Maurits Sloots

Success or failure of chronic pain rehabilitation: the importance of good interaction - a qualitative study under patients and professionals.

Abstract Aim: The aim of this study was to explore which factors are associated with a successful treatment outcome in chronic pain patients and professionals participating in a multidisciplinary rehabilitation program, with a specific focus on the patient–professional interaction. Methods: Patients (n = 16) and professionals (n = 10) were interviewed and/or observed. The transcribed interviews and observations were analyzed and themes were described. Results: Patients with a positive treatment outcome came to a shared understanding of their pain with their professional, demonstrated new learned behavior and were able to continue their learning process at home. Patients with a negative treatment outcome did not reach a shared understanding of their pain with their professional, were not able to change their behavior and wanted more help to achieve this. Both patient groups experienced organizational barriers within the treatment process. Factors associated with a high quality of patient–professional interaction included the patient experience of being taken seriously, the involvement of the professional with the patient, a clear explanation of the pain, and an open interaction between patient and professional. Conclusion: This study provides insight into factors which were related to a positively or negatively experienced outcome of pain rehabilitation. A good match within the patient–professional interaction seems essential. Implications of Rehabilitation Within chronic pain rehabilitation good didactic skills and a client-centered attitude of the professional may be helpful in order to make the patient feel being taken seriously. An assessment of the patient’s learning style might lead to a better fit of the patient education and training according to an individual’s learning style. Relapse might be prevented by paying special attention to the integration of new behavior within important life areas as work and sports.

WHEEL-I: DEvELOpMENT OF A WHEELCHAIR pROpULsION LAbORATORY FOR REHAbILITATION

OBJECTIVE To describe the enabling factors and barriers experienced in the Wheelchair Expert Evaluation Laboratory - implementation (WHEEL-i) project, in which scientific knowledge, tools and associated systematic analyses of hand-rim wheelchair propulsion technique, users wheelchair propulsion capacity, wheelchair-user interface, and wheelchair mechanics were implemented in 2 rehabilitation centres. DESIGN Implementation project. PATIENTS Spinal cord injury. METHODS In this implementation project standardized tests were performed: wheelchair skills tests, 2 questionnaires, and a steady-state exercise test on a treadmill in which propulsion technique (forces and torques) and physical strain (oxygen uptake, heart rate and mechanical efficiency) were measured. RESULTS Good interpretation of the test outcomes was the most important barrier. In order to discuss individual wheelchair performance results with patients and clinicians, reference data were developed, smallest detectable differences were calculated and software was developed to simultaneously show video recordings and force and torque signals. CONCLUSION Based on pilot results, the greatest barrier to systematic monitoring of the individual wheelchair fitting and learning process in rehabilitation with, among others, instrumented measurement wheels, was interpretation of outcomes. For proper interpretation of individual outcomes, the availability of reference data, smallest detectable differences and visualization of outcomes is of utmost importance.