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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.

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]

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.

"Long COVID" is a term used to describe a condition when the symptoms and signs associated with coronavirus disease 2019 (COVID-19) persist for more than three months among patients infected with COVID-19; this condition has been reported globally and poses a serious public health issue. Long COVID can manifest in various forms, highlighting the need for appropriate evaluation and management by experts from various fields. However, due to the lack of clear clinical definitions, knowledge of pathophysiology, diagnostic methods, and treatment protocols, it is necessary to develop the best standard clinical guidelines based on the scientific evidence reported to date. We developed this clinical guideline for diagnosing and treating long COVID by analyzing the latest research data collected from the start of the COVID-19 pandemic until June 2023, along with the consensus of expert opinions. This guideline provides recommendations for diagnosis and treatment that can be applied in clinical practice, based on a total of 32 key questions related to patients with long COVID. The evaluation of patients with long COVID should be comprehensive, including medical history, physical examination, blood tests, imaging studies, and functional tests. To reduce the risk of developing long COVID, vaccination and antiviral treatment during the acute phase are recommended. This guideline will be revised when there is a reasonable need for updates based on the availability of new knowledge on the diagnosis and treatment of long COVID. [ABSTRACT FROM AUTHOR]

This study aimed to compare the systemic and local metabolic responses during a 5-min trunk extension exercise in individuals with chronic low back pain (CLBP) and in healthy individuals. Thirteen active participants with CLBP paired with 13 healthy participants performed a standardised 5-min trunk extension exercise on an isokinetic dynamometer set in continuous passive motion mode. During exercise, we used near-infrared spectroscopy to measure tissue oxygenation (TOI) and total haemoglobin-myoglobin (THb). We used a gas exchange analyser to measure breath-by-breath oxygen consumption (V̇O2) and carbon dioxide produced (V̇CO2). We also calculated mechanical efficiency. We assessed the intensity of low back pain sensation before and after exercise by using a visual analogue scale. In participants with CLBP, low back pain increased following exercise (+ 1.5 units; p < 0.001) and THb decreased during exercise (− 4.0 units; p = 0.043). Paraspinal muscle oxygenation (65.0 and 71.0%, respectively; p = 0.009) and mechanical efficiency (4.7 and 5.3%, respectively; p = 0.034) were both lower in participants with CLBP compared with healthy participants. The increase in pain sensation was related to the decrease in tissue oxygenation (R2 = − 0.420; p = 0.036). Decreases in total haemoglobin-myoglobin and mechanical efficiency could involve fatigability in exercise-soliciting paraspinal muscles and, therefore, exacerbate inabilities in daily life. Given the positive correlation between tissue oxygenation and exercise-induced pain exacerbation, muscle oxygenation may be related to persisting and crippling low back pain. [ABSTRACT FROM AUTHOR]

Background: The high number and clinical heterogeneity of neurological impairments in patients with a post-COVID-19 condition (PCC) poses a challenge for outpatient care., Objective: Our aim was to evaluate the applicability of the proposed subtypes according to the guidelines "Long/Post-COVID" (30 May 2024) and their phenotyping using clinical and neuropsychological findings from our post-COVID outpatient clinic., Methods: The evaluation was based on cross-sectional neurological and psychological test examinations of the patients, which were carried out using standardized questionnaires and test batteries. In addition, a detailed anamnesis of the current symptoms and a retrospective survey of the acute symptoms up to 4 weeks after the confirmed infection was conducted. The subtypes were classified according to the abovementioned guidelines based on the medical history and selected patient questionnaires, to which we added a 5th subtype with reference to the previous guidelines "Long/Post-COVID" (as of 5 March 2023)., Results: A total of 157 patients were included between August 2020 and March 2022. The presentation was at a median of 9.4 months (interquartile range, IQR = 5.3) after infection, with a mean age of 49.9 years (IQR = 17.2) and more women (68%) presenting, with a total hospitalization rate of 26%. Subtype 1 (postintensive care syndrome) showed the highest proportion of men, highest body mass index (BMI) scores and the highest rates of subjective complaints of word-finding difficulties (70%). Subtype 2 (secondary diseases) was dominated by cognitive impairment and had the highest depression scores. Subtype 3 (fatigue and exercise-induced insufficiency) was the most common, had the most symptoms and most severe subjective fatigue and the largest proportion of women. Subtype 4 (exacerbation) mainly showed affective symptoms. Subtype 5 (complaints without relevance to everyday life) had the lowest scores for depression, fatigue and BMI. Neurological and psychological conditions were frequently pre-existing in all groups., Discussion: The management of PCC can be improved at various levels. A standardized subtype classification enables early individually tailored treatment concepts. Patients at risk should be identified at the primary care level and informed about risk factors and prevention strategies. Regular monitoring of cardiovascular risk factors and physical activity are essential for PCC treatment. In the case of cognitive deficits and concurrent affective symptoms, psychotherapeutic support and drug treatment with selective serotonin reuptake inhibitors (SSRI) should be provided at an early stage., (© 2024. The Author(s).)

