The self-assessment INTERMED predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments.

OBJECTIVE: To use the self-assessment INTERMED questionnaire to determine the relationship between biopsychosocial complexity and healthcare and social costs of patients after orthopaedic trauma. DESIGN: Secondary prospective analysis based on the validation study cohort of the self-assessment INTERMED questionnaire. SETTING: Inpatients orthopaedic rehabilitation with vocational aspects. SUBJECTS: In total, 136 patients with chronic pain and impairments were included in this study: mean (SD) age, 42.6 (10.7) years; 116 men, with moderate pain intensity (51/100); suffering from upper (n = 55), lower-limb (n = 51) or spine (n = 30) pain after orthopaedic trauma; with minor or moderate injury severity (severe injury for 25). MAIN MEASURES: Biopsychosocial complexity, assessed with the self-assessment INTERMED questionnaire, and other confounding variables collected prospectively during rehabilitation. Outcome measures (healthcare costs, loss of wage costs and time for fitness-to-work) were collected through insurance files after case settlements. Linear multiple regression models adjusted for age, gender, pain, trauma severity, education and employment contract were performed to measure the influence of biopsychosocial complexity on the three outcome variables. RESULTS: High-cost patients were older (+3.6 years) and more anxious (9.0 vs 7.3 points at HADS-A), came later to rehabilitation (+105 days), and showed higher biopsychosocial complexity (+3.2 points). After adjustment, biopsychosocial complexity was significantly associated with healthcare (ß = 0.02; P = 0.003; expß = 1.02) and social costs (ß = 0.03; P = 0.006, expß = 1.03) and duration before fitness-to-work (ß = 0.04; P < 0.001, expß = 1.04). CONCLUSION: Biopsychosocial complexity assessed with the self-assessment INTERMED questionnaire is associated with higher healthcare and social costs.

Task-Contingent Persistence is Related to Better Performance-Based Measures in Patients with Chronic Musculoskeletal Pain.

Purpose: Pacing, avoidance, and overdoing are considered the three main behavioral strategies, also labeled activity patterns. Their relationship with functioning of patients with chronic pain is debated. The purpose of this study was to measure the influence of activity patterns on lifting tasks commonly used in daily life. Method: We performed a monocentric observational study and included patients performing Functional Capacity Evaluation (FCE). Avoidance, pacing, and persistence were assessed with using the Patterns of Activity Measures-Pain (POAM-P). Maximal safe performance was measured for floor-to-waist, waist-to-overhead, horizontal lift, and carrying with dominant-hand tests according to the FCE guidelines. Descriptive statistics, associations of POAM-P subscales with various sociodemographic variables, and correlations are presented. Standard multiple linear regression models were applied to measure the associations between FCE tests and POAM-P subscales, adjusting for the following potential confounders: age, gender, body mass index (BMI), pain severity, trauma severity, localization of injury, and education. Results: Persistence was significantly positively associated with performance on the 4 FCE tests: floor-to-waist (coefficient = 0.20; p=0.001), waist-to-overhead (coefficient = 0.13; p=0.004), horizontal lift (coefficient = 0.31; p ≤ 0.001), and dominant-handed lifting (coefficient = 0.19; p=0.001). Pacing was found to have a negative influence on the carrying dominant-hand test (coefficient = -0.14; p=0.034), and avoidance was not found to have an influence on the 4 FCE tests. Conclusion: This study shows that task-persistence pattern is positively associated with physical performance in FCE, whereas pacing can have a negative influence on some tests.

Predictive Value of the Fear-Avoidance Model on Functional Capacity Evaluation.

Purpose Measuring the predictive value of the Fear-Avoidance Model (FAM) on lifting tasks in Functional Capacity Evaluation (FCE), and on reasons for stopping the evaluation (safe maximal effort, versus self-limited). Methods A monocentric prospective study was conducted on 298 consecutive inpatients. Components of the FAM were analyzed using the Cumulative Psychosocial Factor Index (CPFI: kinesiophobia, catastrophizing, depressive mood) and perceived disability (Hand/Spinal Function Sort: HFS/SFS). Floor-to-waist, waist-to-overhead and dominant-hand lifting tests were measured according to the FCE guidelines. Maximal safe performance was judged by certified FCE assessors. Analyses were conducted with linear multiple regression models. Results The CPFI was significantly associated with the 3 FCE lifting tests: floor-to-waist (ß = - 1.12; p = 0.039), waist-to-overhead (ß = - 0.88; p = 0.011), and dominant-handed lifting (ß = - 1.21; p = 0.027). Higher perceived disability was also related to lower performances: floor-to-waist (ß = 0.09; p < 0.001), waist-to-overhead (ß = 0.04; p < 0.001), and dominant-handed lifting (ß = 0.06; p < 0.001). The CPFI was not related to performances of patients with self-limited effort despite higher psychological scores, while a relationship was found for patients who achieved a safe maximal performance. Higher perceived disability was related to performances in both situations. Conclusions FAM components should be taken into account when interpreting maximal physical performance in FCE. This study also suggests that factors other than pain-related fears may influence patients with self-limited effort.

