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Purpose The aims of this study were, first, to determine the percentage of adolescents with chronic pain/fatigue successfully treated with rehabilitation treatment for chronic pain/fatigue and, second, to identify predictors for a successful rehabilitation treatment. Methods Treatment success is scored based on a combination of predefined clinically relevant changes in 4 outcome measures: level of pain/fatigue, school absence, physical functioning, and psychosocial functioning. A forward stepwise logistic regression analysis with treatment success as a dependent variable is performed to identify predictors for successful treatment. Results A total of 172 adolescents (mean age 16.2 [ SD = 2.5]; 85.5% girls) participated. Almost half (49.6%) of the adolescents had a successful treatment. The explained variance for the complete model explaining treatment success was 49% ( R2 = 0.487). Patients with a higher level of pain/fatigue and a passive coping style pretreatment improved most, and these factors could thus be indicated as predictors for successful treatment. Also, gender significantly contributed to the prediction, in favor of boys. Conclusions Regarding the first aim, using predefined treatment success based on clinically relevant changes, half of the participants had a successful treatment. Concerning the second aim, adolescents with a high level of pain/fatigue and those with a high passive coping style pretreatment have a better ability to change their functioning during treatment. Boys benefit more than girls. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to evaluate whether patients with fibromyalgia FM need more oxygen and more time to complete a walking and stair-climbing task than healthy volunteers and perceive the performance of these tasks as more strenuous. Furthermore, it was evaluated whether a less efficient performance is more pronounced in patients reporting a higher level of fear of movement. Methods Thirty patients with FM and 30 matched healthy volunteers completed a 500-meter walking and a stair-climbing task (60 steps) while wearing a mobile gas analyzing unit. Mean and total oxygen consumption and time needed to complete each task were recorded. After both tasks, a Borg score was used to measure perceived exertion. Fear of movement was measured with the Tampa Scale for Kinesiophobia. Results Patients with FM needed more time to complete the walking and stair-climbing task and reported higher levels of exertion compared to healthy volunteers. However, the total oxygen consumption for performing both tasks was not different. In patients with FM, a higher level of fear of movement was associated with a higher perceived exertion after the walking task. Interestingly, a higher somatic focus is related to a lower mean oxygen consumption needed to perform the stair-climbing task. Conclusion In conclusion, patients with FM perceive a walking and stair-climbing task as more strenuous than healthy controls, even though they walked slower and no differences in total O2 consumption during completion of both tasks were found. [ABSTRACT FROM AUTHOR]

In patients with chronic low back pain (CLBP), a patient's level of physical functioning is evaluated to determine the impact of pain on physical functioning. It appears that in various performance tests the influence of non-physiological factors differs. It is unclear which performance tests are best suited for measurement of maximum capacity or pain-related behaviour. The main aim of the present review is to highlight the influence of psychological factors during different types of performance testing in patients with CLBP. The degree in which pain-related and psychological factors influence test outcome differs between performance tests. A minimum influence of pain intensity and psychological factors is found in (sub)maximal exercise testing in patients who are able to complete the test. The influence of pain intensity and psychological factors is most prominent in holding endurance tasks evaluating the duration a patient can hold a certain weight. In order to decide which assessment tool for physical performance can best be used for the evaluation of physical functioning in patients with CLBP, one should specifically consider the question that has to be answered. In case a patients' physical capacity has to be objectified, another assessment tool seems preferred compared with a situation in which a patient's pain-related behaviour is aimed to be assessed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: More than 50% of patients with upper limb paresis after stroke face long-term impaired arm function and ensuing disability in daily life. This study aims to evaluate the effectiveness of a task-oriented mental practice (MP) approach as an addition to regular arm–hand therapy in patients with subacute stroke. Methods: A multicenter, prospective, single-blind, randomized clinical trial was performed. Patients trained for 6 weeks, at least 3 times per day. In the experimental group, patients performed video-instructed MP. In the control group, patients performed neurodevelopmental therapy–based exercise therapy. The primary outcome measures are Fugl-Meyer test, Frenchay arm test, Wolf motor function test, and accelerometry. Results: The patients did improve over time on Fugl-Meyer test and Wolf motor function test in both the control and the experimental group. A significant improvement on the Frenchay arm test was found after training (which was maintained at 12-month follow-up) only in the experimental group. However, no difference in training effects between groups was demonstrated. Conclusions: Training effects were demonstrated after MP training in patients with subacute stroke. However, the results of this study do not corroborate the hypothesis that the use of MP in addition to therapy as usual in patients with subacute stroke has an additional effect over neurodevelopmental therapy in addition to therapy as usual. [Copyright &y& Elsevier]

Purpose: To compare physical activity levels of adolescents and young adults with chronic pain with that of healthy participants. To investigate the impact of pain intensity, pain catastrophizing and depressive symptoms on the level of physical activity and disability of adolescents and young adults with chronic pain. Methods: Case-control study. Levels of physical activity and disability of adolescents and young adults with chronic non-specific musculoskeletal pain (n = 42) were compared with that of healthy participants (n = 42). For participants with chronic pain, measures of pain catastrophizing, pain intensity and depression were examined for their ability to explain levels of physical activity and disability. Statistics: multivariate regression analysis, Mann-Whitney testing, Pearson correlation analysis. Results: Participants with chronic pain were as active as healthy participants (p = 0.22) (confidence interval [CI] 95%), although they seemed to be less active in sports and heavy-loaded activities. Pain intensity (ß = 0.32) and depressive symptoms (ß = 0.36) contributed significantly to disability (CI 95%). There was no significant association between physical activity and disability (CI 95%). Conclusions: Chronic non-specific musculoskeletal pain is a disabling condition for adolescents and young adults. The level of physical activity in the daily life of adolescents and young adults with chronic pain is comparable to that of healthy counterparts, although the performance of sports and heavy-loaded activities seems diminished. Both pain intensity and depressive symptoms are disabling. [ABSTRACT FROM AUTHOR]

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘The trainee demonstrates a knowledge of diagnostic approaches for specific impairments including cognitive dysfunction as a result of cardiac arrest.’AbstractObjective: To describe a new early intervention service for survivors of cardiac arrest and their caregivers, and to explain the evidence and rationale behind it.Rationale: A cardiac arrest may cause hypoxic–ischaemic brain injury, which often results in cognitive impairments. Survivors of cardiac arrest can also encounter emotional problems, limitations in daily life, reduced participation in society and a decreased quality of life. A new early intervention service was designed based on literature study, expert opinion and patient experiences.Description of the intervention: The early intervention service is an individualized programme, consisting of one to six consultations by a specialized nurse for the patient and their caregiver. The intervention starts soon after discharge from the hospital and can last up to three months. The intervention consists of screening for cognitive and emotional problems, provision of information and support, promotion of self-management strategies and can include referral to further specialized care if indicated.Discussion: This intervention is assumed to reduce future problems related to hypoxic–ischaemic brain injury in the patient and caregiver, and its effectiveness is currently being investigated in a randomized controlled multicentre trial. [ABSTRACT FROM PUBLISHER]

Introduction: In the last decade new treatments based on mental imagery have been developed for patients with stroke. Whether this therapy works for patients with neglect is currently unclear. Objective: To investigate whether patients with a right hemisphere stoke complicated with unilateral neglect were less capable of performing motor imagery as compared to patients with a right hemisphere stroke without unilateral neglect. Methods: In a patient-control study, 20 patients with a right hemisphere stroke were included. Twelve patients were diagnosed on admission with neglect and eight without neglect. The ability to perform motor imagery was tested using mental rotation tasks, based on either a visual (CMIA ''Hand Rotation'' test) or a verbal (Questionnaire d''Imagerie Mentale: Rotation des Mains) instruction. In both tasks subjects were instructed to generate a mental image of their hand. Results: Patients with neglect scored significantly less ( p == 0.02) as compared to patients without neglect on the visual mental rotation task, but not on the mental rotation task with verbal instruction. Conclusion: Patients with a right-hemisphere stroke and neglect seem less capable of performing visual mental rotation tasks in comparison to patients with a stroke without neglect. [ABSTRACT FROM AUTHOR]

