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).

Validity of the test-table-test for Nordic skiing for classification of paralympic sit-ski sports participants.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To assess the interrater reliability and validity of the test-table-test (TTT) with which paralympic sports participants involved in Nordic sit-ski sports may be classified. SETTING: Movement laboratory in a rehabilitation centre, The Netherlands. METHODS: Thirty-three persons with a spinal cord injury caudally to Th2, a leg amputation, poliomyelitis affecting the trunk and/or lower extremities, or cerebral palsy participated. Subjects were classified according to a classification system for Nordic skiing (that is, five subclasses between LW10 and LW12) by two raters, involving, among others, a combination of four balance tests called TTT. The validity of the TTT was investigated using a gold standard, involving balance perturbation tests on a force plate and centre of pressure (CoP) displacement measurements. RESULTS: As for the interrater reliability, Spearman's rank-correlation coefficient was 0.95 (P<0.001). As regards the validity of the TTT, correlation coefficients ranging from 0.61 to 0.74 (P<0.001) were found when comparing the data with the gold standard. CONCLUSION: Interrater reliability was high in both scoring and classification. With regard to TTT validity, strong positive correlations between CoP displacement and TTT classification were found. Overall, the results of this study show that the TTT is a reliable and valid test. However, the relations between TTT and CoP displacement in the LW10 and LW10.5 subclasses found in this study are somewhat vague, which could be due to the small number of participants in these subclasses. For the LW10 and LW10.5 subclasses further refinement of the four tests within the TTT is warranted.