Danish short form Örebro Musculoskeletal Pain Screening Questionnaire: Translation, cross-cultural adaptation, and evaluation of measurement properties.

BACKGROUND: Low back pain (LBP) is the leading cause of disability and an increasing sick leave in Denmark. Psychosocial risk factors have been linked to the development of LBP-related disability and work-absenteeism. The short form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-sf) was developed to screen for psychosocial risk factors and assess the risk of long-term disability and work-absenteeism. OBJECTIVE: To translate and cross-culturally adapt ÖMPSQ-sf into Danish and evaluate test-retest reliability with relative and absolute reliability and internal consistency in LBP-patients in a secondary setting. METHODS: A six-step translation and cross-culturally adaptation process was used. Forty-four patients with subacute and chronic LBP were recruited at an outpatient clinic. RESULTS: Test-retest reliability (n= 37) was found to be excellent (ICC2.1= 0.92), Internal Consistency (n= 44) was adequate (Cronbach's alpha = 0.72). Absolute reliability included Standard Error of Measurement (SEM = 3.97 points), 95% Limits of Agreement (95% LOA = 0.08, -15.90-15.74), and Smallest Detectable Change (SDC = 10.87 points). CONCLUSION: The Danish ÖMPSQ-sf showed acceptable measurements properties in subacute and chronic LBP-patients. Further research is needed to assess other measurement properties of the ÖMPSQ-sf, in relation to validity, responsiveness, and the predictive ability before application in research or clinical practice.

The Effect of Graded Activity and Pain Education After Lumbar Spinal Fusion on Sedentary Behavior 3 and 12 Months Postsurgery: A Randomized Controlled Trial.

OBJECTIVES: To examine the effect of an early postsurgical intervention consisting of graded activity and pain education (GAPE) in patients with chronic low back pain (CLBP) undergoing lumbar spinal fusion (LSF) on sedentary behavior, disability, pain, fear of movement, self-efficacy for exercise and health-related quality of life (HRQoL) at 3-, 6-, and 12 months follow-up. DESIGN: A parallel-group, observer-blinded randomized controlled trial. SETTING: Department of Occupational- and Physiotherapy and the Centre for Rheumatology and Spine Diseases, Rigshospitalet, Denmark. PARTICIPANTS: In total, 144 participants undergoing an LSF for CLBP were randomly assigned to an intervention or a control group. INTERVENTIONS: The intervention group received 9 sessions of GAPE, based on principles of operant conditioning. MAIN OUTCOME MEASURES: The primary outcome was reduction in time spent in sedentary behavior, measured by an accelerometer at 3 months. The secondary outcomes were reduction in time spent in sedentary behavior at 12 months and changes from baseline to 3-, 6-, and 12 months on disability, pain, fear of movement, self-efficacy for exercise, and HRQoL. RESULTS: No difference in changes in sedentary behavior between groups was found 3 months after surgery. At 12 months after surgery, there was a significant difference between groups (mean difference: -25.4 min/d (95% confidence interval -49.1 to -1.7)) in favor of the intervention group. CONCLUSIONS: Compared with usual care, GAPE had no effect on short-term changes in sedentary behavior but GAPE had a statistical, but possibly not clinical significant effect on sedentary behavior 12 months after LSF. Further, the behavioral intervention was safe to perform.

Physiotherapists' prognosis of 1-year outcome after lumbar spinal fusion - A prospective cohort study.

BACKGROUND: Physiotherapists (PTs) have an essential role in the facilitation of patients' mobilization after lumbar spinal fusion (LSF). The aim of this study is to investigate whether PTs can predict one-year post-surgery outcome based on their first meeting with the patient immediately after LSF. METHOD: A prospective cohort study with one-year follow-up was conducted. In the first days after surgery, the PTs from hospital wards were asked to predict the patients' overall LSF outcome one year after surgery. One year after surgery, the patients received a questionnaire including the Oswestry Disability Index (ODI), visual analogue scales (VAS) for leg and back pain, quality of life survey (EQ-5D-3 L), global perceived effect (GPA), and satisfaction with surgery outcome (SSO). Univariate and logistic regression were used to calculate the associations between the prognosis and predictive values. RESULTS: The study included 170 patients. The analyses showed a significant association between the PTs' prognosis and the primary outcome ODI (p < .01), VAS leg and back, EQ-5D-3 L, and GPE one-year post-surgery (p ≤ .04). However, the predictive value of the PTs' prognosis was low (R2 ≤ 0.09). There was no significant association between the PTs' prognosis and the patients' SSO (p = .17; R2 = 0.01). CONCLUSION: There were significant associations between the PTs' prognosis and disability, pain, health-related quality of life and global perceived effect one-year post-surgery, although the associations had low predictive values. There was no significant association between the PTs' prognosis and patients' SSO after one year. The PTs' prognosis should not be used as a single component in further rehabilitation planning.

