Body awareness and cognitive behavioral therapy for multisite musculoskeletal pain: patients` experiences with group rehabilitation.

BACKGROUND: An extended group program called Mind and Body (MB), based on body awareness exercises and cognitive behavioral therapy (CBT), was offered to a subgroup of patients who had completed their traditional outpatient multidisciplinary rehabilitation and were motivated for further treatment. PURPOSE: To explore how patients with multisite musculoskeletal pain experienced participation in the MB program with respect to usefulness, meaningfulness, behavioral changes, and transferability to daily life and work. METHOD: The study is rooted in the phenomenological tradition. Individual, semi-structured interviews were performed with eight patients aged 29-56 years. The data were analyzed using systematic text condensation. RESULTS: Two main themes emerged: 1) New knowledge provided increased body awareness, new ways of thinking, and acceptance of one's own situation. This theme reflected how new knowledge and MB coping strategies were useful in the process of changing problematic thoughts, increasing body awareness, and facilitating acceptance; and 2) Implementing new habits and strategies in daily life revealed how demanding it was to alter behavior, a process that unfolded over time. CONCLUSION: A combination of body awareness exercises and cognitive coping strategies was described as helpful in further improving function and coping with pain and stress in daily life and work.

Do ICF core sets for low back pain include patients' self-reported activity limitations because of back problems?

PURPOSE: The aim of this study was to investigate content validity of the International Classification of Functioning, Disability and Health (ICF) Core Sets for low back pain (LBP), by examining whether common activities reported as difficult to perform are included in the Core Sets. METHODS: A cross-sectional design was used. Ninety-eight patients with long-lasting back pain (>3 months) between 18 and 65 years of age were consecutively recruited from a Multidisciplinary Outpatient Spine Clinic. Difficulties with daily life and work task activities because of back pain were examined by asking the patients two questions: 1) can you specify activities that are difficult to perform because of your back pain? and 2) are there specific work tasks that you are unable to do because of your back pain? Two raters independently classified the written responses according to the ICF Core Sets' component Activities and Participation. RESULTS: Activities and work tasks were linked to 15 of 29 categories (52%) in the Comprehensive Core Set, and 9 of 12 (75%) in the Brief Core Set, and the initial agreement between the two raters in coding the answers according to the Core Sets was (83%, k = 0.80) and (93%, k = 0.9), respectively, before consensus was reached. CONCLUSIONS: The Comprehensive Core Set for LBP to a large degree contains daily life and work-related activities frequently reported as difficult to perform by patients with long-lasting LBP. The categories, however, are very broad and do not provide specified descriptions of the most frequently reported activity limitations such as sitting, standing and walking. The Brief Core Set does not include categories for frequently reported activities such as pulling/pushing and leisure/recreation activities. ICF Core Sets for LBP seem suitable for obtaining a gross overview of the patients' functional limitations, but do not give sufficient information from a therapeutic point of view.

What functional aspects explain patients' impression of change after rehabilitation for long-lasting low back pain?

BACKGROUND: Physical tests and self-report measures are being used to measure physical functioning. The latter tends to be preferred in intervention studies. PURPOSE: To examine whether the patients' global impression of change (PGIC) after rehabilitation was explained by change in pain, daily functioning, fear-avoidance of activities and various physical aspects, expecting contribution primarily by the self-reported measures. METHODS: A test-retest design, within a prospective cohort study of patients with long-lasting low back pain. 96 patients were consecutively recruited from an outpatient spine clinic, assessed by three self-report questionnaires and seven physical tests at inclusion and after 3.5 weeks of multidisciplinary treatment. With PGIC as the dependent variable, linear regression analyses of all variables were performed. The study was approved by the Regional Committee for Medical Research Ethics and the National Data Inspectorate of Norway. RESULTS: In unadjusted analysis, change in pain, daily functioning and change in six physical tests contributed to the explained variance (R2: 6-24%). In the adjusted analysis, only pain and back endurance strength contributed (adjusted R2: 48%). In the final backward stepwise blockwise analyses, daily functioning and spinal mobility were also found to contribute to the explained variance (R2: 48%). The time span of 3.5 weeks of training is too short to give a lasting effect, but the contribution to explained variance of PGIC of self-report measures and physical tests were the focus of this study, not the effect of training. CONCLUSION: Most measures demonstrated change that was of significance to the patients after rehabilitation. Change in spinal mobility and back strength assessed by physical tests contributed to explain the patients' impression of change after controlling for change in pain and daily life functioning and may seem important to assess in addition to the self-report measures in intervention studies.