The predictive value of subsets of the Örebro Musculoskeletal Pain Screening Questionnaire for return to work in chronic low back pain.

BACKGROUND: Studies have shown that positive recovery expectations are associated with positive health outcomes in patients with chronic low back pain (CLBP) such as return to work (RTW) and the time to RTW. AIM: To compare the predictive value for RTW in CLBP using different subsets of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). DESIGN: Longitudinal cohort study. SETTING: Rehabilitation center. POPULATION: Ninety-eight inpatients with CLBP (>3 months). METHODS: The ÖMPSQ at baseline was used to predict RTW three months after discharge from the rehabilitation clinic. The area under the ROC-curve was calculated based on a logistic regression model. Cox-regression was used to analyze time to RTW with C statistics for the original full (25-items) version of the ÖMPSQ, the 10-item version as well as for the two items about self-expected RTW and self-expected recovery. RESULTS: The area under the curve (AUC) for the overall score of the full version ÖMPSQ was 0.82 (95% CI: 0.73 to 0.90), the AUC for the short version was 0.79 (95% CI: 0.70 to 0.88), the AUC for the item about self-expected recovery (#15) was 0.67 (95% CI: 0.57 to 0.78), and the AUC for the item about self-expected RTW (#16) was 0.76 (95% CI: 0.66 to 0.85). Harrell's C for the full version was 0.74 (95% CI: 0.66 to 0.81), for the short version the C was 0.71 (95% CI: 0.64 to 0.79), for item #15 the C was 0.62 (95% CI: 0.53 to 0.72), and for item #16 the C was 0.71 (95% CI: 0.64 to 0.78). CONCLUSIONS: Two items about expectations from the ÖMPSQ showed similar predictive value for RTW compared to the short and full original versions, and could be used as first screening questions. CLINICAL REHABILITATION IMPACT: Clinicians may make an informed choice whether they use the full or the short version of the ÖMPSQ for screening of psychosocial problems, or whether they use the two single items about expectations. Knowledge about patient's expectations provides a base for discussion between health professionals and the patient.

Test-retest reliability of the Örebro Musculoskeletal Pain Screening Questionnaire and the Situational Pain Scale in patients with chronic low back pain.

OBJECTIVE: To determine the test-retest reliability of the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) and of the Situational Pain Scale (SPS) in patients with chronic low back pain (CLBP). METHODS: CLBP patients (n = 30) who were capable of reading French completed the OMPSQ and the SPS twice with a 1-week interval in one rehabilitation centre in French-speaking Switzerland. To study the test-retest reliability, we calculated intraclass correlation coefficients (ICCs) for the reliability of the overall scores of the two questionnaires. RESULTS: The ICC for the OMPSQ overall score was 0.89 (95% confidence interval [CI] 0.79‒0.95). For the overall scores of the SPS, the ICC was 0.87 (95% CI 0.74‒0.93). The standard error of the mean, expressed as percentage of the mean, was 6.6% for the SPS and 10% for the OMPSQ. CONCLUSIONS: The reproducibility of these two questionnaires in a sample of patients with CLBP is considered good at the overall score level. The French translation of the OMPSQ could be considered as a tool to examine the evolution of psychosocial factors.

Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial.

BACKGROUND: Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. METHODS: Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups. RESULTS: Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes. CONCLUSIONS: This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly. TRIAL REGISTRATION NUMBER: NCT01496144.

Rehabilitation outcomes for orthopaedic trauma individuals as measured by the INTERMED.

