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McConnell R, Lane E, Webb G, LaPeze D, Grillo H, Fritz J. A multicenter feasibility randomized controlled trial using a virtual reality application of pain neuroscience education for adults with chronic low back pain. Ann Med 2024; 56:2311846. [PMID: 38354690 PMCID: PMC10868420 DOI: 10.1080/07853890.2024.2311846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a highly prevalent condition among adults and is correlated to high levels of pain, high disability, and lower quality of life. Pain neuroscience education (PNE) helps to explain the pain experience and can affect psychosocial factors, such as fear of movement, anxiety, socioeconomic status, work life satisfaction, etc. More recently, virtual reality (VR) programs have emerged allowing for immersive PNE experiences. OBJECTIVE The purpose of this randomized clinical trial is to determine the feasibility of using a VR application for the delivery of immersive PNE (VR-PNE) and other activity training for patients with CLBP presenting to outpatient physical therapy (PT) clinics. METHODS A two-arm, parallel group, randomized controlled feasibility trial of patients was conducted at 12 outpatient PT clinics from March 9, 2022, through September 9, 2022. The intervention group received PT as usual and VR-PNE while the control group received PT as usual. Between group feasibility, acceptability outcomes and other patient-reported outcomes were assessed at six weeks. RESULTS A total of 595 individuals were evaluated for low back pain during the recruitment period. Seventy individuals were eligible and met definition for CLBP, 52 enrolled and 32 completed the trial. Participant adherence was 63.6% for VR-PNE and 63.2% for PT as usual. Participants found VR-PNE acceptable and reported satisfaction scores (0-100) of 87.37 ± 11.05 compared to 81.17 ± 23.72 in the PT as usual group. There were no significant differences between groups for the BBQ, BRS, FABQ-PA, FABQ-W, GROC, NPRS, NPQ, PCS, and PSEQ at 6 weeks. CONCLUSION The results of the trial suggest that VR-PNE may be acceptable and feasible for patients with CLBP. Study procedures and PT delivery modifications should be considered for the next iteration of this study to improve follow-up assessment rates.
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Affiliation(s)
- Ryan McConnell
- Department of Physical Therapy, Belmont University, Nashville, TN, USA
- Benchmark Physical Therapy, Chattanooga, TN, USA
| | | | - Grace Webb
- Benchmark Physical Therapy, Chattanooga, TN, USA
| | - Dana LaPeze
- Benchmark Physical Therapy, Chattanooga, TN, USA
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McLaughlin P, Chowdary P, Khair K, Smith C, Stephensen D, Hurley M. Exercise-based telerehabilitation for the management of chronic pain in people with severe haemophilia: a mixed-methods feasibility study. Pilot Feasibility Stud 2024; 10:128. [PMID: 39380074 PMCID: PMC11460162 DOI: 10.1186/s40814-024-01550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/25/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Chronic pain is reported by between 30 and 71% of people with haemophilia (PWH). Exercise is shown to be effective for pain management in other arthritides, but it remains unclear if such an approach is effective or acceptable to PWH. The aim of this study was to evaluate the feasibility and acceptability of a telerehabilitation exercise intervention for PWH living with chronic pain. METHODS This was a multisite, non-randomised, pre-post feasibility design, with a nested qualitative study. People with severe haemophilia > 18 years, living with chronic pain, were recruited. The intervention comprised 12 low-impact/moderate intensity, individualised exercise sessions and 3 knowledge-sharing and discussion sessions. Primary objectives assessed according to predefined progression criteria were as follows: (a) recruitment rate (5 participants enrolled per site over 8 weeks), (b) adherence (≥ 75% participants would adhere to ≥ 75% of sessions), (c) follow-up rate (≥ 75% completion of self-reported measures), (d) fidelity (intervention delivered as described in protocol) and (e) safety (≤ 30% participants would report adverse events). Acceptability was evaluated from thematic analysis of post-intervention participant interviews. Preliminary evaluation of self-reported pain, function and quality of life (QoL) was a secondary objective. Results were reported using descriptive statistics integrated with qualitative findings. RESULTS Ten PWH were recruited and completed the intervention. Nine agreed to be interviewed post intervention. Attendance at individual sessions was 84.5% compared to 52.1% for the group sessions. Outcome measures were successfully completed for 100% at baseline, 70% at intervention end and 60% at 3-month follow-up. No serious adverse events were recorded. Group median values in outcome measures (pain, function, QoL) showed minimal change post intervention. Participant interviews highlighted high levels of enjoyment, confidence in continuing exercises independently and positive views of virtual delivery and condition-specific exercise. CONCLUSIONS Recruitment rate and safety met the predefined progression criteria. Fidelity partially met the progression criteria, but the follow-up rate for self-reported measures did not. The study was acceptable to both participants and physiotherapists. Further intervention development is needed to review approaches to outcome measure collection and refine the usefulness of the knowledge-sharing sessions. TRIAL REGISTRATION The study was prospectively registered on 9 July 2021: International Standard Randomised Controlled Trial Number ISRCTN 17454597.
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Affiliation(s)
- Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK.
- Department of Academic Haematology, University College London, London, UK.
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
- Department of Academic Haematology, University College London, London, UK
| | | | | | - David Stephensen
- School of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
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Forte G, Favieri F, De Pascalis V, Casagrande M. To Be in Pain: Pain Multidimensional Questionnaire as Reliable Tool to Evaluate Multifaceted Aspects of Pain. J Clin Med 2024; 13:5886. [PMID: 39407946 PMCID: PMC11477689 DOI: 10.3390/jcm13195886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 09/23/2024] [Accepted: 10/01/2024] [Indexed: 10/20/2024] Open
Abstract
Background/Objectives: Pain is a multidimensional experience influenced by sensory, emotional, and cognitive factors. Traditional pain assessments often fail to capture this complexity. This study aimed to develop and validate the Pain Multidimensional Questionnaire (Pa-M-QU), a new self-report tool designed to assess pain catastrophizing, sensitivity, and coping strategies. Methods: Two independent samples of Italian-speaking participants, aged 18 and above, were recruited online. The first sample (n = 392; mean age = 29.36) was used for exploratory factor analysis (EFA), and the second sample (n = 123; mean age = 28.0) for confirmatory factor analysis (CFA). Pearson's correlations and convergent validity analyses were conducted. Results: From an initial pool of 59 items identified through focus group discussions, 35 items were removed based on reliability analysis. The final 24-item Pa-M-QU features a three-factor structure: catastrophizing, pain sensitivity, and coping with pain. Conclusions: The Pa-M-QU offers a rapid, non-invasive assessment that captures the multidimensional nature of pain. It is a starting point to develop tools for both clinical and research settings, aiding in evaluating pain in healthy individuals and predicting acute and chronic pain disorders. Future research should focus on refining the Pa-M-QU for broader clinical applications and exploring its potential to complement or replace traditional pain assessments, thereby advancing pain management and research.
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Affiliation(s)
- Giuseppe Forte
- Department of Dynamic and Clinical Psychology and Heath Studies, “Sapienza” University of Rome, 00185 Rome, Italy; (G.F.); (M.C.)
| | - Francesca Favieri
- Department of Dynamic and Clinical Psychology and Heath Studies, “Sapienza” University of Rome, 00185 Rome, Italy; (G.F.); (M.C.)
| | | | - Maria Casagrande
- Department of Dynamic and Clinical Psychology and Heath Studies, “Sapienza” University of Rome, 00185 Rome, Italy; (G.F.); (M.C.)
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Lanzara R, Conti C, Lalli V, Cannizzaro P, Affaitati GP, Giamberardino MA, Williams A, Porcelli P. Emotions in search of words: Does alexithymia predict treatment outcome in chronic musculoskeletal pain? Stress Health 2024; 40:e3436. [PMID: 38896506 DOI: 10.1002/smi.3436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 05/22/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Chronic pain, with its complex and multidimensional nature, poses significant challenges in identifying effective long-term treatments. There is growing scientific interest in how psychopathological and personality dimensions may influence the maintenance and development of chronic pain. This longitudinal study aimed to investigate whether alexithymia can predict the improvement of pain severity following a treatment-as-usual programme for chronic musculoskeletal pain over and above psychological cofactors (emotional distress, catastrophizing, and self-efficacy). A consecutive sample of 129 patients with diagnosed chronic musculoskeletal pain referred to two tertiary care centres was recruited and treated for 16 weeks. Clinical pain, psychological distress, self-efficacy, catastrophizing, and alexithymia were assessed with validated self-report measures at the first medical visit (T0) and at 16-week follow-up (T1). Compared with non-responder patients (n = 72, 55.8%), those who responded (i.e., reduction of >30% in pain severity; n = 57, 44.2%) reported an overall improvement in psychological variables except alexithymia. Alexithymia showed relative stability between baseline and follow-up within the entire sample and remained a significant predictor of treatment outcome even when other predictive cofactors (i.e., pain interference, depressive symptoms, and catastrophizing) were considered simultaneously. Our results suggest that identifying patients with a co-occurrence between alexithymia, depressive symptoms, catastrophizing, and the stressful experience of chronic pain can be clinically relevant in pain prevention and intervention programs.
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Affiliation(s)
- Roberta Lanzara
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Vittorio Lalli
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Paolo Cannizzaro
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Gianna Pia Affaitati
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti, Italy
| | - Maria Adele Giamberardino
- Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alison Williams
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Piero Porcelli
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Hancock M, Smith A, O'Sullivan P, Schütze R, Caneiro JP, Hartvigsen J, O'Sullivan K, McGregor A, Haines T, Vickery A, Campbell A, Kent P. Patients with worse disability respond best to cognitive functional therapy for chronic low back pain: a pre-planned secondary analysis of a randomised trial. J Physiother 2024; 70:294-301. [PMID: 39327170 DOI: 10.1016/j.jphys.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/12/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
QUESTION Do five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care? DESIGN Secondary analysis of the RESTORE randomised controlled trial. PARTICIPANTS A total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation. INTERVENTION Participants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care. OUTCOME MEASURES The outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising. RESULTS Baseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks. CONCLUSION The finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients. REGISTRATION ACTRN12618001396213.
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Affiliation(s)
- Mark Hancock
- Department of Health Sciences, Macquarie University, Sydney, Australia.
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter O'Sullivan
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Robert Schütze
- Curtin School of Allied Health, Curtin University, Perth, Australia; Multidisciplinary Pain Management Centre, Royal Perth Hospital, Perth, Australia
| | - J P Caneiro
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| | - Kieran O'Sullivan
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Alison McGregor
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Sydney, Australia
| | | | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter Kent
- Department of Health Sciences, Macquarie University, Sydney, Australia; Curtin School of Allied Health, Curtin University, Perth, Australia
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Adeyinka BO, Gatti AA, Chopp-Hurley JN. Investigating the relationship between physical activity and self-reported outcomes in adults with rotator cuff related shoulder pain. Physiother Theory Pract 2024; 40:2256-2264. [PMID: 37642369 DOI: 10.1080/09593985.2023.2250438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Rotator cuff related shoulder pain is common among older adults. While exercise is often recommended for this condition, the relationship between physical activity levels and self-reported outcomes is unclear. This study investigated whether self-reported outcomes (pain, function, depressive symptoms, self-efficacy, general mental and physical health) relate to physical activity, and whether those who participated in shoulder-specific exercise had better self-reported outcomes than those who performed whole-body exercise. METHODS Forty-six participants with rotator cuff related shoulder pain participated from which 35 had complete datasets. Questionnaires were used to assess physical activity, pain, physical function, general health, and self-efficacy. Physical activity levels were also measured using an accelerometer. RESULTS Neither pain nor other self-reported outcomes were related to subjective or objective physical activity levels. Participants that completed shoulder-specific exercise had significantly higher exercise self-efficacy than those who completed nonspecific exercise (P = .01; d = 0.91). CONCLUSION A significant relationship between pain or self-reported outcomes and physical activity was not identified. Those who self-reported regularly exercising their injured shoulder had higher exercise self-efficacy than those who did not. These findings have clinical implications, suggesting that strategies to boost exercise self-efficacy may be important for older adults with rotator cuff related shoulder pain.
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Affiliation(s)
- Baithat O Adeyinka
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Anthony A Gatti
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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Dear BF, Gilmore S, Campbell N, Titov N, Beeden A. Internet-Delivered Psychological Pain Management: A Prospective Cohort Study Examining Routine Care Delivery by a Specialist Regional Multidisciplinary Pain Service. THE JOURNAL OF PAIN 2024; 25:104601. [PMID: 38871146 DOI: 10.1016/j.jpain.2024.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
Several clinical trials have demonstrated the effectiveness of internet-delivered psychological-based pain management programs (PMPs). However, to date, no large studies have reported the outcomes of PMPs when delivered by specialist multidisciplinary pain services in routine care. The present study reports (n = 653) the outcomes of an internet-delivered PMP provided as routine care by a specialist Australian regional pain service over a 6-year period. High levels of treatment commencement (85%) and completion (72%) were observed, with more than 80% of patients reporting they were satisfied with the intervention. Clinical improvements were observed from pretreatment to post-treatment (% change, 95% confidence intervals (CI)) in pain-related disability (8.8%; 4.5, 12.8), depression (28.4%; 23.0, 33.4), anxiety (21.9%; 14.6, 28.5), and pain intensity (7%; 3.5, 10.5), which were maintained to 3-month follow-up. At 3-month follow-up, 27% (23, 31), 46% (41, 51), 44% (39, 49), and 22% (19, 26) reported clinically meaningful (defined as ≥ 30%) improvements in pain-related disability, depression, anxiety, and pain intensity, respectively. These results were obtained with relatively little therapist time per patient (M = 30.0, (standard deviation) SD = 18.8) to deliver the intervention. The current findings highlight the potential of internet-delivered PMPs as part of the services provided by specialist pain services, particularly those servicing large geographical regions and for patients unable to travel to clinics for face-to-face care. PERSPECTIVE: This study reports the outcomes of the routine delivery of an internet-delivered psychological PMP by a specialist pain service. The findings highlight the potential of this model of care when provided by specialist pain services, particularly for patients not unable to attend and not requiring intensive face-to-face care.
