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Objective: To assess the effectiveness of diacutaneous fibrolysis in reducing musculoskeletal disorders symptoms such as pain, range of motion and functionality., Data Sources: A systematic review of MEDLINE, Cochrane, PEDro and Science Direct was conducted until September 2020., Review Methods: Computerized search strategy was performed to identify randomized controlled trials applying diacutaneous fibrolysis, on subjects with musculoskeletal disorders. Eligible articles and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by Risk of Bias 2 tool from the Cochrane Collaboration and Physiotherapy Evidence Database. Outcomes assessed were pain intensity, range of motion and functionality., Results: Search strategy identified 98 potential randomized control trials and six studies involving 386 participants, were finally included. Diacutaneous fibrolysis intervention added to usual physiotherapy treatment was compared to control group. Pain intensity immediately after treatment showed a pooled Standard Mean Difference (SMD) of -0.58 with 95% confidence interval (CI) from -1.12 to -0.04, and in the longest follow-up SMD was -0.63 with 95% CI (-1.21 to -0.05). Functionality showed a pooled SMD of -1.02 with 95% CI (-1.67 to -0.36) immediately after intervention and a SMD of -0.84 with 95% CI (-1.54 to -0.14). Range of motion could not be included in the quantitative synthesis., Conclusion: Diacutaneous fibrolysis is an effective treatment, when combined with conventional physiotheraphy, reducing pain immediately after treatment and long term follow-up and improving function in both, short and long term in musculoskeletal disorders.

The objective of this study was to identify subgroups among the participants in inpatient multidisciplinary musculoskeletal rehabilitation based on the differences in the shapes of trajectories of pain medication consumption during the 9 years around the time of intervention. A register-based study among 4578 public sector employees was conducted. Group-based trajectory analysis was done on the purchase of prescribed pain medications during the 9 years around the time of rehabilitation. The participants were on an average 50.7 (SD=6.6) years of age, and 2955 (86%) were women. Average yearly purchase of pain medications increased during the follow-up period from 73.4 (SD=193.0) to 163.3 (SD=295.7) defined daily doses. The analysis suggested six-cluster model. The shapes of the trajectories of three clusters did not show any steep slopes, one trajectory demonstrated nonstop rising through the entire follow-up, and one trajectory was closed to the trajectory average of medication use. One trajectory (11% of the sample) demonstrated a steep growth before the intervention and steep drop after it. When comparing this cluster with all other clusters combined, odds ratios were 0.40 [95% confidence interval (CI): 0.19-0.85] for age group (older vs. younger), 0.78 (95% CI: 0.61-1.01) for sex (women vs. men), and 1.44 (95% CI: 1.09-1.90) for occupational status (lower vs. higher). In other words, the participants belonged to this cluster were younger employees with a lower occupational grade. It seems that younger employees in manual jobs benefitted of the studied multidisciplinary musculoskeletal rehabilitation the most, especially when the timing of intervention is bounded to the substantial rise of pain severity.

Purpose: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders., Method: Semi-structured interviews were performed with 39 women and 30 men, (aged 22-63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis., Results: These people experienced health as "having resources and opportunities to lead the life one wants". Three categories, "a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life", illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on "being ill" and "being well" and what makes the difference. Five aspects influenced the dynamics of their health experiences: "body and soul, prognosis, character of symptoms, physical and social activity, and emotional state". Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want., Conclusions: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies., Implications for Rehabilitation: Musculoskeletal disorders (MSDs) are difficult to cure and actions to alleviate suffering are of most importance to increase wellbeing and thereby work ability. Research on lay perspectives can contribute towards a deepened understanding of the health experiences of the affected, and thereby the development of the goals and activities of rehabilitation. Our models, that present the view of health and aspects important for achieving wellness among people with MSDs, can contribute in the development of multimodal rehabilitation. The results can also be useful as a base in the evaluation of clinical practice.

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.)

The Scales for the Assessment of Functioning at Work (SE-FFB) allow for an ICF-oriented assessment of patient reported work performance and symptoms at work. The aim of the study is to test convergent end discriminate validity through correlations with measures that are typically applied in rehabilitation and responsiveness by means of description of the change in the course of rehabilitation (t0=beginning of the rehabilitation, t1=3 months after rehabilitation). The sample comprises 249 rehabilitation patients with musculoskeletal diseases. The correlations of the SE-FFB with the criteria of convergent and discriminate validity are in accordance with the expectations. For women medium effects were found, indicating better work performance and fewer symptoms 3 months after rehabilitation, for men the effects were small. The SE-FFB allows for a reliable, valid and responsive assessment of the working situation., (© Georg Thieme Verlag KG Stuttgart · New York.)

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

Objectives: This study investigated long-term effects and implementation processes of workplace strength training for musculoskeletal disorders., Methods: 333 and 140 laboratory technicians from private and public sector companies, respectively, replied to a 3-year follow-up questionnaire subsequent to a 1-year randomized controlled trial (RCT) with high-intensity strength training for prevention and treatment of neck, shoulder, and arm pain. Being a natural experiment, the two participating companies implemented and modified the initial training program in different ways during the subsequent 2 years after the RCT., Results: At 3-year follow-up the pain reduction in neck, shoulder, elbow, and wrist achieved during the first year was largely maintained at both companies. However, the private sector company was rated significantly better than the public sector company in (1) training adherence, (2) training culture, that is, relatively more employees trained at the workplace and with colleagues, (3) self-reported health changes, and (4) prevention of neck and wrist pain development among initially pain-free employees., Conclusions: This natural experiment shows that strength training can be implemented successfully at different companies during working hours on a long-term basis with lasting effects on pain in neck, shoulder, and arm.

