Carmen Caeiro

Background/Objectives: Implementing a person-centered practice is considered a priority in healthcare, and the development of a solid and positive therapeutic relationship is a fundamental element. This study conducted a cross-cultural adaptation of the Person-Centered Therapeutic Relationship in Physiotherapy Scale to European Portuguese and contributed to its validation through the study of its structural validity and internal consistency. Methods: This study was conducted from October 2021 to July 2023 and included two phases: a methodological study of cross-cultural adaptation (phase 1) and a transversal study to assess the psychometric properties (phase 2). Structural validity was analyzed using exploratory factor analysis and internal consistency was estimated using Cronbach’s alpha (α). A p-value < 0.05 was considered to indicate statistical significance. Results: The Person-Centered Therapeutic Relationship in Physiotherapy Scale was successfully culturally adapted to European Portuguese (phase 1). During phase 2, 203 individuals [mean age: 50.16 ± 13.10 years (range 18–80 years)] with musculoskeletal conditions, mostly female (63.1%), were recruited. The factorial solution explained 74.7% of the total variability and retained three factors, grouping items 9 to 15 in a common factor (professional empowerment and therapeutic communication). Adequate internal consistency was found (Cronbach’s α = 0.889). Conclusions: This study culturally adapted an instrument to European Portuguese, which allows the assessment of the person-centered therapeutic relationship in physiotherapy, presenting adequate internal consistency. Future studies should contribute to the remaining validation of the instrument so that it can be available to the Portuguese population.

Considering the need to study the experiences of individuals with musculoskeletal problems in contexts that have not yet been investigated as well as the relevance of fostering a research agenda to...

The SPLIT project aims to introduce an interdisciplinary stratified model of care for patients with low back pain. This study aimed to explore the acceptability and identify potential barriers and facilitators regarding the upcoming implementation of this project, based on the general practitioners' and physiotherapists' perceptions. A qualitative study was carried out supported by two focus groups, which were conducted by two researchers. A focus group was carried out with each professional group. One focus group included six general practitioners and the other included six physiotherapists. The focus groups were based on a semi-structured interview schedule, audio-recorded and transcribed verbatim. A thematic analysis was conducted. The participants explored aspects related to the acceptability of the SPLIT project, emphasising the satisfactory amount of effort that is expected to be required for its implementation. Potential facilitators to the implementation of the model were identified, such as the participants`motivation. Potential barriers were also explored, with particular emphasis on the challenges related to the change of routine care. Lastly, the need for particular adjustments in the health services was also highlighted. This study`s participants highlighted the feasibility and acceptability of the SPLIT project. The identification of potential barriers and facilitators to its implementation also attained major relevance to better prepare the upcoming implementation of this project. The generalizability of findings to the larger population of relevant practitioners is limited, since only two focus groups were carried out. Therefore, this study`s findings should be considered in terms of transferability to contexts that may have some similarities to the context where the study was carried out.

