Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation. DATA SOURCES: A search of PubMed, Embase, CINHAL, The Cochrane Library (Trials), Web of Science, and PEDro were conducted up until May 2023. METHODS: Two independent reviewers selected studies for population (patients with stroke), predictive factors (physical functioning), outcome (discharge destination), setting (inpatient rehabilitation), and study designs (observational and experimental studies). Predictive factors were identified among assessments of the "body function" and "activity" components of the International Classification of Functioning. Methodological quality was assessed with the Newcastle-Ottawa Scale. The findings used quantitative and narrative syntheses. Meta-analyses were performed with the inverse variance method and the random-effects model using included studies with sufficient data. RESULTS: Forty-five studies were included with 204,787 participants. Included studies assessed the association of independence in activities of daily living, walking, rolling, transferring, and balance on admission with a probability of returning home. Motor (odds ratio = 1.23, 95% confidence interval: 1.12-1.35, p < .001) and total (odds ratio = 1.34, 95% confidence interval: 1.14-1.57, p < .001) Functional Independence Measure scores on admission were significantly associated with home discharge in meta-analyses. Additionally, included studies showed that independence in motor activities, such as sitting, transferring, and walking, and scores above thresholds for the Functional Independence Measure and Berg Balance Scale on admission were associated with discharge destination. CONCLUSION: This review showed that higher independence in activities of daily living on admission is associated with home discharge after inpatient stroke rehabilitation.

Can the French version of the short Örebro Musculoskeletal Pain Screening Questionnaire or its subsets predict the evolution of patients with acute, (sub) acute and chronic pain?

BACKGROUND: Prevention of chronic pain relies on accurate detection of at-risk patients. Screening tools have been validated mainly in (sub) acute spinal pain and the need of more generic tools is high. We assessed the validity of the French version of the short Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) in patients with a large range of pain duration and localization. METHODS: First, we re-analyzed data from a 6-month longitudinal study of 73 patients with (sub) acute spinal pain consulting in secondary line settings. Secondly, we performed a new 12-month longitudinal study of 542 primary care patients with (sub) acute and chronic pain in different localizations (spinal, limbs, "non-musculoskeletal"). The area under the receiver operating characteristic curve and cutoff scores were computed and compared for different subpopulations and ÖMPSQ subscores. RESULTS: Data from patients suffering from (sub) acute and chronic spinal pain consulting in both primary and secondary care settings confirmed the validity of the short French ÖMPSQ version and its subsets. In the primary care cohort, the performance of the questionnaire and its psychosocial subscore was variable but at least "fair" in most populations ((sub) acute and chronic, spinal and limb pain). Cutoff scores showed quite large variability depending on the outcome and the subpopulation considered. CONCLUSIONS: These results confirm the usefulness of the short French ÖMPSQ for prediction of the evolution of (sub) acute and chronic patients with spinal and limb pain, whatever its duration. However, increasing population heterogeneity results in slightly worse predictive performance and largely variable cutoff scores. Consequently, it might be difficult to choose universal cutoff scores and other criteria, such as patients' values and the available resources for patient management, should be taken into account.

Physiological effects of Therapeutic Body Wraps in healthy volunteers: An observational study.

INTRODUCTION: The clinical management of severe anxiety is challenging. Along with specific medication, several nonpharmacological treatments exist, among which the Therapeutic Body Wraps (TBW). While TBW is clinically known to be efficient, the absence of objective physiological measurements raised some debates about its harmlessness. AIMS: This observational study investigated TBW in healthy volunteers. METHODS: Measurements were done in 26 participants, who experienced TBW, which consisted of tightly wrapping the body in one layer of wet cold sheets and several warm blankets. These were compared to 13 participants, who rested in supine position. RESULTS: Our results showed increase in the trunk skin temperature by the end of TBW similar to rest. Somatosensory perception as assessed with quantitative sensory testing was stable after both TBW and rest. The heart and breath rates decreased both during TBW and rest. It was accompanied by increase in heart rate variability parameters and decrease in salivary cortisol levels. DISCUSSION: Our data indicate anxiolytic effect of TBW in healthy participants. IMPLICATIONS FOR PRACTICE: The TBW is harmless and might be used in patients, who are unable to relax by themselves and/or without anxiolytic medication. Further studies are necessary to investigate physiological response to TBW in clinical population.

