François Luthi

Introduction: Health literacy (HL) is defined as the ability to access, understand, evaluate and apply health-related information, which can influence individuals’ health outcomes. Blue-collar workers, who often have lower educational attainment and experience language barriers, are at increased risk of limited HL. This systematic review aims to assess the prevalence of limited HL among blue-collar workers to inform the development of appropriate interventions for its improvement. Methods and analysis: The systematic review will assess the prevalence of limited HL among blue-collar workers. We will include all quantitative study designs using any instrument for measuring general HL. We will exclude studies that focus on specific types of HL and specific health conditions. We have performed a literature search from inception up to 30 April 2025, in the Medline, Embase, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We will also search eligible articles from Google Scholar and Open Grey as sources of unpublished studies/gray literature. Two independent reviewers will conduct the primary screening of articles, data extraction and quality assessment (using the Cochrane risk-of-bias tool for randomised trials and risk of bias in non-randomised studies of exposure), with a third individual available to resolve conflicts. We will assess heterogeneity using the χ² test and I² test. If there is sufficient homogeneity, we will pool studies in a meta-analysis or summarise the findings narratively if heterogeneity is too high. We will use a random effects model for our analysis, and we will use funnel plots to evaluate potential publication bias. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to assess the certainty of findings. Ethics and dissemination: Ethical approval will not be required for this review as there is no primary data collection involving humans. The results will be published in a peer-reviewed journal and presented at relevant conferences. PROSPERO registration number: CRD42024597732.

Introduction: The effects of pain medication on physical performance in chronic pain are poorly understood. We examined the association between analgesics and physical performance in people with chronic musculoskeletal pain (CMSP) requiring rehabilitation. Methods: We classified participants into 3 categories according to the highest level of medication used at admission for rehabilitation: no analgesics (NAs), nonopioid analgesics (NOAs), and opioid analgesics (OPAs). We measured performance with functional tests (6-minute walk test [6MWT], progressive isoinertial lifting evaluation [PILE], steep ramp test, handgrip strength test [HST], 5 times sit-to-stand test, and 1-minute stair-climbing test [1MSCT]) at admission and discharge. Multiple regression models were used to assess the differences in functional capacity between the 3 groups, adjusting for potential confounders. Results: We included 4,339 individuals; 1,731 took no analgesics (40%), 1,742 took NOAs (40%), and 866 took OPAs (20%). The median consumption was 11.7 mg per day according to morphine-equivalent dose calculation. Physical performance was poorer for patients taking than those not taking analgesics in all tests examined. We found a negative gradient in performance with increasing WHO analgesic ladder. The odds of achieving clinically significant improvements in 4 tests (6MWT, PILE, HST affected side, and 1MSCT) was reduced for people taking opioids compared with the NA group. Conclusion: Given the inconclusive and limited evidence for the benefit of analgesics on pain and disability in CMSP, health professionals should be aware of these results for even low doses of opioids, which were associated with poor physical performance and rehabilitation progress.

Introduction: Opioid prescription is associated with various biopsychosocial (BPS) domains. Explaining how they interact is worth to better understand their role. Objectives: To assess direct and indirect effects of BPS complexity and pain-related factors on opioid prescription in patients with chronic musculoskeletal pain. Methods: We included 3,923 individuals admitted to a tertiary care rehabilitation clinic. Two outcomes were defined: likelihood of opioid prescription at admission (yes/no) and daily morphine equivalent dose (dMED) during rehabilitation. Predictors were sociodemographic factors, injury severity and location, pain-related factors (pain catastrophizing, depressive symptoms, pain severity), and BPS complexity assessed by the INTERMED method. Structural equation modelling was used to assess the direct and indirect effects of BPS complexity on outcomes. Results: Biopsychosocial complexity had a direct effect on opioid prescription (OR 1.20; 95% CI 1.10–1.32) and indirect effects via pain severity (OR 1.09; 95% CI 1.06–1.12) and depressive symptoms (OR 1.02; 95% CI 1.00–1.04). Biopsychosocial complexity also had direct effect on dMED (β = 1.17, 95% CI 1.06–1.28) and an indirect effect via pain severity (exp β = 1.03; 95% CI 1.00–1.07). Pain catastrophizing was indirectly associated with opioid prescription and dose via pain. The likelihood of opioid prescription was associated with female sex, increased education level, and spine trauma; the latter 2 factors were also associated with increased dMED. Conclusion: Our study suggests that BPS complexity is associated with opioid prescription and dose, with direct and indirect effects via pain severity or depressive symptoms. Screening and addressing patients' complexity may help decrease opioid prescriptions and risk of misuse.

To analyse the factors influencing the configuration of accident trajectories from de perspective of patients and assess the role of rehabilitation in managing pain and functional limitations autonomously. Using a qualitative, longitudinal, interdisciplinary approach, we conducted two comprehensive interviews (one year apart) with patients experiencing chronic pain and functional limitations following orthopaedic trauma. Thematic analysis was conducted utilising MaxQDA^® software to systematically analyse the data. Twenty-four patients participated (4 ♀; 20 ♂; 44.9 ± 10.6, min. 19; max. 63.5 yo; 1.0 ± 4.0 years duration; pain 4.6 (1.8) severity subscale (0-10) [mean (SD)]). Through reconstruction their experiences we identified three types of accident trajectories: socio-professional reintegration, ongoing reintegration, and exclusion. Factors influencing these trajectories included physical and psychological health status, occupational status, private and social context, and insurance and therapeutic aspects. Patients' perceptions and socio-demographic characteristics also contributed to trajectories specificities. Understanding the factors that influence accident trajectories links individual and social dimensions, offering an overall comprehension of patients' situations and structural constraints. This understanding enables the factors influencing trajectories to be considered during rehabilitation, thereby promoting the patient's socio-professional reintegration through targeted interventions.

