Physiotherapists' engagement in work ability and return to work issues of patients with musculoskeletal disorders. A cross-sectional survey in Norway.

BACKGROUND: Work and health are a national priority in Norway, and leading health authorities call for treatment approaches that incorporate these perspectives. We have little knowledge of how physiotherapists in private practice integrate the work perspective during the treatment of patients with musculoskeletal disorders. Thus, the purpose of this study was to gain more insight into the way physiotherapists in Norway integrate the aspect of work. METHODS: In 2021, all 2650 privately practising members of the Norwegian Physiotherapist Association received a web-based survey that was answered by 514 physiotherapists. The survey included questions about treatment approaches, competencies, and collaboration with other health professionals in the context of promoting work participation. RESULTS: 91% of the physiotherapists reported that they play an important role in assessing work ability. 75% were confident in assessing the patients' work ability, while 25% stated that they have little or some competence. 49% of the physiotherapists often contacted the general practitioner (GP) to discuss patients' ability to work, and 19% were often contacted by the GP. Only 14% stated that they were invited to participate in dialogue meetings with the Norwegian Labour and Welfare Administration. 28% of the physiotherapists reported that insufficient knowledge about social security issues was an obstacle in promoting the patient's work participation. The physiotherapists believed that increased use of standardised assessment tools, better knowledge of social security issues, and closer collaboration with other professionals may strengthen their role in promoting work participation. DISCUSSION AND CONCLUSION: Although physiotherapists promote work participation when treating patients on sick leave, limited communication with the stakeholders, and inadequate knowledge of social security issues pose an obstacle. To strengthen the physiotherapist's role in the return-to-work facilitation, work and health should become a separate subject in basic and advanced education programmes for physiotherapists.

The ability of the Ages and Stages Questionnaire (ASQ) to indicate motor difficulties in infants in primary care.

INTRODUCTION: Delayed achievement of motor milestones may be an early indicator of motor difficulties. Parent-reported questionnaires may serve as an efficient, low-cost screening to identify infants in need of further clinical assessment, and thus be a helpful tool in busy health care centers. PURPOSE: To examine the ability of the Ages and Stages Questionnaire, second edition (ASQ-2) to indicate motor difficulties in infants using the Infant Motor Profile (IMP) as the reference standard. METHODS: A cross-sectional design was applied to examine the correlation between parent-reported data of the ASQ-2 and data from physiotherapist assessment using IMP. Included were 432 mainly low-risk infants aged 3-12 months from primary care. RESULTS: Overall, ASQ-2 gross and fine motor scores did not correlate well with the IMP total or domain scores. The ASQ-2 gross motor cut point (> 2SD below the mean), showed 34.3% sensitivity and 96.7% specificity using the 15th percentile from IMP performance domain as reference standard. The positive predictive value to indicate motor difficulties was 48%. CONCLUSION: The motor domains of ASQ-2 have poor ability to identify infants with motor difficulties as indicated by their IMP scores in low-risk infants.

Identifying contrasting embodied voices of identity: a qualitative meta-synthesis of experiences of change among patients with chronic musculoskeletal pain in long-term physiotherapy.

BACKGROUND: The aim is to identify and synthesize qualitative research findings about patients with chronic musculoskeletal pain in long-term Norwegian psychomotor physiotherapy, in connection to their voices of meaning of embodied experiences of change and the possible influence on their identities. METHODOLOGY: We systematically searched for qualitative studies in English in ten databases: AMED, Cinahl, Cochrane, Embase, Medline, PsychInfo, Scopus, SportDiscus, Svemed, and Web of Science. We included and analyzed nine publications using meta-ethnography. Bachtin's polyphonic voice perspective influenced the analysis. RESULTS: Three overarching themes emerged: 1) voices of body and mind as disconnected and connected; 2) ambiguous voices in the therapeutic relationship; and 3) identification of embodied voices of constraint and freedom influence identity. CONCLUSIONS: The patients' polyphonic voices of ambiguous and contrasting expressions of embodied sensations and the therapeutic relationship in inner and external dialog seemed to facilitate the choices of change and the creation of new identities. In practice, the physiotherapists' consciousness of the patients' concurrent polyphonic voices may improve change in treatment.

Maternal Folic Acid-Containing Supplement Use in Relation to Offspring Motor Function. A Prospective Study of 503 Mother-Child Dyads.

Background: The preventive effect of maternal folic acid use on offspring neural tube defects is well-established. However, a putative link between supplement use and other neurodevelopmental outcome is inconsistent. The aim of this study was to examine the association of folic acid-containing supplement use before and during pregnancy with motor function in children aged 3-18 months. Method: The study has a prospective cohort design including 503 mother-infant dyads. Motor function was measured by the Infant Motor Profile (IMP) and Ages and Stages Questionnaire Second Edition (ASQ-2). Associations between exposure and outcome were examined using linear regression analysis with robust standard error estimation. Results: Offspring total IMP score was not associated with any maternal folic acid-containing supplement use when they were used during pregnancy only (adjusted ß = 0.11 95% CI = -1.19, 1.40; p = 0.87) or when they were used both before and during pregnancy (adjusted ß = 0.22 95% CI = -0.95, 1.40; p = 0.70). When examining the five domain scores separately, only the IMP domain adaptability showed some association with supplement use during pregnancy (adjusted ß = 2.87; 95% CI = 0.08, 5.68; p = 0.04), but the strength of the association was weak. Further, supplement use was not associated with any of the two motor domains of ASQ-2. Conclusion: Although no association between folic acid-containing supplement use and offspring motor function was found, the complexity of this topic and its potential mechanisms, requires further investigation. This research should include robust and accurate measures on maternal nutritional status along with thorough endpoint assessments.

Developing self-care in an interdependent therapeutic relationship: patients' experiences from Norwegian psychomotor physiotherapy.

Factors causing and sustaining long-lasting musculoskeletal pain differ between patients, but must be identified in order to target treatment. During physiotherapy, there are multiple factors influencing the treatment outcome. The focus in the present study was to grasp patients' experiences of how social burdens influence the development and persistence of symptoms of muscle pain, and how the relationship with the physiotherapist influences the process of change during Norwegian Psychomotor Physiotherapy. A phenomenological, descriptive, and retrospective design was chosen. Data were collected through focus-group interviews. Eleven patients participated. They ranged in age from 34 to 67 years. The analysis was inspired by Giorgi's phenomenological method. The results identified a general, overarching structure; "Caring for others and developing self-care" and the two interwoven themes "Emerging awareness of overload" and "Receiving care from the physiotherapist." These themes describe the essence of the experiences from the treatment process. To be recognized by the physiotherapist, both through the hands-on treatment and verbal communication, appears to be crucial for patients to develop an awareness of the factors causing and sustaining their pain problems. This awareness seemed necessary for the process of change to take place and for the patients to take more responsibility for their own care.

Norwegian Psychomotor Physiotherapy versus Cognitive Patient Education and active physiotherapy-A randomized controlled trial.

BACKGROUND AND PURPOSE: Norwegian Psychomotor Physiotherapy (NPMP) has been an established treatment approach for more than 50 years, mostly in the Scandinavian countries, usually applied to patients with widespread and long-lasting musculoskeletal pain and/or psychosomatic disorders. Few studies have investigated the outcomes of NPMP, and no randomized clinical trials (RCT) with a comparing treatment group have systematically been tried out on individuals. METHODS: This is a pragmatic, single-blinded RCT where 128 participants with long-lasting widespread musculoskeletal pain and/or pain located to the neck and shoulders were block randomized to NPMP or Cognitive Patient Education combined with active individualized physiotherapy (COPE-PT). Intention-to-treat with linear mixed models were used to estimate the group differences in treatment effects. The outcomes at 3, 6, and 12 months follow-up were pain intensity, function, anxiety and depression, quality of life, sleep, fear of movement, and subjective health complaints. Risk profile (Örebro) was examined at 3 and 6 months. All participants underwent physical tests at baseline and 6 months. RESULTS: One-year data were available for 66.4% of the original participants. Calculated with intention-to-treat analysis, at 3 months statistically significant differences were found in favor of COPE-PT for pain, anxiety and depression, quality of life-physical dimension, risk profile and fear of movement. At 6 months, statistically significant differences in favor of COPE-PT were found for anxiety and depression, and sleep. At 12 months, the improvements were still statistically significant for anxiety, depression and sleep. Both groups improved, but no statistically significant differences were found between the groups on the physical tests at 6 months. CONCLUSIONS: COPE-PT, which is targeted towards pain-coping and increasing activity, contribute to more improvements than NPMP.

Transferring patients's experiences of change from the context of physiotherapy to daily life.

Purpose: In the treatment of patients with long-lasting musculoskeletal pain, the challenge is to identify causal and sustaining factors and targeted treatment in order to improve function. Norwegian Psychomotor Physiotherapy (NPMP) is an approach often applied to patients with such pain. Long-term NPMP processes from the patients' perspective have been studied and discussed in the light of phenomenology of the body.The study purpose was to explore what kind of changes patients with long-lasting musculoskeletal pain experience during NPMP and further transfer into daily life context.Methods: A phenomenological, descriptive, and retrospective design was applied. Two focus-group interviews were conducted with 11 patients receiving such treatment. The interviews were audiotaped, transcribed, and analysed inspired by Giorgi's phenomenological methodology.Results: The analysis resulted in an overarching structure: "To develop embodied ownership of oneself over time", and two themes describing the essence of change that the patients experienced: (1) "To get an embodied grip on oneself through treatment"; (2) "To give oneself space in daily life".Conclusions: Enhanced embodied self-perception involving a sense of embodied ownership and agency seemed to be important both to be aware of own bodily needs and to transfer changes from treatment into daily life.

Intra- and Inter-Rater Reliability of the Infant Motor Profile in Infants in Primary Health Care.

AIM: To explore intra-rater and inter-rater reliability of the Infant Motor Profile (IMP). The IMP is a video-based method assessing movement quality (movement variation, adaptability, symmetry and fluency) and motor skills in infants aged 3 to 18 months. METHOD: The IMP assessment was performed on 50 infants aged 3 to 12 months recruited in connection with health control in primary health care, mean gestational age at birth 39.4 weeks, mean birthweight 3462 g. Seven infants had a moderately increased risk of developmental disorders. Three pediatric physiotherapists performed independent rating of the video recordings. One rater assessed the video recordings twice with a four-week interval. RESULTS: Intraclass correlation coefficient (ICC) for intra-rater reliability was found satisfactory for the total IMP score (ICC = 0.95), and the domains: performance (ICC = 0.98), variation (ICC = 0.74), adaptability (ICC = 0.93) and fluency (ICC = 0.86). The ICC value for symmetry was 0.65. For inter-rater reliability, ICC values were satisfactory for the total IMP score (ICC = 0.86-0.91), and the domains: performance (ICC = 0.98), variation (ICC = 0.71-0.82), adaptability (ICC = 0.99) and fluency (ICC = 0.82-0.81). The ICC values for symmetry varied between 0.13-0.35. CONCLUSION: In this sample, including mostly low-risk infants, satisfactory intra- and inter-rater reliability for all domains were demonstrated, except for symmetry.

Demanding treatment processes in Norwegian psychomotor physiotherapy: From the physiotherapists' perspectives.

Long-lasting musculoskeletal pain may be understood as the embodiment of bio-psycho-social strain. A combined theoretical perspective of biomedicine, physiotherapy and phenomenology may make these painproblems more comprehensible for the therapist. Norwegian psychomotor physiotherapy is one treatment approach applied on patients with long-lasting musculoskeletal pain. The approach is process-oriented, and can be long-term, complex and demanding. To explore this issue, we employed a multi-stage focus-group phenomenological methodology including five experienced physiotherapists. We found that during these demanding situations, the physiotherapists described their experiences including the feeling of being stuck, and further, how the experience of being in touch with their own body opened possibilities to bear, and act in the demanding situations. The physiotherapists had to find a balance between being in touch with themselves and concurrently listen to and be in contact with their patients.

Hemorrhoidal Disease Symptom Score and Short Health ScaleHD: New Tools to Evaluate Symptoms and Health-Related Quality of Life in Hemorrhoidal Disease.

BACKGROUND: There are no adequately validated tools to evaluate symptoms or disease-specific health-related quality of life in hemorrhoidal disease. OBJECTIVE: The purpose of this study was to assess validity, reliability, and responsiveness of a symptom score of patient-reported pain, itching, bleeding, soiling, and prolapse (Hemorrhoidal Disease Symptom Score). In addition, the study set out to assess reliability and responsiveness of an instrument to measure health-related quality of life in patients with hemorrhoids (Short Health ScaleHD), with 1 item in its 4 dimensions: symptom load, functional status, disease-specific worries, and general well-being. DESIGN: This was a cross-sectional (validity and reliability) and longitudinal (responsiveness) study. SETTINGS: The study was conducted at a single center. PATIENTS: Cohort 1 included 295 patients with hemorrhoids to study validity and 60 patients with test-retest scores to study reliability. Cohort 2 included 128 and 121 patients operated for hemorrhoids to study responsiveness of the Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD. MAIN OUTCOME MEASURES: The study evaluated validity, reliability, and responsiveness. Patient-reported symptom load on a 7-point Likert scale was used as comparator, and receiver operating characteristics curve assessed discriminative validity. Interclass correlation assessed reliability. Receiver operating characteristics curve assessed responsiveness, meaning the ability to discriminate between patients with and without improvement after surgery. RESULTS: The Hemorrhoidal Disease Symptom Score demonstrated the ability to discriminate between patients reporting high or low symptom load (area under the curve = 0.786 (95% CI, 0.725-0.848)). The Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD demonstrated adequate reliability and responsiveness, with interclass correlation of 0.822 (95% CI, 0.715-0.891) and 0.763 (95% CI, 0.634-0.851) and area under the curve of 0.843 (95% CI, 0.756-0.929) and 0.840 (95% CI, 0.752-0.929). LIMITATIONS: We had no gold standard comparator to assess validity and responsiveness. CONCLUSIONS: The findings suggest that the Hemorrhoidal Disease Symptom Score is valid, reliable, and responsive and that the Short Health ScaleHD is reliable and responsive. Used together, these tools provide a good overview of symptoms and their impact on patient well-being. See Video Abstract at http://links.lww.com/DCR/A770.

The Revised Body Awareness Rating Questionnaire: Development Into a Unidimensional Scale Using Rasch Analysis.

Background: The Body Awareness Rating Questionnaire (BARQ) is a self-report questionnaire aimed at capturing how people with long-lasting musculoskeletal pain reflect on their own body awareness. Methods based on classical test theory were applied to the development of the instrument and resulted in 4 subscales. However, the scales were not correlated, and construct validity might be questioned. Objective: The primary purpose of this study was to explore the possibility of developing a unidimensional scale from items initially collected for the BARQ using Rasch analysis. A secondary purpose was to investigate the test-retest reliability of a revised version of the BARQ. Design: This was a methodological study. Methods: Rasch and reliability analyses were performed for 3 samples of participants with long-lasting musculoskeletal pain. The first Rasch analysis was carried out on 66 items generated for the original BARQ and scored by 300 participants. The items supported by the first analysis were scored by a new group of 127 participants and analyzed in a second Rasch analysis. For the test-retest reliability analysis, 48 participants scored the revised BARQ items twice within 1 week. Results: The 2-step Rasch analysis resulted in a unidimensional 12-item revised version of the BARQ with a 4-point response scale (scores from 0 to 36). It showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered thresholds. Test-retest reliability was high, with an intraclass correlation coefficient of .83 (95% CI = .71-.89) and a smallest detectable change of 6.3 points. Limitations: The small sample size in the second Rasch analysis was a study limitation. Conclusions: The revised BARQ is a unidimensional and feasible measurement of body awareness, recommended for use in the context of body-mind physical therapy approaches for musculoskeletal conditions.

