Darcy Ummels

118 | Chapter 6 Figure 6.2 Flowchart on how to use activity trackers in daily clinical practice in the first draft manual. Blue, start using the activity tracker; yellow, assessment period; green, monitoring period. Assessment: period in which the physical activity level is assessed in the first three to four weeks for a short period (<2 weeks) or a long period (>2 weeks) after the initial assessment. Monitoring: period in which the patient is monitored whether they meet with their goals to be more or less physically active or to divide physical activity equally over the day. Setting and context The study was performed in a specialized mental healthcare center for people with chronic somatic symptom disorders specific to spinal pain (Het Rughuis Parkstad in the Netherlands). Therapy is generally provided three times a week by an interdisciplinary team over a period of six months. The team consisted of a physiotherapist, a cognitive behavioral therapist, and a psychosomatic therapist. The psychosomatic therapists were proposed to participate in this study by the specialized mental healthcare center itself since they need the most information about the physical activity level of their patients within the multidisciplinary team in order to use the pain functioning model (a theoretical framework which is used as a departure point for their approach 52 ). This model describes how chronic pain can originate and can persist or worsen. Together with the patient, the consequences of their pain and influencing factors are explored. Both the bio ‐ medical and the bio ‐ psychological aspects are included in this model. 52 This model provides insight into the pain belief, the willingness, and possibilities of the patient to reflect on their role within their pain management. With the use of this model, psychosomatic therapists divide patients into three pain ‐ coping mechanism groups: (1) defeatism, (2) catastrophizing, and (3) non ‐ accepting coping mechanism. The therapists use the following definitions: patients with a defeatism coping mechanism demonstrate expectation or acceptance of failure, patients with a catastrophizing coping mechanism view a situation as worse than it actually is, and patients with a non ‐