Abstract: Patients with chronic pain may have difficulties estimating their own physical activity level in daily life. Pain-related factors such as depression and pain intensity may affect a patients’ ability to estimate their own daily life activity level. This study evaluates whether patients with Chronic Low Back Pain (CLBP) who are more depressed and/or report more pain indeed have a lower objectively assessed daily life activity level or whether they only perceive their activity level as lower. Patients with CLBP were included in a cross-sectional study. During 14days physical activity in daily life was measured, with both an electronic diary and an accelerometer. Multilevel analyses were performed to evaluate whether a higher level of depression and/or pain intensity was associated with a lower objectively assessed activity level or the discrepancy between the self-reported and objectively assessed daily life activity levels. Results, based on 66 patients with CLBP (mean RDQ score 11.8), showed that the objectively assessed daily life activity level is not associated with depression or pain intensity. There was a moderate association between the self-reported and objectively assessed activity levels (β =0.39, p <0.01). The discrepancy between the two was significantly and negatively related to depression (β =−0.19, p =0.01), indicating that patients who had higher levels of depression judged their own activity level to be relatively low compared to their objectively assessed activity level. Pain intensity was not associated with the perception of a patient’s activity level (β =0.12, ns). [Copyright &y& Elsevier]

Abstract: Objective: To describe the current evidence on the frequency and nature of cognitive impairments in survivors of out-of-hospital cardiac arrest. Design: Systematic review. Data sources: Pubmed, Embase, PsychInfo and Cinahl (1980–2006). No language restriction was imposed. Review methods: The following inclusion criteria were used: participants had to be survivors of out-of-hospital cardiac arrest, 18 years or older, and there had to be least one cognitive outcome measure with a follow-up of 3 months or more. Case reports and qualitative studies were excluded. The articles were screened on title, abstract and full text by two reviewers. All selected articles were reviewed and assessed by two reviewers independently using a quality criteria list. Results: Out of the 286 articles initially identified, 28 were selected for final evaluation. There was a high heterogeneity between the studies with regard to study design, number of participants, outcome measures and duration of follow-up. In general, the quality of the articles appeared low, with a few positive exceptions. The reported frequency of cognitive impairments in survivors of out-of-hospital cardiac arrest ranged from 6% to 100%. Memory problems were the most common cognitive impairment, followed by impairments in attention and executive functioning. Three high-quality prospective studies found that cognitive problems occurred in about half of the survivors of out-of-hospital cardiac arrest. Conclusion: There are few good studies on the frequency of cognitive impairments after out-of-hospital cardiac arrest. However, cognitive problems, in particular memory problems, seem common in survivors of out-of-hospital cardiac arrest. [Copyright &y& Elsevier]

Background: Over 50% of patients with upper limb paresis resulting from stroke face long-term impaired arm function and ensuing disability in daily life. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. This study aims to evaluate a new therapy for improving arm function in sub-acute stroke patients based on mental practice theories and functional task-oriented training, and to study the predictors for a positive treatment result. It is hypothesized that a six-week, mental practice-based training program (additional to regular therapy) targeting the specific upper extremity skills important to the individual patient will significantly improve both arm function and daily activity performance, as well as being cost effective. Methods/design: One hundred and sixty sub-acute stroke patients with upper limb paresis (MRC grade 1-3) will participate in a single-blinded, multi-centre RCT. The experimental group will undertake a sixweek, individually tailored therapy regime focused on improving arm function using mental practice. The control group will perform bimanual upper extremity exercises in addition to regular therapy. Total contact time and training intensity will be similar for both groups. Measurements will be taken at therapy onset, after its cessation and during the follow-up period (after 6 and 12 months). Primary outcome measures will assess upper extremity functioning on the ICF level of daily life activity (Wolf Motor Function Test, Frenchay Arm Test, accelerometry), while secondary outcome measures cover the ICF impairment level (Brunnstrom-Fu-Meyer test). Level of societal participation (IPA) and quality of life (EuroQol; SS-Qol) will also be tested. Costs will be based on a cost questionnaire, and statistical analyses on MAN(C)OVA and GEE (generalized estimated equations). Discussion: The results of this study will provide evidence on the effectiveness of this mental practicebased rehabilitation training, as well as the cost-effectiveness. Trial registration: Current Controlled Trials [ISRCTN33487341) [ABSTRACT FROM AUTHOR]

Background: Patients with fibromyalgia often feel disabled in the performance of daily activities. Psychological factors seem to play a pronounced disabling role in fibromyalgia. The objectives of the study are: Firstly, to investigate contributing factors for disability in fibromyalgia. Secondly, to study psychological distress in patients with fibromyalgia as compared to other nonspecific pain syndromes. And finally, to explore the impact of fibromyalgia on a patient's quality of life. Methods: In this cross sectional study, explaining factors for disability were studied based on a regression analysis with gender, mental health, physical and social functioning as independent variables. For the assessment of disability in fibromyalgia the FIQ was used. The levels of psychological distress in patients with fibromyalgia, Complex Regional Pain Syndrome (CRPS) and chronic low back pain (CLBP) were compared based on scores on the Symptom Checklist (SCL90). Quality of life of patients with fibromyalgia was compared with scores (SF36) of both patients with fibromyalgia and other health conditions as derived from the literature. Results: Disability in fibromyalgia seemed best explained by a patients mental health condition (ß = -0.360 p = 0.02). The level of psychological distress was higher in patients with fibromyalgia as compared to patients with CRPS or CLBP (p < 0.01). The impact of fibromyalgia on quality of life appeared to be high as compared to the impact of other health conditions. Conclusion: Patients with fibromyalgia report a considerable impact on their quality of life and their perceived disability level seems influenced by their mental health condition. In comparison with patients with other pain conditions psychological distress is higher. [ABSTRACT FROM AUTHOR]

Abstract: For years, physical deconditioning has been thought to be both a cause and a result of back pain. As a consequence physical reconditioning has been proposed as treatment-goal in patients with chronic low back pain (LBP). However, it is still unclear whether a patient’s physical fitness level really decreases after pain-onset. The objectives of the present study were, firstly, to test the assumption that long-term non-specific LBP leads to a decrease of the level of physical activity (disuse), secondly, to evaluate any development of physical deconditioning as a result of disuse in CLBP, and thirdly, to evaluate predictors for disuse in CLBP. A longitudinal cohort study over one year including 124 patients with sub-acute LBP (i.e., 4–7 weeks after pain onset) was performed. Main outcome measures were change in physical activity level (PAL) and physical fitness (measured by changes in body weight, body fat and muscle strength) over one year. Hypothesized predictors for disuse were: pain catastrophizing; fear of movement; depression; physical activity decline; the perceived level of disability and PAL prior to pain. Results showed that only in a subgroup of patients a PAL-decrease had occurred after the onset of pain, whereas no signs of physical deconditioning were found. Negative affect and the patients’ perceived physical activity decline in the subacute phase predicted a decreased level of PAL over one year. Based on these results, we conclude that as to the assumption that patients with CLBP suffer from disuse and physical deconditioning empirical evidence is still lacking. [Copyright &y& Elsevier]