Responsiveness to change of 10 physical tests used for patients with back pain.

BACKGROUND: Few studies have examined the responsiveness of physical tests. OBJECTIVE: The purpose of this study was to explore the responsiveness of 10 physical tests used for patients with back pain in order to illuminate the significance of changes in scores. DESIGN: Cross-sectional and longitudinal designs within a prospective cohort study were applied. METHODS: Distribution-based and anchor-based methods were used. Ninety-eight patients (18-65 years of age) with long-lasting back pain were recruited consecutively at an outpatient spine clinic. Measurements The participants were assessed using 10 physical tests and 2 questionnaires (Hannover Functional Ability Questionnaire and Roland-Morris Disability Questionnaire) at inclusion and after rehabilitation. Six predefined hypotheses for each test were examined regarding the association between changes in scores on the physical tests and the self-report measures of functioning and regarding the relationship of changes in scores on the physical tests and external anchors of important change. RESULTS: Five physical tests demonstrated responsiveness by both distribution-based and anchor-based methods: spondylometry, lateral flexion test, fingertip-to-floor test, lift test, and Back Performance Scale (4 hypotheses confirmed). The minimal important change values were all within the range of the smallest detectable change for individual patients. Responsiveness by distribution-based methods only (3 hypotheses confirmed) was shown for the Biering-Sørensen test and the loaded reach test, whereas little evidence of responsiveness (1 hypothesis confirmed) was shown for the Global Physiotherapy Examination flexibility subscale, the Progressive Isoinertial Lifting Evaluation, and the 15-m (50-ft) walk test. Limitations The smallest detectable change values were examined in a small sample of patients and need further exploration. CONCLUSIONS: Responsiveness varied among the 10 physical tests.

Validation of the Norwegian version ofHannover Functional Ability Questionnaire.

STUDY DESIGN: Cross-sectional and longitudinal designs within a prospective cohort study. OBJECTIVE: Translation of Hannover Functional Ability Questionnaire (FFbH-R) into Norwegian and examination of its factor structure, internal consistency, reproducibility, construct validity, and responsiveness in patients with long-lasting back pain. SUMMARY OF BACKGROUND DATA: Several condition-specific instruments have been developed to evaluate functional status in low back pain, but FFbH-R was the only instrument found to solely measure perceived capability of performing daily activities. METHODS: Recommended guidelines for translation of questionnaires and quality criteria for validation were followed. A total of 111 patients (aged 18-65 years) with long-lasting back pain were consecutively recruited from an outpatient spine clinic. Two additional samples of patients with long-lasting back pain were added into the exploratory factor analysis, giving a total number of 224 patients. Predefined hypotheses regarding construct and longitudinal validity (responsiveness) were examined. RESULTS: Factor analysis indicated that 2 items should be removed, resulting in a 3-factor solution as the best fit. The factors were related to flexibility, dynamic strength, and posture endurance. Satisfactory internal consistency and reproducibility were demonstrated for the total and subscales of the Norwegian version of FFbH-R. Most of the predefined hypothesis regarding construct and longitudinal validity were confirmed, and discriminate ability was shown. Minor floor and ceiling effects were demonstrated. CONCLUSION: Psychometric properties of the Norwegian version of FFbH-R were satisfactory in patients with long-lasting back pain, but the dynamic strength and posture endurance subscales might be complemented with additional items.