Multimodal sensory evaluation of neuropathic spinal cord injury pain: an experimental study.

STUDY DESIGN: An experimental study. OBJECTIVES: To investigate the changes in somatosensory functions using the combined application of quantitative sensory testing (QST), contact heat-evoked potentials (CHEPs) and laser-evoked potentials (LEPs) studies in individuals with spinal cord injury (SCI) in relation to neuropathic pain (NeP). SETTING: Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Individuals with SCI were compared: 12 with NeP (SCI NeP) and 12 without NeP (SCI no NeP). Tools used were QST, CHEPs, LEPs and self-reported questionnaires. Tests were applied to the control (hand) and test (dermatome of altered sensation) sites, and compared to the able-bodied group. RESULTS: QST, LEPs and CHEPs assessments showed abnormalities both on the test and control sites, which did not differ between the groups with SCI. QST showed higher prevalence of allodynia in SCI NeP. CHEPs and LEPs demonstrated diminished amplitudes in both groups with SCI in comparison to able-bodied individuals. Only reaction time (RT) analysis revealed the difference of SCI NeP from the other two groups, expressed in partially preserved responses to the laser C-fibre stimulations. CONCLUSIONS: Combination of assessments in our study allowed to examine spinothalamic and dorsal column functions in individuals with SCI. Changes in QST, CHEPs and LEPs were detected below the level of injury independent of NeP and at the control site indicating modifications in sensory processing rostral to the spinal lesion. Analysis of RT during laser stimulation could be an essential component when evaluating the somatosensory functions related to NeP in persons with SCI.

Motor imagery for pain and motor function after spinal cord injury: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVES: To evaluate the therapeutic benefits of motor imagery (MI) for the people with spinal cord injury (SCI). SETTING: International. METHODS: We searched electronic bibliographic databases, trial registers, and relevant reference lists. The review included experimental and quasi-experimental study designs as well as observational studies. For the critical appraisal of the 18 studies retrieved (three RCT, seven quasi-RCT, eight observational), we used instruments from the Joanna Briggs Institute. The primary outcome measure was pain. Secondary outcome measures included motor function and neurophysiological parameters. Adverse effects were extracted if reported in the included studies. Because of data heterogeneity, only a qualitative synthesis is offered. RESULTS: The included studies involved 282 patients. In most, results were an improvement in motor function and decreased pain; however, some reported no effect or an increase in pain. Although protocols of MI intervention were heterogeneous, sessions of 8-20 min were used for pain treatments, and of 30-60 min were used for motor function improvement. Neurophysiological measurements showed changes in brain region activation and excitability imposed by SCI, which were partially recovered by MI interventions. No serious adverse effects were reported. CONCLUSIONS: High heterogeneity in the SCI population, MI interventions, and outcomes measured makes it difficult to judge the therapeutic effects and best MI intervention protocol, especially for people with SCI with neuropathic pain. Further clinical trials evaluating MI intervention as adjunct therapy for pain in SCI patients are warranted.

Validity and responsiveness of the French version of the Örebro Musculoskeletal Pain Screening Questionnaire in chronic low back pain.

PURPOSE: The assessment of a broad range of biopsychosocial aspects is important in the rehabilitation of patients with chronic low back pain (CLBP) for the prediction of outcome as well as for evaluation. The objective of this study was to test the responsiveness, construct validity and predictive value of the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) compared to other instruments widely used to assess biopsychosocial aspects in patients with CLBP. METHODS: 111 patients with CLBP admitted to an inpatient rehabilitation completed a set of questionnaires on biopsychosocial aspects at baseline and at discharge. Ninety-eight patients responded at three months for an assessment of the return to work status. Responsiveness of the OMPSQ, the ability to detect change in the construct of interest, was investigated by a set of hypotheses on correlations with widely used questionnaires. We tested the hypothesis that the changes in the OMPSQ would vary along with the responses in the Patient's Global Impression of Change. Prediction of disability at discharge, work status at three months and time to return to work was evaluated with linear, logistic and cox regression models. RESULTS: The OMPSQ showed good predictive values for disability and return to work and construct validity of the instrument was corroborated. Seventy-nine percent of our hypotheses for responsiveness could be confirmed, with the OMPSQ showing the second highest change during the rehabilitation. CONCLUSIONS: The OMPSQ can also be applied in patients with CLBP, but for the assessment of change in psychosocial variables one should add specific questionnaires.

Physical activity and endogenous pain modulation in older people: a scoping review protocol.

OBJECTIVE: This scoping review aims to provide an overview of the existing literature on physical activity and endogenous pain modulation (EPM), assessed using conditioned pain modulation (CPM), with a specific focus on older people with chronic pain. INTRODUCTION: Approximately 20% of the European population reports chronic pain, highlighting the problem of chronic pain in the general population. This prevalence increases to 50% in older people. Physical activity is one of the most frequently used treatments for pain management and relief. A possible mechanism underlying the positive effects of physical activity on pain may be related to its influence on EPM. The review will map i) types of physical activity used to study its effect on EPM in older people; ii) intervention protocols investigating physical activity and EPM, measured using CPM, in older people experiencing pain; and iii) knowledge gaps requiring further research or interventions adapted to older people with pain. INCLUSION CRITERIA: This review will consider studies of people aged 60 years or older, using CPM to examine the effect of physical activity on EPM. All types of care settings will be eligible. METHODS: This review will be conducted in accordance with the JBI methodology for scoping reviews. The following databases will be searched: MEDLINE (Ovid), CINAHL (EBSCOhost), Embase, Cochrane Library, Web of Science, JBI Evidence Synthesis , PsycINFO, and PEDro. REVIEW REGISTRATION: Open Science Framework https://osf.io/e7ndy/.

Challenges, Concerns, and Experiences of Community-Dwelling Older Women with Chronic Low Back Pain-A Qualitative Study in Hong Kong, China.

BACKGROUND AND OBJECTIVES: Although chronic low back pain (CLBP) is known to negatively affect multiple aspects of the lives of older people, prior qualitative studies mainly focused on the lived experiences of older people with CLBP in Western countries. Given cultural and contextual differences and poor understanding of CLBP in older women with CLBP, it is important to better understand the concerns and lived experiences of Chinese older women with CLBP. The current study aimed to investigate the experiences, challenges, concerns, and coping strategies of older women with CLBP in Hong Kong. RESEARCH DESIGN AND METHODS: A total of 15 community-dwelling older women with CLBP aged ≥60 years were recruited from a physiotherapy clinic or a community center for semi-structured interviews. The interviews were audio recorded and transcribed 'verbatim'. The transcription was imported to NVivo 12 software. Thematic analysis was conducted using Braun and Clarke's method. RESULTS: Five themes were identified: (1) physical impacts of CLBP on daily life; (2) psychological influences of CLBP; (3) management of CLBP; (4) family support; and (5) social activities and support. DISCUSSION AND IMPLICATIONS: Negative physical and psychosocial impacts of CLBP were common among older women, and they adopted diverse pain management strategies, although some of their treatment options were influenced by the Chinese culture. Misbeliefs and responses of family and friends also affected their management strategies. Elderly community centers are a significant source of social support for older women with CLBP, making it an ideal platform for establishing self-help groups to facilitate their self-management of CLBP.

Socio-environmental predictive factors for discharge destination after inpatient rehabilitation in patients with stroke: a systematic review and meta-analysis.

PURPOSE: To identify which of the socio-environmental factors of patients with stroke are predictive for discharge to their home after inpatient rehabilitation. Because discharge planning is a key component of rehabilitation, it is important to recognize the predictive factors for a discharge home. Other systematic reviews demonstrated the value of functional outcome measures. This review adds to the current literature by assessing the predictive value of socio-environmental factors, which shape the context in which a person lives. METHODS: We performed a systematic search in seven databases. Two independent reviewers selected studies and assessed them for methodological quality. We extracted data to estimate pooled odds ratio for household situation, social support, ethnicity and socioeconomic status. RESULTS: Forty studies were included. Significant estimates were found for living with others (OR 2.60; 95%CI 1.84-3.68), having support at home (OR 11.48; 95%CI 6.52-20.21), being married (OR 2.05; 95%CI 1.80-2.33) and living at home before stroke (OR 31.01; 95%CI 7.38-130.18). CONCLUSION: Living at home and benefiting from social support, including living with others, are important factors to consider during discharge planning after stroke. Further research should consider the impact of socioeconomic status.IMPLICATIONS FOR REHABILITATIONEvaluating the social and environmental factors of patients with stroke plays an important role in discharge planning.Next to functional status, caregiver availability (support at home) is among the strongest predictive factors for discharge home.To assess caregiver availability, the presence of a willing and able caregiver should be surveyed at admission.Further predictive factors for discharge home are cohabitation and marital status.

Experiences of community-dwelling older adults with chronic low back pain in Hong Kong and Switzerland - A qualitative study.

Introduction: The prevalence of chronic low back pain (LBP) increases with age and older adults are more vulnerable to develop chronic LBP. A recent Swiss study has shown that 78% of community-dwelling older adults aged ≥65 years experienced chronic LBP. Similarly, a study in Hong Kong found that approximately 30% of people aged above 60 years experienced chronic LBP. The aim of this collaborative research project was to illuminate older adults' experiences of living with chronic LBP and its implication on older adults' daily life in Western and Eastern cultures. Methods: Twenty-five older people experiencing chronic LBP living in Switzerland or Hong Kong were recruited through health professionals or community centres. Using semi-structured interviews, participants shared their experiences regarding chronic LBP and its implications on their daily life. The interviews were recorded and transcribed "ad verbatim" in the original language. An inductive thematic analysis was used, using a qualitative data analysis software program (NVivo) and a shared code book in English. The Swiss and Hong Kong research teams engaged in collaborative analysis until a consensus was established, taking into consideration of cultural specificities. Ethical approval was obtained from the local ethic committees in both regions. Results: Themes were related to negative perceptions/experiences: (1) interferences of daily function; (2) pessimistic attitudes toward their conditions/prognosis; and (3) self-perceived burden related to families. Conversely, four themes revealed attributes to social roles: (1) maintaining their roles in families; (2) experiencing supports from family and friends; (3) being content despite LBP; and (4) enjoying social activities. Cultural differences between Switzerland and Hong Kong were related to social circles and offers from the healthcare system, influencing individual experiences and perceptions. Discussion: Although chronic LBP may negatively impact older adults, individual approaches as well as social and health system supports influence older adults' attitude toward their pain and self-management strategies. Developing effective and culturally sensitive interventions for an elderly population with chronic LBP can be challenging but essential for the development of innovative healthcare services tailored to the population's needs. The methodological approach used for this research project establishes the framework for developing and evaluating complex interventions.

Transcultural adaptation and validation of a French version of the University of California, Los Angeles geriatrics attitudes scale (UCLA-GAS-F).

BACKGROUND: In the context of demographic aging, active aging must be encouraged. In addition, the increase in life expectancy requires specific care for the elderly. Therefore, it is important to ensure appropriate training and education to caregivers. Educational institutions put value in positively influencing the attitudes and behaviours towards elderly people in order to ensure the quality of patient care in the future. Questionnaires are often used to assess attitudes. Among them, the University of California, Los Angeles Geriatrics Attitudes Scale (UCLA-GAS) was developed to assess attitudes towards older people and caring for older patients. This scale has been used to evaluate attitude of healthcare professionals and students including undergraduate physiotherapy students. To our knowledge, there is no scale that assesses the same concept in French. Therefore, this study aimed to translate and adapt the UCLA-GAS into French and to test its psychometric properties. METHODS: We conducted this study in two phases. First, we translated and adapted the UCLA-GAS from English into French following the five recommended stages of cross-cultural adaptation. Second, we validated the French version of the scale with undergraduate physiotherapy students. One hundred nineteen students participated from the first to the third academic years. We estimated reliability and validity of the scale. We performed correlation analyses between the French version of the UCLA-GAS (UCLA-GAS-F) with the Aging Stereotypes and Exercise Scale (ASES) and the Attitudes to Aging Questionnaire (AAQ). RESULTS: The scale was translated and adapted into French. Results of the validation phase showed that the UCLA-GAS-F had high test-retest reliability (ICC 0.83, 95%CI 0.74-0.89), but internal consistency below 0.7 (Cronbach's alpha 0.49 to 0.57). The scale showed no ceiling or floor effect. As expected, the French version showed a weak correlation to the ASES (r = 0.28, p = .003) and to the AAQ (r = 0.32, p = .001). CONCLUSIONS: Despite low internal consistency, the French version of the UCLA-GAS showed appropriate psychometric properties. Further validation should include healthcare professionals and other healthcare students.

Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis.

ABSTRACT: This meta-analysis investigated whether more negative psychological factors are associated with less spinal amplitude of movement and higher trunk muscle activity in individuals with low back pain. Furthermore, it examined whether pain intensity was a confounding factor in this relationship. We included studies that provided at least 1 correlation coefficient between psychological (pain-related fear, catastrophizing, depression, anxiety, and self-efficacy) and spinal motor behaviour (spinal amplitude and trunk muscle activity) measures. In total, 52 studies (3949 participants) were included. The pooled correlation coefficients (95% confidence interval; number of participants) were -0.13 (-0.18 to -0.09; 2832) for pain-related fear, -0.16 (-0.23 to -0.09; 756) for catastrophizing, -0.08 (-0.13 to -0.03; 1570) for depression, -0.08 (-0.30 to 0.14; 336) for anxiety, and -0.06 (-0.46 to 0.36; 66) for self-efficacy. The results indicated that higher levels of pain-related fear, catastrophizing, and depression are significantly associated with reduced amplitudes of movement and larger muscle activity and were consistent across subgroup and moderation analyses. Pain intensity did not significantly affect the association between these psychological factors and spinal motor behaviour and had a very small independent association with spinal motor behaviour. In conclusion, the very small effect sizes found in the meta-analyses question the role of psychological factors as major causes of spinal movement avoidance in low back pain. Experimental studies with more specific and individualized measures of psychological factors, pain intensity, and spinal motor behaviour are recommended.

Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis.

BACKGROUND: People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual's abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme. METHODS: A "construct map" approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses. RESULTS: Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait "balance exercises in PwMS" comprised three subdimensions ("stable BOS", "sway" and "step and walk"). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS. CONCLUSION: A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate.

Physiotherapists' use and perceptions of digital remote physiotherapy during COVID-19 lockdown in Switzerland: an online cross-sectional survey.

BACKGROUND: The Swiss containment strategy for the COVID-19 pandemic during the first wave in spring 2020 resulted in a moratorium on non-urgent physiotherapy via regular direct patient contact. Consequently, such physiotherapy sessions declined by 84%. This study investigates the impact of this moratorium on the use of digital remote physiotherapy in Switzerland during this period and the perceptions of its use by Swiss physiotherapists (PTs). METHODS: A cross-sectional online questionnaire was distributed between June and August of 2020 via the Swiss Physiotherapy Association (physioswiss) and various associations of physiotherapy specialists (e.g., sport, pediatric) working in both inpatient and outpatient settings. The questionnaire was designed to capture the demographics of participants and the perceptions of PTs using 33 questions in the following domains: Demography; Attitudes towards digital technology; Private and professional use of digital technology; Use of digital technology during therapy; and, Support requirements. Closed and open-ended questions were included and the frequency of answers was analyzed. Non-parametric inferential statistics were used to identify differences, where appropriate. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adopted. RESULTS: Participants in the survey were 742 PTs (23.5% male, mean age of 43 years, mean working experience of 18 years) from the German-speaking (75.5%), French-speaking (15.1%), and Italian-speaking (9.4%) regions of Switzerland. The percentage of PTs using digital remote therapy increased from 4.9% prior to the lockdown to 44.6% during the lockdown period. The majority of PTs did not consider that digital remote therapy could complement usual physiotherapy practice and did not plan to continue with digital remote therapy after the pandemic. CONCLUSIONS: During the lockdown, Swiss PTs adopted various low-cost and easily accessible digital technologies. However, several barriers hampered further implementation of this modality. Specific education and training programs need to be provided among PTs, appropriate digital technologies should be introduced, and a correct reimbursement scheme should be developed. TRIAL REGISTRATION: COVIDPhysio Registry of World Physiotherapy, registered 15th June 2020 ( https://world.physio/covid-19-information-hub/covid-19-covidphysio-registry ).