Introduction: Individuals with spinal cord injury (SCI) can experience accelerated cognitive aging. Myokines (factors released from muscle cells during contractions), such as brain-derived neurotrophic factor (BDNF), are thought to have beneficial effects on cognition. Neuromuscular electrical stimulation (NMES) was shown to elicit a large release of myokines. However, the effects of NMES on cognitive function have not been studied. Objective: To present the study protocol for a clinical trial evaluating the effects of NMES aimed at improving cognition and BDNF. Methods: A replicated randomized three-phases single-case experimental design (SCED) with sequential multiple baseline time series and a single-armed prospective trial will be conducted with 15 adults with chronic SCI (> 12 months after injury) above L1 neurological level undergoing 30-min quadriceps NMES, 3 days per week for 12 weeks. Main study endpoints: Primary endpoint is cognitive performance (assessed by a smartphone test) conducted three times per week during the baseline phase with random duration of 3 to 8 weeks, the intervention phase of 12 weeks, and the follow-up phase of 3 weeks after a no measurement rest period of 12 weeks. Secondary endpoints are changes in BDNF levels and cognitive performance measured before the baseline period, before and after intervention and after a 12 weeks follow-up. Conclusion: This will be the first study investigating the effects of 12 weeks NMES on both cognition and BDNF levels in individuals with SCI. The SCED results provide information on individual treatment effect courses which may direct future research. Trial registration: ClinicalTrials.gov (NCT05822297, 12/01/2023). [ABSTRACT FROM AUTHOR]

Neurological complications of the COVID-19 infection may be caused in part by local neurochemical and structural abnormalities that could not be detected during routine medical examinations. We examined within subject neurometabolic and structural brain alterations from pre-to post-COVID-19 in the hippocampal region of three elderly individuals (aged 63–68 years) who had a COVID-19 infection with mild symptoms. Patients were participating in an interventional study in which they were closely monitored at the time they were diagnosed with COVID-19. Patients 1 and 2 just completed 18–20 resistance training sessions prior to their diagnosis. Patient 3 was assigned to a non-training condition in the same study. Whole brain magnetic resonance imaging (MRI) images and proton magnetic resonance spectroscopy (1H-MRS) of the left hippocampus were collected before and after infection. Structural and spectroscopic imaging measures post-COVID-19 were contrasted to the pre-COVID-19 measures and were compared with values for Minimal Detectable Change at 95% (MDC 95) and 90% (MDC 90) confidence from a group of six elderly (aged 60–79 years) without COVID-19 that participated in the same study. After SARS-COV-2 infection, we observed a reduction of glutamate-glutamine (Glx) in Patients 1 and 2 (≥ 42.0%) and elevation of myo-inositol (mIns) and N -acetyl-aspartate (NAA) in Patient 3 (≥ 36.4%); all > MDC 90. MRI findings showed increased (Patients 1 and 2) or unchanged (Patient 3) hippocampal volume. Overall, findings from this exploratory study suggest that mild COVID-19 infection could be associated with development of local neuroinflammation and reduced glutamate levels in the hippocampus. Our 1H-MRS findings may have clinical value for explaining chronic neurological and psychological complaints in COVID-19 long-haulers. • 1H-MRS spectra and MRI images were collected from hippocampus of 3 COVID-19 patients. • COVID-19 disease was associated with increased myoinositol and reduced Glx levels. • Resistance trained patients showed hippocampal volume increase despite COVID-19. • COVID-19 disease was associated with increased anxiety and depression levels. • 1H-MRS may be applied to detect neurochemical abnormalities in COVID-19 long-haulers. [ABSTRACT FROM AUTHOR]

A randomized controlled trial was conducted comparing the effects of a biopsychosocial course (PRESTO-Play) vs. physical activity promotion (PRESTO-Fit) to reduce disability related to musculoskeletal disorders in music students. The current study provides an external validation and a formative and process evaluation, allowing for a better interpretation of results. First, a group of experts was asked to complete a structured evaluation of design and content of the trial. Second, quantitative and qualitative data were analysed from different stakeholders (students, therapists and conservatory staff) using questionnaires, logs, field notes and emails to evaluate fidelity, dose delivered, dose received, reach and context. Results are presented descriptively. Two authors independently identified key responses that were merged into themes. Although no difference in disability was found between interventions, closer evaluation revealed that participants in PRESTO-Play reported that they learned about prevention of physical complaints and were more satisfied with course contents compared with PRESTO-Fit. Study design and contents of the interventions were found to be valid, with an appropriate dose delivered. Feedback from students and logs suggested that behavioural change and psychosocial principles in PRESTO-Play might have not been implemented optimally. Only moderate fidelity in both groups and too little contrast between interventions could have influenced results. Low attendance rates and a presumed lack of generalization further decreased possible effectiveness. Context greatly influenced implementation. Implementing a future health course with closer collaboration with the institution could optimize accessibility and communication, encourage attendance and enhance motivation for behavioural change. [ABSTRACT FROM AUTHOR]

Treatment fidelity and proficiency of a nurse-led motivational interviewing (MI)-based pre-treatment and control condition was evaluated. A random sample was scored by means of the Motivational Interviewing Treatment Integrity (MITI) scale, and a second rater was in charge. MI fidelity was satisfactory for three out of five ratings. Most mean ratings were higher in the MI-based intervention, but differences were not statistically significant. The threshold for beginning MI proficiency was only exceeded for one score and one additional measure. In general, higher levels of fidelity in the intervention condition confirmed that MI was partially applied there. Although the quality of MI delivery as well as mixed inter-rater reliabilities of the fidelity scores leaves room for improvement, robust findings between the two raters were found. These results suggest the need for rigor selection of MI counselors on beforehand, and continuous supervision. Furthermore, fidelity check in studies using MI is needed. [ABSTRACT FROM AUTHOR]

Background: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme.Methods: In this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme.Results: A part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients' home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme.Conclusion: This study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation. Arm-hand rehabilitation may be enriched in content and variation by using technology-assisted training. Especially for people with a severely affected arm, technology-assisted training offers more challenging training possibilities. OBJECTIVE: The aim of this study was to explore the feasibility of ReHab-TOAT, a "Remote Handling Based Task-Oriented Arm Training" approach featuring enriched haptic feedback aimed at improving daily activities and participation. METHODS: Five subacute or chronic stroke patients suffering moderate to severe arm-hand impairments and five rehabilitation therapists participated. All participants received 2 ReHab-TOAT sessions. Outcome measure was a bespoke feasibility questionnaire on user experiences and satisfaction regarding 'motivation', 'individualization of training', 'potential training effects', and 'implementation in rehabilitation' of patients and therapists. RESULTS: Both patients and therapists experienced ReHab-TOAT as being feasible. They found ReHab-TOAT very motivating and challenging. All patients perceived an added value of ReHab-TOAT and would continue the training. Small improvements regarding exercise variability were suggested. CONCLUSION: ReHab-TOAT seems to be a feasible and very promising training approach for arm-hand rehabilitation of stroke patients with a moderately or severely affected arm. Further research is necessary to investigate potential training effects of ReHab-TOAT. [ABSTRACT FROM AUTHOR]