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Affiliation(s)
- Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia.
| | - Shereen Gilmore
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Nicole Campbell
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alison Beeden
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
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Lee YJ, Bettick D, Rosenberg C. Improving Pain Self-Efficacy in Orthopedic Surgery Patients Through Video-Based Education: A Quality Improvement Project. Pain Manag Nurs 2024; 25:451-458. [PMID: 38719657 DOI: 10.1016/j.pmn.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Effective pain management following discharge is critical for postoperative recovery, with pain self-efficacy serving as a crucial component in this process. Patient education plays a key role in enhancing self-efficacy. Among various educational modalities, a growing body of evidence supports the efficacy of video-based methods. LOCAL PROBLEM A lack of evidence-based pain education programs for patients undergoing elective orthopedic surgery was identified at an urban academic hospital on the East Coast of the United States. This quality improvement project aimed to develop and assess a video-based pain education program, focusing on pain self-efficacy and self-reported preparedness among adult patients prescribed opioids for postsurgical pain. METHODS This project adopted a pretest-posttest design, utilizing the knowledge-to-action framework. Data collection spanned 3 months. Among the 69 patients screened for eligibility, 13 participants were included in the analysis. The primary intervention consisted of a 15-minute educational video covering essential pain management aspects. Following the intervention, pain self-efficacy and self-reported preparedness were evaluated using the Pain Self-Efficacy Questionnaire and a five-point Likert scale, respectively. RESULTS Median (IQR) scores on the Pain Self-Efficacy Questionnaire increased significantly from 20 (16) to 32 (14) (p < .01). Mean (SD) scores for patients' self-reported preparedness also increased from 21.92 (6.53) to 31.85 (2.41) (p < .01). All participants reported being satisfied or very satisfied with the educational intervention. CONCLUSION Video-based education is a time-efficient and cost-effective approach. Healthcare providers can consider integrating video education to enhance pain self-efficacy in the postoperative phase, thus enhancing postsurgical pain outcomes and overall recovery experience.
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Affiliation(s)
- Yoon-Jae Lee
- School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Dianne Bettick
- Department of Quality, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224, USA
| | - Carol Rosenberg
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, 21205, USA
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Hollis D, Mendis MD, Ng SK, Lewis J, Thomas M, Marks D, Hides J, Bisset L. Altered Sensory Processing in People Attending Specialist Orthopaedic Consultation for Management of Persistent Shoulder Pain: An Observational Cross-Sectional Study. J Orthop Sports Phys Ther 2024; 54:1-10. [PMID: 39329479 DOI: 10.2519/jospt.2024.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
OBJECTIVES: The primary objective was to compare sensory processing measures in people attending specialist orthopaedic consultation for management of persistent shoulder pain with control participants. The secondary objective was to compare the groups' sociodemographic, clinical, general health and lifestyle, and psychological characteristics. DESIGN: Observational cross-sectional. METHODS: Participants with shoulder pain for ≥3 months, who attended a public hospital orthopaedic department (n = 119), and community participants without shoulder pain (n = 44) underwent a standardized quantitative sensory testing protocol, measuring pressure pain threshold, temporal summation, and conditioned pain modulation. Sociodemographic, clinical, general health and lifestyle, and psychological characteristics were also collected. RESULTS: Participants with shoulder pain had significantly lower pressure pain thresholds at all sites (ie, local and widespread mechanical hyperalgesia) and significantly decreased conditioned pain modulation effect (ie, descending inhibition of nociception) than control participants. There was no significant difference between groups for temporal summation. Participants with shoulder pain had decreased general health and function, less healthy lifestyles, and poorer psychological health compared with controls. CONCLUSION: People referred to specialist orthopaedic care for management of persistent shoulder pain had clinical signs of altered sensory processing and poor health outcomes. J Orthop Sports Phys Ther 2024;54(10):1-10. Epub 25 July 2024. doi:10.2519/jospt.2024.12512.
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Ippersiel P, Preuss R, Wideman TH, Robbins SM. Pain-related threat and coordination in adults with chronic low back pain during a lifting task: A cross-sectional study. J Electromyogr Kinesiol 2024; 78:102923. [PMID: 39208555 DOI: 10.1016/j.jelekin.2024.102923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES People with low back pain (LBP) exhibit altered coordination, possibly indicating guarded movement. The connection between these changes and pain-related threat remains unclear. We aimed to determine if pain-related threat was related to spinal coordination and variability, during a lifting task, in people with chronic LBP. METHODS Participants were adults with chronic LBP (n = 47). Upper lumbar, lower lumbar, and hipkinematics were measured during 10crate lifting/lowering repetitions. Coordination and variability of the Hip-Lower Lumbar, and Lower Lumbar-Upper Lumbar joint pairs were calculated. Pain-related threat was measured using the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and task-specific fear. Linear regression analyses tested the relationship between pain-related threat and coordination. RESULTS Adding catastrophizing to our base model (sex) explained variance in Hip-Lower lumbar coordination (r2 change = 0.125, p = 0.013). General and task specific measures of fear were unrelated to coordination and variability at both joint pairs (r2 change < 0.064, p > 0.05). Exploratory t-tests revealed subgroups aligned with phenotypes of "tight" and "loose" control, where "tight" control was characterized by greater catastrophizing and disability. CONCLUSION Pain catastrophizing, but not measures of fear, was related to more in-phase ("tight") Hip-Lower Lumbar coordination during lifting/lowering. Considering this relationship based on subgroups may add clarity.
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Affiliation(s)
- P Ippersiel
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, Quebec, Canada.
| | - R Preuss
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, Quebec, Canada
| | - T H Wideman
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, Quebec, Canada
| | - S M Robbins
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, Quebec, Canada
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Kim S, Mangum LC, Glaviano NR. Influence of unilateral versus bilateral patellofemoral pain on physical activity, pain self-efficacy, and disability. Musculoskelet Sci Pract 2024; 73:103167. [PMID: 39178490 DOI: 10.1016/j.msksp.2024.103167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 08/10/2024] [Accepted: 08/19/2024] [Indexed: 08/25/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) affects physical and psychosocial health; however, it is unclear if unilateral and bilateral PFP induce similar levels of impairments. OBJECTIVES We aimed to compare physical activity (PA), pain self-efficacy, and disability between individuals with unilateral and bilateral PFP, and to compare these groups against pain-free controls. DESIGN Cross-sectional case-control. METHOD Sixty-two individuals with PFP (25 unilateral and 37 bilateral) and 20 pain-free controls completed the PA assessment using an accelerometer by daily steps, light PA, and moderate-to-vigorous PA (MVPA). We also calculated variability in each PA variable. Pain self-efficacy and disability were measured using the Pain Self-Efficacy Questionnaire and Anterior Knee Pain Scale, respectively. RESULTS Individuals with bilateral PFP took fewer daily steps compared to pain-free controls (9568.1 ± 3827.0 vs. 12,285.8 ± 2821.2 steps/day; P = 0.018, Cohen d = 0.79), whereas individuals with unilateral PFP did not (11,099.2 ± 3547.1 steps/day; P = 0.503, Cohen d = 0.37). Individuals with bilateral PFP showed greater variability in MVPA compared to individuals with unilateral PFP (42.9 ± 23.1 vs. 29.0 ± 15.9; P = 0.011, Cohen d = 0.91) and pain-free controls (42.9 ± 23.1 vs. 17.6 ± 6.1; P < 0.001, Cohen d = 1.21). Individuals with unilateral and bilateral PFP similarly exhibited less time spent in MVPA, greater variability in daily steps, lower pain self-efficacy, and greater disability compared to pain-free controls (P < 0.001, Cohen d = 1.14-3.89). CONCLUSIONS Versus pain-free controls, individuals with bilateral PFP displayed greater variability in MVPA than individuals with unilateral PFP. However, it is important to note that unilateral PFP influenced time spent in MVPA, variability in daily steps, pain self-efficacy, and disability at similar levels to bilateral PFP.
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Affiliation(s)
- Sungwan Kim
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States; Institute for Sports Medicine, University of Connecticut, Storrs, CT, United States.
| | - L Colby Mangum
- School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL, United States; Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, United States
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States; Institute for Sports Medicine, University of Connecticut, Storrs, CT, United States
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12
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Woldeamanuel YW, Sanjanwala BM, Cowan RP. Deep and unbiased proteomics, pathway enrichment analysis, and protein-protein interaction of biomarker signatures in migraine. Ther Adv Chronic Dis 2024; 15:20406223241274302. [PMID: 39314676 PMCID: PMC11418313 DOI: 10.1177/20406223241274302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/24/2024] [Indexed: 09/25/2024] Open
Abstract
Background Currently, there are no biomarkers for migraine. Objectives We aimed to identify proteomic biomarker signatures for diagnosing, subclassifying, and predicting treatment response in migraine. Design This is a cross-sectional and longitudinal study of untargeted serum and cerebrospinal fluid (CSF) proteomics in episodic migraine (EM; n = 26), chronic migraine (CM; n = 26), and healthy controls (HC; n = 26). Methods We developed classification models for biomarker identification and natural clusters through unsupervised classification using agglomerative hierarchical clustering (AHC). Pathway analysis of differentially expressed proteins was performed. Results Of 405 CSF proteins, the top five proteins that discriminated between migraine patients and HC were angiotensinogen, cell adhesion molecule 3, immunoglobulin heavy variable (IGHV) V-III region JON, insulin-like growth factor binding protein 6 (IGFBP-6), and IGFBP-7. The top-performing classifier demonstrated 100% sensitivity and 75% specificity in differentiating the two groups. Of 229 serum proteins, the top five proteins in classifying patients with migraine were immunoglobulin heavy variable 3-74 (IGHV 3-74), proteoglycan 4, immunoglobulin kappa variable 3D-15, zinc finger protein (ZFP)-814, and mediator of RNA polymerase II transcription subunit 12. The best-performing classifier exhibited 94% sensitivity and 92% specificity. AHC separated EM, CM, and HC into distinct clusters with 90% success. Migraine patients exhibited increased ZFP-814 and calcium voltage-gated channel subunit alpha 1F (CACNA1F) levels, while IGHV 3-74 levels decreased in both cross-sectional and longitudinal serum analyses. ZFP-814 remained upregulated during the CM-to-EM reversion but was suppressed when CM persisted. CACNA1F was pronounced in CM persistence. Pathway analysis revealed immune, coagulation, glucose metabolism, erythrocyte oxygen and carbon dioxide exchange, and insulin-like growth factor regulation pathways. Conclusion Our data-driven study provides evidence for identifying novel proteomic biomarker signatures to diagnose, subclassify, and predict treatment responses for migraine. The dysregulated biomolecules affect multiple pathways, leading to cortical spreading depression, trigeminal nociceptor sensitization, oxidative stress, blood-brain barrier disruption, immune response, and coagulation cascades. Trial registration NCT03231241, ClincialTrials.gov.
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Affiliation(s)
- Yohannes W. Woldeamanuel
- Division of Headache, Department of Neurology, Mayo Clinic Arizona, 6161 E. Mayo Blvd, Phoenix, AZ, USA
| | - Bharati M. Sanjanwala
- Division of Headache and Facial Pain, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA, USA
| | - Robert P. Cowan
- Division of Headache and Facial Pain, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA, USA
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13
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Monroe KS, Schiehser DM, Parr AW, Simmons AN, Hays Weeks CC, Bailey BA, Shahidi B. Biological markers of brain network connectivity and pain sensitivity distinguish low coping from high coping Veterans with persistent post-traumatic headache. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.16.24313761. [PMID: 39371153 PMCID: PMC11451760 DOI: 10.1101/2024.09.16.24313761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Headache is the most common type of pain following mild traumatic brain injury. Roughly half of those with persistent post-traumatic headache (PPTH) also report neck pain which is associated with greater severity and functional impact of headache. This observational cohort study aimed to identify biological phenotypes to help inform mechanism-based approaches in the management of PPTH with and without concomitant neck pain. Thirty-three military Veterans (mean (SD) = 37±16 years, 29 males) with PPTH completed a clinical assessment, quantitative sensory testing, and magnetic resonance imaging of the brain and cervical spine. Multidimensional phenotyping was performed using a Random Forest analysis and Partitioning Around Medoids (PAM) clustering of input features from three biologic domains: 1) resting state functional connectivity (rsFC) of the periaqueductal gray (PAG), 2) quality and size of cervical muscles, and 3) mechanical pain sensitivity and central modulation of pain. Two subgroups were distinguished by biological features that included forehead pressure pain threshold and rsFC between the PAG and selected nodes within the default mode, salience, and sensorimotor networks. Compared to the High Pain Coping group, the Low Pain Coping group exhibited higher pain-related anxiety (p=0.009), higher pain catastrophizing (p=0.004), lower pain self-efficacy (p=0.010), and greater headache-related disability (p=0.012). Findings suggest that greater functional connectivity of pain modulation networks involving the PAG combined with impairments in craniofacial pain sensitivity, but not cervical muscle health, distinguish a clinically important subgroup of individuals with PPTH who are less able to cope with pain and more severely impacted by headache.