This article explores the treatment options for adhesive capsulitis, or frozen shoulder. It presents two different perspectives on the best approach for treating this condition: ultrasound-guided hydrodilatation (HD) plus steroid injection and ultrasound-guided intra-articular steroid injection. The authors provide evidence and studies to support their respective viewpoints. They also emphasize the importance of early intervention and discuss the potential benefits of joint manipulation after the procedure. While some studies suggest that intra-articular steroid injections are more effective in reducing pain and improving function in the short term, there is no clear evidence on the optimal approach for corticosteroid injection. The authors conclude that intra-articular steroid injections using ultrasound guidance are the preferred approach for treating adhesive capsulitis, but further research on hydrodilatation is needed. [Extracted from the article]

Objectives: Ultrasound‐guided injections are used to treat common shoulder pathologies and have been shown to be more accurate and effective than traditional landmark‐guided procedures. Currently, there exists no inexpensive shoulder model that accurately simulates the anatomical structures of the shoulder while also facilitating glenohumeral joint (GHJ) injection. Our model is an alternative to the traditional bedside training and provides a low‐risk training environment. Methods: We created this model from easily accessible materials. Polyvinyl chloride pipe was used to create the skeletal infrastructure pectoral girdle. A detergent pod was used to represent the GHJ space. Steaks were used to simulate the infraspinatus and deltoid muscles, with meat glue as a fascial layer between the two simulated muscles. Total cost of materials for the model was $19.71. Results: Our model successfully replicates known anatomical features of the GHJ. Additionally, the model facilitates injection into a GHJ space, representing a GHJ injection. Our model was replicated to train medical student practitioners during five different educational sessions. The model was validated through comparison to standardized educational ultrasound training videos. It was further validated by ultrasound experts. Conclusions: The shoulder model we created is effective in simulating GHJ injections under ultrasound guidance. It simulates realistic muscle and bony landmarks both for ultrasound imaging and injection feel. Importantly, it is inexpensive and easy to replicate allowing more access to medical practitioners and students to be educated on the procedure. [ABSTRACT FROM AUTHOR]

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Physical activity used in rehabilitation can trigger post-exertional malaise (PEM) in people with Long COVID. Concerns remain if the STOP-REST-PACE approach promoted by patient communities and professional organizations can be safely administered and contributes to return to usual activities. (1) To observe PEM over 12 weeks of telerehabilitation based on the STOP-REST-PACE approach. (2) To describe the changes in health-related quality of life (HRQoL), respiratory symptoms, fatigue and return to work. This was an observational prospective cohort of participants with Long COVID referred to a telerehabilitation service. Participants received up to 14 h of physiotherapy and occupational therapy over 12 weeks based on the STOP-REST-PACE approach. Frequency was personalized, up to two sessions weekly. An independent coordinator assessed PEM, HRQoL, respiratory symptoms, fatigue and return to work. Thirty-four participants were included and 30 completed the 12 weeks of telerehabilitation. Participants had an average of eight impairments. We found PEM in all participants at baseline. After 12 weeks, PEM remained present for 19 out of 30 participants. Respiratory symptoms significantly improved (COPD Assessment Test: 19.2 ± 7.3 vs 13.8 ± 7.7, p <.001). Fatigue and HRQoL did not significantly improve (p = 0.32 and p = 0.20, respectively). Only four participants were able to work full time. PEM persisted for close to two-third of participants despite learning the STOP-REST-PACE approach through physical and occupational therapy sessions over 12 weeks. Respiratory symptoms improved, but we did not observe a difference in fatigue and HRQoL. Return to work was out of reach for most participants. [ABSTRACT FROM AUTHOR]

Objective: To compare clinical outcomes following steroid injections using the anterior and posterior approaches., Design: Systematic review with meta-analysis., Setting: Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies., Patients: Patients with adhesive capsulitis., Interventions: Glenohumeral steroid injections using either anterior or posterior approach., Main Outcome Measures: Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs., Results: We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications., Conclusions: While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

BACKGROUND: Mood and adjustment disorders are two major causes of long-term sick leave among employees, leading to large social losses. Therefore, a return to work (RTW) intervention was attempted, targeting patients with mood and adjustment disorders. OBJECTIVE: This study aimed to investigate the outcome of an interdisciplinary RTW intervention including occupational therapy implemented within the Japanese healthcare framework. METHODS: An interdisciplinary RTW intervention including occupational therapy was conducted five times a week for approximately three months, targeting individuals with mood and adjustment disorders who took a leave of absence. Their mental symptoms, cognitive functioning, job performance, temperament, social adaptation, psychosocial state, and readiness to RTW before and after the intervention were evaluated. Full-time RTW ratios at 3, 6, 12, 18, and 24 months from baseline were followed up and compared with those of prior studies. RESULTS: A total of 30 individuals completed the intervention. After the intervention, participants' psychological symptoms, cognitive function, vocational aptitude, temperament, social adaptation, psychosocial state, and readiness to RTW improved (p≤0.001–0.0279). The ratios of RTW at 3, 6, 12, 18, and 24 months from the baseline were 6.7%, 46.7%, 73.3%, 77.8%, and 82.6%, respectively, reflecting a higher pattern than prior reports. CONCLUSIONS: The interdisciplinary RTW intervention including occupational therapy has the potential to improve not only depressive symptoms but also cognitive functioning, job performance, social adaptation, and readiness to RTW. They can also raise RTW ratios. [ABSTRACT FROM AUTHOR]

