Biopsychosocial Understanding Research Articles

Are cisnormative surveys adequate to assess sexual well-being in trans men post-genital gender-affirming surgery?

For transmasculine spectrum individuals, there is a lack of validated surveys to assess sexual well-being (SWB) post-genital gender-affirming surgery. Currently, either providers are designing their own SWB surveys or surveys designed for cisgender men are being used. This study investigated the applicability of SWB surveys validated for cisgender men to transmasculine spectrum individuals post-genital gender-affirming surgery (TMSX). Recognizing the paucity of validated tools for assessing SWB in transmasculine individuals post-genital gender-affirming surgery (TMSX), we evaluated current surveys for their inclusiveness and relevance to this population. Our methodology involved analyzing surveys validated in English-speaking North American cisgender men. We conducted a systematic review, yielding 31 surveys, out of which 12 met our inclusion criteria. These were then assessed against the 10 domains of holistic SWB as identified by Özer etal. Each survey was scored based on its reflection of these domains, thus generating an SWB score. Additionally, we performed a thematic analysis to identify areas needing modification for better applicability to TMSX. Our findings indicate an average SWB score of 5.17 out of 10 across the surveys. The surveys predominantly addressed sexual function, with a marked underrepresentation of domains like quality of life, sexuality, and sexual pleasure. This underscores the tendency of these surveys to focus more on the biological mechanisms of sex, rather than on a nuanced biopsychosocial understanding. Thematic analysis revealed significant gaps, such as the irrelevance of questions about erections and ejaculations for TMSX, and the need for greater emphasis on psychosocial factors. Given these gaps and the inadequacy of most cisnormative surveys, we recommend the creation of a novel, validated SWB survey specifically for TMSX. This should be developed in collaboration with a multidisciplinary panel and TMSX community advisory board, ensuring a tool that truly reflects the unique SWB needs of this population.

Community Mental Health Transformation in England: The implications for clinical psychologists

The Community Mental Health Transformation in England has introduced a range of opportunities for clinical psychologists. Whilst the focus to increase delivery of evidence based psychological therapies requires associated expertise to deliver, train and supervise these therapies, the opportunities go beyond therapy. Genuine transformation relies on local systems moving away from a bio-medically dominated approach to mental health service delivery, to provision underpinned by a more nuanced bio-psychosocial understanding of wellbeing and personal recovery. Clinical psychologists are ideally placed to support teams and services to offer true personalised care: offering expert advice to ensure care and support is formulation based and acknowledges the individual, systemic and structural elements that contribute to mental distress. Ultimately, the cultural change required to achieve the transformation described within national policy is dependent on leadership from those with appropriate expert knowledge and understanding of mental distress. Clinical psychologists should have these competences and can offer this leadership.

An instrument to assess biopsychosocial pain concepts in adults : Development and evaluation by experts

The biopsychosocial model is fundamental for the understanding and treatment of chronic pain; however, little research has focused on whether those affected show a biopsychosocial understanding. The multidimensional questionnaire Biopsychosocial Pain Concept Matrix (BiPS matrix) is presented. The conception of the BiPS matrix is based on the biological, psychological and social areas as well as on the common sense model of self-regulation with five dimensions: (1) type of disorder, (2) assumptions on the causes, (3) consequences, (4) duration of the disease and (5) possibilities for control and treatment. The present study aims to examine the content relevance and comprehension of the areas, dimensions and items, including the use of the BiPS matrix with children by interdisciplinary expert ratings. The questionnaire can be perspectively used by treating professionals for diagnostic purposes. In an online study 17experts were questioned. In addition to descriptive statistics, comments were evaluated using qualitative content analysis according to Mayring. All experts rated the assessment of pain concepts with the BiPS matrix as well as the areas and dimensions as very relevant. With respect to the items, suggestions were made mainly regarding the wording of the items and adjustments for children. From an expert point of view the BiPS matrix represents arelevant instrument. Further research on the psychometric properties of the BiPS matrix in adults and children is indicated. In addition, the BiPS matrix can also be used to investigate pain concepts of medical and psychotherapeutic professional groups to demonstrate the biopsychosocial understanding of pain and the associated treatment options.

Addressing Cyberscams and Acquired Brain Injury ("I Desperately Need to Know What to Do"): Qualitative Exploration of Clinicians' and Service Providers' Perspectives.

