Bakgrund: Långvarig smärta antas drabba var femte person i Sverige och bland dem är rörelserädsla vanligt. Rörelserädsla är komplext och kan påverka en person biomedicinskt, psykologiskt och socialt, varför fysioterapeuten bör använda ett beteendemedicinskt arbetssätt. Forskning har visat att fysioterapeuter har svårt att identifiera psykosociala faktorer kopplade till rörelserädsla. Syfte: Att studera hur fysioterapeuter beskriver sitt arbete med patienter med rörelserädsla relaterat till långvarig smärta. Metod: En kvalitativ intervjustudie genomfördes. Sju fysioterapeuter från olika typer av verksamheter rekryterades genom ett ändamålsenligt bekvämlighetsurval. Data analyserades manifest med en induktiv ansats. Resultat: Analysen resulterade i fem kategorier med tre till fem underkategorier vardera: “Uppfattning om utmärkande drag och beteenden hos patienter med rörelserädsla”, “Grundförutsättningar för ett framgångsrikt arbete”, “Identifiera och skapa förståelse för patientens rörelserädsla”, “Strategier för att förändra tankar och känslor i samband med rörelse” och “Omständigheter som kan göra arbetet utmanande eller svårt”. Slutsats: Ett biopsykosocialt och beteendemedicinskt arbetssätt beskrevs användas vid arbetet med dessa patienter. Arbetet beskrevs som komplext och utmanande för en fysioterapeut att hantera ensam. Teamarbete, tydliga målsättningar och en god relation mellan parterna uttrycktes vara viktigt för att lyckas. / Background: Chronic pain is assumed to affect every fifth person in Sweden and fear of movement is common. Fear of movement is complex and affects a person biomedically, psychologically and socially, why physiotherapist's should use a behavioral medicine approach. Research has shown that physiotherapist's have difficulty identifying psychosocial factors involved in fear of movement. Aim: To study how physiotherapist's describe their work with patients with fear of movement related to chronic pain. Method: A qualitative interview study was conducted. Seven physiotherapist's were recruited through a purposive convenience sample. Data was analyzed manifestly with an inductive approach. Result: The analysis resulted in five main categories: “Perception of distinguishing features and behaviors in patients with fear of movement”, “Essential prerequisites for successful work”, “Identify and create understanding of the patient's fear of movement”, “Strategies for changing thoughts and emotions related to movement” and “Circumstances that can make the work challenging or difficult”. Conclusion: A biopsychosocial and behavioral medicine approach was described to be used when working with these patients. The work was described as challenging for physiotherapist's to handle alone. Teamwork, clear goal setting and a good patient-therapist relationship were expressed to be important.

No description available.

Rehabilitation treatments used for fear avoidance need to be further developed to be more adaptable to the different needs of patients. Fear avoidance is a condition whereby people avoid performing certain movements because they afraid of the pain they will experience or think they will experience from performing the movement. There is a need for exercises in fear-avoidance treatments to be fun, motivating and effective. This is to encourage the patients to continuously do exercises in the treatment. In this master thesis project, the experience of having audio feedback in music whilst performing exercises is investigated. A proof-of-concept prototype using one way of presenting audio feedback was built and used in experiments to investigate the experience. The prototype was built in Java and uses a camera-based motion capture system and markers to track movements. The results show that 100% of the participants thought about movements they had made when feedback was given, 60% claimed the feedback made them feel more aware of how they should move, and 70% said that the music with audio feedback was fun and/or exciting. The conclusion is that the use of music encouraged the participants to perform the exercises, and the feedback made them more conscious of the movements in the exercises and they reflect about the movements they made. / Rehabiliteringsmetoder som används vid behandling av rörelserädsla behöver vidareutvecklas för att behandlingar ska kunna anpassas bättre efter olika behov hos patienter. Rörelserädsla är ett tillstånd där en person undviker att utföra vissa rörelser för att hon är rädda för smärtan som hon upplever eller tror hon kommer uppleva när rörelsen utförs. Det finns behov av att övningar som utförs i behandlingar är roliga, motiverande och effektiva i att behandla rörelserädsla. Detta för att uppmuntra patienter som lider av rörelserädsla att utföra övningar de fått i rehabiliteringsbehandlingen. Detta masterarbete undersöker upplevelsen av att ha auditiv återkoppling i musik medan övningar utförs. En proof-of-concept prototyp som använder en typ av ljudfeedback byggdes och användes i experiment för att undersöka detta. Prototypen är byggd i Java och använder ett system för kamera-baserad rörelseföljning samt markörer för att följa rörelser. Resultaten visar att 100% av deltagarna tänkte på rörelser de utfört då ljudfeedback gavs i musiken, 60% tyckte att de blev mer medvetna om hur de skulle göra rörelserna och 70% sa att musik med ljudfeedback var kul och/eller spännande. Slutsatsen är att användandet av musik uppmuntrade deltagarna till att utföra övningarna samt att återkopplingen gjorde att de blev mer medvetna om rörelserna i övningarna och reflekterade kring rörelser de gjorde.

