Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain: interventions and promising long-term outcomes

Abstract Background There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed. Aim To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period. Methods All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014–2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured ‘clinical reasoning’ using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients’ medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge. Results In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up. Conclusions A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.

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Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up

BMC Public Health ◽

10.1186/s12889-019-7955-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Julia S. Malmborg ◽

Ann Bremander ◽

M. Charlotte Olsson ◽

Anna-Carin Bergman ◽

A. Sofia Brorsson ◽

...

Keyword(s):

Physical Activity ◽

Logistic Regression ◽

Health Status ◽

Musculoskeletal Pain ◽

Multiple Logistic Regression Analysis ◽

Chronic Musculoskeletal Pain ◽

Anxiety And Depression ◽

Independent Variables ◽

Sleeping Problems

Abstract Background Chronic musculoskeletal pain is common in adolescents, and it has been shown that adolescents with pain may become young adults with pain. Pain often coincides with psychosomatic symptoms in adults, but little is known about longitudinal associations and predictors of pain in adolescents. The aim was to investigate chronic musculoskeletal pain and its associations with health status, sleeping problems, stress, anxiety, depression, and physical activity in 16-year-old students at baseline, and to identify risk factors using a three-year follow-up. Methods This was a longitudinal study of 256 students attending a Swedish upper secondary school. Questionnaires regarding chronic musculoskeletal pain and distribution of pain (mannequin), health status (EQ-5D-3 L), sleeping problems (Uppsala Sleep Inventory), stress symptoms (single-item question), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) were issued at baseline and follow-up. Student’s t-test and chi2 test were used for descriptive statistics and logistic regression analyses were used to study associations between chronic pain and independent variables. Results Fifty-two out of 221 students at baseline (23.5%) and 39 out of 154 students at follow-up (25.3%) were categorized as having chronic musculoskeletal pain. Chronic musculoskeletal pain at follow-up was separately associated with reporting of an EQ-5D value below median (OR 4.06, 95% CI 1.83–9.01), severe sleeping problems (OR 3.63, 95% CI 1.69–7.82), and possible anxiety (OR 4.19, 95% CI 1.74–10.11) or probable anxiety (OR 3.82, 95% CI 1.17–12.48) at baseline. Similar results were found for associations between chronic musculoskeletal pain and independent variables at baseline. In multiple logistic regression analysis, chronic musculoskeletal pain at baseline was a predictor of chronic musculoskeletal pain at follow-up (OR 2.99, 95% CI 1.09–8.24, R2 = 0.240). Conclusion Chronic musculoskeletal pain at baseline was the most important predictor for reporting chronic musculoskeletal pain at the three-year follow-up, but a worse health status, severe sleeping problems, and anxiety also predicted persistence or development of chronic musculoskeletal pain over time. Interventions should be introduced early on by the school health services to promote student health.

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Pain interference with physical functioning is associated with physical activity level in patients with chronic musculoskeletal pain

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.05.042 ◽

2018 ◽

Vol 61 ◽

pp. e19 ◽

Cited By ~ 1

Author(s):

P. Terrier ◽

C. Praz ◽

J. Le Carré ◽

P. Vuistiner ◽

B. Léger ◽

...

Keyword(s):

Physical Activity ◽

Musculoskeletal Pain ◽

Physical Functioning ◽

Physical Activity Level ◽

Activity Level ◽

Chronic Musculoskeletal Pain ◽

Pain Interference

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Evaluating a Self-Determination Model of Physical Activity and Exercise in People With Chronic Musculoskeletal Pain

Rehabilitation Research Policy and Education ◽

10.1891/re-21-05 ◽

2021 ◽

Vol 35 (3) ◽

pp. 248-262

Author(s):

Jia Rung Wu ◽

Jessica Brooks ◽

Fong Chan ◽

Kanako Iwanaga ◽

Nicole Ditchman ◽

...

Keyword(s):

Physical Activity ◽

Health Promotion ◽

Musculoskeletal Pain ◽

Structural Equation ◽

Autonomous Motivation ◽

Chronic Musculoskeletal Pain ◽

Self Determination ◽

Equation Modeling ◽

Physical Activity And Exercise ◽

Health Promotion Interventions

BackgroundResearch evidence supports the assertion that healthy employees are happier and more productive. Employers prefer to hire healthy workers to reduce absenteeism. Rehabilitation counselors have started to explore health promotion interventions to help individuals with chronic health conditions and disability improve their physical and mental health as a strategy to increase their employment opportunities.PurposeThe present study evaluated a self-determination theory (SDT) model of physical activity and exercise in a sample of 218 individuals with chronic musculoskeletal pain using structural equation modeling.ResultsThe SDT model fit the data well, accounting for 54% of the variance in physical activity and exercise. Relatedness was significantly associated with autonomous motivation for physical activity and exercise. Autonomous motivation was associated with competency. Competency was associated with physical activity and exercise. Autonomous motivation and competency mediated relatedness and physical activity and exercise.ImplicationsThis study contributes to an emerging body of theory-informed health promotion literature and identifies the specific pathways that will increase the motivation to engage in physical activity and exercise. Findings can be used to design and validate theory-driven health promotion interventions as an employment strategy for people with chronic musculoskeletal pain receiving vocational rehabilitation services.

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Augmented Rehabilitation Program for Young Patients Following Total Hip Arthroplasty

10.21203/rs.3.rs-138081/v1 ◽

2021 ◽

Author(s):

Ahmed Negm ◽

Milad Yavarai ◽

Gian Jhangri ◽

Robert Haennel ◽

Allyson Jones

Keyword(s):

Physical Activity ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Intervention Group ◽

Young Patients ◽

Rehabilitation Program ◽

Control Group ◽

Total Hip ◽

The Impact

Abstract BackgroundThe increase rate seen in Total Hip Arthroplasty (THA) for younger patients has implications for future rehabilitation demands for primary and revision THA surgery. This study aims to determine the impact of a 6-week post-operative rehabilitation program designed for THA patients ≤ 60 years on physical activity (PA) and function compared to age- and a sex-matched control group received usual postoperative care at 12-week post-THA. MethodsIn this quasi-experimental study, a cohort of THA candidates was recruited during their 6-week postoperative visit to their surgeons. The out-patient rehabilitation program consisted of 12 structured exercise classes (2 hrs/class) over 6 weeks. Physical activity was assessed using Sense Wear Pro ArmbandTM [SWA]. Participants completed the Hip Osteoarthritis Outcome Score (HOOS), and THA satisfaction questionnaire before and immediately after the intervention. ResultsThe intervention group took significantly more steps/day at the follow-up compared to baseline. The intervention group had a higher mean change in the number of weekly PA bouts than the control group. Within the intervention groups, all HOOS subscales were significantly higher at the follow-up compared to baseline. ConclusionThe augmented rehabilitation program may have immediate effects on pain relief and symptom reduction for patients (≤60 years) following THA.

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Modello di riabilitazione cardiologica teleguidata durante pandemia da COVID-19

CARDIOLOGIA AMBULATORIALE ◽

10.17473/1971-6818-2020-4-6 ◽

2020 ◽

pp. 271-275

Author(s):

Giovanni Pasanisi ◽

Biagio Sassone ◽

Jonathan Myers ◽

Giorgio Chiaranda ◽

Andrea Raisi ◽

...

Keyword(s):

Physical Activity ◽

Cardiac Rehabilitation ◽

Physical Activity Intervention ◽

Rehabilitation Program ◽

Physical And Mental Health ◽

Rehabilitation Programs ◽

Home Based ◽

Video Tutorials ◽

Rapid Spread ◽

Collateral Effects

Background. The COVID-19 pandemic has induced many governments to promote national lockdowns. Despite a period of quarantine is the best option and recommendation to stop the rapid spread of infections, this may have collateral effects on other dimensions of the isolated patients’ physical and mental health. Physical activity is the major component of cardiac rehabilitation programs that have been abruptly discontinued. Aims. To counteract physical inactivity during the COVID-19 outbreak we propose an home cardiac rehabilitation program under telemonitoring guidance, the home-bAsed physiCal acTivity Intervention during cOvid-19 quaraNtine (ACTION) study, testing its feasibility. Methods and results. ACTION is an observational study in cardiac outpatients referred to an exercise-based cardiac rehabilita-tion program. A program consisting of aerobic recommendations combined with a selection of strength and balance exercises is recommended. Video tutorials providing details of the workouts will be sent to patients. Selected patients can be followed during the home-sessions via video connection using current smartphone applications. Conclusions. The ACTION study could provide applicable results for safe and effective exercise therapy in outpatients with car-diovascular disease, while preventing the COVID-19 outbreak from generating adverse health consequences due to acute cessa-tion of physical activity. Findings from the ACTION study can also be useful after the end of COVID-19 outbreak for patients who cannot participate in traditional center- or home-based cardiac rehabilitation programs.

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Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial

Pain Medicine ◽

10.1093/pm/pnaa145 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2811-2822

Author(s):

Brandon C Yarns ◽

Mark A Lumley ◽

Justina T Cassidy ◽

W Neil Steers ◽

Sheryl Osato ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Musculoskeletal Pain ◽

Behavioral Therapy ◽

Emotional Awareness ◽

Pain Reduction ◽

Post Treatment ◽

Chronic Musculoskeletal Pain ◽

Comparison Trial ◽

Secondary Outcomes

Abstract Objective Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain. Design Randomized comparison trial. Setting Outpatient clinics at the West Los Angeles VA Medical Center. Subjects Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain. Methods Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up. Results EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance. Conclusions This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.

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