People with acquired brain injury (ABI) may be more susceptible to scams owing to postinjury cognitive and psychosocial consequences. Cyberscams result in financial loss and debilitating psychological impacts such as shame and mistrust, interference with neurorehabilitation, and reduced independence. Despite these significant consequences, there are no psychological treatments to support cyberscam survivors. There is limited evidence regarding how the current workforce is addressing post-ABI cyberscams. This study aims to understand the perspectives and needs of clinicians and service providers in addressing post-ABI cyberscams. Overall, 20 multidisciplinary clinicians and service providers were recruited through purposive sampling across Australia. Semistructured interviews explored post-ABI scam experiences and vulnerabilities, treatments and their efficacy, and recommendations for future cybersafety recovery interventions. Reflexive thematic analysis was used. In total, 8 themes encompassing a biopsychosocial understanding of scam vulnerabilities and impacts were identified: "genuine lack of awareness: cognitive-executive difficulties"; "not coping with the loss of it all"; "needing trust and connection"; "strong reactions of trusted others"; "nothing structured to do"; "financial stress and independence"; "cyberability"; and "scammer persuasion." Each theme informed clinical recommendations including the need to provide psychological and cognitive support, enhance financial and cybersafety skills, promote meaningful social engagement, and foster collaboration between families and clinical support teams. The multifaceted range of scam vulnerabilities and impacts highlighted the need for individualized, comprehensive, and targeted treatments using a biopsychosocial approach to enable cyberscam recovery among people with ABI. These findings will guide the development of a co-designed intervention.

Filling in the Gaps. Making Sense of Living with Temporomandibular Disorders: A Reflexive Thematic Analysis.

Persistent, painful temporomandibular disorders (TMDs) are challenging to manage and usually require the active engagement of patients. To achieve this, it is necessary to understand the complex and multifactorial nature of persistent pain. Many dental professionals have little education about persistent pain and may prefer to offer structural management and advice. This research aims to explore how people understand their persistent TMD and how this understanding has been influenced by their treatment providers. Twenty-one people were recruited to represent a diversity of experience with persistent TMD. Interviews followed a semistructured topic guide. Themes were constructed through reflexive thematic analysis to represent how people made sense of their symptoms and the messages that they had picked up through their treatment journey. Participants described examples of conflicting opinions and inconsistent management recommendations. They rarely recalled collaborative discussions about the nature and complexity of their symptoms and different options for treatment. This experience is represented by a single theme, "a medical merry-go-round." Subthemes of "a medical journey to nowhere-participants' frustrated attempts to find medical management that will end their pain" and "is it me?-participants' questioning their role in persisting pain" kept participants on the merry-go-round, while symptom resolution and participants' emerging development of a holistic understanding of their TMD pain provided exit points. Understanding pain holistically tended to be helpful and typically occurred despite rather than because of the advice given in routine treatment settings. Participants in this study had not typically found their pain management within dental and medical settings to have helped them to construct meaning and understand their experiences of painful TMD. However, understanding symptoms holistically was experienced as beneficial. This study suggests that improved communication and signposting within services for persistent TMD may be beneficial to patients with TMD pain. Results of this study confirm that being offered a series of anatomically based, singular-cause explanations for persisting pain symptoms had been experienced as unhelpful by the participants who had sought help for their TMD. Participants highlighted the importance of accurate and collaborative communication and of dental professionals explicitly adopting and communicating a biopsychosocial understanding of pain to their patients who have TMD. Results highlight that some people can struggle to manage persisting pain with minimal support. Signposting patients to appropriate services and resources may help them to understand more about the nature of persistent pain and methods of managing it.

A model curriculum in sexual medicine for undergraduate education in Europe

Sexual health has been recognized as an essential component of the overall health and wellbeing. The current article aims, first, to review the current state of sexual health education in undergraduate medical curricula, identifying gaps, needs and challenges. The main part of this paper describes the development and content of an undergraduate sexual medicine curriculum based on a clear concept of the competencies students should learn regarding knowledge, skills and attitudes. The content is based on a biopsychosocial understanding of human sexuality elaborated by international experts from different European countries integrating basic knowledge in biology, psychology, sociocultural and political sciences, preventive medicine, and the various therapeutic approaches to help women, men and couples with sexual health problems on a primary care level. In order to enable students to learn the basic skills of sexual history taking and sexual basic counselling two educational videos were produced. The material presented is part of the European Collaboration in Science and Technology (COST) supported project European Sexual Medicine Network (ESMN). The material provided can serve universities to give the training as a 25-30 hours course equivalent to 1 ECTS.

