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Introduction: The clinical management of Chronic Low Back Pain (CLBP) substantially varying among general practitioners, specialists and physical therapists belonging to the same country, resulting in a wide spectrum of approaches. Objective: To determine how outcome expectations influence conservative treatment of working-age patients with CLBP. Methods: This is a narrative review of studies investigating or reporting an association between patients’ expectation and conservative treatment in patients with CLBP in working-age. Narrative review’s guidelines were followed during the design, research, and reporting. Results: The articles were screened by reading the titles and abstracts or full articles. This process resulted in a total of 5 studies that met the selection criteria and were therefore included in the systematic review and considered eligible for quality assessment through the Critical Appraisal Skills Programme (CASP) tool and PEDro (Physiotherapy Evidence Database) scale. What emerges from the studies included in the review essentially concerned three main topics: (a) the expectations of results, highly influenced by patients’ previous experiences; (b) the expectation concerning the clinical professional which includes the desire to receive information and education about the disorder and (c) those about environment or context. Conclusions: The results of the studies analyzed show that certain patients’ expectations, such as the expectation of tailored training with frequent follow-ups, the hope for the best possible outcomes, realism or resignation regarding pain relief, activity levels, good dialogue and communication, the need to be seen and confirmed as an individual and the desire to receive an explanation for the pain could be related to a better recovery outcomes.

Background: Chronic low back pain (CLBP) is considered one of the most common health conditions, significantly increasing the disease burden worldwide. Several interventions have been used to relieve CLBP. Pain Neuroscience Education (PNE) approach is used to help patients better understand their pain from a biological and physiological perspectives. Specialists also provide it to reduce pain and disability in chronic pain patients. Also, neuromuscular exercises (NMS) are targeted exercises to control impairments presented in CLBP. In this study, PNE combined with NMS is being investigated. Objective: This Randomized Control Trial (RCT) aims to investigate whether a program of NMS combined with PNE on pain, functional disability and psychological factors related to CLBP is effective. Methods/ Design: In this single-blind RCT, 42 patients (men and women, aged 30 to 60) diagnosed with CLBP will be randomly assigned to one of the following groups: (1) PNE plus NMS (21 people) and (2) the NMS (21 people). Outcome assessors will be blinded toward group allocation. The primary outcome will be pain intensity. The secondary outcomes will be disability, fear-avoidance beliefs during work and physical activity, self-efficacy, fear of movement, and kinesiophobia. A blinded assessor will assess all outcomes pre- and post-test. The primary and secondary outcomes will be assessed at baseline and post-intervention (8 weeks) and also at 6 months. Discussion: Pain neuroscience education has been recognized as an effective approach to chronic low back pain management. PNE appears to be effective when combined with NME to reduce pain, improve the patient's knowledge of pain, reduce disability and reduce psychosocial factors, increase movement and minimize the use of health care. Therefore, PNE combined with NME is an effective intervention for patients with chronic low back pain. Study registration: The registration reference is IRCT20190427043384N2. Registered on 17 March 2023.

Objective This study aimed at exploring the perspectives and experiences of individuals with neck pain by synthesizing all available qualitative studies. Methods A systematic, qualitative meta-summary and meta-synthesis was conducted following the 5-step methodology proposed by Sandelowski and Barroso. A systematic search of 9 electronic databases was conducted in May 2021. Methodological quality was assessed using the Critical Appraisal Skills Programme tool. Results Nine studies were included in the meta-synthesis for a total of 103 participants (73 women). Eleven categories were identified as belonging to 3 main themes: physical (“My neck has gone wrong”); psychological (“I am worried about my recovery”); and social (“Pain limits my life”). In the physical theme, the categories with the highest frequency were symptoms (67%) followed by body perception (44%). The psychological theme frequencies from highest to lowest were psychological consequences (100%), coping strategies (100%), mindset (67%), expectations from health care professionals (44%), and gender influence (22%). In the social theme, frequencies from highest to lowest were social relationships (56%), work, and activities of daily living and physical activity (44%, respectively). Conclusion An individual’s experience with neck pain is a multidimensional phenomenon in which physical, psychological, and social dimensions influence each other. These findings suggested that health care professionals should be aware of recognizing and evaluating all of the individual’s experiences to offer a truly patient-centered care pathway. Impact This qualitative meta-synthesis responded to a call to action to explore perspectives and experiences of individuals with neck pain. These findings can provide crucial guidance for clinicians as they plan and implement evidence-based recommendations for neck pain.

Refereed/Peer-reviewed Control interventions (often called “sham,” “placebo,” or “attention controls”) are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standard in non-pharmacological intervention research. A framework of additional considerations supports researchers’ decision making in this context. We also provide a reporting checklist for control interventions to enhance research transparency, usefulness, and rigour.

Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers. The study used a multi-stage virtual Nominal Group Technique (vNGT) to create and rank contextual factor definitions. Nominal group techniques are a form of consensus-based research, and are beneficial for identifying problems, exploring solutions and establishing priorities. The 10 international vNGT participants had a variety of clinical backgrounds and research specializations and were all specialists in contextual factors research. The initial stages of the vNGT resulted in the creation of 14 independent contextual factor definitions. After a prolonged discussion period, the initial definitions were heavily modified, and 12 final definitions were rank ordered by the vNGT participants from first to last. A sixth round was used to identify a final consensus, which reflected the complexity of contextual factors and included three primary domains: 1) an overall definition; 2) qualifiers that serve as examples of the key areas of the definition; and 3) how contextual factors may influence clinical outcomes. Our consensus definition of contextual factors seeks to improve the understanding and communication between clinicians and researchers. These are especially important in recognizing their potential role in moderating/mediating clinical outcomes.

UNSTRUCTURED No abstract available

IntroductionWhile the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects.PurposeIn this masterclass article, clinicians, researchers, and educators are invited to reflect on such possibilities, in an attempt to stimulate research and raise awareness for the mitigation of such undesirable effects.ImplicationsThis masterclass briefly introduces the nocebo effect and its underlying mechanisms. It then traces the historical development of chiropractic, osteopathy, and physiotherapy, arguing that there was and continues to be an excessive focus on the patient's body. Next, aspects of clinical practice, including communication, the therapeutic relationship, clinical rituals, and the wider social and economic context of practice are examined for their potential to generate nocebo and other undesirable effects. To aid reflection, a model to reflect on clinical practice and individual professions through the ‘prism’ of nocebo and other undesirable effects is introduced and illustrated. Finally, steps are proposed for how researchers, educators, and practitioners can maximise positive and minimise negative clinical context.

The coronavirus disease 2019 (COVID-19) pandemic has induced worldwide governments to adopt severe rules limiting individual freedom and imposing social distancing (eg, closing school, mandatory quarantine, restricting entertainments)1 in order to prevent the collapse of national health care systems. In addition to the goal of reducing the COVID-19 pandemic, this paradigm shift brings a different allocation of resources within diagnosis-related groups toward high-intensity levels of care (eg, intensive care units) needed for patients suffering of severe COVID-19. Although these measures are necessary in this pandemic, they constitute a barrier for health care professionals who are usually in close contact with patients needing low-intensity care, such as musculoskeletal (MSK) physical therapists.

Currently, the coronavirus disease 2019 (COVID-19) severely influences physiotherapy education which is based mostly on face-to-face teaching. Thus, educators have been compelled to adapt their pedagogical approaches moving to digital education. In this commentary, we debate on digital education highlighting its effectiveness, the users' perspectives, and its weakness in the context of physiotherapy teaching aimed at informing post-COVID-19 future directions in this educational field. Existing evidence on digital education produced before COVID-19 supports its implementation into entry-level physiotherapy education. However, some challenges (e.g. social inequality and evaluation of students) threaten its applicability in post-COVID-19 era, calling educators to take appropriate actions. ispartof: MEDICAL SCIENCE EDUCATOR vol:31 issue:6 pages:2071-2083 ispartof: location:United States status: published

