Multimodal cognitive behavioral treatment of patients sicklisted for musculoskeletal pain: a randomized controlled study. Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults Does an Exercise Intervention Improving Aerobic Capacity Among Construction Workers Also Improve Musculoskeletal Pain, Work Ability, Productivity, Perceived Physical Exertion, and Sick Leave?: A Randomized Controlled Trial Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: Background, design and conceptual model of FINALE Determinants of disability after a work related musculetal injury. Cognitive behavioral stress management effects on injury and illness among competitive athletes: A Randomized Clinical trial Effect of cognitive task on postural control of the patients with chronic ankle instability during single and double leg standing. Effects of a movement training oriented rehabilitation program on symptoms, functional limitations and acromiohumeral distance in individuals with subacromial pain syndrome. Does having a computerized prosthetic knee influence cognitive performance during amputee walking? Effect of a general fitness program on musculoskeletal symptoms, clinical status, physiological capacity, and perceived work environment among home care service personnel Walking and talking therapy: improving cognitive-motor dual-tasking in neurological illness. Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors Efficacy of a Multimodal Cognitive Rehabilitation Including Psychomotor and Endurance Training in Parkinson's Disease Effects of Task Goal and Personal Preference on Seated Reaching Kinematics After Stroke Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study Evaluating the cognitive consequences of mild traumatic brain injury and concussion by using electrophysiology.
In a r and omized controlled study multimodal cognitive behavioral treatment ( MMCBT ) , including physical treatment , cognitive behavioral modification , education , and examination of the work situation for each patient , was given to patients sick-listed for musculoskeletal pain ( n = 469 ) . Patients were recruited through the National Insurance System . After a pre-test by an independent physiotherapist the patients were allocated at r and om to the  intervention group ( n = 312 ) or the control group ( n = 157 ) . The MMBCT program lasted for 4 weeks . The control group returned to their general practitioners , without any feedback or advice on therapy from the project . At the one year follow-up the MMCBT group had not returned to work at a higher rate than the control group receiving ordinary treatment available through their general practitioners . However , the MMCBT group had improved their ergonomic behavior , work potential , life quality , physical , and psychological health Purpose Physical exercise and cognitive training have been shown to enhance cognition among older adults . However , few studies have looked at the potential synergetic effects of combining physical and cognitive training in a single study . Prior trials on combined training have led to interesting yet equivocal results . The aim of this study was to examine the effects of combined physical and cognitive interventions on physical fitness and neuropsychological performance in healthy older adults . Methods Seventy-six participants were r and omly assigned to one of four training combinations using a 2 × 2 factorial design . The physical intervention was a mixed aerobic and resistance training program , and the cognitive intervention was a dual-task ( DT ) training program . Stretching and toning exercises and computer lessons were used as active control conditions  . Physical and cognitive measures were collected pre- and postintervention . Results All groups showed equivalent improvements in measures of functional mobility . The aerobic – strength condition led to larger effect size in lower body strength , independently of cognitive training . All groups showed improved speed of processing and inhibition abilities , but only participants who took part in the DT training , independently of physical training , showed increased task-switching abilities . The level of functional mobility after intervention was significantly associated with task-switching abilities . Conclusion Combined training did not yield synergetic effects . However , DT training did lead to transfer effects on executive performance in neuropsychological tests . Both aerobic-resistance training and stretching-toning exercises can improve functional mobility in older adults Objective : To investigate whether an exercise intervention shown to increase aerobic capacity , would also lead to less musculoskeletal pain ; improved work ability , productivity , and perceived physical exertion ; and less sick leave . Methods : Sixty-seven construction workers were r and omized into an exercise group training 3 × 20 minutes per week and a control group . Question naires and text messages were completed before and after the 12-week intervention . Results : No significant changes were found in musculoskeletal pain , work ability , productivity , perceived physical exertion , and sick leave with the intervention . Question naires and text messages provided similar results of pain and work ability . Conclusions : Although the intervention improved aerobic capacity , it was not successful in improving musculoskeletal pain and other work-related factors . A detectable improvement presumably requires a more multifaceted intervention , larger sample size , or longer follow-up . Text messages may be a convenient data - collection method in future studies Background A mismatch between individual physical capacities and physical work dem and s enhance the risk for musculoskeletal disorders , poor work ability and sickness absence , termed physical deterioration . However , effective intervention strategies for preventing physical deterioration in job groups with high physical dem and s remains to be established . This paper describes the background , design and conceptual model of the FINALE programme , a framework for health promoting interventions at 4 Danish job groups ( i.e. cleaners , health-care workers , construction workers and industrial workers ) characterized by high physical work dem and s , musculoskeletal disorders , poor work ability and sickness absence . Methods / Design A novel approach of the FINALE programme is that the interventions , i.e. 3 r and omized controlled trials ( RCT ) and 1 exploratory case-control study are tailored to the physical work dem and s , physical capacities and health profile of workers in each job-group . The RCT among cleaners , characterized by repetitive work tasks and musculoskeletal disorders , aims at making the cleaners less susceptible to musculoskeletal disorders by physical coordination training or cognitive behavioral theory based training ( CBTr ) . Because health-care workers are reported to have high prevalence of overweight and heavy lifts , the aim of the RCT is long-term weight-loss by combined physical exercise training , CBTr and diet . Construction work , characterized by heavy lifting , pushing and pulling , the RCT aims at improving physical capacity and promoting musculoskeletal and cardiovascular health . At the industrial work-place characterized by repetitive work tasks , the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training , CBTr and participatory ergonomics . The overall aim of the FINALE programme is to improve the safety margin between individual re sources ( i.e. physical capacities , and cognitive and behavioral skills ) and physical work dem and s , and thereby reduce the physical deterioration in a long term perspective by interventions tailored for each respective job-group . Discussion The FINALE programme has the potential to provide evidence -based knowledge of significant importance for public health policy and health promotion strategies for employees at high risk for physical deterioration . Trial registration sIS RCT N96241850 , NCT01015716 and OBJECTIVE Musculoskeletal soft tissue injuries consume considerable re sources in personal suffering , medical care , work absenteeism , and compensation benefits . Our aim was to determine specific clinical and behavioral factors that prognostically influence return to work following musculoskeletal work related injuries . METHODS A longitudinal cohort study was conducted on 148 r and omly selected workers who had not returned to work in 3 months following musculoskeletal soft tissue injury . The cohort was identified from the files of the Workers ' Compensation Board of Ontario , Canada . The workers were interviewed and assessed at 3 , 9 , 15 , and 21 months after injury . The WHO Classification of Impairment , Disabilities and H and icap was used as the conceptual framework . The analysis employed a proportional hazards regression model with allowance for time dependent covariates . RESULTS The rate of return to work for men was 1.5 times that for women , and 20 % less for every 10 year increase in age . Controlling for sex and age , psychological distress and functional disability were associated with a slower rate of return to work . The rate of return to work for workers who were provided with modified jobs was 2 times higher than for those with no such accommodation in employment . CONCLUSION The negative effect of psychological distress and functional disability on return to work rates must be considered in the design and delivery of rehabilitation programming for workers with musculoskeletal soft tissue injuries . The employer 's provision of a " modified job " is important in the prevention of continued disability Cognitive behavioral stress management ( CBSM ) has previously been found to reduce fatigue , depression , and cortisol response to heavy exercise training among competitive collegiate athletes and to speed physical and psychological recovery from surgery ( 1,2 ) . Our study assessed the efficacy of a CBSM program to reduce the frequency of injury and illness among collegiate athletes in a r and omized , single-blind , controlled clinical trial . Following assessment of baseline