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Background: Injuries are the cause of professional and social deactivation. The rehabilitation program provided under Social Security prevention pension enables earlier rehabilitation measures., Objective: The study's aim was to determine the efficiency of the rehabilitation as a part of Social Security prevention pension in the group of patients after limb injuries depending on the time when rehabilitation was undertaken., Methods: The study was a retrospective data analysis, based on medical histories of 93 patients after injuries, rehabilitated as part of Social Security prevention pension from January 2016 until July 2017. The effects of rehabilitation were assessed in 2 groups: early (up to 6 months from the injury) and late rehabilitation (over 6 months). Medical effects are based on measurements of the motion range in extremities' joints, functional test results and final evaluation of the rehabilitation., Results: For both groups, the motion range of most joints improved. Improvement among the group of early rehabilitated patients concerned everyday activities (p = 0.035), the results of medical rehabilitation (p = 0.046) and also the results of the functional tests., Conclusion: Comprehensive rehabilitation of patients after the injuries in Social Security prevention pension leads to better medical effects. The results are better for earlier rehabilitated patients.

Importance: It is hard for policy makers and health professionals to develop musculoskeletal rehabilitation strategies because secular trends for musculoskeletal rehabilitation by region and country remain unknown., Objective: To evaluate the secular trends in global musculoskeletal rehabilitation needs by sex, age, region, country, and health condition., Design, Setting, and Participants: This cross-sectional study included data from 191 countries and territories from the World Health Organization Rehabilitation Need Estimator between January 1, 1990, and December 31, 2019. Data analyses were performed from February to May 2021., Main Outcomes and Measures: Prevalence and years lived with disability (YLDs) of musculoskeletal disorders in need of rehabilitation, overall and by sex, age, region, country, and health condition. Trends in rehabilitation needs were evaluated by the estimated annual percentage changes (EAPCs) in age-standardized rates. Pearson correlation analysis was used to examine the associations between EAPCs and the age-standardized rates in 1990. The associations between the age-standardized rates and universal health coverage (UHC) effective coverage index were assessed by fitting a restricted cubic spline in a linear model., Results: From 1990 to 2019, the global number of prevalent cases of musculoskeletal disorders in need of rehabilitation increased from 1060.6 (95% uncertainty interval [UI], 1009.1-1116.4) million to 1713.6 (95% UI, 1632.4-1800.4) million, with a steady increase in the number of YLDs from 93.9 (95% UI, 67.7-123.6) million to 149.0 (95% UI, 107.5-198.6) million. Overall, 55 countries and territories (28.8%) had annual increase in age-standardized prevalence rates, and 18 countries and territories (9.4%) had annual increase in YLD rates. The global age-standardized prevalence and YLD rates of musculoskeletal disorders decreased annually with EAPCs of 0.34 (95% CI, -0.37 to -0.31) and 0.42 (95% CI, -0.51 to -0.32), respectively. Specifically, the global age-standardized prevalence and YLD rates decreased for low back pain (prevalence: EAPC, -0.52; 95% CI, -0.57 to -0.47; YLD: EAPC, -0.52; 95% CI, -0.66 to -0.37), fractures (prevalence: EAPC, -0.35; 95% CI, -0.41 to -0.30; YLD: EAPC, -0.42; 95% CI, -0.65 to -0.19), other injuries (prevalence: EAPC, -0.75; 95% CI, -0.82 to -0.68; YLD: EAPC, -1.04; 95% CI, -1.38 to -0.71), and amputation (prevalence: EAPC, -0.64; 95% CI, -0.73 to -0.55; YLD: EAPC, -1.13; 95% CI, -1.60 to -0.65). The age-standardized prevalence rate decreased for neck pain (EAPC, -0.10; 95% CI, -0.18 to -0.02) but increased for osteoarthritis (EAPC, 0.13; 95% CI, 0.06-0.19) and rheumatoid arthritis (EAPC, 0.37; 95% CI, 0.04-0.70). In contrast, the age-standardized YLD rates remained stable for neck pain (EAPC, -0.09; 95% CI, -0.35 to 0.16), osteoarthritis (EAPC, 0.14; 95% CI, -0.14 to 0.42), and rheumatoid arthritis (EAPC, 0.38; 95% CI, -0.40 to 1.16). The age-standardized prevalence rate of neck pain decreased faster in male individuals, with an EAPC of -0.10 (95% CI, -0.19 to -0.02), while the age-standardized prevalence rate of low back pain decreased faster in female individuals, with an EAPC of -0.55 (95% CI, -0.60 to -0.51). EAPCs were significantly associated with the baseline age-standardized rates (prevalence: ρ = -0.49; P < .001; YLD: ρ = -0.55; P < .001), except for those of neck pain and rheumatoid arthritis. Excess rehabilitation needs were observed in countries with both higher and lower UHC effective coverage indexes (prevalence: β = 749.04; SE, 288.52; P = .01; YLD: β = 49.70; SE, 22.89; P = .03)., Conclusions and Relevance: In this cross-sectional study, substantial increases in musculoskeletal rehabilitation needs were found across locations, suggesting rehabilitation needs have become a global health concern. Mitigating risk factors, strengthening rehabilitation in primary health care, and allocating sufficient funds are encouraged to satisfy rehabilitation needs.

Background: Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury., Methods: To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific)., Findings: Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34-2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235-392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588-636] and 83 million YLDs [62-106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68-1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed., Interpretation: To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need., Funding: Bill & Melinda Gates Foundation., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article published under the CC BY-NC-ND 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)