Background: In chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS), the capacity for activity and participation is strongly limited. The disease definition is very broad, and considering the lack of evidence for best treatment, it is important to understand what is ME/CFS-specific in the biopsychosocial perspective in comparison with similar syndromes. The objective was to study the difference between those diagnosed with ME/CFS and those with similar symptoms but no ME/CFS diagnosis for self-perceived level of physical activity, work ability, anxiety/depression, and health-related quality of life. Methods: This was a clinical cross-sectional study with data collected from mailed questionnaires. The following variables were compared between patients diagnosed with ME/CFS (n = 205) and those with similar symptoms but no diagnosis (n = 57); level of physical activity, Work ability index (WAI), Hospital anxiety and depression scale (HAD-A/HAD-D), and RAND-36 Physical functioning, Role limitations due to physical health problems, Role limitations due to personal or emotional problems, Social functioning, Energy/fatigue, Bodily pain, Emotional well-being, and General health perceptions. The Chi-squared test (nominal data), the Mann-Whitney U test, the Student's t test and regression analysis were used to analyze the data. Results: The group diagnosed with ME/CFS had a more impaired physical and mental exertion ability as compared to the group that had similar symptoms but was not diagnosed with ME/CFS, shown by a RAND-36 lower index of physical role functioning, social functioning, energy, worse pain and poorer overall health (p ≤ 0.05). In contrast, no significant group differences emerged for weekly level of physical activity, work ability, anxiety/depression, and RAND-36 Emotional role limitation and well-being. Conclusion: Our results indicate that those with a diagnosis of ME/CFS are characterized by an impaired ability for physical or mental exertion, worse pain, and poorer overall health as compared to individuals with similar symptoms but for whom ME/CFS-diagnosis was not established. The results may be cautiously interpreted as support when focusing on patients' self-care in terms of management of energy levels. The results must however be verified in future studies. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis is a common cause of painful shoulder, characterized by pain and restricted range of motion of the glenohumeral joint. With a well-known clinical presentation, and an increasing understanding of its clinical and radiologic features, early diagnosis of adhesive capsulitis is becoming a reality. Although often treated conservatively, for refractory cases arthroscopic release and open capsulotomy have been the only therapeutic option for a long time. Therefore, in the last years, a particular effort was put into the development of novel minimal-invasive techniques capable of pain relief and functional range improvement of the glenohumeral joint. The purpose of this literature review is to report the main updates on diagnosis and treatment for adhesive capsulitis with a focus on imaging diagnosis techniques and novel minimally invasive ultrasound-guided treatments. Results showed that ultrasound-guided procedures come with a high success rate in terms of pain reduction and improved range of motion, thus making the ultrasound a unique tool capable of giving the operator real-time diagnostic information confirming the clinical suspicion, and subsequently performing an interventional procedure. [ABSTRACT FROM AUTHOR]

Fatigue is frequently reported in people with a non-communicable chronic disease. More insight in the nature of this symptom may enhance targeted treatment of fatigue. In this study, we aimed to gain more insight in the prevalence of different types of fatigue and in current prescribed treatment strategies to reduce fatigue in non-communicable chronic diseases. People with non-communicable chronic diseases were contacted via public, non-profit, disease-specific health funds and patient associations and invited to complete a web-based survey. The survey included a general question about the experience ("Do you now or have you ever had complaints of fatigue?") and nature of fatigue (physically/mentally/combination), the Checklist Individual Strength-subscale subjective fatigue (CIS-Fatigue; 8–56 points), self-constructed questions for the distinction between physical and mental fatigue (both 3–21 points) and questions on prescribed treatments for fatigue. In total, 4199 participants (77% females) completed the online survey. 3945 participants (94.0%) reported experiencing fatigue, of which 64.4% reported a combination of both physical and mental fatigue. Median CIS-Fatigue score was 41 (32–48) points, with 68% of the participants reporting severe fatigue (≥36 points). Median scores for physical and mental fatigue were 15 (11–18) and 12 (8–16) points, respectively. In 55% of the participants, fatigue was only occasionally or never discussed with the healthcare professional, and only 23% of the participants were prescribed a treatment for fatigue. Participants often reported no effect or even an increase in fatigue after treatment. Findings indicate that both physical and mental fatigue are often experienced simultaneously in people with non-communicable chronic diseases, but can also occur separately. Fatigue is often only occasionally or never discussed, let alone treated, highlighting the need to raise awareness among healthcare professionals. Future studies are needed to gain more insight in underlying factors of fatigue in non-communicable chronic diseases, its impact on daily life and development and evaluation of targeted treatment strategies. Both physical and mental fatigue are frequently present in people with non-communicable chronic diseases. Fatigue is often only occasionally or never discussed during consultation with the physician, highlighting the need to raise awareness among healthcare professionals for adequate screening and evaluating of fatigue in people with non-communicable chronic diseases. Only less than a quarter of the people with non-communicable chronic diseases who reported to experience fatigue were prescribed a treatment for fatigue, which was often experienced as ineffective. [ABSTRACT FROM AUTHOR]

BACKGROUND: Frozen shoulder (FS), also known as shoulder adhesive capsulitis, is a musculoskeletal disorder associated with pain and functional disability. There is a lack of evidence on the optimal treatment strategy for FS. OBJECTIVE: The present study aimed to evaluate the effectiveness and safety of ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of FS. METHODS: In this prospective randomized, double-blind, controlled study, 63 FS patients were recruited, and equally allocated to treatment group and control group. The treatment group was treated with ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy, while the control group was only treated with ultrasound-guided hydrodilatation of glenohumeral joint. The pain and mobility of shoulder, overall efficacy and adverse reactions were evaluated 3 months after treatment. RESULTS: At baseline, no significant difference in all characteristic value was found between the treatment group (n = 33) and control group (n = 30). Three months after operation, the joint's Active Range of Motion (AROM) and Constant-Murley Scale (CMS) scores in the experimental group were higher than those in the control group, and the coracohumeral ligament (CHL) thickness and the rate of hypoechoic thickening in rotator cuff space in the experimental group were lower than those in the control group (all P < 0.05). The amount of injection volume at the third hydrodilatation was significantly higher in the experimental group than that in the control group (15.8 ± 4.7 vs 12.2 ± 5.2, P = 0.03). After 2 times of treatment, the volume increment of glenohumeral joint Δ 2 in the experimental group was greater than that in the control group (3.5 ± 1.8 vs 1.2 ± 1.6, P < 0.001). There were significant differences in the effective rate between the two groups (93.94% vs. 76.67%, P = 0.04). CONCLUSION: The ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy may benefit FS patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Persistent symptoms in patients with systemic joint laxity (SJL) are often equivalent with complications. Screening for SJL is an important part of the assessment of musculoskeletal phenotype. The common measuring tool, the Beighton score (BS), still has unclear evidence. OBJECTIVE: To assess the Beighton score in a clinical context for (1) ability to classify SJL as absent or present (criterion validity), and (2) interrater reliability (physician-physiotherapist), for a dichotomous cut-off (yes/no), as well as for interpretation in categories (no, some, clear SJL). METHODS: This real-world observational study included 149 consecutive patients seeking secondary care for investigation of possible myalgic encephalomyelitis/chronic fatigue syndrome. Assessment was done during a routine examination. Data were evaluated with Cohen's kappa and Spearman's rho. RESULTS: BS criterion validity showed poor agreement with the assessment of SJL: percentage agreement was 74 % and kappa 0.39 (3-cut level), 73 % and kappa 0.39/0.45 (4-/5-cut level). The best interrater reliability was moderate (rho 0.66) for interpretation in categories. CONCLUSIONS: The BS alone was not a reliable proxy for SJL and should be supplemented with a targeted history. Nevertheless, its interrater reliability was acceptable, and the categorised score appears to have greater clinical relevance than the dichotomous score. [ABSTRACT FROM AUTHOR]

