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Trost Z, Sturgeon J, Agtarap S, McMinn K, McShan E, Boals A, Arewasikporn A, Foreman M, Warren AM. The impact of perceived injustice on pain and psychological outcomes after traumatic injury: a longitudinal analysis. Pain 2024; 165:1583-1591. [PMID: 38258952 DOI: 10.1097/j.pain.0000000000003160] [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: 06/13/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024]
Abstract
ABSTRACT Individuals' appraisals regarding the injustice of their pain or physical injury have emerged as a significant risk factor for worse physical and psychological outcomes. Injustice appraisals are defined by perceptions of external blame for pain or injury and viewing pain or injury as a source of irreparable loss. To date, research on the impact of injustice appraisal has been primarily cross sectional, and existing longitudinal studies have examined injustice appraisals at only 2 time points in the context of rehabilitation treatment. This study examined the trajectory of injustice appraisals in 171 patients admitted for traumatic injury at admission, as well as 3, 6, and 12 months after discharge and examined injustice appraisals as a potential moderator of recovery after injury. Findings can be summarized as follows: First, injustice perception was largely stable in the 12 months after hospital discharge. Second, elevated injustice perception was associated with decreased recovery in pain intensity and depressive symptomatology over the study period but did not moderate changes in pain catastrophizing or posttraumatic stress symptomatology over time. This study is the first naturalistic prospective analysis of injustice appraisal following trauma admission within the American healthcare system. Findings indicate that injustice appraisals do not naturally decrease in the aftermath of traumatic injury and may be a risk factor for poorer physical and psychological recovery. Future research should examine additional sociodemographic and psychosocial factors that may contribute to elevated injustice appraisal, as well as ways of addressing the potential deleterious impact of injustice appraisals in treatment settings.
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Affiliation(s)
- Zina Trost
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - John Sturgeon
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Kenleigh McMinn
- Division of Trauma, Baylor University of Medical Center, Dallas, TX, United States
| | - Evan McShan
- Baylor Scott & White Institute for Rehabilitation Dallas, TX, United States
| | - Adriel Boals
- Department of Psychology, University of North Texas, Denton, TX, United States
| | - Anne Arewasikporn
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Michael Foreman
- Division of Trauma, Baylor University of Medical Center, Dallas, TX, United States
| | - Ann Marie Warren
- Division of Trauma, Baylor University of Medical Center, Dallas, TX, United States
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Azab AR, Elnaggar RK, Aly SM, Basalem N, Alamri AM, Saleh AK, Ibrahim MN, Basha MA, Abdelbasset WK. From injury to rehabilitation: How kinesiology taping helps patients with first metatarsophalangeal joint sprain (turf toe) in pain reduction, gait parameters and functional ability improvement. A randomized clinical trial. Heliyon 2024; 10:e29746. [PMID: 38681645 PMCID: PMC11053215 DOI: 10.1016/j.heliyon.2024.e29746] [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: 10/12/2023] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Turf toe is a common sports injury that may affect mobility and functional ability. For complete recovery, rehabilitation modalities are required to overcome these issues. This study investigated whether kinesio taping (KT) would reduce pain, improve gait performance, and enhance the functional capacity of turf toe patients undergoing physical therapy. Methods sixty patients with grade II turf toe (age; 25-30 years) assigned randomly into three treatment groups; KT applied alongside an exercise program conducted three times/week for 12 successive weeks. (KT group; n = 20), placebo taping plus exercise (Placebo group; n = 20), or exercise only (Control group; n = 20). Pain, gait parameters, and functional ability assessed using VAS, 3D gait analysis, and 6MWT respectively pre- and post-treatment. Results There was a significant post-treatment decrease in VAS score in the KT group lower than the control or placebo group and a significant increase in 6MWT distance in the KT group higher than the control or placebo group (p < 0.001). Additionally, there was a significant post-treatment increase in step length, stride length, cadence and velocity of KT group higher than control and placebo group (p < 0.05). There was no significant difference in gait parameters between control and placebo groups post treatment (p > 0.05). Conclusions The findings of the study demonstrated that KT is a useful complementary modality to exercise in patients with turf toe, as it may result in more favorable improvements to pain, gait characteristics, and functional abilities. Further studies should be conducted to assess the long-term effects, different KT application methods, and tailored treatment protocols on turf toe.
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Affiliation(s)
- Alshimaa R. Azab
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ragab K. Elnaggar
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Sobhy M. Aly
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Saudi Arabia
| | - Nourah Basalem
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Aiyshah M. Alamri
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mohamed N. Ibrahim
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Maged A. Basha
- Department of Physical Therapy College of Applied Medical Sciences Qassim University. Buraydah 51452. P.O. Box 6666. Saudi Arabia
- Department of Physical Therapy, ElSahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - Walid Kamal Abdelbasset
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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3
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Robinson CL, Phung A, Dominguez M, Remotti E, Ricciardelli R, Momah DU, Wahab S, Kim RS, Norman M, Zhang E, Hasoon J, Orhurh V, Viswanath O, Yazdi C, Chen GH, Simopoulos TT, Gill J. Pain Scales: What Are They and What Do They Mean. Curr Pain Headache Rep 2024; 28:11-25. [PMID: 38060102 DOI: 10.1007/s11916-023-01195-2] [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] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages. RECENT FINDINGS Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings. CONCLUSION Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anh Phung
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Moises Dominguez
- Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Edgar Remotti
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ryan Ricciardelli
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - D Uju Momah
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Wahab
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rosa S Kim
- Department of General Surgery, Georgetown University Hospital, MedStar, Washington, DC, USA
| | | | - Evan Zhang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA.
| | - Vwaire Orhurh
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Grant H Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA
| | - Thomas T Simopoulos
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jatinder Gill
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Crouch T, Sturgeon J, Guck A, Hagiwara N, Smith W, Trost Z. Race, Ethnicity, and Belief in a Just World: Implications for Chronic Pain Acceptance Among Individuals with Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:2309-2318. [PMID: 37454884 PMCID: PMC10789909 DOI: 10.1016/j.jpain.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Chronic pain acceptance is a psychological process consistently linked with improved functional outcomes. However, existing research on this construct has not considered the role of racial or ethnic background, despite growing evidence of racialized disparities in pain experience and treatment. This study aimed to examine racial differences in chronic pain acceptance, as measured by the chronic pain acceptance questionnaires (CPAQ), in a multicultural sample of individuals with chronic low back pain (N = 137-37.2% White, 31.4% Hispanic, and 31.4% Black/African American). We further sought to examine moderating effects of discrimination, pain-related perceived injustice (PI), and just world belief (JWB). Analyses consisted of cross-sectional one-way analyses of variance with Bonferroni-corrected post hoc comparisons, followed by regression models with interaction terms, main effects, and relevant covariates. Results indicated higher scores on the CPAQ for White individuals compared to Black or Hispanic individuals. Significant interactions were noted between race/ethnicity and JWB in predicting pain acceptance, after controlling for demographic and pain-related variables, such that the positive association between JWB and pain acceptance was significant for White participants only. Race/ethnicity did not show significant interactions with PI or prior racial discrimination. Findings highlight racial differences in levels of chronic pain acceptance, an adaptive pain coping response, and a stronger JWB appears to have a positive impact on pain acceptance for White individuals only. Results further confirm that members of disadvantaged racial groups may be more susceptible to poorer pain adjustment, which is the result of complex, multi-level factors. PERSPECTIVE: This study identifies racial differences in levels of pain acceptance, an adaptive psychological response to chronic pain, such that White individuals with chronic low back pain demonstrate higher levels of pain acceptance. The article further explores the impacts of intrapersonal and sociocultural variables on racial differences in pain acceptance.