Fascia can be considered part of the connective tissues that permeates the human body. However, in medical training its definition is not clear, and even among specialists its role is not completely understood. Physiatrists have a unique opportunity to add to the growing scientific and clinical knowledge about fascia, particularly about how this connective tissue network may apply clinically to musculoskeletal disorders. In this narrative review, the structure and function of fascia is discussed from the perspective of physiatry.

Objective: The physical activity programmes in the workplace (PAPW) are applied to minimize the prevalence, incidence and intensity of pain. This study evaluated the perception of pain and quantifies its intensity among garment workers before and after performing a PAPW., Participants: We included 61 workers of a clothing company, who were classified randomly into experimental group (n = 44) 28.7 ± 8.8 years old and a control group (n = 17) 27.8 ± 7.4 years (20-43 years)., Methods: The Trigger Points test questionnaire was used to assess pain perception and quantify its intensity. The PAPW was conducted in 15-minute sessions per day, consisting of stretching exercises (40%), muscular endurance (40%), self-massage relaxation and massage techniques (10%), and group dynamics (10%)., Results: The garment workers who participated in the PAPW showed a significant reduction of pain felt in the neck and wrists, and also a reduction in pain intensity in shoulders, arms, fingers and wrists that are most often strained during sewing., Conclusions: Our findings suggest that PAPW that target muscle groups that are more tense in sewing tasks, may be considered by companies for supporting adaptation to the work environment and improving health by reducing muscle and joint pain.

Background and Purpose: The purpose of this case series is to explore the possibility that: (1) throwing athletes respond to fear-avoidance model (FAM) measures differently than patients in other orthopedic populations; and (2) there is an association between the FAM measures, pain and function scores., Methods: Five competitive throwing athletes with elbow pain between the ages of 17-23 were included. Patients were given the Fear Avoidance Belief Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), QuickDash, and Numeric Pain Rating Scale (NPRS) at initial evaluation and at 4 weeks., Outcomes: Subjects all demonstrated low levels of fear on initial evaluation and all returned to sport. FABQ-PA, TSK, and PCS subscales were all highly associated with the initial total scales (r = >0.80) with the exception of the PCS helplessness subscale (r = 0.61). Subjects demonstrated an average decrease in the NPRS score of 2.3 points and average improvement of 23.6 points in their QuickDash score. There was a fair association between initial TSK fear of injury (FOI) subscale and initial QuickDash scores (r = 0.47) and a moderate association between initial TSK-11 FOI subscale and initial pain scores (r = 0.61)., Discussion: Subjects in this case study appeared to respond to the FAM questionnaires differently than patients in other orthopedic populations. The TSK FOI subscale may be the most beneficial to use with throwing athletes.

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

Objectives: The purpose of this study was to assess the effects of early part-time sick leave on return to work (RTW) and sickness absence among patients with musculoskeletal disorders., Methods: A randomized controlled trial was conducted in six occupational health units of medium- and large-size enterprises. Patients aged 18-60 years with musculoskeletal disorders (N=63) unable to perform their regular work were randomly allocated to part- or full-time sick leave. In the former group, workload was reduced by restricting work time by about a half. Remaining work tasks were modified when necessary, as specified in a "fit note" from the physician. The main outcomes were time to return to regular work activities and sickness absence during 12-month follow-up., Results: Time to RTW sustained for ≥4 weeks was shorter in the intervention group (median 12 versus 20 days, P=0.10). Hazard ratio of RTW adjusted for age was 1.60 [95% confidence interval (95% CI) 0.98-2.63] and 1.76 (95% CI 1.21-2.56) after further adjustment for pain interference with sleep and previous sickness absence at baseline. Total sickness absence during the 12-month follow-up was about 20% lower in the intervention than the control group. Compliance with the intervention was high with no discontinuations of part-time sick leave due to musculoskeletal reasons., Conclusions: Early part-time sick leave may provide a faster and more sustainable return to regular duties than full-time sick leave among patients with musculoskeletal disorders. This is the first study to show that work participation can be safely increased with early part-time sick leave.

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

Objective: To estimate the impact of pain in different body regions on future long-term sickness absence (LTSA) among blue- and white-collar workers., Method: Prospective cohort study in a representative sample of 5603 employees (the Danish Work Environment Cohort Study) interviewed in 2000, and followed in 2001-2002 in a national sickness absence register. Cox regression analysis was performed to assess the risk estimates of mutually adjusted severe pain in the neck/shoulder, low back, hand/wrist and knees for onset of LTSA, defined as receiving sickness absence compensation for at least 3 consecutive weeks. Age, gender, body mass index, smoking and diagnosed disease were controlled for., Results: In 2000 the prevalence among blue- and white-collar workers, respectively, of severe pain was 33% and 29% (neck/shoulder), 33% and 25% (low back), 16% and 11% (hand/wrists), and 16% and 12% (knees). During 2001-2002, the prevalence of LTSA among blue- and white-collar workers was 18% and 12%, respectively. Hand/wrist pain (HR 1.49, 95% CI 1.23 to 1.81) and low back pain (HR 1.30, 95% CI 1.11 to 1.53) were significant risk factors among the total cohort. Neck/shoulder pain was a significant risk factor among white-collar workers only (HR 1.35, 95% CI 1.21 to 1.85). Knee pain was not a significant risk factor., Conclusion: While hand/wrist pain and low back pain are general risk factors for LTSA, neck/shoulder pain is a specific risk factor among white-collar workers. This study suggests the potential for preventing future LTSA through interventions to manage or reduce musculoskeletal pain.

