Daily Pain Measurements and Retrospective Pain Measurements in Hip Osteoarthritis Patients With Intermittent Pain

Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation

Restoring somatosensory feedback in individuals with lower-limb amputations would reduce the risk of falls and alleviate phantom limb pain. Here we show, in three individuals with transtibial amputation (one traumatic and two owing to diabetic peripheral neuropathy), that sensations from the missing foot, with control over their location and intensity, can be evoked via lateral lumbosacral spinal cord stimulation with commercially available electrodes and by modulating the intensity of stimulation in real time on the basis of signals from a wireless pressure-sensitive shoe insole. The restored somatosensation via closed-loop stimulation improved balance control (with a 19-point improvement in the composite score of the Sensory Organization Test in one individual) and gait stability (with a 5-point improvement in the Functional Gait Assessment in one individual). And over the implantation period of the stimulation leads, the three individuals experienced a clinically meaningful decrease in phantom limb pain (with an average reduction of nearly 70% on a visual analogue scale). Our findings support the further clinical assessment of lower-limb neuroprostheses providing somatosensory feedback.

A scoping review of patient self-report measures of flare in knee and hip osteoarthritis (OA): A report from the OMERACT flares in OA working group

PURPOSE

We aimed to analyze the content validity/domain match and feasibility of self-report instruments that could measure flare in osteoarthritis (OA), by extending our 2017 literature review on the definition of flare in knee and hip OA.

METHOD

We searched PubMed (Medline), Web of Science and PsycInfo (Ebsco Host) databases for original articles reporting research about flare (or synonyms) in humans with knee and hip OA, between 2017 and 2023. Four experts worked independently, checking the records, and assessing content validity and feasibility, writing justification for exclusion.

RESULTS

At literature review phase, 575 papers were filtered. After experts' analysis, 59 studies were included, and 44 instruments associated with flare in OA were identified. Most were studies about pain in knee or hip OA (35 %), cultural adaptation of a measure (33 %) or studies investigating psychometric properties of full (16 %) or short form (4 %) instruments. The assessment of domain match and feasibility revealed that 15 instruments were assigned a label of 'yes' or 'uncertain' as to whether or not there was a good match with the domain concept or whether the instrument was considered feasible to use.

DISCUSSION

Most identified instruments considered different aspects of pain and the associated discomfort in performing daily activities but did not include the central aspects of flare in OA, i.e. the change of state, nor the additional Outcome Measures in Rheumatology (OMERACT) endorsed domains for OA flare namely stiffness, swelling, psychological aspects, impact of symptoms including fatigue and sleep disturbance. Although it is possible that the period specified to conduct this literature review may have led to some recognized instruments being excluded, this review demonstrates the need for the research community to reach consensus on the best way to measure self-reported flares in future clinical trials and observational studies.

Recall Bias Affects Pain Assessment in Knee Osteoarthritis: A Pilot Study

OBJECTIVE

The objective of this study was to evaluate the recall bias of symptoms evaluation in knee osteoarthritis (OA).

DESIGN

In this multicentric pilot study, 50 patients with knee OA used a mobile App (Ecological Momentary Assessment [EMA]) to collect pain and function on two 0 to 10 numerical rating scales (NRS) 2 times a day for 2 months. At the 1-month and at the 2-month follow-up visits, patients retrospectively evaluated the mean level of pain/function of the last month. Recall bias was computed as the difference between the mean level of pain/function reported using the App and the level reported with the retrospective assessment. The correlation between the recall bias and patients' characteristics, as well as pain/function trajectories, was analyzed.

RESULTS

A statistically significant recall bias was documented with higher pain reported at 1-month with the retrospective assessment (P < 0.001). These results were confirmed also at the 2-month follow-up (P = 0.002). For function, no significant recall bias was documented. During the first and second months, 47 and 31 patients showed pain peaks, respectively. The number of pain peaks during the first month was correlated with the magnitude of the recall bias (P = 0.02).

CONCLUSIONS

The recall bias influences the retrospective self-assessment of pain at the follow-up visits and the presence of pain peaks, a common event in the patients with OA, increases the magnitude of recall bias. The EMA performed with a mobile App is a useful tool to limit the influence of recall bias in the clinical and research setting evaluation of knee OA.

Evaluating the Effect of Daily Diary Instructional Phrases on Respondents' Recall Time Frames: Survey Experiment

Background

Daily diaries are extensively used for examining participants’ daily experience in behavioral and medical science. However, little attention is paid to whether participants recall their experiences within the time frames prescribed by the task.

Objective

This study aimed to describe survey respondents’ self-reported recall time frames and to evaluate the impact of different daily diary items on respondents’ reported affective states.

Methods

In this study, 577 participants completed a mood survey with one of the following 4 time frame instructions: (1) today, (2) since waking up today, (3) during the last 24 hours, or (4) in the last day. They were also asked to indicate the periods they considered when answering these items and to recall the instructional phrases associated with the items.

Results

Almost all participants in the today (141/146, 96.6%) and since waking up today (136/145, 93.8%) conditions reported using periods consistent with our expectations, whereas a lower proportion was observed in the during the last 24 hours (100/145, 69.0%) condition. A diverse range of responses was observed in the in the last day condition. Furthermore, the instructions influenced the levels of some self-reported affects, although exploratory analyses were not able to identify the mechanism underlying this finding.

Conclusions

Overall, these results indicate that today and since waking up today are the most effective instructional phrases for inquiring about daily experience and that investigators should use caution when using the other 2 instructional phrases.