Background The results of a recent study have suggested that the current clinical practice is not in line with clinical guideline recommendations and may not be delivering the best outcomes to Low Back Pain (LBP) Portuguese patients. Since the stratified primary care approach has demonstrated clinical and cost-effectiveness in the UK and other countries, the SPLIT project aimed to introduce a similar approach that involves general practitioners (GPs) and physiotherapists (PTs) in the triage and targeted treatment for LBP patients, in Portugal. In order to facilitate the implementation of this project a training program for GPs and PTs was delivered by rheumatologists and PTs. Considering the specific organization of the Portuguese primary care, it was important to explore the perceptions of the GPs and PTs, who attended to the training, regarding the implementation of the SPLIT stratified model of care in the Portuguese context. Objectives Identify and understand the potential barriers and facilitators to the implementation of the SPLIT stratified model of care. Methods After obtaining ethical approval, two focus groups (one for each professional group) were carried out. The focus groups were based on a semi-structured interview schedule, audio-recorded and transcribed verbatim. A thematic analysis was conducted. Firstly, two researchers independently coded the transcripts. Secondly, these researchers discussed the codes and examined their scope and relevance. Thirdly, the researchers developed a coding scheme that included the main themes and sub-themes, as well as the connections among them. Results The potential barriers were identified and explored by both professional groups. The introduction of change into the routine delivery care was identified as one of the most important barriers. According to the GPs` perspective, the possibility of inadequate referral was considered as an issue. The PTs highlighted the challenges inherent to the psychosocial informed physiotherapy treatment of patients classified with high risk of developing persistent and disabling pain. More specifically, they emphasised the need to receive mentoring sessions in clinical practice, in order to develop competences for the management of psychosocial issues. In what concerns to the potential facilitators to the implementation of the model, the participants` personal motivation was considered as one of the most important factors. The alignment of the SPLIT model with the mission and goals of the health care units where the project was going to be piloted was also identified as an important facilitator. Finally, both professionals groups considered that the SPLIT model may facilitate the interdisciplinary approach to the management of this condition, as it clarifies the specific contribution of GPs and PTs in the approach to LBP patients Conclusion The knowledge about the potential barriers and facilitators to the implementation of the SPLIT stratified model of care may contribute to the successful implementation of stratified care for LBP patients in Portugal. References [1] Foster, N., et al. (2018) Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 10137(391): 2368-2383. [2] Gouveia, N., et al. (2016) Prevalence and social burden of active chronic low back pain in the adult Portuguese population: results from a national survey. Rheumatology International. 36(2): 183-97. Disclosure of Interests None declared

Background: Low back pain (LBP) is the leading cause of disability in Portugal and worldwide. The majority of the patients use primary health care services but the treatment outcomes are unknown. Findings of prognostic studies indicate that a marked reduction in mean pain and disability is expected in the first 6-8 weeks, for acute or persistent LBP. Beyond that time frame period, improvement slows and thereafter the probability to develop a persistent disabling back pain condition improves. Therefore, it seems important to measure the patients’ outcomes at this time-point to better assess the effectiveness of the care provided. Objectives: This study aims to describe the short-term outcomes for LBP patients treated in a primary health care centre in Portugal and to identify the prognostic factors for non-recovery and poor health related quality of live (HRQoL). Methods: 116 patients with LBP were consecutively recruited from 7 different primary care units in Portugal. Baseline assessment includes socio-demographic and clinical data, psychosocial factors, pain, disability, and HRQoL. Pain, disability and HRQoL were then assessed at 8-weeks follow-up. A Global Rating of Change Scale to assess patient perception of improvement with treatment was added in the follow-up reassessment. Recovery criteria were determined according to the Minimal Clinically Important Difference established for pain and disability (reduction of ≥30% from baseline). The EQ-5D,3L index was dichotomised into ‘poor’ HRQoL (≥ 0.6), based on a proposed cut-off for having sufficient capacity to be able to work for a population with LBP. The relationship between variables on baseline and non-recovery/‘poor’ HRQoL was modulated through logistic regression. Results: Of the 116 participants enrolled, 110 completed the 8-weeks follow-up. (mean age of 48,06±11,41). Approximately half of the participants (53.4%) were acute presentations of LBP. The main treatment strategy was medication (83.5%), with only 8.3% of patients having been referred for physiotherapy. At 8 weeks follow-up, there were statistically significant improvements on pain, disability and HRQoL (p≤ 0.05). However, 38% of the patients reported they felt the same or worse, 76.4% had a poor HRQoL, and only half of the patients reached the established recovery criteria (49% in disability and 50% in pain). In the adjusted model, the probability of non-recovery (p≤0.05) was associated with the presence of maladaptive psychosocial factors (OR: 1.65, 95% CI 1.13-2.40, for pain; OR: 1.61, 95% CI 1.15-2.24, for disability), a chronic pain condition (OR: 1.71, 95% CI 1.33-1.88, for pain; OR: 1.76, 95%CI 1.43-1.89, for disability), and high levels of pain at baseline for pain (OR: 1.26, 95%CI 1.09-1.39). Poor HRQoL was associated to the female gender (OR: 1.88, 95%CI 1.61-1.96), chronic pain condition (OR: 1.68, 95%CI 1.03-1.89) and high levels of pain intensity at baseline (OR: 1.36, 95%CI 1.11-1.67). Conclusion: These results suggest there is a room for improvement in the healthcare delivered to LBP patients in the Portuguese primary healthcare setting. Disclosure of Interests: None declared

