Personalizing rehabilitation for individuals with musculoskeletal impairments: Feasibility of implementation of the Measures Associated to Prognostic (MAPS) tool.

INTRODUCTION: The Measures Associated to PrognoStic (MAPS) tool is a standardized questionnaire that integrates validated prognostic tools to detect the presence of biopsychosocial prognostic factors in patients consulting for musculoskeletal disorders. PURPOSE: The objectives were to assess the: 1) feasibility of implementation of the MAPS tool, 2) clinicians' acceptability of the dashboard, and 3) patients' acceptability of the MAPS tool. METHODS: Twenty physiotherapists and two occupational therapists from seven outpatient musculoskeletal clinics were recruited to implement the MAPS tool during a 3-month timeframe, where new patients completed the questionnaire upon initial assessment. The results were presented to the clinicians via a dashboard. Surveys and semi-structured interviews were conducted to measure feasibility and acceptability. RESULTS: Six out of 11 feasibility criteria (55%) and 21 out of 24 acceptability criteria (88%) reached the a priori threshold for success. The interviews allowed us to identify three main themes to facilitate implementation: 1) limiting the burden, 2) ensuring patients' understanding of the tool's purpose, and 3) integrating the dashboard as a clinical information tool. CONCLUSION: Our quantitative and qualitative results support the feasibility of implementation and acceptability of the MAPS tool pending minor adjustments. Depicting the patients' prognostic profile has the potential to help clinicians optimize their interventions for patients presenting with musculoskeletal disorders.

Establishing the prognostic profile of patients with work-related musculoskeletal disorders: Development and acceptability of the MAPS questionnaire.

PURPOSE: Work-related musculoskeletal disorders (WRMD) are the most common causes of disability worldwide and are associated with significant use of healthcare. One way to optimize the clinical outcomes of injured workers receiving rehabilitation is to identify and address individual prognostic factors (PF), which can facilitate the personalization of the treatment plan. As there is no pragmatic and systematic method to collect prognostic-related data, the purpose of the study was to develop and assess the acceptability of a set of questionnaires to establish the "prognostic profile" of workers with WRMD. METHODS: We utilized a multistep process to inform the acceptability of the Measures Associated to PrognoStic (MAPS) questionnaire. During STEP-1, a preliminary version of the was developed through a literature search followed by an expert consensus including a patient-advisor. During STEP-2, future users (rehabilitation professionals, healthcare administrators and compensation officers) were consulted through an online survey and were asked to rate the relevance of each content item; items that obtained ≥80% of "totally agree" answers were included. They were also asked to prioritize PF according to their usefulness for clinical decision-making, as well as perceived efficacy to enhance the treatment plan. RESULTS: The questionnaire was developed with three categories: the outcome predicted, the unique PF, and prognostic tools. Personal PF (i.e.: coping strategies, fear-avoidance beliefs), pain related PF (i.e.: pain intensity/severity, duration of pain), and work-related PF (i.e.: work physical demands, work accommodations) were identified to be totally relevant and included in the questionnaire. 84% of the respondents agreed that their patients could complete the MAPS questionnaire in their clinical setting, while 75% totally agreed that the questionnaire is useful to personalize rehabilitation interventions. CONCLUSION: The MAPS questionnaire was deemed acceptable to establish the "prognostic profile" of injured workers and help the clinicians in the treatment decision-making process.

Prognostic factors specific to work-related musculoskeletal disorders: An overview of recent systematic reviews.

PURPOSE: Work-related injuries affect a considerable number of people each year and represent a significant burden for society. To reduce this burden, optimizing rehabilitation care by integrating prognostic factors (PF) into the clinical decision-making process is a promising way to improve clinical outcomes. The aim of this study was to identify PF specific to work-related musculoskeletal disorders. METHODS: We performed an overview of systematic reviews reporting on PF that had the following outcomes of interest: Return to work, pain, disability, functional status, or poor outcomes. Each extracted PF was categorized according to its level of evidence (grade A or B) and whether it was modifiable or not. The risk of bias of each study was assessed with the ROBIS tool. RESULTS: We retrieved 757 citations from 3 databases. After removing 307 duplicates, 450 records were screened, and 20 studies were retained. We extracted a total of 20 PF with a Grade A recommendation, where 7 were deemed modifiable, 11 non-modifiable and 2 were index test. For example, return to work expectations, previous sick leave, delay in referral and pain intensity were found to be predictors of return-to-work outcomes. We also identified 17 PF with a Grade B recommendation, where 11 were deemed modifiable. For example, poor general health, negative recovery expectations, coping and fear-avoidance beliefs, pain severity, and particularly physical work were found to predict return to work outcomes. CONCLUSION: We found numerous modifiable PFs that can help clinicians personalize their treatment plan beyond diagnostic-related information for work-related musculoskeletal disorders.

