The Self-Regulation Assessment (SeRA) questionnaire: development and exploratory analyses of a new patient-reported outcome measure for rehabilitation.

PURPOSE: To develop and explore underlying dimensions of the Self-Regulation Assessment (SeRA) and psychometric features of potential components. Further, to identify associations between the SeRA and disability-management self-efficacy, type of diagnosis, and type of rehabilitation. MATERIALS AND METHODS: Based on a previously developed model of self-regulation, expert and patient opinions, and cognitive interviews, a list of 22 items on self-regulation (the SeRA) was constructed. The SeRA was included in a cross-sectional survey among a multi-diagnostic group of 563 former rehabilitation patients. Exploratory analyses were conducted. RESULTS: Respondents had a mean age of 56.5 (SD 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. Four components were found within the SeRA, labelled as "insight into own health condition," "insight into own capabilities," "apply self-regulation," and "organization of help." Cronbach's alpha was high (total scale: 0.93, subscales: range 0.85-0.89). Only scores on the first subscale showed a ceiling effect. Subscale three showed the highest correlation with a self-efficacy measure. Small differences in SeRA total scores (range 71.6-78.1) were found between different diagnostic groups. CONCLUSION: The SeRA is a new self-regulation measure with four subscales. Further research is needed to establish the validity and reliability of the SeRA. IMPLICATIONS FOR REHABILITATIONThe Self-Regulation Assessment (SeRA) was developed to provide a comprehensive measurement of self-regulation among rehabilitation populations.The SeRA could potentially be used to identify persons with self-regulation problems at the start of rehabilitation treatment and measure outcomes of rehabilitation for self-regulation.The SeRA could potentially be used to help analyse outcomes of rehabilitation practice as well as evaluate interventions on self-regulation.

Reliability and Agreement of Neck Functional Capacity Evaluation Tests in Patients With Chronic Multifactorial Neck Pain.

OBJECTIVES: To analyze test-retest reliability and agreement, and to explore the safety of neck functional capacity evaluation (Neck-FCE) tests in patients with chronic multifactorial neck pain. DESIGN: Test-retest; 2 FCE sessions were held with a 2-week interval. SETTING: University-based outpatient rehabilitation center. PARTICIPANTS: Individuals (N=18; 14 women) with a mean age of 34 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Neck-FCE protocol consists of 6 tests: lifting waist to overhead (kg), 2-handed carrying (kg), overhead working (s), bending and overhead reaching (s), and repetitive side reaching (left and right) (s). Intraclass correlation coefficients (ICCs) and limits of agreement (LoA) were calculated. ICC point estimates between .75 and .90 were considered as good, and >.90 were considered as excellent reliability. RESULTS: ICC point estimates ranged between .39 and .96. Ratios of the LoA ranged between 32.0% and 56.5%. Mean ± SD numeric rating scale pain scores in the neck and shoulder 24 hours after the test were 6.7±2.6 and 6.3±3.0, respectively. CONCLUSIONS: Based on ICC point estimates and 95% confidence intervals, 3 tests had excellent reliability and 3 had poor reliability. LoA were substantial in all 6 tests. Safety was confirmed.

Dutch Dataset Pain Rehabilitation in daily practice: Content, patient characteristics and reference data.

BACKGROUND: No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. METHODS: The Dutch Dataset Pain Rehabilitation was developed which included the six domains of the IMMPACT core set and three new domains relevant in the field of rehabilitation (medical consumption, patient-specific goals and activities/participation). Between 2010 and 2013 the core set was implemented in 32 rehabilitation facilities throughout the Netherlands. RESULTS: A total of 8200 adult patients with chronic pain completed the core set at first consultation with the rehabilitation physician. Adult patients (18-90 years) suffering from a long history of pain (38% >5 years) were referred. Patients had high medical consumption and less than half were working. Although patients were referred with diagnosis of low back pain or neck or shoulder pain, a large group (85%) had multisite pain (39% 2-5 painful body regions; 46% >5 painful body regions). Scores on psychosocial questionnaires were high, indicating high case complexity of referred patients. Reference data for subgroups based on gender, pain severity, pain locations and on pain duration are presented. CONCLUSIONS: The data from this clinical core set can be used to compare patient characteristics of patients of other treatment setting and/or scientific publications. As treatment success might depend on case complexity, which is high in the referred patients, the advantages of earlier referral to comprehensive multidisciplinary treatment were discussed. SIGNIFICANCE: A detailed description of case complexity of patients with chronic pain referred for pain rehabilitation. Insight in case complexity of patients within subgroups on the basis of gender, pain duration, pain severity and pain location. These descriptions can be used as reference data for daily practice in the field of pain rehabilitation and can be used to evaluate, monitor and improve rehabilitation care in care settings nationwide as well as internationally.

