Prediction of function in daily life following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain; a prospective study Improved Quality of Life, Working Ability, and Patient Satisfaction After a Pretreatment Multimodal Assessment Method in Patients With Mixed Chronic Muscular Pain: A Randomized-controlled Study Does Teaching Physical Therapists to Deliver a Biopsychosocial Treatment Program Result in Better Patient Outcomes? A Randomized Controlled Trial A randomized prospective study of vocational outcome in rehabilitation of patients with non-specific musculoskeletal pain: a multidisciplinary approach to patients identified after 90 days of sick-leave. Prediction of Success From a Multidisciplinary Treatment Program for Chronic Low Back Pain Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial. Point-of-care prognosis for common musculoskeletal pain in older adults. Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Evaluation of a comprehensive rehabilitation program for post-treatment patients with cancer. The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care. Predictors of pain outcomes in patients with chronic musculoskeletal pain co-morbid with depression: results from a randomized controlled trial. The Comparative Prognostic Value of Directional Preference and Centralization: A Useful Tool for Front-Line Clinicians? Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 RADAR. Clinical effectiveness of an interdisciplinary pain management programme compared with standard inpatient rehabilitation in chronic pain: a naturalistic, prospective controlled cohort study.
Background The prevalence of chronic musculoskeletal pain is high , with widespread negative economic , psychological , and social consequences for the individual . It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life . The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function , and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain . Methods A prospect i ve study was conducted among one hundred and forty three ( N = 143 ) musculoskeletal pain patients .  Measures of pain , function , and functional health status were obtained at baseline , after 5 weeks of intensive training , at the end of the 57-week rehabilitation programme , and at a 1 year follow-up , using vali date d self-administrated measures . Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain , individual- , and psychosocial factors in function . Results The participants studied showed a significant increase in function during the 57 weeks rehabilitation period . There was also a significant increase in function from the end of the rehabilitation period ( 57th week ) to the one year follow-up measures . Pain intensity associated significantly with pain experience over all measurement periods . High levels of pain intensity ( β = .42 * * ) and pain experience ( β = .37 * ) , and poor psychological capacity ( β = -.68 * ) at baseline , as well as poor physiological capacity ( β = -.44 * * ) and high levels of anxiety ( β = .48 * * ) and depression ( β = .58 * * * ) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods . Conclusion The data suggest that physical capacity , emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life Objective : To investigate whether a pretreatment multimodal ( MM ) assessment of patients with chronic muscular pain has an impact on treatment outcome . Methods : The present r and omized-controlled study evaluated an MM assessment compared with routine multidisciplinary assessment given to a control group . The study population consisted of primary care patients with mixed chronic muscular pain . Variables assessed were : pain intensity , depression , life stress , quality of life ( QOL ) , disability , working ability , and treatment satisfaction . Follow-up was performed at 15 months and 182 patients of 220 ( 83 % ) completed the study . Results : Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function ( odds ratio 2.40 ; 95 % confidence interval 1.32 - 4.37 ) , role physical ( 2.37 ; 1.10 - 5.09 ) , and role emotional ( 2.05 ; 1.05 - 3.96 ) . Working ability improved more significantly in the MM group ( 46 % vs. 35 % ) and impairment was less ( 1 % vs. 15 % ) compared with the control group ( P=0.016 ) . Satisfaction with the assessment was , on average , higher ( P<0.001 ) in the MM group than in the control group . Discussion : Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL , working ability , and were also significantly more satisfied . This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting , and also be used to prepare patients for future rehabilitation Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability . However , patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course This study was design ed to evaluate the effectiveness of a multidisciplinary rehabilitation programme offered to a general population with 90 days of sick-leave due to non-specific musculoskeletal pain . The results concerning return to work and re-sick-listing during a follow-up period of five years were evaluated for Swedes and immigrants separately . Compared to a control group , the rehabilitation offer result ed in improved work stability after work return among the Swedes . The immigrants , as a group , did not benefit from the programme compared to the controls in primary care Study Design . The study included 90 disabled patients with chronic low back pain recruited from a pain clinic who were admitted to an 8-week program of functional restoration and behavioral support .  