Management of Chronic Pain by Occupational Therapist: A Description of Practice Profile.

Background. Current state of knowledge regarding occupational therapy's contribution to chronic pain (CP) management has evolved over the past decade. Yet, has this been transferred to clinical practice? Purpose. Describe the current state of practice of CP management-specific occupational therapy. Method. An online survey was sent to occupational therapists working with CP patients. Findings. Of the 90 respondents (11.9%), 42.2% worked in primary care and 52.2% in secondary care. They reported that their primary role aimed at enabling occupation and providing vocational rehabilitation. The Canadian Model of Occupational Performance and Engagement (CMOP-E) (87.8%), semi-structured interview (86.7%), and education on energy conservation (65.6%) and postural hygiene (60.0%) were the most frequently reported conceptual model, assessment, and intervention methods. Implications. Results illustrate the diversity of current occupational therapy practice in CP management and suggest opportunities for improvement to ensure best practices are adopted, by emphasizing an occupation-based vision of health and well-being.

Occupational Adaptation of People Living With Fibromyalgia: A Systematic Review and Thematic Synthesis.

IMPORTANCE: Fibromyalgia (FM) is a chronic pain disorder that interferes with daily activities. Because occupational adaptation varies among people, there is a need to determine which factors can influence adaptation to FM in order to better intervene with them. OBJECTIVE: To understand the occupational adaptation process of people living with FM. DATA SOURCES: A systematic review of the literature was conducted in the AMED, CINAHL, MEDLINE, OTseeker, OTDBASE, and PsycINFO databases. Articles dated before September 2020 were searched using a strategy with the keywords fibromyalgia and occupation. Study Selection and Data Collection: This article follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Qualitative articles were included if they documented occupational aspects of participants with FM. Two independent reviewers screened the articles and performed the quality assessment using the Critical Appraisal Skills Program checklist. A thematic synthesis was conducted. FINDINGS: Of the 560 articles identified, 347 remained after duplicates were removed. After screening titles and abstracts, 303 articles were rejected, and 44 articles were read in their entirety. Twelve qualitative articles were included in the review. The synthesis highlights that support from relatives is a key to successfully adapting to FM. Identity is crucial to a fulfilled life, and occupational competence is greatly affected by the experience of FM. Occupational adaptation is an issue for some people, but maintaining routines and integrating management strategies would help them to achieve it. CONCLUSIONS AND RELEVANCE: This review highlights the importance of considering the components of occupational adaptation while caring for people with FM. What This Article Adds: This systematic review identifies the factors influencing the occupational adaptation of people living with FM and emphasizes the importance of addressing those factors.

Understanding the Benefits, Challenges, and the Role of Pet Ownership in the Daily Lives of Community-Dwelling Older Adults: A Case Study.

Human-animal interactions may positively impact the health and well-being of older adults. Considering about one third of community-dwelling older adults report owning a pet, better understanding the benefits, challenges, and the role of pet ownership may help support the relationships between older adults and their pets. This case study aims to better understand the role of pet ownership in the daily lives of older adults and explore the benefits and the challenges of owning a pet for this population. Interviews were conducted with Violet, a 77-year-old dog owner and her healthcare provider. Qualitative data were analyzed by two evaluators and validated by the participants. Both participants agree that the benefits outweigh the challenges for both the older adult and her pet. The benefits and challenges were the following: Violet, taking care of her dog (Jack), (1) could provide Violet with a sense of safety and positively influence her mood; (2) may introduce a slight fall risk; (3) includes financial costs to consider. Ensuring Jack's well-being is important for Violet and her dog benefits from Violet's continual presence and care. The findings suggest that improving the fit between characteristics of the owner and their pet may support the meaningful role of pet ownership within the context of aging-in-place.

Chronic pain and frequent use of emergency department: A systematic review.

INTRODUCTION: Emergency department (ED) overcrowding is an important issue in healthcare worldwide. A small group of patients account for a disproportionate number of ED visits and a few studies have suggested that chronic pain (CP) sufferers may be part of that group. The aim of this study was to review all studies having examined the association between CP and frequent use of ED services. METHODS: A systematic review of the literature was performed. The CINAHL, PsycINFO, PubMed and Scopus databases were searched from January 1997 to August 2019, using a strategy containing the keywords frequent use, CP and ED. Two independent reviewers screened articles and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. To be included in the review, studies had to: (1) document frequent use of ED services; (2) evaluate CP patients; and (3) use regression models. Studies were excluded if they addressed cancer pain; evaluated an intervention; or targeted an exclusively paediatric population. A narrative synthesis was conducted. RESULTS: Of the 1182 articles identified, 927 remained after removing duplicates and 47 remained after the evaluation of titles and abstracts, which were read completely. Finally, five articles, published between 2004 and 2016, were included in the study. Every study showed that CP was associated with higher ED visits. Two studies documented that frequent users had a higher level of disability than non-frequent users, or that disability was associated with frequent use. CONCLUSIONS: This review suggests that CP is associated with frequent use of ED services.

Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review.

Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.

The Effectiveness of Transcranial Direct Current Stimulation as an Add-on Modality to Graded Motor Imagery for Treatment of Complex Regional Pain Syndrome: A Randomized Proof of Concept Study.

BACKGROUND: The efficacy of Graded Motor Imagery (GMI) for the management of Complex Regional Pain Syndrome (CRPS) is supported by evidence, but its treatment effect remains generally modest. Transcranial Direct Current Stimulation (tDCS) has been advocated as an adjunct intervention to enhance the effect of motor imagery approaches in pain populations. OBJECTIVE: The purpose of this study was to investigate the effectiveness of GMI+active tDCS compared with the GMI+sham tDCS in the treatment of CRPS type I. METHODS: A total of 22 patients (n=11/group) were randomly assigned to the experimental (GMI+tDCS) or placebo (GMI+sham tDCS) group. GMI treatments lasted 6 weeks; anodal tDCS was applied over the motor cortex for 5 consecutive days during the first 2 weeks and once a week thereafter. Changes in pain perception, quality of life, kinesiophobia, pain catastrophizing, anxiety and mood were monitored after 6 weeks of treatment (T1) and 1-month posttreatment (T2). RESULTS: GMI+tDCS induced no statistically significant reduction in pain compared with GMI+sham tDCS. Although we observed significant group differences in kinesiophobia (P=0.012), pain catastrophizing (P=0.049), and anxiety (P=0.046) at T1, these improvements were not maintained at T2 and did not reached a clinically significant difference. DISCUSSION: We found no added value of tDCS combined with GMI treatments for reducing pain in patients with chronic CRPS. However, given that GMI+sham tDCS induced no significant change, further studies comparing GMI+tDCS and tDCS alone are needed to further document tDCS's effect in CRPS.

Modified graded motor imagery for complex regional pain syndrome type 1 of the upper extremity in the acute phase: a patient series.

Complex regional pain syndrome (CRPS) is a pathologic condition in which the painful experience is disproportionate in time and intensity in comparison with the inciting event. At present, the pathophysiology of CRPS is not well understood. Several studies have indicated that cortical reorganization plays a role in the persistence of the symptoms. A new promising approach, graded motor imagery (GMI), seems to be effective, but there are limited data for the CRPS-1 upper extremity population. The aim of this study was to demonstrate the effectiveness of a modified GMI (mGMI) protocol based on the work of Moseley to reduce pain and enhance functional capacities for a population with nonchronic CRPS-1 of the upper extremity. The following outcome measures were used to assess the clinical effectiveness: pain (short form of the McGill Pain Questionnaire), grip force (Martin vigorimeter), perception of upper extremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire), and patient's global impression of change. All outcomes at T4 were compared with the baseline data (T0) using the Mann-Whitney test and the χ test (nonparametric tests). Seven patients were recruited for the study. At the end of the mGMI (T4), we obtained significant results for the decrease in the pain experienced in the last 7 days (visual analog scale; P=0.046), improvement in the affected extremity grip force (P=0.042), and the patient's global impression of change (P=0.015). However, the data of the perception of upper extremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire) were not clinically or statistically significant. Our results indicate that this mGMI protocol seems to be a promising therapeutic modality to reduce pain. However, more investigations are needed to determine whether mGMI has a significant impact on upper extremity function.