Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study.

BACKGROUND: The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain. METHODS: This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression. RESULTS: Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups. CONCLUSION: Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.

Anterior cruciate ligament-return to sport after injury scale: validation of the Norwegian language version.

PURPOSE: Evidence is emerging on the importance of psychological readiness to return to sport after anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) is developed to assess this. The aim of the current study was to translate ACL-RSI into Norwegian and examine the measurement properties of the Norwegian version (ACL-RSI-No). METHODS: ACL-RSI was translated according to international guidelines. A cohort of 197 ACL-reconstructed patients completed ACL-RSI-No and related questionnaires nine months post-surgery. One hundred and forty-six patients completed hop tests and 142 patients completed strength tests. Face and structural validity (confirmative factor analysis and explorative analyses), internal consistency [Cronbach's alpha (α)], test-retest reliability [Intraclass Correlation Coefficients (ICC)], measurement error [Standard error of measurement (SEM) and smallest detectable change at individual (SDCind) and group level (SDCgroup)] and construct validity (hypotheses testing; independent t tests, Pearson's r) were examined. RESULTS: ACL-RSI-No had good face validity. Factor analyses suggested that the use of a sum score is reasonable. Internal consistency and test-retest reliability were good (α 0.95, ICC 0.94 (95% CI 0.84-0.97) and measurement error low (SEM 5.7). SDCind was 15.8 points and SDCgroup was 2.0. Six of seven hypotheses were confirmed. CONCLUSIONS: ACL-RSI-No displayed good measurement properties. Factor analyses suggested one underlying explanatory factor for "psychological readiness"-supporting the use of a single sum score. ACL-RSI-No can be used in the evaluation of psychological readiness to return to sport after ACL injury. LEVEL OF EVIDENCE: III.

Implementation of conservative treatment prior to arthroscopic subacromial decompression of the shoulder.

PURPOSE: The aim of the study was to investigate to what extent patients undergo evidence-based conservative treatment prior to arthroscopic subacromial decompression of the shoulder. METHODS: One hundred and twenty patients (65 women, 55 men, median age 53.5 years (range 28-70), referred to arthroscopic subacromial decompression at two hospitals in Norway, were consecutively included in the study. The patients completed a self-administered questionnaire including questions concerning the quantity and nature of preoperative treatment as well as the QuickDASH score. They were specifically asked for the extent of evidence-based conservative treatment, i.e. the combination of strengthening and stretching exercises at a minimum weekly amount and total duration. RESULTS: One hundred and nine patients (91 %) reported having received conservative treatment guided by a physiotherapist preoperatively. The patients' main reasons for not seeing a physiotherapist were lack of trust in the treatment (N = 7) and the assumption that surgery would provide faster relief of symptoms (N = 6). Of those visiting a physiotherapist, 80 % received specific shoulder exercises. Forty-five per cent did both strengthening and stretching exercises, only 32 % did the exercises three times per week more than 2 months, and 24 % did more than 3 months as recommended. Seventy-six per cent of the patients who discontinued the prescribed exercise programme did this due to increasing pain. CONCLUSIONS: Most of the patients in the current study reported having visited a physiotherapist before surgery. However, less than half of them underwent evidence-based exercise treatment, and increased pain was the main reason for not completing the prescribed exercise treatment. The results might be of clinical relevance for physiotherapists treating patients with SAPS, but also for orthopaedic surgeons doing preoperative evaluations. LEVEL OF EVIDENCE: Case series, IV.

Correspondence in Stakeholder Assessment of Health, Work Capacity and Sick Leave in Workers with Comorbid Subjective Health Complaints? A Video Vignette Study.