Initial evaluations included a medical examination , rating of the physical impairment , a personal interview , a visual analogue scale to record pain intensity , an assessment of limitations for daily activities , a pain disability index , a depression and psychovegetative scale , and a scale to evaluate general living st and ards . The physical assessment included different flexibility measurements , measurement of power and endurance through st and ardized exercises , and measurements of isokinetic trunk and lifting strength and general endurance . The measurements were repeated at the end of the 8-week program and thereafter at intervals of 6 and 12 months . Final analyses were carried out on 82 patients . Objectives . To determine whether objective or subjective signs most influence the outcome of rehabilitation . Summary of Background Data . In recent years , several studies have shown that active and intensive multimodal treatment of chronic low back pain is successful . Until now there has been lack of information about which patients will respond to the therapy and what is the most effective part of treatment . Methods . Prognostic factors ( return to work , pain intensity , self- assessment of treatment success by patients ) were tested by study ing variance and regression analyses for their ability to predict treatment outcome . Results . Certain factors were identified that had a significant impact on determining the probability of a patient 's return to work and the reduction of pain intensity . These factors included self-evaluation for predicting a return to work , the length of absence from work , application for pension , and a decrease in disability after treatment . Overall satisfaction with treatment was best determined by the number of medical consultations before treatment , the extent of disability , previous measures taken for coping with the disease , and reduction of disability during treatment . Medical background , medical diagnosis , and physical impairment had no predictive value . Physical variables ( i.e. , mobility , strength , endurance , and physical performance ) also demonstrated only limited predictive value . Conclusion . This study has demonstrated that the most important variable in determining a successful treatment of chronic low back pain is the reduction of subjective feelings of disability in patients Objectives ( 1 ) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and ( 2 ) to explore the value of potentially prognostic factors further . Methods Data were derived from a r and omized controlled trial on the effect of a multidisciplinary rehabilitation program for chronic low back pain compared with usual care .  The primary outcome measure was the Rol and and Morris Disability Question naire and secondary outcomes were the Physical and Mental Component Summary Scales , derived from the Short Form Health Survey . Outcomes were expressed as the differences between baseline and follow-up ( 8 wk and 6 mo ) values . A confirmatory and an exploratory model were defined . Baseline predictors included in the confirmatory model were pain intensity , work status , and Multidimensional Pain Inventory subgroup membership . The exploratory model included sick leave , compensation , depression , and fear-avoidance beliefs . Statistical analysis was performed using multiple linear regression analysis . Results One hundred and sixty-three patients participated in the study . More pain was prognostic for more improvement in the rehabilitation group . No value was found for work status or the Multidimensional Pain Inventory subgroups . For the exploratory model , more depression and fear-avoidance beliefs predicted more improvement after rehabilitation . The explained variance ranged from 18.5 % to 43.8 % depending on the length of follow-up evaluation , the treatment group , and the outcome variable of interest . Discussion The results of this study do not support the construction of a clinical prediction model . Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain , a multidisciplinary rehabilitation programme for an outpatient group setting was developed . The main treatment components address the patient 's physical functional capacity ( functional restoring ) , cognitive and affective processes ( pain management strategies ) , and behavioural and ergonomical aspects ( back school elements ) . Short-term ( immediately after intervention ) and long-term effects ( at 6-months follow-up ) of the intervention were assessed in a r and omized controlled study . Dependent variables were pain measures , functional capacity , disability , muscular strength and endurance , pain and posture-related self-efficacy , attitudes , depression , well-being , behavioural habits and posture assessed by a st and ardized behavioural observation method . Immediately after the intervention , patients in the treatment group ( n=36 ) showed significant improvement over patients in the control group ( n=29 ) in all variables except depression and muscular strength and endurance . At 6-months follow-up , compared to pretreatment scores , patients continued to show beneficial effects in pain intensity and frequency , posture , posture-related self-efficacy and well-being . In contrast to post-treatment results , there were also