Purpose of Review: To consider whether pain is a barrier to work and if so how this can be overcome., Recent Findings: Recent findings demonstrate that in addition to absence, pain can lead to a significant loss of productivity. The reasons why employees take absence or attend work while ill are complex and include personal, social and moral pressures around absence, and personally and institutionally mediated presenteeism. Interventions have moved on from a purely biomedical or psychosocial focus towards integrated programmes supporting individuals in managing their pain in the workplace., Summary: Pain is one of the leading causes of absenteeism and presenteeism with related costs for both employees and employers. Ongoing pain presents a number of physical, psychological and social obstacles to work, which may or may not be modifiable. A range of interventions has been tested in randomized trials with a recent move towards identifying and tackling musculoskeletal pain in the wider context as conceptualized by the flags framework. However, in order for any intervention to be successful in ensuring employees overcome pain as a barrier to work, there needs to be widespread change in behaviour with regard to occupational health in general and effective interventions need to be implemented in both workplace and healthcare settings.

Objective: To review the literature regarding the effects of exercise in patients with musculoskeletal pain on modifying: (1) the plasma or cerebral spinal fluid concentrations of pain-relieving peptides and (2) changing the cerebral activity of areas linked with pain processing and modulation systematically., Methods: An extensive search of bibliographic databases including MEDLINE, EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, ISI Web of Science, Scopus, PeDro, AMED, and CINAHL was made. Two independent investigators screened the titles of publications and completed quality assessment of the selected studies., Results: The search of the literature resulted in a total of 1819 published studies. Of these only 1 study of low methodological quality was considered to be relevant. The agreement between reviewers to select the articles was κ=1. The agreement for the methodological quality evaluation was κ=0.9., Discussion: Given the small number of studies identified and the low quality of research, no firm conclusions could be reached about the impact of therapeutic exercise on modifying concentrations of pain-relieving peptides or its effect on changing the cerebral activity of areas linked with pain processing in patients with musculoskeletal pain. There is a clear need for well-designed trials examining exercise therapy interventions and their effect on both pain-relieving peptides and cerebral activity in patients with musculoskeletal pain.

Study Design: Prospective cohort., Objective: To investigate fear-avoidance beliefs across different anatomical regions for patients with musculoskeletal pain., Background: Fear-avoidance beliefs were first widely studied in patients with low back pain. The early results of studies involving patients with cervical spine, knee, and shoulder disorders suggest that fear-avoidance beliefs have the potential to influence pain and function in different anatomical regions. However, very few prospective studies of fear-avoidance beliefs involve multiple anatomical regions., Methods: The sample of this study consisted of 313 patients (mean age, 45.5 years; 115 males, 198 females) seeking outpatient physical therapy for cervical spine (n = 63), upper extremity (n = 58), lumbar spine (n = 79), or lower extremity (n = 113) complaints. During the intake session, patients completed the Fear-Avoidance Beliefs Questionnaire physical activity scale (FABQ-PA), modified for the appropriate anatomical location. Patients also rated pain intensity and function on the Therapeutic Associates Outcomes System (TAOS) Functional Index at intake and discharge. The collection of treatment-related parameters included the number of visits, calendar days of physical therapy, and treatment received. FABQ-PA scores were compared across anatomical regions. Elevated FABQ-PA scores and anatomical regions were also investigated for association with intake pain and function, clinical outcomes, and treatment utility parameters., Results: Similar FABQ-PA levels were observed across the 4 anatomical regions (P>.05). Number of visits, calendar days of physical therapy, and treatment received did not differ between elevated and lower fear-avoidance belief levels (P>.05). Findings for pain intensity and function were similar for each anatomical region. Patients with elevated fear-avoidance beliefs had higher intake scores (P<.05), larger improvements (P<.05), but similar discharge scores (P>.05), compared to those with lower fear-avoidance beliefs., Conclusion: These data suggest that, in patients with cervical, upper extremity, lumbar, or lower extremity complaints, fear-avoidance beliefs may have a similar influence on intake and change scores for pain intensity and function. General assessment of fear-avoidance beliefs using the FABQ-PA, especially to predict change scores, may be appropriate for use in patients with various musculoskeletal pain conditions.

Background: Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions., Objective: The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design This was a prospective, associational study., Methods: Demographic, clinical, depressive symptom (Symptom Checklist 90-Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes., Results: Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d=0.55-0.87) and a small to large effect on functional status (Cohen d=0.28-0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region., Conclusions: Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy settings.