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Affiliation(s)
- Katrina S Monroe
- School of Physical Therapy, College of Health and Human Services, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161; Professor, School of Medicine, Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA 92093, USA
| | - Aaron W Parr
- Joint Doctoral Program in Public Health, San Diego State University/University of California San Diego, 9500 Gilman Dr. MC0863 La Jolla, CA 92093, USA
| | - Alan N Simmons
- University of California San Diego, Research Health Scientist, Center of Excellence in Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Chelsea C Hays Weeks
- University of California San Diego; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Barbara A Bailey
- Department of Mathematics and Statistics, College of Sciences, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, University of California San Diego, 9500 Gilman Dr. MC0863 La Jolla, CA 92093, USA
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14
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Angerer F, Mennel V, Grund S, Mayer A, Büscher R, Sander LB, Cuijpers P, Terhorst Y, Baumeister H, Domhardt M. Mechanisms of change in digital interventions for depression: A systematic review and meta-analysis of six mediator domains. J Affect Disord 2024; 368:615-632. [PMID: 39284530 DOI: 10.1016/j.jad.2024.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 08/02/2024] [Accepted: 09/10/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND While the efficacy of digital interventions for the treatment of depression is well established, comprehensive knowledge on how therapeutic changes come about is still limited. This systematic review aimed to provide an overview of research on change mechanisms in digital interventions for depression and meta-analytically evaluate indirect effects of potential mediators. METHODS The databases CENTRAL, Embase, MEDLINE, and PsycINFO were systematically searched for randomized controlled trials investigating mediators of digital interventions for adults with depression. Two reviewers independently screened studies for inclusion, assessed study quality and categorized potential mediators. Indirect effects were synthesized with a two-stage structural equation modeling approach (TSSEM). RESULTS Overall, 25 trials (8110 participants) investigating 84 potential mediators were identified, of which attentional (8 %), self-related (6 %), biophysiological (6 %), affective (5 %), socio-cultural (2 %) and motivational (1 %) variables were the scope of this study. TSSEM revealed significant mediation effects for combined self-related variables (ab = -0.098; 95 %-CI: [-0.150, -0.051]), combined biophysiological variables (ab = -0.073; 95 %-CI: [-0.119, -0.025]) and mindfulness (ab = -0.042; 95 %-CI: [-0.080, -0.015]). Meta-analytical evaluations of the other three domains were not feasible. LIMITATIONS Methodological shortcomings of the included studies, the considerable heterogeneity and the small number of investigated variables within domains limit the generalizability of the results. CONCLUSION The findings further the understanding of potential change mechanisms in digital interventions for depression and highlight recommendations for future process research, such as the consideration of temporal precedence and experimental manipulation of potential mediators, as well as the application of network approaches.
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Affiliation(s)
- Florian Angerer
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Vera Mennel
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Simon Grund
- Psychology with focus on Quantitative Methods, Universität Hamburg, Germany
| | - Axel Mayer
- Department of Psychological Methods and Evaluation, Bielefeld University, Germany
| | - Rebekka Büscher
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Germany; Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Lasse B Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
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15
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Beales D, Boyle E, Fary R, Mikhailov A, Saunders B, Coates S, Evans K, Simic M, Sterling M, Bennell K, Rebbeck T. Patient acceptance of care of a novel care pathway for those at risk of poor outcomes from musculoskeletal pain: A mixed methods study. Musculoskelet Sci Pract 2024; 74:103178. [PMID: 39270531 DOI: 10.1016/j.msksp.2024.103178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 08/11/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Investigate people's acceptance of specialist musculoskeletal care within a new care pathway for common musculoskeletal conditions (low back pain, neck pain/whiplash, knee osteoarthritis). DESIGN Convergent parallel mixed methods design referencing the Theoretical Framework of Acceptability. The study included a subset of participants (n = 29) at-risk of poor outcomes from the intervention arm of the PAthway of CarE for common musculoskeletal conditions (PACE-MSK) trial. In the PACE-MSK arm, participants received specialist physiotherapist care as an adjunct to the care provided by their primary healthcare professional(s). One-to-one semi-structured interviews were conducted around 3-months after commencing in the trial. Quantitative data were collected at baseline and 3-month follow-up (health-related quality of life, pain self-efficacy, global perceived change, satisfaction). RESULTS Five themes were identified (Expectations and beliefs shaped patient experience; Clinical expertise and competence influence acceptance; Person-centred care; Mechanisms facilitating beneficial responses to care; Gaps in care pathway implementation). There were positive individual changes in physical quality of life for 17/29 (59%) participants, mental health quality of life for 12/29 (41%), pain self-efficacy for 8/29 (28%) and global perceived change for 19/29 (66%). Management met expectations with the majority reporting high levels of satisfaction. Integrating the qualitative and quantitative data with the Theoretical Framework of Acceptability, there were complementary meta-inferences in the constructs of 'ethicality', 'intervention coherence', 'self-efficacy' and 'affective attitude'. Divergence was identified in 'perceived effectiveness'. DISCUSSION In general, there was positive acceptance of the care pathway by participants. Specialist physiotherapists' care was perceived as a positive addition to usual care.
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Affiliation(s)
- Darren Beales
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845. https://twitter.com/DBealesPhysio
| | - Eileen Boyle
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Robyn Fary
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Anton Mikhailov
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Benjamin Saunders
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Sonia Coates
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia; School of Allied Health, Australian Catholic University, 33 Berry Street, North Sydney, New South Wales, 2060, Australia.
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia; Healthia Limited, Brisbane, Queensland, 4006, Australia.
| | - Milena Simic
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia.
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMR CRE: Better Health Outcomes for Compensable Injuries University of Queensland, Level 7 STARS Building, Herston Road, Herston, 4006, Australia.
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria, 3053, Australia.
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia.
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Watson ED, Marshall PW, Morrison NMV, Moloney N, O'Halloran P, Rabey M, Niazi IK, Stevens K, Kingsley M. Breaking the cycle of reoccurring low back pain with integrated motivational interviewing and cognitive behavioural therapy to facilitate education and exercise advice: a superiority randomised controlled trial study protocol. BMC Public Health 2024; 24:2415. [PMID: 39237978 PMCID: PMC11375947 DOI: 10.1186/s12889-024-19930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Non-specific low back pain is a common and costly global issue. Many people with low back pain live for years with ongoing symptom recurrence and disability, making it crucial to find effective prevention strategies. Motivational interviewing (MI) is an evidence-based patient-centred counselling style that helps motivate individuals to change their behaviours. In combination, MI and cognitive-behavioural therapy (MI-CBT) has the potential to yield long term improvements in pain and disability and reduce incidence of recurrence. METHOD This is a two-arm superiority randomised controlled trial comparing MI-CBT and Education (n = 83) with Education only (n = 83). Participants that have recovered from a recent episode of non-specific low back pain (7th consecutive day with pain ≤ 2 on a 0-10 numeric pain rating scale) will be eligible for inclusion into the study. Both groups will receive five 30-min sessions over a 10-week period as well as the Navigating Pain booklet, homework book and a standardised exercise programme. In the intervention group, MI-CBT techniques will be used to provide individualised support, identify beliefs, and increase engagement with the resources provided. Outcomes measures include pain (current and in the last 7 days) as rated on the numeric pain rating scale. This will be used to determine recurrence (number of participants who report back pain ≥ 3 out of 10 on the numeric pain rating scale). Furthermore, self-reported (1) pain intensity; (2) pain catastrophizing; (3) fear-avoidance beliefs; (4) pain self-efficacy; (5) depression and anxiety; (6) disability will be measured. All outcomes will be measured at baseline, and again at 3-, 6-, and 12-months post allocation. DISCUSSION The effective delivery of self-management strategies to prevent recurrence of low back pain is an important aspect that requires urgent attention. This study will provide new information on the effectiveness of using an MI-CBT approach to facilitate self-management through education and exercise to improve low back pain outcomes. Evidence emerging from this trial has the potential to inform clinical practice and healthcare management of non-specific low back pain. TRIAL REGISTRATION Prospectively registered with Australian New Zealand Clinical Trials Registry: ACTRN12623000746639 (10/07/2023).
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Affiliation(s)
- Estelle D Watson
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland, New Zealand.
| | - Paul W Marshall
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Natalie M V Morrison
- Translational Health Research Institute Western Sydney University, Sydney, Australia
| | - Niamh Moloney
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Martin Rabey
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Kirk Stevens
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Michael Kingsley
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland, New Zealand
- Holsworth Research Initiative, La Trobe University, Melbourne, Australia
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Ataya J, Hamdi M, Daboul R, Aboulkher MG, Ghanem L, Shekhani SE, Zarzar M, Alwaa H, Saduon S, Albardan H. Effects of pain, hospitalization, and medication on depressive symptom in Syrian patients with chronic diseases. Sci Rep 2024; 14:20751. [PMID: 39237574 PMCID: PMC11377786 DOI: 10.1038/s41598-024-71543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 08/28/2024] [Indexed: 09/07/2024] Open
Abstract
Chronic diseases and pain exacerbate depressive symptom in Syria. Limited research on hospital-induced depressive symptom among Syrian patients with chronic diseases warrants further study. A cross-sectional study in four Damascus hospitals revealed high rates of pain and depressive symptom. This study aims to investigate the prevalence and severity of chronic pain and hospital-induced depressive symptom in Syrian patients, as well as the relationship between pain, depressive symptom, and medication behavior. This study analyzes the impact of pain, hospitalization, and medication on patients with chronic diseases. The four Damascus hospitals included 453 patients from various departments. Data were collected through structured interviews and internationally recognized scales such as the PSEQ, HADS, and MMAS. These findings offer insights into pain management and psychological well-being, with implications for patient care and support strategies. The study involved 453 patients with chronic diseases, with gender distribution showing 46.6% females and 53.4% males. The age range was from 7 to 87 years, with an average of 46.87 years. Chi-square tests revealed a significant connection between gender and HADS-A scores, where 48.3% of females had abnormalities (χ2 (1, N = 453) = 7.125, p = 0.028). Marital status was significantly associated with anxiety and depressive symptom levels, particularly among widowed and divorced patients. Employment status, education, and comorbidity were linked to abnormal HADS-A scores, while education level showed a positive correlation with HADS-D scores. ANOVA tests showed significant differences in MMAS scores across income groups (F (3, 449) = 3.167, p = 0.024), with a notable difference between low-income and lower-middle-income groups (mean difference = 0.389, p = 0.031. Chronic pain and HID are prevalent among Syrian patients with chronic diseases and influenced by socio-demographic factors. Personalized interventions are needed to address psychological symptoms and medication behavior.
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Affiliation(s)
- Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Mohammad Hamdi
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Rawan Daboul
- Faculty of Medicine, Al_Baath University, Homs, Syria
| | - Mhd Ghazi Aboulkher
- Faculty of Medicine, Damascus University, Damascus, Syria
- Stemosis for Scientific Research, Damascus, Syria
| | - Lubana Ghanem
- Department of Laboratory Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Mouayad Zarzar
- Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Heba Alwaa
- Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Someia Saduon
- Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Hussam Albardan
- Internal Medicine Department, Critial Care, Damascus University, Damascus, Syria
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18
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Kongstad LP, Øverås CK, Skovsgaard CV, Sandal LF, Hartvigsen J, Søgaard K, Mork PJ, Stochkendahl MJ. Cost-effectiveness analysis of app-delivered self-management support (selfBACK) in addition to usual care for people with low back pain in Denmark. BMJ Open 2024; 14:e086800. [PMID: 39242164 PMCID: PMC11381704 DOI: 10.1136/bmjopen-2024-086800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVES This study aims to investigate the cost-effectiveness of individually tailored self-management support, delivered via the artificial intelligence-based selfBACK app, as an add-on to usual care for people with low back pain (LBP). DESIGN Secondary health-economic analysis of the selfBACK randomised controlled trial (RCT) with a 9-month follow-up conducted from a Danish national healthcare perspective (primary scenario) and a societal perspective limited to long-term productivity in the form of long-term absenteeism (secondary scenario). SETTING Primary care and an outpatient spine clinic in Denmark. PARTICIPANTS A subset of Danish participants in the selfBACK RCT, including 297 adults with LBP randomised to the intervention (n=148) or the control group (n=149). INTERVENTIONS App-delivered evidence-based, individually tailored self-management support as an add-on to usual care compared with usual care alone among people with LBP. OUTCOME MEASURES Costs of healthcare usage and productivity loss, quality-adjusted life-years (QALYs) based on the EuroQol-5L Dimension Questionnaire, meaningful changes in LBP-related disability measured by the Roland-Morris Disability Questionnaire (RMDQ) and the Pain Self-Efficacy Questionnaire (PSEQ), costs (healthcare and productivity loss measured in Euro) and incremental cost-effectiveness ratios (ICERs). RESULTS The incremental costs were higher for the selfBACK intervention (mean difference €230 (95% CI -136 to 595)), where ICERs showed an increase in costs of €7336 per QALY gained in the intervention group, and €1302 and €1634 for an additional person with minimal important change on the PSEQ and RMDQ score, respectively. At a cost-effectiveness threshold value of €23250, the selfBACK intervention has a 98% probability of being cost-effective. Analysis of productivity loss was very sensitive, which creates uncertainty about the results from a societal perspective limited to long-term productivity. CONCLUSIONS From a healthcare perspective, the selfBACK intervention is likely to represent a cost-effective treatment for people with LBP. However, including productivity loss introduces uncertainty to the results. TRIAL REGISTRATION NUMBER NCT03798288.
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Affiliation(s)
- Line Planck Kongstad
- Department of Public Health, DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Cecilie Krage Øverås
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian Chiropractors' Research Foundation - Et Liv i Bevegelse (ELiB), Oslo, Norway
| | - Christian Volmar Skovsgaard
- Department of Public Health, DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Louise Fleng Sandal
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mette Jensen Stochkendahl
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
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Chang WJ, Jenkins LC, Humburg P, Schabrun SM. The Influence of Pain Hypersensitivity and Psychological Factors on Pain and Disability in the Transition From Acute to Chronic Low Back Pain: A Longitudinal Exploratory Investigation and Cluster Analysis. THE JOURNAL OF PAIN 2024; 25:104584. [PMID: 38825052 DOI: 10.1016/j.jpain.2024.104584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/13/2024] [Accepted: 05/25/2024] [Indexed: 06/04/2024]
Abstract
Pain hypersensitivity is present in some people with acute low back pain (LBP) and thought to be involved in the development of chronic LBP. Early evidence suggests that pain hypersensitivity in acute LBP precedes poor long-term outcome. We aimed to examine whether the presence of pain hypersensitivity in acute LBP influenced recovery status at 6 months and differentiated how pain and disability changed over time. Participants with acute nonspecific LBP (<6 weeks after pain onset, N = 118) were included in this longitudinal study. Quantitative sensory testing, including pressure and heat pain thresholds, and conditioned pain modulation and questionnaires were compared at baseline and longitudinally (at 3 and 6 months) between recovered and unrecovered participants. Using k-means clustering, we identified subgroups based on baseline sensory measures alone, and in combination with psychological factors, and compared pain and disability outcomes between subgroups. Sensory measures did not differ at baseline or longitudinally between recovered (N = 50) and unrecovered (N = 68) participants. Subgrouping based on baseline sensory measures alone did not differentiate pain or disability outcomes at any timepoint. Participants with high psychological distress at baseline (N = 19) had greater disability, but not pain, at all timepoints than those with low psychological distress, regardless of the degrees of pain sensitivity. Our findings suggest that pain hypersensitivity in acute LBP does not precede poor recovery at 6 months or differentiate how pain and disability change over time. High psychological distress during acute LBP is associated with unremitting and pronounced disability, while pain severity is unaffected. PERSPECTIVE: Pain hypersensitivity is thought to be involved in the transition to chronic LBP. Contradictory to prevailing hypothesis, our findings suggest pain hypersensitivity alone in acute LBP does not precede poor recovery. High psychological distress in acute LBP has a stronger influence than pain hypersensitivity on long-term disability, but not pain outcomes.
