BACKGROUND: Chronic musculoskeletal pain (CMP), Generalized Joint Hypermobility (GJH) and pain-related fear have influence on physical functioning in adolescents.AIM: to evaluate differences in physical functioning between adolescents with CMP, GJH or the combination of both, and in addition evaluate the potential contribution of pain-related fear.DESIGN: The design of this study was observational and cross-sectional.SETTING: The adolescents with CMP were recruited by a physician in rehabilitation medicine and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). The adolescents without CMP were recruited in the Southern area of the Netherlands and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands).POPULATION: Four subgroups of adolescents were included; 21 adolescents with CMP without GJH, 9 adolescents with CMP and GJH, 51 adolescents without CMP without GJH, and 11 adolescents without CMP with GJH.METHODS: Outcome measures were muscle strength and endurance, motor performance, physical activity level, and pain-related fear. Hierarchical regression analyses were used to study differences in physical functioning and the contribution of pain-related fear in adolescents with/without CMP as well as with/without GJH.RESULTS: Adolescents with CMP had decreased muscle strength (P=0.01), endurance (P=0.02), and lower motor performance (P<0.01) compared to adolescents without CMP. Higher levels of pain-related fear were related to decreased muscle strength (P=0.01), endurance (P<0.01), and motor performance (P<0.01). No differences in physical functioning and pain-related fear between hypermobile and non-hypermobile adolescents with CMP were found.CONCLUSIONS: Adolescents with CMP had decreased muscle strength and motor performance associated with increased levels of pain-related fear compared to adolescents without CMP. The association of being hypermobile with physical functioning is not more pronounced in adolescents with CMP.CLINICAL REHABILITATION IMPACT: No differences were found in physical functioning and pain-related fear between hypermobile adolescents with CMP compared to non-hypermobile adolescents with CMP. Future rehabilitation treatment in hypermobile adolescents with CMP should also focus on psychological components, such as pain-related fear.
Chronic pain rehabilitation programs are aimed at helping patients to increase their functioning despite being in pain, thereby improving their quality of life. However, conversations between patients and practitioners about how the patient could deal with his/her pain and pain-related disabilities in a different way can be interactionally challenging. This study adopts a discursive psychological perspective to explore how pain-related disability is negotiated by patients and practitioners during consultations. The analysis shows that pain-related disability is treated by both patients and practitioners as negotiable rather than a fixed reality. Moreover, it shows that patients’ and practitioners’ negotiations of disability are subject to issues of agency, accountability, and blame, and it provides insight into the interactional dilemmas that are at stake, both for patients and practitioners. Revalidatieprogramma’s voor patiënten met chronische pijn zijn gericht op het verbeteren van het functioneren ondanks de pijn, waardoor kwaliteit van leven wordt bevorderd. Conversaties tussen patiënten en behandelaars over de manier waarop de patiënt kan omgaan met de pijn en gerelateerde beperkingen kunnen interactionele uitdagingen met zich meebrengen. Dit hoofdstuk verkent vanuit discursief-psychologisch perspectief hoe beperkingen worden onderhandeld door patiënten en behandelaars in consulten. De analyse toont aan dat de beperkingen worden behandeld als onderhandelbaar in plaats van als een onveranderbare werkelijkheid. Bovendien toont de analyse dat in deze onderhandelingen bepaalde issues relevant worden gemaakt, zoals ‘agency’, verantwoordelijkheid en schuld. Inzicht wordt geboden in de interactionele dilemma’s die op het spel staan voor zowel patiënten als behandelaars.
The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs.
LINK