The Predictive Value of Fear Avoidance Beliefs for Outcomes Following Surgery for Lumbar Degenerative Disease: A Systematic Review and Best Evidence Synthesis.

BACKGROUND: Currently, evidence regarding fear avoidance beliefs as potential predictors for lumbar surgery outcomes seems insufficient and strong conclusions are not yet available. OBJECTIVE: This systematic review aimed to evaluate the predictive value of preoperative fear avoidance beliefs for postoperative pain intensity, functional status, and health-related quality of life following surgery for lumbar degenerative disease. STUDY DESIGN: Systematic review and best evidence synthesis. METHODS: An extensive search was performed in PubMed/Medline, EMBASE, PsycINFO, CINAHL and the Cochrane library for articles published up until October 2021. Two independent reviewers performed the screening, data extraction, and quality assessment, with a third independent reviewer consulting to resolve any disagreement. Observational studies that included patients undergoing surgery for lumbar degenerative disease, as well as evaluated fear avoidance beliefs (i.e., pain-related fear, pain catastrophizing, pain anxiety) in relation to a surgical outcome measure (i.e., pain intensity, functional status and health-related quality of life) were included in the review. The CHARMS- and QUIPS-tools were used for data extraction and quality assessment, respectively. A best evidence synthesis was performed resulting in conclusions regarding strong, moderate, conflicting, and limited levels of evidence. RESULTS: A total of 24 studies (n = 17,881) were included in this review. Following best evidence synthesis, 3 included studies reported no significant predictive value of preoperative pain-related fear for postoperative pain intensity resulting in moderate evidence for this relationship. Moderate evidence was also found indicating no significant predictive value of preoperative pain-related fear for postoperative functional status, as 6 out of 8 relevant studies reported this result. Only one study reported on the predictive value of preoperative pain catastrophizing for postoperative health-related quality of life, resulting in limited evidence for the absence of this predictive relationship. All other relationships were found to have conflicting evidence. LIMITATIONS: To evaluate surgical outcome, only patient-reported outcome measures as used by spine registries were included. Thus, our findings cannot be extrapolated to all surgery outcomes following lumbar degenerative disease and should only be interpreted in relation to postoperative pain intensity, functional status, or health-related quality of life. CONCLUSION: Best evidence synthesis showed moderate evidence indicating that preoperative pain-related fear is not a significant predictor for postoperative pain and function following surgery for lumbar degenerative disease. Additionally, limited evidence was found for a lack of predictive value of preoperative pain catastrophizing for postoperative health-related quality of life. As current evidence regarding the predictive value of preoperative fear avoidance beliefs following such a surgery is mixed, further research is required before more definitive conclusions can be made.

The effect of graded activity and pain education (GAPE): an early post-surgical rehabilitation programme after lumbar spinal fusion-study protocol for a randomized controlled trial.

BACKGROUND: Patients with chronic low back pain undergoing lumbar spinal fusion (LSF) are physically inactive and thereby at risk of poor health. Barriers to being physically active need to be acknowledged in post-surgical rehabilitation. The primary objective of this randomized controlled trial (RCT) is to examine the effect of an early active intervention consisting of graded activity and pain education (GAPE) on sedentary behaviour in a population of patients undergoing LSF. The secondary objective is to examine the effect of GAPE on disability, pain, fear of movement, self-efficacy for exercise, and health-related quality of life. METHODS: The study is an RCT planned to include 144 patients undergoing LSF at 1-2 levels for low back pain caused by degeneration of the lumbar spine. The patients will be randomly assigned to receive either usual care or usual care plus GAPE. GAPE consists of nine individual physiotherapist-guided sessions over a 10-week period. The overall purpose is to reduce sedentary behaviour, by educating the patient about pain and, based on a cognitive behavioural perspective, gradually strengthen the patient's self-efficacy to be physically active and reduce fear of movement. The physiotherapist will plan the intervention in collaboration with the patient. Based on a semi-structured interview and observations of the patient in their home, they will set individually functional goals. The primary outcome will be a reduction in sedentary behaviour, measured by an accelerometer at baseline (pre-surgery) and at 3 and 12 months post-surgery. Secondary outcomes will include disability, pain, fear of movement, self-efficacy for exercise, and quality of life. Secondary outcome data will be collected at baseline (pre-surgery) and at 3, 6 and 12 months post-surgery. DISCUSSION: We hypothesize that, compared with the "usual care group", GAPE will primarily lead to a significant reduction in sedentary behaviour, and secondarily a reduction in disability, pain intensity, and fear of movement; further, it will increase the patient's self-efficacy for exercise and quality of life. TRIAL REGISTRATION: www.clinicaltrials.gov NCT04103970 , Registered on 24 September 2019.