medical history , mood state , stress , cortisol , sleep , alcohol use , and exercise training , collegiate rowers were stratified by gender and competitive level and r and omly assigned to either a control group or a CBSM group . Exercise training information and psychosocial assessment s were repeated immediately following the intervention period , and health care providers who were blinded to participant assignment recorded the frequency of medical visits and the number of days injured or ill until the end of the season . Athletes r and omly assigned to a CBSM group experienced significant reductions in the number of illness and injury days as compared to control group athletes . CBSM participants also had half the number of health service visits as did controls . The data suggest that a time-limited CBSM intervention design ed specifically for an athlete population may be an effective prophylactic treatment to reduce the incidence of injury and illness among competitive collegiate athletes OBJECTIVE The aim of this study was to investigate the effect of a cognitive task on st and ing postural control of the injured and non-injured leg of athletes with chronic ankle instability . METHODS Postural stability was measured by center of pressure parameters while chronic ankle instability patients ( n = 8) r and omly performed single and double leg st and ing in isolation or concurrently with a digit-backward cognitive task . RESULTS After performing a concurrent cognitive task , anteroposterior sway significantly decreased in injured leg ( P < 0.05 ) and area significantly decreased in both injured and non-injured legs ( P < 0.05 ) . There was no significant difference in all center of pressure parameters between injured and non-injured legs . CONCLUSION The findings confirm the effect of a concurrent digit-backwards memory task on single leg st and ing balance in chronic ankle instability patients but the response to cognitive loading was not significantly different between the injured and non-injured legs BACKGROUND Multiple factors have been associated with the presence of a subacromial pain syndrome ( SPS ) , including deficits in performance of scapular and glenohumeral muscles . Such deficits can lead to inadequate kinematics and decreased acromiohumeral distance ( AHD ) . Exercises that aim at correcting these deficits , such as movement training , were suggested to improve symptoms and functional limitations . To date , few studies have assessed outcomes following an intervention focused on movement training . OBJECTIVES Evaluate the effects of a rehabilitation program based on movement training on symptoms , functional limitations and AHD in individuals with SPS . DESIGN Prospect i ve single group pre-post design . METHODS Twenty-five participants with SPS ( SPS group ) participated in a 6-week program .  Twenty asymptomatic volunteers were recruited for normative AHD values ( control group ) . Outcomes of both groups were evaluated at baseline and 6 weeks , i.e. immediately following intervention for the SPS group . Changes in symptoms and functional limitations for SPS group were assessed using the Western Ontario Rotator Cuff ( WORC ) index and Disability of the Arm Shoulder and H and ( DASH ) question naire . Changes in AHD for both groups were assessed using ultrasonographic measures . RESULTS Following the rehabilitation program , the scores on WORC and DASH were significantly improved ( p < 0.001 ) . AHD increased significantly in the SPS group ( p = 0.019 ) , especially in a subgroup with initial deficits ( p < 0.001 ) . CONCLUSION The rehabilitation program yielded improvements in symptoms and functional limitations in participants with SPS . Moreover , it led to an increase of the AHD -- thus potentially decreasing subacromial compression , particularly in participants with an initially smaller AHD . The trial was registered at Clinical Trials.gov : identifier -- NCT02395770 OBJECTIVE To compare objective cognitive performance and perception of cognitive burden during walking tasks using 2 different prosthetic knees : a computerized hydraulic knee ( Otto Bock C-leg ) and a noncomputerized hydraulic knee ( Ossur Mauch SNS ) . DESIGN Two-group crossover trial , with participants r and omly assigned to order of prosthesis . Participants completed assessment s under 2 conditions , a self-selected speed walk and a controlled speed walk , on 2 separate occasions ( precrossover , postcrossover ) . SETTING Veterans Health Administration hospital . PARTICIPANTS Eight transfemoral amputees . INTERVENTION Computerized versus noncomputerized prosthetic knee . MAIN OUTCOME MEASURES Objective cognitive performance measures included verbal fluency ( Controlled Oral Word Association Test , Category Test ) , attention and working memory ( serial subtraction ) , and walking speed during cognitive tasks . Measures of perceived cognitive burden included subjective attentional requirements of walking and cognitive tasks and subjective general cognitive burden of prosthesis . RESULTS There were no significant differences in