Training on involving cognitions and perceptions in the occupational health management and work disability assessment of workers: development and evaluation

Background In order to improve work participation of workers with a chronic disease, it is important for occupational health professionals (OHPs) to focus on those factors that can influence work participation. Cognitions and perceptions, such as recovery expectations and self-efficacy, are examples of these factors that can influence work participation. However, no training program is available for OHPs on how to involve cognitions and perceptions during their practice. Therefore, the aim of this study was to develop a training program for OHPs on how to involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. In addition, to evaluate the OHPs’ satisfaction with the training and the feasibility of the training and learned skills. Methods The training program was developed using information from previously conducted studies regarding cognitions and perceptions in relation to work participation. Satisfaction with the training by OHPs was evaluated by means of a questionnaire. A smaller group of OHPs were interviewed three to six months after the training to evaluate the feasibility of the training and learned skills. Results The 4.5-h training program consisted of four parts concerning: 1) cognitions and perceptions associated with work participation, 2) how to obtain information on them, 3) the course of the conversation on these factors, and 4) intervening on these factors. Eight training sessions were conducted with 57 OHPs, of whom 54 evaluated the training. Participants were very satisfied (score 8.5 on a scale from 1 to 10). The eleven interviewed participants were more aware of cognitions and perceptions during consultations and perceived the training to be feasible. However, not all participants had applied the acquired skills in their practice, partially because of a lack of time. Conclusions OHPs are very satisfied with the training program and perceive it to be feasible. The training increases awareness of important cognitions and perceptions and may possibly help to increase work participation of workers with a chronic disease.

How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data

Purpose Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model. Methods 300 randomised controlled trial participants (153 male, 147 female, mean age 44.1) with low back pain (of duration 6–26 weeks) received either individualised physiotherapy or advice. Variables with potential to explain how individualised physiotherapy works were included in a multivariate Bayesian Network model. Modelling incorporated the intervention period (0–10 weeks after study commencement–“early” changes) and the follow-up period (10–52 weeks after study commencement–“late” changes). Sequences of variables in the Bayesian Network showed the most common direct and indirect recovery pathways followed by participants with low back pain receiving individualised physiotherapy versus advice. Results Individualised physiotherapy directly reduced early disability in people with low back pain. Individualised physiotherapy exerted indirect effects on pain intensity, recovery expectations, sleep, fear, anxiety, and depression via its ability to facilitate early improvement in disability. Early improvement in disability, led to an early reduction in depression both directly and via more complex pathways involving fear, recovery expectations, anxiety, and pain intensity. Individualised physiotherapy had its greatest influence on early change variables (during the intervention period). Conclusion Individualised physiotherapy for low back pain appears to work predominately by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. The current study cannot rule out that unmeasured mechanisms (such as tissue healing or reduced inflammation) may mediate the relationship between individualised physiotherapy treatment and improvement in disability. Further data-driven analyses involving a broad range of plausible biopsychosocial variables are recommended to fully understand how treatments work for people with low back pain. Trials registration ACTRN12609000834257.

A-137 Role of Neuropsychology in Framing and Assisting the Development of Recovery Efforts: Education for Providers across Disciplines

Objective Information regarding differences in concussion and mild TBI recovery management protocols and recovery expectations vary across disciplines. This often leads to imprecise expectations for prognosis and adverse impacts on effective treatment and recovery. National groups and institutions provide training regarding concussion by neuropsychologists and rehabilitation psychologists to psychologists; however, broadband cross-discipline training is limited. Clinically, psychoeducation and clarification fall on Neuropsychologists and Rehabilitation psychologists. The purpose of this poster is to highlight the importance of the role of neuropsychologists in the education of concussion versus TBI recovery to support medical providers, teachers, and educators to facilitate appropriate care. Data Selection The current literature was review and obtained through the search within various databases such as PsycInfo, Google Scholar, and OhioLink. Keywords such as concussion, mild traumatic brain injury, psychoeducation, and neuropsychology were utilized to provide an inclusive review of the current research (2016–2021). Data Synthesis The focus of existing literature supports the education of concussions for patients and their families. Much of the literature supports the role of many disciplines to aid in recovery. There is limited research to support neuropsychology/Rehabilitation psychology’s efficacy to provide didactic training for providers of different fields supporting this population. Conclusion Through research, advocacy, and program development, the field of Neuropsychology and Rehabilitation psychology can utilize the holistic framework of the brain–body relationship to further facilitate the discussion of concussion and TBI recovery for providers of other disciplines serving these populations. Since treatment is multi-disciplinary for this clinical population, further programmatic evaluation provides interdisciplinary didactics to improve patient care.

Recovery expectations of neck pain patients do not predict treatments outcome in manual therapy

Patient recovery expectations can predict treatment outcome. Little is known about the association of patient recovery expectations on treatment outcome in patients with neck pain consulting a manual therapist. This study evaluates the predictive value of recovery expectations in neck pain patients consulting manual therapists in the Netherlands. The primary outcome measure ‘recovery’ is defined as ‘reduction in pain and perceived improvement’. A prospective cohort study a total of 1195 neck pain patients. Patients completed the Patient Expectancies List (PEL) at baseline (3 item questionnaire, score range from 3 to 12), functional status (NDI), the Global Perceived Effect (GPE) for recovery (7-points Likert scale) post treatment and pain scores (NRS) at baseline and post treatment. The relationship between recovery expectancy and recovery (dichotomized GPE scores) was assessed by logistic regression analysis. Patients generally reported high recovery expectations on all three questions of the PEL (mean sumscores ranging from 11.3 to 11.6). When adjusted for covariates the PEL sum-score did not predict recovery (explained variance was 0.10 for the total PEL). Separately, the first question of the PEL showed predictive potential (OR 3.7; 95%CI 0.19–73.74) for recovery, but failed to reach statistical significance. In this study patient recovery expectations did not predict treatment outcome. Variables predicting recovery were recurrence and duration of pain. The precise relationship between patient recovery expectations and outcome is complex and still inconclusive. Research on patient expectancy would benefit from more consistent use of theoretical expectancy and outcome models.