Obesity and sarcopenia are associated with cognitive impairments at older age. Current research suggests that blood biomarkers may mediate this body-brain crosstalk, altering neurometabolism and brain structure eventually resulting in cognitive performance changes. Seventy-four older adults (60–85 years old) underwent bio-impedance body composition analysis, handgrip strength measurements, 8-Foot Up-and-Go (8UG) test, Montreal Cognitive Assessment (MoCA), blood analysis of interleukin-6 (IL-6), kynurenine, and insulin-like growth factor-1 (IGF-1), as well as brain magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS), estimating neurodegeneration and neuroinflammation. Normal fat% or overweight was associated with larger total gray matter volume compared to underweight or obesity in older adults and obesity was associated with higher N-acetylaspartate/Creatine levels in the sensorimotor and dorsolateral prefrontal cortex. Muscle strength, not muscle mass/physical performance, corresponded to lower kynurenine and higher N-acetylaspartate/Creatine levels in the dorsal posterior cingulate and dorsolateral prefrontal cortex. The inflammatory and neurotrophic blood biomarkers did not significantly mediate these body-brain associations. This study used a multimodal approach to comprehensively assess the proposed mechanism of body-brain crosstalk. [ABSTRACT FROM AUTHOR]

Aim: For those patients who suffer unfavourable outcome after survival of cardiac arrest, it is important to know whether this can be predicted at an early stage. Support can subsequently be provided. This study aimed to identify early prognostic factors of quality of life (QOL) and societal participation at one year post-cardiac arrest.Methods: The design was a prospective longitudinal cohort study following cardiac arrest survivors up to one year. Prognostic personal, injury-related, function-related and subjective outcome factors were selected and entered into a hierarchical regression model to assess whether they were predictive of QOL and societal participation at one year post-cardiac arrest.Results: Hundred and ten cardiac arrest survivors were included. Not having a partner, more functional limitations (at two weeks) and cognitive complaints were significantly predictive of lower physical QOL, while higher levels of anxiety and depression symptoms (at three months) were significant predictors of mental QOL. A neurological history and higher levels of anxiety and depression symptoms were significantly predictive of lower brain injury-specific QOL. Societal participation was only predicted by premorbid functioning.Conclusion: This study identified prognostic factors of QOL and societal participation one year after survival of cardiac arrest. Screening of these factors in early stages can identify those survivors with possibly unfavourable QOL at one year post cardiac arrest. For those survivors, preventive and targeted interventions may be offered. [ABSTRACT FROM AUTHOR]

Background:A minority of patients with mild traumatic brain injury (mTBI) experience a persistent symptom complex also known as post-concussion syndrome. Explanations for this syndrome are still lacking. Objective:To investigate if the fear avoidance model, including catastrophizing thoughts and fear avoidance behaviour, poses a possible biopsychosocial explanation for lingering symptoms and delay in recovery after traumatic brain injury (TBI) with special focus on mTBI. Design:Cross-sectional study. Participants:48 patients with TBI, of which 31 patients with mTBI, had persistent symptoms (mean time since injury 48.2 months); 92% of the entire sample fulfilled the criteria for post-concussion syndrome. Outcome variables:catastrophizing, fear-avoidance, depression and post-concussion symptoms. Results:High levels of catastrophizing were found in 10% and high levels of fear avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour, depressive symptoms and post-concussion symptoms correlated significantly with each other (p < 0.05). Conclusion:The fear-avoidance model proposes a possible explanation for persistent symptoms. Validation and normative data are needed for suitable measures of catastrophizing and fear avoidance of post-concussion symptoms after TBI. Longitudinal prospective cohort studies are needed to establish its causal and explanatory nature. [ABSTRACT FROM PUBLISHER]

Background: Cardiac arrest can lead to hypoxic brain injury, which can affect cognitive functioning.Objective: To investigate the course of objective and subjective cognitive functioning and their association during the first year after cardiac arrest.Methods: A multi-centre prospective longitudinal cohort study with one year follow-up (measurements at two weeks, three months and one year). Cognitive functioning was measured with a neuropsychological test battery and subjective cognitive functioning with the Cognitive Failures Questionnaire.Results: 141 cardiac arrest survivors participated. Two weeks post cardiac arrest 16% to 29% of survivors were cognitively impaired varying on the different tests, at three months between 9% and 23% and at one year 10%-22% remained impaired with executive functioning being affected most. Significant reduction of cognitive impairments was seen for all tests, with most recovery during the first three months after cardiac arrest. Subjective cognitive complaints were present at two weeks after cardiac arrest in 11%, 12% at three months and 14% at one year. There were no significant associations between cognitive impairments and cognitive complaints at any time point.Conclusions: Cognitive impairments are common in cardiac arrest survivors with executive functioning being mostly affected. Most recovery is seen in the first three months after cardiac arrest. After one year, a substantial number of patients remain impaired, especially in executive functioning. Because of absence of associations between impairments and complaints, cognitive testing using a sensitive test battery is important and should be part of routine follow-up after a cardiac arrest. [ABSTRACT FROM AUTHOR]

Background Content validity, the proper reflection of the concept to be measured, is yet unknown for the Credibility and Expectancy Questionnaire ( CEQ). It is frequently used in pain rehabilitation because treatment expectancy is influential on the outcome. Objective To test and improve the content validity of the CEQ in a sample of patients with chronic pain in different phases of their treatment. Methods A qualitative observational study design using the Three-Step Test-Interview method was used. Therein, data collection, analyses, and adaptations occur iteratively. Results Seventeen patients with chronic pain in different stages of treatment participated through convenience sampling from the mother sample of a randomized controlled trial. The main study parameter is content validity, which is defined as (1) interpretations and responses of the participants and (2) the identification of response problems operationalized, and resulting in changes in the CEQ. For patients waiting for treatment, the written instruction of the CEQ allowed different interpretations. After changing the instructions, the CEQ became an easy-to-understand and content-valid questionnaire. For patients who had already undergone treatment, changes regarding time frame and recall period were necessary to overcome interpretation and response problems to the CEQ. Discussion After small changes, the CEQ appeared to be a content-valid measurement instrument for patients waiting for treatment. However, for patients who had already undergone treatment, the content validity of the CEQ was less, and considerable changes were necessary. [ABSTRACT FROM AUTHOR]

Aim: Cardiac arrest survivors are at risk of long-term cognitive impairment. Patients with cognitive impairments do not always have cognitive complaints and vice versa. Not reporting cognitive complaints could be caused by a lack of awareness. We hypothesized that caregivers report more cognitive failures than patients, indicating patients' lack of insight into cognitive functioning.Methods: This is a secondary analysis of the Activity and Life After Survival of Cardiac Arrest study on survivors of cardiac arrest and their caregivers. They were assessed at two weeks, three months, and one year after cardiac arrest. At each time point, the patient and the caregiver filled out the cognitive failure questionnaire (CFQ) regarding the patient. We analysed the correlation, intraclass correlation, and self-proxy discrepancy between patients and caregivers on the CFQ over time.Results: One-hundred-and-nineteen cardiac arrest survivors (mean age = 60, 85 % male) and their caregivers were included. The CFQ scores of the patients and caregivers were equally low. The correlation (T1 r = 0.31; T2 r = 0.40; T3 r = 0.55) and intraclass correlation (T1 r = 0.48; T2 r = 0.56; T3 r = 0.71) between patient and caregiver increased over time.Conclusion: This study does not support a lack of awareness of cognitive impairments by long-term cardiac arrest survivors. Future research may focus on alternative explanations for why patients have less cognitive complaints than expected based on the frequency of cognitive impairments. Possible explanations include a response shift. [ABSTRACT FROM AUTHOR]

Background and aims: Integration of care is lacking for chronic musculoskeletal pain patients. Network Pain Rehabilitation Limburg, a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients' levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability. Methods: This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. The network comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase. Results: According to health care professionals, guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One mentioned barrier is the stigmatization of chronic pain by the general population. In regular care, approaches are often more biomedical than biopsychosocial, causing patients to resist participating. The current organization of health care acts as a barrier, complicating implementation between and within practices. Health care professionals were enthusiastic about the iterative, bottom-up development. A critical mass of participating organizations is needed for proper implementation. Conclusion: Network Pain Rehabilitation Limburg is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine Network Pain Rehabilitation Limburg. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model. Trail registration: Registration number: NTR6654 or https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6654. [ABSTRACT FROM AUTHOR]