Study protocol for Norwegian Psychomotor Physiotherapy versus Cognitive Patient Education in combination with active individualized physiotherapy in patients with long-lasting musculoskeletal pain - a randomized controlled trial.

BACKGROUND: Norwegian Psychomotor Physiotherapy (NPMP) has been an established treatment approach for more than 50 years, although mostly in the Scandinavian countries, and is usually applied to patients with widespread and long-lasting musculoskeletal pain and/or psychosomatic disorders. Few studies have been investigating outcome of NPMP and no randomized clinical trials (RCT) have been systematically tried out on individuals. METHODS/DESIGN: This is a study protocol for a pragmatic, single blinded RCT, which will take place in a city of Norway. The participants will be block randomized either to receive NPMP or Cognitive Patient Education in combination with active individualized physiotherapy (COPE-PT). The intervention will reflect usual care and will be conducted in physiotherapy clinics by five experienced physiotherapists in each of the two treatment approaches. DISCUSSION: The findings of the present study may give an important contribution to our knowledge of the outcome of NPMP, on patients with long-lasting widespread musculoskeletal pain and/or pain located to the neck and shoulder region. TRIAL REGISTRATION: The study has been registered with ClinicalTrials.gov (June 9 th 2015, NCT02482792).

Norwegian psychomotor physiotherapy and patients with chronic pain: patients' perspective on body awareness.

This study has explored the experience of body awareness in patients with chronic pain as well as possible changes in this phenomenon as a consequence of Norwegian psychomotor physiotherapy (NPMP), were explored in the present study. Four focus group interviews were performed. Two groups consisted of patients on waiting lists for NPMP, whereas the other two were patients receiving NPMP. The interview material was analysed according to an ad hoc meaning generation. The interviews brought out three main themes of body awareness: being aware of one's own body; associations about one's own body; and feelings for one's own body. The differences and similarities in body awareness described by those receiving treatment and those on waiting lists are presented and discussed, as well as differences between participants within the groups. The patients' experiences ranged from a reduction of symptoms and coping quite well with chronic pain, to a feeling of being totally stuck in pain, followed by either a new body awareness or being preoccupied by pain. The participants receiving long-term NPMP--with one exception--experienced new body awareness, described as essential to increasing their ability to cope with pain.

Test-retest reliability of the Progressive Isoinertial Lifting Evaluation (PILE).

STUDY DESIGN: A repeated measures single group design. OBJECTIVES: To investigate test-retest reliability of Progressive Isoinertial Lifting Evaluation on patients with long lasting musculoskeletal problems related to the lumbar spine. SUMMARY OF BACKGROUND DATA: Test-retest reliability has been satisfactory in healthy men. Test-retest reliability for clinical populations has not been reported. METHODS: A total of 31 patients (17 women and 14 men) with long lasting low back pain participated in the study. The patients were tested twice at an interval of 2 days and at the same time of the day. The heaviest load that the patient could lift 4 times was used as outcome measure. RESULTS: The error of measurement indicates that the true result in 95% of cases will be within +/-4.5 kg from the measured value, while the difference between 2 measurements in 95% of cases will be less than 6.4 kg. Intra-class correlation (1,1) was 0.91. CONCLUSIONS: Relative test-retest reliability was high assessed by intra-class correlation, but absolute measurement variability reported as the smallest detectable difference has relevance for the interpretation of clinical test results and should also be considered.