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Measuring pain self-efficacy is suggested as relevant in patients with musculoskeletal disorders (MSDs) in a primary care setting. However, there is no pain self-efficacy questionnaire (PSEQ) available in Swedish. The aim of this study was to translate and culturally adapt PSEQ-2 to Swedish and evaluate reliability and validity in a population of patients with MSDs.

Purpose: To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. Methods: Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. Results: The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078–0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. Conclusions: The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn. IMPLICATIONS FOR REHABILITATION: Early identification of at-risk patients and team-based rehabilitation within primary care to prevent sickness absence and long-term problems due to acute/subacute musculoskeletal disorders has been scarcely studied. The PREVSAM model provides a framework for team-based interventions in primary care rehabilitation. The PREVSAM model may be used in the management of acute/subacute musculoskeletal disorders in the prevention of sickness absence. [ABSTRACT FROM AUTHOR]

Physical strength can be an important parameter to monitor for patients with diabetes mellitus type 2 (T2DM) to promote healthy lifestyle choices. Functional measurements can contribute to healthcare advice and possibly motivate more active lifestyles. The aim of the study was to investigate whether adding measurement and feedback concerning handgrip strength (HGS) to the parameters measured for patients with T2DM at annual check-ups leads to change in physical activity (PA) level, HGS, HbA1c or waist circumference. Methods: Measurement of HGS with Jamar dynamometers was added to annual check-ups for patients with T2DM by diabetes nurses in primary care with feedback about normal values for age and sex in the intervention group. The control group had standard check-ups. Change in self-reported PA level was measured with questionnaires. Results: Seven clinics and 334 patients participated. The intervention led to similar effects on PA in both groups. Patients with T2DM had comparable HGS to the general public. Regression analyses showed statistically significantly higher HGS in the intervention group than in the control group at follow-up and no improvement in PA, HbA1c, or waist circumference. Increased HGS was found for older people, men, and people with normal-to-high inclusion HGS, while patients with low inclusion HGS reduced their strength levels. Conclusions: Measuring HGS and giving feedback to patients with T2DM can lead to increased HGS but does not seem to affect general PA level, HbA1c, or waist circumference. People over 65 years, men, and people with normal-to-high HGS were influenced positively by the intervention. Patients with low HGS may need personalised support to increase physical activity and improve function. ClinicalTrials registration: NCT03693521 [ABSTRACT FROM AUTHOR]