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Affiliation(s)
- Taylor Crouch
- Department of Psychiatry, Virginia Commonwealth University, VA, USA
| | - John Sturgeon
- Department of Anaesthesiology, Michigan State University, MI, USA
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Ft. Worth, TX, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, VA, USA
| | - Wally Smith
- Department of Internal Medicine, Virginia Commonwealth University, VA, USA
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, VA, USA
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Gardashkhani S, Imani Khangah N, Ebrahimi Belil F. Psychometric Properties and The Best Form of The Revised Short-Form Mc-Gill Pain Questionnaire in Iranian Burn Patients. J Burn Care Res 2023; 44:1334-1338. [PMID: 36723910 DOI: 10.1093/jbcr/irad011] [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: 03/01/2022] [Indexed: 02/02/2023]
Abstract
Pain is the most important factor that forces patients to seek help from health care systems. Burn injuries are associated with severe pain and the assessment and interventions are a focus of nursing care. The aim of this study was to evaluate the psychometric properties of the revised short-form Mc-Gill Pain Questionnaire (MPQ) in burn patients. The present study is a methodological study in which 153 burn patients were included by convenience sampling. To evaluate the psychometric properties of the 22-item revised MPQ, face validity, construct validity (exploratory factor analysis), and reliability were determined by Cronbach's α coefficient and split-half method. Data analysis was performed using SPSS22.0 software. During the quantitative face validity test, four items were removed from the instrument due to the impact score of less than 1.5 by burn patients. The results of exploratory factor analysis showed five factors (emotional, neuropathic, continuous, stimulatory, and shooting), which explained 72.32% of the total variance. The overall Cronbach's instrument was 0.836 and the coefficient obtained by the split-half method was 0.81. According to the validity and reliability, the 18-item MPQ obtained in the present study can be used to assess pain in Persian-speaking adult burn patients.
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Affiliation(s)
- Sevda Gardashkhani
- Student Committee Research, Nursing & Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nafiseh Imani Khangah
- Student Committee Research, Nursing & Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Fatemeh Ebrahimi Belil
- Department of Medical-Surgical Nursing, Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
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Hu Y, Liu J, Xin L, Wan L, Qi Y, Li Y, Chen Y. Huangqin Qingre Chubi Capsule is Associated with Reduced Risk of Readmission in Patients with Rheumatoid Arthritis: A Real-World Retrospective Cohort Study. Int J Gen Med 2023; 16:4819-4834. [PMID: 37908759 PMCID: PMC10615257 DOI: 10.2147/ijgm.s431124] [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: 07/28/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose The therapeutic effects of Huangqin Qingre Chubi (HQC) in rheumatoid arthritis (RA) have been documented. However, there is a lack of real-world clinical evidence supporting its efficacy. Methods Patients diagnosed with RA were recruited from the First Affiliated Hospital of the Anhui University of Chinese Medicine. Patient information was obtained from the hospital's database. Propensity score matching (PSM), Kaplan-Meier curve, and Cox proportional hazards model were used to control confounding factors and analyze the factors influencing readmission. Association rule analysis and random walk evaluation models were used to evaluate the correlations among HQC treatment, inflammation indicators, and self-perception of patients (SPP) scale. Results After PSM, 3423 patients were enrolled, with 1142 in the HQC group and 2281 in the non-HQC group. The readmission risk of the HQC group was significantly lower than that of the non-HQC group. Combined univariate and multivariate analysis results revealed that risk factors for readmission were age >60 years, female sex, hypertension, chronic gastritis, and elevated levels of laboratory indices, including anticyclic citrullinated peptide and complement component 3 (C3) and C4. HQC, disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, and glucocorticoid therapy were protective factors for readmission. HQC treatment was closely associated with improvements in many factors, including erythrocyte sedimentation rate, C-reactive protein, C3, rheumatoid factor levels, visual analog scale, depression self-assessment scale, and patient-reported activity index scores with RA. Conclusion HQC treatment can reduce the risk of readmission and significantly improve immune inflammatory indicators and SPP in patients with RA, with no risk of hepatorenal toxicity.