As activity levels of intensively managed broiler chicken vary over time, detailed knowledge on their influence is potentially useful to further adjust welfare assessment schemes. Therefore, this study investigated the influence of daytime and age on the performance of broiler chicken in two applied fear tests.On-farm studies were carried out in 14 flocks of intensively managed broiler chicken. A forced and a voluntary approach test were conducted during morning and evening hours and at three different ages (1: 6-12d; 2: 21-24d; 3: prior to slaughter). At each observation, avoidance distances (AD) and the number of animals voluntarily approaching (VA) an observer were collected.No significant correlation was found between daytime and AD or VA. When tested at different ages, daytime and VA were significantly correlated (1: r= 0.56*; 2: r= 0.40*; 3: r= 0.64*), but the results were not consistent. At three weeks the VA was found to be higher in the morning but at younger age and prior to slaughter, more birds approach an observer in the evening. Both, approach and avoidance peaked at three weeks and decreased prior to slaughter. Further, the effect of differing observer locations in the chicken house on the behavioural response of broiler chicken was studied. A higher proportion of birds voluntarily approached an unknown human in the area close to the main entrance door, but the avoidance behaviour was not affected.From the results of this study I conclude, that the time of assessment has no effect on avoidance or approach behaviour of commercial slow-growing broiler chicken. However, fear related behaviour changed depending on age. This makes the applied tests potentially applicable independent of daytime restrictions when performed with birds of the same age.

No description available.

Chronic pain is common and a burden for both the individual and society. In chronic pain, the pain has lost its function as a warning system and instead has become a disease in itself. Neurobiologically, several areas of the brain are involved, but to gain a broader understanding of the long-term pain, the biopsychosocial model is the best starting point. In line with thisand many scientific studies since the late 90's, psychological factors have proven to be an important factor in the development and maintenance of chronic pain. Interdisciplinary multimodal rehabilitation programs (IMMRP) are the treatment currently given to patients with long-term pain in the specialized pain rehabilitation. When the IMMRP has been reviewed, patients have shown improvement over time, but it is not possible to say whether it is the IMMRP or which parts of the IMMRP that explain the improvement (1). In this licentiate thesis, I have studied the importance of psychological factors in the rehabilitation of patients with chronic pain. This has been done in three studies reported in three published articles. All the studies have been close to the clinic and have been performed on patients in the specialized pain rehabilitation care in Sweden. The first article studied the effect of the multimodal investigation (MMI). More specifically, it was investigated whether alliance building and feelings of validation in patients with chronic pain affected their acceptance of pain, pain management, catastrophic thoughts, and depression. This was performed in a "single case" study on six patients in MMI. The results showed that despite good alliance and sense of validation, acceptance increased only in one patient and no improvement was seen in pain management, catastrophizing, and depression. In study two, subgroups of patients with chronic pain were studied. The subgroup analysis showed that patients referred for IMMRP could be divided into groups with different profiles regarding emotional problems and pain avoidance. These profiles were important for how the patients relatedto their pain and the results of IMMRP. The results of the study can increase the understanding of which patients should be selected for IMMRP and how the treatment can be adapted to the patients' needs. In study three, opioid treatment in patients with long-term pain who were referred to IMMRP was studied. The result showed that opioid prescribing was common and 55% of the participants received at least one prescription for opioids during the two years after the first assessment. It also turns out that there was a connection between individual patient characteristics (especially pain and depressive symptoms) and opioid prescription. Understanding how individual patient characteristics relate to prescribing patterns and long-term opioid use is an important prerequisite for managing opioid prescribing and the basics for preventing overuse. Overall, this licentiate thesis shows that MMU has no therapeutic effect on patients with long-term pain. It also shows that patients with chronic pain are a heterogeneous group that can be divided into subgroups based on psychological characteristics. The subgroups, in turn, had different ways of managing their pain and absorbing the treatment offered. In addition, it emerged that opioid prescribing was common among patients with long-term pain and that there was a link between opioids and patient characteristics.