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Affiliation(s)
- Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Luke C Jenkins
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Peter Humburg
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, New South Wales, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Physical Therapy, University of Western Ontario, London, Ontario, Canada; The Gray Centre for Mobility and Activity, Parkwood Institute, St. Josephs HealthCare, London, Ontario, Canada
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20
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Mace RA, Brewer JR, Cohen JE, Ly TV, Weaver MJ, Borsook D. Virtual Reality for Subacute Pain After Orthopedic Traumatic Musculoskeletal Injuries: A Mixed Methods Pilot Study. Clin J Pain 2024; 40:526-541. [PMID: 39016312 DOI: 10.1097/ajp.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (eg, pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed-methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx ), integrating principles of mindfulness and cognitive-behavioral therapy, for pain self-management at home following orthopedic injury. METHODS We enrolled 10 adults with acute orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham health care system. Participants completed daily RelieVRx sessions at home for 8 weeks, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and hypothesized mechanisms (pain self-efficacy, mindfulness, and coping). RESULTS The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients. DISCUSSION The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.
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Affiliation(s)
- Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital
- Harvard Medical School
- Department of Psychiatry, Massachusetts General Hospital
| | - Julie R Brewer
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital
| | - Joshua E Cohen
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital
| | - Thuan V Ly
- Harvard Medical School
- Department of Orthopaedic Surgery, Massachusetts General Hospital
| | - Michael J Weaver
- Harvard Medical School
- Department of Orthopaedic Surgery, Brigham and Women's Hospital
| | - David Borsook
- Harvard Medical School
- Department of Psychiatry, Massachusetts General Hospital
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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21
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Thompson DP, Ramshead M, Antcliff D. An Assessment of the Efficacy of an Online Pain Management Programme During the Covid-19 Pandemic. Musculoskeletal Care 2024; 22:e1929. [PMID: 39205376 DOI: 10.1002/msc.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Following the outbreak of the Covid-19 pandemic and associated social distancing requirements, Pain Services were no longer able to deliver face-to-face Pain Management Programmes (PMP). As an alternative, the Bury Integrated Pain Service developed an interactive, online programme, delivered via Microsoft Teams videoconferencing technology. However, the efficacy of such programmes is unclear. The aim of this project was to assess whether comparable results were observed with online PMPs as with face-to-face PMPs. METHODS A non-inferiority study comparing patients attending an online PMP to a historical cohort of patients attending face-to-face PMPs. Analyses of variance were performed to assess between group differences and chi squared tests to compare the proportion of patients making clinically meaningful changes in pain, musculoskeletal health, anxiety, depression and self-efficacy. RESULTS 24% of patients (n = 9) deemed suitable for the online PMP were unable to participate due to technological difficulties. This resulted in 28 people attending the online PMP. Greater mean reductions in anxiety (GAD-7 mean difference = 1.9; p < 0.05) and depression (PHQ-9 mean difference 3.3; p < 0.05) were observed with face-to-face PMP and a greater proportion of patients made clinically meaningful improvements in musculoskeletal health (face-to-face = 13; online = 5), anxiety (face-to-face = 7; online = 1), and depression (face-to-face = 11; online = 2). CONCLUSIONS Some patients appear to obtain significant benefit from online PMPs, but this appeared to be to a lesser extent than face-to-face PMPs. It is possible that factors related to the experience of the pandemic influenced these results. However, online PMPs appear to show some promise and further research is warranted to explore the value of online PMPs.
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Affiliation(s)
- Dave P Thompson
- Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- Department of Sport & Exercise Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK
| | - Matthew Ramshead
- Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- Department of Sport & Exercise Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK
| | - Deborah Antcliff
- Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- School of Medicine, Keele University, Keele, UK
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22
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Vallance P, Kidgell DJ, Vicenzino B, Frazer AK, Garofolini A, Malliaras P. The Functional Organization of Corticomotor Neurons Within the Motor Cortex Differs Among Basketball and Volleyball Athletes With Patellar Tendinopathy Compared to Asymptomatic Controls. Scand J Med Sci Sports 2024; 34:e14726. [PMID: 39263841 DOI: 10.1111/sms.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/04/2024] [Accepted: 08/24/2024] [Indexed: 09/13/2024]
Abstract
Patellar tendinopathy (PT) typically affects jumping-sport athletes with functional impairments frequently observed. Alterations to the functional organization of corticomotor neurons within the motor cortex that project to working muscles are evident in some musculoskeletal conditions and linked to functional impairments. We aimed to determine if functional organization of corticomotor neuron projections differs between athletes with PT and asymptomatic controls, and if organization is associated with neuromuscular control. We used a cross-sectional design, and the setting was Monash Biomedical Imaging. Basketball and volleyball athletes with (n = 8) and without PT (n = 8) completed knee extension and ankle dorsiflexion force matching tasks while undergoing fMRI. We determined functional organization via identification of the location of peak corticomotor neuron activation during respective tasks (expressed in X, Y, and Z coordinates) and calculated force matching accuracy for both tasks to quantify neuromuscular control. We observed significant interactions between group and coordinate plane for functional organization of corticomotor projections to knee extensors (p < 0.001) and ankle dorsiflexors (p = 0.016). Compared to controls, PT group peak corticomotor activation during the knee extension task was 9.6 mm medial (p < 0.001) and 5.2 mm posterior (p = 0.036), and during the ankle dorsiflexion task 8.2 mm inferior (p = 0.024). In the PT group, more posterior Y coordinate peak activation location during the knee extension task was associated with greater task accuracy (r = 0.749, p = 0.034). Functional organization of corticomotor neurons differed in jumping athletes with PT compared to controls. Links between functional organization and neuromuscular control in the PT group suggest organizational differences may be relevant to knee extension neuromuscular control preservation.
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Affiliation(s)
- Patrick Vallance
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Service and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash Musculoskeletal Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Dawson J Kidgell
- Department of Physiotherapy, Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Ashlyn K Frazer
- Department of Physiotherapy, Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Alessandro Garofolini
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Department of Physiotherapy, Monash Musculoskeletal Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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23
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Ehrlich O, Lackowski A, Glover TL, Vallerand AH. Use of Goals in Cancer Pain Management: A Systematic Review. J Pain Symptom Manage 2024; 68:e194-e205. [PMID: 38851545 DOI: 10.1016/j.jpainsymman.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/08/2024] [Accepted: 05/25/2024] [Indexed: 06/10/2024]
Abstract
CONTEXT Cancer pain is multidimensional and management should be individualized to patient goals. The current standard for pain goal assessment is the personal pain goal (PPG), a numeric rating for tolerable pain intensity. However, the PPG may not accurately capture a personally meaningful goal for tailoring pain management. OBJECTIVES Identify how pain goals are used in cancer pain management and types of goals researched. METHODS CINAHL, PsychInfo, and PubMed databases and manual searching were used to locate research or scholarship about cancer pain goals. Authors reviewed titles, abstracts and full text to agree on the final sample. RESULTS Sixteen articles met inclusion criteria. Study designs included: quality improvement project (1), concept analysis (1), qualitative methods (5), quantitative methods (8), and mixed methods (1). Findings included: goal setting as a key attribute of pain management; achieving personal goals as the outcome of pain management work; qualitative themes discussed personal goals related to pain management; developing a patient pain management resource including a SMART goal; using motivational interviewing to set functional pain goals; PPG assessment was feasible; and achieving PPG equated to having controlled pain when compared to the clinically important difference measure used in research (≥30%). Quantitative studies reported on PPGs only. CONCLUSION Currently, assessments for cancer pain goals do not include function, activities, moods, medication effects, or safety that patients wish to achieve as a pain management outcome. Development and testing of multidimensional patient pain goals assessments is warranted so that goals can be consistently assessed, documented, and personally meaningful.
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Affiliation(s)
- Olga Ehrlich
- School of Nursing, Oakland University, (O.E, A.L, T.L.G), Rochester, MI, USA.
| | - Alyssa Lackowski
- School of Nursing, Oakland University, (O.E, A.L, T.L.G), Rochester, MI, USA
| | - Toni L Glover
- School of Nursing, Oakland University, (O.E, A.L, T.L.G), Rochester, MI, USA
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24
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Jones KF, Long DM, Bair MJ, Agil D, Browne L, Burkholder G, Clay OJ, Conder K, Durr AL, Farel CE, King K, Johnson B, Liebschutz JM, Demonte W, Leone M, Mullen L, Orris SM, Thomas T, Johnson M, Napravnik S, Merlin JS. Efficacy of a Pain Self-Management Intervention Tailored to People With HIV: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:1074-1082. [PMID: 39008317 PMCID: PMC11250263 DOI: 10.1001/jamainternmed.2024.3071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/17/2024] [Indexed: 07/16/2024]
Abstract
Importance Chronic pain is a common condition for which efficacious interventions tailored to highly affected populations are urgently needed. People with HIV have a high prevalence of chronic pain and share phenotypic similarities with other highly affected populations. Objective To evaluate the efficacy of a behavioral pain self-management intervention called Skills to Manage Pain (STOMP) compared to enhanced usual care (EUC). Design, Setting, and Participants This randomized clinical trial included adults with HIV who experienced at least moderate chronic pain for 3 months or more. The study was set at the University of Alabama at Birmingham and the University of North Carolina-Chapel Hill large medical centers from August 2019 to September 2022. Intervention STOMP combined 1-on-1 skill-building sessions delivered by staff interventionists with group sessions co-led by peer interventionists. The EUC control group received the STOMP manual without any 1-on-1 or group instructional sessions. Main Outcomes and Measures The primary outcome was pain severity and the impact of pain on function, measured by the Brief Pain Inventory (BPI) summary score. The primary a priori hypothesis was that STOMP would be associated with a decreased BPI in people with HIV compared to EUC. Results Among 407 individuals screened, 278 were randomized to STOMP intervention (n = 139) or EUC control group (n = 139). Among the 278 people with HIV who were randomized, the mean (SD) age was 53.5 (10.0) years; 126 (45.0%) identified as female, 146 (53.0%) identified as male, 6 (2.0%) identified as transgender female. Of the 6 possible 1-on-1 sessions, participants attended a mean (SD) of 2.9 (2.5) sessions. Of the 6 possible group sessions, participants attended a mean (SD) of 2.4 (2.1) sessions. Immediately after the intervention compared to EUC, STOMP was associated with a statistically significant mean difference for the primary outcome, BPI total score: -1.25 points (95% CI, -1.71 to -0.78 points; P < .001). Three months after the intervention, the mean difference in BPI total score remained statistically significant, favoring the STOMP intervention -0.62 points (95% CI, -1.09 to -0.14 points; P = .01). Conclusion and Relevance The findings of this randomized clinical trial support the efficaciousness of STOMP as an intervention for chronic pain in people with HIV. Future research will include implementation studies and work to understand the optimal delivery of the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT03692611.
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Affiliation(s)
- Katie Fitzgerald Jones
- New England Geriatric Research Education and Clinical Center, Section of Palliative Care, VA Boston Healthcare System, Boston, Massachusetts
| | - Dustin M. Long
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew J. Bair
- VA HSR&D Center for Health Information and Communication, Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Lindsay Browne
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Greer Burkholder
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham
| | - Kendall Conder
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Amy L. Durr
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Claire E. Farel
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Kiko King
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Bernadette Johnson
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Jane M. Liebschutz
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Mireille Leone
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - LaToya Mullen
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of North Carolina at Chapel Hill
| | - Sarah Margaret Orris
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tammi Thomas
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Mallory Johnson
- Center for AIDS Prevention Studies, University of San Francisco, San Francisco, California
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Jessica S. Merlin
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Dubé MO, Desmeules F, Lewis J, Chester R, Roy JS. Will my shoulder pain get better? - secondary analysis of data from a multi-arm randomised controlled trial. Physiotherapy 2024; 124:65-74. [PMID: 38875839 DOI: 10.1016/j.physio.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To determine whether higher level or improvements over time in pain self-efficacy (PSE) and expectations of intervention effectiveness lead to better outcomes and whether the intervention used to manage rotator cuff related shoulder pain (RCRSP) impacts PSE and expectations over time. DESIGN Secondary analysis of data from a randomised controlled trial. PARTICIPANTS 123 individuals (48 [15] years old; 51% female) with RCRSP. INTERVENTIONS Participants randomised into one of three 12-weeks interventions (education; education and motor control exercises; education and strengthening exercises). MAIN OUTCOME MEASURES QuickDASH and Western Ontario Rotator Cuff Index (WORC) were administered at baseline and 12 weeks. Pain self-efficacy was assessed at 0 and 6 weeks. Patients' expectations regarding intervention effectiveness were assessed before randomisation and after the first and the last intervention sessions. NparLD were used for the analyses. A time effect indicated a significant change in patients' expectations or PSE over time, while a resolution effect indicated a significant difference in patients' expectations or PSE between those whose symptoms resolved and those whose did not. RESULTS Patients' expectations (-3 to 3) increased over time (0.33/3 [0.19 to 0.77]). Overall expectations were higher for those who experienced symptom resolution based on the WORC (0.19/3 [0.05 to 0.33]). PSE increased over time (5.5/60 [3.6 to 7.4]). Overall PSE was higher for those who experienced symptom resolution based on the WORC (7.0 [3.9 to 10.1]) and the QuickDASH (4.9 [1.7 to 8.2]). CONCLUSION Clinicians should consider monitoring PSE and patients' expectations as they are important indicators of outcome. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Marc-Olivier Dubé
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec G1R 1P5, Canada; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - François Desmeules
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec G1R 1P5, Canada.
