Search

Objective: To determine the significance of degree of symptom-specificity in the disablement condition in chronic back pain.Design: Cross-sectional design.Subjects: All inhabitants of a restricted geographical area of Norway, who had had 8 weeks of sick-leave due to back pain during a 2-year period, were included in this study. Following examination they were diagnosed as having 'specific back pain' (n=34), 'non-specific back pain' (n=113) or 'widespread pain' (n=49).Methods: Functioning of the 3 diagnostic subgroups was described and compared. Functioning assessment was guided by the concepts of the International Classification of Functioning, Disability and Health (ICF): health condition, body function and structure, activity, participation and contextual factors.Results: Pain components and final participation restriction did not differ among the diagnostic subgroups. However, with increasing symptom-specificity, loss of physical body functions and structures and subsequent activity limitation tended to increase. On the other hand, with decreasing symptom-specificity, mental distress, unfavourable contextual factors and dissatisfaction with various factors of life tend to increase, which may raise the impact of pain on restricting participation in activities.Conclusion: Functioning description according to the components of the ICF model indicated that the disablement condition in patients with back pain who had been on sick-leave for 8 weeks may appear more complex with decreasing symptom-specificity. [ABSTRACT FROM AUTHOR]

Background: Post-exertional malaise (PEM) is considered a hallmark characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This may also apply to subgroups of patients with long COVID-induced ME/CFS. However, it is uncertain to what extent PEM is acknowledged in routine specialist healthcare for ME/CFS patients, and how this affects patient outcomes., Objective: This study aims to evaluate to what extent ME/CFS patients experienced focus on PEM in specialist healthcare practice and its significance for outcome and care quality., Methods: Data from two online cross-sectional surveys covering specialist healthcare services for ME/CFS patients at rehabilitation institutes in Norway and two regional hospitals, respectively, were analyzed. Evaluations of 788 rehabilitation stays, 86 hospital consultations, and 89 hospital interventions were included. Logistic regression models and Mann-Whitney U-tests were used to quantify the impact of addressing PEM on health and functioning, care satisfaction, or benefit. Spearman's rank correlation and Cronbach's alpha of focus on PEM with the respondents' perception of healthcare providers' knowledge, symptom acknowledgment, and suitability of intervention were assessed as measures for care quality and their internal consistency, respectively., Results: PEM was addressed in 48% of the rehabilitation stays, 43% of the consultations, and 65% of the hospital interventions. Failure to address PEM roughly doubled the risk of health deterioration, following rehabilitation (OR = 0.39, 95% CI 0.29-0.52; 40.1% vs. 63.2% P  = <0.001) and hospital intervention (OR = 0.34, 95% CI 0.13-0.89; 22.4% vs. 45.2%, p  = 0.026). The focus on PEM (PEM-focus) during the clinical contact was associated with significantly higher scores on patients' rated care satisfaction and benefit of both consultation and intervention. Furthermore, addressing PEM was (inter)related to positive views about healthcare providers' level of knowledge of ME/CFS, their acknowledgment of symptoms, obtained knowledge, and the perceived suitability of intervention (Cronbach's alpha ≥0.80)., Discussion: PEM is still frequently not acknowledged in specialist healthcare practice for ME/CFS patients in Norway. Not addressing PEM substantially increased the probability of a decline in health and functioning following the intervention and was strongly associated with reduced perceived care quality, satisfaction, and benefit. These findings may be related to the applied explanatory models for ME/CFS and are most likely of relevance to long COVID., Competing Interests: MW was employed by one of the evaluated hospitals. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wormgoor and Rodenburg.)

Objectives: This explorative study analyses the influence of baseline comorbid long-lasting spinal pain (CSP) on improvement of long term work participation and clinical remission of mental health illness following either brief coping-focussed or short-term psychotherapy for depression. Whether type of treatment modifies outcome with or without CSP is also analysed., Design: A secondary post hoc subgroup analysis of a pragmatic randomised controlled trial., Interventions: Brief or standard short psychotherapy., Methods: Based on baseline assessment, the sample was subdivided into a subgroup with and a subgroup without CSP. Work participation and clinical remission of depression and anxiety were assessed as treatment outcome at two-year follow-up. Simple and multivariate logistic regression analyses, across the intervention arms, were applied to evaluate the impact of CSP on treatment outcome. Selected baseline variables were considered as potential confounders and included as variates if relevant. The modifying effect of CSP on treatment outcome was evaluated by including intervention modality as an interaction term., Main Results: Among the 236 participants with depressive symptoms, 83 participants (35%) were identified with CSP. In simple logistic regression analysis, CSP reduced improvements on both work participation and clinical remission rate. In the multivariate analysis however, the impact of CSP on work participation and on clinical remission were not significant after adjusting for confounding variables. Reduction of work participation was mainly explained by the higher age of the CSP participants and the reduced clinical remission by the additional co-occurrence of anxiety symptoms at baseline. The occurrence of CSP at baseline did not modify long term outcome of brief compared to short psychotherapy., Conclusions: CSP at baseline reduced work participation and worsened remission of mental health symptoms two-year following psychotherapy. Older age and more severe baseline anxiety are associated to reduced effectiveness. Type of psychotherapy received did not contribute to differences., Competing Interests: The authors have declared that no competing interests exist.