Post-COVID syndrome (PCS) is recognized as a new entity in the context of SARS-CoV-2 infection. Though its pathogenesis is not completely understood, persistent inflammation from acute illness and the development of autoimmunity play a critical role in its development. The mechanisms involved in the emergence of PCS, their similarities with post-viral and post-care syndromes, its inclusion in the spectrum of autoimmunity and possible targets for its treatment. An autoimmune phenomenon plays a major role in most causative theories explaining PCS. There is a need for both PCS definition and classification criteria (including severity scores). Longitudinal and controlled studies are necessary to better understand this new entity, and to find what additional factors participate into its development. With the high prevalence of COVID-19 cases worldwide, together with the current evidence on latent autoimmunity in PCS, we may observe an increase of autoimmune diseases (ADs) in the coming years. Vaccination's effect on the development of PCS and ADs will also receive attention in the future. Health and social care services need to develop a new framework to deal with PCS. [ABSTRACT FROM AUTHOR]

Objective. People living with long COVID describe a high symptom burden, and a more detailed assessment is needed to inform rehabilitation recommendations. The objectives were to use validated questionnaires to measure the severity of fatigue and compare this with normative data and thresholds for clinical relevance in other diseases; measure and describe the impact of postexertional malaise (PEM); and assess symptoms of dysfunctional breathing, self-reported physical activity, and health-related quality of life. Methods. This was an observational study with a cross-sectional survey design (data collection from February 2021 to April 2021). Eligible participants were adults experiencing persistent symptoms due to COVID-19 that did not predate the confirmed or suspected infection. Questionnaires included the Functional Assessment of Chronic Illness Therapy--Fatigue Scale and the DePaul Symptom Questionnaire--Post-Exertional Malaise. Results. After data cleaning, 213 participants were included in the analysis. The total Functional Assessment of Chronic Illness Therapy--Fatigue Scale score was 18 (SD=10) (where the score can range from 0 to 52, and a lower score indicates more severe fatigue), and 71.4% were experiencing chronic fatigue. Postexertional symptom exacerbation affected most participants, and 58.7% met the PEM scoring thresholds used in people living with myalgic encephalomyelitis/chronic fatigue syndrome. Conclusion. Long COVID is characterized by chronic fatigue that is clinically relevant and at least as severe as fatigue in several other clinical conditions. PEM is a significant challenge for this patient group. Because of the potential for setbacks and deteriorated function following overexertion, fatigue and postexertional symptom exacerbation must be monitored and reported in clinical practice and in studies involving interventions for people with long COVID. Impact. Physical therapists working with people with long COVID should measure and validate the patient's experience. Postexertional symptom exacerbation must be considered, and rehabilitation needs to be carefully designed based on individual presentation. Beneficial interventions might first ensure symptom stabilization via pacing, a self-management strategy for the activity that helps minimize postexertional malaise. [ABSTRACT FROM AUTHOR]

Introduction: Adhesive capsulitis (AC), which is characterised by shoulder pain and a limited range of motion (ROM), is usually diagnosed on the basis of clinical suspicion, with imaging only being used to exclude other causes of similar symptoms. The aim of this study was to identify and describe the typical ultrasound (US) features of AC in a group of patients with shoulder pain and stiffness. Methods: This was a cross-sectional study of 1486 patients with AC in which two experienced US specialists examined the axillary pouch (AP), the coracohumeral ligament (CHL), the superior glenohumeral ligament (SGHL), and the long head of the biceps tendon (LHBT), and dynamically visualised the infraspinatus tendon during passive external rotation (PER) during a US evaluation of shoulder ROM. Results: AC was confirmed in 106 patients (7.1%). Thickening of the AP of more than 4 mm was observed in 93.4% of the patients, whereas 6.6% showed AP thickening of less than 4 mm but more than 60% of the thickening in the contralateral shoulder. Effusion within the LHBT sheath was detected in 71% of the patients, and thickening of the CHL or SGHL in 88%. The dynamic study of the infraspinatus tendon showed reduced sliding with folding towards the joint capsule in 73% of cases, thus changing the tendon's profile from flat to concave during PER. The reduced tendon sliding was associated with a bouncing movement that returned the tendon to its baseline resting position in 41.5% of cases. Conclusions: We believe a sufficiently experienced US specialist can confirm a clinical diagnosis of AC by carrying out a comparative study of APs, evaluating the thickness of the CHL and SGHL, and detecting reduced sliding of the infraspinatus tendon. [ABSTRACT FROM AUTHOR]

*OBJECTIVE: To examine the effectiveness of implementing interventions to improve guideline-recommended imaging referrals in low back pain. *DESIGN: Systematic review with meta-analysis. *LITERATURE SEARCH: We searched MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials from inception to June 14, 2021, as well as Google Scholar and reference lists of relevant systematic reviews published in the last 10 years. We conducted forward and backward citation tracking. *STUDY SELECTION CRITERIA: Randomized controlled or clinical trials in adults with low back pain to improve imaging referrals. *DATA SYNTHESIS: Bias was assessed using the Cochrane Risk of Bias 2 tool. Data were synthesized using narrative synthesis and random-effects meta-analysis (Hartung-Knapp-Sidik-Jonkman method). We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.*RESULTS: Of the 2719 identified records, 8 trials were included, with 6 studies eligible for meta-analysis (participants: N = 170 460). All trials incorporated clinician education; 4 included audit and/or feedback components. Comparators were no-intervention control and passive dissemination of guidelines. Five trials were rated as low risk of bias, and 2 trials were rated as having some concerns. There was low-certainty evidence that implementing interventions to improve guideline-recommended imaging referrals had no effect (odds ratio [95% confidence interval]: 0.87 [0.72, 1.05]; I² = 0%; studies: n = 6). The main finding was robust to sensitivity analyses. * CONCLUSION: We found low-certainty evidence that interventions to reduce imaging referrals or use in low back pain had no effect. Education interventions are unlikely to be effective. Organizational- and policy-level interventions are more likely to be effective. [ABSTRACT FROM AUTHOR]

This study assesses the potential of workplace-based micro-exercise (brief and simple exercise bouts) to prevent long-term sickness absence (LTSA) at the population level. In the Work Environment and Health in Denmark Study (2012–2018), we followed 70,130 workers from the general working population, without prior LTSA, for two years in the Danish Register for Evaluation of Marginalisation. We used Cox regression with model-assisted weights and controlled for various confounders. From 2012 to 2018, the percentage of workers in Denmark using workplace-based micro-exercise during and outside of working hours increased from 7.1 to 10.9% and from 0.8 to 1.4%, respectively. The incidence of long-term sickness absence (at least 30 days) was 8.4% during follow-up. The fully adjusted model showed reduced risk of long-term sickness absence from using micro-exercise during working hours, (HR 0.86, 95% CI 0.77–0.96), but not when used outside of working hours. If used by all workers, micro-exercise during working hours could potentially prevent 12.8% of incident long-term sickness absence cases (population attributable fraction). In conclusion, micro-exercise performed during working hours holds certain potential to prevent incident long-term sickness absence in the general working population. Large-scale implementation of workplace-based micro-exercise may represent an unexploited opportunity for public health promotion. [ABSTRACT FROM AUTHOR]

The article discusses recovery of COVID patient. It mentions Covid-19 as the now-familiar name for the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that led to a global pandemic starting in 2020. It reveals that brain stem controls many involuntary mechanisms in the body, such as breathing, blood pressure, heart rate, vomiting.

Background: Low back pain (LBP) is one of the most common reasons for seeking health care and is costly to the health care system. Recent evidence has shown that LBP care provided by many providers is divergent from guidelines and one reason may be patient's beliefs and expectations about treatment. Thus, examining the nature of patient beliefs and expectations regarding low back pain treatment will help coordinate efforts to improve consistency and quality of care.Methods: This study was a cross-sectional population-based survey of adults living in Newfoundland, Canada. The survey included demographic information (e.g. age, gender, back pain status and care seeking behaviors) and assessed outcomes related to beliefs about the inevitable consequences of back pain with the validated back beliefs questionnaire as well as six additional questions relating beliefs about imaging, physical activity and medication. Surveys were mailed to 3000 households in July-August 2018 and responses collected until September 30th, 2018.Results: Fout hundred twenty-eight surveys were returned (mean age 55 years (SD 14.6), 66% female, 90% had experienced an episode of LBP). The mean Back Beliefs Questionnaire score was 27.3 (SD 7.2), suggesting that people perceive back pain to have inevitable negative consequences. Large proportions of respondents held the following beliefs that are contrary to best available evidence: (i) having back pain means you will always have weakness in your back (49.3%), (ii) it will get progressively worse (48.0%), (iii) resting is good (41.4%) and (iv) x-rays or scans are necessary to get the best medical care for LBP (54.2%).Conclusions: A high proportion of the public believe LBP to have inevitable negative consequences and hold incorrect beliefs about diagnosis and management options, which is similar to findings from other countries. This presents challenges for clinicians and suggests that considering how to influence beliefs about LBP in the broader community could have value. Given the high prevalence of LBP and that many will consult a range of healthcare professionals, future efforts could consider using broad reaching public health campaigns that target patients, policy makers and all relevant health providers with specific content to change commonly held unhelpful beliefs. [ABSTRACT FROM AUTHOR]

Ultrasound is a fast, accessible, reliable, and radiation-free imaging modality routinely used to assess the soft tissues around the shoulder. It enables to identify a wide range of pathological conditions. Furthermore, most ultrasound-guided musculoskeletal interventional procedures around the shoulder produce better results in terms of accuracy and clinical efficacy than those performed in a blinded fashion. Indeed, intra-articular and peri-articular interventional procedures can be easily performed under continuous ultrasound monitoring to ensure the correct position of the needle and to deliver the medication to a specific target. Several technical approaches and medications can be used to treat different causes of painful shoulder. Intra-articular injections are applied to treat acromioclavicular osteoarthritis as well as glenohumeral joint osteoarthritis and adhesive capsulitis. Subacromialsubdeltoid bursitis, either presenting as a primary inflammatory condition or secondary to rotator cuff disorders, can be easily approached using ultrasound guidance to aspirate synovial effusion and to inject medications. Ultrasound-guided percutaneous irrigation is a well-established technique increasingly applied to treat patients with rotator cuff calcific tendinopathy. Also, degenerative rotator cuff tendinopathy can be conservatively treated by image-guided interventions, specifically with needling under ultrasound guidance that can be associated with injections of platelet-rich plasma. Lastly, periarticular peripheral nerve block can be quickly and safely performed under ultrasound guidance, particularly in conditions involving the suprascapular nerve in the setting of pre-operative analgesia or pain treatment in glenohumeral osteoarthritis and adhesive capsulitis. In this article, the most common ultrasound-guided procedures around the shoulder have been reviewed to discuss indications and techniques. [ABSTRACT FROM AUTHOR]

Background: Low back pain is a common reason for patients to seek medical care. Physician non-adherence to clinical guidelines has been observed. We investigated the extent to which patient expectations correspond to recommendations of the German national guideline for management of low back pain (G-LBP) and whether patient characteristics, history of LBP and previous treatment experience are associated with expectations. Methods: A cross-sectional study including patients from 13 general practices was conducted. Data were collected using a questionnaire. Inverse probability weights were used to address non-response bias. Descriptive analysis and multivariate logistic regression models were performed. Results: A total of 977 patients were included in analyses (median age 57 years, 39% male). 75% of patients reported experiencing LBP currently or within the last year. More than 65% indicated they would agree to forgo further examinations if their LBP was judged by their physician to be of no serious concern. This was associated with the highest level of education and no prior imaging, and negatively associated with good-to-poor health status and moderate-to-severe pain intensity. 40% of participants expected imaging. The highest educational level, female gender and no prior imaging were associated with a decreased expectation of imaging. 70% expected prescriptions for massages. Females, participants with good-to-poor health status, current LBP or LBP in the last 12 months had an increased expectation for massages. Expectations for injection therapy (45%) were mainly associated with previous injections. Expectations for physiotherapy (64%) were associated with female gender, lower educational level, good-to-poor health status, current LBP or in the last 12 months. The perspective that daily activities should be continued (66%) was associated with female gender and higher educational level. Participants who agreed to the statement 'There is no effective treatment for LBP' (11%) had a poor health status, current LBP and a severe pain intensity. Conclusion: Patient views regarding LBP management are partially concordant with guideline recommendations and are strongly influenced by previous treatment experiences and education level. Exploration of patient expectations and experiences in LBP treatment may help minimize dissatisfaction of patients expecting treatments not endorsed by guidelines and simultaneously increase physician guideline adherence. [ABSTRACT FROM AUTHOR]

Aim of the study: To evaluate changes in the elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder treated with ultrasound-guided rotator interval injections. Methods: Shear wave elastography was used to evaluate elasticity of the coracohumeral ligament in symptomatic and asymptomatic shoulders in the shoulder-neutral position and 30° external rotation. A total of 24 shoulders were assessed. Symptomatic shoulders were treated with targeted steroid injection via the rotator interval and manipulation under local anaesthetic block. Follow-up assessment of the elasticity of the coracohumeral ligament was obtained at 10 weeks post-injection. Results: In all subjects, the coracohumeral ligament elastic modulus was larger at 30° external rotation than in the neutral position. In patients with adhesive capsulitis, the coracohumeral ligament thickness and elastic modulus was significantly greater in the symptomatic shoulder in the neutral position and 30° ER. Treated patients had an excellent response with improved Oxford Shoulder Score and reduced visual analogue scale pain scores. Median Oxford Shoulder Score was 13.5 pre-injection and 34 at 10 weeks postinjection. Median visual analogue scale pain scores measured 8.5 pre-injection, 3.5 at 1 day, 2 at 1 week, and 2.5 at 10 weeks. Improved Oxford Shoulder Score and visual analogue scale pain score was associated with a trend to normalisation of the elastic modus of the coracohumeral ligament. Conclusion: In patients with adhesive capsulitis of the shoulder, shear wave elastography demonstrated the coracohumeral ligament is stiffer in the symptomatic shoulder than in the unaffected shoulder. Treatment with the ultrasound-guided rotator interval injection is associated with improved Oxford Shoulder Score, reduced visual analogue scale pain scores, and reduced stiffness in the coracohumeral ligament. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis, a common primary care and orthopedic diagnosis often referred to as frozen shoulder, is a painful inflammatory process that leads to a mechanical block in active and passive range of shoulder motion. Risk factors include diabetes and thyroid dysfunction. Diagnosis is made based on physical examination, but can be augmented by diagnostic imaging. Nonsurgical management is the mainstay of treatment because the disease is self-limiting. However, some patients may need surgical intervention. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to investigate the possible difference between the Modified atWork intervention (MAW) and the Original atWork intervention (OAW) on sick leave and other health related outcomes. atWork is a group intervention using the workplace as an arena for distribution of evidence-based knowledge about musculoskeletal and mental health complaints. Methods A cluster randomized controlled trial with 93 kindergartens, comprising a total of 1011 employees, was conducted. Kindergartens were stratified by county and size and randomly allocated to MAW (45 clusters, 324 respondents) or OAW (48 clusters, 313 respondents). The randomization and intervention allocation processes were concealed. There was no blinding to group allocation. Primary outcome was register data on sick leave at cluster level. Secondary outcomes were health complaints, job satisfaction, social support, coping, and beliefs about musculoskeletal and mental health complaints, measured at the individual level. Results The MAW group reduced sick leave by 5.7% during the intervention year, while the OAW group had a 7.5% increase. Overall, the changes were not statistically significant, and no difference was detected between groups, based on 45 and 47 kindergartens. Compared to the OAW group, the MAW group had a smaller reduction for two of the statements concerning faulty beliefs about back pain, but believed less in the hereditary nature of depression. Conclusions The MAW did not have a different effect on sick leave at cluster level compared to the OAW. Trial registrationhttps://Clinicaltrials.gov/: NCT02396797. Registered March 23th, 2015. [ABSTRACT FROM AUTHOR]

Background: Current evidence suggests that corticosteroid injection alone expedites the recovery of pain-free range of motion (ROM) in patients with adhesive capsulitis compared to physiotherapy or placebo. However, it remains unclear whether the addition of hydrodilatation with corticosteroid provides improvement in pain-free ROM as well as pain relief.Objective: A review of the literature was conducted to determine whether the combined intervention of hydrodilatation and corticosteroid injection expedites restoration of pain-free ROM compared to a control treatment of corticosteroid injection in patients with adhesive capsulitis.Methods: EMBASE, MEDLINE, and CINAHL were searched from database inception to January 2017. Relevant studies were determined as randomized controlled trials written in English, comparing the outcomes of hydrodilatation and corticosteroid injection to a control group treated with corticosteroid injection alone in patients with adhesive capsulitis. Two independent reviewers assessed manuscripts for study inclusion and extracted data.Results: A total of 2276 studies were identified through the search, of which 6 randomized controlled studies (involving 410 shoulders) met criteria for inclusion in this review. Mean age ranged from 51-61 years, with mean symptom duration of 4-9 months. Studies varied significantly regarding the volume of injectate, anatomical injection approach, symptom duration, and the method of glenohumeral capsule distension (capsular rupture versus preservation). Two studies demonstrated clinically and statistically significant improvement in the combination group at 3-month follow-up, and one study demonstrated clinically significant improvement only in ROM and/or pain/functional scales, compared to 3 studies demonstrating no benefit when compared to corticosteroid injection alone.Conclusion: Combining hydrodilatation with corticosteroid injection potentially expedites recovery of pain-free ROM. The greatest benefit is experienced within the first 3 months of intervention. Differences in hydrodilatation techniques, inclusion of capsular preservation, anatomical approach, and length of symptoms may explain the variability in efficacy demonstrated. Further trials using larger sample sizes, better anatomical approaches, image guidance, and hydrodilatation techniques are required to determine the true nature of benefits of hydrodilatation with corticosteroid injection.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Objectives This study evaluates the Danish national Job & Body campaign on beliefs about musculoskeletal pain and work. Methods Initiated in 2011, a national campaign in Denmark targeted public-sector employees with a mixture of networking activities, workplace visits, and a mass media outreach with topics related to job and body (eg, musculoskeletal pain, movement and work) and creating balance between demands at work and physical capacity. At baseline (2011) and at four time points until the end of 2014, random cross-sectional samples of =1000 representative public-sector employees (total N=5012) replied to eight questions concerning beliefs about musculoskeletal pain and work. Changes over time were modelled using general linear models (averaged for all questions, 0-100 points, where 0 is completely negative and 100 completely positive) and logistic regression analyses (for the single questions) controlling for age, gender and a number of work-related factors. Results At the last follow-up in 2014, 17.3% of public-sector employees were familiar with the campaign. Beliefs about musculoskeletal pain and work were 3.4 points (95% CI 2.4-4.3) higher than at baseline. For the single questions, 4 out of 8 showed improved odds for more positive beliefs [odds ratios (OR) of 1.28-1.89]. Conclusion During follow-up of the national campaign, beliefs about musculoskeletal pain and work were more positive among public-sector employees in Denmark. Due to the time-wise mixture of several campaign activities, the isolated effect of each component could not be disentangled. Whether changes in health occurred remain unknown. [ABSTRACT FROM AUTHOR]

Abstract: Adhesive capsulitis, a common primary care and orthopedic diagnosis often referred to as frozen shoulder, is a painful inflammatory process that leads to a mechanical block in active and passive range of shoulder motion. Risk factors include diabetes and thyroid dysfunction. Diagnosis is made based on physical examination, but can be augmented by diagnostic imaging. Nonsurgical management is the mainstay of treatment because the disease is self-limiting. However, some patients may need surgical intervention., (Copyright © 2021 American Academy of Physician Assistants.)

Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees' response outcome expectancies. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate whether a workplace educational low back pain intervention had an effect on sick leave at the individual level and to identify possible predictors of the effect of intervention. Methods: Work units in two municipalities were cluster randomized to (a) educational meetings and peer support (45 units), (b) educational meetings, peer support and access to an outpatient clinic if needed (48 units) or (c) a control group (42 units). Both intervention groups attended educational meetings with information about back pain based on a non-injury model. A peer adviser was selected from among their colleagues. The outcome was days of sick leave at the individual level at 3, 6, 9 and 12 months, adjusting for previous sick leave at the unit level. As a result of similar effects on sick leave, the two intervention groups were merged (n=646) and compared with the control group (n=211). The predictors were different levels of belief in back pain myths, pain-related fear, helplessness/hopelessness and low back pain. Results: The intervention group had significantly less days of sick leave at the three month (4.9 days, p=0.001) and six month (4.4 days, p=0.016) follow ups compared with the control group. At three months, a low level of pain-related fear was the only predictor for the intervention effect (8.0 less days of sick leave, p<0.001). Conclusions: A workplace educational back pain intervention had an effect on sick leave for up to six months. A low score on pain-related fear was a predictor of the intervention effect. [ABSTRACT FROM AUTHOR]

As an attempt to tackle the challenge in serving facial pain patients, the first primary care-based facial pain unit was founded in 2003 as part of public dental primary care of Vantaa, Finland. Data were collected, consisting of sex, age, sources of referrals, reasons for seeking care, diagnoses made, therapeutic procedures, and numbers of visits to dentists and phone consultations. To describe the development of the present pain management system, we divided the observation periods into two parts: 2003-2006 and 2007-2009 and compared frequencies of the studied parameters between the two follow-up periods. During 2003-2006, 370 patients were examined and the number of visits was 659, corresponding patients′ number was 437 and visits′ number 960 during 2007-2009. Referrals to the primary care facial pain unit came from primary care dentists (80%), respective primary care pain unit GPs (6%), oral hygienists (3%) and ordinary GPs (2%). Four percentage of the patients′ referrals came from secondary and tertiary care clinics of various types and 5% from private sector dentists and specialists. The average number of telephone consultations per year increased from 51 to 300 between study periods. During the follow-up period, the main reason for seeking care from our unit was temporomandibular disorders. Education in self-care, oral appliance therapy and physiotherapy were mostly used as management for these pain problems. The facial pain management unit in primary health care could be a useful model to serve increasing numbers of chronic facial pain patients. [ABSTRACT FROM AUTHOR]

Background The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and disengagement among chronically ill workers. Methods A 2-h roundtable symposium involving 28 participants was held at an international conference (Second Scientific Conference on Work Disability Prevention & Integration, Groningen, The Netherlands) in October 2012. In that symposium, small groups of participants were invited to discuss theoretical, methodological, and implementation considerations for studying workplace function and well-being among workers with chronic health conditions. As a follow-up to the symposium, the organizers invited authors to submit original articles to a Special Section of the Journal of Occupational Rehabilitation for peer review and publication. Results Results of the symposium reflected the need to address social, not just physical, aspects of the workplace, to include both individual-level and organizational interventions, and to integrate employer perspectives and operational models. Contributions to the Special Issue focus on outcome measurement, symptom self-management at work, job accommodations, prognostic factors for disability escalation, and the perceived needs of affected workers. Conclusions The content of the Special Section reflects an evolving body of research that continues to grapple with basic issues around choice of outcome measures, level of intervention, and the optimal ways to meet the needs of workers with chronic health conditions, including supporting efforts to manage symptoms and function at work. Future research should focus on integrating organizational and individual-level interventions. [ABSTRACT FROM AUTHOR]

Introduction Theoretical frameworks for preventing work disability have evolved over the last decade and various experimental models have been tested in occupational rehabilitation settings. The successful application and uptake of the most recent research evidence in rehabilitation practices depend on a complex interplay of the decisions of multi-stakeholders, including their perceptions of the evidence, a proper regulatory framework for injury prevention, compensation and disability management; as well as the cultural and socioeconomic factors unique to each country (social context). This paper summarizes the scope of the work disability prevention field and describes the contextual barriers and support mechanisms for implementing evidence-based practices for disability prevention in China's national rehabilitation system. Methods Expert opinions and relevant publications in the field were reasoned around key constructs of a translational model used to identify potential barriers and support platforms for research uptake in China. Results A crucial component of experimental models for disability prevention is to promote well-coordinated return to work actions centred in the workplace. Potential barriers and support mechanisms for implementing this and other evidence-based recommendations in China are described. Conclusions The complexity of implementing a system-wide disability prevention model in a country as large and diverse as China is well-recognized. Improved efforts are thus required for international knowledge-sharing that can empower greater research utilization of effective disability prevention methods in China. The development of well-connected communities of practice might be a helpful strategy for enhancing stakeholders' perceptions, attitudes and collaborative efforts towards locally relevant and cultural sensitive solutions to work disability. [ABSTRACT FROM AUTHOR]

Despite lack of convincing evidence that reduced aerobic fitness is associated with chronic back pain (CBP), exercise programs are regarded as being effective for persons with non-specific CBP. It is unsure whether gain in aerobic fitness following intervention is associated with functioning improvement in persons with CBP. The objective of this prospective cohort study was to study the impact of aerobic fitness on functioning in persons with CBP, at baseline and following 3-week intensive interdisciplinary intervention. This study included persons who had passed 8 weeks of sick-listing because of back pain ( n = 94) and were referred to a 3-week intensive biopsychosocial rehabilitation program. Aerobic fitness was assessed with a sub-maximal bicycle test at baseline, at admission to and discharge from the rehabilitation program, and at 6 months follow-up. Contextual factors, body function, activity and participation were evaluated before and after intervention. In addition, working ability was recorded at 3-years follow-up. At baseline aerobic fitness was reduced in most subjects, but improved significantly following intervention. Baseline measurements and intervention effects did not differ among the diagnostic sub-groups. Neither contextual factors nor functioning at baseline were associated with aerobic fitness. Increase in aerobic fitness was not associated with improvements in functioning and contextual factors and work-return following intervention either. From this study we conclude that improvement of aerobic fitness seems of limited value as goal of treatment outcome for patients with CBP. [ABSTRACT FROM AUTHOR]

The article focuses on the diagnosis and treatment of nonspecific chronic low back pain (CLBP). The use of diagnostic triage and the assessment of prognostic factors are suggested. Psychosocial distress, depressive mood, and prior episodes of LBP should be considered in the assessment of patients with nonspecific CLBP. Cognitive behavioural therapy, supervised exercise therapy and brief educational interventions are recommended to treat nonspecific CLBP.

Objective To assess the effect of controlled workplace interventions on low back pain (LBP) through a review of controlled studies. The rising costs of employees with LBP have resulted in an abundance of offers to society and organizations of interventions to prevent and/or treat the problem. Little is known of the effect of the different interventions.Methods A systematic literature search based on the inclusion criteria: controlled trial, work setting and assessment of at least one of the four main outcome measures: sick leave; costs; new episodes of LBP; and pain. Effect of the interventions was reported for the four main outcome measures.Results Thirty-one publications from 28 interventions were found to comply with the inclusion criteria. Exercise interventions to prevent LBP among employees and interventions to treat employees with LBP have documented an effect on sick leave, costs and new episodes of LBP. Multidisciplinary interventions have documented an effect on the level of pain.Conclusions The results show that there is good reason to be careful when considering interventions aiming to prevent LBP among employees. Of all the workplace interventions only exercise and the comprehensive multidisciplinary and treatment interventions have a documented effect on LBP. There is a need for studies employing good methodology. [ABSTRACT FROM AUTHOR]