Objective: Functional outcome represents the most central objective of rehabilitation programs. Understanding which factors could affect functional status at discharge is crucial for the planning of appropriate treatments in both neurologic and orthopedic patients. The aim of this study was to investigate which clinical and demographic variables, collected at the patient's admission, could influence the functional outcome, assessed by the modified Barthel Index (mBI), at discharge., Design: A retrospective study was conducted on a large cohort (n = 3548) of orthopedic and neurologic patients. Functional, demographic, and clinical records at patient admission and mBI score at discharge were collected. General linear model analysis was performed to assess the influence of these variables on functional outcome at discharge., Results: The results reported a significant effect of mBI score at admission (P < 0.0001), age (P < 0.0001), and time from the acute event (P < 0.0001) on mBI score at discharge. Moreover, the disease type (neurologic or orthopedic) adjusted by sex (male or female) and presence of different impairments (cognitive and behavioral impairments) and complications (hypertension and cardiovascular diseases) significantly influenced mBI score at discharge (P < 0.05) (R2 = 0.497). No significant interactions between other factors were found (P > 0.05)., Conclusion: Several prognostic factors should be considered when planning an appropriate tailored rehabilitation program., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: Low back pain (LPB) is a prevalent rheumatic and musculoskeletal disease and patients often experience physical discomfort and functional limitations. This study aimed to evaluate how subjective suffering relates to illness perceptions, pain intensity and psychological morbidity as well as to understand the mediator (direct and indirect) effects on functional disability., Methods: A cross-sectional study with 125 patients who received physiotherapy and answered the following instruments: Illness Perception Questionnaire-Revised; Illness Subjective Suffering Inventory; Hospital Anxiety and Depression Scale and the Oswestry LBP Incapacity Questionnaire., Results: In the structural equation modeling analysis, subjective suffering totally mediated the relationship between both emotional response (estimate = 0.068, 95% highest posterior density interval [HPDI] = [0.017, 0.133]), consequences (estimate = 0.118, 95% HPDI = [0.035, 0.211]) and functional disability. The relationship between coherence and disability was partially mediated by subjective suffering (estimate = -0.067, 95% HPDI = [-0.134, -0.016]). Only identity and pain intensity showed direct effects on functional disability., Conclusion: Intervention in patients with LBP should focus on subjective suffering to reduce functional disability, providing information and promoting the acceptance of disease and pain., (© 2020 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Objective: To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric., Design: Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets., Setting: Swiss national public rehabilitation outcome quality reports on the clinic level., Participants: A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18 047 patients., Interventions: Neurological or musculoskeletal rehabilitation., Main Outcome Measures: Functional Independence Measure™ or Extended Barthel Index., Results: Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric's content with ICF Core Sets suggests to include 'energy and drive functions' or 'maintaining a basic body position' to enhance the content of functioning as an indicator., Conclusions: A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS' ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation., (© The Author(s) 2020. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background Symptoms of fatigue have been shown to be associated with heightened levels of disability in patients suffering from a wide range of debilitating health and mental health conditions. The role of fatigue as a determinant of work disability in individuals with work-related musculoskeletal disorders (WRMD) has received little attention. The present study examined the role of fatigue as a determinant of work-disability in individuals with WRMDs. Methods Participants included 117 individuals with WRMDs who completed measures of pain severity, fatigue, depression and disability before and after participating in a behavioral activation rehabilitation intervention. Results Cross-sectional analyses on pre-treatment measures revealed that fatigue contributed significant variance to the prediction of self-reported disability, beyond the variance accounted for by pain severity and depression. Prospective analyses revealed that reductions in fatigue through the course of treatment predicted occupational re-engagement following termination of the intervention. Conclusions The results of the present study suggest fatigue contributes to occupational disability, independent of the effects of pain and depression. The findings also suggest that meaningful reductions in fatigue might be achieved through psychosocial interventions that promote gradual re-integration into discontinued activities, increase participants' exposure to success and achievement experiences, and reduce the severity of depressive symptoms. Behavioural activation interventions such as the one used in the present study might contribute to more positive occupational outcomes in work-disabled individuals who report high levels of fatigue.

Background: Musculoskeletal impairments (MSI) are a major global contributor to disability. Evidence suggests entrenched cyclical links between disability and poverty, although few data are available on the link of poverty with MSI specifically. More data are needed on the association of MSI with functioning, socio-economic status and quality of life, particularly in resource-poor settings where MSI is common., Methods: We undertook a case-control study of the association between MSI and poverty, time use and quality of life in post-conflict Myanmar. Cases were recruited from two physical rehabilitation service-centres, prior to the receipt of any services. One age- (+/- 5 years of case's age) and sex- matched control was recruited per case, from their home community. 108 cases and 104 controls were recruited between July - December 2015. Cases and controls underwent in-depth structured interviews and functional performance tests at multiple time points over a twelve-month period. The baseline characteristics of cases and controls are reported in this manuscript, using multivariate logistic regression analysis and various tests of association., Results: 89% of cases were male, 93% were lower limb amputees, and the vast majority had acquired MSI in adulthood. 69% were not working compared with 6% of controls (Odds Ratio 27.4, 95% Confidence Interval 10.6-70.7). Overall income, expenditure and assets were similar between cases and controls, with three-quarters of both living below the international LMIC poverty line. However, cases' health expenditure was significantly higher than controls' and associated with catastrophic health expenditure and an income gap for one fifth and two thirds of cases respectively. Quality of life scores were lower for cases than controls overall and in each sub-category of quality of life, and cases were far less likely to have participated in productive work the previous day than controls., Conclusion: Adults with MSI in Myanmar who are not in receipt of rehabilitative services may be at increased risk of poverty and lower quality of life in relation to increased health needs and limited opportunities to participate in productive work. This study highlights the need for more comprehensive and appropriate support to persons with physical impairments in Myanmar.

Objective: To characterize the Physical Therapy Services delivered at the Polyclinic during the Rio 2016 Paralympic Games., Design: Retrospective Cohort Study., Setting: Physical Therapy Services (PTS) of the Polyclinic., Participants: Athletes attended for Physical Therapy treatment at the Polyclinic during Rio 2016 Paralympic Games., Main Outcome Measures: The number of athletes treated, their nationalities, their sports modality, the most frequently treated regions and the interventions applied., Results: A total of 4504 interventions were delivered and 399 athletes were treated in the PTS. Athletes representing athletics and sitting volleyball were the most frequently attended for treatment. The main diagnoses were muscle tension and tendinopathy. Analgesia was the main purpose of treatment and myofascial release and electrotherapy was the most frequent interventions. Recovery service had a total of 1579 encounters and male athletes used cryo-immersion 3 times more when compared to female., Conclusion: Athletes representing athletics and sitting volleyball were the most frequently attended for treatment and the thoracic/lumbar spine and pelvis/hip were the most commonly affected regions. Muscle strain and tendinopathy were the most frequent diagnoses and myofascial release and electrotherapy were the most frequent therapies used to achieve analgesia., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders., Method: This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively., Results: The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders' concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers' diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker's capacities were essential for return-to-work success., Conclusion: These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions. Implications for rehabilitation Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker's capacities, is important for return-to-work success. Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities. Rehabilitation professionals should also be constantly watching for workers' and employers' return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