significant improvements in strength and endurance . Overall results testify to the effectiveness of the intervention programme . Future studies ( with larger sample sizes ) should aim at a further improvement of functional capacity and disability perception , an analysis of differential treatment effects , and strategies for an improved long-term maintenance of the changes induced by the programme IMPORTANCE Many site-specific , multivariable risk models for predicting the outcome of musculoskeletal pain problems have been published . The overlapping content in these models suggests a common set of generic indicators suitable for use in primary care . OBJECTIVE To investigate whether a brief set of generic prognostic indicators can predict the outcome of musculoskeletal pain in older patients presenting to general practitioners . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve observational cohort study conducted from September 1 , 2006 , through March 31 , 2007 , of consecutive patients 50 years or older presenting with noninflammatory musculoskeletal pain to 1 of the 5 participating general practice s in the United Kingdom . MAIN OUTCOME MEASURES During consultation , the treating physician assessed and recorded 5 brief generic items ( duration of present pain episode , current pain intensity , pain interference with daily activities , presence of multiple-site pain , and ultrashort depression screen ) and recorded their overall prognostic judgment . The primary outcome was patient-rated improvement , which was measured 6 months after consultation and cross-vali date d with repeated measures up to 3 years . RESULTS A total of 194 ( 48.1 % ) of 403 participants were classified as having an unfavorable outcome at 6 months . Inclusion of 3 generic prognostic indicators ( duration of present pain episode , pain interference with daily activities , and presence of multiple-site pain ) in the prognostic model improved on reliance on physicians ' prognostic judgment alone ( C statistic = 0.72 vs 0.62 ; net reclassification index = 0.136 ; proportion correctly classified = 69 % ) . The improvement in prognostic accuracy was attributable to correcting physicians ' tendency toward overoptimistic expectations of outcome . CONCLUSIONS AND RELEVANCE Three easy-to-obtain pieces of information followed by systematic recording of the general practitioners ' prognostic judgment provide a simple generic assessment of prognosis at point of care in older persons presenting with musculoskeletal problems to primary care practice s in the United Kingdom . Such an assessment offers a common foundation for investigating the usefulness of prognostic stratification for guiding management in the consultation across a range of common painful conditions Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 PURPOSE / OBJECTIVES To evaluate the effects of a rehabilitation program on quality of life , fatigue , fear of movement ( kinesiophobia ) , distress , anxiety , depression , and physical condition . DESIGN Pretest/post-test . SETTING An outpatient rehabilitation setting in the Oncology Centre at the University Hospital Brussels in Belgium . SAMPLE 36 patients who had completed cancer treatment with a curative potential . METHODS Participants completed a question naire and underwent a physical test at baseline and at the end of the program . The measurement instruments used included the European Organisation for Research and Treatment of Cancer Quality -of-Life Question naire-Core 30 , Functional Assessment of Cancer Therapy-Fatigue , Hospital Anxiety and Depression Scale , R AND -36 , Tampa Scale for Kinesiophobia , Distress Barometer , and Tecumseh Step Test . MAIN RESEARCH VARIABLES Quality of life , fatigue , kinesiophobia , distress , anxiety , depression , and physical condition . FINDINGS Significant improvement was observed in quality of life ( p < 0.001 ) , physical condition ( p = 0.007 ) , fatigue ( p = 0.01 ) , and depression ( p = 0.012 ) . In contrast , kinesiophobia ( p = 0.229 ) , distress ( p = 0.344 ) , and anxiety ( p = 0.101 ) did not change significantly . CONCLUSIONS A general and significant improvement in all aspects affecting quality of life and rehabilitation was observed , but less so for aspects that might be influenced by prognostic concerns . The relative contribution of the program versus spontaneous recovery and long-term impact need to be determined further in a prospect i ve r and omized study . IMPLICATION S FOR NURSING Multidisciplinary rehabilitation should become part of the total care plan for patients with cancer Objective To evaluate the short-term efficacy of multidisciplinary , inpatient rehabilitation of multiple sclerosis ( MS ) patients . Methods A double-blind , r and omized , parallel group design was used . The intervention group were offered comprehensive , multidisciplinary inpatient rehabilitation  at the Haslev MS Hospital for an average of 35.5 days , while the control group received no treatment related to the study . All patients were examined in their homes twice with a 10-week interval . The rehabilitation of the intervention group started 2 - 3 weeks after the first examination and ended 2 - 3 weeks before the second examination . Impairment was assessed by the Multiple Sclerosis Impairment Scale and the Exp and ed Disability Status Scale . Disability was assessed by means of Guy ’s Neurological Disability Scale . Two specific