Purpose The purpose of this study is to test if there is correspondence in stakeholders' assessments of health, work capacity and sickness certification in four workers with comorbid subjective health complaints based on video vignettes. Methods A cross sectional survey among stakeholders (N = 514) in Norway in 2009/2010. Logistic regression and multinomial logistic regression was used to obtain the estimated probability of stakeholders choosing 100 % sick leave, partial sick leave or work and the estimation of odds ratio of stakeholder assessment compared to the other stakeholders for the individual worker. Results The supervisors were less likely to assess poor health and reduced work capacity, and more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. The public was less likely to assess comorbidity and reduced work capacity, and 6 and 12 times more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. Stakeholders generally agreed in their assessments of workers 2 and 3. The public was more likely to assess poor health, comorbidity and reduced work capacity, and the supervisors more likely to assess comorbidity and reduced work capacity, compared to the GPs for worker 4. Compared to the GPs, all other stakeholders were less likely to suggest full time work for this worker. Conclusions Our results seem to suggest that stakeholders have divergent assessments of complaints, health, work capacity, and sickness certification in workers with comorbid subjective health complaints.

GPs' negotiation strategies regarding sick leave for subjective health complaints.

OBJECTIVES: To explore general practitioners' (GPs') specific negotiation strategies regarding sick-leave issues with patients suffering from subjective health complaints. DESIGN: Focus-group study. SETTING: Nine focus-group interviews in three cities in different regions of Norway. PARTICIPANTS: 48 GPs (31 men, 17 women; age 32-65), participating in a course dealing with diagnostic practice and assessment of sickness certificates related to patients with subjective health complaints. RESULTS: The GPs identified some specific strategies that they claimed to apply when dealing with the question of sick leave for patients with subjective health complaints. The first step would be to build an alliance with the patient by complying with the wish for sick leave, and at the same time searching for information to acquire the patient's perspective. This position would become the basis for the main goal: motivating the patient for a rapid return to work by pointing out the positive effects of staying at work, making legal and moral arguments, and warning against long-term sick leave. Additional solutions might also be applied, such as involving other stakeholders in this process to provide alternatives to sick leave. CONCLUSIONS AND IMPLICATIONS: GPs seem to have a conscious approach to negotiations of sickness certification, as they report applying specific strategies to limit the duration of sick leave due to subjective health complaints. This give-and-take way of handling sick-leave negotiations has been suggested by others to enhance return to work, and should be further encouraged. However, specific effectiveness of this strategy is yet to be proven, and further investigation into the actual dealings between doctor and patients in these complex encounters is needed.

Supervisors' Strategies to Facilitate Work Functioning among Employees with Musculoskeletal Complaints: A Focus Group Study.

AIM: To explore what strategies the supervisors found beneficial to prevent or reduce sickness absence among employees with musculoskeletal complaints. METHODS: Five focus groups were conducted and 26 supervisors from health and social sector participated. Commonly used strategies to prevent sickness absence and interdisciplinary cooperation in this work were discussed in the focus groups. Systematic text condensation was used to analyse the data. RESULTS: The supervisors described five strategies for sick leave management: (1) promoting well-being and a healthy working environment, (2) providing early support and adjustments, (3) making employees more responsible, (4) using confrontational strategies in relation to employees on long-term sick leave, and (5) cooperation with general practitioners (GPs). CONCLUSIONS: Strategies of promoting a healthy working environment and facilitating early return to work were utilised in the follow-up of employees with musculoskeletal complaints. Supportive strategies were found most useful especially in the early phases, while finding a balance between being supportive, on one side, and confronting the employee, on the other, was endeavoured in cases of recurrent or long-term sick leave. Further, the supervisors requested a closer cooperation with the GPs, which they believed would facilitate return to work.

Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program.