L’invalidité attribuable à la douleur représente un problème important en raison de ses coûts personnels, financiers et sociétaux. L’effort scientifique mène à l’identification des facteurs de risque pour l’évolution de la douleur vers un état qui mine la capacité de la personne affligée à vaquer à ses occupations fondamentales. Cet effort met en relief le rôle déterminant que jouent les facteurs psychosociaux à chaque stade de l’évolution vers l’invalidité en raison de la douleur. Parmi les facteurs mis en cause, se trouvent les difficultés psychologiques (dépression, anxiété, somatisation, trouble de la personnalité, catastrophisme et évitement de l’activité), l’insatisfaction au travail et le contexte de réclamation. Forts de cette connaissance, les pays industrialisés se dotent de lignes directrices pour la prise en charge de la douleur aiguë dans le but de réduire les coûts, tant pour la personne que pour la société. Vingt ans après la parution des premiers guides de pratique, et la publication subséquente de dizaines d’autres guides véhiculant essentiellement les mêmes informations, les médecins peinent toujours à appliquer les recommandations. À partir des données probantes issues de la littérature scientifique, le présent ouvrage propose une synthèse critique des résultats pour pousser la réflexion et faire avancer la démarche dans le sens d’une réduction des coûts personnels, financiers et sociétaux. / Disability due to pain is a significant problem owing to its personal, financial and societal costs. Scientific efforts are aimed towards the identification of the risk factors for the development of pain leading to a state which undermines the afflicted person’s ability to attend to his/her basic functions. These efforts highlight the key role that psycho-social factors play in each stage of the progression towards disability due to pain. Among the influencing factors are psychological difficulties (depression, anxiety, somatization, personality disorder, catastrophization and activity avoidance), dissatisfaction at work and the compensation context. In light of this awareness, industrialized countries have instituted policies for the management of acute pain with the aim of reducing costs, both for the patient and for society. Twenty years after the appearance of the first clinical practice guidelines and the subsequent publication of numerous other guides propounding essentially the same information, physicians are still struggling to apply the recommendations. Relying on the evidence from the scientific literature, this study proposes a critical synthesis of the results to provoke thought and to advance the process towards a reduction in the personal, financial and societal costs of pain.