Objective: To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation called the Physical Work Performance Evaluation (PWPE)., Design: Cross-sectional., Setting: Outpatient rehabilitation., Participants: Adults (N=50) participating in physical therapy for musculoskeletal conditions., Interventions: Not applicable., Main Outcome Measures: Patients completed the PWPE and the WD-FAB physical function scales including Changing and Maintaining Body Position, Whole Body Mobility, Upper Body Function, and Upper Extremity Fine Motor. The physical therapist also answered the WD-FAB questions on the patient's physical functioning. The WD-FAB computer-adaptive test version administered up to 10 items for each scale. The PWPE produces ratings from 0 to 5 indicating overall Level of Work ability: 0 (unable to work); 1 (sedentary); 2 (light); 3 (medium); 4 (heavy); 5 (very heavy). The PWPE also produces Level of Work ability ratings in the Dynamic Strength, Position Tolerance, and Mobility subsections., Results: Participating in the study were 50 patients with 1 or more conditions (shoulder, n=21; knee, n=16; low back, n=13; ankle/foot, n=10; neck, n=8; hip, n=7). The patient-based WD-FAB scores demonstrated moderate, statistically significant correlations with the provider proxy WD-FAB report (R=.49-.65). The WD-FAB Upper Body Function scale scores demonstrated moderate strength relationships with the PWPE overall ratings. The Whole Body Mobility and Changing and Maintaining Body Position scales did not demonstrate statistically significant relationships with the PWPE overall ratings., Conclusions: We found moderate evidence for validity for the WD-FAB Upper Body Function, Whole Body Mobility, and Changing and Maintaining Body Position scales relative to clinician report and varied evidence relative to the PWPE in this clinical sample., (Copyright © 2018 American Congress of Rehabilitation Medicine. All rights reserved.)

Background: An accurate diagnosis of the leading health condition and comorbidities is a prerequisite for safe and effective rehabilitation. The problem of diagnostic errors in physical and rehabilitation medicine (PRM) has not been addressed sufficiently. The responsibility of a referring physician is to determine indications and contraindications for rehabilitation., Aim: To assess the rate of and risk factors for inaccurate referral diagnoses (RD) in patients referred to a rehabilitation facility. We hypothesized that inaccurate RD would be more common in patients: 1) referred by non-PRM physicians; 2) waiting longer for the admission; 3) older patients., Design: Retrospective observational study., Population: One thousand randomly selected patients admitted between 2012 and 2016 to a day-rehabilitation center (DRC)., Setting: University DRC specialized in musculoskeletal diseases., Methods: On admission all cases underwent clinical verification of RD. Inappropriateness regarding primary diagnoses and comorbidities were noted. Influence of several factors affecting probability of inaccurate RD was analyzed with multiple binary regression model applied to 6 categories of diseases., Results: The rate of inaccurate RD was 25.2%. Higher frequency of inaccurate RD was noted among patients referred by non-PRM specialists (30.3% vs. 17.3% in cases referred by PRM specialists). Application of logit regression showed highly significant influence of the specialty of a referring physician on the odds of inaccurate RD (joint Wald Test χ2 (6)=38.98, P value =0.000), controlling for the influence of other variables. This may reflect a suboptimal knowledge of the rehabilitation process and a tendency to neglect of comorbidities by non-PRM specialists. The rate of inaccurate RD did not correlate with time between referral and admission (joint Wald Test of all odds ratios equal to 1, χ2 (6)=5.62, P value =0.467), however, mean and median waiting times were relatively short (35.7 and 25 days respectively). A high risk of overlooked multimorbidity was revealed in elderly patients (all odds ratios for variable age significantly higher than 1). Hypotheses 1 and 3 were confirmed., Conclusions: Over 25% of patients referred to DRC had inaccurate RD. Risk factors for inaccurate RD include referral by a non-PRM specialist and elderly age., Clinical Rehabilitation Impact: Verification of RD should be routinely introduced to PRM practice.

Purpose Although functional restoration programs appear effective in assisting injured workers to return-to-work (RTW) after a work related musculoskeletal (MSK) disorder, the addition of Motivational Interviewing (MI) to these programs may result in higher RTW. Methods We conducted a cluster randomized controlled trial with claimants attending an occupational rehabilitation facility from November 17, 2014 to June 30, 2015. Six clinicians provided MI in addition to the standard functional restoration program and formed an intervention group. Six clinicians continued to provide the standard functional restoration program based on graded activity, therapeutic exercise, and workplace accommodations. Independent t tests and chi square analysis were used to compare groups. Multivariable logistic regression was used to obtain the odds ratio of claimants' confirmed RTW status at time of program discharge. Results 728 workers' compensation claimants with MSK disorders were entered into 1 of 12 therapist clusters (MI group = 367, control group = 361). Claimants were predominantly employed (72.7%), males (63.2%), with moderate levels of pain and disability (mean pain VAS = 5.0/10 and mean Pain Disability Index = 48/70). Claimants were stratified based on job attachment status. The proportion of successful RTW at program discharge was 12.1% higher for unemployed workers in the intervention group (intervention group 21.6 vs. 9.5% in control, p = 0.03) and 3.0% higher for job attached workers compared to the control group (intervention group 97.1 vs. 94.1% in control, p = 0.10). Adherence to MI was mixed, but RTW was significantly higher among MI-adherent clinicians. The odds ratio for unemployed claimants was 2.64 (0.69-10.14) and 2.50 (0.68-9.14) for employed claimants after adjusting for age, sex, pain intensity, perceived disability, and therapist cluster. Conclusion MI in addition to routine functional restoration is more effective than routine functional restoration program alone in improving RTW among workers with disabling MSK disorders.

The assessment of work functioning is important to define needs in the context of vocational rehabilitation. The International Classification of Functioning, Disability, and Health (ICF) serves as a framework to describe functioning and health. In reference to the ICF, work functioning can be described as consisting of work activities and work participation. A range of instruments are used in rehabilitation practice to assess work functioning. The purpose of this systematic review was to identify questionnaires measuring work functioning with reference to the ICF and to describe these instruments, their linkage to the ICF, and their psychometric properties. Instruments should be suitable for individuals with musculoskeletal disorders. Web of Science and PubMed were searched for English and German studies published between 2001 and 2015. We focused on self-reported questionnaires measuring work functioning with reference to the ICF. Sixteen questionnaires fulfilled the inclusion criteria. The instruments varied in their linkage to the ICF and in their focus on work functioning. Questionnaires measuring concrete work activities differ from instruments measuring aspects of work participation in terms of absenteeism. The Work Rehabilitation Questionnaire is the instrument covering most ICF categories. The results show a range of different instruments that could be useful in certain settings. The description and comparison of the questionnaires can help to choose appropriate instruments in practice.