AIM: The aim of this study was to explore how functional ability, coping and health were related to work and benefit status three years after participating in a four-week inpatient interdisciplinary occupational rehabilitation program. METHODS: The cohort consisted of 338 individuals (75% females, mean age 51 years (SD=8.6)) who three years earlier had participated in a comprehensive inpatient interdisciplinary occupational rehabilitation program, due to long-term sick leave. The participants answered standardised questionnaires about subjective health complaints, functional ability, coping, and current work and benefit status. The relationships between these variables were analysed using logistic regression analyses. RESULTS: At the time of the survey, 59% of the participants worked at least 50% of a full working day. Twenty-five percent received at least 50% disability pension and 16% received other benefits. Poor functional ability (OR 4.8; CI 3.0-7.6), poor general health (OR 3.8; CI 2.3-6.1), high level of subjective health complaints (OR 3.3; CI 2.1-5.2), low coping (OR 2.8; CI 1.7-4.4), poor physical fitness (OR 2.8; CI 1.7-4.6) and poor sleep quality (OR 2.4; CI 1.5-3.7) were associated with receiving allowances. In a fully adjusted model, only poor functional ability and low coping were associated with receiving allowances three years after occupational rehabilitation. CONCLUSIONS: Functional ability and coping were the variables most strongly associated with not having returned to work. More attention should therefore be paid to enhance these factors in occupational rehabilitation programs. Part-time work may be a feasible way to integrate individuals with reduced workability in working life, if the alternative is complete absence from work.

Physiotherapists' engagement in work ability and return to work issues of patients with musculoskeletal disorders. A cross-sectional survey in Norway.

BACKGROUND: Work and health are a national priority in Norway, and leading health authorities call for treatment approaches that incorporate these perspectives. We have little knowledge of how physiotherapists in private practice integrate the work perspective during the treatment of patients with musculoskeletal disorders. Thus, the purpose of this study was to gain more insight into the way physiotherapists in Norway integrate the aspect of work. METHODS: In 2021, all 2650 privately practising members of the Norwegian Physiotherapist Association received a web-based survey that was answered by 514 physiotherapists. The survey included questions about treatment approaches, competencies, and collaboration with other health professionals in the context of promoting work participation. RESULTS: 91% of the physiotherapists reported that they play an important role in assessing work ability. 75% were confident in assessing the patients' work ability, while 25% stated that they have little or some competence. 49% of the physiotherapists often contacted the general practitioner (GP) to discuss patients' ability to work, and 19% were often contacted by the GP. Only 14% stated that they were invited to participate in dialogue meetings with the Norwegian Labour and Welfare Administration. 28% of the physiotherapists reported that insufficient knowledge about social security issues was an obstacle in promoting the patient's work participation. The physiotherapists believed that increased use of standardised assessment tools, better knowledge of social security issues, and closer collaboration with other professionals may strengthen their role in promoting work participation. DISCUSSION AND CONCLUSION: Although physiotherapists promote work participation when treating patients on sick leave, limited communication with the stakeholders, and inadequate knowledge of social security issues pose an obstacle. To strengthen the physiotherapist's role in the return-to-work facilitation, work and health should become a separate subject in basic and advanced education programmes for physiotherapists.

Experiences of individually tailored physical exercise in boys with Duchenne muscular dystrophy: a qualitative study.

INTRODUCTION: Excessive and insufficient physical exercise have both been associated with accelerated muscle function decline in boys with Duchenne Muscular Dystrophy (DMD), and optimal exercise remains unclear. OBJECTIVE: This study explored participants' experiences with a one-year training program. METHODS: Five semi-structured qualitative individual interviews and one focus group interview were conducted and analyzed using systematic text condensation. RESULTS: Participants included boys with DMD who participated in the intervention study (n = 10), their relatives and/or assistants (n = 7). Four main themes emerged: 1) the crucial role of motivation to maintain training routines, 2) benefiting from exercise, but with a need for balancing it, 3) time management challenges, and 4) the training as a social arena and meeting place. The participants emphasized the importance of experiencing progress, basic skills and enjoyable training. Parents were reassured knowing the appropriate exercise intensity and technique. The boys needed flexibility and support to find a balance between exercise and other activities and described benefits from sharing experiences with each other. CONCLUSION: Clinical guidelines for physical exercise in DMD should encompass customization of exercise interventions supporting motivational factors, balance and social interaction, and identify competing commitments. Successful training programs may enhance quality of life and functionality for these boys.