Background Research on non-pharmacological treatments for fibromyalgia patients has demonstrated that exercise and education have positive effects on pain and disability¹. However, the traditional approach of studying treatment effectiveness based exclusively on quantitative measures has been questioned. There is growing recognition of the importance of integrating patients` perspectives into clinical research. Outcome measures focused on patients` perceptions of improvement have been increasingly used, however they do not offer expanded definitions of what constitutes a “successful” outcome². The further exploration of patients` perspectives about treatment benefits may contribute to the development of treatments that better match patients` needs. Objectives The aim of this study was twofold: firstly, to examine the effectiveness of a group physiotherapy programme (incorporating exercise and education) on pain intensity, disability and global impression of change in fibromyalgia patients; and, to explore how patients, who achieved success in pain and/or disability (according to the score from the Patient Global Impression of Change Scale - PGIC), understand and make sense of the results. Methods A sequential explanatory mixed methods approach, combining quantitative (1 st phase) and qualitative methods (2nd phase), was carried out. In the 1 st phase, the participants underwent an 8 week (3 times weekly) standardised group programme. Participants were assessed at baseline, 4 and 8 weeks later. Outcome measures included the Numeric Pain Rating Scale (NPRS), the Revised Fibromyalgia Impact Questionnaire (FIQR) and the PGIC. Participants who had scored ≥5 in the PGIC were invited to participate in a focus group. In the 2nd phase, 2 focus groups meetings were carried out to collect data. A semi-structured interview schedule was used and the sessions were audiotaped and transcribed verbatim. Results Thirty-seven participants (females; 49.3±10.2 years) completed the 1 st phase. Analysis using SPSS revealed statistically significant improvements on pain intensity (mean SD change:−1.38±2.363,p=0.001) and disability (−21.577±21.02,pConclusions The combination of data from both phases provided detailed information about the participants` perceptions regarding the key elements for achieving success with a physiotherapy programme. Further research on patients` perspectives regarding treatment effectiveness is recommended since it may contribute to the design of more effective and patient-centred treatments. References [1] Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases2017;76:318–328. [2] Evans R, et al. “‘I Know It’s Changed’: a Mixed-Methods Study of the Meaning of Global Perceived Effect in Chronic Neck Pain Patients. European Spine Journal2014;23(4):888–97. Disclosure of Interest None declared

The aim of this study was to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in chronic low back pain patients. Single-blind randomized controlled trial. Outpatient clinic. Sixty-two chronic low back pain patients were randomly allocated to receive aquatic exercise and pain neurophysiology education (n = 30) or aquatic exercise alone (n = 32). Twelve sessions of a 6-week aquatic exercise programme preceded by 2 sessions of pain neurophysiology education. Controls received only 12 sessions of the 6-week aquatic exercise programme. The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale) at the baseline, 6 weeks after the beginning of the aquatic exercise programme and at the 3 months follow-up. Secondary outcome was kinesiophobia (Tampa Scale of Kinesiophobia). Fifty-five participants completed the study. Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favoring the education group (mean SD change: −25.4± 26.7 vs −6.6 ± 30.7, P < 0.005). Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up (RR=1.63, 95%CI: 1.01–2.63), no significant differences were found in functional disability and kinesiophobia between groups at any time. This study’s findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercise.