Pain-related fear in adolescents with chronic musculoskeletal pain: process evaluation of an interdisciplinary graded exposure program.

BACKGROUND: For studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol. OBJECTIVES: To evaluate whether an interdisciplinary graded exposure program, for adolescents with chronic musculoskeletal pain reporting pain-related fear, was performed according to protocol, and whether it is feasible to implement the program in rehabilitation care. METHODS: A process evaluation where quantitative and qualitative data on participant characteristics (adolescents, parents and therapists), attendance and participants' opinion on the program were collected, by means of registration forms, questionnaires and group interviews. To evaluate treatment fidelity, audio and video recordings of program sessions were analyzed. RESULTS: Thirty adolescents were offered the program, of which 23 started the program. Adolescents attended on average 90% of the sessions. At least one parent per adolescent participated in the program. Analysis of 20 randomly selected recordings of treatment sessions revealed that treatment fidelity was high, since 81% of essential treatment elements were offered to the adolescents. The program was considered client-centered by adolescents and family-centered by parents. Treatment teams wished to continue offering the program in their center. CONCLUSION: The interdisciplinary graded exposure program was performed largely according to protocol, and therapists, adolescents and their parents had a favorable opinion on the program. Implementation of the program in rehabilitation care is considered feasible. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02181725 (7 February 2014).

[Analysing gait in the GP's consulting room]. / Observatie van lopen in de huisartsenspreekkamer.

Gait disorders are often seen in the general practitioner (GP)'s consulting room. Orthopaedic or neurological problems may lead to abnormalities in gait. A careful analysis is important to advice or refer the patient for additional diagnostics or treatment. Basic gait analysis can be performed on any patient by applying a systematic stepwise observation. This is illustrated here by three case reports. This observation starts by looking at parameters such as walking speed, safety, efficiency etc. Analysis of biomechanical pattern such as step frequency, stride length and a detailed analysis of the different joint movements during the stance and swing phase can subsequently be performed. This observation will be helpful for the GP, guiding further examinations of function level such as mobility, strength, or balance and resulting in adequate advice to the patient or referral for additional diagnostics or treatment.