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Introduction: Targeting psychosocial factors in patients with persistent spinal pain is recommended for more favourable outcomes in physiotherapy. However, some clinical challenges hinder a biopsychosocial treatment. Hence, Back2Action was developed. This study aims to gain insight into the experiences of physiotherapists using this blended treatment for patients with persistent spinal pain. Methods: The design of this study is mixed methods; The qualitative component is a thematic content analysis of semi-structured interviews with physiotherapists (N = 15) from the RCT 'Back2Action'. The quantitative component used digital questionnaires assessing user-friendliness. Results: Five themes emerged from the interviews; (1) Back2Action is an unexpected shift in treatment. The added eHealth intervention provides quality of information and structure. (2) Physiotherapists report becoming aware of their own biases and capabilities. (3) Their expectations towards patients with persistent pain and perceived patient expectations of a 'quick fix', could lead to a resistance of this new approach. (4) A surprising strengthening of the therapeutic relationship is reported due to growing experience and confidence. (5) Successful implementation requires supervision, intervision and means. The quantitative analyses showed that the overall intervention is perceived as user-friendly with a mean score of 74 (range 0-100) and a net promotor score of 7.9 (range 0-10). Discussion: Back2Action is considered a valuable treatment tool for physiotherapists. Process evaluation: A limitation of this study is the expert level of the physiotherapists and the generalisation of these results. [ABSTRACT FROM AUTHOR]

Introduction: Psychosocial factors predict recovery in patients with spinal pain. Several of these factors are modifiable. However, physiotherapists indicate that they do not feel sufficiently equipped to address these factors. We developed an eHealth intervention to support physiotherapists in managing psychosocial factors in patients with spinal pain. This paper describes the protocol for a pragmatic randomised clinical trial which evaluates the effectiveness of this eHealth intervention blended with physiotherapy compared to physiotherapy alone. Methods: Participants with non-specific low back pain and/or neck pain for at least six weeks who also experience psychosocial symptoms will be recruited in a pragmatic multi-centre cluster randomised clinical trial. The experimental intervention consists of physiotherapy blended with six online modules of pain education and behavioural activation. The control intervention consists of usual care physiotherapy. The primary outcomes are disability and perceived effect. Outcomes will be assessed at baseline, and at 2, 6 and 12 months after baseline. The results will be analysed using linear mixed models. Results: At this moment, 357 patients were assessed for eligibility and 140 patients are included. Our hypothesis is that the blended intervention is more effective than usual physiotherapy at 12 month follow-up. Process evaluation: Inclusion of participants has proven challenging, we have extended the inclusion phase with 1.5 years and recruited more physiotherapy practices. [ABSTRACT FROM AUTHOR]

