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Purpose: Literature shows promising effects for interdisciplinary biopsychosocial rehabilitation programs in patients with chronic low back pain (CLBP). Not every patient needs an interdisciplinary rehabilitation trajectory provided in a secondary care setting. Patients with moderate complex psychosocial complaints might benefit from biopsychosocial interventions offered in primary care under supervision of a physician in rehabilitation medicine (i.e. biopsychosocial integrated care intervention). This study investigated the feasibility and effectiveness of such intervention in patients with CLBP with moderate complex psychosocial complaints. Methods: mixed-method. Patients (aged 18-65 years, low back pain ≥12 weeks, moderate complex psychosocial complaints) received the intervention (4 individual sessions, 8 group sessions) provided by trained primary care physiotherapists. Physicians in rehabilitation medicine provided one consultation afterwards. Data from patients (n¼18), physicians (n¼4) and physiotherapists (n¼12) were used. Results: Physiotherapists were satisfied with the training. Patient attendance was good for individual sessions, less for groups. Physiotherapists sufficiently delivered the intervention, although recruitment and contextual factors influenced delivery. Patients reported significantly reduced functional disability (Quebec Back Pain Disability Scale) post-treatment (-8.3, 95% CI -13.3 to -2.7) and at 3months follow-up (-7.6, 95% CI -12.9 to -2.2). Conclusions: A biopsychosocial integrated intervention is feasible and potentially effective in patients with CLBP. [ABSTRACT FROM AUTHOR]

Objective: The first aim of this study was to determine whether adolescents with asymptomatic Generalized Joint Hypermobility (GJH) have a lower level of physical functioning (physical activity level, muscle strength and performance) compared to non-hypermobile controls. Secondly, to evaluate whether the negative impact of perceived harmfulness on physical functioning was more pronounced in adolescents with asymptomatic GJH. Methods: Cross-sectional study. Sixty-two healthy adolescents (mean age 16.8, range 12–21) participated. Hypermobility (Beighton score), perceived harmfulness (PHODA-youth) and muscle strength (dynamometry), motor performance (Single-Leg-Hop-for-Distance) and physical activity level (PAL) (accelerometry) were measured. Hierarchical regression analyses were used to study differences in physical functioning and perceived harmfulness between asymptomatic GJH and non-hypermobile controls. Results: Asymptomatic GJH was associated with increased knee extensor muscle strength (peak torque/body weight; PT/BW), controlled for age and gender (dominant leg; ß = 0.29; p =.02). No other associations between asymptomatic GJH and muscle strength, motor performance and PAL were found. Perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH. Conclusions: Adolescents with asymptomatic GJH had increased knee extensor muscle strength compared to non-hypermobile controls. No other differences in the level of physical functioning was found and the negative impact of perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH. [ABSTRACT FROM AUTHOR]

Introduction: Healthy people often experience headache, cognitive failures, or mental fatigue. Some people even experience these symptoms on a level comparable to patients with mild spectrum brain injuries. In these individuals, the fear-avoidance model explains symptoms as a consequence of catastrophizing and fear-avoidance toward mental activities. This experimental study investigated in healthy adults whether fear-avoidance and catastrophizing about mental activities are related to fear-avoidance behavior (i.e., behavioral avoidance of mental activities) according to the fear-avoidance model. Method: A randomized crossover within-subject design was used with two measurements and 80 participants. Participants were exposed to three demanding cognitive tasks and their simplified counterparts. Post-concussion symptoms, catastrophizing, fear-avoidance, behavioral avoidance (time spent working on cognitive tasks), exposure to mental activity, depression, heart rate, and state-trait anxiety were assessed. Results: Significant correlations between the variables of the fear-avoidance model were found. Furthermore, catastrophizers spent less time on difficult tasks compared to easy tasks. Both catastrophizing and female sex predicted time spent on difficult tasks, whereas only female sex predicted time spent on easy tasks. Conclusions: This study found that, according to the fear-avoidance model, catastrophizing is related to behavioral avoidance of cognitively challenging tasks in a community sample. [ABSTRACT FROM AUTHOR]

To compare the effectiveness of a biopsychosocial primary care intervention (Back on Track) with primary care physiotherapy as usual in patients with chronic low back pain (CLBP) experiencing low complex psychosocial complaints. A double-blind multicentre pilot-randomised controlled trial. Twenty-five patients (≥18 years) with non-specific CLBP (≥12 weeks) experience low psychosocial complaints and a low to moderate level of disability. The Back on Track intervention (four individual and eight group sessions) versus physiotherapy as usual (maximally 12 individual sessions). Primary outcome: functional disability (Quebec Back Pain Disability Score) at post-treatment and 3 months follow-up. Anxiety, depression, catastrophizing, pain intensity, kinesiophobia, self-efficacy, global perceived effect. Effects were analysed using linear mixed model analysis. No significant differences in functional disability were found between interventions at post-treatment (mean difference 0.10, 95% CI: −12.9 to 13.1) and 3 months follow-up (mean difference −5.4, 95% CI −19.1 to 8.3). Secondary outcomes also showed no significant differences. No differences in effects were found between patients with CLBP experiencing low complex psychosocial complaints who receive the Back on Track intervention compared to patients receiving primary care physiotherapy as usual. Well-powered studies of sufficient methodological quality are needed to detect differences in effects. [ABSTRACT FROM AUTHOR]

Purpose: To assess the factor structure, related constructs and internal consistency of the Child Activity Limitation Interview 21-Child version for use in Dutch-language countries. Methods: Cross-sectional validation study: After forward and back translation of the Dutch version of the Child Activity Limitation Interview 21-Child adolescents (11-21 years old) with chronic musculoskeletal pain completed an assessment. The assessment contained the Dutch Child Activity Limitation Interview, and questionnaires about demographics, pain intensity, functional disability, anxiety and depression. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain intensity, activity limitations, anxiety and depression as comparative constructs. Results: Seventy-four adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 50% of the variance. Internal consistency was good (Cronbach's α = 0.91 total scale, α = 0.90 Factor 1, α = 0.80 Factor 2). All nine hypotheses were confirmed. Conclusion: The Dutch version can be used to assess pain-related disability in Dutch-speaking adolescents comparable to the study sample. Scores on both subscales provide insight into the severity of the pain-related disability in both daily routine and more physically vigorous activities. Implications for Rehabilitation: Chronic pain is a disabling disorder which not only impacts physically but restricts quality of life. This study provides clinicians a questionnaire to measure pain-related disability and quantify the impact of pain on the daily living of adolescents. The advantage of the Dutch version of the Child Activity and Limitations Interview over other measurements is that it can distinguish limitations in daily activities from more physically vigorous activities. [ABSTRACT FROM AUTHOR]

Objective: Painful diabetic neuropathy (PDN) is known to negatively affect quality of life. Being physically active is a crucial part of successful diabetes self-management, but regimen adherence is often low. Coping strategies and fears have shown to be related to less physical activity (PA). The aim of the present study was to obtain more in-depth information on psychological risk factors leading to less PA in persons with PDN. Design: Three semi-structured focus group interviews were conducted with a representative sample of persons with PDN (N = 12). Data were transcribed verbatim and analysed using a hybrid method of thematic analyses and a grounded theory approach. Main Outcome Measures: Fears and coping strategies related to PA in persons with PDN. Results: Several specific fears were identified; fear of hypoglycaemia, fear of pain increase, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity, and fear of negative evaluation by others. To cope with these fears, avoidance, remaining active, cognitive distraction, and acceptance strategies were described. Conclusion: In persons with PDN, diabetes-related fears and pain-related fears play a role in less engagement in PA, indicating the need for new methods for improving self-management in persons with PDN. [ABSTRACT FROM AUTHOR]

Background: Fear of pain is important in the development and maintenance of chronic pain. The Fear of Pain Questionnaire-Child version has been developed to assess pain related fear in children and adolescents.Objective: Translating the original questionnaire into Dutch, and investigating internal consistency and construct validity to enable use in the Dutch pain rehabilitation setting for treatment and research.Methods: Cross-sectional validation study: After forward and back translation of the FOPQ-C, adolescents (11-22 years old) with chronic musculoskeletal pain completed an assessment containing the Dutch Fear of Pain Questionnaire, and questionnaires about demographics, pain catastrophizing, functional disability, and pain intensity. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain catastrophizing, functional disability, and pain intensity as comparative constructs.Results: Eighty-six adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 43% of the variance. Internal consistency was strong (Cronbach’s α = 0.92 total scale, α = 0.88 factor 1, and α = .86 factor 2). Five out of 6 hypotheses were confirmed.Conclusions: The Dutch version demonstrated good internal consistency and good construct validity in a population of adolescents with chronic musculoskeletal pain. Implications for rehabilitation The Fear of Pain Questionnaire-Child version was developed to measure fear of pain and avoidance in children and adolescents with chronic pain.Identification of fear of pain and activities that are being avoided are important during screening and assessment of the adolescent for chronic pain rehabilitation treatment.The presence of fear of pain and/or avoidance behavior is important information to shape and target multidisciplinary rehabilitation treatment. [ABSTRACT FROM AUTHOR]

