Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Background Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Objective Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Methods Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Results Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Strengths and limitations This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. Conclusions We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. Trial registration NCT, NCT04092946. Registered 17/09/2019;

Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain

Purpose To verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain. Methods Individuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient(3,1) and internal consistency with Cronbach’s alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC). Results Exploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach’s alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC. Conclusion FABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.

Comparison of chronic widespread pain prevalence with different criteria in two cohorts of rheumatoid arthritis

Objective This study aims to investigate chronic widespread pain with the 1990 (CWP1990) and 2019 (CWP2019) definitions 6 years after the onset of rheumatoid arthritis (RA), in one patient cohort with tight controls and one conventional cohort, and factors associated with reporting CWP1990 and CWP2019, respectively. Methods A cohort of 80 RA patients with monthly visits to the physician the first 6 months was compared to a cohort of 101 patients from the same clinic with conventional follow-up. Both cohorts had early RA (< 13 months). The prevalence of CWP1990 and the more stringent CWP2019 were in a 6-year follow-up investigated with a questionnaire, including a pain mannequin and a fear-avoidance beliefs questionnaire. Results In the tight control cohort, 10% reported CWP2019 after 6 years compared to 23% in the conventional cohort (p = 0.026). There was no difference when using the CWP1990 definition (27% vs 31%, p = 0.546). When adjusted for important baseline data, the odds ratio for having CWP2019 was 2.57 (95% CI 1.02–6.50), in the conventional group compared to the tight control group (p = 0.046). A high level of fear-avoidance behaviour towards physical activity was associated with CWP2019, OR 10.66 (95% CI 1.01–112.14), but not with CWP1990 in the tight control cohort. Conclusion A more stringent definition of CWP identifies patients with a more serious pain condition, which potentially could be prevented by an initial tight control management. Besides tight control, caregivers should pay attention to fear-avoidance behaviour and tailor treatment. Key Points • CWP2019 is a more stringent definition of chronic widespread pain and identifies patients with a more serious pain condition. • Patients with a serious pain condition could be helped by frequent follow-ups. • This study suggests that a special attention of fear-avoidance behaviour towards physical activity in patients with RA is needed.

Australian Perspectives on Opt-In and Opt-Out Consent Systems for Deceased Organ Donation

Introduction: As many countries change to opt-out systems to address organ shortages, calls for similar reform in Australia persist. Community perspectives on consent systems for donation remain under-researched, therefore Australian perspectives on consent systems and their effectiveness in increasing donation rates were explored. Design: In this descriptive cross-sectional study, participants completed a survey presenting opt-in, soft opt-out, and hard opt-out systems, with corresponding descriptions. Participants chose the system they perceived as most effective and described their reasoning. Results: Participants (N = 509) designated soft opt-out as the most effective system (52.3%; hard opt-out 33.7%; opt-in 13.7%). Those who identified with an ethnic/cultural group or were not registered had greater odds of choosing opt-out. Six themes identified in thematic analysis reflected their reasoning: (1) who decides (individual, shared decision with family); (2) right to choose; (3) acceptability (ethics, fairness); and utility in overcoming barriers for (4) individuals (apathy, awareness, ease of donating, fear/avoidance of death); (5) family (easier family experience, family veto); (6) society (normalizing donation, donation as default, expanding donor pool). Choice and overcoming individual barriers were more frequently endorsed themes for opt-in and opt-out, respectively. Discussion: Results suggested the following insights regarding system effectiveness: uphold/prioritize individual's recorded donation decision above family wishes; involve family in decision making if no donation preference is recorded; retain a register enabling opt-in and opt-out for unequivocal decisions and promoting individual control; and maximize ease of registering. Future research should establish whether systems considered effective are also acceptable to the community to address organ shortages.

Effects of Game Situation-Dependent Emotions on Sport Spectators’ Food Craving

This study sought to challenge prevalent accounts of emotional eating by exploring the effects of situation-dependent emotions on consumers’ food craving. Four specific game situations in the context of spectator sports, each corresponding to the four types of emotional coping (outcome-desire conflict, avoidance, fulfillment, and pursuit), were identified as follows: decisive victories, decisive losses, close victories, and close losses. By employing laboratory-based virtual reality spectatorship, Study 1 tested the causal effects of happiness (fulfillment), anger (conflict), sadness (conflict), fear (avoidance), and hope (pursuit) on food craving. Study 2 further designed fans’ previous association between emotions and eating as a moderating mechanism in the context of online sport viewership. The results of the two experiments supported the three theoretical principles of eating behavior, including the “food as fuel” principle of anger, the hedonic eating principle of happiness, and the self-regulation principle of hope. However, the results rejected the escape awareness principle of sadness and fear. The study concludes with a discussion of context-dependent emotional positioning and intervention strategies for marketers and policy makers.

Influência do protagonismo do paciente no tratamento fisioterapêutico da dor crônica na coluna vertebral

Este estudo buscou descrever o perfil sociodemográfico de pacientes de fisioterapia com dor crônica (DC) na coluna vertebral (CV) e a relação psicossocial com o protagonismo após a realização de exercícios físicos. Estudo exploratório-descritivo, de intervenção, com análise quantitativa dos dados, realizado na Clínica Escola de Fisioterapia (CEF) da Universidade do Vale do Taquari - Univates, Lajeado, RS. A coleta de dados se deu por questionário de identificação e os protocolos Start Back Screening Tool (SBST), Fear Avoidance Belief Questionnaire (FABQ), Questionário de Qualidade de Vida SF-36 e Índice Oswestry de Incapacidade (IOI). Participaram nove pacientes com DC na CV, sendo alocados em grupos: intervenção, participou de um grupo de promoção à saúde durante quatro semanas, duas vezes na semana, para a realização de exercícios na CEF; controle, recebeu cartilha com os mesmos exercícios para serem realizados no domicílio pelo mesmo período. Ambos os grupos apresentaram melhora no SF-36, SBST e IOI. No FABQ, apresentaram melhora no item atividade física e piora no trabalho. Conclui-se que o programa de exercícios utilizado em pacientes que apresentam DC na CV é positivo na melhora do prognóstico e qualidade de vida; redução de incapacidades e crenças. Ainda, exercícios domiciliares incentivam o protagonismo dos pacientes.

The Prediction of Chronicity in Patients with Acute and Sub-Acute Non-Specific Low Back Pain and Associated Risk Factors: A Case-Control Study

Background: Chronic low back pain is one of the most common musculoskeletal disorders in different countries that people of any age can experience many times. This study aimed to predict the chronicity of non-specific acute and sub-acute LBP and related risk factors among cases referred to physiotherapy clinics.Methods: This case-control study was performed among 420 patients suffered from acute, sub-acute and chronic LBP referred to two physiotherapy centers in Tehran-Iran in 2020. Data were obtained using the Fear-Avoidance Beliefs Questionnaire (FABQ), Patient Health Questionnaire (PHQ-9), Pain Catastrophic Scale (PCS-13), Tampa Scale for Kinesiophobia (TSK-11), Pittsburgh Sleep Quality Index (PSQI), Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire (RMDQ) and Numerical Pain Rating Scale (NPRS). Data analysis was performed by applying independent sample t-test, chi-square, and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was employed for path analysis.Results: The mean age and body mass index in all patients were 43.94 ± 6.72 years and 25.69 ± 3.54 kg.m-2, respectively. It was found that some demographic parameters (i.e. weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters ( i.e. fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e. health responsibility, physical activity and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and sub-acute LBP (P < 0.05).Conclusion: Personal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and sub-acute non-specific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and sub-acute into chronic LBP has particular importance.