Purpose: Literature shows promising effects for interdisciplinary biopsychosocial rehabilitation programs in patients with chronic low back pain (CLBP). Not every patient needs an interdisciplinary rehabilitation trajectory provided in a secondary care setting. Patients with moderate complex psychosocial complaints might benefit from biopsychosocial interventions offered in primary care under supervision of a physician in rehabilitation medicine (i.e. biopsychosocial integrated care intervention). This study investigated the feasibility and effectiveness of such intervention in patients with CLBP with moderate complex psychosocial complaints. Methods: mixed-method. Patients (aged 18-65 years, low back pain ≥12 weeks, moderate complex psychosocial complaints) received the intervention (4 individual sessions, 8 group sessions) provided by trained primary care physiotherapists. Physicians in rehabilitation medicine provided one consultation afterwards. Data from patients (n¼18), physicians (n¼4) and physiotherapists (n¼12) were used. Results: Physiotherapists were satisfied with the training. Patient attendance was good for individual sessions, less for groups. Physiotherapists sufficiently delivered the intervention, although recruitment and contextual factors influenced delivery. Patients reported significantly reduced functional disability (Quebec Back Pain Disability Scale) post-treatment (-8.3, 95% CI -13.3 to -2.7) and at 3months follow-up (-7.6, 95% CI -12.9 to -2.2). Conclusions: A biopsychosocial integrated intervention is feasible and potentially effective in patients with CLBP. [ABSTRACT FROM AUTHOR]

to investigate changes in caregiver strain, mental health complaints and QoL in caregivers of COVID-19 ICU survivors in the first year after discharge, and their associations with patients' participation and quality of life. Post-ICU COVID-19 survivors, needing inpatient rehabilitation and their informal caregivers were included. Caregiver self-administered questionnaires included quality of life, self-rated health, caregiver strain, anxiety and depression symptoms, post-traumatic stress and coping style. Patients' participation in society was assessed and quality of life. 67 patients (78% male) and 57 caregivers (23.6% male) were included. Three months post-ICU, caregivers experienced caregiver strain (32%), anxiety (41%), depressive symptoms (16%) and PTSD (24%). One year post-ICU, rates decreased, still being 11%, 26%, 10% and 5%, respectively. Caregiver anxiety symptoms and self-rated health at three months were associated with worse patient levels of participation and quality of life one year after ICU discharge (p < 0.05). COVID-19 caregivers experience high levels of mental health complaints one year after a patient's ICU discharge. Furthermore, our results indicate that patient participation levels and quality of life one year after ICU discharge may be negatively associated by caregiver complaints. Counselling and routine assessment of emotional complaints and unmet needs of the informal caregiver should be incorporated and addressed in the rehabilitation treatment of (COVID-19) post-ICU patients. • Many post-ICU COVID-19 caregivers experience high levels of mental health complaints one year after patient's ICU discharge. • Patient participation levels and QoL one year after ICU discharge may be negatively associated by caregiver complaints. • Personal and environmental factors seem to be important in the recovery of societal participation and QoL after ICU discharge. • An integral perspective on health to long-term consequences of PICS and PICS-f seems to be important. • Rehabilitation of (COVID-19) post-ICU patients should include assessment of emotional complaints and unmet needs of the caregivers. [ABSTRACT FROM AUTHOR]

Indeed, research during the first COVID-19 lockdown showed that individuals with chronic pain were more adversely affected compared with pain-free people, showing greater increase in anxiety, depression, loneliness, as well as self-perceived pain.[30] Undeniably, individuals with CPP are increasingly prone to suffer severe consequences from both COVID-19 and the taken containment measures, which may culminate into augmented levels of stress. Contemporary pain models assign a key role to psychosocial factors in the development and maintenance of chronic pain and augmented levels of disability and distress.[18] Among others, health anxiety,[42]cognitive-processing biases for pain and pain-related information, particularly attention [27] and interpretation biases,[56] and proneness towards negative outcome expectancies[101] (eg, overgeneralization [65] and catastrophic worry [103]) have often been considered vulnerabilities contributing to pain-related disability in CPP.[102] Indeed, a wealth of research has shown that negative outcome expectancies are associated with poor pain outcomes. We used CPP as a prototypic pain diagnosis, but this model may be extended or applied to other chronic pain diagnoses (eg, arthritis, cancer, and diabetes) and even to subacute or new-onset pain. People suffering from chronic pain may be at risk of disease severity when infected with SARS-CoV-2 because the prevalence of chronic pain in elderly is higher and they also have increased levels of comorbidity,[23] both known risk factors for COVID-19. [Extracted from the article]

Objective: The first aim of this study was to determine whether adolescents with asymptomatic Generalized Joint Hypermobility (GJH) have a lower level of physical functioning (physical activity level, muscle strength and performance) compared to non-hypermobile controls. Secondly, to evaluate whether the negative impact of perceived harmfulness on physical functioning was more pronounced in adolescents with asymptomatic GJH. Methods: Cross-sectional study. Sixty-two healthy adolescents (mean age 16.8, range 12–21) participated. Hypermobility (Beighton score), perceived harmfulness (PHODA-youth) and muscle strength (dynamometry), motor performance (Single-Leg-Hop-for-Distance) and physical activity level (PAL) (accelerometry) were measured. Hierarchical regression analyses were used to study differences in physical functioning and perceived harmfulness between asymptomatic GJH and non-hypermobile controls. Results: Asymptomatic GJH was associated with increased knee extensor muscle strength (peak torque/body weight; PT/BW), controlled for age and gender (dominant leg; ß = 0.29; p =.02). No other associations between asymptomatic GJH and muscle strength, motor performance and PAL were found. Perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH. Conclusions: Adolescents with asymptomatic GJH had increased knee extensor muscle strength compared to non-hypermobile controls. No other differences in the level of physical functioning was found and the negative impact of perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH. [ABSTRACT FROM AUTHOR]

Background: Non-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment. Methods/design: Study design: A parallel randomized controlled trial including two interventions: a motivational interviewing pre-pain rehabilitation intervention (MIP) and a usual care (UC) control arm. Follow-up will be 6 months after completion of rehabilitation treatment. Study population: One hundred and sixty (n = 80 per arm) patients with chronic non-specific musculoskeletal pain visiting an outpatient rehabilitation department, who are eligible to participate in an outpatient cognitive behavioral pain rehabilitation program. Intervention: MIP consists of two sessions to prepare and motivate the patient for pain rehabilitation treatment and its bio psychosocial approach. UC consists of information and education about the etiology and the general rehabilitation approach of chronic pain. Both the MIP and UC contain two sessions of 45 to 60 minutes each. Objective: The aim of the current study is to evaluate the effectiveness of MIP compared to UC in terms of an increase in the long-term level of societal participation and decrease of drop-out during rehabilitation treatment. Main study endpoints: Primary outcome is the change in level of participation (according to the ICF-definition: 'involvement in a life situation') 6 months after completion of rehabilitation treatment. Secondary outcomes are adherence and treatment drop-out, disability, pain intensity, self-reported main complaints, (pain-specific) self-efficacy, motivation, and quality of life. Costs are calculated including the costs of the pre-treatment intervention, productivity losses, and healthcare utilization. Potential moderators and active ingredients of MI are explored. For the process evaluation, parameters such as MI fidelity, feasibility, and experiences are explored. Discussion: The results of this study will provide evidence on the effectiveness of this MI-based pre-treatment in pain rehabilitation. Furthermore, a cost-effectiveness analysis and exploration of moderating and working mechanisms of MI and an extensive process evaluation takes place. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To provide an overview of methodological issues specifically related to the evaluation of rehabilitation interventions studies. Study Design and Setting: Narrative review covering studies evaluating interventions in rehabilitation medicine with methodological issues. Results: Four main methodological issues could be identified. First, the inclusion of patients. Patients should be selected based on having the problem being addressed by the intervention and not based on other criteria such as disease diagnosis. Second, the description of the intervention. Rehabilitation is a problem-solving process undertaken by one group of people (therapists) with another group (patient and family). The specific intervention being studied is only one of many that may affect outcome. Describing the whole package is a real challenge. Third, the control group. A control intervention has to raise equal expectations in patients and therapists. Expectation bias is a very probable influence on measured outcomes. Fourth, the definition of an appropriate outcome. In contrast to traditional biomedical research, rehabilitation research should have at least one “process” (proximate) or intervening variable measure and several distal primary outcome measures. [Copyright &y& Elsevier]

