OBJECTIVE: To reach consensus on the most important biopsychosocial factors that influence functional capacity results in patients with chronic nonspecific musculoskeletal pain, arranged in the framework of the International Classification of Functioning, Disability and Health.DESIGN: Three-round, internet-based Delphi survey.SETTING: Not applicable.PARTICIPANTS: Participants were scientists, clinicians, and patients familiar with functional capacity testing. Scientists were invited through purposive sampling based on the number of relevant publications in peer-reviewed journals. The scientists recruited clinicians and patients through snowball sampling.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Consensus was reached if at least moderate influence (25%) was achieved and an interquartile range of no more than 1 point was reached.RESULTS: Thirty-three scientists, 21 clinicians, and 21 patients from 9 countries participated. Participants reached consensus on 6 factors that can influence the outcome of the lifting test, having a median of severe influence (50%-95%): catastrophic thoughts and fear, patient adherence to "doctor's orders," internal and external motivation, muscle power, chronic pain behavior, and avoidance behavior. Motivation, chronic pain behavior, and sensation of pain were the top 3 factors affecting postural tolerance and repetitive movement functional capacity tests. Furthermore, participants reported 28 factors having a median of moderate influence (25%-49%) that could influence the outcome of lifting, postural tolerance, and repetitive movement tests.CONCLUSIONS: Overall, chronic pain behavior, motivation, and sensation of pain are the main factors that can influence functional capacity results. We recommend that scientists and clinicians, respectively, consider the most important factors when planning future studies and when interpreting functional capacity test results.
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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.
AIM: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms.DESIGN: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966-2018), Cochrane (1898-2018) and Cinahl (1988-2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible, a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument.RESULTS: From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85-0.89) and specificity of 0.75 (95% CI: 0.72-0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire - Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55-0.80) and specificity of 0.90 (95% CI 0.77-0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21-0.54) and specificity of 0.86 (95% CI 0.74-0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72-0.94) and specificity of 0.82 (95% CI 0.73-0.91).DISCUSSION: The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple headaches.
Low back pain is the leading cause of disability worldwide and a significant contributor to work incapacity. Although effective therapeutic options are scarce, exercises supervised by a physiotherapist have shown to be effective. However, the effects found in research studies tend to be small, likely due to the heterogeneous nature of patients' complaints and movement limitations. Personalized treatment is necessary as a 'one-size-fits-all' approach is not sufficient. High-tech solutions consisting of motions sensors supported by artificial intelligence will facilitate physiotherapists to achieve this goal. To date, physiotherapists use questionnaires and physical examinations, which provide subjective results and therefore limited support for treatment decisions. Objective measurement data obtained by motion sensors can help to determine abnormal movement patterns. This information may be crucial in evaluating the prognosis and designing the physiotherapy treatment plan. The proposed study is a small cohort study (n=30) that involves low back pain patients visiting a physiotherapist and performing simple movement tasks such as walking and repeated forward bending. The movements will be recorded using sensors that estimate orientation from accelerations, angular velocities and magnetometer data. Participants complete questionnaires about their pain and functioning before and after treatment. Artificial analysis techniques will be used to link the sensor and questionnaire data to identify clinically relevant subgroups based on movement patterns, and to determine if there are differences in prognosis between these subgroups that serve as a starting point of personalized treatments. This pilot study aims to investigate the potential benefits of using motion sensors to personalize the treatment of low back pain. It serves as a foundation for future research into the use of motion sensors in the treatment of low back pain and other musculoskeletal or neurological movement disorders.
Achtergrond: Chronische pijn is een veelvoorkomend probleem. Hulpverleners hebben behoefte aan handvatten om de hulp aan mensen met chronische pjjn te verbeteren. Huidige behandelingen sorteren beperkt effect en de waardering van mensen over de ontvangen zorg is matig. Het faciliteren van betrokkenheid en eigen regie zijn voorwaardelijk voor effectieve hulp. EHealth toepassingen inclusief het monitoren van objectieve biomarkers voor pijn kunnen hierbij behulpzaam zijn. Een bestaande EHealth toepassing gericht op het informeren van mensen met een chronische aandoening en het faciliteren van zelfmanagement is beschikbaar. Doelstelling: 1)Het doorontwikkelen van een bestaande EHealth toepassing specifiek voor mensen met chronische pijn en het evalueren van biomarkers. 2)De ontwikkelde EHealth toepassing inclusief biomarkeranalyse te implementeren bij een beperkte groep van mensen met chronische musculoskeletale pijn om eerste effecten te evalueren en gebruikerservaringen te inventariseren en 3)op basis van de verkregen resultaten een vervolg onderzoeksaanvraag te schrijven om de effecten van deze nieuwe behandelwijze te onderzoeken en nieuwe biomarker-testen te ontwikkelen. Vraagstellingen: 1)Hoe ziet de doorontwikkeling (op basis van co-creatie) van de EHealth toepassing er concreet uit? 2)Is de biomarker α-amylase een objectieve maat voor pijnintensiteit? 3)Wat zijn de eerste effecten van deze EHealth applicatie? (uitkomstmaten zijn pijn, α-amylase concentratie, dagelijks functioneren en kwaliteit van leven) 4)Wat zijn de ervaringen van gebruikers (patiënten en hulpverleners)? Aanpak: Het onderzoek wordt uitgevoerd door een consortium van deskundigen op het gebied van niet-farmaceutische behandeling van mensen met chronische pijn en zelfmanagement, de ontwikkeling en het gebruik van biomarkers voor chronische pijn, een EHealth ontwikkelaar en behandelaren van mensen met chronische pijn en patiënten. Een EHealth toepassing wordt ontwikkeld, biomarkers waaronder α-amylase worden geëvalueerd en de eerste effecten en gebruikerservaringen van deze interventie inclusief biomarkerbepaling worden gemonitord in een populatie van mensen met chronische lage rug en/of nekpijn.
De fysiotherapie staat onder toenemende druk, daarom is er een noodzaak om de zorg effectiever en efficienter in te richten. Dit project onderzoekt of de toepassing van technologieën als augmented videoconferencing (integratie van sensoren in videoconsulten) de fysiotherapiebehandeling effectiever en efficiënter kan maken.
