Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: A systematic review

We sought to systematically analyze the influence of dose of pain rehabilitation programs (PRPs) for patients with chronic low back pain (CLBP) on disability, work participation, and quality of life (QoL). Literature searches were performed in PubMed, Cochrane Library, Cinahl, and Embase up to October 2012, using MeSH terms, other relevant terms and free-text words. Randomized controlled trials in English, Dutch, and German, analyzing the effect of PRPs, were included. One of the analyzed interventions had to be a PRP. Outcomes should be reported regarding disability, work participation, or QoL. To analyze dose, the number of contact hours should be reported. Two reviewers independently selected titles, abstracts, and full-text articles on the basis of inclusion and exclusion criteria. Data were extracted and risk of bias was assessed. Effect sizes (ES) were calculated for each intervention, and influence of dose variables was analyzed by a mixed model analysis. Eighteen studies were identified, reporting a wide variety of dose variables and contents of PRPs. Analyses showed that evaluation moment, number of disciplines, type of intervention, duration of intervention in weeks, percentage of women, and age influenced the outcomes of PRPs. The independent effect of dose variables could not be distinguished from content because these variables were strongly associated. Because dose variables were never studied separately or reported independently, we were not able to disentangle the relationship between dose, content, and effects of PRPs on disability, work participation, and QoL.     

Reconditioning in groups: an effective programme for the rehabilitation of patients with low back pain?]

The article reports on a study in which elements of a group-oriented reconditioning programme for patients with low back pain were incorporated into the routine of an in-patient orthopaedic rehabilitation clinic. The specific elements of the new programme consisted of stable group structures during the whole stay of 3 to 4 weeks, and of 3 to 7 hrs. walks in hilly ground three times a week. The effects of this programme were tested against a standard programme with a mix of passive and active elements using a controlled study design. 92 persons participated in an experimental group and 81 persons in a control group with no significant differences found between the two groups at admission. Effects were measured by means of a physicians' questionnaire and a multidimensional patients' questionnaire (IRES) answered at admission, at discharge, and at six- and twelve-month follow-up. The results of a two-factorial analysis of variance with repeated measures showed that the interaction between group and time on the summary score of the IRES was not significant, although the experimental group showed somewhat better effects at all times of measurement. The discussion focuses on the reasons for this result, among which the unexpectedly good effects in the control group are named, as well as certain difficulties with the implementation of a strongly activity-oriented programme into the course of a "normal" rehabilitation clinic.     

Can the back-to-work rate of patients with long-term non-malignant pain be predicted?

The objective of this study was to evaluate the outcome of a structured multidisciplinary rehabilitation programme regarding the return-to-work rate. Sixty-seven patients were enrolled in an 8-week, structured rehabilitation programme. The prediction of the return-to-work rate was evaluated before entering the programme. The patients' own perception of returning to work as well as their pain intensity were estimated on a visual analogue scale and their period of sick leave was also recorded. The multidisciplinary rehabilitation team made an impairment and disability evaluation and analysis (IDEA) to assess possible work ability. This evaluation was made during the first 3 weeks of the 8-week programme. The return-to-work rate was also evaluated by means of the modified somatic perception questionnaire (MSPQ) and the disability rating index (DRI) before entering the programme. The results were compared with the actual return-to-work rate 1 year after completing the programme. A comparison group of 14 patients who were rejected due to lack of space in the programme was used in this study. There was a positive, statistically significant correlation (P<0.01) between the evaluation of the multidisciplinary rehabilitation team and the actual outcome of the return-to-work rate 1 year after completing the programme. At the 1-year follow-up, 63% of the patients had returned to work or were in work-related activities. The results on MSPQ or DRI, the patients' own perception of returning to work, the pain intensity, age or the period of time out of work did not predict the return-to-work ability. This study has shown that 63% of the patients with long-term non-malignant pain were back to work or in work-related activities 1 year after completing the rehabilitation programme. The IDEA made by the rehabilitation team was crucial in predicting the return-to-work rate in this patient group. The MSPQ and DRI questionnaires, the patients' own prediction, pain intensity, age and time out of work had a low value for predicting the return-to-work rate following a structured multidisciplinary rehabilitation programme.     

Health education and rehabilitation measures of patients with osteoporosis

1WaysofhealtheducationThewaysincludelanguageintroduction,literalexpression,settingupfollow-upcard,healtheducation.2Contentsofhealtheducation2.1DiagnosiscriteriaofosteoporotosisAccordingtoWHO,osteoporosismeansbonedensity(BMD)islowerthan2.5sofnormaladultmean,thatistvalueislowerthan-2.5.Severeosteoporosismeanstvalueislowerthan-2.5andtherearedis-easecourseofoneorsevralfracture.Classifiedcriteriaofosteo-porosisincludesprimaryosteoporosiswhichisrelatedtoagesuchaselderosteoporosis,postmenopausalo…     

Life satisfaction in patients with long-term non-malignant pain–relation to demographic factors and pain intensity

Purpose. Life satisfaction can be defined as a measure of a patient's perception of the difference between his reality and his needs or wants. Here we compare life satisfaction in patients with long-term pain to a reference group sampled from the normal population, and relate the results to pain intensity and to demographic factors.

Method. Questionnaires containing the Life satisfaction (LiSat-11) checklist, a visual analogue scale (VAS) for pain, and questions on demographic background.

Results. The prevalence of responders with low level of life satisfaction was larger among the patients than in the reference group. In particular, patients born outside Northern Europe scored significantly lower than patients born in Northern Europe in many of the LiSat-11 domains. Pain intensity did not correlate well to the level of life satisfaction, except for weak negative correlations to satisfaction with physical health and with financial situation.

Conclusion. Long-term pain is strongly associated with low life satisfaction. In order to increase life satisfaction, interventions related to social factors seem to be important.     

Pain requires processing – How the experience of pain is influenced by Basic Body Awareness Therapy in patients with long-term pain

Background and purposeLong-term pain is common and entails large costs to society. One physiotherapy treatment with documented positive effects for patients with long-term pain is Basic Body Awareness therapy (BBAT). However, studies are lacking about patients' experience of BBAT's influence on their pain. Therefore, the aim of this study was to investigate how patients experience BBAT's influence on their long-term pain.MethodsFor this qualitative interview study, participants were selected from two supervised BBAT groups. To qualify for the study, participants had to meet two inclusion criteria: having pain for at least 6 months, and attending BBAT for at least 6 months. Six females between the ages of 25 and 61 years were included. Pain duration ranged from 9 to 20 years, and duration of practicing BBAT ranged from 8 to 120 months. Semi-structured interviews were conducted and qualitative content analysis was performed.ResultsThe analysis revealed four main categories of BBAT experience: increases motivation, requires processing, increases control over pain and changes attitude to oneself, body and pain.DiscussionPatients with long-term pain experienced BBAT as being helpful in processing their pain because they were forced to face the pain instead of trying to ignore it. Participants experienced a decrease in pain through development of an increased sense of control as well as a changed attitude to themselves, their bodies and their pain. It is important for physiotherapists to understand that pain can increase during BBAT and to support the patients in this process during the therapy.     

Are the changes in observed functioning after multi-disciplinary rehabilitation of patients with fibromyalgia associated with changes in pain self-efficacy?

Objective: To examine the hypothesis that change in pain self-efficacy is associated with observed and self-reported activity, pain intensity, catastrophizing, and quality of life after multi-disciplinary rehabilitation of fibromyalgia patients.

Design: In-depth analyses of secondary outcomes of a randomized-controlled trial.

Subjects: Women (N?=?187) with fibromyalgia.