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Affiliation(s)
- Yuedi Hu
- Department of Rheumatology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
- College of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
| | - Jian Liu
- Department of Rheumatology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
- Institute of Rheumatology, Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
- Department of Internal Medicine Application Foundation Research and Development, Anhui Province—Key Laboratory of Modern Chinese Medicine, Hefei, Anhui, People’s Republic of China
| | - Ling Xin
- Institute of Rheumatology, Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
- Department of Internal Medicine Application Foundation Research and Development, Anhui Province—Key Laboratory of Modern Chinese Medicine, Hefei, Anhui, People’s Republic of China
| | - Lei Wan
- Department of Rheumatology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
- Institute of Rheumatology, Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
- Department of Internal Medicine Application Foundation Research and Development, Anhui Province—Key Laboratory of Modern Chinese Medicine, Hefei, Anhui, People’s Republic of China
| | - Yajun Qi
- Department of Rheumatology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
| | - Yang Li
- Department of Rheumatology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
| | - Yiming Chen
- Department of Rheumatology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China
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Gussoni M, Moretti S, Vezzoli A, Genitoni V, Giardini G, Balestra C, Bosco G, Pratali L, Spagnolo E, Montorsi M, Mrakic-Sposta S. Effects of Electrical Stimulation on Delayed Onset Muscle Soreness (DOMS): Evidences from Laboratory and In-Field Studies. J Funct Morphol Kinesiol 2023; 8:146. [PMID: 37873905 PMCID: PMC10594470 DOI: 10.3390/jfmk8040146] [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: 09/03/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Intense, long exercise can increase oxidative stress, leading to higher levels of inflammatory mediators and muscle damage. At the same time, fatigue has been suggested as one of the factors giving rise to delayed-onset muscle soreness (DOMS). The aim of this study was to investigate the efficacy of a specific electrical stimulation (ES) treatment (without elicited muscular contraction) on two different scenarios: in the laboratory on eleven healthy volunteers (56.45 ± 4.87 years) after upper limbs eccentric exercise (Study 1) and in the field on fourteen ultra-endurance athletes (age 47.4 ± 10.2 year) after an ultra-running race (134 km, altitude difference of 10,970 m+) by lower exercising limbs (Study 2). Subjects were randomly assigned to two experimental tasks in cross-over: Active or Sham ES treatments. The ES efficacy was assessed by monitoring the oxy-inflammation status: Reactive Oxygen Species production, total antioxidant capacity, IL-6 cytokine levels, and lactate with micro-invasive measurements (capillary blood, urine) and scales for fatigue and recovery assessments. No significant differences (p > 0.05) were found in the time course of recovery and/or pre-post-race between Sham and Active groups in both study conditions. A subjective positive role of sham stimulation (VAS scores for muscle pain assessment) was reported. In conclusion, the effectiveness of ES in treating DOMS and its effects on muscle recovery remain still unclear.
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Affiliation(s)
- Maristella Gussoni
- Institute of Chemical Sciences and Technologies “G. Natta”, National Research Council (SCITEC-CNR), 20133 Milan, Italy;
| | - Sarah Moretti
- National Research Council (IFC-CNR), 20159 Roma, Italy;
| | - Alessandra Vezzoli
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20159 Milan, Italy; (A.V.); (L.P.); (E.S.)
| | | | - Guido Giardini
- Neurology and Neurophysiology Department, Mountain Medicine Center Valle d’ Aosta Regional Hospital Umberto Parini, 11100 Aosta, Italy;
- Società Italiana Medicina di Montagna, SIMeM, 35138 Padova, Italy
| | - Costantino Balestra
- Motor Sciences Department, Physical Activity Teaching Unit, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium;
| | - Gerardo Bosco
- Environmental Physiology & Medicine Lab, Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy;
| | - Lorenza Pratali
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20159 Milan, Italy; (A.V.); (L.P.); (E.S.)