Analysis of YouTube content on substance use disorder treatment and recovery.

Emerging literature suggests the role of social media in substance use disorders (SUD). This study aimed to explore the content of YouTube videos for persons on SUD treatment/recovery, describing the users' exposure and engagement metrics and understanding viewers' perspectives. We generated a set of 10 key phrases to search on YouTube. Eighty eligible videos were analyzed using a mixed-methods approach. Content analysis of all videos and thematic analysis of 30 videos were done using the three most viewed videos from each key phrase. The reliability of videos was assessed using a modified DISCERN. The total number of views, likes, dislikes, and comments were noted and created engagement metrics. The linguistic analysis of viewers' comments was done to assess their perspectives. Sixty-three (78.8%) videos were from the US, and 59 (73.8%) were intended for persons or families with substance misuse. Persons in recovery uploaded 23 (28.7%) videos. We identified five themes - reasons for using drugs, symptoms of addiction, consequences of drug use, how to stop drug use, and expressed tone in the language. The positivity and relative positivity ratios were highest for videos developed by persons in recovery. There was a negative correlation between the relative positivity ratio and content fostering internalized stigma. Words with negative emotional experiences dominated the viewers' comments. YouTube content on SUD treatment and recovery is popular and revolves around the biopsychosocial understanding of addiction. There is an urgent need for a language policy and regulation of non-scientific content.

Practitioner Review: Neurobiological consequences of childhood maltreatment - clinical and therapeutic implications for practitioners.

Childhood maltreatment is one of the most important preventable risk factors for a wide variety of psychiatric disorders. Further, when psychiatric disorders emerge in maltreated individuals they typically do so at younger ages, with greater severity, more psychiatric comorbid conditions, and poorer response to established treatments, resulting in a more pernicious course with an increased risk for suicide. Practitioners treating children, adolescents, and young adults with psychiatric disorders will likely encounter the highest prevalence of clients with early-onset maltreatment-associated psychiatric disorders. These may be some of their most challenging cases. In this report, we explore key validated alterations in brain structure, function, and connectivity associated with exposure to childhood maltreatment as potential mechanisms behind their patients' clinical presentations. We then summarize key behavioral presentations likely associated with neurobiological alterations and propose a toolkit of established trauma and skills-based strategies that may help diminish symptoms and foster recovery. We also discuss how some of these alterations may serve as latent vulnerability factors for the possible development of future psychopathology. Research on the neurobiological consequences of childhood adversity provides a vastly enriched biopsychosocial understanding of the developmental origins of health and pathology that will hopefully lead to fundamental advances in clinical psychology and psychiatry.

The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis.

The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP. We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data. A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship. These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP. The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.

Experiences of shifts in physiotherapy for rheumatoid arthritis over time – an autoethnography

ABSTRACT Introduction Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. Objective This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author’s work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. Methods A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. Results The storyline from the 1980s to approximately the turn of the millennium is called ‘Shifts determined mainly by clinical context-driven events’ which occurred in response to medical advances and physiotherapists’ clinical experiences. These shifts were later justified by physiotherapists’ research in the clinical context. The other storyline covers mainly the 2000s and is called ‘Shifts increasingly determined by events beyond clinical physiotherapy context.’ They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. Conclusion These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities.

European Cancer Summit 2022 submission for Survivoship and Quality of Life NetworkEffect of Pain Neuroscience Education after breast cancer surgery on pain, physical and psychosocial functioning: a double-blinded randomized controlled trial (EduCan trial)