objective cognitive performance on any task between prostheses , nor did walking speed vary by prosthesis during the free-speed walk . Participants reported that walking required less attention while wearing the C-leg and that the C-leg was less of a cognitive burden than the noncomputerized prosthesis . CONCLUSIONS In nondem and ing walking conditions with experienced amputees , participants reported that the more costly C-leg required less cognitive attention than the noncomputerized knee . However , this subjective experience did not translate to improved performance on neuropsychologic screening instruments or on walking speed . Noncomputerized prostheses may be adequate for a majority of amputees , and further research is needed to identify particular groups of amputees ( ie , new amputees , amputees with complex physical or cognitive dem and s ) who may benefit from computerized prostheses The aim of the present controlled study was to evaluate the effect of a general fitness program , performed by an occupational health service , using pre-post assessment for a number of different outcome measures . A total of 160 employees working in the central home care service district of Umeå , Sweden were asked to participate in a program of a 1-year long exercise program . Of the 160 selected , 54 subjects declined to participate and nine subjects were rejected after a medical check up . The remaining 97 subjects participated in a schedule consisting of pre-post medical and physiotherapy examinations , question naires concerning sociodemography , musculoskeletal and general health complaints and work environment , physiological tests of cardiovascular fitness , and of strength and endurance of shoulder flexors and knee extensors , and registration of sick leave . The subjects were r and omly assigned to an exercise ( treatment ) or control group . The exercise group trained twice a week for 1 year using a mixed program including exercises for coordination , strength/endurance , and fitness . The test schedule was repeated for both groups after 1 year . The exercise intervention was associated with positive changes in prevalence and intensity of musculoskeletal and psychosomatic complaints , better physiotherapy status ( less muscle tightness , better neck mobility , and less tender points ) , increased shoulder strength and increased coordination in thigh muscles . However , the exercise group reported worse situations post-exercise concerning aspects of their physical and psychosocial work-environment ( i.e. , concerning ergonomy , influence , appreciation and communication with work manager ) , which might have been due to stress associated with the exercise situation Using r and omized control trial methodology , we evaluated the effectiveness of a 5-week cognitive-motor dual-tasking training program developed to improve performance of a group of people with dual-tasking difficulties arising from acquired brain injury . Training involved twice-daily practice on exercises involving walking being combined with tasks which increased in cognitive dem and over the course of the intervention . A treatment group ( n = 10 ) was compared with a control group ( n = 9 ) . The primary outcome measure was a task requiring participants to walk and carry out a spoken sentence verification task simultaneously . Secondary outcome measures were measures of dual-tasking involving either two motor tasks or two cognitive tasks . A question naire measure relating to activities of daily living requiring dual-tasking was also completed . Compliance with the training program was good . We found evidence of improvement in performance on the primary outcome measure , but little evidence of generalization to other measures . There was some evidence that participants believed that their dual-tasking performance in everyday life was improved after the intervention . The study was limited in terms of sample size , was not blinded and did not control fully for therapist contact time , but has produced valuable data relating to effect sizes associated with this form of intervention . ( JINS , 2009 , 15 , 112 - 120 . ) Background and Objective . This study investigated the relative effects of distributed constraint-induced therapy ( CIT ) and bilateral arm training ( BAT ) on motor performance , daily function , functional use of the affected arm , and quality of life in patients with hemiparetic stroke . Methods . A total of 60 patients were r and omized to  distributed CIT , BAT , or a control intervention of less specific but active therapy . Each group received intensive training for 2 hours/day , 5 days/week , for 3 weeks . Pretreatment and posttreatment measures included the Fugl — Meyer Assessment ( FMA ) , Functional Independence Measure ( FIM ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The proximal and distal scores of FMA were used to examine separate upper limb ( UL ) elements of movement . Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group . The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups . Enhanced performance was found for the distributed CIT group in the MAL , the subtest of locomotion in the FIM , and certain domains of the SIS ( eg , ADL/IADL ) . Conclusion . BAT may uniquely improve proximal UL motor impairment . In contrast , distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis Mild cognitive impairment , especially executive dysfunction might occur early in the course of Parkinson 's disease . Cognitive training is thought to improve cognitive performance . However , transfer of improvements achieved in paper and pencil tests into daily life has been difficult . The aim of the current study was to investigate whether a multimodal cognitive rehabilitation programme including physical exercises might be more successful than cognitive training programmes without motor training .  240 PD- patients were included in the study and r and omly allocated to three treatment arms , group A cognitive training , group B cognitive training and transfer training and group C cognitive training , transfer training and psychomotor and endurance training . The primary outcome measure was the ADAS-Cog . The secondary outcome measure was the SCOPA-Cog . Training was conducted for 4 weeks on a rehabilitation unit , followed by 6 months training at home . Caregivers received an education programme . The combination of cognitive training using paper and pencil and the computer , transfer training and physical training seems to have the greatest effect on cognitive function . Thus , patients of group C showed the greatest improvement on the ADAS-Cog and SCOPA-COG and were more likely to continue with the training programme after the study Background and Purpose — Current theories of motor control in rehabilitation focus on how the nervous system responds to many types of external and internal constraints to execute motor behavior to accomplish a task . However , the dynamic interplay between these 2 constraints remains unclear . This study examined the impact of some aspects of internal and external constraints on motor performance in persons with stroke . Methods — Twenty-seven persons with stroke used the uninvolved arms  to perform an upper-extremity reaching task under 4 experimental conditions , formed by the crossing of functional goals and personal preferences . For the higher level of a functional goal , subjects took a drink from a can of beverage . For the lower level of a functional goal , subjects brought the can to the mouth without drinking . The level of personal preferences was determined , by interview , by the degree of predilection for particular beverages . Results — Significant and large effects of functional goals and personal preference were found in the variables of movement time and reaction time . However , the data trend of the 4 testing conditions varied according to presence of visuospatial neglect and side of lesion . Conclusions — Offering choices for the treatment activities and incorporating functional goals to therapeutic tasks might enhance response rate or movement efficiency , depending on the side of the lesion and presence of visuospatial neglect . The findings suggest that the consideration of the neglect phenomenon is a necessity when rehabilitative treatment planning incorporates constraint factors UNLABELLED This study compares the outcomes of an individually tailored behavioral medicine intervention ( experimental ) with physical exercise therapy ( control ) . The experimental intervention was systematic ally individualized according to each participant 's behavioral treatment goals and functional behavioral analyses . One hundred twenty-two patients seeking care at 3 primary health care clinics because of musculoskeletal pain were r and omized . Ninety-seven completed the trial . Data were collected at baseline , immediately after treatment , and at a 3-month follow-up . Analyses of data from completers , as well as intention-to-treat analyses , showed that the experimental group experienced lower levels of disability ( P = .01 ) , lower maximum pain intensity ( P = .02 ) , higher levels of pain control ( P = .001 ) , and lower fear of movement ( P = .022 ) as a result of treatment condition . Self-efficacy ( P = .0001 ) and physical performance ( P = .0001 ) increased over time for both groups . Participants in the experimental group generally reported more positive effects after treatment . Treatment fidelity was maintained during the course of the study . Activity can be resumed and pain might be managed by the patients themselves if treatment incorporates the biopsychosocial explanatory model of pain and strategies are tailored according to individual 's priorities of everyday life activities and empirically derived determinants of pain-related disability . PERSPECTIVE This study shows that the biomedical and the psychosocial perspectives of the experiences and consequences of pain complement rather than contradict each other . Primary health care patients with persistent musculoskeletal pain benefit more from a systematic tailoring of treatments according to biopsychosocial factors than from