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Derricks V, Hirsh AT, Perkins AJ, Daggy JK, Matthias MS. Health Care Discrimination Affects Patient Activation, Communication Self-Efficacy, and Pain for Black Americans. THE JOURNAL OF PAIN 2024:104663. [PMID: 39214439 DOI: 10.1016/j.jpain.2024.104663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/12/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
This study examines whether a key psychosocial factor-perceiving racial discrimination in health care-is associated with worse patient activation, communication self-efficacy, and physical health outcomes for Black veterans with chronic pain. Moreover, we explore the role of physician-patient working alliance as a moderator that may alleviate the potential consequences of perceiving racial discrimination. This work is a secondary analysis of baseline data from a clinical trial with 250 U.S. Black veterans with chronic musculoskeletal pain. Participants were recruited from primary care clinics at a Midwestern VA hospital between 2018 and 2021. Perceiving racial discrimination in health care was associated with lower patient activation, lower self-efficacy in communicating with one's physician, higher pain intensity, and lower pain management self-efficacy (ps < .049) but was unrelated to reports of pain interference or use of pain coping strategies (ps > .157). Although the relationship between perceived discrimination and patient activation was moderated by working alliance (P = .014), having a stronger working alliance improved patient activation to varying degrees across levels of perceived discrimination (rather than buffering against negative outcomes when perceiving higher levels of discrimination). Moderation was not significant on any other measures. This study deepens our understanding of the broad range of health outcomes that are (not) associated with perceiving racial discrimination in health care. Contrary to prior theorizing, this work also indicates that having a strong working alliance does not attenuate the consequences of perceiving discrimination among Black individuals living with pain. These results highlight the need for system-level interventions to address perceptions of racial mistreatment in health care. PERSPECTIVE: This work has important public health implications by identifying the broad range of outcomes associated with perceived discrimination in health care among Black Americans. Importantly, a strong physician-patient relationship did not buffer Black individuals from the consequences of perceiving discrimination. These findings inform intervention targets to mitigate racial health disparities.
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Affiliation(s)
- Veronica Derricks
- Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana.
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Joanne K Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marianne S Matthias
- VA HSR Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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27
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Mowery HC, Campello M, Ziemke G, Oh C, Hope T, Jansen B, Weiser S. Psychological Risk Factors for Delayed Recovery Among Active Duty Service Members Seeking Treatment for Musculoskeletal Complaints at a Navy Shore-Based Military Medical Treatment Facility. Mil Med 2024; 189:12-17. [PMID: 39160797 DOI: 10.1093/milmed/usae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/02/2024] [Accepted: 01/31/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. MATERIALS AND METHODS Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. RESULTS Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. CONCLUSIONS A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness.
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Affiliation(s)
- Hope C Mowery
- Department of Orthopedics, New York University Langone Orthopedic Hospital, New York, NY 10014, USA
| | - Marco Campello
- Department of Orthopedics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Gregg Ziemke
- Henry Jackson Foundation, Bethesda, MD 20817, USA
| | - Cheongeun Oh
- Department of Orthopedics, New York University Grossman School of Medicine, New York, NY 10016, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Timothy Hope
- Henry Jackson Foundation, Bethesda, MD 20817, USA
| | - Brittany Jansen
- Physical Medicine and Rehabilitation, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Sherri Weiser
- Department of Orthopedics, New York University Grossman School of Medicine, New York, NY 10016, USA
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Ueda M, Tetsunaga T, Tetsunaga T, Nishida K, Takatori R, Shitozawa H, Uotani K, Shinohara K, Oda Y, Ozaki T. Insomnia among patients with chronic pain: A retrospective study. Medicine (Baltimore) 2024; 103:e39113. [PMID: 39121265 PMCID: PMC11315514 DOI: 10.1097/md.0000000000039113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/08/2024] [Indexed: 08/11/2024] Open
Abstract
Insomnia can coexist with chronic pain and is a major cause of rapidly increasing medical expenses. However, insomnia has not been fully evaluated in patients with chronic pain. This retrospective study aimed to identify the risk factors for insomnia in patients with chronic non-cancer pain. A total of 301 patients with chronic non-cancer pain were enrolled. Patients with the Athens insomnia scale scores ≥ 6 and < 6 were classified into insomnia (+) and insomnia (-) groups, respectively. All patients completed self-report questionnaires as part of their chronic pain treatment approach. Univariate and multivariate analyses were performed to predict insomnia. We found that 219 of 301 (72.8%) patients met the AIS criteria for insomnia. Significant differences were depicted between patients with and without insomnia in terms of body mass index, numeric rating scale, pain catastrophizing scale, hospital anxiety, and depression scale (HADS), pain disability assessment scale, EuroQol 5 dimension (EQ5D), and pain self-efficacy questionnaire. Multiple regression analysis identified the numeric rating scale, HADS, and EQ5D scores as factors related to insomnia in patients with chronic non-cancer pain. Anxiety, depression, and disability were associated with a greater tendency toward insomnia. HADS and EQ5D scores are useful screening tools for preventing insomnia in patients with chronic non-cancer pain.
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Affiliation(s)
- Masataka Ueda
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Tomonori Tetsunaga
- Department of Musculoskeletal Health Promotion, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Keiichiro Nishida
- Division of Chronic Pain Medicine and Division of Comprehensive Rheumatology, Locomotive Pain Center, Okayama University Hospital
| | - Ryo Takatori
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisakazu Shitozawa
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama University
| | - Kennsuke Shinohara
- Department of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Yoshiaki Oda
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
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Zouch J, Bhimani N, Bussières A, Ferreira ML, Foster NE, Ferreira P. Prognostic Factors and Treatment Effect Modifiers for Physical Health, Opioid Prescription, and Health Care Utilization in Patients With Musculoskeletal Disorders in Primary Care: Exploratory Secondary Analysis of the STEMS Randomized Trial of Direct Access to Physical Therapist-Led Care. Phys Ther 2024; 104:pzae066. [PMID: 38696361 PMCID: PMC11365697 DOI: 10.1093/ptj/pzae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/23/2023] [Accepted: 04/30/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE The aims of the study were to identify prognostic factors associated with health care outcomes in patients with musculoskeletal (MSK) conditions in primary care and to determine whether characteristics associated with choice of care modify treatment effects of a direct-access physical therapist-led pathway in addition to general practitioner (GP)-led care compared to GP-led care alone. METHODS A secondary analysis of a 2-parallel-arm, cluster randomized controlled trial involving general practices in the United Kingdom was conducted. Practices were randomized to continue offering GP-led care or to also offer a direct-access physical therapist-led pathway. Data from adults with MSK conditions who completed the 6-month follow-up questionnaire were analyzed. Outcomes included physical health, opioid prescription, and self-reported health care utilization over 6 months. Treatment effect modifiers were selected a priori from associations in observational studies. Multivariable regression models identified potential prognostic factors, and interaction analysis tested for potential treatment effect modifiers. RESULTS Analysis of 767 participants indicated that baseline pain self-efficacy, pain severity, and having low back pain statistically predicted outcomes at 6 months. Higher pain self-efficacy scores at baseline were associated with improved physical health scores, reduced opioid prescription, and less health care utilization. Higher bodily pain at baseline and having low back pain were associated with worse physical health scores and increased opioid prescription. Main interaction analyses did not reveal that patients' age, level of education, duration of symptoms, or MSK presentation influenced response to treatment, but visual trends suggested those in the older age group proceeded to fewer opioid prescriptions and utilized less health care when offered direct access to physical therapy. CONCLUSIONS Patients with MSK conditions with lower levels of pain self-efficacy, higher pain severity, and presenting with low back pain have less favorable clinical and health care outcomes in primary care. Prespecified characteristics did not modify the treatment effect of the offer of a direct-access physical therapist-led pathway compared to GP-led care. IMPACT Patients with MSK conditions receiving primary care in the form of direct-access physical therapist-led or GP-led care who have lower levels of self-efficacy, higher pain severity, and low back pain are likely to have a less favorable prognosis. Age and duration of symptoms should be explored as potential patient characteristics that modify the treatment response to a direct-access physical therapist-led model of care.
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Affiliation(s)
- James Zouch
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nazim Bhimani
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - André Bussières
- Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Manuela L Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadine E Foster
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, United Kingdom
| | - Paulo Ferreira
- Faculty of Medicine and Health, Musculoskeletal Pain Hub, Charles Perkins Centre, Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
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Wang L, Qin F, Zhen L, Li R, Tao S, Li G. Development of a nomogram for predicting acute pain among patients after abdominal surgery: A prospective observational study. J Clin Nurs 2024; 33:3586-3598. [PMID: 38379369 DOI: 10.1111/jocn.17031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
AIMS To develop a nomogram to provide a screening tool for recognising patients at risk of post-operative pain undergoing abdominal operations. BACKGROUND Risk prediction models for acute post-operative pain can allow initiating prevention strategies, which are valuable for post-operative pain management and recovery. Despite the increasing number of studies on risk factors, there were inconsistent findings across different studies. In addition, few studies have comprehensively explored predictors of post-operative acute pain and built prediction models. DESIGN A prospective observational study. METHODS A total of 352 patients undergoing abdominal operations from June 2022 to December 2022 participated in this investigation. A nomogram was developed for predicting the probability of acute pain after abdominal surgery according to the results of binary logistic regression. The nomogram's predictive performance was assessed by discrimination and calibration. Internal validation was performed via Bootstrap with 1000 re-samplings. RESULTS A total of 139 patients experienced acute post-operative pain following abdominal surgery, with an incidence of 39.49%. Age <60, marital status (unmarried, divorced, or widowed), consumption of intraoperative remifentanil >2 mg, indwelling of drainage tubes, poor quality sleep, high pain catastrophizing, low pain self-efficacy, and PCIA not used were predictors of inadequate pain control in patients after abdominal surgery. Using these variables, we developed a nomogram model. All tested indicators showed that the model has reliable discrimination and calibration. CONCLUSIONS This study established an online dynamic predictive model that can offer an individualised risk assessment of acute pain after abdominal surgery. Our model had good differentiation and calibration and was verified internally as a useful tool for risk assessment. RELEVANCE TO CLINICAL PRACTICE The constructed nomogram model could be a practical tool for predicting the risk of experiencing acute post-operative pain in patients undergoing abdominal operations, which would be helpful to realise personalised management and prevention strategies for post-operative pain. REPORTING METHOD The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. PATIENT OR PUBLIC CONTRIBUTION Before the surgery, research group members visited the patients who met the inclusion criteria and explained the purpose and scope of the study to them. After informed consent, they completed the questionnaire. The patients' pain scores (VAS) were regularly assessed and documented by the bedside nurse for the first 3 days following surgery. Other information was obtained from medical records.
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Affiliation(s)
- Ling Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Fang Qin
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Zhen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ruihua Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Siqi Tao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Tran G, Hensor EMA, Kingsbury SR, O’Connor P, Cowling P, Conaghan PG. The usefulness of ultrasound in predicting outcomes in patients with shoulder pain: a prospective observational study. Rheumatology (Oxford) 2024; 63:2162-2169. [PMID: 37862223 PMCID: PMC11292045 DOI: 10.1093/rheumatology/kead546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVES Shoulder pain is common but current clinical classification has limited utility. We aimed to determine whether groups of ultrasound-based shoulder pathologies exist and to evaluate outcomes according to identified groups and individual pathologies. METHODS This was a prospective study of a community-based cohort with shoulder pain referred for their first ultrasound scan at a single radiology unit, with subsequent routine clinical care. Patient-reported outcomes were collected at baseline, 2 weeks and 6 months; standardized ultrasound reporting was employed. Latent class analysis (LCA) identified ultrasound pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and Shoulder Pain and Disability Index (SPADI). Short-term response to corticosteroid injections was investigated. RESULTS Of 500 participants (mean age 53.6 years; 52% female), 330 completed follow-up. LCA identified four groups: bursitis with (33%) or without (27%) acromioclavicular joint degeneration, rotator cuff tear (21%) and no bursitis/tear (19%). Total SPADI was higher at baseline for cuff tears (mean 55.1 vs 49.7-51.3; overall P = 0.005), but accounting for this, groups did not differ at 6 months (43.5 vs 38.5-40.5; P = 0.379). Baseline SPADI was the only predictor of 6-month SPADI retained by penalized modelling; neither LCA-derived ultrasound groups nor individual pathologies were selected. Response to baseline injection at week 2 did not differ between groups (mean SPADI 40.1-43.8; P = 0.423). CONCLUSION Ultrasound-based classification (groups or individual pathologies) of shoulder pain did not predict medium-term outcomes using current treatments. The role of routine diagnostic ultrasound for shoulder pain needs consideration; it may be useful to establish evidence-based therapies for specific pathologies.
