Objective To develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy primary care, emphasising modifiable biomedical, psychological and social factors. Design A prospective cohort study with a 6-month follow-up between January 2020 and March 2023. Setting 30 physiotherapy primary care practices. Participants Patients with a new presentation of non-specific idiopathic, non-traumatic neck pain, with a duration lasting no longer than 12 weeks from onset. Baseline measures Candidate prognostic variables collected from participants included age and sex, neck pain symptoms, work-related factors, general factors, psychological and behavioural factors and the remaining factors: therapeutic relation and healthcare provider attitude. Outcome measures Pain intensity at 6 weeks, 3 months and 6 months on a Numeric Pain Rating Scale (NPRS) after inclusion. An NPRS score of ≥3 at each time point was used to define chronic neck pain. Results 62 (10%) of the 603 participants developed chronic neck pain. The prognostic factors in the final model were sex, pain intensity, reported pain in different body regions, headache since and before the neck pain, posture during work, employment status, illness beliefs about pain identity and recovery, treatment beliefs, distress and self-efficacy. The model demonstrated an optimism-corrected area under the curve of 0.83 and a corrected R2 of 0.24. Calibration was deemed acceptable to good, as indicated by the calibration curve. The Hosmer–Lemeshow test yielded a p-value of 0.7167, indicating a good model fit. Conclusion This model has the potential to obtain a valid prognosis for developing chronic pain after a new episode of acute and subacute non-specific idiopathic, non-traumatic neck pain. It includes mostly potentially modifiable factors for physiotherapy practice. External validation of this model is recommended.
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Background: To determine whether adolescents with generalized hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (G-HSD/hEDS) show changes in the level of disability, physical functioning, perceived harmfulness and pain intensity after completing multidisciplinary rehabilitation treatment.Methods: Pre-test post-test design. Fourteen adolescents with G-HSD/hEDS participated. The multi-disciplinary rehabilitation treatment consisted of a combination of physical training and exposure in vivo. Physical training aims to improve aerobic capacity, muscle strength and propriocepsis for compensating hypermobility. Exposure in vivo aims to decrease disability and pain-related fear. Pre- and post-treatment assessments were conducted to assess the level of disability, physical functioning (motor performance, muscle strength and physical activity level), perceived harmfulness and pain intensity.Results: After completing multidisciplinary rehabilitation treatment, the adolescents showed a significant and clinically relevant improvement (improvement of 67%, p < 0.01) in functional disability. Furthermore, significant improvements were found in motor performance (p < 0.01), muscle strength (p < 0.05), perceived harmfulness (p < 0.01) and pain intensity (p < 0.01) after completing multidisciplinary rehabilitation treatment.Conclusion: Multidisciplinary rehabilitation treatment leads to a significantly and clinically relevant improvement in the level of disability for adolescents with G-HSD/hEDS. Positive effects were also found in physical functioning, perceived harmfulness and pain intensity. Although the results of this multidisciplinary rehabilitation treatment for adolescents with G-HSD/hEDS are promising, further study is needed to confirm these findings in a randomized design.
Description: The Neck Pain and Disability Scale (NPDS or NPAD) is a questionnaire aiming to quantify neck pain and disability.1 It is a patient-reported outcome measure for patients with any type of neck pain, of any duration, with or without injury.1,2 It consists of 20 items: three related to pain intensity, four related to emotion and cognition, four related to mobility of the neck, eight related to activity limitations and participation restrictions and one on medication.1,3 Patients respond to each item on a 0 to 5 visual analogue scale of 10 cm. There is also a nine-item short version.4 Feasibility: The NPDS is published and available online (https://mountainphysiotherapy.com.au/wp-content/uploads/2016/08/Neck-Pain-and-Disability-Scale.pdf).1 The NPDS is an easy to use questionnaire that can be completed within 5 to 8 minutes.1,5 There is no training needed to administer the instrument but its validity is compromised if the questionnaire must be read to the patient.2 Higher scores indicate higher severity (0 for normal functioning to 5 for the worst possible situation ‘your’ pain problem has caused you).2 The total score is the sum of scores on the 20 items (0 to 100).1 The maximum acceptable number of missing answers is three (15%).4 Two studies found a minimum important change of 10 points (sensitivity 0.93; specificity 0.83) and 11.5 points (sensibility 0.74; specificity 0.70), respectively.6,7 The NPDS is available in English, Dutch, Finnish, French, German, Italian, Hindi, Iranian, Korean, Turkish, Japanese and Thai. Reliability and validity: Two systematic reviews have evaluated the clinimetric properties of 11 of the translated versions.5,8 The Finnish, German and Italian translations were particularly recommended for use in clinical practice. Face validity was established and content validity was confirmed by an adequate reflection of all aspects of neck pain and disability.1,8 Regarding structural validity, the NPDS is a multidimensional scale, with moderate evidence that the NPDS has a three-factor structure (with explained variance ranging from 63 to 78%): neck dysfunction related to general activities; neck pain and neck-specific function; and cognitive-emotional-behavioural functioning. 4,5,9 A recent overview of four systematic reviews found moderate-quality evidence of high internal consistency (Cronbach’s alphas ranging from 0.86 to 0.93 for the various factors).10 Excellent test-retest reliability was found (ICC of 0.97); however, the studies were considered to be of low quality.3,10 Construct validity (hypotheses-testing) seems adequate when the NPDS is compared with the Neck Disability Index and the Global Assessment of Change with moderate to strong correlations (r = 0.52 to 0.86), based on limited moderate-quality studies.3,11,12 One systematic review reported good responsiveness to change in patients (r = 0.59).12
Chronische pijn is een groot, complex en duur probleem en heeft een grote impact op de kwaliteit van leven van patiënten, dagelijks functioneren, stemming en ziekteverzuim. Er zijn verschillende interventies ontwikkeld die met name gericht zijn op het beïnvloeden en veranderen van het gedrag waarbij zelfmanagement een belangrijke rol speelt. Echter het bestendigen van resultaten op lange termijn blijkt een groot probleem en leidt zelfs tot terugval naar “oud” gedrag waardoor patiënten opnieuw vaak kostbare hulp gaan zoeken. Er zijn twee additionele interventies ontwikkeld in een eerder RAAK-project (SOLACE) ter voorkoming van deze terugval: “Do It Your Self” en “Waarde gerichte Doelen” , echter de werkzaamheid van deze interventies op de lange termijn is niet onderzocht. Een eerste feasibility studie lijkt veelbelovend met positieve effecten naar de bruikbaarheid van deze interventies in de betrokken revalidatiecentra. Vanuit dit werkveld maar ook vanuit de patiënten kwam nadrukkelijk de vraag om deze interventies op effectiviteit te toetsen. Dit heeft geleid tot de onderzoeksvraag; “Is een additionele interventie (do it yourself en/of waarde gerichte doelen) gericht op het blijven toepassen van aangeleerde vaardigheden na een succesvol doorlopen pijn programma effectief in het bestendigen van de resultaten op de lange termijn en leidt dit tot een afname van het zorggebruik.” Het onderzoek wordt uitgevoerd in twee werkpakketten; (1) het ontwikkelen van een bruikbare app voor de ontwikkelde interventies in samenwerking met DIO Design en (2) een effectiviteit studie in de revalidatiecentra Adelante in Hoensbroek en Maastricht, Libra R&A locatie Weert en Heliomare Revalidatie in Wijk aan Zee. De doelstelling van het consortium is om de samen met zorgprofessionals, patiënten, beroepsvereniging en ontwerpers een product ter voorkoming van terugval verder te ontwikkelen en te toetsen. Na afronding van dit project zijn de op effectiviteit getoetste additionele interventies, DIY en WD, klaar om landelijk te worden uitgerold.
Veel patiënten met chronische pijn vallen na revalidatie toch een keer terug naar ‘oud’ gedrag. In het project SOLACE zijn twee strategieën ontwikkeld om terugval te voorkomen. Deze interventies leken effectief in de betrokken revalidatiecentra. Maar werken ze ook op de lange termijn?Doel Het doel van project Agrippa (Additional intervention for self-management in chronic pain patients) is om strategieën die terugval na revalidatie voorkomen verder te ontwikkelen en te toetsen. Dit doen we samen met zorgprofessionals, patiënten met chronische pijn, beroepsverenigingen en ontwerpers. Na afronding van dit onderzoek kunnen de strategieën landelijk in de praktijk worden gebracht. Resultaten Dit onderzoek loopt nog. Na afronding vind je hier een samenvatting van de resultaten. Looptijd 01 februari 2019 - 01 februari 2021 Aanpak Het onderzoek bestaat uit twee onderdelen: 1. We ontwikkelen een app waarin de twee interventies ‘Do It Your Self’ en ‘Waardegerichte Doelen’ worden opgenomen. 2. We toetsen de effectiviteit van de app in drie revalidatiecentra. Meer informatie Voor meer informatie bezoek je de uitgebreide projectpagina Agrippa.
This PD project aims to gather new knowledge through artistic and participatory design research within neighbourhoods for possible ways of addressing and understanding the avoidance and numbness caused by feelings of vulnerability, discomfort and pain associated with eco-anxiety and chronic fear of environmental doom. The project will include artistic production and suitable forms of fieldwork. The objectives of the PD are to find answers to the practice problem of society which call for art that sensitises, makes aware and helps initiate behavioural change around the consequences of climate change. Rather than visualize future sea levels directly, it will seek to engage with climate change in a metaphorical and poetic way. Neither a doom nor an overly techno-optimistic scenario seem useful to understand the complexity of flood risk management or the dangers of flooding. By challenging both perspectives with artistic means, this research hopes to counter eco-anxiety and create a sense of open thought and susceptibility to new ideas, feelings and chains of thought. Animation and humour, are possible ingredients. The objective is to find and create multiple Dutch water stories, not just one. To achieve this, it is necessary to develop new methods for selecting and repurposing existing impactful stories and strong images. Citizens and students will be included to do so via fieldwork. In addition, archival materials will be used. Archives serve as a repository for memory recollection and reuse, selecting material from the audiovisual archive of the Institute of Sound & Vision will be a crucial part of the creative work which will include two films and accompanying music.