Neurophysiological Pain Education for Patients With Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). METHODS: A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. RESULTS: Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD=-1.03 (95% confidence interval [CI], -0.55 to -1.52), and after 3 months, WMD=-1.09 (95% CI, -2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD=-0.47 (95% CI, -0.80 to -0.13) and after 3 months SMD=-0.38 (95% CI, -0.74 to -0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD=-5.73 (95% CI, -13.60 to 2.14) and after 3 months WMD=-0.94 (95% CI, -6.28 to 4.40). DISCUSSION: There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.

The experience of patients with fear-avoidance belief hospitalised for low back pain - a qualitative study.

PURPOSE: Severe pain, anxiety, depression, and fear-avoidance belief (FAB) are widespread among patients hospitalised for acute low back pain (LBP). Research shows that these psychological factors impact negatively on rehabilitation. This study aimed to investigate and develop an understanding of pain in patients with fear avoidance belief hospitalised for LBP. METHOD: Semi-structured interviews were conducted with nine patients selected by an FAB questionnaire: averaged FAB - physical activity score was 21 and FAB - work score was 30. All participants were recruited from a rheumatology ward. Analyses were based on the content analysis. RESULTS: The analysis revealed two main categories: (1) back history until the pain became dominant, demonstrating the importance of the LBP histories before admission to hospital. (2) Being in a universe of pain verified, the severe pain expressed through metaphors and a need to be involved in the rehabilitation. During interviews, the participants did not indicate high FAB behaviour. CONCLUSIONS: Despite high scores, the FAB questionnaire might not be sufficient to detect FAB in patients hospitalised for acute LBP. It is important to include the deeper meaning of metaphors and the personal story behind the expression of pain as a way of understanding each individual with LBP. Implications for Rehabilitation FAB questionnaire is not sufficient either to detect fear avoidance in LBP patients hospitalised with acute conditions or to catch the complexities of individual pain experiences. It seems essential for health care professionals (HCP) to involve the patient in their treatment and development of a rehabilitation plan based on their individual histories and concerns about the future. The metaphors expressed are a way for HCPs to gain insight into the psychological aspect of pain for the individual patient.

Gait analysis of adults with generalised joint hypermobility.

BACKGROUND: The majority of adults with Generalised Joint Hypermobility experience symptoms such as pain and joint instability, which is likely to influence their gait pattern. Accordingly, the purpose of the present project was to perform a biomechanical gait analysis on a group of patients with Generalised Joint Hypermobility and compare them to a group of healthy subjects. METHODS: Seventeen adults clinically classified with Generalised Joint Hypermobility (6 males and 11 females) and seventeen healthy subjects (9 males and 8 females) were included in the project. The subjects walked across three force platforms while they were filmed by five video cameras. Net joint moments were calculated in 3D by inverse dynamics and peak values were input to statistical analyses. A 3D knee joint model was used to calculate bone-on-bone forces. FINDINGS: In the frontal plane both the peak knee and hip abductor moments were 13% higher in the patient group. In the sagittal plane the peak knee extensor moment was 10% higher for the patients and the flexor moment about the knee joint in the middle of stance was 27% lower for the patients. Increased flexion in the knee joint for the patients was also observed. INTERPRETATION: The finding that adults with Generalised Joint Hypermobility display higher joint moments during walking in both the frontal and the sagittal planes and increased knee joint loadings may explain the pain symptoms in the patient group and indicate these subjects are subjected to an increased risk of developing osteo-arthritis.