BackgroundApproximately one in five women experiences persistent pain after breast cancer surgery. Despite the effectiveness of different physical therapy modalities (e.g., manual therapy, physical activity), pain and associated limitations in daily functioning remain common. Recently, there has been a greater awareness of the role of education in the treatment of pain. The goal of educational interventions is to help patients better understand, manage and cope with their pain. Currently, these are often limited to instruction based on a more biomedical approach to pain and the administration of pain medications. Increased understanding of the neurophysiology of pain resulted in a different educational approach. Pain neuroscience education (PNE) aims to reconceptualize pain away from the biomedical model towards a biopsychosocial understanding, in order to decrease the threat value of pain. This double-blinded randomized controlled trial investigated whether PNE, in addition to best-evidence physiotherapy after breast cancer surgery, was more beneficial than biomedical education on pain-related, physical and psychosocial functioning. MethodsThree educational sessions were given in addition to a four-month physiotherapy program starting immediately postoperative. The content of the educational interventions differed between the intervention (PNE, n=92) and control group (biomedical pain education, n=92). Additional educational and physiotherapy sessions were provided at six, eight and twelve months postoperatively. The primary outcome was the change in pain-related disability (Pain Disability Index) after twelve months. Secondary outcomes were pain intensity, upper limb function, physical activity and psychosocial functioning. All outcomes were evaluated pre-and postoperatively, and at four, six, eight, twelve and eighteen months. ResultsChange in pain-related disability from baseline to twelve months postoperatively did not differ between groups (p=0.525). Secondary outcomes yielded similar results. ConclusionsAdding six sessions of PNE to physiotherapy immediately after breast cancer surgery did not result in a better course of functioning up to eighteen months postoperatively as compared to biomedical pain education. This finding broadens our understanding of PNE in this population and provides the basis for future research to fine-tune the optimal delivery format. Instead of imposing a one-size-fits-all formula, future research should investigate the effectiveness of a more patient-tailored PNE approach, based on a patient's specific needs and readiness.

War experiences and relationship problems predict pain sensitivity cross-sectionally among patients with chronic primary pain

Background: Most patients suffering from chronic pain are more susceptible to pain and pressure due to higher pain sensitivity. Since psychosocial factors play a central role in developing and maintaining chronic pain, investigating associations between pain sensitivity and psychosocial stressors promises to advance the biopsychosocial understanding of chronic pain. Objectives: We aimed to replicate Studer et al.'s (2016) findings about associations of psychosocial stressors with pain sensitivity in a new sample of patients with chronic primary pain (ICD-11, MG30.0). Methods: A pain provocation test was used on both middle fingers and earlobes to assess pain sensitivity among 460 inpatients with chronic primary pain. Potentially life-threatening accidents, war experiences, relationship problems, certified inability to work, and adverse childhood experiences were assessed as potential psychosocial stressors. Structural equation modeling was used to investigate associations between psychosocial stressors and pain sensitivity. Results: We partially replicated Studer et al.'s findings. Similar to the original study, patients with chronic primary pain showed enhanced pain sensitivity values. Within the investigated group, war experiences (β = 0.160, p < .001) and relationship problems (β = 0.096, p = .014) were associated with higher pain sensitivity. In addition, the control variables of age, sex, and pain intensity also showed a predictive value for higher pain sensitivity. Unlike Studer et al., we could not identify a certified inability to work as a predictor of higher pain sensitivity. Conclusions: This study showed that beyond age, sex, and pain intensity, the psychosocial stressors of war experiences and relationship problems were associated with higher pain sensitivity.

Arab refugees in the world of mental health: A literature review

Purpose: In an effort to specifically address the needs of Arab refugees with regards to psychotherapy, this literature review covers the published research data within eleven scholarly articles and studies from the years 2005 to 2019 on the topics of common psychological ailments and symptoms among Iraqi and Syrian refugees, their perspectives and literacy on mental health &amp; mental health treatments, and concludes with a brief discussion on implications for practice and unanswered questions for future research. Conclusions: In the face of collective trauma, persecutions, adversity, exile and acculturation stress, many Arab refugees are astoundingly resilient. Although these refugees have significant, unaddressed mental health issues and other concerns regarding stigma and the avoidance of psychological treatment, there is evidence to suggest that their attitudes may change upon interaction with mental health professionals. To effectively treat refugees, practitioners must hold a concrete comprehension of the heritage, cultural, psychohistorical, and sociopolitical environments of which these refugees are a product; they must also confront their own biases and misperceptions. Recommendations: Trans-diagnostic treatments that include an emphasis on increasing personal resilience, a comprehensive biopsychosocial understanding of the individual, and employ culturally-informed, evidence-based treatments like narrative exposure therapy for trauma, relaxation techniques, and direct, solution-focused approaches work best. More collaborations between mental health practitioners and prominent community leaders may help in addressing refugee mental health concerns and gaps in coverage. In future research, the attitudes and willingness of Arab refugees to seek psychological help must be examined.

