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Purpose: Occupational biomechanical factors are implicated in the aetiology and progression of low back pain (LBP). This study cross-culturally adapted and psychometrically investigated the Occupational Risk Factor Questionnaire (ORFQ) in a low literate Nigerian Igbo population with chronic LBP. Methods: Forward and back translation of the original ORFQ by clinical and non-clinical translators was followed by an expert committee review. The adapted ORFQ was pre-tested amongst rural Nigerian adults with chronic LBP using cognitive think-aloud interviewing. Internal consistency (Cronbach's alpha) and test–retest reliability (unweighted and linear weighted k statistic for item-by-item agreement, and intra-class correlation coefficient—ICC) were investigated amongst 50 rural and urban Nigerian dwellers with chronic LBP. Spearman's correlation and regression analyses were conducted with the Igbo-ORFQ, and measures of disability [World Health Organisation Disability Assessment Schedule (WHODAS 2.0), Roland Morris Disability Questionnaire (RMDQ), Back performance scale (BPS)], pain intensity [Eleven-point box scale (BS-11)] and social support [Multidimensional Scale of Perceived Social Support (MSPSS)], to test construct validity with 200 rural Nigerian dwellers with chronic LBP. Results: Cross-cultural adaptation highlighted difficulty conceptualising and concretising exposure to biomechanical risk factors. Item-by-item agreement, internal consistency (α = 0.84) and intraclass correlation coefficient (ICC = 0.83) were good. Some unexpected direction of associations between the biomechanical components of the Igbo-ORFQ, and disability, pain intensity, and social support prohibits establishment of construct validity. Conclusion: Prospective studies comparing the Igbo-ORFQ to other measures of exposure to occupational biomechanical risk factors are required to establish the construct validity of the Igbo-ORFQ. [ABSTRACT FROM AUTHOR]

Purpose: Evidence on rehabilitation after revision total hip replacement (THR) is inadequate and development of rehabilitation interventions is warranted. Even so, little is known about patients' experiences with revision THR rehabilitation. This study aimed to explore patients' rehabilitation exercise experiences after revision THR. Materials and methods: Using constructivist grounded theory, we conducted semi-structured qualitative interviews with twelve patients with completed or almost completed rehabilitation exercise after revision THR. Data collection and analysis were a constant comparative process conducted in three phases; initial, focused, and theoretical. Findings: From the data, we generated a substantial theory of the participant's circumstances and ability to integrate rehabilitation exercise into their everyday life after revision THR. Four categories were constructed based on patients' experiences in different contexts: hesitance, fear avoidance, self-commitment, and fidelity. Conclusions: This study highlighted that patients' expectations, past experiences, attitudes, trusts, and circumstances interact to influence engagement and adherence to rehabilitation exercise and described four categories relating to the integration of revision THR rehabilitation exercise into their everyday life. Clinicians should be aware of and account for these categories during rehabilitation exercise. Tailored individual rehabilitation exercise interventions and clinician approaches to optimize engagement and adherence are needed among patients with revision THR. IMPLICATIONS FOR REHABILITATION: Patients' rehabilitation exercise experiences after revision total hip replacement may serve as guidance for clinicians. A need exists to tailor individual rehabilitation interventions and clinicians' approaches to optimize patients' engagement and rehabilitation exercise adherence following revision total hip replacement. Clinicians can tailor rehabilitation exercise for patients with revision total hip replacement by focusing on therapeutic relationships, support needs, and physical function while incorporating insights from previous rehabilitation exercise experiences. An important goal of rehabilitation exercise is to enhance patient engagement, thereby facilitating the integration of rehabilitation exercises into the patients' everyday life. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Illness perceptions predict chronic low back pain (CLBP) disability. This study cross-culturally adapted and validated the Igbo Brief Illness Perceptions Questionnaire (Igbo-BIPQ) in people with CLBP in rural/urban Nigeria. METHODS: A cross-cultural adaptation and validation of the Igbo-BIPQ was undertaken. The BIPQ was forward/back-translated by clinical/non-clinical translators. An expert review committee appraised the translations. The questionnaire was pre-tested on twelve rural Nigerian dwellers with CLBP. Internal consistency using Cronbach's alpha; test-retest reliability using intra-class correlation coefficient and Bland-Altman plot; and minimal detectable change were investigated amongst 50 people with CLBP in rural and urban Nigeria. Construct validity was determined by correlating the Igbo-BIPQ score with those of eleven-point box scale and Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ) using Pearson's correlation analyses in 200 adults with CLBP in rural Nigeria. Ceiling and floor effects were investigated in both samples. RESULTS: Good face/content validity, internal consistency (α = 0.76) and intraclass correlation coefficient (ICC = 0.78); standard error of measurement and minimal detectable change of 5.44 and 15.08 respectively; moderate correlations with pain intensity and self-reported disability (r ⩾ 0.4); no ceiling/floor effects were observed for Igbo-BIPQ. CONCLUSION: This study provides evidence of some aspects of validity and reliability of the Igbo-BIPQ. [ABSTRACT FROM AUTHOR]

Exercise and physical activity may improve pain and function in people with persistent musculoskeletal pain, but adherence is often low. Understanding the barriers and facilitators of exercise adherence could aid in the development of an intervention to promote exercise adherence. This study explored the factors influencing adherence to prescribed exercise in people with persistent musculoskeletal pain. Qualitative semi-structured interviews were conducted with patients with persistent musculoskeletal pain. Registered physiotherapists specializing in the treatment of persistent musculoskeletal pain were recruited to two focus groups. Data was analyzed using framework analysis informed by the Theoretical Domains Framework. Twenty patient participants (mean age = 44 years, standard deviation = 14) and ten physiotherapists (mean duration registered = 11 years, standard deviation = 5) were included. Four themes were identified: the role of environment, the therapeutic relationship, facilitating engagement with self-management and the influence of pain and negative affect. The Health Action Process Approach was identified as an appropriate model to inform intervention development. Personal, social, and environmental factors as well as the relationship with the physiotherapist influences exercise adherence. These findings may inform practice and the development of theoretically-informed interventions to enhance exercise adherence in people with persistent musculoskeletal pain. Exercise and physical activity can decrease pain while improving mobility in a population with persistent musculoskeletal pain, but adherence to prescribed programs is low. The physical and social environment, the influence of pain, and negative affect may act as barriers to exercise adherence, while fostering a collaborative therapeutic relationship and facilitating self-management may enhance exercise adherence. The findings from the current study align with the constructs theorized by the Health Action Process Approach to support initiation and maintenance of behavior. This may provide a suitable theoretical framework to support the development of a targeted intervention. Healthcare providers, specifically physiotherapists, may find that facilitating self-management strategies that emphasize coping skills to overcome personal, social and environmental barriers may enhance exercise adherence in their patients. [ABSTRACT FROM AUTHOR]

Background: There are currently no client generated measures able to capture a child's perspective of the value of generic therapeutic mental health interventions. We have developed a new measure called 'PSYCHLOPS Kids'. It measures areas of individual importance to the respondent and contains both quantitative and qualitative elements. We aimed to pilot this new outcome measure and determine its psychometric properties. Methods: PSYCHLOPS Kids was adapted from the adult PSYCHLOPS questionnaire, a validated and reliable client‐generated measure used in primary care mental health. Development of PSYCHLOPS Kids involved an expert group, pilot testing with dramatherapists followed by psychometric testing with children receiving dramatherapy aged 7–13 years. Results: One hundred and thirty‐two children completed pre‐ and postintervention questionnaires. Mean initial PSYCHLOPS Kids scores (scale of 0–12) were 4.98 (SD: 3.42); mean post‐therapy, 3.24 (SD: 3.03); mean effect size of change, 0.51. The Strengths and Difficulties Questionnaire (SDQ) was used as a comparator instrument completed by parent/carers of 32 children; mean effect size, 0.39. The effect size difference between both instruments was not significant (t = 1.05; p = .30); the PSYCHLOPS Kids Problem domain effect size (mean, 0.68) was significantly greater than for the SDQ (t = 2.06; p = .04). Concurrent validity was demonstrated by strong predictive power of change scores for the self‐assessment of change item in PSYCHLOPS Kids; therapist‐assessment of change was not a significant predictor of change scores. PSYCHLOPS Kids and SDQ change scores were not significantly correlated. Conclusions: PSYCHLOPS Kids is the first client generated mental health outcome measure focussing on problems for generic use in children. It has demonstrated moderate responsiveness to change and satisfactory testing for measured aspects of validity and reliability. PSYCHLOPS Kids now requires further validity, reliability and qualitative testing. [ABSTRACT FROM AUTHOR]

Purpose: This study explored the experiences of people living with non-specific chronic low back pain (CLBP) in a rural Nigerian community. Method: Qualitative in-depth semi-structured face-to-face interviews were conducted with purposively sampled participants until data saturation. Questions explored back pain beliefs, coping/management strategies and daily activities. Thematic analysis of transcripts was performed using the Framework approach. Results: Themes showed that back pain beliefs were related to manual labour/deprivation, infection/degeneration, spiritual/cultural beliefs and rural–urban divide. These beliefs impacted on gender roles resulting in adaptive or maladaptive coping. Adaptive coping was facilitated by positive beliefs, such as not regarding CLBP as an illness, whereas viewing CLBP as illness stimulated maladaptive coping strategies. Spirituality was associated with both adaptive and maladaptive coping. Maladaptive coping strategies led to dissatisfaction with health care in this community. Conclusions: CLBP-related disability in rural Nigeria is strongly influenced by beliefs that facilitate coping strategies that either enhance or inhibit recovery. Interventions should therefore target maladaptive beliefs while emphasizing behavioural modification. Non-specific chronic low back pain (CLBP) is highly prevalent and responsible for much pain and disability in rural Nigeria. No qualitative study has investigated the experiences of people living with CLBP in rural Nigeria or any other rural African context. Qualitative study of peoples' experiences of living with CLBP in rural Nigeria has the potential of exposing complex socio-cultural and psychological factors associated with CLBP which has potential implications for designing effective interventions. The results of this study may inform the development of complex interventions for reducing the disability associated with CLBP in rural Nigeria and other rural African contexts. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices.Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined.Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores.Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices. [ABSTRACT FROM AUTHOR]