Introduction: Psychosocial factors predict recovery in patients with spinal pain. Several of these factors are modifiable, such as depression and anxiety. However, primary care physiotherapists who typically manage these patients indicate that they do not feel sufficiently competent and equipped to address these factors optimally. We developed an eHealth intervention with a focus on pain education and behavioural activation to support physiotherapists in managing psychosocial factors in patients with spinal pain. This paper describes the protocol for a pragmatic randomised clinical trial, which evaluates the effectiveness of this eHealth intervention blended with physiotherapy compared with physiotherapy alone., Methods and Analysis: Participants with non-specific low back pain and/or neck pain for at least 6 weeks who also have psychosocial risk factors associated with the development or maintenance of persistent pain will be recruited in a pragmatic multicentre cluster randomised clinical trial. The experimental intervention consists of physiotherapy blended with six online modules of pain education and behavioural activation. The control intervention consists of usual care physiotherapy. The primary outcomes are disability (Oswestry Disability Index for low back pain and Neck Disability Index for neck pain) and perceived effect (Global Perceived Effect). Outcomes will be assessed at baseline and at 2, 6 and 12 months after baseline. The results will be analysed using linear mixed models., Ethics and Dissemination: The study is approved by the Medical Ethical Committee of VU Medical Center Amsterdam, The Netherlands (2017.286). Results will be reported in peer-reviewed journals, at national and international conferences, and in diverse media to share the findings with patients, clinicians and the public., Trial Registration Number: NL 5941; The Netherlands Trial Register., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The way people with musculoskeletal disorders deal with pain influences their prognosis. Psychosocial factors that influence outcomes include fear of movement, coping, self-efficacy, and catastrophizing. A 3-round modified Delphi study was conducted with the aim to reach consensus on the most appropriate questionnaires to assess these 4 psychosocial factors in patients at risk of developing persistent musculoskeletal pain. The panel consisted of 36 experts, with track records in medicine, psychology, and allied health. To be considered an expert, a minimum number of authorships were required on research articles using self-administered questionnaires to assess these psychosocial factors in relevant patient populations. In round 1, the experts proposed 30 questionnaires to assess the 4 factors. In round 2, experts rated the questionnaires on suitability, considering clinimetric properties, content, feasibility, personal experiences, and expertise. The highest ranked questionnaires (maximally 5 per factor) were retained for round 3, in which the experts made a final assessment of the questionnaires and provided their positive and negative experiences with the questionnaires. Consensus was reached for the following questionnaires to assess (1) fear of movement: Fear Avoidance Beliefs Questionnaire and Tampa Scale (full version or 11-item version); (2) coping: Coping Strategies Questionnaire (initial or revised version) and Chronic Pain Coping Index; (3) self-efficacy: Pain Self-Efficacy Questionnaire (full version or 2-item version); and (4) catastrophizing: Pain Catastrophizing Scale and the revised version of the Coping Strategies Questionnaire. Although other questionnaires can be considered in specific circumstances, these questionnaires are recommended in people with musculoskeletal pain.

[This corrects the article DOI: 10.1016/j.invent.2017.06.003.].

Background: Depression has a high impact on both patients and the people around them. These non-professional caregivers often experience overburdening and are at risk for developing psychological symptoms themselves. Internet interventions have the potential to be accessible and (cost)-effective in terms of reducing and preventing psychological symptoms. Less is known about their potential to decrease psychological distress among caregivers. The primary aim of this study is to evaluate (1) the user-friendliness and (2) the initial short-term effects on psychological distress of 'E-care for caregivers', an internet based guided self-management intervention for non-professional caregivers of depressed patients., Methods: A pilot randomized controlled trial (RCT: n  = 80) comparing 'E-care for caregivers' ( n  = 41) with a waitlist-control group ( n  = 39). The primary outcome measure (user-friendliness) was assessed with the System Usability Scale (SUS) and semi-structured telephone interviews among participants. Interviews were qualitatively analyzed with thematic content analysis. Secondary outcomes were assessed through online questionnaires administered at baseline and post-intervention at six weeks among caregivers. Statistical analyses were conducted according to the intention-to-treat principle using regression techniques for the secondary outcomes., Results: All participants were recruited within six weeks through online advertising. Two-thirds of participants experienced higher levels of psychological distress (K10 > 20). The internet intervention was evaluated as user-friendly by caregivers (average score of 81.5, range [0-100]). Results did not show a reduction in psychological distress or other secondary outcome measures. Sensitivity analyses showed a decreased quality of life in the control condition compared to the intervention condition ( p  = 0.02, Cohen's d = 0.44) and higher levels of mastery ( p  = 0.02, Cohen's d = 0.48) in the intervention condition compared to controls., Discussion: The internet intervention was evaluated positively for usability and was considered as easy to use. The study did not show a reduction in symptoms of psychological distress. However, there were some indications that those completing the internet intervention perceived higher levels of mastery and a protective effect in quality of life post-intervention., Strengths and Limitations: As far as we know, this study is the first to examine the user-friendliness and initial effects of an internet intervention specifically designed for non-professional caregivers of depressed patients. As this was a pilot study, the findings should be interpreted with caution. We recommend investigating the possibilities of providing a (partially) sequential design as well as incorporating themes like stigma and expressed emotion in the online course and subsequent evaluation of the internet intervention in a full-scale RCT, with a six-month follow-up., Trial Registration: Netherlands Trial Register: NTR5268. Registered on 30 June 2015.