People with chronic musculoskeletal pain (CMSP) often have low physical activity. Various factors can influence the activity level. The aim of this study was to monitor physical activity, assessed by the number of steps per day, over time in people with CMSP and identify factors that could be associated with this activity feature. This prospective study involved people undergoing rehabilitation following an orthopedic trauma that had led to CMSP. At entry, participants completed self-reported questionnaires assessing pain, anxiety, depression, catastrophyzing, kinesiophobia, and behavioural activity patterns (avoidance, pacing and overdoing). They also underwent functional tests, assessing walking endurance and physical fitness. To determine daily step counts, participants wore an accelerometer for 1 week during rehabilitation and 3 months post-rehabilitation. The number of steps per day was compared among three time points: weekend of rehabilitation (an estimate of pre-rehabilitation activity; T1), weekdays of rehabilitation (T2), and post-rehabilitation (T3). Linear regression models were used to analyze the association between daily steps at T2 and at T3 and self-reported and performance-based parameters. Data from 145 participants were analyzed. The mean number of steps was significantly higher during T2 than T1 and T3 (7323 [3047] vs. 4782 [2689], p < 0.001, Cohen’s d = 0.769, and 4757 [2680], p < 0.001, Cohen’s d = 0.693), whereas T1 and T3 results were similar (p = 0.92, Cohen’s d = 0.008). Correlations of number of steps per day among time points were low (r ≤ 0.4). Multivariable regression models revealed an association between daily steps at T2 and pain interfering with walking, anxiety and overdoing behaviour. Daily steps at T3 were associated with overdoing behaviour and physical fitness. Despite chronic pain, people in rehabilitation after an orthopedic trauma increased their physical activity if they were given incentives to do so. When these incentives disappeared, most people returned to their previous activity levels. A multimodal follow-up approach could include both therapeutic and environmental incentives to help maintain physical activity in this population.

Purpose: To assess and compare the healthcare costs, time to fitness for work (TFW) between chronic complex regional pain syndrome (CRPS) and non-CRPS; and identify factors associated with these outcomes in a comparative longitudinal study. Patients and Methods: 148 patients with chronic CRPS of the hand and 273 patients with chronic hand impairments but without CRPS (non-CRPS) were admitted at a Swiss rehabilitation clinic between 2007 and 2016. Healthcare costs and TFW were retrieved from insurance data over 5 years after the accident. Socio-demographic factors, biopsychosocial complexity measured by means of the INTERMED questionnaire, pain intensity and DASH disability scores were collected during rehabilitation. Generalized estimation equations and Cox proportional-hazards models were used to identify factors associated with outcomes. Results: Healthcare costs were increased by 20% for the CRPS versus non-CRPS group (coefficient = 1.20, 95% CI = 1.08-1.35, p<0.001). The median TFW was longer for CRPS than non-CRPS patients (816 vs 672 days, p = 0.02). After adjusting for covariates, TFW did not differ between the two groups (hazard ratio = 0.94, 95% CI = 0.73-1.21, p=0.61). For CRPS patients, higher healthcare costs were associated with severe or moderate initial injury, high INTERMED or DASH disability scores. Longer TFW were associated with severe initial injury, low educational level, no work contract, and high INTERMED or DASH disability scores. Conclusion: Overall, the healthcare costs were higher for CRPS than non-CRPS patients, but the TFW was comparable. We demonstrated also the significant associations of disability and biopsychosocial factors with the healthcare costs and TFW in CRPS patients.

Purpose: Chronic pain is a complex phenomenon. Understanding its multiple dimensions requires the use of a combination of several patient-reported outcome measures (PROMs). However, completing multiple PROMs is time-consuming and can be a burden for patients. The objective of our study was to simultaneously reduce the French versions of the Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK) questionnaires to enable their use in an ambulatory and clinical settings. Patients and Methods: We conducted a clinical study between May 2014 and August 2020 in our rehabilitation center. 1428 chronic musculoskeletal pain patients (CMSP) were included. The originality of our approach is that the reduction method included qualitative as well as quantitative analyses. The study was divided into two parts: 1) reduction of the questionnaires (n=1363) based on internal consistency (item-to-total correlation), principal component analysis (item loadings), Rasch analysis (infit/outfit), floor and ceiling effect (quantitative analyses) and expert judgment of items (qualitative analysis), and 2) validation of the reduced questionnaires (n=65), including test–retest reliability (intraclass correlation coefficient [ICC]), homogeneity (Cronbach α), criterion validity (Pearson correlation [r] with the long-version score), determination of the pathological cutoff and Minimal Clinically Important Difference (MCID). The two full-length questionnaires include 30 items in total. Results: The reduction resulted in a 5-item PCS (score 0– 20) and 6-item TSK (score 0– 24). Psychometric properties of the reduced questionnaires were all acceptable as compared with other version (α=0.89 and 0.71, ICC=0.75 and 0.60, r=0.86 and 0.70, MCID=2 and 2 for PCS and TSK, respectively) while keeping the structure and coherence of the long versions. Conclusion: The two reduced versions of the PCS and TSK can be used in CMSP patient. As their administration only requires a few minutes, they can be implemented in outpatient consultation as well as in clinical settings.