Purpose: To systematically review the literature on effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders. Materials and methods: Using online data sources PubMed, Embase, and Cochrane in adults with musculoskeletal disorders with a pain-related complaint. Remote physiotherapeutic e-Health interventions were analysed. Control interventions were not specified. Outcomes on effect of remote e-Health interventions in terms of pain intensity. Results: From 11,811 studies identified, 27 studies were included. There is limited evidence for the effectiveness for remote e-Health for patients with back pain based on five articles. Twelve articles studied chronic pain and the effectiveness was dependent on the control group and involvement of healthcare providers. In patients with osteoarthritis (five articles), total knee surgery (two articles), and knee pain (three articles) no significant effects were found for remote e-Health compared to control groups. Conclusions: There is limited evidence for the effectiveness of remote physiotherapeutic e-Health interventions to decrease pain intensity in patients with back pain. There is some evidence for effectiveness of remote e-Health in patients with chronic pain. For patients with osteoarthritis, after total knee surgery and knee pain, there appears to be no effect of e-Health when solely looking at reduction of pain. Implications for rehabilitation This review shows that e-Health can be an effective way of reducing pain in some populations. Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain. Autonomous e-Health is more effective than no treatment in patients with chronic pain. There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain.Implications for rehabilitation* This review shows that e-Health can be an effective way of reducing pain in some populations.* Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain.* Autonomous e-Health is more effective than no treatment in patients with chronic pain.* There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain.
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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A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability. Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability. It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism. In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.
De zorg voor de 1.6 miljoen mensen met chronische musculoskeletale pijn in Nederland kan en moet beter. Hoewel fysio- en oefentherapeuten een belangrijke rol hebben in het herstel van mensen met chronische musculoskeletale pijn is de biomedische aanpak die veelal wordt gekozen niet in lijn met de nieuwste wetenschappelijke inzichten en praktijkrichtlijnen. Veel eerstelijns zorgverleners voelen zich op dit moment incompetent bij het integreren van biopsychosociale factoren in diagnostiek en behandeling bij deze patiëntengroep. Daarom is de vraag uit de beroepspraktijk: Hoe kunnen fysio- en oefentherapeuten in de eerste lijn beter in staat worden gesteld om mensen te herkennen die beperkt zijn door chronische pijn, een inschatting te maken van de complexiteit van de klachten, en te behandelen vanuit een biopsychosociale visie? Het project is opgedeeld in drie fasen. Al eerste zullen bestaande eerstelijns biopsychosociale Beweegzorg interventies in kaart worden gebracht met behulp een scoping review. Het doel hiervan is om kennishiaten te identificeren, maar ook om een set van kennis en vaardigheden op te stellen die essentieel is voor een effectieve behandeling. De tweede fase zal bestaan uit het ontwikkelen van een compleet scholingsprogramma, inclusief ondersteunende materialen zoals richtlijnen, vragenlijsten, oefeningen en intervisie-structuren. Dit totaalpakket stelt fysiotherapeuten in staat om een state-of-the-art biopsychosociale interventie vorm te geven die aansluit op de specifieke hulpvraag en de persoonlijke context patiënten. In de derde fase zal deze aanpak worden getest in een feasibility studie, met als doel om inzicht te krijgen in de haalbaarheid van het scholingsprogramma en de biopsychosociaal georiënteerde interventies. Met behulp van dit project zal er een beweging worden gemaakt in de richting van eerstelijns Beweegzorg op maat, die inhoudelijk aansluit op de tweede- en derdelijns behandelprincipes. Daarnaast is het de ambitie van dit consortium om de inzichten uit dit project breed te verspreiden over aankomende en huidige zorgprofessionals.