scales were used to assess upper limb function and ambulation : The Nine-Hole Peg Test and timed 10-metre walking . Patients ’ own perception of bodily pain , bladder symptoms , spasticity , fatigue , impaired walking and transfers were recorded using visual analogue scales . Finally , quality of life was assessed using the Life Appreciation and Satisfaction Question naire and the Functional Assessment in Multiple Sclerosis . Patients Two hundred and thirty-three patients were screened and of those 38 were included for treatment and 52 as controls . Results We found no statistically significant differences between the two groups in any of the outcome measures . Conclusion Although the study was underpowered , the negative outcome exposes the difficulties in quantitative analyses of the efficacy of multidisciplinary rehabilitation , which is liable to confounding factors such as variation in the indication for treatment , in the placebo effect , and in the reliability and responsiveness of the outcome measures This study examined long-term effects of a tailored behavioural treatment protocol ( TBT ) , as compared with an exercise based physical therapy protocol ( EBT ) .  One-hundred and twenty-two patients who , due to persistent musculoskeletal pain , consulted physical therapists in primary care were originally r and omized to either of the two conditions . Follow-up assessment s two-year post-treatment were completed by 65 participants . According to per- protocol analyses , short-term effects were maintained in both groups for the primary outcome , pain-related disability . The TBT-group reported lower disability levels compared with the EBT-group . Intention-to-treat analyses ( ITT ) conveyed similar results . Secondary outcomes of pain intensity , pain control , and functional self-efficacy were maintained over the 2-year post-treatment , but previous group differences were levelled out according to the most conservative method of ITT . Fear of movement/(re)injury increased in the EBT-group , and EBT participants reported higher fear of movement/(re)injury two years post-treatment compared to TBT . The study supports tailoring of treatments in concordance with patients ' needs and preferences of activity goals and functional behavioural analyses including predictors of pain-related disability , for successful immediate outcomes and their maintenance in the long run . Exercise-based treatments result ed in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2-year follow-up period OBJECTIVE The combination of chronic musculoskeletal pain and depression is associated with worse clinical outcomes than either condition alone . In this study , we report the predictors of pain intensity and activity interference in primary care patients with co-morbid pain and depression . METHODS This is a secondary data analysis of the 250 persons who participated in a r and omized clinical trial design ed to test the effectiveness of 12 weeks of optimized antidepressant therapy for both depression and pain . Using multivariate linear regression analysis , we assessed the predictive value of baseline  self-efficacy , fear of movement , pain  beliefs  , and demographic and clinical factors on 3-month Grade d Chronic Pain Scale pain intensity and activity interference outcomes . RESULTS In the full model , significant sociodemographic predictors of less activity interference included being non-white ( beta-5.8 , P = 0.04 ) and being employed ( beta-13.3 , P < 0.0001 ) . The latter was also predictive of less pain intensity ( beta-5.6 , P = 0.01 ) . As expected , the optimized antidepressant treatment arm was associated with improved outcomes ( pain intensity : beta-3.7 , P = 0.0005 and activity interference : beta-6.4 , P = 0.01 ) . Whereas stronger perceived pain control ( beta 3.6 , P = 0.01 ) was associated with greater activity interference , higher degree of fear of movement ( or fear avoidance ) predicted greater pain intensity ( beta 0.46 , P = 0.04 ) and activity interference ( beta 0.57 , P = 0.05 ) . Neither the location ( low back vs hip/knee ) nor duration of pain were predictive of pain intensity or interference outcomes . CONCLUSION The findings are consistent with a bio-psychosocial model , implicating the need to consider the impact of sociodemographic variables and pain-related beliefs and cognition on pain-related outcomes for patients with co-morbid musculoskeletal pain and depression Abstract A large number of prognostic factors have been associated with recovery from an episode of back pain , and much emphasis has been placed on psychosocial prognostic factors . The large number of prognostic factors and the lack of comparative analysis of different factors make use of these difficult in clinical practice . The aim of this study was to evaluate the comparative usefulness of a range of factors to predict outcome using data from a r and omized controlled trial ( RCT ) in which 312 patients with sub-acute to chronic back pain received a mechanical evaluation and were sub-grouped based on the presence or absence of directional preference ( DP ) . Patients were then r and omized to treatment that was matched or unmatched to that DP . Patients with a minimal reduction of 30 % in Rol and -Morris Disability Question naire ( RMDQ ) score were defined as the good outcome group . Seventeen baseline variables were entered into a step-wise logistic regression analysis