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Table 1 Intervention group: Multimodal Rehabilitation Program, description of the treatment

From: Study protocol for a multicentre randomized controlled trial on effectiveness of an outpatient multimodal rehabilitation program for adolescents with chronic musculoskeletal pain (2B Active)

Graded Exposure module OR Combination module (Graded exposure and physical training)
Phase 1 Intake and PHODA-Youth (60 min)
• Information about cognitive, behavioral and psychophysiological aspects of pain complaints
• Description of family system and situation
• Identification of activities that are being avoided, and accompanying cognitions
Phase 2 Education (60 min)
• Explanation of treatment rationale
• Explanation of treatment
• Alternative explanation for persistence of pain complaints
• Personal fear avoidance model
Phase 3 Graded Exposure treatment sessions (12 × 60 min)
• Systematic exposure to fear provoking activities and movements
• Behavioral experiments
• Generalization and relapse prevention
  Phase 1 Intake, PHODA-Youth, and physical examination (60 min)
• Information about cognitive, behavioral and psychophysiological aspects of pain complaints
• Description of family system and situation
• Identification of activities that are being avoided, and accompanying cognitions
• Physical examination of strength, balance and propriocepsis.
Phase 2 Education Graded Exposure and training (60 min)
• Explanation of treatment rationale
• Explanation of treatment: Training and graded exposure sessions
• Alternative explanation for persistence of pain problems
• Explanation of physical training
• Personal fear avoidance model
Phase 3 Training (16x120 min)
• Training (hydrotherapy if possible), focusing on aerobic capacity, muscle strength, core stability, propriocepsis
• Homework (training exercises)
Phase 4 Graded Exposure treatment sessions (6x 60 min)
• If necessary: repetition of treatment rationale
• Systematic exposure to fear provoking activities and movements
• Behavioral experiments
• Generalization and relapse prevention
  AND  
Parent module
Phase 1 Medical education and treatment rationale
• Explanation of treatment rationale
• Explanation of treatment
• Alternative explanation for persistence of pain complaints
• Personal fear avoidance model for their child
Phase 2 The role of pain within the family system
• Explanation of the influence of pain on the family system and interaction between parents and child
• Tools to support the child in creating and maintaining behavioral change
Phase 3 Generalization and relapse prevention
• Identifying and recognizing risky situations that can trigger relapse
• Preventing relapse by making plans