| 1. |
- Bergbom, Sofia, 1982-, et al.
(författare)
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Relationship Among Pain Catastrophizing, Depressed Mood, and Outcomes Across Physical Therapy Treatments
- 2011
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Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 91:5, s. 754-764
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain catastrophizing and emotional distress can act as prognosticfactors for pain and disability. Research on how these variables interact withinindividuals and over time is in an early stage. Understanding various patterns ofprognostic factors and how these factors change during treatment is important fordeveloping treatments targeting important factors.Objective: The primary aim of this study was to investigate relationships betweenpain catastrophizing and depressed mood in people seeking primary care for mus-culoskeletal pain. An additional aim was to relate these patterns of prognostic factorsto outcomes during a 6-month period.Design: The design was prospective; data were obtained at baseline and atfollow-up.Methods: Forty-two physical therapists taking part in an educational programrecruited, from their clinical practices in primary care, consecutive patients whowere currently experiencing a pain problem. Patients received various physicaltherapy interventions between baseline and follow-up.Results: On the basis of patterns of scoring for pain catastrophizing and depressedmood, 4 subgroups of participants were found. Belonging to a subgroup withelevated levels of either pain catastrophizing or depressed mood at baseline wasrelated to the absence of improvement and elevated levels of disability after physicaltherapy interventions. Furthermore, elevated levels of both variables were related tothe highest levels of disability.Limitations: The analyses relied on self-report. Neither treatment content norpain-related fear was measured. The sample was a mixture of participants reportingacute pain and subacute pain.Conclusions: The results stress the importance of assessing and targeting prog-nostic factors. Moreover, the results suggest the need to tailor treatments to matchpatterns of prognostic factors and the need to target depressed mood and paincatastrophizing in physical therapy interventions.
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| 2. |
- Boersma, Katja, 1973-, et al.
(författare)
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Lowering fear-avoidance and enhancing function through exposure in vivo : a multiple baseline study across six patients with back pain
- 2004
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 108:1-2, s. 8-16
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The fear-avoidance model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.
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| 3. |
- Elvén, Maria, 1973-, et al.
(författare)
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Assessing clinical reasoning in physical therapy : discriminative validity of the Reasoning 4 Change instrument
- 2022
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Ingår i: Physiotherapy. - : Elsevier BV. - 0031-9406 .- 1873-1465. ; 117, s. 8-15
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate discriminative validity of the Reasoning 4 Change (R4C) instrument by investigating differences in clinical reasoning skills between first semester, final semester physical therapy students and physical therapy experts.Design:Cross-sectional designSetting: University and physical therapy practiceParticipantsStudents from the first (n = 87) and final semester (n = 47) of an entry-level physical therapy program and experts in physical therapy with a behavioral medicine approach (n = 14).Methods: The students and experts answered the web-based R4C instrument on one occasion. The R4C instrument includes four domains designed to assess physical therapists’ clinical reasoning skills with a focus on supporting clients’ behavior change and has demonstrated acceptable content validity, convergent validity and reliability. Data was analyzed with one-way analysis of variance and Games-Howell post hoc test.Results: Differences in all domains and subscale scores were found between the three groups. Pairwise comparisons demonstrated that experts scored higher (better clinical reasoning skills) than first semester students in all domains and subscales; and higher scores than final semester students, except for two subscales. Final semester students scored higher than first semester students, except for one subscale.Conclusions: The findings highlight differences in clinical reasoning skills focusing on clients’ behavior change among physical therapy students with different degrees of training and education in clinical reasoning and physical therapists with extensive experience and expertise. The results provide evidence for the discriminative validity of the R4C instrument which support the use of the R4C instrument in education, research and clinical practice.
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| 4. |
- Overmeer, Thomas, 1960-, et al.
(författare)
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Do physical therapists recognise established risk factors? : Swedish physical therapists' evaluation in comparison to guidelines
- 2004
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Ingår i: Physiotherapy. - Amsterdam : Elsevier. - 0031-9406 .- 1873-1465. ; 90:1, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose The Swedish Council on Technology Assessment in Health Care has widely distributed the most recent Swedish evidence-based review on neck and back pain. In this review psychosocial factors were acknowledged as important risk factors for developing chronic pain. We surveyed physical therapists’ evaluation of risk factors for the development of chronic pain. The results were compared to the review of the Swedish Council on Technology Assessment in Health Care.Methods A postal questionnaire was sent to all 117 physical therapists working in primary care in Örebro County, Sweden.Results The survey was responded to by 102 physical therapists (87%). Over 50% of them indicated as important more than twice as many risk factors than are supported by the evidence-based review.More than 50% of the physical therapists pointed out all eight evidence-based factors described in the evidence-based review but they also indicated a median of 10 additional factors with little or no support in the literature. More than 80% of the physical therapists responded according to the recommendations of the evidence-based review concerning sick leave and instructions to patients regarding activities and pain relief. Forty-four physical therapists (43%) indicated that they could predict which patients would develop chronic pain in the future.Conclusions Physical therapists represented by this sample were well aware of the importance of psychosocial risk factors, but because of the large number of additional factors indicated it seems physical therapists lack specificity about which factors are important.
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| 5. |
- Overmeer, Thomas, et al.
(författare)
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What messages do patients remember? : The relationship between patient perception of physical therapist’s messages, patient characteristics, satisfaction and outcome
- 2016
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Ingår i: Physical Therapy. - : American Physical Therapy Association. - 0031-9023 .- 1538-6724. ; 96:3, s. 275-283
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Tidskriftsartikel (refereegranskat)abstract
- Background: Based on a behavioral medicine perspective, modern recommendations for physical therapists treating patients with spinal pain include performing a trustworthy physical examination, conveying the message that back pain is benign, and stressing that activity is a key to recovery. However, little evidence is available on how patients perceive these biopsychosocial messages and how patients' perceptions of these messages relate to their recovery.Objectives: The aim of this study was to explore the relationships between perceptions of treatment delivery that are related to an evidence-based approach and psychological factors, treatment outcome, and treatment satisfaction.Design: A cohort study with 3 measurement points was conducted.Methods: Data on 281 participants were collected.Results: High catastrophizing and lower mood in the participants were correlated to "not perceiving the biopsychosocial message" measured at 6 weeks after treatment start. Participants who did not perceive the biopsychosocial message were at higher risk for disability and had lower treatment satisfaction 6 months after treatment start even when controlling for pretreatment pain intensity. "Not perceiving the biopsychosocial message" was not a mediator for treatment outcome and treatment satisfaction. Physical therapists' treatment orientations or attitudes were not related to the perception of the message by the patients.Limitations: There was no measure of actual practice behavior.Conclusions: Maladaptive cognitions and negative emotions appear to affect the way information provided during treatment is perceived by patients. The way information is perceived by patients influences treatment outcome and treatment satisfaction. Physical therapists are advised to check that patients with higher levels of catastrophizing and lower mood are correctly perceiving and interpreting a biopsychosocial message.
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