The fear avoidance model of pain (FAM) conceptualizes pain catastrophizing as the cognitive antecedent of pain-related fear, and pain-related fear as the emotional antecedent of depression and disability. The FAM is essentially one of mediation whereby pain-related fear becomes the process by which depression or disability ensue. However, emerging literature suggests that pain catastrophizing, pain-related fear, and depression might be at least partially distinct in their prediction of different pain-related outcomes. The primary purpose of the present study was to evaluate whether psychological factors in the FAM (pain catastrophizing, pain-related fear, and depression) differentially predict long-term pain-related outcomes. Toward this objective, we conducted a prospective study using a cohort of 202 individuals with subacute work-related musculoskeletal injuries. Participants completed a 7-week physical therapy program with a functional rehabilitation orientation. Posttreatment measures of fear of movement, pain catastrophizing, depression, and pain self-efficacy were used to predict the persistence of pain symptoms, healthcare use, medication use, and return-to-work at one-year follow-up. Results from hierarchical linear and logistic regression analyses revealed that pain catastrophizing and fear of movement act as differential predictors of long-term pain-related outcomes. Specifically, we found unique relationships between pain catastrophizing and long-term pain intensity, and fear of movement and long-term work disability. After controlling for pain intensity and FAM variables, pain self-efficacy was shown to be a unique predictor of medication use. Implications for the FAM and the clinical management of musculoskeletal pain conditions are discussed. Unique relationships were found between pain catastrophizing and long-term pain intensity, between fear of movement and long-term work disability, and between pain self-efficacy and medication use at one-year follow-up., (Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

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

Poor adherence to treatment is commonplace and may adversely affect outcomes, efficiency and healthcare cost. The aim of this systematic review was to identify strategies to improve adherence with musculoskeletal outpatient treatment. Five suitable studies were identified which provided moderate evidence that a motivational cognitive-behavioural (CB) programme can improve attendance at exercise-based clinic sessions. There was conflicting evidence that adherence interventions increase short-term adherence with exercise. There was strong evidence that adherence strategies are not effective at improving long-term adherence with home exercise. Due to the multi-dimensional nature of non-adherence, the strategies to improve adherence with physiotherapy treatment are likely to be broad in spectrum. Combined interventions may be effective at promoting adherence with clinic appointments and exercise, though further research would be required to confirm this. Further research to increase basic understanding of the factors, which act as a barrier to adherence, could facilitate development of strategies to overcome non-adherence., (Copyright © 2010. Published by Elsevier Ltd.)

The extent of cortical neuroplastic changes has been shown to be a key neurophysiological feature that correlates with the level of functional recovery. Therefore, rehabilitation efforts that attempt to maximize cortical reorganization provide the greatest potential for rehabilitation success. This paper reviews the evidence of cortical neuroplastic changes that have been shown to occur in association with experimental or chronic pain disorders. Further, the promising role of novel motor-skill training is discussed in order to best direct the clinician to optimize rehabilitation strategies for patients with musculoskeletal pain disorders., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Physical therapists consider many factors in the treatment of patients with musculoskeletal pain. The current literature suggests expectation is an influential component of clinical outcomes related to musculoskeletal pain for which physical therapists frequently do not account. The purpose of this clinical perspective is to highlight the potential role of expectation in the clinical outcomes associated with the rehabilitation of individuals experiencing musculoskeletal pain. The discussion focuses on the definition and measurement of expectation, the relationship between expectation and outcomes related to musculoskeletal pain conditions, the mechanisms through which expectation may alter musculoskeletal pain conditions, and suggested ways in which clinicians may integrate the current literature regarding expectation into clinical practice.

Background: Tailored treatments are topical in pain rehabilitation. One key issue for correlational studies is the identification of factors having a potential causal impact on essential treatment outcomes., Objective: To study associations between pain beliefs and disability with regard to the amount and time-frame of available data., Design: A prospective, correlational design., Subjects and Setting: Ninety-two patients consulting physical therapists in primary care for persistent musculoskeletal pain., Main Measures: The Pain Disability Index, the Self-Efficacy Scale and the Tampa Scale of Kinesiophobia., Results: Functional self-efficacy and fear of movement/(re)injury explained variance in pain-related disability pretreatment (adj R(2) = 0.41). Self-efficacy was the most salient predictor. Adding data from immediately post treatment decreased explained variance (adj R(2) = 0.25). Functional self-efficacy and fear of movement/ (re)injury lost their significant contribution in favour of pain-related disability at baseline. Change scores in functional self-efficacy and fear of movement/(re)injury accounted for a modest share of explained variance in change scores of disability (adj R(2) = 0.11). Fear of movement/(re)injury but not functional self-efficacy was related to a reliable change in pain-related disability., Conclusions: Longitudinal data suggest that pretreatment levels of pain-related disability and changes in fear of movement/(re)injury are most important to immediate treatment outcomes and individual reliable change. Disability and elevated fear of movement/(re)injury should therefore be addressed in tailored pain treatments.

Central sensitization plays an important role in the pathophysiology of numerous musculoskeletal pain disorders, yet it remains unclear how manual therapists can recognize this condition. Therefore, mechanism based clinical guidelines for the recognition of central sensitization in patients with musculoskeletal pain are provided. By using our current understanding of central sensitization during the clinical assessment of patients with musculoskeletal pain, manual therapists can apply the science of nociceptive and pain processing neurophysiology to the practice of manual therapy. The diagnosis/assessment of central sensitization in individual patients with musculoskeletal pain is not straightforward, however manual therapists can use information obtained from the medical diagnosis, combined with the medical history of the patient, as well as the clinical examination and the analysis of the treatment response in order to recognize central sensitization. The clinical examination used to recognize central sensitization entails the distinction between primary and secondary hyperalgesia., (Copyright 2009 Elsevier Ltd. All rights reserved.)