Objectives: To determine the level of daily functioning and quality of life of patients with hypoxic brain injury after a cardiac arrest and to investigate the predictive value of the duration of coma and post-traumatic amnesia in long-term functioning. Design: A retrospective cohort study. Setting: A Dutch rehabilitation centre. Subjects: Thirty-two patients with hypoxic brain injury caused by a cardiac arrest 2–7 years ago, who were admitted to a brain injury rehabilitation programme. Main outcome measures: Cognitive Failures Questionnaire (CFQ), Frenchay Activities Index (FAI), Impact on Participation and Autonomy Questionnaire (IPAQ) and Quality of Life after Brain Injury questionnaire (QOLIBRI). Data on duration of coma and post-traumatic amnesia were retrieved from medical files. Results: A significant association was found between duration of coma, complaints of cognitive functioning ( r=0.57, P<0.05) and quality of life after brain injury ( r=-0.70, P<0.01). Duration of post-traumatic amnesia was associated with both daily functioning ( r=-0.70, P<0.01) and quality of life ( r=-0.70, P<0.01). Furthermore complaints of cognitive functioning were associated with both the level of participation in society ( r=0.76, P<0.01) and quality of life ( r=0.77, P<0.01). Conclusions: Long-term outcome of patients with hypoxic brain injury after a cardiac arrest shows that this group is limited in cognitive and daily functioning, participation and quality of life. Based on the duration of coma and post-traumatic amnesia, an estimation of daily life functioning and quality of life 2–7 years after a cardiac arrest can be made. [ABSTRACT FROM AUTHOR]

Objectives: We performed a comprehensive health assessment in mechanically ventilated coronavirus disease 2019 survivors to assess the impact of respiratory and skeletal muscle injury sustained during ICU stay on physical performance at 3 months following hospital discharge.Design: Preregistered prospective observational cohort study.Setting: University hospital ICU.Patients: All mechanically ventilated coronavirus disease 2019 patients admitted to our ICU during the first European pandemic wave.Measurements and Main Results: At 3 months after hospital discharge, 46 survivors underwent a comprehensive physical assessment (6-min walking distance, Medical Research Council sum score and handgrip strength), a full pulmonary function test, and a chest CT scan which was used to analyze skeletal muscle architecture. In addition, patient-reported outcomes measures were collected. Physical performance assessed by 6-minute walking distance was below 80% of predicted in 48% of patients. Patients with impaired physical performance had more muscle weakness (Medical Research Council sum score 53 [51-56] vs 59 [56-60]; p < 0.001), lower lung diffusing capacity (54% [44-66%] vs 68% of predicted [61-72% of predicted]; p = 0.002), and higher intermuscular adipose tissue area (p = 0.037). Reduced lung diffusing capacity and increased intermuscular adipose tissue were independently associated with physical performance.Conclusions: Physical disability is common at 3 months in severe coronavirus disease 2019 survivors. Lung diffusing capacity and intermuscular adipose tissue assessed on CT were independently associated with walking distance, suggesting a key role for pulmonary function and muscle quality in functional disability. [ABSTRACT FROM AUTHOR]

To compare the effectiveness of a biopsychosocial primary care intervention (Back on Track) with primary care physiotherapy as usual in patients with chronic low back pain (CLBP) experiencing low complex psychosocial complaints. A double-blind multicentre pilot-randomised controlled trial. Twenty-five patients (≥18 years) with non-specific CLBP (≥12 weeks) experience low psychosocial complaints and a low to moderate level of disability. The Back on Track intervention (four individual and eight group sessions) versus physiotherapy as usual (maximally 12 individual sessions). Primary outcome: functional disability (Quebec Back Pain Disability Score) at post-treatment and 3 months follow-up. Anxiety, depression, catastrophizing, pain intensity, kinesiophobia, self-efficacy, global perceived effect. Effects were analysed using linear mixed model analysis. No significant differences in functional disability were found between interventions at post-treatment (mean difference 0.10, 95% CI: −12.9 to 13.1) and 3 months follow-up (mean difference −5.4, 95% CI −19.1 to 8.3). Secondary outcomes also showed no significant differences. No differences in effects were found between patients with CLBP experiencing low complex psychosocial complaints who receive the Back on Track intervention compared to patients receiving primary care physiotherapy as usual. Well-powered studies of sufficient methodological quality are needed to detect differences in effects. [ABSTRACT FROM AUTHOR]

Introduction: Healthy people often experience headache, cognitive failures, or mental fatigue. Some people even experience these symptoms on a level comparable to patients with mild spectrum brain injuries. In these individuals, the fear-avoidance model explains symptoms as a consequence of catastrophizing and fear-avoidance toward mental activities. This experimental study investigated in healthy adults whether fear-avoidance and catastrophizing about mental activities are related to fear-avoidance behavior (i.e., behavioral avoidance of mental activities) according to the fear-avoidance model. Method: A randomized crossover within-subject design was used with two measurements and 80 participants. Participants were exposed to three demanding cognitive tasks and their simplified counterparts. Post-concussion symptoms, catastrophizing, fear-avoidance, behavioral avoidance (time spent working on cognitive tasks), exposure to mental activity, depression, heart rate, and state-trait anxiety were assessed. Results: Significant correlations between the variables of the fear-avoidance model were found. Furthermore, catastrophizers spent less time on difficult tasks compared to easy tasks. Both catastrophizing and female sex predicted time spent on difficult tasks, whereas only female sex predicted time spent on easy tasks. Conclusions: This study found that, according to the fear-avoidance model, catastrophizing is related to behavioral avoidance of cognitively challenging tasks in a community sample. [ABSTRACT FROM AUTHOR]

Objectives: A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability. Content: Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability. Summary and outlook: It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism. In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety. [ABSTRACT FROM AUTHOR]

