OBJECTIVE: To investigate the appreciation of written education about pain neurophysiology in patients with fibromyalgia (FM) and its effects on illness perceptions and perceived health status.METHODS: A booklet explaining pain neurophysiology was sent to participants with FM. Appreciation was assessed with 10 questions addressing relevance (0-30) and reassurance (0-30). Illness perceptions, catastrophizing and health status were measured with the Revised Illness Perception Questionnaire (IPQ-R), the Pain Catastrophizing Scale (PCS) and the Fibromyalgia Impact Questionnaire (FIQ) at baseline (T0), after a 2-week control period (T1) and 6 weeks after the intervention (T2).RESULTS: Forty-one patients participated. Mean (SD) scores for relevance and reassurance were 21.6 (5.6) and 18.7 (5.7), respectively. Only illness coherence, emotional representations, pain and fatigue changed significantly between T0 and T2. Correlations between appreciation and changes in outcomes ranged between r=0.00 and r=0.34.CONCLUSIONS: Although a majority of subjects appreciated the written information, it did not have clinically relevant effects on illness perceptions, catastrophizing or impact of FM on daily life.PRACTICE IMPLICATIONS: Written education about pain neurophysiology is inadequate toward changing illness perceptions, catastrophizing or perceived health status of participants with FM; education should be incorporated into a broader multidisciplinary self-management program.
Background: Healthcare practitioner beliefs influence patients’ beliefs and health outcomes in musculoskeletal (MSK) pain. A validated questionnaire based on modern pain neuroscience assessing Knowledge and Attitudes ofPain (KNAP) was unavailable.Objectives: The aim of this study was to develop and test measurement properties of KNAP.Design: Phase 1; Development of KNAP reflecting modern pain neuroscience and expert opinion. Phase 2; a crosssectional and longitudinal study among Dutch physiotherapy students.Method: In the cross-sectional study (n = 424), internal consistency, structural validity, hypotheses testing, and Rasch analysis were examined. Longitudinal designs were applied to analyse test-retest reliability (n = 156), responsiveness, and interpretability (n = 76).Results: A 30-item KNAP was developed in 4 stages. Test-retest reliability: ICC (2,1) 0.80. Internal consistency: Cronbach’s α 0.80. Smallest Detectable Difference 90%: 4.99 (4.31; 5.75). Structural validity: exploratory factor analysis showed 2 factors. Hypotheses testing: associations with the Pain Attitudes and Beliefs Scale for Physiotherapists biopsychosocial subscale r = 0.60, with biomedical subscale r = 0.58, with the Neurophysiology of Pain Questionnaire r = 0.52. Responsiveness: 93% improved on KNAP after studying pain education. MinimalImportant Change: 4.84 (95%CI: 2.77; 6.91).Conclusions: The KNAP has adequate measurement properties. This new questionnaire could be useful to evaluate physiotherapy students’ knowledge and attitudes of modern pain neuroscience that could help to create awareness and evaluate physiotherapy education programs, and ultimately provide better pain management.
Context: Only 55% of the athletes return to competitive sports after an anterior cruciate ligament (ACL) injury. Athletes younger than 25 years who return to sports have a second injury rate of 23%. There may be a mismatch between rehabilitation contents and the demands an athlete faces after returning to sports. Current return-to-sports (RTS) tests utilize closed and predictable motor skills; however, demands on the field are different. Neurocognitive functions are essential to manage dynamic sport situations and may fluctuate after peripheral injuries. Most RTS and rehabilitation paradigms appear to lack this aspect, which might be linked to increased risk of second injury.Objective: This systematic and scoping review aims to map existing evidence about neurocognitive and neurophysiological functions in athletes, which could be linked to ACL injury in an integrated fashion and bring an extensive perspective to assessment and rehabilitation approaches.Data Sources: PubMed and Cochrane databases were searched to identify relevant studies published between 2005 and 2020 using the keywords ACL, brain, cortical, neuroplasticity, cognitive, cognition, neurocognition, and athletes.Study Selection: Studies investigating either neurocognitive or neurophysiological functions in athletes and linking these to ACL injury regardless of their design and technique were included.Study Design: Systematic review. Level of Evidence: Level 3.Data Extraction: The demographic, temporal, neurological, and behavioral data revealing possible injury-related aspects were extracted and summarized.Results: A total of 16 studies were included in this review. Deficits in different neurocognitive domains and changes in neurophysiological functions could be a predisposing risk factor for, or a consequence caused by, ACL injuries.Conclusion: Clinicians should view ACL injuries not only as a musculoskeletal but also as a neural lesion with neurocognitive and neurophysiological aspects. Rehabilitation and RTS paradigms should consider these changes for assessment and interventions after injury.