Psychological factors unrelated to activity level in patients with chronic musculoskeletal pain.

BACKGROUND: Enhancement of physical activities is an important goal in rehabilitation programmes for patients with chronic musculoskeletal pain (CMP). A relationship between activity level and psychological factors is suggested but studied scarcely. AIM: To explore the relationship between the activity level and psychological factors in patients with CMP. METHODS: Study design is cross-sectional, explorative. Participants are patients with CMP, included for outpatient multidisciplinary pain rehabilitation. MEASURES: Activity level was measured by the RT3 accelerometer during 1 week; pain intensity was measured with a 100-mm visual analogue scale; depression, somatization and distress were measured with Symptom Checklist-90-Revised (SCL-90-R), coping strategy with the Utrecht Coping List (UCL, scales active coping, passive coping, avoiding), fear of movement measured with Tampa Scale of Kinesiophobia (TSK), scale activity avoidance. Depending on data distribution, correlations between the mean number of activity counts and psychological factors were tested with Pearson or Spearman correlation coefficients. RESULTS: Fifty three patients were included: age mean 39.9 years [standard deviation (SD) 11.3]; activity counts per day mean 198,243 (SD 78,000); pain intensity mean 58 (SD 27.7); SCL-90-R mean 149.4 (SD 42.5); UCL active coping mean 17.9 (SD 3.7); UCL passive coping mean 12.3 (SD 3.7); UCL avoiding mean 15.3 (SD 3.0); TSK total mean 35.4 (SD 7.4); TSK activity avoidance mean 16.9 SD (4.7). Correlations between psychological factors and the mean number of activity counts per day ranged from r = -0.27 to r = 0.01 and were all non-significant (p ≥ 0.05). CONCLUSION: Psychological factors and activity level were unrelated in patients with CMP.

Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain.

Cross sectional study, performed in an outpatient university based pain rehabilitation setting. To analyze the relationship between psychological factors (psychosocial distress, depression, self efficacy, self-esteem, fear of movement, pain cognitions and coping reactions) and performance-based and self-reported disability, as measured with a Functional Capacity Evaluation (FCE) and the Roland Morris Disability Questionnaire (RMDQ), in patients with chronic low back pain (CLBP). It has been suggested that a strong relationship exists between psychological factors and disability in patients with CLBP. In former research disability was often measured by self-report and seldom performance-based. Study sample consisted of 92 patients with CLBP admitted for multidisciplinary rehabilitation. Prior to treatment, all patients completed questionnaires to measure psychological factors and self-reported disability, and performed an FCE to measure performance-based disability. Correlation coefficients between psychological variables and FCE and self-reported disability were calculated. Multivariate linear regression analyses were performed with self-reported or performance based disability measures as outcome variables, and psychological measures as predictor variables. Out of 42 relations analyzed, 5 were statistically significant. This concerned one significant correlation between kinesiophobia and a subtest of FCE, and four correlations between psychological factors and RMDQ. No correlation was significant after the Bonferroni correction was applied (P < 0.001). The strength of significant correlations ranged from r = -0.33 to r = 0.25. The multivariate analysis revealed that psychological variables measured in this study could explain 19% of the variance of self-reported disability, with kinesiophobia being the only psychological variable that contributed significantly. The suggested strong relationship between psychological factors and performance-based and self-reported disability could not be confirmed in this study. This may implicate that the relationship between psychological factors and disability in patients with CLBP is not as unambiguous as suggested.

Preliminary evaluation of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain.

PURPOSE: To describe the outcome of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain. STUDY DESIGN: exploratory retrospective cohort study. The study sample consisted of a cohort of 70 children and adolescents (age: 8-21 years) with chronic musculoskeletal pain who completed a 3-month inpatient multidisciplinary pain management program. The program consisted of graded physical exercises, graded activities and counseling of the children and their parents. Assessed were motor and social activities, pain intensity, global assessment of physical functioning and psychosocial well-being (by patient and physician), understanding of the pain process and reduction of medical consumption. Assessments were performed at pre-admission, day of admission, day of discharge and at three months after discharge. Data collection took place over a 10-year period. RESULTS: Compared to admission, at discharge there were significant improvements in motor performances, school attendance, reduction of pain scores, understanding of the chronic pain process and reduction of medical consumption. Results remained stable at follow-up after three months. CONCLUSION: The results of this study indicate that a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain may be effective.

Assessment and treatment of chronic work-related pain disorders in an outpatient university rehabilitation setting in The Netherlands.

Points of view of the assessment and treatment of chronic work-related disorders in a Dutch university rehabilitation setting are described. After a general introduction in which the basic philosophy is outlined, medical issues as well as issues regarding two treatment programs and the evaluation of functional capacity are described. The article ends with a brief description of current and future research programs.