Background: Rehabilitation care for patients with chronic musculoskeletal pain (CMP) is not optimally organized. The Network Pain Rehabilitation Limburg 2.0 (NPRL2.0) provides integrated care with a biopsychosocial approach and strives to improve the Quadruple Aim outcomes: pain-related disability of patients with CMP; experiences of care of patients with CMP; meaning in the work of healthcare professionals; and healthcare costs. Firstly, in this study, the effectiveness (with regard to the functioning and participation of patients) of primary care for patients with CMP will be assessed, comparing care organized following the NPRL2.0 procedure with usual care. Secondly, the cost-effectiveness and cost-utility with regard to health-related quality of life and healthcare costs will be assessed. And thirdly, the effect of duration of participation in a local network in primary care will be studied.Methods: In this pragmatic study, it is expected that two local networks with 105 patients will participate in the prospective cohort study and six local networks with 184 patients in the stepped-wedge based design. Healthcare professionals in the local networks will recruit patients.Inclusion Criteria: age ≥ 18 years; having CMP; willing to improve functioning despite pain; and adequate Dutch literacy.Exclusion Criteria: pregnancy; and having a treatable medical or psychiatric disease. Patients will complete questionnaires at baseline (T1), 3 months (T2), 6 months (T3), and 9 months (T4). Questionnaires at T1 and T4 will include the Pain Disability Index and Short Form Health Survey. Questionnaires at T1, T2, T3, and T4 will include the EQ-5D-5L, and iMTA Medical Consumption and Productivity Cost Questionnaires. Outcomes will be compared using linear mixed-model analysis and costs will be compared using bootstrapping methods.Discussion: NPRL2.0 is a multidimensional, complex intervention, executed in daily practice, and therefore needing a pragmatic study design. The current study will assess NPRL2.0 with respect to the Quadruple Aim outcomes: patient health and costs. This will provide more information on the (cost-) effectiveness of the organization of care in a network structure regarding patients with CMP. The other two Quadruple Aim outcomes will be examined alongside this study. Trial registration Netherlands Trial Register: NL7643. https://www.trialregister.nl/trial/7643 . [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: The purpose of this study is to determine whether patients, classified by their treating consultant in rehabilitation medicine as avoider or persister, show differences in a large set of detailed outcomes of actual, objectively measured daily physical behaviour. METHODS: In this explorative cross-sectional study, 16 patients were included; 9 patients were categorized as avoider and 7 patients as persister. Subjects wore the VitaMove activity monitor, a high-end accelerometry-based device that allowed automatic detection of a large set of body postures and motions. Physical behaviour was assessed in detail by total duration of body postures and motions as percentages of 24 hours, as well as by the number of sit-to-stand transfers, overall activity level, walking speed, and the distribution of bouts of physical activity and sedentary behaviour. Differences between groups were tested with the Mann Whitney U test. RESULTS: There were no significant differences between groups in any of the physical behaviour outcomes. CONCLUSIONS: Our study showed that activity-related behavioural style categorization by consultants in rehabilitation medicine is not expressed in objectively measured detailed outcomes of daily physical behaviour. [ABSTRACT FROM AUTHOR]

Background and aims: Approximately 25% of patients with diabetes mellitus type 2 (DMII) develop painful diabetic neuropathy (PDN). PDN is known to affect both mental and physical wellbeing, resulting in anxiety, depression, low quality of life and physical disability. Pharmacological treatment of PDN aims at pain relief and is often ineffective and/or has many side effects. Rehabilitation treatment modalities that are designed to help the patient deal with PDN related complaints, are mostly focussed on either physical (e.g. exercise therapy) or psychological aspects (e.g. cognitive behavioural therapy, CBT). There is emerging evidence that PDN can be approached from a biopsychosocial perspective, in which physical and psychosocial aspects are integrated. From this biopsychosocial approach it is plausible that integrated treatment modalities such as acceptance commitment therapy (ACT) or exposure in vivo (EXP) could be effective in patients with PDN. The objective of this review was to provide an overview of the current evidence on the effects of rehabilitation treatments that combine exercise therapies with psychological therapies in order to improve physical activity (PA) and quality of life (QoL) in patients with PDN. Methods: Systematic review of the current literature. EMBASE, MEDLINE, Medline In-Process citations and e-Pubs ahead-of-print, Pedro, Web of Science, PsycINFO, CENTRAL, PubMed and Google Scholar were searched. All studies on interventions combining exercise therapy with psychological interventions in patients with PDN, aged >18 years, were included. Outcome measures were PA, QoL. Results: The search resulted in 1603 records after removing duplicates. After screening on titles and abstracts, 100 records remained. From these, not one study reported on interventions that combined exercise therapy with psychological interventions. Through a secondary hand search, a total of three reviews were identified that described a total of five studies regarding either physical or psychological interventions in patients with PDN. These studies reported moderate effects of (1) mindfulness meditation on QoL, (2) CBT on pain severity, (3) mindfulness-based stress reduction intervention on function, health-related QoL, pain catastrophizing and depression, (4) aerobic exercise on QoL and (5) Tai Chi on glucose control, balance, neuropathic symptoms, and some dimensions of QoL in patients with PDN. All studies were of a moderate quality, and results should be interpreted with caution. Conclusions: Based on increasing knowledge in the domain of chronic pain, it could be assumed that integrated rehabilitation treatments for patients with PDN are beneficial. There is no literature to support this and more research should be done on integrated biopsychosocial interventions in patients with PDN. Implications: This empty review highlights the importance that more research should be done on integrated biopsychosocial interventions in patients with PDN. Currently, our research group is performing a study on the effects of EXP treatment in patients with PDN. [ABSTRACT FROM AUTHOR]

Purpose: To assess the factor structure, related constructs and internal consistency of the Child Activity Limitation Interview 21-Child version for use in Dutch-language countries. Methods: Cross-sectional validation study: After forward and back translation of the Dutch version of the Child Activity Limitation Interview 21-Child adolescents (11-21 years old) with chronic musculoskeletal pain completed an assessment. The assessment contained the Dutch Child Activity Limitation Interview, and questionnaires about demographics, pain intensity, functional disability, anxiety and depression. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain intensity, activity limitations, anxiety and depression as comparative constructs. Results: Seventy-four adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 50% of the variance. Internal consistency was good (Cronbach's α = 0.91 total scale, α = 0.90 Factor 1, α = 0.80 Factor 2). All nine hypotheses were confirmed. Conclusion: The Dutch version can be used to assess pain-related disability in Dutch-speaking adolescents comparable to the study sample. Scores on both subscales provide insight into the severity of the pain-related disability in both daily routine and more physically vigorous activities. Implications for Rehabilitation: Chronic pain is a disabling disorder which not only impacts physically but restricts quality of life. This study provides clinicians a questionnaire to measure pain-related disability and quantify the impact of pain on the daily living of adolescents. The advantage of the Dutch version of the Child Activity and Limitations Interview over other measurements is that it can distinguish limitations in daily activities from more physically vigorous activities. [ABSTRACT FROM AUTHOR]

Objective: Painful diabetic neuropathy (PDN) is known to negatively affect quality of life. Being physically active is a crucial part of successful diabetes self-management, but regimen adherence is often low. Coping strategies and fears have shown to be related to less physical activity (PA). The aim of the present study was to obtain more in-depth information on psychological risk factors leading to less PA in persons with PDN. Design: Three semi-structured focus group interviews were conducted with a representative sample of persons with PDN (N = 12). Data were transcribed verbatim and analysed using a hybrid method of thematic analyses and a grounded theory approach. Main Outcome Measures: Fears and coping strategies related to PA in persons with PDN. Results: Several specific fears were identified; fear of hypoglycaemia, fear of pain increase, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity, and fear of negative evaluation by others. To cope with these fears, avoidance, remaining active, cognitive distraction, and acceptance strategies were described. Conclusion: In persons with PDN, diabetes-related fears and pain-related fears play a role in less engagement in PA, indicating the need for new methods for improving self-management in persons with PDN. [ABSTRACT FROM AUTHOR]

An editorial is presented on the chronic pain in European population. It expresses the view that in line with an ageing population, the number of people with disability from CMP is rapidly increasing. An overview of the secondary and tertiary care, (rehabilitation) physicians and their teams will assist primary care by a focus on a select patient group with complex pain related disability is presented.

