Long-term follow-up of disability pensioners having musculoskeletal disorders

<p>Abstract</p> <p>Background</p> <p>Previously we have conducted a randomised controlled trial (RCT) to evaluate the effect of a brief cognitive behavioural program with a vocational approach aiming to return disability pensioners with back pain to work, as compared to no intervention. One year after the intervention, 10 participants (22%) who received the program and 5 (11%) in the control group reported to have entered a return to work process. The aims of this study were to evaluate long-term effects of the intervention, and compare this effect to 2 reference populations not participating in the original trial.</p> <p>Methods</p> <p>Three groups of disability pensioners were investigated: 1) Disability pensioners having back pain (n = 89) previously participating in the RCT (randomized to either a brief cognitive behavioural intervention or to a control group), 2) 342 disability pensioners having back pain, but refusing to participate in the study and 3) 449 disability pensioners having other musculoskeletal disorders than back pain. Primary outcome was return to work, defined as a reduction in payment of disability pension.</p> <p>Results</p> <p>Only 2 of 89 (2.3%) participants from the RCT had reduced disability pension at 3-years follow-up, both from the control group. None of the participants that had been in a process of returning to work after 1 year had actually gained employment at 3-years follow-up. In the 2 groups not participating in the previous RCT, only 4 (1.2%) and 8 (1.6%) had returned to work after 3 years respectively.</p> <p>Conclusion</p> <p>The number of pensioners who returned to work was negligible in all groups regardless of having participated in a cognitive behavioural intervention or not.</p

Measurement properties of the Dizziness Handicap Inventory by cross-sectional and longitudinal designs

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

The effect of two exercise regimes; motor control versus endurance/strength training for patients with whiplash-associated disorders: a randomized controlled pilot study

Objective: To compare the effect of exercise regimes with focus on either motor control training or endurance/strength training for patients with whiplash-associated disorders in subacute phase. Design: Randomized controlled trial. Setting: An outpatient spine clinic in Norway. Participants: Twenty-five subjects with a whiplash-associated disorder still having symptoms or disability six weeks after injury. Interventions: The participants received 6—10 sessions of physiotherapy for six weeks with focus on either motor control or endurance and strength of neck muscles. Measurements: The primary outcome measure was the Neck Disability Index. Secondary outcome measures were pain intensity, neck functioning and sick leave. Results: No statistical significant differences concerning primary and secondary outcome measures were demonstrated between the groups. Approximately half of the participants in both groups obtained a clinically important change (improvement) on perceived disability assessed by Neck Disability Index at six weeks and one-year follow-up. The changes within both groups were statistically significant at six weeks, but not at one-year follow-up. For most pain-related variables clinical significant improvement was demonstrated in both groups at six weeks, but for fewer participants at one year. There was also statistical significant improvement within groups in some of the physical performance tests at one-year follow-up. Conclusion: The changes associated with motor control training and endurance/ strength training of neck muscles were similar for reduced disability, pain and for improving physical performance. With a low number of participants and no control group, however, we cannot be sure whether the improvements are due to interventions or other reasons. </jats:p

Discriminative Validity of the Pain Attitudes and Beliefs Scale for Physical Therapists

