A cross-sectional analysis of motivation and decision-making in referrals to lifestyle interventions by primary care general practitioners: a call for guidance

Aim: To explore 1) GPs´ motivation to refer to lifestyle interventions and to investigate the association between GPs’ own lifestyle-behaviors and their referral behavior, and 2) patient indicators in the decision-making process of the GPs’ referral to lifestyle interventions. Method: A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs’ referral behaviors were assessed - considering referral and self-reported actual referral - and their own lifestyle behaviors - physical activity, dieting, being overweight). Decision-making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and by case-based referring (vignettes). Results: A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs’ refer behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important patient indicators in referral to lifestyle interventions were somatic indicators, and patients’ motivation for lifestyle interventions. Conclusions: GPs motivation and referral behavior might be improved by providing them with tailored resources about evidence based lifestyle interventions, with support from allied health professionals, and with official guidelines for a more objective and systematic screening of patients

The barrier-belief approach in the counseling of physical activity

Objective: To understand inactivity and relapse from PA, and to develop theory-based behaviour change strategies to stimulate and support maintenance of PA. Methods: We conducted a literature search to explore barriers to PA. Social cognitive theories and empirical evidence were evaluated and guided the process developing a theoretical framework and counselling strategies. Results: A theoretical framework is presented to understand why people do not engage in PA and often relapse once they started PA. A distinction is made between three related types of BBs. In PA counselling these three beliefs are addressed using four different BB behaviour change strategies. Conclusion: BB counselling aims to develop an individual pattern of PA for the long term that is adapted to the (often limited) motivation of the client, thereby preventing the occurrence of BBs. The client will learn to cope with factors that may inhibit PA in the future. Practice implications: The BBs approach composes a way of counselling around the central construct of barrier-beliefs to stimulate engagement in PA independently, in the long term

Chronic pain and severe disuse syndrome:long-term outcome of an inpatient multidisciplinary cognitive behavioural programme

Objective: Patients with chronic pain and severe disuse syndrome have pain with physiological, psychological and social adaptations. The duration and severity of complaints, combined with previously failed treatments, makes them unsuitable for treatment in primary care. Design: A prospective waiting list controlled study. Patients: A total of 32 patients with chronic pain for at least one year and severe disuse syndrome were included in an inpatient multidisciplinary cognitive behavioural treatment. Methods: Patients were assessed before the waiting list period, before the clinical phase, after the clinical phase and after follow-ups of 6 months and one year. The visual analogue scale for pain and fatigue were assessed. Muscle strength of the arms and legs, arm endurance and a 6-minute walking test were used to assess physical outcome. The Symptom Check-list-90, RAND-36, pain cognition list and the Tampa scale for kinesiophobia were used to assess psychological outcome. Results: Long-term significant (p <0.001) improvements were found for pain, fatigue, walking distance, muscle strength, anxiety, depression, somatization, negative self-efficacy, and catastrophizing in the intervention period. Conclusion: An inpatient multidisciplinary cognitive behavioural programme is beneficial for patients with chronic pain and a severe disuse syndrome

Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network

Objective To conduct and report a scoping review of the available evidence of the effects and content of pain neuroscience education for patients with persistent painful tendinopathies. Methods PubMed, Embase, Web of Science, CINAHL, SPORTDiscus, and grey literature databases were searched from database inception to May 2022. Randomised and non-randomised controlled trials, non-controlled clinical trials, cohort studies, case series, case studies including people with persistent painful tendinopathy aged ≥18 years, a pain education intervention, and in English were included. Studies were excluded if they were cross-sectional studies, reviews, editorials, abstracts, or full-text not available or if included heterogeneous study cohorts, patients with tendon rupture, or patients with systemic diseases. Results five studies (n = 164) were included. Pain neuroscience education entailed face-to-face discussion sessions or educational materials including videos, brochures, paper drawings, and review questions. All studies used pain neuroscience education in conjunction with other interventions, obtaining significant benefits in outcomes related to pain, physical performance, or self-reported function, among others. Conclusions The application of pain neuroscience education in conjunction with other interventions seemed to improve several outcomes. However, considering the current knowledge about tendon pain and the scarcity of well-designed trials studying pain neuroscience education in tendinopathy, additional research is needed.Funding for open acces charge: Universidad de Málaga / CBU