Background:A minority of patients with mild traumatic brain injury (mTBI) experience a persistent symptom complex also known as post-concussion syndrome. Explanations for this syndrome are still lacking. Objective:To investigate if the fear avoidance model, including catastrophizing thoughts and fear avoidance behaviour, poses a possible biopsychosocial explanation for lingering symptoms and delay in recovery after traumatic brain injury (TBI) with special focus on mTBI. Design:Cross-sectional study. Participants:48 patients with TBI, of which 31 patients with mTBI, had persistent symptoms (mean time since injury 48.2 months); 92% of the entire sample fulfilled the criteria for post-concussion syndrome. Outcome variables:catastrophizing, fear-avoidance, depression and post-concussion symptoms. Results:High levels of catastrophizing were found in 10% and high levels of fear avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour, depressive symptoms and post-concussion symptoms correlated significantly with each other (p < 0.05). Conclusion:The fear-avoidance model proposes a possible explanation for persistent symptoms. Validation and normative data are needed for suitable measures of catastrophizing and fear avoidance of post-concussion symptoms after TBI. Longitudinal prospective cohort studies are needed to establish its causal and explanatory nature. [ABSTRACT FROM PUBLISHER]

An editorial is presented on the chronic pain in European population. It expresses the view that in line with an ageing population, the number of people with disability from CMP is rapidly increasing. An overview of the secondary and tertiary care, (rehabilitation) physicians and their teams will assist primary care by a focus on a select patient group with complex pain related disability is presented.

In patients with chronic low back pain (CLBP), a patient's level of physical functioning is evaluated to determine the impact of pain on physical functioning. It appears that in various performance tests the influence of non-physiological factors differs. It is unclear which performance tests are best suited for measurement of maximum capacity or pain-related behaviour. The main aim of the present review is to highlight the influence of psychological factors during different types of performance testing in patients with CLBP. The degree in which pain-related and psychological factors influence test outcome differs between performance tests. A minimum influence of pain intensity and psychological factors is found in (sub)maximal exercise testing in patients who are able to complete the test. The influence of pain intensity and psychological factors is most prominent in holding endurance tasks evaluating the duration a patient can hold a certain weight. In order to decide which assessment tool for physical performance can best be used for the evaluation of physical functioning in patients with CLBP, one should specifically consider the question that has to be answered. In case a patients' physical capacity has to be objectified, another assessment tool seems preferred compared with a situation in which a patient's pain-related behaviour is aimed to be assessed. [ABSTRACT FROM AUTHOR]

Purpose: To compare physical activity levels of adolescents and young adults with chronic pain with that of healthy participants. To investigate the impact of pain intensity, pain catastrophizing and depressive symptoms on the level of physical activity and disability of adolescents and young adults with chronic pain. Methods: Case-control study. Levels of physical activity and disability of adolescents and young adults with chronic non-specific musculoskeletal pain (n = 42) were compared with that of healthy participants (n = 42). For participants with chronic pain, measures of pain catastrophizing, pain intensity and depression were examined for their ability to explain levels of physical activity and disability. Statistics: multivariate regression analysis, Mann-Whitney testing, Pearson correlation analysis. Results: Participants with chronic pain were as active as healthy participants (p = 0.22) (confidence interval [CI] 95%), although they seemed to be less active in sports and heavy-loaded activities. Pain intensity (ß = 0.32) and depressive symptoms (ß = 0.36) contributed significantly to disability (CI 95%). There was no significant association between physical activity and disability (CI 95%). Conclusions: Chronic non-specific musculoskeletal pain is a disabling condition for adolescents and young adults. The level of physical activity in the daily life of adolescents and young adults with chronic pain is comparable to that of healthy counterparts, although the performance of sports and heavy-loaded activities seems diminished. Both pain intensity and depressive symptoms are disabling. [ABSTRACT FROM AUTHOR]

Introduction: In the last decade new treatments based on mental imagery have been developed for patients with stroke. Whether this therapy works for patients with neglect is currently unclear. Objective: To investigate whether patients with a right hemisphere stoke complicated with unilateral neglect were less capable of performing motor imagery as compared to patients with a right hemisphere stroke without unilateral neglect. Methods: In a patient-control study, 20 patients with a right hemisphere stroke were included. Twelve patients were diagnosed on admission with neglect and eight without neglect. The ability to perform motor imagery was tested using mental rotation tasks, based on either a visual (CMIA ''Hand Rotation'' test) or a verbal (Questionnaire d''Imagerie Mentale: Rotation des Mains) instruction. In both tasks subjects were instructed to generate a mental image of their hand. Results: Patients with neglect scored significantly less ( p == 0.02) as compared to patients without neglect on the visual mental rotation task, but not on the mental rotation task with verbal instruction. Conclusion: Patients with a right-hemisphere stroke and neglect seem less capable of performing visual mental rotation tasks in comparison to patients with a stroke without neglect. [ABSTRACT FROM AUTHOR]