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3Background: Chronic musculoskeletal pain is best addressed from a biopsychosocial perspective. Despite physiotherapists’ awareness of this approach, translating it into practice remains a challenge. A three-month post-graduate course was designed to facilitate Dutch physiotherapists in private practice to implement the biopsychosocial approach through experiential learning, workplace facilitation, and home assignments. This study evaluates the perceived feasibility of the course regarding its contextual alignment with, and practical applicability in, clinical settings. Methods: We conducted a qualitative study, using semi-structured interviews with all thirteen participants who completed the course, and applied a qualitative analysis to investigate perceived feasibility. Results: Three interrelated concepts emerged: 1) the individual process; 2) the course as an intervention; 3) social and professional context. Although each participant had their own journey, they all experienced a change in attitude and confidence, as well as feeling more comfortable in using communication strategies and psychology informed movement interventions focusing on valued daily activities and social participation. Learning with and from peers and experiential learning were seen as important facilitators. Social and material factors were mentioned as influencing the implementation of learned knowledge and skills. Conclusions: Findings from this study show promise in using a course that contains experiential learning, workplace facilitation, and home assignments, to train physiotherapists working in private practice to implement a biopsychosocial approach. Valuable insights into key barriers and facilitators show potential in informing the refinement of course design, and support understanding of the use of educational strategies for promoting new practice behaviors.
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Objective
Primary aim; to determine the feasibility of implementation of the INTERMED Self-Assessment (IM-SA) in adult patients scheduled for total knee arthroplasty (TKA). Secondary aim; to measure biopsychosocial complexity, referral to psychiatry or psychology in cases of complexity and to gain insight into the relation between biopsychosocial complexity and length of stay (LOS), method of discharge (MOD) and polypharmacy.
Methods
A feasibility study was conducted with 76 participants in a general hospital in the Netherlands. Feasibility was determined by the number of completed questionnaires, time spent completing the questionnaire and the attitude of staff and patients towards the IM-SA.
A cut off point ≥19 on the IM-SA was used to determine the prevalence of biopsychosocial complexity. A case file study was performed to check if referral to psychiatry or psychology had taken place.
The Spearman's Rank Correlation Coefficient or Phi was used to determine if there was a relation between biopsychosocial complexity and LOS, MOD and polypharmacy.
Results
All participants completed the IM-SA. The average time spent completing the questionnaire was 11.46 min (SD 5.74). The attitude towards the IM-SA was positive.
The prevalence of biopsychosocial complexity was 11.84%. Referral to psychiatry or psychology did not take place.
There was no relation between complexity and LOS (Spearman's rho (r) = 0.079, p = 0.499, MOD (Phi = 0.169, p = 0.173) and polypharmacy (Phi = 0.007, p = 0.953).
Conclusion
Biopsychosocial complexity can be identified in TKA patients during the pre-operative phase by using the IM-SA. Implementation of the IM-SA in a Dutch general hospital is feasible.
DOCUMENT
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.
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Background Transitioning from paediatric to adult healthcare is a pivotal phase for adolescents and young adults (AYAs) with chronic conditions. Effective healthcare transition (HCT) supports continued healthcare engagement and stable psychosocial outcomes, reducing risks for patients, their families, and the healthcare system. Yet the determinants of a smooth transition are complex, shaped by the interplay of various biopsychosocial constructs. Objective The ExPeCT study (acronym: Exploring Predictors of a successful healthCare Transition) seeks to: A) examine the relationship between biopsychosocial development, transition readiness, and HCT outcomes, including patients’ experiences; and B) identify key predictors of successful HCT in AYAs with chronic conditions. Method This longitudinal, observational, exploratory cohort study is embedded in the PROactive cohort, which annually measures biopsychosocial well-being of children with chronic conditions. The ExPeCT study supplements the PROactive cohort by collecting additional data on HCT experiences at three time points: once in paediatric care and twice after transfer to adult care. Data will be obtained from a range of chronic disease groups. Advanced statistical modelling will be employed to analyse transition outcomes and experiences, and to investigate associations between biopsychosocial development and transition readiness. Significance This study is expected to fill a critical gap in the field by providing comprehensive understanding of predictors of successful healthcare transition in AYAs with chronic conditions. The insights gained will help improve care strategies and guide healthcare professionals in supporting successful transition to adult care.
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Introduction: – Whether person-centered pain education approaches for Physical Therapist (PT) students elicit positive guideline-consistent changes in knowledge, attitudes, and clinical behavior is unknown. This study aims to evaluate the effects of enhanced-education compared to standard-education among entry-level PT students.Review of Literature: – Many (future) PTs adhere poorly to evidence-based clinical guidelines and find it challenging to integrate biopsychosocial (BPS) elements in the management of persistent musculoskeletal pain.Subjects: – The eligibility criteria included all first- and second-year students from the Dutch 4-year entry-level PT education program at Hanze University of Applied Sciences in Groningen, the Netherlands.Methods: – A cluster-randomized controlled trial design was used. Primary outcomes—including BPS pain knowledge, attitudes, and self-reported clinical behaviors—were assessed by comparing enhanced-education with standard-education on 5 measures. Intervention duration was 8 weeks. Enhanced-education teachers were additionally trained. Students were blinded to group allocation. Data were analyzed using linear mixed models and responder description.Results: – N = 187 students responded at baseline and n = 264 postintervention, 63% being paired measurements. Both groups improved significantly on all outcomes, with the enhanced-education group demonstrating greater improvement than the standard-education group in 4 out of 5 outcomes: Video Vignette score (P =
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OBJECTIVES: The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability and validity of the IMSA within a large and heterogeneous international sample of adult hospital in- and outpatients, and its predictive value for health care utilization (HCU) and quality of life (QoL).
METHODS: 850 participants aged 17 to 90 from 5 countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach's alpha; interrater agreement by intraclass correlation coefficients (ICCs); convergent validity of IMSA scores with mental health (SF-36 emotional well-being subscale and HADS), medical health (CIRS) and QoL (EQ-5D) by Spearmans rank correlations; predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models.
RESULTS: Feasibility, face validity and reliability (Cronbach's alpha 0.80) were satisfactory. ICC between IMSA and IM total scores was .78 (95% CI .75-.81). Correlations of the IMSA with the SF-36, HADS, CIRS and EQ-5D (convergent validity) were -.65, .15, .28 and -.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency room visits, hospitalization, outpatient visits, and diagnostic exams) after 3 and 6 months follow-up. Results were comparable between hospital sites, in- and outpatients, and age groups.
CONCLUSION: The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.
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Background: Health care practitioners' knowledge and attitudes influence patients’ beliefs and health outcomes in musculoskeletal (MSK) pain. It is unclear to what extent physiotherapists undertaking a postgraduate master in manual therapy (MT students) possess the knowledge and attitudes toward pain neuroscience to be able to apply the biopsychosocial model in patients with MSK pain. Objectives: The aim of this study was to assess the knowledge and attitudes toward pain neuroscience in MT students. Design: A cross-sectional study. Method: Self-reported knowledge and attitudes were measured among students (n = 662) at baseline and in all years of the MT postgraduate programs in the Netherlands. The Knowledge and Attitudes of Pain questionnaire (KNAP) was used as a primary measure. Difference in KNAP-scores between baseline (0), year 1, year 2 and year 3 was tested using a one-way ANOVA (hypothesis: 0 < 1
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Background: Healthcare practitioner beliefs influence patients’ beliefs and health outcomes in musculoskeletal (MSK) pain. A validated questionnaire based on modern pain neuroscience assessing Knowledge and Attitudes of
Pain (KNAP) was unavailable.
Objectives: The aim of this study was to develop and test measurement properties of KNAP.
Design: Phase 1; Development of KNAP reflecting modern pain neuroscience and expert opinion. Phase 2; a crosssectional and longitudinal study among Dutch physiotherapy students.
Method: In the cross-sectional study (n = 424), internal consistency, structural validity, hypotheses testing, and Rasch analysis were examined. Longitudinal designs were applied to analyse test-retest reliability (n = 156), responsiveness, and interpretability (n = 76).
Results: A 30-item KNAP was developed in 4 stages. Test-retest reliability: ICC (2,1) 0.80. Internal consistency: Cronbach’s α 0.80. Smallest Detectable Difference 90%: 4.99 (4.31; 5.75). Structural validity: exploratory factor analysis showed 2 factors. Hypotheses testing: associations with the Pain Attitudes and Beliefs Scale for Physiotherapists biopsychosocial subscale r = 0.60, with biomedical subscale r = 0.58, with the Neurophysiology of Pain Questionnaire r = 0.52. Responsiveness: 93% improved on KNAP after studying pain education. Minimal
Important Change: 4.84 (95%CI: 2.77; 6.91).
Conclusions: The KNAP has adequate measurement properties. This new questionnaire could be useful to evaluate physiotherapy students’ knowledge and attitudes of modern pain neuroscience that could help to create awareness and evaluate physiotherapy education programs, and ultimately provide better pain management.
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Physiotherapists recognise the biopsychosocial model as important in treating chronic pain. However, the adoption of this model in Dutch private practice is limited. Participatory action research, including co-design methods and an explicit perspective on workplace learning, may be helpful in developing a work-integrated learning programme to facilitate the use of a biopsychosocial perspective in private practice physiotherapy. Objective: To give insight into the development of a work-integrated learning programme for private practice physiotherapists in assessing and treating patients with chronic pain from a biopsychosocial perspective.
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Neck pain is a common condition that hinders people's daily functioning. The care of people with non-specific neck pain requires a personalised biopsychosocial approach. However, integrating psychological factors in therapeutic interventions remains a challenge. Understanding psychological mechanisms underlying the persistence of neck pain can support healthcare professionals in offering more rational and personalised (self)management strategies. This PhD-thesis advances this knowledge by providing deeper insights into several underlying psychological mechanisms in people with non-specific neck pain. Part 1 examines the role of associative learning and attentional focus in movement-related pain. Part 2 focuses on illness perceptions and the impact of personalised, psychologically-informed physiotherapy.
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