- Società Italiana Medicina di Montagna, SIMeM, 35138 Padova, Italy
| | - Elisabetta Spagnolo
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20159 Milan, Italy; (A.V.); (L.P.); (E.S.)
| | - Michela Montorsi
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Roma, Italy
| | - Simona Mrakic-Sposta
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20159 Milan, Italy; (A.V.); (L.P.); (E.S.)
- Società Italiana Medicina di Montagna, SIMeM, 35138 Padova, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Roma, Italy
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Kaps D, Siebers HL, Betz U, Pfirrmann D, Eschweiler J, Hildebrand F, Betsch M, Huthwelker J, Wolf C, Drees P, Konradi J. Creation and Evaluation of a Severity Classification of Hyperkyphosis and Hypolordosis for Exercise Therapy. Life (Basel) 2023; 13:1392. [PMID: 37374174 DOI: 10.3390/life13061392] [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: 04/19/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The rise in the occurrence of musculoskeletal disorders, such as thoracic hyperkyphosis (THK) or lumbar hypolordosis (LHL), is a result of demographic changes. Exercise therapy is an effective approach that can reduce related disabilities and costs. To ensure successful therapy, an individualized exercise program adapted to the severity of the disorder is expedient. Nevertheless, appropriate classification systems are scarce. This project aimed to develop and evaluate a severity classification focused on exercise therapy for patients with THK or LHL. A multilevel severity classification was developed and evaluated by means of an online survey. Reference limits of spinal shape angles were established by data from video rasterstereography of 201 healthy participants. A mean kyphosis angle of 50.03° and an average lordosis angle of 40.72° were calculated as healthy references. The strength of the multilevel classification consisting of the combination of subjective pain and objective spinal shape factors was confirmed by the survey (70% agreement). In particular, the included pain parameters were considered relevant by 78% of the experts. Even though the results of the survey provide important evidence for further analyses and optimization options of the classification system, the current version is still acceptable as therapeutic support.
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Affiliation(s)
- David Kaps
- Center for Mental Health, Hospital Stuttgart-Bad Cannstatt Hospital, 70374 Stuttgart, Germany
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
- Institute of Social Science, Media, and Sports, Johannes Gutenberg-University Mainz, 55128 Mainz, Germany
| | - Hannah L Siebers
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation (IPTPR), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Daniel Pfirrmann
- Institute of Social Science, Media, and Sports, Johannes Gutenberg-University Mainz, 55128 Mainz, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics and Trauma Surgery, University Hospital Erlangen of the University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Janine Huthwelker
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Claudia Wolf
- Institute of Physical Therapy, Prevention and Rehabilitation (IPTPR), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Trauma Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Jürgen Konradi
- Institute of Physical Therapy, Prevention and Rehabilitation (IPTPR), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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9
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Diz-Arias E, Fernández-Jiménez E, Peral A, Gomez-Pedrero JA. A Comparative Study of Two Imaging Techniques of Meibomian Glands. Life (Basel) 2023; 13:life13030791. [PMID: 36983946 PMCID: PMC10051416 DOI: 10.3390/life13030791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
In the present study, two different meibographers, Oculus Keratograph 5M (K5M) that uses 840 nm infrared light and the Visible Light Non-Contact Meibographer (VLNCM) that uses 610 nm visible light have been used to obtain meibography images from normal and Meibomian Gland Dysfunction (MGD) population. The main objective has been to validate and demonstrate that the use of visible light is useful for observation and quantification of MG in clinical practice. Twenty participants were enrolled in this prospective study. The upper eyelids of one randomly chosen eye were used to obtain results. Forty images were captured and analysed. Three specialized observers were recruited to grade images using Pult and Riede Pult 5-degree scale, in two different sessions. Intra-observer agreement between sessions for both devices was shown. Inter-observer variability analysis showed discrepancy between meiboscores obtained from observers with K5M (p-value < 0.05), except for session 2 in the pathology group, while no statistical difference was found with VLNCM. Repeatability analysis found no statistically significant differences between sessions. Correlation between meibographers showed no statistically significant difference and a moderate correlation coefficient between meiboscores graded with the two devices. The current study suggests that VLNCM can allow MG to be properly visualized and classified in the upper eyelids.
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Affiliation(s)
- Elena Diz-Arias
- Optics Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
- Correspondence: ; Tel.: +34-680821782
| | - Elena Fernández-Jiménez
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Assumpta Peral
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Jose A. Gomez-Pedrero
- Optics Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
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10
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Chmiel J, Guzy G. Effectiveness of Local Cryotherapy Treatment with the Use of Carbon Dioxide and Liquid Nitrogen Among Patients with Low Back Pain Syndrome. REHABILITACJA MEDYCZNA 2022. [DOI: 10.5604/01.3001.0015.9814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Low back pain syndromes (LBPS) are common. One of the methods of treating LBPS is local cryotherapy, which can be based on various cooling substances. In the available literature, it is suggested that effective cold treatment may depend on the type and temperature of the cooling substance used.
Research objective: The aim of the study was to evaluate the effectiveness of 2 local cryotherapy (Carbon Dioxide and Liquid Nitrogen) types among patients with low back pain syndrome (LBPS).
Materials and methods: The study included 60 patients diagnosed with chronic LBPS of discopathic origin. Patients were randomised into 2 study groups. Local cryotherapy treatment with Carbon Dioxide was used in the 1st group (G1), while in the 2nd (G2), cryotherapy treatment with applied Liquid Nitrogen. Two measurements were taken, before and after 2 weeks treatment. The following were used for assessment: centralisation of symptoms (Pain Drawings), pain intensity (Numeral Rating Scale), duration of the current pain episode (Quebec Task Force Classification), level of disability (Roland-Morris Disability Questionnaire), quality and intensity of subjective pain (McGill Pain Questionnaire), patients’ emotional state (Adjectival Scale for Testing Emotions) and self-efficacy related to pain (Pain Self-Efficacy Questionnaire). Statistical analysis was performed via the Student’s t-test for dependent and independent samples.
Results: In both study groups, the perceived pain was either completely eliminated or centralised to the spine, hip joint and buttock. The level of pain, disability and pain-related self-efficacy decreased significantly, regardless of the therapy used. In terms of these variables, no greater therapeutic efficacy was demonstrated with either cryostimulation treatment. Qualitative assessment of pain and emotions (especially anxiety and anger) decreased significantly in G1 and G2. However, in the nitrogen-treated group, a significantly greater improvement was noted for WOB:OC, anger and anxiety scores (for these variables, the G2 group started from a higher level prior to therapy).
Conclusions: Both analysed treatments are equally effective in terms of variables such as: centralisation of symptoms, level of pain intensity, disability, joy, self-efficacy related to pain, as well as the majority of the analysed MPQ indicators. Cryostimulation with liquid nitrogen may be more effective, but only in improving the WOB: OC index of the MPQ questionnaire and the level of anger and anxiety. Nonetheless, the obtained results do not allow for definitive confirmation of these results. The use of both cryostimulation treatment methods may assist in the treatment process of LBPS.
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Affiliation(s)
- Jagoda Chmiel
- Institute of Clinical Rehabilitation, University of Physical Education in Kraków, Poland / Instytut Rehabilitacji Klinicznej, Akademia Wychowania Fizycznego im. Bronisława Czecha w Krakowie
| | - Grażyna Guzy
- Institute of Applied Sciences, University of Physical Education in Kraków, Poland / Instytut Nauk Stosowanych, Akademia Wychowania Fizycznego im. Bronisława Czecha w Krakowie
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11
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Fernandez E, Wu W, Shattuck EC, Kolaparthi K. Sensory Versus Affective Pain Descriptors Predicting Functional Versus Psychosocial Disability. THE JOURNAL OF PAIN 2022; 23:1556-1563. [PMID: 35462069 PMCID: PMC9464672 DOI: 10.1016/j.jpain.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
In the lexical assessment of pain, an offshoot of the McGill Pain Questionnaire is the Pain Descriptor System (PDS) which assesses sensory, affective, and overall intensity of pain. To determine if sensory versus affective pain components might be selectively related to different aspects of disability, PDS scores were examined in relation to functional status and psychosocial impairment on the Pain Disability Questionnaire (PDQ). A sample of 629 chronic pain patients rated the degree to which each of 36 PDS words described their pain and also rated 15 items of the PDQ. Three regression models (including Group Lasso) were applied to the data. Results showed that as hypothesized, PDS sensory scores significantly predicted PDQ functional status, accounting for about 13% of the variance; PDS affective scores significantly predicted PDQ psychosocial impairment, accounting for 17% of the variance; PDS total scores significantly predicted PDQ total scores, accounting for approximately 24% of the variance. This supports the overall predictive validity of pain descriptors, while confirming more specific links between components of pain and facets of disability. Clinically, the patient's description of pain sensation may hold valuable clues to physical impairment, whereas the communication of affect/suffering is more likely to connote psychosocial difficulties in functioning. PERSPECTIVE: Regression models (including Group Lasso) were applied to data on pain and disability from 629 patients. Findings support the Pain Descriptor System in assessing pain but further suggest that sensory descriptors are predictive of physical impairment from chronic pain, whereas affective descriptors are more predictive of psychologically-related disability.
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Affiliation(s)
- Ephrem Fernandez
- Psychology Department, University of Texas at San Antonio, San Antonio, Texas.
| | - Wenbo Wu
- Department of Management Science and Statistics, University of Texas at San Antonio, Texas
| | - Eric C Shattuck
- Institute for Health Disparities Research and Department of Public Health, Department of Anthropology, University of Texas at San Antonio, University of Toronto at Mississauga, Ontario, Canada
| | - Krishna Kolaparthi
- University of Texas at San Antonio, Institute for Health Disparities Research, Texas
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12
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Wah SW, Chatchawan U, Chatprem T, Puntumetakul R. Prevalence of Static Balance Impairment and Associated Factors of University Student Smartphone Users with Subclinical Neck Pain: Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10723. [PMID: 36078439 PMCID: PMC9518560 DOI: 10.3390/ijerph191710723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to assess the prevalence of static balance impairment in university student smartphone users with subclinical neck pain and identify the associated risk factors. Because of rapid and widespread smartphones use, and the subsequent effect on neck pain in university students, it is essential to determine the prevalence of balance impairment and associated factors in this population. Simple random sampling was completed among eighty-one participants in this cross-sectional study. A self-reported questionnaire, fitted precisely for smartphone users, was used prior to clinical assessment by the Balance Error Scoring System. Both simple and multiple logistic regressions were used to analyze the prevalence of static balance impairment and associated factors. The prevalence of static balance impairment in university student smartphone users with subclinical neck pain was 74.07% (95% CI: 64.32 to 83.82). The significant risk factors were "daily smartphone use ≥ 4 h'' (AOR: 19.24 (95% CI 4.72 to 78.48) p = 0.000), "≥4 years of smartphone use" (AOR: 5.01 (95% CI 1.12 to 22.38) p = 0.035), and "≥7 neck disability index score'' (AOR: 12.91 (95% CI 2.24 to 74.45) p = 0.004). There was a high prevalence of static balance impairment in university smartphone users with subclinical neck pain. University student smartphone users with subclinical neck pain who met at least one of the risk factors should realize their static balance impairment.