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

This study investigated effects of physical exercise on musculoskeletal pain symptoms in all regions of the body, as well as on other musculoskeletal pain in association with neck pain. A single blind randomized controlled trial testing a one-year exercise intervention was performed among 549 office workers; specific neck/shoulder resistance training, all-round physical exercise, or a reference intervention. Pain symptoms were determined by questionnaire screening of twelve selected body regions. Case individuals were identified for each body region as those reporting pain intensities at baseline of 3 or more (scale of 0-9) during the last three months. For neck cases specifically, the additional number of pain regions was counted. Intensity of pain decreased significantly more in the neck, low back, right elbow and right hand in cases of the two exercise groups compared with the reference group (P<0.0001-0.05). The additional number of pain regions in neck cases decreased in the two exercise groups only (P<0.01-0.05). In individuals with no or minor pain at baseline, development of pain was minor in all three groups. In conclusion, both specific resistance training and all-round physical exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body.

Background: Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness., Objectives: To assess the effects of interventions to improve adherence to exercise and physical activity for people with chronic musculoskeletal pain., Search Strategy: We searched the trials registers of relevant Cochrane Review Groups. In addition, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Science Citation Index and Social Science Citation Index and reference lists of articles to October 2007. We consulted experts for unpublished trials., Selection Criteria: Randomised or quasi-randomised trials evaluating interventions that aimed to improve adherence to exercise and physical activity in adults with pain for three months and over in the axial skeleton or large peripheral joints., Data Collection and Analysis: Two of the four authors independently assessed the quality of each included trial and extracted data. We contacted study authors for missing information., Main Results: We included 42 trials with 8243 participants, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared different types of exercise showed positive effects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied different methods of delivering exercise, such as supervising exercise sessions, refresher sessions and audio or videotapes of the exercises to take home. Of these, five trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; three of these showed a positive effect on exercise adherence. In eight trials studying self-management programmes, six improved adherence measures. One trial found graded activity was more effective than usual care for improving exercise adherence. Cognitive behavioural therapy was effective in a trial in people with whiplash-associated disorder, but not in trials of people with other CMP. In the trials that showed a positive effect on adherence, association between clinical outcomes and exercise adherence was conflicting., Authors' Conclusions: Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.

Purpose: The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden., Methods: An experimental group comprising 89 patients from two primary health care units received individualised treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine. All participants completed questionnaires measuring pain, sick leave, quality of life, health care utilisation, drug consumption and psychosocial factors at baseline and at 3-year follow-up., Results: After 3 years, utilisation of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The control group showed a trend of having a higher risk of high consumption after 3 years compared to the intervention group. There was no significant difference between the two groups concerning remaining variables such as function, catastrophising and pain., Conclusion: Both groups demonstrated considerable improvement over the course of 3 years. The experimental group had lower health care utilisation and a reduced risk of using large amounts of medication at the 3-year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain.

Purpose: The purpose of this critical review is to describe the available theoretical models for understanding the gender issues in prolonged work disability related to persistent musculoskeletal (MSK) pain., Method: A critical literature review was conducted in medicine, health sciences, and social sciences databases (MEDLINE, CINHAL, PsychINFO and SOCINDEX) using specific keywords. After screening titles and abstracts, followed by methodological quality assessment, a total of 55 references were retained for content analysis., Results: Gender issues in disability related to persistent MSK pain show that men and women may experience pain and rehabilitation process in different ways. Three main themes were exftracted and further described: (1) the experience of distrust; (2) the self-identity process; and (3) the domestic strain. Each of these themes has a specific and potentially different impact on men and women, and we report that experiential differences may strongly impact the rehabilitation process and outcomes such as return to work., Conclusions: This critical review provides insight into gender issues in the process of rehabilitation and outcomes such as return to work. We suggest that work and family considerations are the two most important issues in the rehabilitation process and that differences between men and women are likely to occur.

Unlabelled: Previous studies have found illness representations to be associated with the degree to which patients adopt health behaviours. Surprisingly, pain representations, especially those in a work rehabilitation context, have rarely been explored., Objective: To conduct a thorough investigation of the pain representations held by workers who were on sick leave due to persistent musculoskeletal pain during the process of an intensive work rehabilitation program., Methods: Qualitative semi-structured interviews were conducted with 16 participants (male, female), three times during the program and one month after discharge. Data analysis was based on a narrative approach., Results: Throughout the process, pain representation was an indicator of the type of action the participants were ready to take to control the immediate or possible consequences of their pain. Using the context of a work rehabilitation trajectory we identified the differential impact of reconstruction or status quo in pain representations that eventually led to a return to work, or not., Discussion: This study highlights the importance of identifying and acknowledging workers' pain representations in facilitating their return to work.

Purpose: The overall aim of this study was to estimate the possible mediating role of self-efficacy, catastrophic thinking and fear of movement and (re)injury between pain intensity and pain-related disability in two samples of acute pain patients, i.e. patients with musculoskeletal injuries and patients with whiplash injury., Method: A cross sectional design with data-collection after an acute injury was used. Subjects were recruited at an emergency department. Sixty-four patients with acute whiplash associated disorders (WAD) and 74 patients with musculoskeletal injury completed the questionnaires., Results: Self-efficacy was found to be a mediator between pain intensity and pain-related disability in the WAD group, whereas fear of movement and (re)injury appeared as mediator in the musculoskeletal-injury group. The strength of association between variables was weaker in the musculoskeletal-injury group compared to the WAD group., Conclusions: It is important to assess fear of movement beliefs in patients with musculoskeletal injuries. Similarly, patients with acute WAD expressing low self-efficacy beliefs should be identified. An early detection of these beliefs may improve management at the acute phase and possibly reduce risks for slow improvements.