How people with knee pain understand why their pain changes or remains the same over time: A qualitative study

ObjectivesGuidelines recommend knee osteoarthritis pain management based on biopsychosocial mechanisms. Treatment adherence and effectiveness may be affected if there is a mismatch between patient perspectives and treatment focus. We therefore examined patient perspectives on mechanisms of their knee pain, why it persisted or changed over the past year, whether their understanding had changed, and whether their understanding aligned with that of others with whom they interact. MethodsIndividuals with chronic knee pain (n ​= ​50) were purposively recruited from the Knee Pain and related health In the Community (KPIC) cohort to represent worsened, improved, or unchanged pain or anxiety between baseline and one year later. Framework analysis, a comparative form of thematic analysis, was used across transcripts of semi-structured telephone interviews. ResultsData were collapsed into themes of diagnosis, joint structure, ageing, physical activity, weight management, and treatment. Participants focused on biomechanical rather than psychological pain mechanisms. Some participants attributed pain improvement to increased and others to decreased physical activity. Participants reported no change in their understanding of their pain during the preceding year, but that their attitudes to pain, for example acceptance, had changed. Participants reported that they and others around them lacked understanding of their pain and why it did or did not change. ConclusionPeople report a predominantly biomechanical understanding of why their knee pain remains constant or changes over time. Clinicians should support patients to develop a biopsychosocial understanding of knee pain aligned to treatment across the range of biological, psychological, and social modalities.

A Grounded Theory of the Process of Healing From Opioid Addiction

The Centers for Disease Control and Prevention found that opioids are involved in almost 71% of all drug overdose deaths. Although there is increased attention on the lethal potential of opioid addiction, narratives about healing, wherein people have sustained long-term health and well-being from opioid addiction, are few. Our purpose with this study was to develop a biopsychosocial understanding of how people heal from opioid addiction, not only maintain abstinence. The Theory of Healing from Opioid Addiction yielded five categories, 15 themes, and seven subthemes. Results showed four phases of healing (i.e., Inactive Healing, Early Active Healing, Middle Active Healing, and Late Active Healing), four Continuous Core Components of healing (i.e., 12-Step Programs, Psychotherapy, Spirituality, and Relationships with Others), and 15 themes ranging from Substance Use Treatment to Effectively Processing Trauma to Self-Love. Participants’ ( N = 11) healing journey began during opioid addiction itself and continued through to the last phase of healing, wherein participants had transformed their lives and concretized a sense of personal empowerment.

Association Among Pelvic Girdle Pain, Diastasis Recti Abdominis, Pubic Symphysis Width, and Pain Catastrophizing: A Matched Case-Control Study.

ObjectivePregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women’s lives. There is uncertainty regarding the association between the structures of the bony pelvis, diastasis recti abdominis (DRA), pain processing, and PGP and to what extent these factors should be considered during physical therapy. This study aimed to evaluate the differences between women with and without PGP shortly after delivery regarding the separation of a pubic symphysis, DRA, and pain catastrophizing.MethodsWomen diagnosed with PGP 24 to 72 hours after vaginal delivery were matched to pain-free controls according to age and parity. Ultrasound evaluations of diastasis recti (interrecti distance [IRD]) during rest and curl-up task and pubic symphysis (interpubic width) were performed. The Pain Catastrophizing Scale was used to assess the level of catastrophizing. A special Cox regression model was used to fit a conditional logistic regression for a 1:2 matched case–control study.ResultsThirty-five women with clinically diagnosed PGP and 70 matched controls were included in the study. The PGP group had a significantly higher pre-pregnancy body mass index than the control group. After adjusting for body mass index in multiple conditional logistic regression, the interpubic distance (odds ratio = 1.64; 95% CI = 1.22 to 2.20) and IRD during curl-up (odds ratio = 2.01; 95% CI = 1.08 to 3.74) were significantly associated with PGP. Pain catastrophizing and IRD at rest were not associated with PGP in univariable or multivariable analysis.ConclusionsPain catastrophizing is similar for women with and without PGP early postpartum. However, the degree of the pubic symphysis and rectus abdominis separation during the curl-up task are positively associated with PGP shortly after delivery.ImpactThis study indicates that a reconsideration of the way we look at DRA is warranted. The development of a more comprehensive assessment including objective measurements and a biopsychosocial understanding is needed to inform directions for further postpartum physical therapy.