Neck Pain (NP) is a widespread and disabling condition with high prevalence and incidence worldwide (Safiri et al. 2020). The impact of NP on patients is high, with important repercussions on a psychological level due to its multifactorial nature (Haldeman, Carroll, and Cassidy 2010; Henschke, Kamper, and Maher 2015). Attention to the patient's experience represents a milestone in the transition from a purely biomedical to a biopsychosocial approach, which considers the patient's beliefs and expectations as a fundamental elements of the care process (Brouwer et al. 2020). The lack of attention to the patient's point of view could result in poor adherence to the care process because of the negative experience previously lived (Dikkers et al. 2016) or because the treatments received were not congruent with their beliefs and expectations (Evans et al. 2014). This discrepancy represents an important condition that negatively affect the perception of positive change (Evans et al. 2014; Rossettini et al. 2020), causing dissatisfaction in the patient (Bowling et al. 2012) and making difficult to reach an effective therapeutic alliance. In order to reduce this distance, it becomes essential to thoroughly investigate the patient's point of view (Ritchie, Ehrlich, and Sterling 2017). Despite many qualitative primary studies have been produced in recent years involving patients with pain experience, the literature is still scarce of studies attempting to summarize these results. Meta-summary and meta-syntheses represents a suitable method to interpret the results of qualitative primary studies (Korhonen et al. 2013; VanderKaay et al. 2018). This approach allows to collect the different experiences and perspectives of the patients reported in various contexts and to reinterpret those results in a new theoretical models. Moreover, this method makes possible to provide important indications for clinical practice.

Background Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the exposure characteristics of physiotherapists (PTs) working in different Italian regions during the first wave of COVID-19. Methods Between April and May 2020 a structured anonymous online survey was distributed to all PTs registered in the National Professional Registry to collect prevalence data of a confirmed diagnosis of COVID-19 (i.e., nasopharyngeal swab and/or serological test). A bottom-up agglomerative nesting hierarchical clustering method was applied to identify groups of regions based on response rate. Multivariable logistic regression was used to explore personal and work-related factors associated with a confirmed diagnosis of COVID-19. Results A total of 15,566 PTs completed the survey (response rate 43.3%). The majority of respondents (57.7%) were from Northern regions. Considering all respondents, the number of confirmed COVID-19 cases in Northern and Central Italy, was higher compared to those in Southern Italy (6.9% vs. 1.8%, P P P Conclusions Work-related risk factors were differently distributed between Italian regions at the time of first pandemic wave, and PTs working in the Northern and Central regions were more at risk of a confirmed diagnosis of COVID-19, especially when working in hospitals. Preventive and organizational measures should be applied to harmonize physiotherapy services in the national context. Registration https://osf.io/x7cha

Background Low Back Pain (LBP) is commonly reported as a very frequent disorder in sports, but its prevalence in runners remains unclear. Objectives To determine the prevalence of LBP in a wide sample of Italian runners. Design A cross-sectional online survey. Setting A national survey, according to the CHERRIES and STROBE guidelines, was performed in 2019. Participants 2539 Italian runners. Methods A sample of Italian runners registered with national running associations was recruited. The survey was conducted using an online survey development platform. The questionnaire was self-reported and included 38 questions. Main outcome measures Descriptive statistics and frequencies were used to analyze results. Relationships between demographics, daily habits and running characteristics and the responses given was calculated with Cramer’s V. Only correlation values higher >0.60 were deemed of interest. Results 2539 questionnaires (63.5%) were valid for analysis. In total, 22.6% of runners reported having experienced LBP in the past year. Most participants (77.0%) reporting episodes of LBP believed it was not caused by running. No significant correlations (Cramer’s V Conclusion The prevalence of LBP among Italian runners was 22,57%. LBP was not associated with training, equipment or lifestyle.