Purpose: To assess quality of life (QoL) in two groups of patients with long-term musculoskeletal pain with and without psychiatric co-morbidity and to compare them with a reference group of normative controls. The patients in both study groups were sick-listed full or part time for 3 months or more., Method: The patients were recruited from a company health service and consulting psychiatry. A generic QoL questionnaire, the SF-36, was used to assess QoL. Each group was compared with age- and gender-matched normative controls., Results: Both groups reported a pronounced impairment of QoL (p < 0.001) compared with their age- and gender-matched populations. The greatest impairment was seen among the patients referred for psychiatric assessment (n = 30). The patients in the company health service (n = 42) reported significantly higher QoL with regard to the dimensions mental health (p < 0.028), social functioning (p < 0.034) and role emotional (p < 0.040) compared with the patients referred for psychiatric assessment., Conclusion: Patients with long-term pain in the company health care and patients with psychiatric co-morbidity, sick-listed full or part-time reported severely impaired QoL with regard both to physical, social and mental dimensions. Psychiatric co-morbidity reported even more pronounced impairment of emotional, social and mental dimensions of QoL which might indicate dysfunctional coping strategies.

A few years after leaving the navy, a 50-year-old Veteran* presents to a new family physician with chronic knee and back pain. He is seeking a new physician for opioid and benzodiazepine refills, referrals for ongoing acupuncture and massage therapy, and completion of Veteran Affairs Canada (VAC) disability claim forms for his back. He was medically released at the rank of Petty Officer owing to knee impairment secondary to a fracture sustained aboard ship. He twice strained his back on deployments, but did not develop chronic low back pain until after leaving the Canadian Forces (CF). On release from the CF he completed comprehensive medical, psychosocial, and vocational rehabilitation in the VAC Rehabilitation Program for disability related to his knee impairment. Lately, chronic low back pain prevents him from continuing civilian employment and enjoying life.The physician takes the Veteran's history, performs appropriate physical examination and diagnostic investigations, and obtains previous medical records. The physician diagnoses chronic mechanic allow back pain and knee osteoarthritis, and is concerned about the Veteran's mental health. When the family physician tries to explore the mental health differential diagnosis, the Veteran initially becomes upset,but he responds to motivational interviewing. The physician books follow-up appointments to develop a therapeutic relationship with the Veteran and completes the VAC forms. With consent, the physician also sends a referral letter to the VAC district office, outlining the Veteran's health issues. The client is found to be eligible to re-enter the VAC Rehabilitation Program to manage disability related to his back pain. The Veteran is ultimately able to withdraw from chronic opiate and benzodiazepine medications and optimize his participation in life.

During the past decade, scientific research has provided new insight into the development from an acute, localised musculoskeletal disorder towards chronic widespread pain/fibromyalgia (FM). Chronic widespread pain/FM is characterised by sensitisation of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients. It is explained that manual therapy might be able to influence the process of chronicity in three different ways. (I) In order to prevent chronicity in (sub)acute musculoskeletal disorders, it seems crucial to limit the time course of afferent stimulation of peripheral nociceptors. (II) In the case of chronic widespread pain and established sensitisation of central pain pathways, relatively minor injuries/trauma at any locations are likely to sustain the process of central sensitisation and should be treated appropriately with manual therapy accounting for the decreased sensory threshold. Inappropriate pain beliefs should be addressed and exercise interventions should account for the process of central sensitisation. (III) However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may cause more harm then benefit to the patient by triggering or sustaining central sensitisation.

Purpose: The aim of this study was to assess the usability of a modified Astrand bicycle test in subjects with musculoskeletal pain disorder (MSPD) and healthy controls., Methods: In a random cross-over design, 31 subjects with a MSPD who have been referred to rehabilitation medicine and 33 healthy subjects matched for age, gender, height and body weight, performed an Astrand bicycle test and a modified test with a time interval of 7 days. Drop-out rates, VO2max values (in mL/kg lean body mass (LBM) min(-1)), intraclass correlation coefficients (ICCs) and critical difference (Bland-Altman plots) for both tests within each group of subjects were compared., Results: The drop-out rate in both tests for the MSPD group was comparable, and mainly caused by pain, fatigue or breathlessness. Compared with the modified version, the Astrand test showed higher VO2max-scores: 4.83 mL/kg LBM min(-1) (9.96%) in the MSPD group and 3.5 mL/kg LBM min(-1) (5.57%) in the healthy group. ICCs were 0.79 and 0.87 and the limits of agreement were 8.5 mL/kg LBM min(-1) (15.9%) and 10.2 mL/kg LBM min(-1) (18.1%), respectively., Conclusion: The usability of the modified test is acceptable, as well as in healthy individuals as subjects suffering from MSPD being referred to rehabilitation medicine. However, a slight under estimation of VO2max with the modified test has to be taken into account.