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Affiliation(s)
- Gui Tran
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
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Khoja O, Silva-Passadouro B, Cristescu E, McEwan K, Doherty D, O’Connell F, Ponchel F, Mulvey M, Astill S, Tan AL, Sivan M. Clinical Characterization of New-Onset Chronic Musculoskeletal Pain in Long COVID: A Cross-Sectional Study. J Pain Res 2024; 17:2531-2550. [PMID: 39100135 PMCID: PMC11298172 DOI: 10.2147/jpr.s466294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose New-onset chronic musculoskeletal (MSK) pain is one of the common persistent symptoms in Long COVID (LC). This study investigated its clinical characteristics, underlying mechanisms, and impact on function, psychological health, and quality of life. Patients and Methods Thirty adults (19 female, 11 male) with LC and new-onset chronic MSK pain underwent clinical examination, Quantitative Sensory Testing (QST), and blood tests for inflammatory markers and completed the following outcome measures: Timed Up and Go test (TUG), handgrip strength test, COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), Brief Pain Inventory (BPI), Pain Self-Efficacy Questionnaire (PSEQ), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire-short form (IPAQ-sf), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and EuroQol Five Dimensions health-related quality of life (EQ-5D-5L). Results New-onset chronic MSK pain was widespread and continuous in nature, and worse in the joints. When compared to normative values reported in the literature: a) QST revealed mechanical hyperalgesia, heightened temporal summation of pain, and hypoesthesia to vibration stimuli, which is strongly suggestive of central sensitization; b) Plasma cytokine assays indicated distinct pro-inflammatory profiles; c) TUG time indicated reduced balance and mobility; d) handgrip strength revealed general weakness; e) physical activity was lower; and f) there were moderate levels of depression and anxiety with lower self-efficacy scores and lower levels of pain catastrophizing. LC symptoms were of moderate severity (44.8/100), moderate functional disability (22.8/50) and severely compromised overall health (2.6/10) when compared to pre-COVID scores. Conclusion New-onset chronic MSK pain in LC tends to be widespread, constant, and associated with weakness, reduced function, depression, anxiety, and reduced quality of life. There is associated central sensitization and proinflammatory state in the condition. Further research is essential to explore the longitudinal progression and natural evolution of the new-onset chronic MSK pain in LC.
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Affiliation(s)
- Omar Khoja
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Elena Cristescu
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Katie McEwan
- COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Derek Doherty
- School of Medicine, Trinity College Dublin, Trinity Translational Medicine Institute, St. James’s Hospital, Dublin, Ireland
| | - Fiona O’Connell
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Dublin, Ireland
| | - Frederique Ponchel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Matthew Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sarah Astill
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Magel JS, Beneciuk JM, Siantz E, Fritz J, Garland EL, Hanley A, Shen J, Blosser P, Matev T, Gordon AJ. PT-IN-MIND: study protocol for a multisite randomised feasibility trial investigating physical therapy with integrated mindfulness (PT-IN-MIND) for patients with chronic musculoskeletal pain and long-term opioid treatment who attend outpatient physical therapy. BMJ Open 2024; 14:e082611. [PMID: 39079926 PMCID: PMC11293391 DOI: 10.1136/bmjopen-2023-082611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Many individuals receiving outpatient physical therapy have musculoskeletal pain and up to one-third use prescription opioids. The impact of physical therapist-led mindfulness-based interventions integrated with evidence-based physical therapy (I-EPT) to manage patients with chronic musculoskeletal pain and long-term opioid treatment has not been elucidated. This project evaluates the feasibility of conducting a cluster randomised trial to test the effectiveness of I-EPT. METHODS AND ANALYSIS Study 1 aim: Refine and manualise the I-EPT treatment protocol. Our approach will use semistructured interviews of patients and physical therapists to refine an I-EPT training manual. Study 2 aim: Evaluate different intensities of physical therapist training programmes for the refined I-EPT treatment protocol. Physical therapists will be randomised 1:1:1 to high-intensity training (HighIT), low-IT (LowIT) training and no training arms. Following training, competency in the provision of I-EPT (LowIT and HighIT groups) will be assessed using standardised patient simulations. Study 3 aim: Evaluate the feasibility of the I-EPT intervention across domains of the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework. The refined I-EPT treatment protocol will be tested in two different health systems with 90 patients managed by the randomised physical therapists. The coprimary endpoints for study 3 are the proportions of the Pain, Enjoyment of Life and General Activity Scale and the Timeline Followback for opioid use/dose collected at 12 weeks. ETHICS AND DISSEMINATION Ethics approval for the study was obtained from the University of Utah, University of Florida and Florida State University Institutional Review Boards. Informed consent is required for participant enrolment in all phases of this project. On completion, study data will be made available in compliance with NIH data sharing policies. TRIAL REGISTRATION NUMBER NCT05875207.
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Affiliation(s)
- John S Magel
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Jason M. Beneciuk
- Physical Therapy, University of Florida, Gainesville, Florida, USA
- Clinical Research, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Elizabeth Siantz
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Julie Fritz
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Eric L. Garland
- Sanford Institute for Empathy and Compassion, University of California, San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California, San Diego, California, USA
| | - Adam Hanley
- Florida State University, Tallahassee, Florida, USA
| | - Jincheng Shen
- Population Health Sciences, University of Utah Health, Salt Lake City, Utah, USA
| | - Priscilla Blosser
- Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Adam J Gordon
- School of Medicine, University of Utah Health, Salt Lake City, Utah, USA
- VA Health Care System, Salt Lake City, Utah, USA
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Farì G, Mariconda C, Dell'Anna L, Quarta F, Donati D, Sconza C, Ricci V, Varrassi G, Coco V, Manelli A, Spadini E, Giglio MT, Bernetti A. How to Evaluate the Efficacy of Manipulations in Spine Disorders-A Comprehensive Review of New and Traditional Outcome Measures. Clin Pract 2024; 14:1478-1495. [PMID: 39194923 DOI: 10.3390/clinpract14040119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/29/2024] Open
Abstract
Spine pain (SP) is the most common musculoskeletal disorder that causes transitional forms of motor disability. Considering its affordability and safety, manipulative therapy (MT) stands as one of the primary therapeutic approaches for SP and the related dysfunctional consequences. However, it is still difficult to assess and quantify the results of this treatment since there is a lack of objective evaluation tools in the available scientific literature. Thus, the purpose of this comprehensive review is to summarize the main outcomes used to evaluate the effectiveness of spine manipulations, focusing on their strengths and weaknesses. An extensive review of the PubMed, Cochrane, and Embase databases was performed to identify the literature of the last ten years regarding MT and the related assessment tools. A total of 12 studies met the inclusion criteria. The analyzed literature indicates that a wide range of outcome measures have been used to assess the effectiveness of spine MT. Pain is the main aspect to be investigated but it remains difficult to elucidate since it is strongly linked to various dimensions such as self-perception and psychological aspects. Therefore, it seems necessary to include new tools for evaluating the effects of spine MT, with the aim of exploiting new technologies and taking into consideration the SP biomechanical and biopsychosocial aspects.
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Affiliation(s)
- Giacomo Farì
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
- Department of Experimental Medicine (Di.Me.S), University of Salento, 73100 Lecce, Italy
| | - Carlo Mariconda
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, 10153 Turin, Italy
| | - Laura Dell'Anna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Francesco Quarta
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Danilo Donati
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | | | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, 20157 Milano, Italy
| | | | - Valeria Coco
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
| | - Alessandro Manelli
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
| | - Ennio Spadini
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
| | - Maria Teresa Giglio
- Anaesthesia and Intensive Care Unit, Policlinico Hospital, 70124 Bari, Italy
| | - Andrea Bernetti
- Department of Experimental Medicine (Di.Me.S), University of Salento, 73100 Lecce, Italy
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Makhoul M, Noureddine S, Abu-Saad Huijer H, Farhood L, Fares S, Uthman I, French DJ, France CR. Psychometric Properties of the Arabic Version of the Pain Resilience Scale among Lebanese Adults with Chronic Musculoskeletal Pain. Pain Res Manag 2024; 2024:7361038. [PMID: 39104726 PMCID: PMC11300090 DOI: 10.1155/2024/7361038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
Background The Pain Resilience Scale (PRS), which measures behavioral perseverance and the ability to regulate emotions and cognition despite ongoing pain, lacks an Arabic version. Objectives This study aimed to translate, culturally adapt, and validate an Arabic version of the Pain Resilience Scale (PRS-A) among Lebanese adults. Methods Phase 1 involved translation and cross-cultural adaptation of the PRS into Arabic. Phase 2 examined the reliability and validity of the PRS-A. A convenience sample of 154 Lebanese adults with chronic musculoskeletal pain completed the PRS-A and self-report measures of pain catastrophizing, pain self-efficacy, pain intensity and interference, depression and anxiety, and quality of life. Results The PRS-A yielded a two-factor structure with factor 1 representing "cognitive/affective positivity" and factor 2 representing "behavioral perseverance," accounting for 41.93% and 15.15% of the variance in pain resilience, respectively. Total PRS-A score (M = 33.20 and SD = 9.90) showed significant correlations with pain catastrophizing (M = 27.65, SD = 13.03, and r = -0.52), pain self-efficacy (median = 9.00, IQR = 4, and rho = 0.61), pain intensity (M = 4.50, SD = 2.25, and r = -0.28), pain interference (M = 4.30, SD = 2.89, and r = -0.56), physical (M = 34.95, SD = 9.52, and r = 0.34) and mental (M = 40.08, SD = 12.49, and r = 0.58) health functioning, anxiety (median = 7.00, IQR = 7, and rho = -0.57), and depression (median = 4.00, IQR = 6, and rho = -0.58). PRS-A subscale was also significantly related to all measures except pain intensity, which was correlated with cognitive/affective positivity (r = -0.33) but not behavioral perseverance (r = -0.09). Cronbach's alpha for the PRS-A was 0.87. Conclusion The PRS-A demonstrated validity and acceptable reliability among Arab-speaking individuals with chronic musculoskeletal pain, suggesting its potential utility for assessing pain resilience within this population.
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Affiliation(s)
- Melissa Makhoul
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | - Samar Noureddine
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | | | - Laila Farhood
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | - Souha Fares
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal MedicineAmerican University of Beirut Medical Center, Beirut, Lebanon
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Macedo L, Di Pelino S, Santos VS, Richardson J, MacDermid J, Hancock M, Battie MC, Saragiotto BT, Hayden JA, Rushton A, Packham T, Freman M, Bray S, Griffin M, Hladysh G, Miller P, Attwell S. Implementation of back to living well, a community-based program for the tertiary prevention of low back pain: a study protocol. BMC Musculoskelet Disord 2024; 25:593. [PMID: 39068385 PMCID: PMC11283700 DOI: 10.1186/s12891-024-07712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives. METHODS This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application. DISCUSSION The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society. TRIAL REGISTRATION ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354.
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Affiliation(s)
- Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | | | - Veronica Souza Santos
- School of Rehabilitation Science, McMaster University and Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Bruno T Saragiotto
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | | | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Matt Freman
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Steven Bray
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Meridith Griffin
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Pat Miller
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Archer KR. Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury: The Results of a Randomized Controlled Trial. J Bone Joint Surg Am 2024; 106:1300-1308. [PMID: 38781313 DOI: 10.2106/jbjs.23.01234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Lower-extremity injuries can result in severe impairment and substantial years lived with a disability. Persistent pain and psychological distress are risk factors for poor long-term outcomes and negatively influence the recovery process following a traumatic injury. Cognitive-behavioral therapy (CBT) interventions have the potential to address these risk factors and subsequently improve outcomes. This study aimed to evaluate the effect of a telephone-delivered cognitive-behavioral-based physical therapy (CBPT) program on physical function, pain, and general health at 12 months after hospital discharge following lower-extremity trauma. The CBPT program was hypothesized to improve outcomes compared with an education program. METHODS A multicenter, randomized controlled trial was conducted involving 325 patients who were 18 to 60 years of age and had at least 1 acute orthopaedic injury to the lower extremity or to the pelvis or acetabulum requiring operative fixation. Patients were recruited from 6 Level-I trauma centers and were screened and randomized to the CBPT program or the education program early after hospital discharge. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scale. The secondary outcomes were objective physical function tests (4-square step test, timed stair ascent test, sit-to-stand test, and self-selected walking speed test), PROMIS Pain Intensity and Pain Interference, and the Veterans RAND 12-Item Health Survey. Treatment effects were calculated using targeted maximum likelihood estimation, a robust analytical approach appropriate for causal inference with longitudinal data. RESULTS The mean treatment effect on the 12-month baseline change in PROMIS PF was 0.94 (95% confidence interval, -0.68 to 2.64; p = 0.23). There were also no observed differences in secondary outcomes between the intervention group and the control group. CONCLUSIONS The telephone-delivered CBPT did not appear to yield any benefits for patients with traumatic lower-extremity injuries in terms of physical function, pain intensity, pain interference, or general health. Improvements were observed in both groups, which questions the utility of telephone-delivered cognitive-behavioral strategies over educational programs. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Paolucci T, Pezzi L, Coraci D, Tognolo L, Pantalone A, Attanasi C, Graziani G, Dalla Costa D, Arippa F, Cichelli A, Monticone M. Reliability, Concurrent Validity, and Clinical Performances of the Shorter Version of the Roland Morris Disability Questionnaire in a Sample of Italian People with Non-Specific Low Back Pain. J Pers Med 2024; 14:740. [PMID: 39063994 PMCID: PMC11277590 DOI: 10.3390/jpm14070740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Evaluating the psychometric and clinical performances of the RM-18, the shorter version of the Roland Morris Disability Questionnaire (RMQ), in Italian people with non-specific low back pain (NSLBP) as a time-saving and clinically useful method of assessing disability. METHODS This cross-sectional study included 74 people (52 females and 22 males, 53.03 ± 15.25 years old) with NSLBP. The RM-18, the RMQ, the Oswestry Disability Index (ODI), and a pain intensity numerical rating scale (NRS) were administered. Psychometric testing included reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intraclass Correlation Coefficient, ICC2.1), and concurrent validity by comparing the RM-18 with the RMQ and the ODI (Pearson's r correlation). Two separate regression analyses were performed to investigate the different impact of RM-18 and RMQ on NRS. RESULTS Cronbach's α of RM-18 was 0.92 and ICC (2,1) = 0.96. Strong correlations were found with the RMQ and the ODI (r = 0.98; r = 0.78, respectively). The regression models showed that the RM-18 and the RMQ similarly impacted the NRS (p < 0.001). CONCLUSION The RM-18 showed satisfactory psychometric testing and similarly impacted the NRS when compared to the RMQ. It can be recommended for clinical and research purposes in Italian people with NSLBP.