Mental practice for chronic pain in people with spinal cord injury: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The primary objective of this systematic review is to identify the effects of mental practice (MP) interventions on chronic neuropathic and nociceptive pain and motor function recovery in individuals after spinal cord injury (SCI). Where possible, this review will also describe the optimal type and dosage (i.e. frequency, intensity and duration) of MP interventions for patients with SCI.

The predictive value of subsets of the Örebro Musculoskeletal Pain Screening Questionnaire for return to work in chronic low back pain.

BACKGROUND: Studies have shown that positive recovery expectations are associated with positive health outcomes in patients with chronic low back pain (CLBP) such as return to work (RTW) and the time to RTW. AIM: To compare the predictive value for RTW in CLBP using different subsets of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). DESIGN: Longitudinal cohort study. SETTING: Rehabilitation center. POPULATION: Ninety-eight inpatients with CLBP (>3 months). METHODS: The ÖMPSQ at baseline was used to predict RTW three months after discharge from the rehabilitation clinic. The area under the ROC-curve was calculated based on a logistic regression model. Cox-regression was used to analyze time to RTW with C statistics for the original full (25-items) version of the ÖMPSQ, the 10-item version as well as for the two items about self-expected RTW and self-expected recovery. RESULTS: The area under the curve (AUC) for the overall score of the full version ÖMPSQ was 0.82 (95% CI: 0.73 to 0.90), the AUC for the short version was 0.79 (95% CI: 0.70 to 0.88), the AUC for the item about self-expected recovery (#15) was 0.67 (95% CI: 0.57 to 0.78), and the AUC for the item about self-expected RTW (#16) was 0.76 (95% CI: 0.66 to 0.85). Harrell's C for the full version was 0.74 (95% CI: 0.66 to 0.81), for the short version the C was 0.71 (95% CI: 0.64 to 0.79), for item #15 the C was 0.62 (95% CI: 0.53 to 0.72), and for item #16 the C was 0.71 (95% CI: 0.64 to 0.78). CONCLUSIONS: Two items about expectations from the ÖMPSQ showed similar predictive value for RTW compared to the short and full original versions, and could be used as first screening questions. CLINICAL REHABILITATION IMPACT: Clinicians may make an informed choice whether they use the full or the short version of the ÖMPSQ for screening of psychosocial problems, or whether they use the two single items about expectations. Knowledge about patient's expectations provides a base for discussion between health professionals and the patient.

Effectiveness of temporary deafferentation of the arm on somatosensory and motor functions following stroke: a systematic review.

BACKGROUND: After stroke, regaining functional use of the upper limb can be challenging. Temporary deafferentation (TD) is a novel approach used in neurorehabilitation to voluntarily reduce the somatosensory input in a body part by temporary anesthesia; which has been shown to improve sensorimotor functions in the affected limb. OBJECTIVES: The primary objective of this systematic review was to present the best available evidence related to the effects of TD of the affected arm on the recovery of motor function and activity of the upper limb (arm and hand) following stroke. Further, this review aimed to assess the effects of TD on sensory function, activities of daily living (ADL) and quality of life following stroke, the acceptability and safety of the intervention as well as adverse events. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adult patients (18 years and older) with a clinical diagnosis of stroke, either hemorrhagic or ischemic. TYPES OF INTERVENTIONS: Reports of rehabilitation that included the use of a pneumatic tourniquet, regional anesthesia or nerve block to achieve TD of an arm, or the use of TD as a stand-alone intervention. OUTCOMES: Primary outcomes were motor function and activity of the upper limb using assessment scales, motor tests and global motor functions.Secondary outcomes included measures of sensory function, ADL, impact of stroke and quality of life and pain.Additional outcomes were neurophysiological changes as studied with functional magnetic resonance imaging, magnetoencephalography and/or transcranial magnetic stimulation.Acceptability and safety of the intervention as well as adverse events were also included. TYPES OF STUDIES: We included any experimental and epidemiological studies. There were no randomized controlled trials. We included non-randomized controlled trials, quasi-experimental, before and after studies and case-control studies. SEARCH STRATEGY: We searched for both published and unpublished studies in major databases and all reference lists of relevant articles in English, German or French languages. We included studies published from January 1980 to October 2015. DATA EXTRACTION: Data were extracted from included studies using a standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS: There was heterogeneity in the types of intervention and outcome measures, therefore statistical pooling of the findings was not appropriate. As such, the studies were grouped according to type of outcome where possible. Findings are presented in a narrative form. RESULTS: Eight studies met the eligibility criteria. All outcome parameters related to the primary outcome (motor function and activity of the more affected upper extremity) showed an improvement during or after TD. The sensory functions significantly improved during or after TD when measured either by the grating orienting task or the grating orientation accuracy, and slightly improved when measured using the von Frey hair testing during TD. CONCLUSION: There is evidence supporting the use of TD of the upper extremity in adults after stroke. Temporary deafferentation can be recommended (Grade B).

Exogenous and endogenous components of ultralate (C-fibre) evoked potentials following CO2 laser stimuli to tiny skin surface areas in healthy subjects.

CO2 laser stimulation of tiny skin surface areas on the hand dorsum generate ultralate laser evoked potentials (LEPs) with a major positivity maximal at the vertex at a latency of about 1 s. These potentials follow selective and direct activation of C-fibres in the superficial layers of the skin. To identify the endogenous P3 component in ultralate LEPs, we used a 2-stimulus oddball paradigm (20% probability of targets). Ultralate LEPs were recorded in eight healthy subjects with 19 channels EEG and EOG. Laser stimuli (n = 200/subject, < 0.5 mm diameter, 5 ms duration, 9.4 mJ/mm2 energy density) were applied in a pseudo-random order to the proximal phalanx of either middle finger (target) or index (non-target) of the left hand. Vigilance was maintained during recording sessions. Subject's task was to press a button to any kind of sensation perceived at the target zone. We observed a negative-positive (N965-P1139) complex maximal at Cz for all stimulus conditions. This complex was of significantly larger amplitude for rare events. For the target responses, a second distinct positive peak was observed with a mean latency of 1343 +/- 103.5 ms with maximum amplitude at Pz. This latest peak may represent an endogenous P3-like component as it is linked to the subject's detection of the target stimulus (rare events).

'Tell me about your troubles': description of patient-physiotherapist interaction during initial encounters.

BACKGROUND AND PURPOSE: Communication skills are essential for physiotherapy practice. It has been shown that patients, especially those with chronic pain problems, are more satisfied with services when therapists communicate adequately. The objective of this study was to explore how French-speaking physiotherapists and patients with low back pain explore and assess the patient's pain experience during initial encounters. METHODS: The initial consultation of six consenting patients with low back pain and two physiotherapists was videotaped. Conversation analysis was used to describe and analyse the communication practices related to pain assessment. RESULTS: When physiotherapists explored patients' pain experience, they specifically focused on the impact of pain on function. The observed physiotherapists used the following communication strategies: 1) using yes/no questions and 'okay' as a resource to shift to a new topic; 2) following documentation quite stringently without allowing digression; 3) building the next question on the basis of the patient's discourse; 4) inviting the patient to talk using formulations such as 'tell me about your troubles?'; and 5) using gaze and nodding as continuers. The physiotherapists used two different approaches to close the encounter. While one therapist chose to summarize the consultation, including a prognostic assessment, the other one ended the consultation by organizing the follow-up consultation. CONCLUSION: This exploratory study examines the interaction between patients and physiotherapists during initial encounters and identifies assumptions underlying pain assessment that shape the therapists' exploration of patients' pain experience. It also shows evidence of the physiotherapists' difficulties to inquire about the patient's perspective.