Clinicians' and patients' assessment of activity overuse and underuse and its relation to physical capacity

To explore clinicians' and patients' (self)-assessment of activity overuse and underuse, and its relationship with physical capacity in patients with chronic musculoskeletal pain (CMP). Study design was cross-sectional. Participants included patients with CMP, admitted to a multidisciplinary outpatient pain rehabilitation program. The main measures used were as follows: a five-point scale to rate overuse and underuse, filled out by clinicians and patients; a five-point scale to rate physical capacity, filled out by clinicians and patients; and lifting and aerobic capacity. Cohen's kappa were calculated to test the agreement between assessments. Depending on the normality, a t-test or a Mann-Whitney U-test was used to test differences between the results of a capacity test and patients' and clinicians' assessments of capacity. A total of 141 patients were included: 42% were men, and 60% had back pain, 21% had neck pain, 19% had pain in a different location. Six percent of the patients rated themselves as underusers; clinicians rated 23% of the patients as underusers. Clinicians and patients fairly agreed (61%; kappa = 0.23) in their assessments of overuse and underuse. Differences in the physical capacity of overuse and underusers, as assessed by clinicians and patients, were all nonsignificant (P > 0.05). The physical capacity of overusers did not differ from that of underusers (P < 0.05). In conclusion, although clinicians and patients with CMP fairly agree on their assessment of activity overuse and underuse, the physical capacity of overusers was not different from that of underusers

Life satisfaction questionnaire (Lisat-9): reliability and validity for patients with acquired brain injury

The aim of this study was to determine the reliability and discriminant validity of the Dutch version of the life satisfaction questionnaire (Lisat-9 DV) to assess patients with an acquired brain injury. The reliability study used a test-retest design, and the validity study used a cross-sectional design. The setting was the general rehabilitation centre. There were 159 patients over 18 years of age, with an acquired brain injury, in the chronic phase. The main outcome measures were weighted kappa of test and retest data on the nine questions of the Lisat-9 DV and significance levels of differences between subgroups of patients who are expected to differ in terms of Lisat-9 scores, on the basis of other instruments. The results were as follows: the reliability was moderate, with the weighted kappa ranging from 0.41 to 0.64. In terms of validity, subgroups of patients who were expected to differ in terms of the Lisat-9 domains did indeed differ significantly, except for the difference in the Lisat score for 'contact with friends and acquaintances' between subgroups defined by higher or lower scores on the corresponding domain of the Frenchay Activities Index. As there was a plausible explanation for not finding a significant difference between subgroups defined by one of the Frenchay Activities Index domains and significant differences were found between the subgroups defined by other instruments corresponding to the same domain, we conclude that the discriminant validity is good. The reliability was not clearly affected by cognitive disorder or aphasia. The conclusions were that the reliability of the Lisat-9 DV for patients with an acquired brain injury was moderate; the discriminant validity was good

Access to an Effective Remedy in European Asylum Procedures

In this contribution the author tries to identify the meaning and content of the Community principles of effectiveness and effective judicial protection with regard to the right of access to an effective remedy in the context of the Common European Asylum System. With this purpose the relevant case-law by the Court of Justice, the European Court on Human Rights, the Committee against Torture and the Human Rights Committee will be discussed. On the bases of this case-law some general conclusions will be drawn regarding the right of access to an effective remedy and the lawfulness of certain limitations of this right, such as time-limits or the immediate enforcement of expulsion measures

Future Prairie Prospects in the Puget Sound

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'I think positivity breeds positivity': a qualitative exploration of the role of family members in supporting those with chronic musculoskeletal pain to stay at work

Background: It is proposed that family members are important sources of support in helping those with chronic musculoskeletal pain to remain at work, but the phenomenon remains largely unexplored. The aim of this study was to examine the extent and nature of support provided by family members in this respect. Methods: Qualitative data were collected from workers and their ‘significant others’ spouses/partners/close family members) in two un-related studies focused on working with pain; one conducted in the United Kingdom (n = 10 dyads) and one in the Netherlands (n = 21 dyads). Thematic analysis techniques were applied to both sets of data independently, and findings were then assimilated to establish common themes. Results: Findings were broadly similar in both studies. Workers acknowledged significant other support in helping them to manage their pain and remain at work, and their descriptions of the type of support provided and required were echoed by their significant others. Three common themes were identified - ‘connectivity’, ‘activity’ and ‘positivity’. Worker and significant other responses were largely congruent, but significant others provided more in-depth information on the nature of their support, their concerns and the impact on their relationship. Conclusions: This research presents novel insights about the specific contribution made by significant others in helping their relatives with chronic musculoskeletal pain to stay at work. These findings add to the under-represented ‘social’ dimension of the biopsychosocial model currently applied to our understanding and treatment of pain, and point to harnessing support from significant others as a potentially effective management strategy

Upper lifting performance of healthy young adults in functional capacity evaluations:A comparison of two protocols

The objectives of this study were to explore the concurrent validity of test results of upper lifting tasks of the Ergo-Kit FCE and the Isernhagen Work Systems (IWS) FCE. Seventy-one healthy young adults performed 5 upper lifting tests with at least 5 min of rest in between. The lifting tests included 3 standard protocols and 2 modified protocols. Three criteria for concurrent validity were established: 1) Pearson correlation higher than .75, 2) nonsignificant two-tailed t test, and 3) mean difference smaller than 5 kg. The results showed that none of the criteria were met for the standard protocols. For the modified protocols criteria 2 and 3 were not met. Individual differences larger than 10 kg were found for both standard and modified protocols. It was concluded that the standard protocols for upper lifting tasks of the Ergo-Kit FCE and the IWS FCE do not meet the criteria for concurrent validity and can, therefore, not be used interchangeably

Interinstrument reliability of the RT3 accelerometer

The objective of this study was to assess the interinstrument reliability of six RT3 accelerometers for measuring physical activities. Each of the six healthy participants, mean age 36.1 years (SD 9.4), carried six RT3 accelerometers (same type and same producer) simultaneously placed ventrally at the waist belt. The participants performed three standardized activities: walking on a treadmill at 3.0 km/h and 5.0 km/h, and sitting on a chair. Each activity lasted 5 min. The recordings of the accelerometers were compared with each other to assess interinstrument reliability. A correlation of 0.75 or higher was interpreted as sufficient. The mean Pearson correlation between the six accelerometers was r = 0.78 (0.46-0.97). The intraclass correlation between the accelerometers was 0.75 (95% confidence interval: 0.46-0.95, P <0.01). In conclusion, the interinstrument reliability of the RT3 accelerometer is sufficient. However, the lower limit of the confidence interval is low, indicating a challenge to the reliability. International Journal of Rehabilitation Research 33:178-179 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins