Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists

Background: Patellofemoral pain (PFP) is considered one of the commonest forms of knee pain. This study aimed to identify how physiotherapists in the United Kingdom (UK) currently manage patellofemoral pain (PFP), particularly in relation to exercise prescription, and response to pain. Methods: An anonymous survey was designed with reference to previous surveys and recent systematic reviews. Practising UK physiotherapists who treat patients with PFP were invited to take part via an invitation email sent through professional networks, the ‘interactive Chartered Society of Physiotherapy (iCSP)’ message board, and social media (Twitter). Descriptive statistics were used to analyse the data. Results: A total of 99 surveys were completed. Responders reported a wide range of management strategies, including a broad selection of type and dose of exercise prescription. The five most common management strategies chosen were: closed chain strengthening exercises (98%); education and advice (96%); open chain strengthening exercises (76%); taping (70%) and stretches (65%). Physiotherapists with a special interest in treating PFP were statistically more likely to manage patients with orthotics (P=0.02) and bracing (P=0.01) compared to physiotherapists without a special interest. Approximately 55% would not prescribe an exercise if it was painful. Thirty-one percent of physiotherapists would advise patients not to continue with leisure and/or sporting activity if they experienced any pain. Conclusion: Current UK practice in the management strategies of PFP is variable. Further high quality research on which to inform physiotherapy practice is warranted for this troublesome musculoskeletal condition

Fear of movement/injury in the general population: Factor structure and psychometric properties of an adapted version of the Tampa Scale for Kinesiophobia

In equal sized samples, a strong association between a positive family history of early coronary heart disease (famhx) and early age at initial diagnosis (aaid) was found only for males, and thus all further analyses were restricted to males. All three scales of the self-report version of the ketterer stress symptom frequency checklist—revised (kssfcr)—“aiai” (or aggravation, irritation, anger, and impatience), depression, and anxiety—were associated with both a positive famhx and early aaid. A series of regression models was used to demonstrate that the kssfcr scales may plausibly account for 22–32% of the variance in the relationship between a positive famhx and early aaid. Because of previously documented denial in males, the analyses were repeated in a subgroup of males for whom spouse/friend kssfcrs were obtained. Spouse/friend-reported aiai was related to both early famhx and early aaid, and could account for 68% of the common variance

Psychometric properties of the Dutch version of the Mental Adjustment to Cancer scale in Dutch cancer patients

Objectives: The measurement of adjustment to cancer is relevant for research purposes and daily practice. In this study, the psychometric properties of the original five subscales and the two recently proposed summary scales of the Mental Adjustment to Cancer (MAC) scale were examined in Dutch cancer patients. Methods: Data from 289 cancer patients were assessed with the Dutch version of the MAC scale and the Hospital and Anxiety Depression scale (HADS); 259 patients completed the MAC scale for a second time. Results: In total, 85.5% of the participants completed the full MAC scale. The internal consistency of the five subscales and the summary scales were mostly similar to the original versions. The test-retest reliability of the Fighting Spirit, Helplessness/Hopelessness, Anxious Preoccupation, Summary Positive Adjustment and Summary Negative Adjustment subscales were moderate and the test retest reliability of the Fatalism and Avoidance subscales were low. Correlations between the original and the two summary scales of the MAC scale and the depression and anxiety subscales of the HADS indicated good convergent validity. The structure of the five original subscales as well as the structure of the two proposed summary scales was adequate as shown by construct validity using confirmatory factor analyses. Conclusion: The Dutch version of the MAC scale is a feasible questionnaire and appeared to have comparable psychometric properties as demonstrated by studies in the UK. The psychometric properties of the summary scales and Fighting Spirit and Helplessness/Hopelessness subscales seem to be acceptable. This supports the cross-national usefulness of the MAC scale. Copyright (C) 2009 John Wiley & Sons, Ltd

Do community pharmacists have the attitudes and knowledge to support evidence based self-management of low back pain?

Background In many countries, community pharmacists can be consulted without appointment in a large number of convenient locations. They are in an ideal position to give advice to patients at the onset of low back pain and also reinforce advice given by other healthcare professionals. There is little specific information about the quality of care provided in the pharmacy for people with back pain. The main objectives of this survey were to determine the attitudes, knowledge and reported practice of English pharmacists advising people who present with acute or chronic low back pain. Methods A questionnaire was designed for anonymous self-completion by pharmacists attending continuing education sessions. Demographic questions were designed to allow comparison with a national pharmacy workforce survey. Attitudes were measured with the Back Beliefs Questionnaire (BBQ) and questions based on the Working Backs Scotland campaign. Questions about the treatment of back pain in the community pharmacy were written (or adapted) to reflect and characterise the nature of practice. In response to two clinical vignettes, respondents were asked to select proposals that they would recommend in practice. Results 335 responses from community pharmacists were analysed. Middle aged pharmacists, women, pharmacy managers and locums were over-represented compared to registration and workforce data. The mean (SD) BBQ score for the pharmacists was 31.37 (5.75), which was slightly more positive than in similar surveys of other groups. Those who had suffered from back pain seem to demonstrate more confidence (fewer negative feelings, more advice opportunities and better advice provision) in their perception of advice given in the pharmacy. Awareness of written information that could help to support practice was low. Reponses to the clinical vignettes were generally in line with the evidence base. Pharmacists expressed some caution about recommending activity. Most respondents said they would benefit from more education about back pain. Conclusion Those sampled generally expressed positive attitudes about back pain and were able to offer evidence based advice. Pharmacists may benefit from training to increase their ability and confidence to offer support for self-care in back pain. Further research would be useful to clarify the representativeness of the sample

Multifactoriële analyse in de medisch-specialistische revalidatie

Als een patiënt met chronische pijn wordt verwezen naar de revalidatiearts dan kan er sprake zijn van laag complexe of hoog complexe problematiek. Interdisciplinaire behandeling in de medisch-specialistische revalidatie (MSR) is alleen geïndiceerd bij hoog-complexe problematiek. Bij de vaststelling van de mate van complexiteit van het pijnprobleem maakt de revalidatiearts gebruik van verwijsinformatie (correspondentie, eerder verrichte diagnostiek), neemt een uitgebreide anamnese af, eventueel gecombineerd met korte vragenlijsten, verricht lichamelijk onderzoek en laat zo nodig zelf aanvullende diagnostiek verrichten. Als er voldoende informatie is verzameld, begint het proces van analyse. Voor analyse wordt gebruik gemaakt van de zogenaamde ‘vlaggen’, waarbij de aanwezigheid van rode vlaggen kan wijzen op onderliggende (ernstige) somatische problematiek en de overige vlaggen (geel, oranje, blauw, zwart) te beschouwen zijn als prognostisch relevante factoren. Daarnaast wordt gebruik gemaakt van het exploreren van predisponerende, uitlokkende en onderhoudende factoren als hulpmiddel bij de analyse, waarbij met name de laatste van groot belang zijn voor het bepalen van mogelijke aangrijpingspunten van behandeling. Zo komt de revalidatiearts tot een indicatiestelling voor een interventie en aangrijpingspunten voor behandeling. In dit hoofdstuk worden de predisponerende, uitlokkende en onderhoudende factoren besproken. Onderhoudende factoren kunnen biomedisch, psychologisch en/of sociaal zijn en al deze worden factoren worden uitgebreid toegelicht. Er wordt speciaal aandacht geschonken aan de mogelijk negatieve beïnvloeding door medewerkers uit het (para en peri-)medische circuit