Purpose: Return to work often requires collaboration between different stakeholders. Rehabilitation coordination is a resource in coordinating efforts during sick leave to facilitate return to work. The purpose of the present study was to describe how people at risk for sick leave or on sick leave with mental health problems experienced rehabilitation coordination. Materials and Method: The study had a qualitative approach using qualitative content analysis as described by Graneheim and Lundman. Eleven semi-structured interviews were conducted with persons at risk for sick leave or on sick leave due to mental health problems and with experience of rehabilitation coordination. Results: The participants experience of rehabilitation coordination were described by the overarching theme Building a bridge with many bricks between the person and society. The theme was formed by four categories and eleven subcategories reflecting the complex context of rehabilitation coordination. The categories were Collaboration in a new setting, Unburdened within certain limits, The way back to work is a joint project and Recognising challenges beyond the person. Conclusions: People with mental health problems experienced rehabilitation coordination as a meaningful link between healthcare and work. However, rehabilitation coordination needs to be more recognised within healthcare to increase accessibility. It seems important that interventions are directed not only towards the person, but also include the workplace for a sustainable return to work. KEY POINTS: It is important to make rehabilitation coordination visible within primary health care and actively inform people on sick leave with mental health problems that it is an option, as they often have difficulties finding information. It will increase their accessibility and enable autonomous decisions. A respectful interplay based on a person-centred care approach seems fundamental for rehabilitation coordination. The interplay with rehabilitation coordinators and with other stakeholders affects the sick leave process and all parties need to collaborate for a sustainable return to work. Three-party meetings with the person on sick leave, the rehabilitation coordinator and the employer, as well as teamwork, may provide better conditions for return to work as this can ensure that all stakeholders are working towards prioritised goals. Targeted interventions at the workplace seem to be important and rehabilitation coordination could be a valuable bridge between healthcare and work for creating sustainable conditions for return to work. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the effect of MediYoga as a group treatment to conventional treatment provided by a physiotherapist for people with perceived stress-related symptoms. Design: Randomized controlled trial. Settings: Primary care rehabilitation, Gothenburg Sweden. Subjects: Fifty-five patients with stress-related symptoms were invited to participate. Nine patients declined, and a total of 46 patients aged 26–70 years (mean 47), 44 women and two men were randomized, 23 to the MediYoga group and 23 to the physiotherapy treatment as usual group. Interventions: The MediYoga group performed MediYoga for one hour a week during an 8-week period. The control group received physiotherapy treatment as usual. Main measures: Data were mainly collected by self-reported questionnaires. For primary outcome the Swedish version of the Perceived Stress Scale (PSS) was used. Secondary outcomes were the Hospital Anxiety and Depression Scale (HADS), EuroQol–5D (EQ-5D) and EuroQol–Visual Analog Scale (EQ-VAS). Thoracic excursion was the only physical measurement. Mixed effect model was used for analyse. Results: For the primary outcome PSS, there was a close to statistically significant group effect over time advantaging MediYoga over physiotherapy (P = 0.06). For secondary outcomes, the group effect over time was statistically significant in HADS anxiety (P = 0.01) and EQ-VAS (P = 0.03). There was a group trend over time advantaging MediYoga in HADS depression (P = 0.08). Conclusion: Despite a large dropout in both groups, MediYoga can be recommended as a treatment option for people suffering from stress-related symptoms. Trial registration: Registered in: ClinicalTrials.gov NCT02907138 [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12 months postpartum. Methods In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n  = 105), minimal low-impact exercisers (n  = 249), regular low-impact exercisers (n  = 117), and high-impact exercisers (n  = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using Chi-square tests, Kruskal–Wallis tests, and Friedman analysis of variance. Results At 3 months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12 months. Conclusion The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum. Impact Physical therapists should encourage women to start with low-impact exercise early after pregnancy. Lay Summary This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. Methods Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. Results Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = −3.13 [95% CI = −5.77 to −0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = −6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. Conclusion The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. Impact This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultsConclusionTo explore and describe patients’ experiences and perceptions of rehabilitation according to the rehabilitation model ‘Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain’ (PREVSAM).A qualitative study was conducted, with individual semi-structured interviews analysed using qualitative content analysis. Fifteen patients from three primary care rehabilitation clinics in Sweden who had undergone rehabilitation based on the PREVSAM model participated.Four categories were identified from the participants’ experiences: Gratitude for the holistic view, Challenging but clarifying to create a health plan, Different needs for addressing work-related factors, and Difficulties and negative experiences. From these categories, an overarching theme was conceptualised: Grateful for being seen for who I am and given the care I need.Participants were generally positive towards the PREVSAM model. The addition of occupational therapy and psychological treatment to physiotherapy was seen by many, albeit not all, as enriching the rehabilitation. Collaboration with the workplace was mainly considered ‘good in theory’. The wide variation in the need for support underscore the importance of person-centredness. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Clinical practice guidelines are a common strategy for implementing research findings into practice and facilitating evidence‐based practice in health care settings. There is a paucity of knowledge about the impact of different guideline implementation strategies on clinical practice in a physiotherapy context. The study aimed to assess the impact of a guideline implementation intervention on clinical physiotherapy practice. Methods: A tailored, multicomponent guideline implementation was compared with usual practice. Clinical practice was evaluated in physiotherapy treatment methods used for 3 common musculoskeletal disorders. Data were collected with a validated web‐based questionnaire. Results: Postimplementation data were collected from 168 physiotherapists in the intervention group and 88 in the control group. The most frequently reported treatment methods for low back pain were advice on posture (reported by 95% in the intervention group vs 90% in the control group), advice to stay active (93% vs 90%), and stabilization exercise (88% vs 80%). Differences between groups were not significant. Reported use of body awareness training (23% vs 6%, P = .023) and spinal manipulation (9% vs 23%, P = .044) differed between the groups. The most frequently used treatment methods for neck pain were advice on posture (95% vs 92%), advice to stay active (89% vs 87%), and ROM exercise (85% vs 71%) (no significant differences between groups). Reported use of body awareness training (24% vs 7%, P = .023) differed between the groups. The most frequently used treatment methods for subacromial pain were range of motion exercises (reported by 93% in both groups), advice on posture (90% vs 87%), home exercise (77% vs 74%), and stabilization exercise (69% vs 66%) (no significant difference between groups). Conclusions: Treatment methods used were largely in line with evidence already before the guideline implementation, which may explain why the guideline implementation had only little impact on clinical practice. [ABSTRACT FROM AUTHOR]