Background The Pain Attitudes and Beliefs Scale (PABS) for Physical Therapists aims to measure clinicians' biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain. Objective The objective of this study was to assess whether the PABS can differentiate between subgroups of physical therapists hypothesized to differ in treatment orientations. Design This study was a cross-sectional survey. Methods The PABS was completed by 662 Norwegian physical therapists with a diversity of professional backgrounds. Twenty-four a priori hypotheses on expected differences in PABS scores were formulated. Sufficient discriminative ability was defined as a minimum of 75% confirmed hypotheses. Hypotheses on differences in scores were tested for the biomedical and biopsychosocial subscales separately as well as for combinations of the 2 subscales, representing responders with high biomedical and low biopsychosocial PABS scores and vice versa. Results Of the 24 hypotheses, only 15 (62.5%) were confirmed. Between-group differences concerning the separate subscales were small, varying from 0.63 to 1.70 scale points, representing values up to 6.0% of the total subscale ranges. Between-group differences were larger when combined subscales were used, varying from 1.80 to 6.70 points, representing values up to 25.1% of the total subscale ranges. Despite little spread in scores, 24% of respondents demonstrated extreme attitudes. Limitations The lack of convincing scientific evidence from previous research on differences in attitudes and beliefs between physical therapists was a limitation for the formulation of hypotheses. Conclusions Discriminative validity of separate subscales of the PABS was not supported. Combining the 2 subscales into global treatment attitudes enabled better discrimination. Little spread in biomedical and biopsychosocial orientations explains why more than one-third of the hypotheses were not confirmed. Either Norwegian physical therapists are basically similar in their treatment orientation or the PABS is not able to detect any differences between them

Pain in older persons with severe dementia. Psychometric properties of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID‐2) Pain Scale in a clinical setting

Background: To assess pain in older persons with severe dementia is a challenge due to reduced self‐report capacity. Recently, the development and psychometric property testing of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID) Pain Scale was described using video‐recording. The purpose of this article was to present the further development of this instrument. In MOBID‐2 Pain Scale, the assessment of inferred pain intensity is based on patient’s pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID‐2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). Objective: The aim of this study was to examine psychometric properties of the MOBID‐2 Pain Scale, like inter‐rater and test–retest reliability, internal consistency, as well as face‐, construct‐ and concurrent validity. Subjects and Setting: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID‐2 Pain Scale. Characteristics of the patients’ pain were also investigated by their physicians (n = 4). Results: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID‐2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (κ = 0.41–0.90 and κ = 0.46–0.93). Inter‐rater and test–retest reliability for pain intensity was very good, ICC (1, 1) ranging 0.80–0.94 and 0.60–0.94. Internal consistency was highly satisfactory; Cronbach’s α ranging 0.82–0.84. Face‐, construct‐ and concurrent validity was good. Overall pain intensity by MOBID‐2 was well correlated with physicians’ clinical examination and defined pain variables (rho = 0.41–0.64). Conclusion: On the basis of pain behaviours, standardized movements and pain drawings, MOBID‐2 Pain Scale was shown to be sufficiently reliable, valid and time‐effective for nurses to assess pain in patients with severe dementia

Physical activity and longitudinal change in 6-min walk distance in COPD patients

SummaryBackgroundThe 6-min walk distance (6MWD) is widely used to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD).AimTo examine predictors for longitudinal change in 6MWD including self-reported physical activity, smoking habits, body composition, exacerbations, comorbidity and lung function.MethodsThe cohort included 389 patients aged 44–75 years, with clinically stable COPD in GOLD stages II–IV. The follow-up time was 3 years. Measurements included 6MWD, spirometry, fat and fat free mass index (FMI and FFMI), and assessment of physical activity, smoking habits, comorbidities and exacerbations by questionnaires. Generalized estimating equations (GEE) regression analyses were used to analyze predictors for the change in 6MWD.ResultsThere was a reduction in 6MWD from baseline to 3 years for patients in GOLD stages III and IV (B = −36 m, 95% CI = −51 to −7, p = 0.009 and B = −79 m, CI = −125 to −20, p = 0.007). The unadjusted GEE analysis demonstrated that baseline self-reported physical activity level, forced expiratory volume in one second (FEV1), forced vital capacity, FFMI, GOLD stages and age predicted change in 6MWD, but in the adjusted GEE analysis only self-reported physical activity level (p = 0.001) and FEV1 (p = 0.019) predicted change over time.ConclusionPatients in GOLD stage II maintained their functional capacity assessed by 6MWD over 3 years, while it was significantly reduced for patients in GOLD stages III and IV. Level of physical activity and FEV1 were predictors for longitudinal change in functional capacity