for the ability to predict a good outcome . Of the patients , 84 met the good outcome criteria and had a mean RMDQ decrease of 58.2 % ( 9.8 points ) in 4 visits . Leg pain , work status , depression , pain location , chronicity , and treatment assignment were significant predictors of outcome in univariate analysis . Only leg bothersomeness rating and treatment assignment survived multivariate analysis . Subjects with DP/ central ization who received matched treatment had a 7.8 times greater likelihood of a good outcome . Matching patients to their DP is a stronger predictor of outcome than a range of other biopsychosocial factors Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making BACKGROUND Long-term prostate cancer ( PCa ) survivors are at increased risk for comorbidities and physical deconditioning . OBJECTIVE To determine the effectiveness of a year-long r and omised controlled trial of exercise training in PCa survivors > 5 yr postdiagnosis on physical functioning . DESIGN , SETTING , AND PARTICIPANTS Between 2010 and 2011 , 100 long-term PCa survivors from Trans-Tasman Radiation Oncology Group 03.04 R and omised And rogen Deprivation and Radiotherapy previously treated with and rogen-deprivation therapy and radiation therapy were r and omly assigned to 6 mo of supervised exercise followed by 6 mo of a home-based maintenance programme ( n=50 ) or printed educational material about physical activity ( n=50 ) for 12 mo across 13 university-affiliated exercise clinics in Australia and New Zeal and . INTERVENTION Supervised resistance and aerobic exercise or printed educational material about physical activity . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was a 400-m walk as a measure of cardiovascular fitness . Secondary end points were physical function , patient-reported outcomes , muscle strength , body composition , and biomarkers . Analysis of covariance was used to compare outcomes for groups at 6 and 12 mo adjusted for baseline values . RESULTS AND LIMITATIONS Participants undergoing supervised exercise showed improvement in cardiorespiratory fitness performance at 6 mo ( -19 s [ p=0.029 ] ) and 12 mo ( -13 s [ p=0.028 ] ) and better lower-body physical function across the 12-mo period ( p<0.01 ) . Supervised exercise also improved self-reported physical functioning at 6 ( p=.006 ) and 12 mo ( p=0.002 ) , appendicular skeletal muscle at 6 mo ( p=0.019 ) , and objective measures of muscle strength at 6 and 12 mo ( p<0.050 ) . Limitations included the restricted number of participants undertaking body composition assessment , no blinding to group assignment for physical functioning measures , and inclusion of well-functioning individuals . CONCLUSIONS Supervised exercise training in long-term PCa survivors is more effective than physical activity educational material for increasing cardiorespiratory fitness , physical function , muscle strength , and self-reported physical functioning at 6 mo . Importantly , these benefits were maintained in the long term with a home-based programme with follow-up at 12 mo . CLINICAL TRIAL REGISTRY The effect of an exercise intervention on cardiovascular and metabolic risk factors in prostate cancer patients from the RADAR study , ACTRN : ACTRN12609000729224 OBJECTIVE To compare the effects of an interdisciplinary pain management programme with those of st and ard in-patient rehabilitation by comprehensive biopsychosocial self-- assessment . METHODS In this naturalistic prospect i ve controlled cohort study , 164 chronic pain patients who participated in the interdisciplinary pain programme and 143 who underwent st and ard rehabilitation were assessed using st and ardized  instruments . Effect differences were compared bivariately and analysed by multivariate logistic regression to control for baseline differences in the outcome variables and confounders . RESULTS On entry into the clinic , the interdisciplinary pain programme  patients were younger and showed significantly worse mental and psychosocial health than the st and ard rehabilitation patients . At discharge , the interdisciplinary pain programme patients reported greater improvement on pain ( multivariate p = 0.034 ) , social functioning ( bivariate p = 0.009 ) , and in trend in catastrophizing and ability to decrease pain . At the 6-month follow-up , the effects experienced by the st and ard rehabilitation group were higher on physical functioning , social functioning , anxiety , and life control ( multivariate p = 0.013 - 0.050 ) . CONCLUSION Intensive interdisciplinary rehabilitation with more behavioural therapies was accompanied by a greater improvement in patients who were severely affected by pain , compared with st and ard rehabilitation by the end of the stay , but not in the mid-term . Highly re source -consuming patients may benefit from subsequent , individually tailored outpatient care
Discussion : While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR , poor pretreatment physical and psychological functioning influenced the prognosis negatively .
Thus , treatment should further target and optimize these modifiable factors and an increased focus on positive , psychological protective factors may perhaps provide an opening for yet untapped clinical gains
Objectives : This systematic review aim ed to identify and evaluate prognostic factors for long-term ( ≥6 mo ) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation ( MDR ) .