Cross-cultural adaptation and validation of the Norwegian Dizziness Catastrophizing Scale in persons with dizziness.

BACKGROUND AND PURPOSE: Dizziness Catastrophizing Scale (DCS) is a questionnaire covering catastrophizing thoughts related to dizziness. The aims of this study were to cross-culturally adapt the DCS into Norwegian (DCS-N) and to examine the internal consistency, content and construct validity, and test-retest reliability of the instrument. METHOD: Patients (18-67 years) with long-term dizziness were recruited from an ear, nose, and throat (ENT) clinic in Western Norway. Validity of the DCS-N was assessed by evaluating data quality (missing, floor and ceiling effects), content validity (relevance, comprehensiveness, and comprehensibility), structural validity (principal component analysis), internal consistency (Cronbach's alpha), and construct validity (predefined hypotheses). Test-retest reliability was examined by intraclass correlation coefficient (ICC1.1 ), standard error of measurement (SEM), smallest detectable change (SDC), and limits of agreement. RESULTS: In total, 97 women and 53 men, mean age (SD) 46.5 (12.7) with dizziness were included (in the study). A subgroup of 44 patients participated in test-retest assessment. Overall, the DCS-N was easy to comprehend. The principal component analysis supported a one-factor solution and internal consistency was satisfactory (α 0.93). Construct validity was acceptable; all the predefined hypotheses were confirmed. Test-retest reliability demonstrated ICC1.1 of 0.90 and a SEM of 4.9. SDC was estimated to be ±13.6. DISCUSSION: The DCS-N demonstrated acceptable measurement properties for assessing catastrophizing thoughts in patients with long-term dizziness. Further studies should examine the responsiveness of the DCS-N and a factor analysis should be undertaken in a larger population.

Patients' experiences of living with patellar instability before and after surgery: a qualitative interview study.

OBJECTIVES: To explore the experience of living with patellar instability before and after surgery. DESIGN: Qualitative individual semistructured interviews of patients with patellar instability using a four-step thematic cross-case analysis strategy (systematic text condensation). SETTING: Two orthopaedic units within two large Hospitals in Norway. PARTICIPANTS: A convenience sample of 15 participants, aged between 16 and 32 years, who had undergone surgery for patellar instability within the last 6-12 months. RESULTS: Participants offered rich and detailed descriptions of the impact and lived experience of patellar instability, including fear of new dislocations, increased awareness of the knee and adaptations to avoidance behaviour in everyday life both before and after surgery. The four major themes that emerged from the data were: (1) fear of patella dislocations governs everyday life activities, (2) adaptation to avoidance behaviour, (3) feeling different, misunderstood and stigmatised affects self-esteem and (4) feeling stronger, but still not fully confident in the knee after surgery. CONCLUSIONS: These findings offer insight into the experience of living with patellar instability. Patients reported that the instability had major impacts on their everyday life, affecting ability to participate in social life and physical activities both before and after surgery. This may imply that an increased attention towards cognitive interventions may be useful in the management of patellar instability. TRIAL REGISTRATION NUMBER: NCT05119088.

Body awareness and cognitive behavioral therapy for multisite musculoskeletal pain: patients` experiences with group rehabilitation.

BACKGROUND: An extended group program called Mind and Body (MB), based on body awareness exercises and cognitive behavioral therapy (CBT), was offered to a subgroup of patients who had completed their traditional outpatient multidisciplinary rehabilitation and were motivated for further treatment. PURPOSE: To explore how patients with multisite musculoskeletal pain experienced participation in the MB program with respect to usefulness, meaningfulness, behavioral changes, and transferability to daily life and work. METHOD: The study is rooted in the phenomenological tradition. Individual, semi-structured interviews were performed with eight patients aged 29-56 years. The data were analyzed using systematic text condensation. RESULTS: Two main themes emerged: 1) New knowledge provided increased body awareness, new ways of thinking, and acceptance of one's own situation. This theme reflected how new knowledge and MB coping strategies were useful in the process of changing problematic thoughts, increasing body awareness, and facilitating acceptance; and 2) Implementing new habits and strategies in daily life revealed how demanding it was to alter behavior, a process that unfolded over time. CONCLUSION: A combination of body awareness exercises and cognitive coping strategies was described as helpful in further improving function and coping with pain and stress in daily life and work.

Cross-cultural Validation of the Norwegian Version of the Banff Patellofemoral Instability Instrument 2.0.

Background: The Banff Patellofemoral Instability Instrument (BPII) 2.0 is a disease-specific quality of life questionnaire for patients with patellofemoral instability. While good psychometric properties have been demonstrated, the data lack cross-cultural validity, construct validity, and an established measurement error. Purpose: To (1) translate and cross-culturally adapt the BPII 2.0 to the Norwegian version (BPII 2.0-No) and (2) examine the psychometric properties of the Norwegian version. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The BPII 2.0 was translated according to international guidelines. A cohort of 100 patients surgically treated for recurrent patellofemoral instability completed the BPII 2.0-No, related outcome measures (Norwich Patellar Instability Score, International Knee Documentation Committee Subjective Knee Form 2000, Knee injury and Osteoarthritis Outcome Score, and Tampa Scale of Kinesiophobia), and functional tests (Y-Balance Test-Lower Quarter, single-leg hop tests, and knee extension strength) before and/or 6 months after surgery. We evaluated the face and content validity, internal consistency (Cronbach α), test-retest reliability (intraclass correlation coefficient [ICC]), measurement error (SEM and smallest detectable change at the individual [SDCind] and group levels [SDCgroup]). Construct validity was assessed by testing 9 hypotheses on the correlation between the BPII 2.0-No and the outcome measures/functional tests (Pearson r). Results: The BPII 2.0-No had good face and content validity. Internal consistency was excellent (α = .95), and no floor or ceiling effects were found. Test-retest reliability was high (ICC2,1 = 0.87; 95% CI, 0.77-0.93), and measurement error was low (SEM = 7.1). The SDCind was 19.7 points and the SDCgroup was 2.8 points. Eight of the 9 hypotheses regarding construct validity were confirmed. Conclusion: The BPII 2.0-No was found to be valid and reliable. This study adds further knowledge on the measurement properties of the BPII 2.0 that can be used internationally.

Relationship between exercise capacity and fatigue, dyspnea, and lung function in non-hospitalized patients with long COVID.

Long COVID is a global health problem that impairs patients' functional status. More than 200 reported symptoms have been identified where fatigue, dyspnea, and exercise impairment are most common. This study aimed to describe exercise capacity, fatigue, dyspnea, and lung function in previously non-hospitalized patients with long COVID, and examine the relationship between exercise capacity and fatigue, dyspnea, and lung function. Sixty-five patients, 54 women (83%), mean age of 39 standard deviation (12) years, were included and completed spirometry, cardiopulmonary exercise test, stair climbing test (SCT), 30 second sit-to-stand test (30STST), and questionnaires regarding fatigue and dyspnea. Fatigue was reported by 95% of the participants, whereas 65% reported severe fatigue, and 66% reported dyspnea. Mean exercise capacity measured with peak oxygen uptake (V̇O2peak % pred.) was ≥85% in 65% of the participants. Mean forced expiratory volume in 1 s. and forced vital capacity were 96.6 (10.7)% and 100.8 (10.9)%, respectively, while reduced diffusion capacity for carbon monoxide (DLCO ) was found in eight participants (13%). Reduced V̇O2peak kg-1 and increased time on SCT were significantly associated with increased dyspnea and reduced DLCO but not with fatigue, while 30STST was associated with increased fatigue and dyspnea in previously non-hospitalized patients with long COVID.

Hearing threshold and physical performance in older people: a cross-sectional study from the HUNT4 cohort.

PURPOSE: To evaluate the association between increased hearing loss and reduced physical performance in older people. METHODS: Cross-sectional population-based study using data from the fourth wave of the Trøndelag Health Survey (HUNT4) in Norway. Data were obtained from the subproject HUNT4 Hearing which collected audiometric data of people > 70 years (N = 13,197). Analyses were performed on all participants who had completed audiometry and measured balance using the Short Physical Performance Battery (SPPB), which was scored from 0 (worst score) to 12. The hearing threshold was expressed as a pure tone average (PTA). Associations between the hearing threshold for the best and worst ear and physical performance were analyzed by linear regression models adjusted for age, sex, education, diabetes, and cardiovascular disease. Hearing threshold was indicated with steps of 10 dB. RESULTS: Of 13,197 eligible participants, 4101 who completed audiometry and SPPB (52.3% women. mean age 76.3 years) were included. The analyses revealed an association between reduced SPPB and increased hearing threshold in the best ear (b = - 0.296; 95% CI - 0.343 to - 0. 249; P < 0.001) and the worst ear (b = - 0.229; 95% CI - 0.270 to - 0.189; P < 0.001). CONCLUSIONS: In this population study, we found that the increased hearing threshold was associated to reduced physical performance as measured by SPPB. The association seemed to be strongest for the best ear. The association between hearing threshold and physical performance illustrates the importance of assessing physical performance in people with hearing loss to prevent the risk of falls and disability. The underlying causes of the associations between hearing loss and poorer physical performance are not fully understood and should be further investigated. LEVEL OF EVIDENCE: Level 3.

Attending work or not when sick - what makes the decision? A qualitative study among car mechanics.

BACKGROUND: High prevalence of sickness absence in countries with generous welfare schemes has generated debates on mechanisms that may influence workers' decisions about calling in sick for work. Little is known about the themes at stake during the decision-making process for reaching the choice of absence or attendance when feeling ill. The aim of the study was to examine decisions of absence versus attendance among car mechanics when feeling ill. METHODS: Interviews with 263 male car mechanics from 19 companies were used for the study, analysed by systematic text condensation and presented as descriptions and quotations of experiences and opinions. RESULTS: Three major themes were at stake during the decision-making process: 1) Experienced degree of illness, focusing on the present health condition and indicators of whether you are fit for work or not; 2) daily life habits, where attending work was a daily routine, often learned from childhood; 3) the importance of the job, with focus on the importance of work, colleagues, customers and work environment. CONCLUSIONS: The car mechanics expressed a strong will to attend work in spite of illness. Knowledge about attitudes and dilemmas in reaching the decision regarding sickness absence or sickness attendance is useful in the prevention of sickness absence.

How do physiotherapists understand and interpret the "Pain Attitudes and Beliefs Scale"? A cognitive interview study.

BACKGROUND: The Pain Attitudes and Beliefs Scale (PABS) for physiotherapists aims to differentiate between clinicians' biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain (LBP). Objective: To study the content validity of the Norwegian PABS by following international guidelines: exploring its relevance, comprehensibility and comprehensiveness. Methods: Cognitive interviews were performed using the Three-Step Test Interview, consisting of think-aloud techniques, retrospective probing and in-depth interviews. Eleven Norwegian physiotherapists with a diversity of professional backgrounds participated. Results: The participants encountered little difficulty in completing the PABS. All items were deemed relevant and important but five items had ambiguous formulations which can easily be handled. The biomedical subscale appeared to be a comprehensive representation of biomedical treatment orientation. The biopsychosocial subscale was found to lack items concerning cognitive behavioral aspects of LBP management, such as patient education, therapeutic alliance, shared decision making and graded exposure. Conclusions: This study provides empirical evidence that the Norwegian version of the PABS-PT is relevant and comprehensible, provided some minor adjustments. The biopsychosocial subscale, however, lacks comprehensiveness, as it is not able to capture important aspects of contemporary biopsychosocial best practice care. Measurement of biopsychosocial treatment orientation may therefore be incomplete.