Background: The incidence of cardiac arrest is high, with a poor survival rate of 8-14%. Currently, only limited evidence is available about long-term consequences of cardiac arrest on quality of life of caregivers.Aims: First, to determine the level of daily functioning and quality of life in caregivers of cardiac arrest survivors two years after the cardiac arrest. Second, to study the long-term impact of witnessing the event of a cardiac arrest.Methods: A longitudinal cohort study including caregivers of cardiac arrest survivors. Participants received a questionnaire at home. Outcome variables were instrumental daily activities(FAI), emotional functioning(HADS), fatigue(FSS), caregiver strain(CSI), impact of event(IES), and quality of life(SF36).Results: 57 caregivers (89% female, age 56,9 ± 12 years) participated. Two years after the cardiac arrest, quality of life of caregivers equals that of the general population, although almost 30% still scored high on the Impact of Events Scale. Mean IES-, FSS-, CSI and FAI-scores were increased as compared to the general population (P < 0.001). Two years after the cardiac arrest, caregivers that witnessed the resuscitation (IES = 23.6 ± 14.9) still experienced significantly more trauma related stress than caregivers that did not witness the resuscitation (11.9 ± 12.5; p < 0.01).Conclusions: Two years after the cardiac arrest, quality of life of caregivers is quite good, but almost one third of the caregivers still experience a high level of trauma-related stress, especially in those that witnessed the resuscitation. Future research will have to focus on the effectiveness of support programs for caregivers of survivors of cardiac arrest. [ABSTRACT FROM AUTHOR]

Background: Fear of pain is important in the development and maintenance of chronic pain. The Fear of Pain Questionnaire-Child version has been developed to assess pain related fear in children and adolescents.Objective: Translating the original questionnaire into Dutch, and investigating internal consistency and construct validity to enable use in the Dutch pain rehabilitation setting for treatment and research.Methods: Cross-sectional validation study: After forward and back translation of the FOPQ-C, adolescents (11-22 years old) with chronic musculoskeletal pain completed an assessment containing the Dutch Fear of Pain Questionnaire, and questionnaires about demographics, pain catastrophizing, functional disability, and pain intensity. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain catastrophizing, functional disability, and pain intensity as comparative constructs.Results: Eighty-six adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 43% of the variance. Internal consistency was strong (Cronbach’s α = 0.92 total scale, α = 0.88 factor 1, and α = .86 factor 2). Five out of 6 hypotheses were confirmed.Conclusions: The Dutch version demonstrated good internal consistency and good construct validity in a population of adolescents with chronic musculoskeletal pain. Implications for rehabilitation The Fear of Pain Questionnaire-Child version was developed to measure fear of pain and avoidance in children and adolescents with chronic pain.Identification of fear of pain and activities that are being avoided are important during screening and assessment of the adolescent for chronic pain rehabilitation treatment.The presence of fear of pain and/or avoidance behavior is important information to shape and target multidisciplinary rehabilitation treatment. [ABSTRACT FROM AUTHOR]

Objective: The purpose was to gain insight in the functioning of caregivers of cardiac arrest survivors at 12 months after a cardiac arrest. Secondly, the course of the wellbeing of the caregivers during the first year was studied. Finally, factors that are associated with a higher care burden at 12 months after the cardiac arrest were investigated. Subjects: A total of 195 family caregivers of cardiac arrest survivors were included. Main measures: Quality of life (SF-36, EuroQol-VAS), caregiver strain (CSI) and emotional functioning (HADS, IES) were measured at two weeks, three months and one year after the cardiac arrest. Thereby, the caregiver was asked to fill out the cognitive failure questionnaire (CFQ) to evaluate their view on the cognitive status of the patient. Results: Caregiver strain was high in 16 (15%) of the caregivers at 12 months. Anxiety was present in 33 (25%) caregivers and depression in 18 (14%) caregivers at 12 months. The repeated measures MANOVA showed that during the first year the following variables improved significantly: SF-36 domains social and mental health, role physical, role emotional and vitality, caregiver strain, HADS and IES (P<0.001). At 12 months caregiver strain correlated significantly (explained variance 63%, P=0.03) with caregiver HADS (P=0.01), EuroQol-VAS (P=0.02), and the CFQ (P<0.001), all measured at 12 months after the cardiac arrest. Conclusions: Overall wellbeing of the caregivers improves during the first year up to normal levels, but caregivers with emotional problems or perceived cognitive problems at 12 months are at risk for developing a higher care burden. [ABSTRACT FROM AUTHOR]

• HIT improves symptoms of central sensitization and perceived stress in persons with CNSLBP. • Effects of HIT on central sensitization are more pronounced in persons with clinically relevant symptoms. • Symptoms of central sensitization and perceived stress are only slightly related with (changes in) pain intensity and functional disability. High intensity training (HIT) improves disability and physical fitness in persons with chronic nonspecific low back pain (CNSLBP). However, it remains unclear if HIT affects pain processing and psychosocial factors. To evaluate 1) the effects of HIT on symptoms of central sensitization and perceived stress and 2) the relationship of symptoms of central sensitization and perceived stress with therapy success, at six-month follow-up, in persons with CNSLBP. This is a secondary analysis of a previously published randomized controlled trial. Persons with CNSLBP (n = 51, age=43.6y) completed the Central Sensitization Inventory (CSI) and Perceived Stress Scale (PSS) at baseline (PRE) and six months after 12-week of HIT consisting of concurrent exercise therapy (FU). Two groups were formed based on CSI scores (low-CSI/high-CSI). First, linear mixed models were fitted for each outcome, with time and groups as covariates. Multiple comparisons were executed to evaluate group (baseline), time (within-group), and interaction (between-group) effects. Second, correlation and regression analyses were performed to evaluate if baseline and changes in CSI/PSS scores were related to therapy success, operationalized as improvements on disability (Modified Oswestry Disability Index), and pain intensity (Numeric Pain Rating Scale). Total sample analyses showed a decrease in both CSI and PSS. Within-group analyses showed a decrease of CSI only in the high-CSI group and a decrease of PSS only in the low-CSI group. Between-group analyses showed a pronounced decrease favouring high-CSI (mean difference: 7.9; 95%CI: 2.1, 12.7) and no differences in PSS (mean difference: 0.1; 95%CI: -3.0, 3.2). CSI, but not PSS, was weakly related to therapy success. HIT improves symptoms of central sensitization in persons with CNSLBP. This effect is the largest in persons with clinically relevant baseline CSI scores. HIT also decreases perceived stress. [ABSTRACT FROM AUTHOR]

Persons with spinal cord injury (SCI) can suffer accelerated cognitive aging, even when correcting for mood and concomitant traumatic brain injury. Studies in healthy older adults have shown that myokines (i.e. factors released from muscle tissue during exercise) may improve brain health and cognitive function. Myokines may target chronic neuroinflammation, which is considered part of the mechanism of cognitive decline both in healthy older adults and SCI. An empty systematic review, registered in PROSPERO (CRD42022335873), was conducted as proof of the lack of current research on this topic in people with SCI. Pubmed, Embase, Cochrane and Web of Science were searched, resulting in 387 articles. None were considered eligible for full text screening. Hence, the effect of myokines on cognitive function following SCI warrants further investigation. An in-depth narrative review on the mechanism of SCI-related cognitive aging and the myokine-cognition link was added to substantiate our hypothetical framework. Readers are fully updated on the potential role of exercise as a treatment strategy against cognitive aging in persons with SCI. [Display omitted] • Persons with SCI suffer accelerated cognitive aging, even in the absence of TBI. • Neuroinflammation may mediate the accelerated cognitive aging following SCI. • Myokines are anti-inflammatory & neurotrophic factors released with muscle training. • Muscle training may target neuroinflammation and improve cognition following SCI. • So far, no studies have investigated the myokine-cognition link in people with SCI. [ABSTRACT FROM AUTHOR]