Methods: Outcomes were Pain Self-Efficacy, Assessment of Motor and Process Skills (AMPS), SF-36 Physical Function (SF-36-PF), pain intensity, and SF-36 Mental Composite Score (SF-36-MCS) to assess quality of life and pain catastrophizing. Individual and group associations between outcomes were examined.

Results: Individual changes in pain self-efficacy were not associated with changes in observed activity: AMPS motor (r_s?=?0.08, p?=?0.27) and process (r_s?=?0.12, p?=?0.11), not even in those patients with a clinically relevant improvement in observed functioning (38.5%), and only weakly or moderatly with changes in SF-36-PF; (r_s?=?0.31, p?r_s?=?0.41, p?r_s?=??0.31, p?p?=?0.24). However, a subgroup (34%) had a clinically relevant improvement in pain self-efficacy. This group was younger (mean age 41.4 vs. 45.8, p?=?0.01), more recently diagnosed (1.8 vs. 2.8 years, p?=?0.003), but had an unresolved welfare situation (59% vs. 40%, p?=?0.02).

Conclusion: The main hypothesis was falsified, as there was no association between pain self-efficacy and actual performance of activity. The relation to functioning may be limited to perceived, cognitive-emotional aspects, as indicated by the weak to moderate correlations to the self-reported measures.

• Implications for Rehabilitation

• Improvement in observed activity post multi-disciplinary rehabilitation was not associated with change in pain self-efficacy.

• Patients performed better after rehabilitation, but did not perceive to have improved their capacity.

• The relationship between pain self-efficacy and functioning may be limited to cognitive-emotional aspects rather than actual activity.

• Both observational and self-reported measures should be included in evaluating outcomes of rehabilitation for patients with fibromyalgia.

     

Postoperational rehabilitation of patients with fracture of femoral stem and knee injury

Background：Jointactivitydirectlyaffectlimbsfunction．Earlycontinualpassivemotion（CPM）canimprovefracturehealingandregenerationandrepairofintraarticularcartilage，effectivelypreventjointadhesionandrecoverlimbsfunction．Objective：ToinvestigatetheeffectofCPMonpostoperationalrehabilitationoffractureoffemoralstemandkneeinjury．Unit：FirstAffiliatedHospital，LanzhouMedicalCollege．Subjects：１７８patients（１１２malesand６６femalesaged１７～５８years）recruitedfrom１９９７to２００１wererand…     

Introduction of family rehabilitation training of low back pain

Background：Lowbackpainisacommonandfrequentdisease，oftenwithsevereischialgianeuralgia．Besidesnormalambulatorytreatmentssuchastractionoflumbarvertebra，computermiddlefre－quentandmassage，trainingoflumbodorsalmyodynamiaoffamilyauxiliarytreatmentisveryessential．Placingasupplementaryinstru－mentmadebyourselvesbelowlowback，lyingseveralhours，makinglumbarvertebralslideforwardandresumethenormalbiomechanicsrelationsoflumbarvertebrabystrentheningphysiologicallordo－sis．Improvethepathologicchangeo…     

The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain – a literature review

Purpose: The purpose of this study is to assess and describe the meanings given to “gender” in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: “Gender as a factual difference”, “The man is the ideal” and “Gender as a result of social role expectations”.

Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

• Implications for rehabilitation

• Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs.

• In rehabilitation for chronic pain the patients’ social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

     

Effects of early rehabilitation to patients with paralysis after cerebral infarction

BACKGROUND:Itisconsiderednowthatearlyrehabilita-tioninterventionalmechanismisrelatedtotheplasticityofbrainthatmeansafterinjuryofneuralfunction,centralnervoussystemhastheabilityofcompensationandfunctionalrecombination.OBJECTIVE:Toexploretheeffectsofearlyrehabilitationonparalysisaftercerebralinfarction.UNIT:DepartmentofNeurology,ThirdHospitalofFushun.SUBJECTS:2000-11/2002-05,allcasesconformedto1995FourthNationalCerebrovascularDiseaseDiagnosisStandards,provedbyCTandthoseofmildtyp…     

Obtaining informed consent for cancer pain research: do patients with advanced cancer and patients with chronic pain have different concerns?

To explore the factors that patients with malignant and nonmalignant pain consider when deciding whether to enroll in pain research studies, determine whether their views are different, and determine whether willingness to enroll in research is associated with pain severity, semi-structured interviews were conducted with 80 patients (cancer pain: n = 40; chronic nonmalignant pain: n = 40). The risks and potential benefits that were important to patients with cancer were the same as those that were important to patients with chronic pain. Willingness to enroll in research was associated with pain severity (Spearman rho = 0.33; P = 0.041) in patients with chronic pain, but not in patients with cancer pain. Patients with cancer pain do not have different concerns than chronic pain patients do. Although chronic pain patients' willingness to enroll in research was related to pain severity and a desire for better pain management, cancer patients' willingness to enroll was not.     

Further evaluation of the pain stages of change questionnaire: is the transtheoretical model of change useful for patients with chronic pain?

Patient readiness to adopt new beliefs and coping responses to pain may predict response to multidisciplinary or cognitive-behavioral pain treatments that emphasize changes in beliefs and coping behaviors. According to the transtheoretical model of change, individuals go through specific stages in the process of changing maladaptive behaviors. Based on this model, Kerns et al. (1997) (Kerns RD, Rosenberg R, Jamison RN, Caudill MA, Haythornthwaite J. Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain 1997;72:227-234) developed a measure of readiness to adopt a self-management approach to pain problems (the Pain Stages of Change Questionnaire; PSOCQ) and provided preliminary data supporting the validity of the measure. The current study sought to further evaluate the PSOCQ by determining the generalizability of these preliminary findings and the ability of the PSOCQ to classify persons with chronic pain into specific stages of readiness to self-manage pain. One hundred ten patients with diverse chronic pain problems, and 119 patients with fibromyalgia completed the PSOCQ and two measures of pain-related beliefs and coping prior to entry into two separate multidisciplinary pain programs. The internal consistency and concurrent validity of the PSOCQ subscales were largely replicated, supporting the validity of the subscales as measures of readiness to self-manage pain. However, the PSOCQ demonstrated less utility as a tool for classifying individuals into one of four specific stages of readiness to adopt a self-management approach. This result may be due to the classification procedure used in the current study, the characteristics of the samples in the study, specific limitations of the measure, and/or limitations in the applicability of the transtheoretical model of change to patients with chronic pain.     

Effects of early post-operation rehabilitation intervention on 69 patients with prolapse of lumbar intervertebral

BACKGROUND：Thoughoperationskilltolumbardiscpro－trusiontherapyisimportant，postoperativerehabilitationisalsoim－portanttopatients＇functionalrestoration．OBJECTIVE：Todiscussthelong－termeffectsofearlypostop－erativerehabilitationinterventiontoprolapseoflumbarintervertebralpatients．UNIT：DepartmentofOrthopaedics，ChinaPetroleumLiaoyangPetroleumChemicalFiberCompanyEmployeeHospitalSUBJECTS：Therewere６９patientswhoreceivedlumbarin－tervertebraloperationsfromOctober１９９９toMa…     

Impact of early rehabilitation therapy on ADL in stroke patients with paralysis

BACKGROUND：Strokecancauseparalysisandthusimpactpatients＇ADL．So，manyresearchersareengaginginstudyofrehabili－tationofstrokeandtheysuggestearlyrehabilitationtherapy．However，therapeuticeffectofearlyrehabilitationtherapyisunderdisputes．OBJECTIVE：ToobserveimpactofearlyrehabilitationtherapyonADLinstrokepatientswithparalysis．UNIT：DepartmentofRehabilitation，RuijinHospital，SecondShanghaiMedicalUniversity．SUBJECTS：４０patientswithacutestrokeadmittedduring２００２－０１／…