Physical Activity Promotion in Exercise Therapy in Medical Rehabilitation: Consequences of the Nationwide Survey for Quality Development

This article aims to summarize the status quo of exercise therapy in medical rehabilitation with regard to the establishment of the biopsychosocial understanding of health with a special focus on physical activity promotion; based on this, consequences for the optimization of exercise therapy are derived. A three-step procedure was chosen, which builds on the elaboration of quality dimensions and quality-relevant areas of physical activity promotion in exercise therapy: 1.) the analysis of the current status quo of exercise therapy with regard to the quality-relevant characteristics. This is based on the current results from the project "Exercise therapy in medical rehabilitation: a national survey at facility and practitioner level" (BewegtheReha); 2.) the elaboration of optimization potential and 3.) the derivation of consequences for the systematic quality development of exercise therapy. We analyzed the status quo of exercise therapy for the following areas: Assessment and information gathering, targets and impact areas, therapeutic contents, working methods and implementation, therapy control as well as allocation to exercise therapy (step 1). The results show that the physical activity promoting potential of exercise therapy within medical rehabilitation has not yet been optimally exploited. In particular, there is a need for more interdisciplinarity, more patient orientation, therapeutic work on the basis of theory- and evidence-based biopsychosocial therapy concepts with stronger manualization and standardization (step 2). Starting points for quality improvement can be found at the therapist level as well as at the program level and the system level. The derived recommendations for quality improvement of physical activity promotion in exercise therapy (step 3) refer to three levels: a) human resource development, e. g. with regard to improved use and quality of the education system, b) organizational development, e. g. promotion of interprofessional cooperation, and c) provision of resources, e. g. access to information. The derived consequences form the basis for the systematic further development and optimization of physical activity in exercise therapy in the context of medical rehabilitation. Based on the results, next steps for improving quality of exercise therapy with a focus on the goal of physical activity promotion can be identified and initiated.

Patient-centered care in musculoskeletal practice: Key elements to support clinicians to focus on the person

Musculoskeletal rehabilitation, including physiotherapy, needs to move towards a broader biopsychosocial understanding of musculoskeletal conditions and the delivery of high-value care for people with persistent pain conditions, in which a patient-centered approach is a key feature. However, it has been reported that clinicians experience difficulties with integrating patient-centered care principles into their clinical practice. Based on a focused symposium about patient-centered care for patients with musculoskeletal conditions, held during the online 2021 World Physiotherapy Congress, the purpose of this article is to share key elements of the content of this symposium with a wider audience, aimed at enabling clinicians to enhance patient-centeredness in their current practice. These key elements include establishing meaningful connections, deciding together and self-management support. Moreover, challenges on patient-centered care in low/middle income countries will be discussed and recommendations to implement patient-centered care in clinical practice will be provided.

Experiences of using positive airway pressure for treatment of obstructive sleep apnea: a systematic review and thematic synthesis.

Suboptimal use of positive airway pressure (PAP) to treat obstructive sleep apnea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. PsycINFO, MEDLINE, CINAHL, and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analyzed were included. Papers were critically appraised using the CASP qualitative checklist to generate a "hierarchy of evidence." Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Twenty-five papers reporting on over 398 people's experiences were analyzed to generate four themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. The findings highlight the applicability of a biopsychosocial understanding to PAP use. This metasynthesis gave voice to user experiences, revealing barriers to PAP use at a healthcare service level across the world, and suggests ways services can address these barriers. PROSPERO registration number: CRD42020157767.

Patient Perspectives on Key Outcomes for Vocational Rehabilitation Interventions Following Traumatic Injury.

Returning to work after traumatic injury can have a range of benefits, but there is currently little research that incorporates patient perspectives to identify outcomes of vocational rehabilitation interventions that are important to survivors. Trauma survivors (n = 17) participated in in-depth semi-structured interviews or focus groups exploring outcomes that were important to them for recovery and return to work. Data were analysed using thematic analysis. Participants identified a range of outcomes that they considered important and necessary to facilitate a successful and sustainable return to work: physical and psychological recovery, purposeful life engagement, managing expectations of recovery, managing expectations about return to work, and employers’ expectations. Our participants advocated for a multifaceted and biopsychosocial understanding of recovery and outcomes that need to be captured for vocational rehabilitation interventions. Implications for practice and research are discussed, and recommendations are given based on the findings.