Prevalence and distribution of musculoskeletal pain in patients with dizziness-A systematic review.

BACKGROUND AND PURPOSE: Musculoskeletal disorders are among the leading causes of disability globally, but their role in patients with dizziness and imbalance is not well understood or explored. Such knowledge may be important as musculoskeletal pain and dizziness can mutually influence each other, leading to a complex condition requiring more comprehensive approaches to promote successful recovery. We conducted a systematic review to examine the extent and characteristic of reported musculoskeletal pain in patients with dizziness. METHODS: A comprehensive literature search in Medline, Embase, Cochrane, Scopus, Amed, Google Scholar, SveMed+, and Web of Science was conducted in March 2021. Inclusion criteria were studies examining patients with a vestibular diagnosis, patients with cervicogenic dizziness and patients included based on having dizziness as a symptom; and reported musculoskeletal pain. Data regarding age, sex, sample size, diagnosis and musculoskeletal pain was extracted. The Crowe Critical Appraisal Tool was used for assessing methodical quality of the included studies. RESULTS: Out of 1507 screened studies, 16 studies met the inclusion criteria. The total sample consisted of 1144 individuals with dizziness. The frequency of patients reporting pain ranged between 43% and 100% in the included studies. Pain intensity were scored between 5 and 7 on a 0-10 scale. Pain in the neck and shoulder girdle was most often reported, but musculoskeletal pain in other parts of the body was also evident. DISCUSSION: In the included studies, musculoskeletal pain was highly prevalent in patients with dizziness, with pain intensity that may have a moderate to severe interference with daily functioning. Pain in the neck and shoulder is well documented, but there are few studies addressing musculoskeletal pain in additional parts of the body. More research is needed to understand the relations between dizziness and musculoskeletal pain.

Basic Body Awareness Therapy versus standard care in hip osteoarthritis. A randomized controlled trial.

BACKGROUND: Compensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA. OBJECTIVE: To examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE). STUDY DESIGN: A prospective, assessor-blinded, and block-randomized controlled trial. METHODS: Community-living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self-reported aspects of function and health. RESULTS: At pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty-one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per-protocol analysis showed changes in favor of the intervention group for self-efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included. CONCLUSIONS: BBAT was not found to be a more effective treatment modality than self-initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.

Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints.

OBJECTIVES: To explore GPs' considerations in decision-making regarding sick-listing of patients suffering from SHC. DESIGN: Qualitative analysis of data from nine focus-group interviews. SETTING: Three cities in different regions of Norway. Participants. A total of 48 GPs (31 men, 17 women; aged 32-65) participated. The GPs were recruited when invited to a course dealing with diagnostic practice and assessment of sickness certificates related to patients with composite SHCs. RESULTS: Decisions on sick-listing patients with SHCs were regarded as a very challenging task. Trust in the patient's own story and self-judgement was deemed crucial, but many GPs missed hard evidence of illness and loss of function. Several factors that might influence decision-making were identified: the patients' ability to present their story to evoke sympathy, the GP's prior knowledge of the patient, and the GPs' own experience as a patient and their tendency to avoid conflicts. The approach to the task of sick-listing differed from patient-led cooperation to resistant confrontation. CONCLUSION AND IMPLICATIONS: Issuing sickness certification in patients with composite health complaints is considered challenging and burdensome. It is seen as mainly patient-driven, and the decisions vary according to GPs' attitudes, beliefs, and personalities. Guiding the GPs to a more focused awareness of the decision process should be considered.