Meta-analyses of rehabilitation studies in chronic back pain patients in Germany showed a lack of sustainability of rehabilitation programs. The German Pension Insurance therefore developed an intensified aftercare program to support rehabilitation outcomes. The aim of this study was to compare disability pension rates, income from regular employment, and duration of welfare benefits in patients with and without rehabilitation aftercare. We used administrative data on finished rehabilitation services. Patients were included if they were aged 18-60 years, had musculoskeletal disorders, and attended an outpatient or an inpatient rehabilitation program during the first term of 2007. Patients were excluded if they received an old-age pension, started a disability pension before January 2008, or died during the follow-up period. Patients with rehabilitation aftercare were matched by propensity scores with patients without rehabilitation aftercare. Estimation of the propensity score considered 20 potential confounders. There were no differences in the cumulative probability of receiving a disability pension. Moreover, patients with and without aftercare did not differ in their income from regular employment and the duration of different types of welfare benefits during the follow-up period. However, stratified analyses found a positive effect of an aftercare program on income in patients who attended a postacute rehabilitation program and patients who were at least 3 months absent because of sickness during the year preceding the initial rehabilitation program. Only patients with strong impairments benefit from attending an aftercare program. Allocation to aftercare programs and the focus on exercise only have to be reconsidered and revised.

Background: Musculoskeletal impairments (MSI) are the leading contributor to global years lived with disability. Comparable epidemiological data on MSI is lacking, and are needed to inform health and rehabilitative services. This study aimed to estimate the prevalence and causes of MSI in Telangana State, India., Method: A population-based survey used probability proportionate to size and compact-segment sampling to select 51 clusters of 80 individuals (all ages). Participants were screened using seven questions and any participant who screened positive underwent standardized examination by a physiotherapist for MSI presence, severity and diagnosis. Data were also collected on vision and hearing impairment, depression and self-reported difficulties with physical functioning., Results: The prevalence of MSI was 19.6% (95% CI: 16.7-22.8%) and this increased with age. The majority (82%; 574/699) of MSI was classified as mild, 11% as moderate and 7% as severe. Over half (57%) of MSI diagnoses were acquired non-traumatic causes, with degenerative joint disease being the most common. There was a high unmet need for physiotherapy services (3% attended vs. 40% recommended). One-fifth (21%) of MSI cases also had at least one of vision (10%) or hearing (11%) impairment or depression (3%)., Conclusions: MSI is common among persons living in Mahabubnagar District, particularly older adults. These estimates can inform public health initiatives for the planning of health and rehabilitation services., (© The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: An important task of our institute is to support social reintegration: including occupational rehabilitation of patients suffering from chronic musculoskeletal diseases with decreased working ability., Aim: The aim of the authors was to provide informations of their daily practice, how they perform patient education, giving information for their patients about their disease, the rehabilitation possibilities, how they support the patients with decreased working ability to take part in their own rehabilitation., Method: Patients taking part in in-patient rehabilitation received teaching and education about their disease and rehabilitation options in groups. Patients interested in part-time jobs were individually interviewed by a 30-120 minutes talk about their educational level and training, social conditions and about the available part time jobs. The part time jobs were available with the help of the Motivation Foundation of the National Association of the Societies of Motion Disabled, and the Alfa Rehabilitation Nonprofit Rt. The data of patients receiving in-patient rehabilitation betwen the 1st of January 2009 and 31st of December 2014 were analyzed., Results: Out of the 230 patients seeking our help for part time job, our social service could organise jobs for 180 disabled persons, all town-inhabitants, but was unsuccesful in getting jobs for patients living in villages and separated farms., Conclusion: Part time jobs can be organized for musculoskeletal disabled living in cities and towns. For village-dwellers there are no suitable jobs and working places. It is necessary to organize rehabilitation working possibitities for musculoskeletal disabled patients living in villages. Orv Hetil. 2017; 158(17): 662-667.

