Capturing case complexity:is clinician selected dose of vocational rehabilitation related to questionnaire results?

BACKGROUND: To establish an optimum dosage interdisciplinary vocational rehabilitation, it is important to be able to reliably and validly assess case complexity. Assessment of case complexity is currently clinician based because no validated means to assess case complexity is presently available. Indices assumed to associate with case complexity can contribute to the choice of dosage. The objective of this study was to explore the extent in which results of questionnaires were associated with the choice of treatment dosage in vocational rehabilitation. METHODS: Design: cross-sectional study of observational data. The study population consisted of workers on part-time or full-time sick leave due to chronic multifactorial problems. Thousand eighty-nine patients who were referred to a privately owned organization with outpatient vocational rehabilitation centers in the Netherlands between July 2016 and March 2017 were allocated to one of the three programs based on case complexity as determined by clinicians based on clinical interview and questionnaires. RESULTS: Questionnaires accounted for 13% of the variance in the total group, 13% in patients with chronic musculoskeletal pain (n = 662) and 29% in patients with chronic fatigue (n = 235). CONCLUSION: The results of the questionnaires contribute little in the assessment of case complexity and dose recommendation. Implications for Rehabilitation Assessment of case complexity of patients with chronic multifactorial complaints and disability is complex. The results of this study suggest that case complexity and choice of treatment dose is slightly explained by questionnaire results. It is largely determined on heuristics developed by knowledge and experience of clinicians. No reliable and validated means to assess case complexity is presently available in the field of rehabilitation and optimum treatment dose cannot be determined transparently. Routinely collected clinical data of baseline characteristics, process measures and results are a valuable source that can be used to answer research questions

Knowledge and attitudes toward musculoskeletal pain neuroscience of manual therapy postgraduate students in the Netherlands

BACKGROUND: Health care practitioners' knowledge and attitudes influence patients' beliefs and health outcomes in musculoskeletal (MSK) pain. It is unclear to what extent physiotherapists undertaking a postgraduate master in manual therapy (MT students) possess the knowledge and attitudes toward pain neuroscience to be able to apply the biopsychosocial model in patients with MSK pain. OBJECTIVES: The aim of this study was to assess the knowledge and attitudes toward pain neuroscience in MT students. DESIGN: A cross-sectional study. METHOD: Self-reported knowledge and attitudes were measured among students (n = 662) at baseline and in all years of the MT postgraduate programs in the Netherlands. The Knowledge and Attitudes of Pain questionnaire (KNAP) was used as a primary measure. Difference in KNAP-scores between baseline (0), year 1, year 2 and year 3 was tested using a one-way ANOVA (hypothesis: 0 < 1<2 < 3). A two factor ANOVA was used to determine the interaction effect of focused pain education and year in the curriculum with KNAP. RESULTS: There was an overall significant difference of KNAP scores with a medium effect size (F(3, 218.18) = 13.56, p < .001, ω2 = 0.059). Differences between years ranged from small to medium. Interaction effect of knowledge and attitudes and focused pain education was significant with a small effect size (F(6) = 2.597, p = .017, ω2 = 0.012). Sensitivity analyses were consistent with the main results. CONCLUSIONS: Positive differences in knowledge and attitudes toward pain neuroscience in MT students occur between the progressing years of the curriculum. Differences may be related to the provision of focused pain education

Pain Rehabilitation During Adolescence; Work in Adulthood? A Long-Term Follow-Up Study to Explore the Facilitators and Barriers for Work:A long-term follow-up study to explore the facilitators and barriers for work

Background Adolescents with chronic musculoskeletal pain face different impairments in daily life. After an inpatient pain rehabilitation program, adolescents function better on several domains. The aim of this study was to explore the long-term work participation of adults who followed inpatient pain rehabilitation during adolescence because of chronic musculoskeletal pain and to identify potential facilitators and barriers regarding work in later life. Methods A mixed-methods study with standardized questionnaires and semi-structured interviews. The questionnaires measured pain, disability, work status, and the quality and quantity of the work. The interviews contained questions about work participation. Potential participants were all patients who had participated in an inpatient pain rehabilitation program 15 to 20 years previously. Analyses were performed by thematic analysis. Using the Sherbrooke model as guidance, themes were classified into 4 systems: healthcare, workplace, legislative/insurance, and personal. Results Fourteen patients consented to participate (12 females). Seventy-one percent of them had paid work. The mean self-reported quality of the work delivered was 9.6 (standard deviation = 0.5). Eighteen facilitators and 12 barriers regarding work participation later on in life were mentioned. The inpatient pain rehabilitation program was the most frequently mentioned facilitator (n = 5), while the personal system and coping-related factors were the most frequently mentioned barriers (n = 5). Conclusions Ten out of 14 participants are currently working, most of them despite experiencing pain. Several factors based on the 4 systems of the Sherbrooke model contribute as facilitators or barriers regarding current work participation. Pain rehabilitation is mostly regarded as a facilitator for work participation later on in life

General and Specific Self-efficacy Reports of Patients with Chronic Low Back Pain: Are They Related to Performances in a Functional Capacity Evaluation?

Introduction The objective of this study was to analyze the relationship of general and specific self-efficacy (SE) beliefs with functional capacity evaluation (FCE) performances in patients with chronic non-specific low back pain (CLBP), while controlling for influence of gender, age, and self-reported pain intensity, self-esteem, disability, psychosocial distress and health status. Methods Included were 92 patients with CLBP referred to an outpatient university based multidisciplinary pain rehabilitation program in The Netherlands. All patients underwent an FCE. General SE was measured with the ALCOS questionnaire prior to the FCE, specific SE was measured with a self-constructed standardized question during the FCE. Paired samples t-tests were used to tests differences between predicted and actual performances. Pearson and Spearman rank correlation coefficients were used to express the strength of the relationships between SE and performances. Multivariate analyses were used to test the influence of control variables on the relationships between SE (general or specific) and performances. Results Performances were consistently higher than patients’ self-predictions. Differences between predictions and performances were significant in male lifting low, male carrying, and female carrying. With exception of the association between specific SE and lifting in males (r = 0.55, P < 0.05), all other correlations between general and specific SE and FCE performances were non-significant. Multivariable regression analyses showed that the relative contribution of SE measures over gender was little or none. Conclusions The contribution of specific SE to the prediction of FCE performances is moderate in one instance, and insignificant in most instances (both specific and general SE). Because of the consistency of the differences between prediction (specific SE) and performances, and depending on the level of accuracy needed, future research may deliberate the use of predicted material handling capacities at group level and correct for a systematic underprediction

Assessing future health care practitioners’ knowledge and attitudes of musculoskeletal pain; development and measurement properties of a new questionnaire

BACKGROUND: Healthcare practitioner beliefs influence patients' beliefs and health outcomes in musculoskeletal (MSK) pain. A validated questionnaire based on modern pain neuroscience assessing Knowledge and Attitudes of Pain (KNAP) was unavailable. OBJECTIVES: The aim of this study was to develop and test measurement properties of KNAP. DESIGN: Phase 1; Development of KNAP reflecting modern pain neuroscience and expert opinion. Phase 2; a cross-sectional and longitudinal study among Dutch physiotherapy students. METHOD: In the cross-sectional study (n = 424), internal consistency, structural validity, hypotheses testing, and Rasch analysis were examined. Longitudinal designs were applied to analyse test-retest reliability (n = 156), responsiveness, and interpretability (n = 76). RESULTS: A 30-item KNAP was developed in 4 stages. Test-retest reliability: ICC (2,1) 0.80. Internal consistency: Cronbach's α 0.80. Smallest Detectable Difference 90%: 4.99 (4.31; 5.75). Structural validity: exploratory factor analysis showed 2 factors. Hypotheses testing: associations with the Pain Attitudes and Beliefs Scale for Physiotherapists biopsychosocial subscale r = 0.60, with biomedical subscale r = -0.58, with the Neurophysiology of Pain Questionnaire r = 0.52. Responsiveness: 93% improved on KNAP after studying pain education. Minimal Important Change: 4.84 (95%CI: 2.77; 6.91). CONCLUSIONS: The KNAP has adequate measurement properties. This new questionnaire could be useful to evaluate physiotherapy students' knowledge and attitudes of modern pain neuroscience that could help to create awareness and evaluate physiotherapy education programs, and ultimately provide better pain management

Explaining Deep Learning Models for Age-related Gait Classification based on time series acceleration

Gait analysis holds significant importance in monitoring daily health, particularly among older adults. Advancements in sensor technology enable the capture of movement in real-life environments and generate big data. Machine learning, notably deep learning (DL), shows promise to use these big data in gait analysis. However, the inherent black-box nature of these models poses challenges for their clinical application. This study aims to enhance transparency in DL-based gait classification for aged-related gait patterns using Explainable Artificial Intelligence, such as SHAP. A total of 244 subjects, comprising 129 adults and 115 older adults (age>65), were included. They performed a 3-minute walking task while accelerometers were affixed to the lumbar segment L3. DL models, convolutional neural network (CNN) and gated recurrent unit (GRU), were trained using 1-stride and 8-stride accelerations, respectively, to classify adult and older adult groups. SHAP was employed to explain the models' predictions. CNN achieved a satisfactory performance with an accuracy of 81.4% and an AUC of 0.89, and GRU demonstrated promising results with an accuracy of 84.5% and an AUC of 0.94. SHAP analysis revealed that both CNN and GRU assigned higher SHAP values to the data from vertical and walking directions, particularly emphasizing data around heel contact, spanning from the terminal swing to loading response phases. Furthermore, SHAP values indicated that GRU did not treat every stride equally. CNN accurately distinguished between adults and older adults based on the characteristics of a single stride's data. GRU achieved accurate classification by considering the relationships and subtle differences between strides. In both models, data around heel contact emerged as most critical, suggesting differences in acceleration and deceleration patterns during walking between different age groups

Measurement Properties of the Full and Brief Version of the Work Rehabilitation Questionnaire in Persons with Physical Disabilities

Purpose The Work Rehabilitation Questionnaire (WORQ) is a self-report vocational rehabilitation assessment. A comprehensive (WORQ-FULL) and a brief version (WORQ-BRIEF) are available. The purpose of this study was to investigate measurement properties of both versions in persons with physical disabilities. Methods Cross sectional and test-retest design. Adults with physical disabilities in vocational rehabilitation were included. Internal consistency (Cronbach's alpha), test-retest reliability (intra-class correlation; ICC), agreement between sessions (Bland-Altman Plots), criterion validity (ICC and agreement with Bland-Altman Plots between WORQ-FULL and WORQ-BRIEF) and convergent validity with the Work Ability Index -Single item (WAS) and the EuroQOL 5D-5L were analyzed. Results Out of the 91 individuals who agreed to participate, 74 (81%) returned questionnaire T1 and 49 (54%) participants returned questionnaire T2 within the maximum time interval (= 27 days). At T2, 28 (57%) participants reported no medical changes compared to T1. Median age was 49 (IQR 40-60), 57% were male, 47% had experienced a stroke and 27% a spinal cord injury (n = 49). Internal consistency was good: 0.95/0.95/0.94 for the WORQ-FULL and 0.88/0.89/0.85 for the WORQ-BRIEF (n = 74/n = 48/n = 28, respectively). Test-retest reliabilitywas good: ICC = 0.86/0.85 for the WORQ-FULL and ICC = 0.87/0.86 for the WORQ-BRIEF (n = 49/ n = 28). Bland Altman plots suggested a higher score at T1. As for criterion validity of the WORQ-FULL versus the WORQ-BRIEF, ICC was good (ICC = 0.84; n = 74), however Bland Altman plots indicated potential bias. Correlations with the WAS/EuroQOL 5D-5L were variable: r = -0.24/r = -0.57 (WORQ-FULL) and r = -0.28/-0.65 (WORQ-BRIEF). Conclusions The WORQ showed good internal consistency and test-retest reliability. Agreement demonstrated large score differences are needed to indicate change beyond random chance at individual level, whereas small changes are sufficient at group level. Criterion validity of the WORQ-FULL versus the WORQ-BRIEF was supported, however, agreement demonstrated moderate to large score differences are needed to indicate change beyond random chance at individual level, whereas small changes are sufficient at group level. This indicates the WORQ-FULL and WORQ-BRIEF are better not used interchangeably. Correlation analyses provided better insight in the validity of the WORQ. Convergent validity was supported for the WORQ-BRIEF with the EuroQoL 5D-5L (r = -0.65)