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Affiliation(s)
- Teresa Paolucci
- Department of Oral, Medical and Biotechnological Sciences (DSMOB), Physical Medicine and Rehabilitation, University of Study “G. D’Annunzio” of Chieti, 66100 Chieti, Italy; (T.P.); (A.C.)
| | - Letizia Pezzi
- Rehabilitation Unit, ASST Cremona-Ospedale di Cremona, Viale Concordia, 1, 26100 Cremona, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, 35122 Padua, Italy; (D.C.); (L.T.)
| | - Lucrezia Tognolo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, 35122 Padua, Italy; (D.C.); (L.T.)
| | - Andrea Pantalone
- Department of Medicine and Science of Aging, University “G. D’Annunzio”, 66100 Chieti, Italy;
| | | | - Giancarlo Graziani
- Dipartimento Specialita’ Mediche, Uoc Medicina Riabilitativa, Asl Roma 1, Borgo Santo Spirito, 3, 00193 Rome, Italy;
| | - Davide Dalla Costa
- Unit of Rehabilitation Medicine and Neurorehabilitation, Department of Neuroscience, ASST Niguarda Hospital, 20162 Milan, Italy;
| | - Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09141 Cagliari, Italy;
| | - Alice Cichelli
- Department of Oral, Medical and Biotechnological Sciences (DSMOB), Physical Medicine and Rehabilitation, University of Study “G. D’Annunzio” of Chieti, 66100 Chieti, Italy; (T.P.); (A.C.)
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
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Slater H, Waller R, Briggs AM, Lord SM, Smith AJ. Characterizing phenotypes and clinical and health utilization associations of young people with chronic pain: latent class analysis using the electronic Persistent Pain Outcomes Collaboration database. Pain 2024:00006396-990000000-00644. [PMID: 38981098 DOI: 10.1097/j.pain.0000000000003326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/27/2024] [Indexed: 07/11/2024]
Abstract
ABSTRACT Using the Australiasian electronic Persistent Pain Outcomes Collaboration, a binational pain registry collecting standardized clinical data from paediatric ePPOC (PaedsePPOC) and adult pain services (AdultePPOC), we explored and characterized nationally representative chronic pain phenotypes and associations with clinical and sociodemographic factors, health care utilization, and medicine use of young people. Young people ≥15.0 and <25.0 years captured in PaedePPOC and AdultePPOC Australian data registry were included. Data from 68 adult and 12 paediatric pain services for a 5-year period January 2018 to December 2022 (first episode, including treatment information) were analysed. Unsupervised latent class analysis was applied to explore the existence of distinct pain phenotypes, with separate models for both services. A 3-phenotype model was selected from both paediatric and adult ePPOC data, with 693 and 3518 young people included, respectively (at least one valid indicator variable). Indicator variables for paediatric models were as follows: pain severity, functional disability (quasisurrogate "pain interference"), pain count, pain duration, pain-related worry (quasisurrogate "catastrophizing"), and emotional functioning; and, for adult models: pain severity, pain interference, pain catastrophizing, emotional functioning, and pain self-efficacy. From both services, 3 similar phenotypes emerged ("low," "moderate," "high"), characterized by an increasing symptom-severity gradient in multidimensional pain-related variables, showing meaningful differences across clinical and sociodemographic factors, health service utilization, and medicines use. Derived phenotypes point to the need for novel care models that differentially respond to the needs of distinct groups of young people, providing timely, targeted, age-appropriate care. To effectively scale such care, digital technologies can be leveraged to augment phenotype-informed clinical care.
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Affiliation(s)
- Helen Slater
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Robert Waller
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Andrew M Briggs
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Susan M Lord
- Children's Complex Pain Service, John Hunter Children's Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Anne J Smith
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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Pinheiro CAB, Bassi-Dibai D, Pontes-Silva A, Pereira FHF, Pinheiro JS, Fidelis-de-Paula-Gomes CA, Dibai-Filho AV. Measurement properties of the Regular Physical Exercise Adherence Scale (REPEAS) in individuals with chronic pain. BMC Public Health 2024; 24:1776. [PMID: 38961346 PMCID: PMC11223431 DOI: 10.1186/s12889-024-19297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE To examine the measurement properties of the Regular Physical Exercise Adherence Scale (REPEAS) in Brazilians with chronic pain. METHODS Cross-sectional and longitudinal design (washout period for reliability). The study was conducted in two Brazilian states, Maranhão and São Paulo, and included Brazilian adults, irregular exercisers, former exercisers or non-exercise practitioners, aged 18 to 59 years and with chronic pain. The instruments used in this study were: the REPEAS, the Numerical Pain Rating Scale (NPRS), the Baecke Habitual Physical Activity Questionnaire (BHPAQ), the Pain Self-Efficacy Questionnaire (PSEQ), and the Roland-Morris Disability Questionnaire for general pain (RMDQ-g). The evaluation focused on structural validity, construct validity, reliability (with standard error of measurement and minimum detectable change), internal consistency, and floor and ceiling effects. RESULTS The two-dimensional structure was tested through confirmatory factor analysis, which resulted in adequate fit indeces: chi-square values/degrees of freedom = 1.541, Tucker-Lewis Index = 0.966, comparative fit index = 0.974, root mean square error of approximation = 0.074, and standardized root mean square residual = 0.068. Additionally, satisfactory factor loadings (> 0.40) were obtained. Test-retest reliability and internal consistency were adequate for the environmental factors domain (intraclass correlation coefficient [ICC] = 0.79, Cronbach's alpha = 0.88) and the personal factors domain (ICC = 0.97, Cronbach's alpha = 0.93). In hypothesis testing for construct validity, we observed a significant correlation with magnitude below 0.30 of the environmental factors domain of the REPEAS with RMDQ-g, PSEQ and sport domain of the BHPAQ. For the personal factors domain, we observed a significant correlation with a magnitude of 0.30 to 0.50 with RMDQ-g, PSEQ, and sport domain of the BHPAQ, and below 0.30 with leisure domain of the BHPAQ. No floor or ceiling effects were found for the REPEAS domains. CONCLUSION The REPEAS is a valid instrument with a two-dimensional internal structure consisting of 12 items. It has a reliable construct and is suitable for use in the clinical and epidemiological context for adults with chronic pain in Brazil.
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Affiliation(s)
| | - Daniela Bassi-Dibai
- Postgraduate Program in Environment, Universidade Ceuma, São Luís, MA, Brazil
| | - André Pontes-Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
| | | | - Jocassia Silva Pinheiro
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Casey MB, Takemasa S, O'Reilly T, Leamy M, Mc Kearney E, Buckley M, Smart KM, Segurado R, Lowry D, Flanagan D, Gopal H, Hearty C, Doody C. Exercise combined with Acceptance and Commitment Therapy for chronic pain: One-year follow-up from a randomized controlled trial. Eur J Pain 2024; 28:913-928. [PMID: 38348557 DOI: 10.1002/ejp.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) is a type of Cognitive Behavioural Therapy, which has demonstrated positive outcomes in individuals with chronic pain. The purpose of this study was to compare the effect of an 8-week programme combining Exercise with Acceptance and Commitment Therapy (ExACT) with a standalone supervised exercise programme at 1-year follow-up. METHODS One hundred and seventy-five people with chronic pain were randomly assigned to ExACT or supervised exercise only. The primary outcome was pain interference measured with the Brief Pain Inventory-Interference Scale. Secondary and treatment process outcomes included pain severity, depression, anxiety, pain catastrophizing, pain self-efficacy, fear avoidance, pain acceptance, committed action, healthcare utilization, patient satisfaction, and global impression of change. Estimates of treatment effects at 1-year follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. RESULTS Eighty-three participants (47.4%) returned the outcome measures at 1-year follow-up. No significant difference was observed between the groups for the primary outcome, pain interference. There was a statistically significant difference between the groups, in favour of ExACT for pain catastrophizing. Within group improvements that were observed within both groups at earlier timepoints were maintained at 1-year follow-up for many of the secondary and treatment process outcomes. ExACT group participants reported higher levels of satisfaction with treatment and global perceived change. CONCLUSIONS The study results showed no significant difference between the two groups for the primary outcome pain interference at 1-year follow-up. Future research could investigate factors that may predict and optimize outcomes from these types of intervention for people living with chronic pain. SIGNIFICANCE Few previous randomized controlled trials investigating ACT for chronic pain have included long-term follow-up. This study found that Exercise combined with ACT was not superior to supervised exercise alone for reducing pain interference at 1-year follow-up. Further research is necessary to identify key processes of therapeutic change and to explore how interventions may be modified to enhance clinical outcomes for people with chronic pain.
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Affiliation(s)
- M B Casey
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - S Takemasa
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Clinical Development, Clinical Development Centre, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - T O'Reilly
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Leamy
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - E Mc Kearney
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Buckley
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - K M Smart
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - R Segurado
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - D Lowry
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D Flanagan
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Doody
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
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Lemos JL, Gomez GI, Tewari P, Amanatullah DF, Chou L, Gardner MJ, Hu S, Safran M, Kamal RN. Pain Self-Efficacy Can Improve During a Visit With an Orthopedic Surgeon. Orthopedics 2024; 47:e197-e203. [PMID: 38864646 DOI: 10.3928/01477447-20240605-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Greater pain self-efficacy (PSE) is associated with reduced pain, fewer limitations, and increased quality of life after treatment for orthopedic conditions. The aims of this study were to (1) assess if PSE improves during a visit with an orthopedic surgeon and (2) identify modifiable visit factors that are associated with an increase in PSE. MATERIALS AND METHODS We performed a prospective observational study of orthopedic clinic visits at a multispecialty clinic from February to May 2022. New patients who presented to one of six orthopedic surgeons were approached for the study. Patients who provided consent completed a pre-visit questionnaire including the Pain Self-Efficacy Questionnaire (PSEQ) and demographic questions. A trained research member recorded the five-item Observing Patient Involvement in Decision Making Instrument (OPTION-5) score, number of questions asked, and visit duration. Immediately after the visit, patients completed a post-visit questionnaire consisting of the PSEQ and Perceived Involvement in Care Scale (PICS). RESULTS Of 132 patients enrolled, 61 (46%) had improved PSE after the orthopedic visit, with 38 (29%) having improvement above a clinically significant threshold. There were no significant differences between patients with increased PSE and those without increased PSE when comparing the PICS, OPTION-5, questions asked, or visit duration. CONCLUSION Almost half of the patients had improvement in PSE during an orthopedic visit. The causal pathway to how to improve PSE and the durability of the improved PSE have implications in strategies to improve patient outcomes in orthopedic surgery, such as communication methods and shared decision-making. Future research can focus on studying different interventions that facilitate improving PSE. [Orthopedics. 2024;47(4):e197-e203.].
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Alves GS, Vera GEZ, Maher CG, Ferreira GE, Machado GC, Buchbinder R, Pinto RZ, Oliveira CB. Clinical care standards for the management of low back pain: a scoping review. Rheumatol Int 2024; 44:1197-1207. [PMID: 38421427 PMCID: PMC11178557 DOI: 10.1007/s00296-024-05543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The objective of this study is to compare and contrast the quality statements and quality indicators across clinical care standards for low back pain. Searches were performed in Medline, guideline databases, and Google searches to identify clinical care standards for the management of low back pain targeting a multidisciplinary audience. Two independent reviewers reviewed the search results and extracted relevant information from the clinical care standards. We compared the quality statements and indicators of the clinical care standards to identify the consistent messages and the discrepancies between them. Three national clinical care standards from Australia, Canada, and the United Kingdom were included. They provided from 6 to 8 quality statements and from 12 to 18 quality indicators. The three standards provide consistent recommendations in the quality statements related to imaging, and patient education/advice and self-management. In addition, the Canadian and Australian standards also provide consistent recommendations regarding comprehensive assessment, psychological support, and review and patient referral. However, the three clinical care standards differ in the statements related to psychological assessment, opioid analgesics, non-opioid analgesics, and non-pharmacological therapies. The three national clinical care standards provide consistent recommendations on imaging and patient education/advice, self-management of the condition, and two standards (Canadian and Australian) agree on recommendations regarding comprehensive assessment, psychological support, and review and patient referral. The standards differ in the quality statements related to psychological assessment, opioid prescription, non-opioid analgesics, and non-pharmacological therapies.
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Affiliation(s)
- Gabriel S Alves
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
| | - Gustavo E Z Vera
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rafael Z Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil.
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Holden J, O'Halloran P, Davidson M, Breckon J, Rahayu W, Monfries M, Taylor NF. Embedded motivational interviewing combined with a smartphone application to increase physical activity in people with sub-acute low back pain: a cluster randomised controlled trial. Braz J Phys Ther 2024; 28:101091. [PMID: 38943741 PMCID: PMC11260563 DOI: 10.1016/j.bjpt.2024.101091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Moderately vigorous physical activity (PA) may be beneficial for people with sub-acute low back pain (LBP), but may initially be painful for patients and challenging for physical therapists to facilitate. OBJECTIVES This study investigated motivational interviewing (MI) delivered by physical therapists and a smartphone app for increasing PA in people with LBP. METHODS A mixed methods cluster randomised controlled trial involving 46 adults with LBP in Melbourne, Australia. Participants attended weekly 30-min physical therapy consultations for 6 weeks. Experimental group physical therapists were taught to embed MI into consultations and patients were provided with a self-directed app. The primary outcome was accelerometer-derived moderately vigorous PA. Secondary outcomes were LBP disability (Oswestry Disability Index), functional capacity (Patient Specific Functional Scale), and self-efficacy (Pain Self-Efficacy Questionnaire). Between-group differences were analysed by ANCOVA post-intervention. RESULTS There was no statistically significant difference between the experimental group and control group for PA. Between-group differences in LBP disability (MD= 19.4 units, 95% CI: 8.5, 30.3), functional capacity (primary MD= -4.1 units, 95% CI: -6.9, -1.3; average MD= -3.1, 95% CI: -4.9, -1.2) and self-efficacy (MD -11.3 units, 95%CI -20.2, -2.5) favoured the control group with small to moderate effect sizes. There were low levels of overall engagement with the app. CONCLUSION The embedded MI intervention was no more beneficial than physical therapy alone for PA and was associated with poorer LBP disability, function, and self-efficacy. The effectiveness of embedding MI and a smartphone app into usual care for LBP was not supported.