The Human Ecology and Geography of Burning in an Unstable Savanna Environment

According to new ecological theories, many savannas are inherently in disequilibrium and can flip from tree-dominated to grass-dominated landscapes depending upon the disturbance regime. In particular, a shift in a fire regime to a more frequent and intensive one can radically alter the tree-to-grass ratio in a given savanna. Drawing upon the ecological buffering model we argue that savanna persistence requires a relatively stable fire regime. We hypothesize that anthropogenic burning practices perform this function by producing a regular annual spatiotemporal pattern of fire that is linked to vegetation type. We test this hypothesis using a study of two areas, one in Mali and the other Burkina Faso. We use two sources of satellite data to produce an 11-year time series of the spatiotemporal pattern of fires and an example of the annual burned area pattern these fires produce. We combine the analysis of satellite imagery with interviews of rural inhabitants who set fires to understand the logic underlying the patterns of fire. Analysis of a time series of imagery reveals a strikingly regular annual spatiotemporal pattern of burning for both study areas, which cannot be explained by the regional climatic pattern alone. We conclude that the regularity of the annual fire regime in West Africa is a human-ecological phenomenon closely linked to vegetation type and controlled by people\u27s burning practices. We argue that the anthropogenic burning regime serves to buffer the savanna and maintain its ecological stability

The Sensitization Model to Explain How Chronic Pain Exists Without Tissue Damage

The interaction of nurses with chronic pain patients is often difficult. One of the reasons is that chronic pain is difficult to explain, because no obvious anatomic defect or tissue damage is present. There is now enough evidence available indicating that chronic pain syndromes such as low back pain, whiplash, and fibromyalgia share the same pathogenesis, namely, sensitization of pain modulating systems in the central nervous system. Sensitization is a neuropathic pain mechanism in which neurophysiologic changes may be as important as behavioral, psychologic, and environmental mechanisms. The sensitization model provides nurses with an opportunity to explain pain as a physical cause related to changes in the nervous system. This explanation may improve the patient's motivation to discuss the importance of psychosocial factors that contribute to the maintenance of chronic pain. In this article, sensitization is described as a model that can be used for the explanation of the existence of chronic pain. The sensitization model is described using a metaphor. The sensitization model is a useful tool for nurses in their communication and education toward patients. (C) 2012 by the American Society for Pain Management Nursin

Uitleg aan patiënten met onverklaarde klachten: Sensitisatiemodel helpt bij acceptatie

Doctors and patients are often not satisfied about the treatment of medically unexplained symptoms (MUS) and chronic pain. Central sensitization (CS) plays an important role in chronic pain and regularly also in MUS and can be used for explanation to these patients. This explanation can cause acceptance and understanding, leading to cessation of further diagnostics and unnecessary treatments. Thereafter the patient will be able to work on reduction of the symptoms, using the biopsychosocial model. The central mechanism of CS is hyperexcitability of the central nervous system. The most important symptoms of CS are: (a) an increased sensitivity to painful stimuli (hyperalgesia), (b) a painful perception of non-painful stimuli (allodynia) and (c) a reduced inhibition of signals from the brain to the body. This can be demonstrated with physical tests. CS can be explained to the patient with a simple model about the functioning of the nervous system

Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

<p>Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain.</p><p>Design Cross-sectional study.</p><p>Participants Four hundred and two members of the general Dutch population, with and without chronic low back pain.</p><p>Main outcome measures Sociodemographics and the translated version of the Illness Perception Questionnaire-Revised, adapted for back pain.</p><p>Results Of the sample, 115 (29%) individuals had chronic low back pain (>6 months) and 287 (71%) did not have chronic low back pain. Many of the participants with chronic low back pain believed that one 'wrong' movement can potentially lead to more severe problems, and that X-rays or computer tomography scans can determine the cause of the pain. Many of the participants with chronic low back pain did not perceive a relationship between psychosocial factors and low back pain.</p><p>Conclusions Illness perceptions differed between individuals with and without chronic low back pain. In the subacute phase, healthcare professionals could assess illness perceptions and, if necessary, incorporate them into the management of patients with low back pain. (C) 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.</p>

Illness perceptions and mood states are associated with injury-related outcomes in athletes

Background. Athletes have to cope adequately with the consequences of their injury in order to return into sports as soon as possible. Besides the physical characteristics of the injury, illness perceptions and emotional responses impact the behavioural responses to the injury. Purpose. To apply Leventhal's Common Sense Model as a theoretical framework in the field of sports medicine, pertaining to injured athletes. Methods. In a sample of 95 injured athletes participating in different sports, sociodemographic, injury and sport-related characteristics, the Illness Perception Questionnaire-Revised-Sports (IPQ-R-S) and the Profile Of Mood States were assessed. Results. Injured athletes' most experienced symptoms were pain (82%) and loss of strength (50%), associated with a high controllability; they see their injury as not chronic, with minor consequences for daily life and minor emotional consequences. Athletes with an injury of longer duration have minor psychological attributions, 28% suffer from fatigue, which is strongly related to a negative mood state. Conclusions. Illness perceptions and mood states are related to injury characteristics. Clinicians ought to incorporate patients' views about their injuries into their treatment in order to increase the concordance between patient's and clinician's perceptions, thereby increasing chances of a quick and uneventful recovery