Objectives: This study investigated the mediating role of coping strategies in the relationship between caregiver burden and depressive symptoms among family caregivers caring for disabled older adults with musculoskeletal (MSK) conditions., Methods: The cross-sectional data were from a quota sampling of 494 pairs of disabled older adults and their primary family caregivers in Shanghai, China. The disabled older adults had MSK conditions and limitations in activities of daily living. The mean ages of the older adults and their caregivers were 83.9 and 62.6 years. Path analysis was conducted to test the proposed hypotheses., Results: Caregivers of adults with MSK conditions were more likely to use active coping to handle time dependence (β [SD]=0.182 [0.055]) and physical burden (β [SD]=0.226 [0.071]) and to use avoidant coping to handle developmental burden (β [SD]=0.414 [0.061]). Both coping strategies were used to handle social burden(active: β [SD]=0.179 [0.078]; avoidant: β [SD]=0.241 [0.073]). Experiencing emotional burden reduced the likelihood of using both coping strategies (active: β [SD]=-0.266 [0.066]; avoidant: β [SD]=-0.373 [0.062]). Active coping had a protective impact on depressive symptoms (β [SD]=-0.228 [0.050]), whereas avoidant coping had an adverse impact on depressive symptoms (β [SD]=0.232 [0.053])., Conclusions: The findings confirm the mediating effects of coping strategies in the relationship between caregiver burden and depressive symptoms., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Work-related medical rehabilitation (WMR) is a strategy to improve work participation in patients with poor work ability. This review summarizes the state of knowledge on WMR. The prevalence of poor work ability and corresponding need for WMR is high (musculoskeletal disorders: 43%; mental disorders: 57%). The meta-analysis of randomized controlled trials in patients with musculoskeletal disorders shows better return to work outcomes after one year in favor of WMR patients than compared to patients participating in usual medical rehabilitation. The amount of work-related measures in rehabilitation was clearly increased during recent years. A direct involvement of the workplace and a closer cooperation with employers and occupational health physicians may further improve the outcomes of WMR., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To explore factors that might be relevant when designing a triage tool., Design: A mixed-methods study using multivariable logistic regression analysis to identify significant factors associated with requiring different levels of care, and qualitative focus groups exploring views of patients and physiotherapy clinicians regarding case complexity., Setting: A community-based adult musculoskeletal service delivering tier 1 (standard physiotherapy) and tier 2 care (complex care beyond the scope of standard physiotherapy) and providing onward referral to orthopedic clinics (tier 3)., Participants: Quantitative data were extracted from a random sample of patients (N=484) who had received treatment for musculoskeletal conditions. Patients and physiotherapists who had received care or who worked in the service participated in focus groups., Interventions: Not applicable., Main Outcome Measures: Themes that emerged from focus groups were compared against predictors of requiring complex care found to be significant (P<.05) after quantitative data analysis., Results: A total of 184 patients (38.0%; 95% confidence interval, 33.8-42.4) received complex care. Peripheral joint problems, unclear diagnosis, and symptoms affecting sleep were significant independent predictors of requiring complex care. These data supported some of the main themes raised at focus groups., Conclusions: A substantial proportion of patients receive tier 2 complex care. Further studies are needed to evaluate whether the predictive factors found to be significant in our study might be useful for developing a tool for more effective triage to the most appropriate tier of musculoskeletal care., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: As the population with a disability increases both in number and life expectancy, so does its demand for health services. Very little original research has been done in Mexican populations regarding the effect of disability on quality of life., Objectives: 1) Assessing the subjective quality of life of patients with neuromusculoskeletal and movement-related function disabilities and, 2) Analyzing the possible effect of the medical condition (diseases of the nervous system vs. diseases of the musculoskeletal system and connective tissue) and its interaction with sex and age., Methods: In a cross-sectional design 330 participants were recruited from a public institution in Mexico providing specialized outpatient rehabilitation. After signing informed consent they responded a brief sociodemographic questionnaire and the WHOQOL-BREF scale., Results: In general quality of life levels were satisfactory. Female and elderly patients with diseases of the nervous system were particularly affected in the physical and psychological dimensions. Women with diseases of the nervous system also showed a negatively affected social quality of life. Elderly with diseases of the musculoskeletal system and connective tissue scored the lowest in general health perception., Conclusions: Even though most patients were quite satisfied with their quality of life, not all aspects or cases have such positive perceptions; both the physical and psychological dimensions were particularly negative in female and elderly patients with nervous system diseases. Clinicians would do well to thoughtfully assess patients in these groups and adjust treatment to achieve the greatest possible rehabilitation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Health related rehabilitation is instrumental in improving functioning and promoting participation by people with disabilities. To make clinical and policy decisions about health-related rehabilitation, resource allocation and cost issues need to be considered., Objectives: To provide an overview of systematic reviews (SRs) on economic evaluations of health-related rehabilitation., Methods: We searched multiple databases to identify relevant SRs of economic evaluations of health-related rehabilitation. Review quality was assessed by AMSTAR checklist., Results: We included 64 SRs, most of which included economic evaluations alongside randomized controlled trials (RCTs). The review quality was low to moderate (AMSTAR score 5-8) in 35, and high (score 9-11) in 29 of the included SRs. The included SRs addressed various health conditions, including spinal or other pain conditions (n = 14), age-related problems (11), stroke (7), musculoskeletal disorders (6), heart diseases (4), pulmonary (3), mental health problems (3), and injury (3). Physiotherapy was the most commonly evaluated rehabilitation intervention in the included SRs (n = 24). Other commonly evaluated interventions included multidisciplinary programmes (14); behavioral, educational or psychological interventions (11); home-based interventions (11); complementary therapy (6); self-management (6); and occupational therapy (4)., Conclusions: Although the available evidence is often described as limited, inconsistent or inconclusive, some rehabilitation interventions were cost-effective or showed cost-saving in a variety of disability conditions. Available evidence comes predominantly from high income countries, therefore economic evaluations of health-related rehabilitation are urgently required in less resourced settings., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions., Methods: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised., Results: Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling "normal", motivation and optimism, redefining self and escapism from everyday boundaries., Conclusions: Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions., Implications for Rehabilitation: Individuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity. It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity. Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered. Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual's barriers to physical activity. A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.

Background: Occupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons' perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy., Methods: Twenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach., Results: At the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process., Conclusions: The occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse and uncertain for most participants. The providers of occupational rehabilitation program should balance this reorientation with specific steps towards return to work. Effect studies and long-term qualitative studies evaluating how this affects long-term work- and health outcomes are underway.

Purpose: When it is possible that the employee's work ability can be restored through treatment or rehabilitation, disability pension in Finland is granted for a fixed period. We examined which factors are associated with return to work (RTW) after such temporary disability pension., Methods: The study included all Finnish residents whose temporary disability pension from the earnings-related pension system started in 2008 (N = 10,269). Competing risks regression analysis was applied to examine register-based determinants for RTW after temporary disability pension due to mental disorders, musculoskeletal diseases, other diseases, and injury over a 4-year follow-up period., Results: The overall cumulative incidence of RTW was 25%. RTW was more probable after temporary disability pension due to injury and musculoskeletal diseases and less probable after temporary disability pension due to mental disorders. Younger age and higher education increased RTW but differences between genders, private and public sector employees, and occupational classes were relatively small. The probability of RTW was higher among those who were employed before their temporary disability pension (subhazard ratio in multivariate analysis 2.41 (95% CI 2.13-2.72) and among the 9% who participated in vocational rehabilitation during their pension [SHR 2.10 (95% CI 1.90-2.31)]. With some exceptions, the results were fairly similar for all diagnostic causes of temporary disability pension., Conclusion: Return to work after temporary disability pension was relatively uncommon. Nevertheless, in all diagnostic groups RTW continued for the whole follow-up period. The low educated and those not employed before temporary disability pension need more support in their RTW. The strong association between vocational rehabilitation and RTW suggests that increasing rehabilitation among those with impaired work ability may promote RTW.

Purpose: First, to evaluate the trajectories of physical and mental functioning in individuals with chronic disabilities receiving adapted physical activity-based rehabilitation. Second, to determine whether demographic factors, disability group, pain, fatigue and self-efficacy at baseline influenced these trajectories., Research Design: A prospective intervention study., Methods: The study included 214 subjects with chronic disabilities who were admitted to a four-week adapted physical activity-based rehabilitation stay at Beitostølen Healthsports Centre. The subjects completed written questionnaires eight and four weeks before the rehabilitation, at admission to and discharge from the rehabilitation centre and again four weeks and 12 months after discharge. Multilevel models were performed to examine the trajectories of SF-12 physical and mental functioning with possible predictors., Results: Time yielded a statistically significant effect on physical and mental functioning (p < 0.001). Low age (p = 0.002), no more than 2 h of personal assistance per week (p = 0.023), non-nervous system disability (p = 0.019), low pain level (p < 0.001) and high chronic disease-efficacy (p = 0.007) were associated with higher physical functioning. There was a greater improvement in physical functioning for subjects with lower chronic disease-efficacy at baseline (p = 0.036) and with a disability not associated with the nervous system (p = 0.040). Low fatigue (p = 0.001) and high chronic disease-efficacy (p = 0.004) predicted higher mental functioning. There was also a greater improvement in mental functioning for subjects with high fatigue (p =0.003) and low chronic disease efficacy at baseline (p = 0.032)., Conclusion: Individuals with chronic disabilities who participated in an adapted physical activity-based intervention showed statistically significant increases in both physical and mental functioning across the 12 months after the intervention. The greatest improvement was among subjects with a high level of fatigue and low chronic disease-efficacy, as well as disabilities not associated with the nervous system, which has implications for the target groups in future rehabilitation.

Objective: In a work rehabilitation context, we assessed occupational therapists' (OTs) shared decision-making (SDM) behaviors with individuals having persistent pain and explored factors influencing SDM behaviors., Methods: A cross-sectional study that used audio-recordings of work rehabilitation consultations between OTs trained in SDM and a convenient sample of patients. Eligible patients were: off work for ≥12 weeks due to persistent pain associated with a musculoskeletal disorder, starting a work rehabilitation program, and French speaking. Transcripts were analyzed using the Observing Patient Involvement in Shared Decision Making (OPTION) instrument and assessed patients' decisional conflict and socioeconomic status., Results: Of 15 OTs trained in SDM, 11 (90% female), provided audiotaped SDM meetings with 37 patients (40.5% female; aged 18-62 years). Their average OPTION score was 53.94 out of 100 (SD=9.68; range 35.42-70.83), indicating basic skills. Significant factors associated with OPTION scores (R (2)adjusted=21.7%) were the interview length (p=0.008) and level of patient education (p=0.038)., Conclusion: Basic SDM behaviors were integrated in the practice of OTs trained in SDM., Practice Implications: Evaluating SDM behaviors is a step toward providing OTs with performance feedback toward achieving client-centered care., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR., Methods: A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4-8 months of disability, N = 373), intermediate duration (ID: 9-18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness., Results: At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88%), work retention (overall 80%), and additional healthcare utilization (overall, 2.2% of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64% in medical costs, and up to 80% in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56% lower when administered early. Overall, ER resulted in estimated cost savings of up to 72% (or almost $170,000 per claim)., Conclusions: Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of "last resort".

Study Design: An analysis of prospectively collected data., Objective: To evaluate how patient-reported insomnia, in patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), responds to a functional restoration program (FRP), and to investigate the relationships among insomnia, psychosocial factors, medication use, and post-FRP socioeconomic outcomes., Summary of Background Data: Insomnia is commonly reported by patients with chronic pain., Methods: A consecutive sample of 262 patients with predominant chronic spinal pain was assessed with the insomnia severity index (ISI) at program admission and discharge. Groups were formed on the basis of the ISI total scores, from no clinically significant insomnia to severe clinical insomnia (SCI). Patient-reported psychosocial measures were administered, medication information was collected, and ISI discharge score categories were compared with 1-year post-FRP socioeconomic outcomes. The Wilcoxon signed rank, repeated measures ANOVAs, ANOVAs and χ tests were performed., Results: The degree of clinical insomnia at admission significantly predicted program completion, P < 0.001. Mean ISI scores improved from admission (M = 17.2) to discharge (M = 10.6, P < 0.001), but a relatively high percentage of patients (36.6%) still reported moderate to severe insomnia symptoms at discharge. The prevalence of SCI decreased by 18.4%, but this remaining group still reported more pain, disability, and depressive symptoms, and demonstrated more use of opioids, sedatives, and antidepressants (P ≤ 0.01), compared with the other insomnia groups at discharge. One year later, only 56% of the patients with severe insomnia at discharge had retained work, whereas 71% to 93% of those with lesser sleep disturbance were still working (P < 0.001). Those with SCI at discharge were 10.4 times less likely to be working than those without clinically significant insomnia., Conclusion: Although insomnia improved for the majority of patients with chronic disabling occupational musculoskeletal disorder, a relatively high percentage continued to report clinically significant insomnia at FRP discharge. Patients with SCI reported more pain, depression, and disability, used more medication, and had poorer work outcomes 1-year post-FRP., Level of Evidence: 2.

Disability is strongly associated with musculoskeletal conditions such as arthritis, low back pain and other soft tissue and joint disorders. The burden of these conditions may become exponentially high in the absence of rehabilitation. To understand disability, the ICF (International Classification of Functioning, Disability and Health) provides the framework to disentangle the different domains that comprise disability. Disability in ICF term is defined as an impairment of the body functions and body structure and limited activity and restricted participation and can be influenced by environmental and personal factors. The ICF can provide the domains of disability pertinent to individuals with musculoskeletal conditions by using ICF Core Sets. Musculoskeletal-related disability is amenable to rehabilitation and there is evidence to suggest the effectiveness of multidisciplinary forms of rehabilitation programs. Community-based programs as an extension of rehabilitation also have evidence to improve clinical and quality of life outcomes in people with musculoskeletal conditions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

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.

U.S. military physical therapists have a proud history of providing medical care during operational deployments ranging from war to complex humanitarian emergencies. Regardless of austerity of environment or intensity of hostility, U.S. military physical therapists serve as autonomous providers, evaluating and treating service members with and without physician referral. This perspective article suggests that the versatility of U.S. military physical therapist practice enables them not only to diagnose musculoskeletal injuries but also to provide a wide range of definitive care and rehabilitation, reducing the need for costly evacuation. War is not sport, but the delivery of skilled musculoskeletal physical therapy services as close to the point of injury as possible parallels the sports medicine model for on- or near-field practice. This model that mixes direct access with near-immediate access enhances outcomes, reduces costs, and allows other health care team members to work at the highest levels of their licensure.

Purpose: To assess internal consistency and construct validity of the French version of the Revised Illness Perception Questionnaire adapted for Work Disability (IPQR-WD)., Method: A cross sectional study was conducted in rehabilitation centers and private clinics in the Montreal region of Canada, involving 43 men and women, French speaking, absent from work between 3 months and a year due to musculoskeletal disorders. The 9 dimension IPQR-WD and the following eight-related instruments for construct validity were administered: Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Psychological Distress Index (PDI-14), Pain Disability Index (PDI), Self-Efficacy for Return to Work Scale (SERWS), Pain Beliefs and Perceptions Inventory (PBPI), Implicit Models of Illness Questionnaire (IMIQ) and a Visual Analog Scale for pain intensity (VAS)., Results: Calculations of Cronbach's α (from 0.58 to 0.87) revealed satisfactory internal consistency of the IPQR-WD dimensions. Multiple regression analyses were performed with each IPQR-WD dimension and significant independent variables. Final models explained a good proportion of the variance (adjusted r(2) = 0.33-0.70) for each dimension, except for the Cyclical timeline dimension for which associations became non-significant after adjusting for gender, age and length of sick leave. The SERWS and the VAS were not significantly associated to any of the IPQR-WD dimensions., Conclusions: Moderate to strong correlations were found with six-related instruments which support the multidimensional nature of the IPQR-WD and its unique contribution as one simple questionnaire that can assess representations related to work disability. [Box: see text].

Background: The purposes of this study were to reveal the prevalence of locomotive syndrome (LS) evaluated by loco-check in the Japanese general population and to analyze the relationship between radiographic knee osteoarthritis (OA) and lumbar spondylosis, metabolic syndrome and LS. Furthermore, we evaluated LS according to functional examinations., Methods: Seven hundred twenty-two volunteers aged 56.6 ± 13.6 years participated in the Iwaki Health Promotion Project in 2010 and were classified into two groups: LS (one or more disabilities) or non-LS (no disability) according to the criteria of LS proposed by the Japanese Orthopaedic Association. Radiographic knee OA and lumbar spondylosis were defined according to the Kellgren-Lawrence grade. Metabolic syndrome was defined as the presence of two or more risk factors in addition to visceral obesity. The prevalence of LS associated with knee OA, lumbar spondylosis and metabolic syndrome was compared statistically. Also, data of six functional examinations were compared between the non-LS and LS groups., Results: The prevalence of LS was 21.2 % in males and 35.6 % in females and increased with aging regardless of gender. The prevalence of LS with knee OA was 48.7 %, with lumbar spondylosis was 33.8 %, and with metabolic syndrome was 43.4 %. The non-LS group had significantly better performance in the functional reach and sit and reach tests than the LS group in males and females by age-adjusted comparison., Conclusion: The prevalence of LS in the general population was higher in females than in males. A strong risk factor for LS was radiographic knee OA. Also, those with LS had loss of skeletal muscle mass, balancing and flexibility. This study showed that evaluation by loco-check was an acceptable tool to detect the early stage of locomotive disability for LS, and interventional prevention for strength, balancing and flexibility would be helpful for those with LS.

Background: Orthopedic rehabilitation is a major entity in rehabilitation. Due to coming demographic changes and its challenges concerning mobility of elderly patients it will increase. The criticism on orthopedic rehabilitation in Germany focuses on its missing evidence in therapeutic eff ectiveness especially in chronic low back pain. This overall-criticism is actually no more valid as there are a number of studies showing eff ectiveness of orthopedic treatment in rehabilitation if psychosocial comorbidities are respected and treatment is focussed on occupational training and eintegration., Goals: This overview describes the actual situation in orthopedic rehabilitation and its research., Results: The need for orthopedic rehabilitation will increase over the next years due to demographic changes. Important fi elds in orthopedic rehabilitation research are chronic low back pain, new rehabilitation models with focus on occupational reintegration, rehabilitation in elderly and following joint surgery as well as the analysis of health-care-system changes due to disease related groups., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To assess the differential effect of personal and work-related psychosocial, physical and organizational determinants by gender on time to return-to-work (RTW) following long-term disability., Methods: Data come from a larger study conducted in the province of Quebec, Canada. A cohort of 455 adults on long-term disability due to work-related musculoskeletal disorders at the back/neck/upper limb was followed for 5 years through structured interviews and administrative databases. Left-truncated Cox regression modeling stratified by gender was used to assess time to a first partial or full RTW of at least 3 days., Results: Survival curves of time to RTW were similar between men and women on long-term disability (log-rank test p value = 0.920) but many personal and occupational factors influencing RTW differed by gender. Women's risk factors included older age (HR = 0.734--in 10 years unit), poor to very poor perceived economic status (HR = 0.625), working ≥40 h/week and having dependents (HR = 0.508) and awareness of workplace-based occupational health and safety program (HR = 0.598); higher gross annual income (in $10,000 s) was a facilitator (HR = 1.225). In men, being over 55 years old (HR = 0.458), poor perceived economic status (HR = 0.653), working ≥40 h/week and high perceived physical workload (HR = 0.720) and higher job insecurity (HR = 0.825) negatively influenced time to RTW. For both men and women, probabilities of not returning to work varied widely according to workers' specific profile of personal and occupational factors (high or low risk profile)., Conclusion: Results confirm the importance of gender-sensitive strategies to investigate RTW determinants from a gender perspective.

Background: The decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance., Methods: A study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression., Results: The rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence., Conclusions: There is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

Objectives: We examined the rate of functional change (using performance measures and a self-report questionnaire) during interdisciplinary occupational rehabilitation in workers' compensation claimants with a variety of musculoskeletal conditions. We also estimated the rate of improvement that could be considered clinically important and examined factors associated with rate of functional improvement., Methods: A prospective cohort design was used, with data collected before and after claimants participated in an interdisciplinary occupational rehabilitation program. A consecutive sample was formed of claimants admitted between July 2005 and June 2007. Measures included performance-based functional measures (functional capacity evaluation, FCE) and a self-report questionnaire (pain disability index, PDI)., Results: The sample included 582 compensation claimants with a variety of musculoskeletal conditions. The majority of claimants experienced functional improvement during rehabilitation. Claimants with the outcome status 'Return-to-Work Pre-accident' had the highest rate of functional change (up to 5 kg/week on floor to waist lifting, ~7 points/week on the PDI)., Conclusion: The clinically important rate of functional change appears to be 5 kg/week on FCE floor-to-waist lifting and 7 points/week on the PDI (scored out of 100). Rate of functional change appears to be multifactorial, with a variety of physical, demographic, clinical, and environmental factors explaining rate of change.

Background: While patients' satisfaction with rehabilitation care is often measured, the knowledge of their experiences during delivery of care and of which characteristics may lead them to experience problems remains largely undocumented., Aim: To assess the quality of patients' experiences receiving post-acute care for musculoskeletal disorders in outpatient rehabilitation settings. To describe the extent to which variations in reported quality of patients' experiences were related to their characteristics., Design: A cross sectional, self-reported survey., Setting: 3 outpatient rehabilitation units., Population: Four hundred sixty-five outpatients. Mean age 39.4 (SD=11.9)., Methods: A problem score (from 0 to 100%) of self-reported experiences was calculated on 7 specific aspects of care (belonging to organizational environment and professionals' attitudes and behaviors) and compared among participants' subgroups., Results: Mean scores of the organizational environment area showed higher amount of problems (43.3%) than the professionals' attitudes and behaviours area (34.7%). Two multivariate linear regression models (with adjusted R(2) 9.3% and 4.9%) indicated that older patients and those with high global rating change were less likely to experience problems in the two areas., Conclusion: Problems on aspects of care were commonly experienced by patients with musculoskeletal disorders in outpatient rehabilitation settings. The age and health of patients were associated to these problems, but explained only a small variation in them., Clinical Rehabilitation Impact: Surveys measuring patients' experiences can be used to monitor the actual performance of rehabilitation settings and to pinpoint the exact issues needing to be addressed to improve quality as well as to make comparison among centres.

Background: The International Classification of Functioning, Disability and Health (ICF) provides a common framework for clinical outcome measurement. Because the Patient-Specific Functional Scale (PSFS) is widely used for documenting change over time in individual patients receiving musculoskeletal physical therapy, investigation of the extent to which PSFS items reflect the ICF is needed., Objective: The study objective was to investigate the extent to which patient-generated PSFS items reflect ICF domains., Design: This investigation was an observational content validity study., Methods: A total of 2,911 PSFS items from 1,050 files for patients with musculoskeletal disorders were analyzed. The data were from a random sample of participants in the Otago Outcome Measures Project at 4 clinics of the School of Physiotherapy, University of Otago, situated in 3 New Zealand cities. Patient-nominated PSFS items were categorized and mapped with thematic analysis techniques to ICF components, chapters, and categories. Subgroup analyses were conducted for body region of injury and age ranges., Results: All (100%) of the analyzed items could be mapped to the ICF. Most patient-nominated items mapped to the activity component (80.0%), some items mapped to the participation component (7.7%), other items were related to impairment (7.4%), and the fourth group contained items that overlapped the activity and participation components (4.9%). Similar results were found for each of the 5 body regions and across age ranges in subgroup analyses., Limitations: These results are limited to individual patients seeking musculoskeletal physical therapy. Patient-generated PSFS items were investigated., Conclusions: The ICF activity component was most commonly represented by patient-nominated PSFS items, the participation component was moderately represented, and impairment was least represented. Hence, the PSFS would complement impairment-based clinical outcome measures.

Background: A large group of patients of Ladek Zdrój spa consists of people with disabilities confirmed by objective tests performed under the pension prevention program of the Social Insurance Institution (ZUS). The purpose of disability prevention is to improve the health conditions to the extent required to continue work. The aim of the study was to identify the differences in the assessment of the treatment and its results between patients referred by the Social Insurance Institution and by the National Health Fund (NFZ)., Material and Methods: A group of 780 people referred to the spa treatment because of different locomotor dysfunctions participated in a questionnaire-based voluntary anonymous survey. The control group consisted of 215 persons with similar illnesses referred by the National Health Fund. The questionnaire included nine specific questions concerning important socio-medical issues of spa rehabilitation., Results: Following the mathematical analysis, the survey data, presented in the percentage form in 10 tables, allowed us to identify differences in the evaluation of treatment of patients referred by ZUS and NFZ., Conclusions: Satisfactory results of rehabilitation were reported more often by patients referred by NFZ than by those treated under the ZUS disability prevention program. The latter group of patients frequently reported anger, fear or despair associated with rehabilitation declaring at the same time active participation in the treatment process. This observation provides evidence that the pension prevention based on the holistic model, preferred by the Social Insurance Institution, is more useful.

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

Objective: We have limited knowledge about the specific elements in an occupational rehabilitation programme that facilitate the process leading to return to work (RTW) as perceived by the patients. The aim of the study was to explore individual experiences regarding contributing factors to a successful RTW, 3 years after a resident occupational rehabilitation programme., Methods: The study is based on interviews of 20 individuals who attended an occupational rehabilitation programme 3 years earlier. Ten informants had returned to work (RTW) and ten were receiving disability pension (DP). Data were analysed by systematic text condensation inspired by Giorgi's phenomenological analysis., Results: The core categories describing a successful RTW process included positive encounters, increased self-understanding and support from the surroundings. While the informants on DP emphasized being seen, heard and taken seriously by the professionals, the RTW group highlighted being challenged to increase self-understanding that promoted new acting in every-day life. Being challenged on self-understanding implied increased awareness of own identity, values and resources. Support from the surroundings included support from peer participants, employer and social welfare system., Conclusion: Successful RTW processes seem to comprise positive encounters, opportunities for increased self-understanding and support from significant others. An explicit focus on topics like identity, own values and resources might improve the outcome of the rehabilitation process.

Background: From many empirical and theoretical points of view, the implementation of shared decision making (SDM) in work rehabilitation for pain due to a musculoskeletal disorder (MSD) is justified but typically the SDM model applies to a one on one encounter between a healthcare provider and a patient and not to an interdisciplinary team., Objectives: To adapt and implement an SDM program adapted to the realities of work rehabilitation for pain associated with a MSD. More specific objectives are to adapt an SDM program applicable to existing rehabilitation programs, and to evaluate the extent of implementation of the SDM program in four rehabilitation centres., Method: For objective one, we will use a mixed perspective combining a theory-based development program/intervention and a user-based perspective. The users are the occupational therapists (OTs) and clinical coordinators. The strategies for developing an SDM program will include consulting the scientific literature and group consensus with clinicians-experts. A sample of convenience of eight OTs, four clinical coordinators and four psychologists all of whom have been working full-time in MSD rehabilitation for more than two years will be recruited from four collaborating rehabilitation centres. For objective two, using the same criteria as for objective one, we will first train eight OTs in SDM. Second, using a descriptive design, the extent to which the SDM program has been implemented will be assessed through observations of the SDM process. The observation data will be triangulated with the dyadic working alliance questionnaire, and findings from a final individual interview with each OT. A total of five patients per trained OT will be recruited, for a total of 40 patients. Patients will be eligible if they have a work-related disability for more than 12 weeks due to musculoskeletal pain and plan to start their work rehabilitation programs., Discussion: This study will be the first evaluation of the program and it is expected that improvements will be made prior to a broader-scale implementation. The ultimate aim is to improve the quality of decision making, patients' quality of life, and reduce the duration of their work-related disability by improving the services offered during the rehabilitation process.

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.