a physically based exercise intervention Abstract Purpose To evaluate the effect of a multidisciplinary rehabilitation programme on disability , kinesiophobia , catastrophizing , pain , quality of life and gait disturbances in patients with chronic low back pain ( CLBP ) . Methods This was a parallel-group , r and omised , superiority-controlled pilot study in which 20 patients were r and omly assigned to a programme consisting of motor training ( spinal stabilising exercises plus usual-care ) and cognitive – behavioural therapy ( experimental group , 10 subjects ) or usual-care alone ( control group , 10 subjects ) . Before treatment , 8 weeks later ( post-treatment ) , and 3 months after the end of treatment , the Oswestry Disability Index , the Tampa Scale for Kinesiophobia , the Pain Catastrophizing Scale , a pain numerical rating scale , and the Short-Form Health Survey were assessed . Spatio-temporal gait parameters were also measured by means of an electronic walking mat . A linear mixed model for repeated measures was used for each outcome measure . Results The programme had significant group ( p = 0.027 ) , time ( p < 0.001 ) , and time-by-group interaction ( p < 0.001 ) effects on disability , with the experimental group showing an improvement after training of about 61 % ( 25 % in the control group ) . The analyses of kinesiophobia , catastrophizing , and the quality of life also revealed significant time , group , and time-by-group interaction effects in favour of the experimental group , and there was a significant effect of time on pain . Both groups showed a general improvement in gait parameters , with the experimental group increasing cadence significantly more . Conclusion The multidisciplinary rehabilitation programme including cognitive – behavioural therapy was superior to the exercise programme in reducing disability , kinesiophobia , catastrophizing , and enhancing the quality of life and gait cadence of patients with CLBP OBJECT Mild traumatic brain injury ( MTBI ) , often referred to as concussion when it occurs in sports , produces persistent cognitive problems in at least 15 % of patients . Unfortunately , conventional neuropsychological tests usually yield results within normal limits in this population . The main objective of this event-related potential ( ERP ) study was to underst and brain functioning during the performance of a working memory ( WM ) task in patients who have sustained an MTBI , mostly due to motor vehicle accident or sports concussion . This study also aim ed for a better underst and ing of the association between brain functioning as measured with ERP , behavioral performance on the WM task , postconcussion symptoms , type of injury ( that is , sports concussion vs other types ) , and time since the injury . METHODS Forty-four patients with MTBI ( 7.6 ± 8.4 months postinjury ) were tested on a visual WM task with simultaneous recording of ERP , and were compared with 40 control volunteers who were their equivalent for age and sex . Amplitude and latency of frontal ( N200 and N350 ) and parietal ( P200 and P300 ) ERP waves were measured and were compared between groups . Correlation analyses were also performed between ERP characteristics , clinical variables , and behavioral performance . RESULTS A significant group difference was found for behavioral performance on the WM task , in which the MTBI group had a lower percentage of correct answers than the control group ( p < 0.05 ) . The patients with MTBI also had smaller amplitudes of both frontal N350 and parietal P300 ERP components when compared with control volunteers ( p < 0.05 ) . No changes were found for latency of ERP components . Smaller ERP amplitudes were associated with slower reaction times and worse accuracy on the WM task among patients with MTBI ( p < 0.05 ) . Types of injury ( that is , sports concussion vs other mechanisms ) were not associated with different ERP characteristics . CONCLUSIONS Abnormal ERP results are observed in patients after MTBI or sports concussion , even for those in the nonacute stage after their injury . Current st and ard clinical evaluations most often fail to detect cerebral dysfunction after MTBI , even when patients or athletes report symptoms . Clinicians should be aware that patients with MTBI , including sports concussion , probably have underlying mild but persistent cerebral dysfunctions that require further investigation
Conclusion The results of this systematic review indicate that motor performance is further impaired by placing a cognitive load on individuals in population s with musculoskeletal injury .
More dem and ing tasks such as gait appear to be more affected in injured individuals than simple balance tasks .
Background Research suggests that individuals with musculoskeletal injury may have difficulty negotiating physical tasks when they are combined with cognitive loads .
Objective Our objective was to conduct a systematic review to underst and the effects of increased cognitive dem and on movement patterns among individuals with musculoskeletal injuries .