Background: Due to the inconsistent use of diagnostic criteria in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), it is unsure whether physiotherapeutic management regarded effective in ME/CFS is appropriate for patients diagnosed with criteria that consider post-exertional malaise (PEM) as a hallmark feature., Purpose: To appraise current evidence of the effects of physiotherapy on symptoms and functioning in ME/CFS patients in view of the significance of PEM in the applied diagnostic criteria for inclusion., Methods: A systematic review of randomized controlled trials published over the last two decades was conducted. Studies evaluating physiotherapeutic interventions for adult ME/CFS patients were included. The diagnostic criteria sets were classified into three groups according to the extent to which the importance of PEM was emphasized: chronic fatigue (CF; PEM not mentioned as a criterion), CFS (PEM included as an optional or minor criterion) or ME (PEM is a required symptom). The main results of included studies were synthesized in relation to the classification of the applied diagnostic criteria. In addition, special attention was given to the tolerability of the interventions., Results: Eighteen RCTs were included in the systematic review: three RCTs with CF patients, 14 RCTs with CFS patients and one RCT covering ME patients with PEM. Intervention effects, if any, seemed to disappear with more narrow case definitions, increasing objectivity of the outcome measures and longer follow-up., Conclusion: Currently, there is no scientific evidence when it comes to effective physiotherapy for ME patients. Applying treatment that seems effective for CF or CFS patients may have adverse consequences for ME patients and should be avoided.

Purpose The aim of this study was to assess short and long-term effectiveness of brief coping-focused psychotherapy (Brief-PsT) compared with short-term psychotherapy (Short-PsT) on work-participation (WP) and mental health. Both treatments were preceded by group education. Methods All participants were on, or at risk of, sick leave due to common mental complaints. Patients were selected for inclusion in this study based on levels of self-reported symptoms ('some' or 'seriously affected') of anxiety and depression. They were randomized to Brief-PsT (n = 141) or Short-PsT with a more extended focus (n = 143). Primary outcome was the transition of WP-state from baseline to 3 months follow-up. In addition, WP at 12 and 24 months follow-up were assessed. The secondary outcome, clinical recovery rate (CR-rate) was obtained from the Beck Depression and Beck Anxiety Inventories, at 2-year follow-up. In addition, self-reported mental health symptom severity, self-efficacy, subjective health complaints and life satisfaction were assessed. Results At 3 months follow-up, the increase in WP was significantly greater in Brief-PsT than in Short-PsT (p = 0.039). At 3 months, 60% in Brief-PsT and 51% in Short-PsT was at work, partial or full. Thereafter, these differences diminished, 84% and 80% were at work at 2-year follow up. The 2-year follow-up of the secondary outcome measurements was completed by 53% in Brief-PsT and 57% in Short PsT. CR-rate was significantly greater in Brief-PsT compared with the Short-PsT (69% vs. 51%, p = 0.024). Furthermore, there was a greater reduction in the number of subjective health complaints in Brief-PsT (4.0 vs. 1.9 p = 0.012). All other measurements favoured Brief-PsT as well, but did not reach statistical significance. Conclusions Brief coping-focused psychotherapy added to group education for persons with depression or anxiety complaints seemed more effective in enhancing early work participation compared with additional short-term psychotherapy of standard duration with more extended focus. Clinical recovery rate and decline of comorbid subjective health complaints at 2-year follow-up were also in favour of the brief coping-focused program.

Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain and disability. Previous studies have reported that intra-articular corticosteroid injections are of benefit compared with placebo up to 6 weeks. It has been suggested that the structures primarily involved in adhesive capsulitis are the capsule and the rotator interval. Systematic reviews have concluded that there is limited evidence of the treatment effectiveness of intra-articular corticosteroid injections and that high-quality primary research is required. The aim of this study was to compare ultrasound-guided intra-articular corticosteroid injection and combined intra-articular and rotator interval injection in a double-blind, sham-controlled randomized clinical trial. The main outcome measure was the group difference in change in shoulder pain (0-10) at 6 weeks. One hundred twenty-two patients were randomized (42 to intra-articular injection, 40 to combined intra-articular/interval injection, and 40 to sham injection). For both corticosteroid injection groups, there was a significant difference compared with sham injection at week 6. The mean group difference (adjusted for gender, age, dominant arm, and duration) in change in shoulder pain for the intra-articular vs sham injection was -1.7 (95% confidence interval, -2.7 to -0.6, P = 0.002) and -2.1 (95% confidence interval, -3.2 to -1.1, P = 0.0001) for the combined injection vs sham injection. The significant group differences were maintained at week 12 but not at week 26. Similar results were found for the secondary outcome measures (night pain, Shoulder Pain and Disability Index). Differences between the corticosteroid groups were not significant at any time.