Low back pain has become one of the most influential musculoskeletal diseases of modern society. It is one of most expensive diseases in terms of medical costs and increased worker absenteeism, which can lead to permanent disability and places strain on the economy as a whole. Pain has been recognised as a disease in itself, which has certain consequences when it becomes chronic. Many kinds of treatment options exist with varying degrees of success. The question is thus which treatment option is the most favourable and cost-effective. Conservative treatment is the most recommended form of treatment when no serious underlying diseases are present. Exercise has been shown to be very effective in the treatment of chronic low back pain but there are still questions regarding the use of exercise therapy. The predetermined goal of the study was to ascertain whether an aggressiveprogressive exercise programme, and specifically what kind of exercises, would be more effective in the treatment of chronic low back pain. This was achieved through a number of steps, which included an extensive literature review, the identification of an appropriate test battery with related minimum physical requirements and cut scores, subject recruitment and screening of subjects, the implementation of the intervention and the subsequent re-testing of the subjects. Once the data was completed, the next step was to make use of two case studies to assist in illustrating the effectiveness of individual patients compared to the sample as a whole. These case studies were of patients who completed the entire programme but one took longer to complete the programme. This assists in illustrating the value of maintaining exercise protocol. The results from the present study are extremely positive. The two case studies provided a glimpse of the potential value that could be added through the implementation of more aggressive-progressive exercise interventions in the treatment of chronic low back pain. The final product will greatly assist exercise therapists concerned with the treatment of chronic low back pain along with cognitive-behavioural techniques. Hopefully this study will provide insight into managing chronic low back pain in South Africa from an exercise standpoint. Secondly the study will provide practical techniques to implement in an era in which economic difficulties are rife.AFRIKAANS: Laerugpyn het een van die invloedrykste muskuloskeletale siektes van die moderne samelewing geword. Dit is een van die duurste siektes in terme van mediese koste en verhoogde siekverlof deur werkers, wat kan lei tot permanente ongeskiktheid en ’n verhoogde las plaas op die ekonomie as ’n geheel. Pyn word erken as ’n siekte op sy eie wat sekere gevolge het wanneer dit chronies begin raak. Verskeie soorte behandelingsopsies is beskikbaar met variërende grade van sukses. Die vraag is dus watter behandelingsopsie is die bruikbaarste en koste-doeltreffendste. Konserwatiewe behandeling is die mees aanbevole metode van behandeling wanneer daar geen ernstige onderliggende siektetoestande teenwoordig is nie. Dit is reeds bewys dat oefening baie doeltreffend is in die behandeling van chroniese laerugpyn. Daar bestaan egter steeds vrae rondom die gebruik van oefening as terapie.Die vooropgestelde doelwit van die studie was om te bepaal of ’n aggressiewe-progressiewe inoefeningsprogram doeltreffend sal wees in die behandeling van chroniese laerugpyn, en meer spesifiek watter tipe oefening die doeltreffendste sal wees. Die navorsing het bestaan uit ’n paar stappe wat ingesluit het ’n intensiewe literatuursoektog, die identifisering van ’n gepaste toetsbattery met verwante minimum fisieke vereistes en afsnytellings, die verkryging en evaluering van proefpersone, die implementering van die intervensieprogram en die daaropvolgende hertoetsing van die proefpersone.Nadat die invordering van die data en die gepaardgaande analise van die data voltooi is, was die volgende stap om gebruik te maak van twee gevallestudies ten einde die doeltreffendheid van die intervensieprogram vir individuele proefpersone te ilustreer deur dit te vergelyk met die groep as ’n geheel. Die twee gevallestudies was van proefpersone wat die intervensieprogram volledig voltooi het, alhoewel die een proefpersoon langer geneem het om die intervensieprogram te voltooi. Dit help om die navolgingswaarde van ’n inoefeningsprotokol te illustreer. Die resultate van die huidige studie is uiters positief. Die twee gevallestudies gee ’n mate van insig wat betref die potensiële waarde wat verkry kan word deur die implementering van ’n meer aggressiewe-progressiewe inoefeningsintervensie vir die behandeling van chroniese lae rugpyn. Die finale produk sal die nodige ondersteuning aan oefeningsterapeute bied wat onseker is oor die behandeling van chroniese laerugpyn deur middel van aggressiewe-progressiewe inoefeningsintervensies en kognitiewe gedragstegnieke. Hierdie studie sal dus die begrip en insig van die behandeling van chroniese laerugpyn in Suid-Afrika verhoog vanuit ’n oefeningsuitgangspunt. Tweedens sal die studie die gebruik van praktiese oefentegnieke aanmoedig in ’n era waarin ekonomiese tye moeilik is. / Thesis (DPhil)--University of Pretoria, 2011. / Biokinetics, Sport and Leisure Sciences / unrestricted

Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care. To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV). Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.