Purpose: To analyze why some responded positively to rehabilitation and why some did not., Method: Sixty participants with musculoskeletal disorders, mainly neck and back pain participated in a 7-week rehabilitation programme which was based on a combination of theoretical and practical education and physical activities. Before and after the programme and 6, 12 and 24 months after completion of the programme all participants were evaluated with the Disability Rating Index (DRI) and Pain Intensity Rating on a Visual analogue scale (VAS)., Results: In the participants who had full-time sick leave from the start of the programme to the 2-year follow-up (Group I) self-experienced physical disability and pain ratings were high and showed no decrease and were maintained up until the 2-year follow-up. For the participants who had part-time sick leave or no sick leave (Group II) physical disability and pain ratings were initially lower than in Group I and decreased gradually, (p < 0.01) and (p < 0.05), respectively throughout the 2-year follow-up period., Conclusion: Participants in Group I did not benefit from the rehabilitation programme and did not show improvement in their physical disability and pain rating. Group II showed decreased physical disability and pain rating. The decrease was gradual and was maintained up until the 2-year follow-up period. These results may indicate that persons with musculoskeletal pain with severe disability and pain require other rehabilitation programmes than those with moderate symptoms. This research has highlighted the need for development of such programmes.

Unlabelled: Psychological illness influences the experience and expression of pain and disability. We tested three null hypotheses: (1) patients with nonspecific pain (medically unexplained and idiopathic) and patients with specific pain (discrete and verifiable) are equally likely to screen for psychiatric illnesses based on a validated screening questionnaire; (2) the presence of psychiatric illness (from a screening questionnaire) will not predict whether patients have specific or nonspecific pain type; and (3) across all patients and regardless of whether they have specific or nonspecific pain, psychiatric illness will not predict disability as measured by the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. We rejected all null hypotheses. The 41 patients with nonspecific arm pain were more likely than the 40 patients with specific arm pain to screen for a somatoform disorder (34% versus 7.5%), posttraumatic stress disorder (24% versus 7.5%), and panic disorder (12.2% versus 5%). The presence of anxiety and somatoform disorders predicted pain type (nonspecific versus specific) and arm-specific disability (DASH). Somatoform disorder was the strongest predictor of pain type and DASH scores. Based on a screening questionnaire, a comorbid psychiatric illness, a somatoform disorder in particular, is associated with nonspecific arm pain and arm-specific disability., Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Objectives: Based on the biopsychosocial model, the present paper investigates the interactions between physical complaints and psychological parameters under the terms of a rehabilitation procedure., Method: In 309 participants of orthopaedic rehabilitation, the course of physical complaints (GBB-24), emotional stress (HADS-D) and locus of control (KU-WS) were recorded using a pre-post design. Additionally, the impact of the factors gender, age and level of chronicity as well as the interactions between the variables were analysed., Results: Compared to the general population, the rehabilitation participants had significantly higher levels of fatigue, limb pain and pressure caused by complaints as well as anxiety and depression. Definite changes under the terms of rehabilitation were found for all single parameters of physical complaints and emotional stress; however, the scales with initially significantly increased values did not reach the levels of the general population. The reduction of physical complaints was significantly correlated with the reduction of emotional stress. The relationship between physical complaints and locus of control was much lower., Conclusion: The present paper confirms the strong interaction between biological and psychological factors under the terms of a rehabilitation process.

Electromyographic biofeedback is a therapeutic modality used along with other interventions in the treatment of pain. This article presents a brief review of the effectiveness of electromyographic biofeedback in treating musculoskeletal pain. Electromyographic biofeedback may provide pain relief for chronic musculoskeletal pain due to cumulative trauma, and may be proposed as an additional intervention to exercise in patellofemoral pain syndrome and acute sciatic pain. Electromyographic biofeedback is comparable to cognitive behavioral treatment and relaxation techniques. When added to an exercise program in patients with patellofemoral pain or acute sciatic pain, no further pain reduction is achieved. Electromyographic biofeedback promotes active participation and thus may motivate patients to adopt an active role in establishing and reaching goals in rehabilitation. Further research is required to investigate its effect on musculoskeletal pain.

Objective: To assemble and synthesize the best evidence on the epidemiology, diagnosis, prognosis, treatment, and prevention of musculoskeletal injuries and pain in dancers., Data Sources: Medline, CINAHL, PsycINFO, Embase, and other electronic databases were searched from 1966 to 2004 using key words such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, and musculoskeletal diseases. In addition, the reference lists of relevant studies were examined, specialized journals were hand-searched, and the websites of major dance associations were scanned for relevant information., Study Selection: Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best evidence synthesis method. After 1865 abstracts were screened, 103 articles were reviewed, and 32 (31%) of these were accepted as scientifically admissible (representing 29 unique studies)., Data Extraction: Data from accepted studies were abstracted into evidence tables relating to the prevalence and associated factors, incidence and risk factors, diagnosis, treatment, economic costs, and prevention of musculoskeletal injuries and pain in dancers., Data Synthesis: The scientifically admissible studies consisted of 15 (52%) cohort studies, 13 (45%) cross-sectional studies, and 1 (3%) validation study of a diagnostic assessment tool. There is a high prevalence and incidence of lower extremity and back injuries, with soft tissue and overuse injuries predominating. For example, lifetime prevalence estimates for injury in professional ballet dancers ranged between 40% and 84%, while the point prevalence of minor injury in a diverse group of university and professional ballet and modern dancers was 74%. Several potential risk factors for injury are suggested by the literature, but conclusive evidence for any of these is lacking. There is preliminary evidence that comprehensive injury prevention and management strategies may help decrease the incidence of future injury., Conclusions: The dance medicine literature is young and heterogeneous, limiting our ability to draw consistent conclusions. Nonetheless, the best available evidence suggests that musculoskeletal injury is an important health issue for dancers at all skill levels. Better quality research is needed in this specialized area. Future research would benefit from clear and relevant research questions being addressed with appropriate study designs, use of conceptually valid and clinically meaningful case definitions of injury and pain, and better reporting of studies in line with current scientific standards.

Musculoskeletal conditions often manifest with the onset of pain and the resulting physical limitations. Musculoskeletal pain is almost inevitable in an individual's lifetime. It is one of the most common reasons for self-medication and entry into the health care system. Musculoskeletal pain affects 1 in 4 adults and is the most common source of serious long-term pain and physical disability. The monumental impact of musculoskeletal conditions is now recognized by the United Nations, the World Health Organization, World Bank, and numerous governments throughout the world through support of the Bone and Joint Decade 2000 to 2010 initiative. Individuals with musculoskeletal pain concerns are regularly ignored, their complaints often misunderstood by health care providers, and accordingly they do not receive timely or effective treatment. The standards of care in this document are designed to provide generic guidelines for appropriate care of people with acute or chronic musculoskeletal pain. This document was developed over a 4-year period using multiple international meetings and a Task Force of the Bone and Joint Decade for developing international standards for the care of acute and chronic musculoskeletal pain. The final document is a product of the World Health Organization Collaborating Centre for Evidence-Based Health Care in Musculoskeletal Disorders.

Introduction: The primary objective of this research was to evaluate the psychometric properties of a questionnaire designed to assess perceive injustice associated with injury., Methods: In Study 1, the 12-item Injustice Experience Questionnaire (IEQ) was administered to 226 individuals with musculoskeletal conditions. A subsample of 85 individuals were interviewed 1-year later about their ongoing symptoms and return to work status. In Study 2, the IEQ and other pain-related measures were administered on two separate occasions to 70 pain patients participating in a functional restoration rehabilitation program., Results: -Study 1 Principal components analysis yielded a two-component solution with eigenvalues greater 1. Item content of the two components reflected elements of blame and irreparability of loss. In cross sectional analyses, the IEQ was significantly correlated with measures of catastrophic thinking, r = .75, P < .01, fear of movement/re-injury, r = .58, P < .01, depression, r = .66, P < .01, and pain severity, r = .54, P < .01. Cross-sectional regression analyses revealed that the IEQ, beta = .44, P < .01, and the PCS, beta = .18, P < .05, each contributed significant unique variance to the prediction of pain severity. The IEQ prospectively predicted return to work status, OR = .75, 95% CI = .58-.99, but not pain severity., Results: -Study 2 Analyses supported the test re-test reliability of the IEQ, r = .90, P < .01. Treatment-related changes in the IEQ were significantly correlated with an objective index of improved physical function, r = .51, P < .01., Conclusions: The findings of these two studies support the construct validity of the IEQ and suggest that this measure might be a useful complement to psychosocial assessment of individuals with persistent pain conditions. Discussion addresses the processes through which perceived injustice might impact on disability and rehabilitation outcomes.

Purpose: Early identification and intervention with those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering associated with long-term work absenteeism. The Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) has been used and validated in several studies for participants with mainly acute pain problems. The aim of this study was to validate the OMPSQ for patients with non-acute pain problems (e.g. 1-6 months sick leave) and compare to other relevant questionnaires., Method: One hundred and fifty-eight patients with musculoskeletal pain and disability recruited to a multidisciplinary rehabilitation project completed a battery of questionnaires at baseline and at 3-year follow-up visits. The main analysis involved the relationship between risk levels in the questionnaire and sick leave and perceived health after 3 years., Results: The OMSPQ predicted future sick leave and health and was found to have six factors. The function and pain factors were the best predictors of sick leave after 3 years, while the distress factor was the best predictor of perceived mental health and return to work-expectancy was borderline significant. Perceived physical health at 3 years was best predicted by the function and pain factors with the fear-avoidance factor being marginally significant., Conclusion: The results demonstrate that psychosocial factors as measured by OMPSQ are related to work disability and perceived health even 3 years after treatment for patients with non-acute pain problems. The OMSPQ was a good predictor of outcome.

To determine the reliability and concurrent validity of a visual analogue scale (VAS) for disability as a single-item instrument measuring disability in chronic pain patients was the objective of the study. For the reliability study a test-retest design and for the validity study a cross-sectional design was used. A general rehabilitation centre and a university rehabilitation centre was the setting for the study. The study population consisted of patients over 18 years of age, suffering from chronic musculoskeletal pain; 52 patients in the reliability study, 344 patients in the validity study. Main outcome measures were as follows. Reliability study: Spearman's correlation coefficients (rho values) of the test and retest data of the VAS for disability; validity study: rho values of the VAS disability scores with the scores on four domains of the Short-Form Health Survey (SF-36) and VAS pain scores, and with Roland-Morris Disability Questionnaire scores in chronic low back pain patients. Results were as follows: in the reliability study rho values varied from 0.60 to 0.77; and in the validity study rho values of VAS disability scores with SF-36 domain scores varied from 0.16 to 0.51, with Roland-Morris Disability Questionnaire scores from 0.38 to 0.43 and with VAS pain scores from 0.76 to 0.84. The conclusion of the study was that the reliability of the VAS for disability is moderate to good. Because of a weak correlation with other disability instruments and a strong correlation with the VAS for pain, however, its validity is questionable.