of the reasons why prognosis for these patients is poor. Implications for rehabilitation: Awareness of the complexity of the subjective health complaints and inquiry into illness perception could contribute with valuable information about these patients' perceptions of their condition. Such information could in its turn be of value for clinicians as they work towards facilitating a more holistic treatment approach, for example patient education and cognitive behavioural therapy. [ABSTRACT FROM AUTHOR]

The exposure of first responders to emergencies and disaster puts them at high risk of experiencing vicarious trauma. First responders are typically male and literature suggests that a negative connotation of masculinity creates a stigma that leads to low help-seeking behaviour and poorer psychological outcomes. This study examines Filipino dimensions of masculinity namely perceived cognitive ability, sense of community, and assertive dominance and how these dimensions predict adaptive coping and its outcomes. Surveys of 135 male first responders reveal that perceived cognitive ability and sense of community positively predict adaptive coping. Results also support the hypothesis that adaptive coping mediates the relationship of perceived cognitive ability, and sense of community positively with psychological well-being. However, there was no relationship between assertive dominance and adaptive coping. Rather, assertive dominance predicted vicarious trauma. The results contribute to the literature by showing that masculinity ideologies have both positive and negative relationships with mental health. This has implications on how emergency organizations can help support first responders. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate differences in pain, risk profile, self-reported and tested function between health care workers and school- and kindergarten workers with musculoskeletal pain and to examine differences in pain and function when the two vocational groups were categorised according to risk profile and pain category. Methods: There were 403 health care workers or school- and kindergarten workers included in the cross-sectional study. Pain, risk profile and self-reported and tested function were measured with questionnaires and a functional evaluation. Differences between and within the two vocational groups were analysed using independent t-test. Non-parametric Mann–Whitney U test was used for non-parametric data. Results: Health care workers have statistically significant higher prevalence of high-risk individuals, while school- and kindergarten workers have statistically significant higher prevalence of individuals with widespread pain. Participants categorised as having high risk of long-lasting pain had statistically significant higher pain intensity and poorer self-reported and tested function compared to low-risk individuals. Conclusion: Categorisation based on pain distribution and especially risk profile has an impact on both pain intensity and function, irrespective of occupation. [ABSTRACT FROM AUTHOR]

Study Design: Case Study.Background and Purpose: Low back pain is a common condition managed by physical therapists (PT). Screening tools have been developed to assist the PT with medical screening of patients for serious disease. Sinister pathologies may present as musculoskeletal symptoms during the patient examination. It is important for the PT to frequently reevaluate their patient’s response to therapeutic interventions and refer for further evaluation if they are not responding to conservative care.Case Description: This case reports on the history and examination findings of a 36-year-old male presenting with recurrent low back pain. An emphasis is placed on the therapist’s understanding and use of screening tools when interviewing patients and determining when medical referral may be indicated based on the patients history and examination findings. A review of the evidence on the diagnostic accuracy of screening strategies for malignancy in patients presenting with low back pain is presented.Conclusion: Sinister causes for low back pain are extremely rare. It is important that PTs be familiar with specific signs and symptoms that may indicate serious pathology when evaluating patients with low back pain. Identification of two red flags from this patient’s history leads the clinician to refer the patient back to their primary care provider (PCP) for further investigation. They included: 1) the patient’s inability to improve after one month and 2) clinicians’ judgment. Use of “clinical judgment” may assist the PT in determining if their patient needs further investigation. [ABSTRACT FROM PUBLISHER]

While previous cross-sectional studies have found that negative beliefs about low back pain are associated with pain intensity, the relationship between back beliefs and persistent low back pain is not well understood. This cohort study aimed to examine the role of back beliefs in persistent low back pain in community-based individuals. A hundred and ninety-two participants from a previous musculoskeletal health study were invited to take part in a two-year follow-up study. Beliefs about back pain were assessed by the Back Beliefs Questionnaire (BBQ) at baseline and low back pain intensity was measured by the Chronic Pain Grade Questionnaire at baseline and follow-up. Of the 150 respondents (78.1%), 16 (10.7%) reported persistent high intensity low back pain, 12 (8.0%) developed high intensity low back pain, in 16 (10.7%) their high intensity low back pain resolved and 106 (70.7%) experienced no high intensity low back pain. While participants were generally positive about low back pain (BBQ mean (SD) = 30.2 (6.4)), those with persistent high intensity pain reported greater negativity (BBQ mean (SD) = 22.6 (4.9)). Negative beliefs about back pain were associated with persistent high intensity low back pain after adjusting for confounders (M(SE) = 23.5 (1.6) vs. >30.1 (1.7),p < .001). This study found negative back beliefs were associated with persistent high intensity low back pain over 2 years in community-based individuals. While further longitudinal studies are required, these findings suggest that targeting beliefs in programs designed to treat and prevent persistent high intensity low back pain may be important. [ABSTRACT FROM PUBLISHER]