PURPOSE: Bio-psychosocial characteristics of patients after orthopaedic traumas may be a strong predictor of poor outcome. The objective of this prospective study was to assess whether the INTERMED, a measure of bio-psychosocial complexity, identifies complex inpatients during rehabilitation including vocational aspects with a poor outcome 1 year after discharge. METHOD: At entry, the INTERMED scores of 118 inpatients were used to assign patients to the high or low complexity group. A questionnaire evaluated 1 year after discharge whether patients: (1) returned to work, (2) still have therapies, (3) take psychoactive drugs, (4) take medication against pain and (5) were satisfied with vocational therapy. Univariate logistic regressions identified which variables predict INTERMED case complexity during hospitalisation as well as predictors (i.e. INTERMED case complexity, French as preferred language, duration of the disability, accident at work, work qualification, severity of the injury, psychiatric co-morbidities, pain) of the five measured outcomes 1 year after discharge. RESULTS: During hospitalisation, the high complexity group was associated with a high prevalence of psychiatric co-morbidities, a higher level of pain and a weaker perception of treatment effects. One year after discharge, the INTERMED was the sole variable to predict all outcomes. CONCLUSION: The INTERMED identifies complex patients during vocational rehabilitation after orthopaedic trauma and is a good predictor of poor outcome 1 year after discharge.

Identification of relevant ICF categories in vocational rehabilitation: a cross sectional study evaluating the clinical perspective.

INTRODUCTION: Vocational rehabilitation (VR) emphasizes a need for medical support, rehabilitation and biopsychosocial approach to enable individuals to successfully participate in the workforce. Optimal rehabilitation management relies on an in-depth knowledge of the typical spectrum of problems encountered of patients in VR. The International Classification of Functioning, Disability and Health (ICF) is based on a universal conceptual model and provides a holistic view of functioning of the lived experience of people such as those undergoing VR. The objectives of this study are to describe the functioning and health of persons undergoing VR and to identify the most common problems around work and in VR using the ICF as the reference framework. METHODS: An empirical cross-sectional multicenter study was conducted using convenience sampling from March 2009 to March 2010. Data were collected using a Case Record Form rated by health professionals which was based on an extended version of the ICF Checklist containing 292 ICF categories and sociodemographic information. RESULTS: 152 patients with various health conditions participated. We identified categories from all four ICF components: 24 for body functions, six for body structures, 45 for activities and participation, and 25 for environmental factors. CONCLUSIONS: Our study identified a multitude of ICF categories that describe functioning domains and which represent the complexity of VR. Such a comprehensive approach in assessing patients in VR may help to understand and customize the process of VR in the clinical setting and to enhance multidisciplinary communication.

Biopsychosocial complexity is correlated with psychiatric comorbidity but not with perceived pain in complex regional pain syndrome type 1 (algodystrophy) of the knee.

AIM: The aim of this study was to compare the characteristics of patients suffering from complex regional pain syndrome type 1 ([CRPS], also known as reflex sympathetic dystrophy or algodystrophy) of the knee with those of a matched group of patients experiencing post-traumatic knee pain. The comparisons looked at biopsychosocial complexity (simple versus complex), psychiatric comorbidity and pain intensity. METHODS: Cross-sectional, single-centre, case-control study using the INTERMED scale, psychiatric diagnostic tools (ICD-10) and visual analogue pain scale. Contingency table and Chi2 tests. One-way analysis of variance for continuous dependent variables. Difference between groups: Tukey's variance test, after the event. For nominal dependent variables, multivariate logistic analysis. RESULTS: Biopsychosocial complexity did not differ between the two groups (p = 0.7). The "complex" patients displayed significantly more psychiatric comorbidity (odds ratio 2.94, 95% confidence interval 1.1-7.8, p < 0.01), independently of whether or not CRPS was present. The pain perceived varied with biopsychosocial complexity only in the control group. The "complex" control patients reported more pain than the "simple" control patients (p < 0.05). The perceived intensity of pain was not different between the "simple" and "complex" patients with CRPS. CONCLUSIONS: Biopsychosocial complexity was comparable between the two groups, and was strongly associated with the presence of psychiatric comorbidity. However, unlike with other pain syndromes, with CRPS the intensity of the perceived pain did not vary with biopsychosocial complexity. Early identification of "complex" patients could make it possible to quickly institute targeted management for both groups of patients.

[Chronic arthroses in children: practical approach and epidemiological data]. / Arthrites chroniques de l'enfant: approche pratique et données épidémiologiques.

Osteo-articular symptoms are frequent in pediatrics, but chronic arthritis is rare in childhood. Arthritis may be difficult to recognize in children and there is a large differential diagnosis including infectious and neoplastic diseases. Even if juvenile arthritis has often a favourable course, significant functional damage may occur. The diagnosis and the follow-up of chronic arthritis should be performed in collaboration with a specialized consultation in pediatric rheumatology, in order to allow access to multidisciplinary medical care and help to increase the clinical and epidemiological knowledge in these rare diseases. A study is starting this fall aimed at collecting epidemiological datas on childhood arthritis in the french part of Switzerland.