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Affiliation(s)
- Jason Holden
- La Trobe University, School of Allied Health, Bundoora, Victoria, Australia.
| | - Paul O'Halloran
- La Trobe University, School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - Megan Davidson
- La Trobe University, School of Allied Health, Bundoora, Victoria, Australia
| | - Jeff Breckon
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, United Kingdom
| | - Wenny Rahayu
- La Trobe University, Office of Engineering and Mathematical Sciences, Bundoora, Victoria, Australia
| | - Melissa Monfries
- La Trobe University, School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- La Trobe University, School of Allied Health, Human Services and Sport, Bundoora, Victoria, Australia; Eastern Health, Arnold St, Box Hill, Victoria, Australia
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Schneider S, Wertli MM, Henzi A, Hebeisen M, Brunner F. Effect of an interdisciplinary inpatient program for patients with complex regional pain syndrome in reducing disease activity-a single-center prospective cohort study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:459-467. [PMID: 38530793 PMCID: PMC11224586 DOI: 10.1093/pm/pnae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/02/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the benefit of inpatient treatment in reducing disease activity in patients with complex regional pain syndrome (CRPS) who have exhausted outpatient options. Furthermore, the study sought to identify patient-related outcome variables that predict a reduction in disease activity. METHODS The primary outcome was disease severity (CRPS Severity Score, range 0-16 points). Secondary outcomes included depression, anxiety, physical function, pain interference, fatigue, sleep disturbance, and the ability to participate in social roles and activities, all of which were assessed using the PROMIS-29. Furthermore, pain catastrophizing, neuropathic pain, quality of life, pain self-efficacy, medication intake, and the patient's global impression of change were examined in accordance with current international agreed recommendations, assessed at discharge, 3-month, and 6-month post-discharge. Mixed-effects models were conducted to identify baseline variables associated with CRPS severity. RESULTS Twenty-five patients completed the program (mean age 49.28 [SD 11.23] years, 92% females, mean symptom duration 8.5 [SD 6.5] months). Results showed a significant reduction between baseline and discharge of disease activity (CSS -2.36, P < .0001), pain (PROMIS-29 pain -0.88, P = .005), and emotional function (PROMIS-29 depression -5.05, P < .001; fatigue -4.63, P = .002). Moderate evidence for a reduction between baseline and discharge could be observed for pain interference (+2.27, P = .05), social participation (PROMIS-29 + 1.93, P = .05), anxiety (PROMIS-29 -3.32, P = .02) and physical function (PROMIS-29 + 1.3, P = .03). On discharge, 92% of patients (23 of 25) reported improvement in their overall condition. In the follow-up period, medication intake could be reduced after 3 (MQS -8.22, P = .002) and 6 months (MQS -8.69, P = .001), and there was further improvement in social participation after 3 months (PROMIS-29 + 1.72, 0.03) and sleep after 6 months (PROMIS-29 + 2.38, 0.008). In the mixed models, it was demonstrated that patients experiencing less pain at baseline also exhibited lower disease activity. CONCLUSION The results of this study confirm that inpatient interdisciplinary treatment of CRPS patients improves disease activity, pain, physical function, emotional function, and social participation. Most improvements were maintained for up to 6 months after discharge. The majority of patients reported that their overall condition had improved during the study period.
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Affiliation(s)
- Stephanie Schneider
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Maria M Wertli
- Department of Internal Medicine, Kantonsspital Baden, 5404 Baden, Switzerland
- Department of General Internal Medicine, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Anna Henzi
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Monika Hebeisen
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, 8008 Zurich, Switzerland
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Almousa S, Vicenzino B, Mellor R, Grimaldi A, Bennett K, Doyle F, McCarthy GM, McDonough SM, Ryan JM, Lynch K, Sorensen J, French HP. An EDucation and eXercise intervention for gluteal tendinopathy in an Irish setting: a protocol for a feasibility randomised clinical trial (LEAP-Ireland RCT). HRB Open Res 2024; 6:76. [PMID: 39045032 PMCID: PMC11263908 DOI: 10.12688/hrbopenres.13796.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/25/2024] Open
Abstract
Background Gluteal tendinopathy (GT) is a degenerative tendon condition characterised by pain over the greater trochanter of the hip. A randomised controlled trial (RCT) in Australia found that 14 sessions of EDucation on load management plus eXercise (EDX) delivered over 8 weeks resulted in greater improvements in global rating of change and pain outcomes at 8 and 52 weeks, compared with corticosteroid injection or 'wait and see'. Typically, 5-6 physiotherapy sessions are provided in public and private physiotherapy settings in Ireland, therefore, the aim of this study is to examine the feasibility of conducting a future definitive RCT to investigate effectiveness of 6 sessions of the EDX programme compared to usual care. Methods We will randomly allocate 64 participants with GT to physiotherapist-administered EDX or usual care. The EDX intervention (EDX-Ireland) will be delivered in 6 sessions over 8 weeks.To determine feasibility of an RCT, we will assess recruitment and retention and outcome measure completion. The health status outcomes to be assessed at baseline, 8 weeks and 3 months include: Global Rating of Change, pain severity, the Victorian Institute of Sport Assessment-Gluteal Questionnaire (VISA-G), the Patient-Specific Functional Scale, the Pain Catastrophizing Scale, Patient Health Questionnaire (PHQ), Pain Self-Efficacy Questionnaire, the EQ-5D-5L, the Central Sensitisation Inventory and hip abductor muscle strength. We will explore acceptability of the EDX-Ireland intervention from the perspective of patients and treatment providers, and the perspective of referrers to the trial. A Study Within A Trial will be also applied to compare recording of exercise adherence using app-based technology to paper diaries. Discussion There is a need to establish effective treatments for GT that potentially can be implemented into existing health systems. The findings of this feasibility trial will inform development of a future definitive RCT. Registration The trial is registered prospectively on ClinicalTrials.gov ( NCT05516563, 27/10/2022).
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Affiliation(s)
- Sania Almousa
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Geraldine M. McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Jennifer M. Ryan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Jan Sorensen
- Health Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Breugelmans L, Smeets RJEM, Köke AJA, Winkens B, Oosterwijk RFA, Beckers LWME. Outpatient interdisciplinary multimodal pain treatment programme for patients with chronic musculoskeletal pain: a longitudinal cohort study. Disabil Rehabil 2024:1-12. [PMID: 38910313 DOI: 10.1080/09638288.2024.2364822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/24/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment. MATERIALS AND METHODS Data were gathered during routine clinical practice during a 3-year period (2019-2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates. RESULTS Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain. CONCLUSIONS At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients.
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Affiliation(s)
- L Breugelmans
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - R J E M Smeets
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- CIR Clinics in Revalidatie, Netherlands
- Pain in Motion International Research Group (PiM), Maastricht, Netherlands
| | - A J A Köke
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Pain in Motion International Research Group (PiM), Maastricht, Netherlands
| | - B Winkens
- Methodology & Statistics, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, Netherlands
| | | | - L W M E Beckers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Alebouyeh F, Boutron I, Ravaud P, Tran VT. Psychometric properties and domains covered by patient-reported outcome measures used in trials assessing interventions for chronic pain. J Clin Epidemiol 2024; 170:111362. [PMID: 38615827 DOI: 10.1016/j.jclinepi.2024.111362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To identify the patient-reported outcome measures (PROMs) used in clinical trials assessing interventions for chronic pain, describe their psychometric properties, and the clinical domains they cover. STUDY DESIGN AND SETTING We identified phase 3 or 4 interventional trials: on adult participants (aged >18 years), registered in clinicaltrials.gov between January 1, 2021 and December 31, 2022, and which provided "chronic pain" as a keyword condition. We excluded diagnostic studies and phase 1 or 2 trials. In each trial, one reviewer extracted all outcomes registered and identified those captured using PROMs. For each PROM used in more than 1% of identified trials, two reviewers assessed whether it covered the six important clinical domains from the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT): pain, emotional functioning, physical functioning, participant ratings of global improvement and satisfaction with treatment, symptoms and adverse events, and participant disposition (eg, adherence to medication). Second, reviewers searched PubMed for both the initial publication and latest review reporting the psychometric properties of each PROM and assessed their content validity, structural validity, internal consistency, reliability, measurement error, hypotheses testing, criterion validity, and responsiveness using published criteria from the literature. RESULTS In total, 596 trials assessing 4843 outcomes were included in the study (median sample size 60, interquartile range 40-100). Trials evaluated behavioral (22%), device-based (21%), and drug-based (10%) interventions. Of 495 unique PROMs, 55 were used in more than 1% trials (16 were generic pain measures; 8 were pain measures for specific diseases; and 30 were measures of other symptoms or consequences of pain). About 50% PROMs had more than 50% of psychometric properties rated as sufficient. Scales often focused on a single clinical domain. Only 25% trials measured at least three clinical domains from IMMPACT. CONCLUSION Half of PROMs used in trials assessing interventions for chronic pain had sufficient psychometric properties for more than 50% of criteria assessed. Few PROMs assessed more than one important clinical domain. Only 25% of trials measured more than 3/6 clinical domains considered important by IMMPACT.
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Affiliation(s)
- Farzaneh Alebouyeh
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Isabelle Boutron
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; Université Paris Cité, CRESS, INSERM, INRAE, Paris, France
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Viet-Thi Tran
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; Université Paris Cité, CRESS, INSERM, INRAE, Paris, France.
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McAuliffe M, Pillay T, Jaber K, Sterling M, O'Leary S. Pre-operative pain pressure threshold association with patient satisfaction following Total Knee Arthroplasty. J Orthop 2024; 52:21-27. [PMID: 38404700 PMCID: PMC10881419 DOI: 10.1016/j.jor.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Total knee arthroplasty (TKA) is commonly performed for the treatment of knee osteoarthritis (KOA). Poor satisfaction continues to be seen after TKA. Whilst reasons for poor patient satisfaction are multifactorial, there is a strong correlation with persistent pain following TKA. Studies have shown an association between local and remote mechanical hypersensitivity, measured using pressure pain thresholds (PPTs), and severity of knee osteoarthritis and functional status. We aimed to determine if the pre-operative PPTs were associated with patient satisfaction following TKA. Methods A prospective longitudinal study of 77 individuals was undertaken. Regression modelling assessed the relationship between Patient Satisfaction using the Knee Society Score (satisfaction subscale) following TKA for KOA, and PPTs recorded pre-operatively locally and remote to the affected knee, while accounting for potentially confounding patient demographic and psychosocial factors. Results Lower PPTs (indicating increased mechanical hypersensitivity) locally and remote to the operative knee were modestly associated with lower patient satisfaction in the short-term (six weeks) following TKA (β 0.25-0.28, adjR2 = 0.14-0.15), independent of demographic or psychosocial influences. However, this relationship progressively diminished in the intermediate and long-term post TKA. Conclusion While pre-operative PPT measures may provide some foresight to patient satisfaction post TKA in the short term, these measures appear to provide little insight to patient satisfaction in the intermediate and longer term.
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Affiliation(s)
- Michael McAuliffe
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia
- The CJM Centre, Ipswich, QLD, 4305, Australia
- The Mater Private Hospital, Springfield Lakes, QLD, 4300, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, QLD, 4305, Australia
| | - Tristan Pillay
- The CJM Centre, Ipswich, QLD, 4305, Australia
- The Mater Private Hospital, Springfield Lakes, QLD, 4300, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, QLD, 4305, Australia
| | - Khalid Jaber
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Qld, Herston, 4006, Australia
| | - Shaun O'Leary
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
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50
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McLoughlin R, Love J, Smith JG, Scott W, Noblet T. Evaluating the feasibility of delivering a pain management programme for adults living with sickle cell disease. Br J Pain 2024; 18:257-273. [PMID: 38751559 PMCID: PMC11092933 DOI: 10.1177/20494637231202744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background Pain is the prominent feature of sickle cell disease (SCD) and negatively affects quality of life. Delivery of pain management programmes (PMPs) has been suggested in clinical guidelines for pain management in SCD; however, further evidence of the feasibility and effectiveness of PMPs in this population is needed. This study explored the feasibility of delivering a sickle cell pain management programme (SCPMP) for adults within a haemoglobinopathies service. Methods A single arm, repeated-measures observational design was used to determine feasibility of delivering the SCPMP at one study site. Primary feasibility outcomes were recruitment, completion of treatment and outcome measures, satisfaction, credibility and acceptability to participants. Secondary feasibility outcomes were treatment outcomes and processes, frequency of vaso-occlusive crisis (VOC) and healthcare utilisation. Results Four of five feasibility criteria were met. Annual recruitment of eight participants to a SCPMP was not achieved. Twenty-nine people began a SCPMP during the study period. Twenty-five (86.2%) participants attended ≥5/8 sessions and 21(84%) programme completers provided all end of programme questionnaires. Mean scores of >7 on ten-point scales were seen across satisfaction and credibility questions. At least moderate (Hedges g >0.5) effect sizes were seen in pre-post SCPMP measures of pain interference, anxiety, depression, self-efficacy, pain-related worry and acceptance. A small (Hedges g 0.4) effect size was seen in HRQoL. Following SCPMP attendance, mean frequency of self-reported VOC and hospital admissions reduced. Conclusions This study suggests that, given an adequate source of referrals, a SCPMP is feasible to deliver and appears acceptable and credible to participants. Exploration of influences on recruitment, such as barriers to group interventions, would be illuminating, prior to investigating feasibility of an adequately powered randomised-controlled trial.
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Affiliation(s)
- Rebecca McLoughlin
- Red Cell Pain Management & Psychology Service, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jenna Love
- Red Cell Pain Management & Psychology Service, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jared G Smith
- Population Health Research Institute, St George’s University of London, London, UK
- Clinical Research Unit, South West London & St George’s Mental Health Trust, Springfield University Hospital, London, UK
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Tim Noblet
- Physiotherapy Department, St George’s University Hospitals NHS Foundation Trust, London, UK
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