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Affiliation(s)
- Saw Wah Wah
- Human Movement Sciences, School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
| | - Uraiwan Chatchawan
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Thiwaphon Chatprem
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Rungthip Puntumetakul
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
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13
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Balchin C, Tan AL, Golding J, Bissell LA, Wilson OJ, McKenna J, Stavropoulos-Kalinoglou A. Acute effects of exercise on pain symptoms, clinical inflammatory markers and inflammatory cytokines in people with rheumatoid arthritis: a systematic literature review. Ther Adv Musculoskelet Dis 2022; 14:1759720X221114104. [PMID: 35991522 PMCID: PMC9386862 DOI: 10.1177/1759720x221114104] [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: 01/27/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Exercise is advocated in the treatment of rheumatoid arthritis (RA). However, uncertainty around the acute effects of exercise on pain and inflammation may be stopping people with RA from exercising more regularly. Objectives To determine the acute effects of exercise on pain symptoms, clinical inflammatory markers, and inflammatory cytokines in RA. Design A systematic review of the literature. Data sources and methods Five databases were searched (PubMed, Cochrane Library, CINAHL, Scopus and SPORTDiscus); inclusion criteria were studies with acute exercise, a definite diagnosis of RA and disease characteristics assessed by clinical function (i.e., disease activity score, health assessment questionnaire and self-reported pain), clinical markers associated with inflammation (i.e., c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), and inflammatory cytokines (i.e., interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α)). Results From a total of 1544 articles, initial screening and full text assessment left 11 studies meeting the inclusion criteria. A total of 274 people were included in the studies (RA = 186; control = 88). Acute bouts of aerobic, resistance, and combined aerobic and resistance exercise did not appear to exacerbate pain symptoms in people with RA. Conclusion Post-exercise responses for pain, clinical inflammatory markers and inflammatory cytokines were not different between people with or without RA. Exercise prescription was variable between studies, which limited between-study comparisons. Therefore, future investigations in people with RA are warranted, which combine different exercise modes and intensities to examine acute effects on pain symptoms and inflammatory markers. Registration The PROSPERO international prospective register of systematic reviews - CRD42018091155.
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Affiliation(s)
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Joshua Golding is now affiliated to School of Medicine, St George’s University of London, London, UK
| | - Joshua Golding
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Lesley-Anne Bissell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Joshua Golding is now affiliated to School of Medicine, St George’s University of London, London, UK
| | | | - Jim McKenna
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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14
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Azab AR, Kamel FH, Basha MA, Alrawaili SM, Aloraini GS, Hassan SM, Ewais NF, Elnaggar RK. Impact of Clinical Pilates Exercise on Pain, Cardiorespiratory Fitness, Functional Ability, and Quality of Life in Children with Polyarticular Juvenile Idiopathic Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137793. [PMID: 35805451 PMCID: PMC9265800 DOI: 10.3390/ijerph19137793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
Objective: This study intended to examine the effects of Pilates exercise on pain, cardiorespiratory fitness, functional ability, and quality of life in children with polyarticular juvenile idiopathic arthritis. Methods: Forty children with polyarticular JIA aged 10−14 years old were randomly allocated into two groups: the control group (n = 20) received conventional physical therapy (CPT), and the experimental group (n = 20) received clinical Pilates exercises combined with CPT. Patients in both groups received their program three times/week for 3 months. Pain, cardiorespiratory fitness, functional ability, and quality of life were assessed through the visual analogue scale, cardiopulmonary exercise test, 6 min walk test, and PedsQL scale, respectively, just before and after treatment. Results: Pain (p = 0.001), cardiorespiratory markers (all p < 0.05), functional ability (p = 0.002), and overall quality of life (p = 0.007) improved significantly in the experimental groups compared to the control group. Conclusion: Incorporating Pilates exercises into CPT is likely more effective for decreasing pain intensity, improving cardiorespiratory fitness, augmenting functional ability, and promoting quality of life in children with JIA than CPT alone.
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Affiliation(s)
- Alshimaa R. Azab
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Correspondence:
| | - FatmaAlzahraa H. Kamel
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt;
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
| | - Maged A. Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
- Department of Physical Therapy, ElSahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo 11697, Egypt
| | - Saud M. Alrawaili
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
| | - Ghfren S. Aloraini
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam University, Al-Kharj 11942, Saudi Arabia;
| | - Sahar M. Hassan
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
- Department of Physical Therapy, Cairo University Hospitals, Cairo University, Cairo 4240310, Egypt
| | - Najlaa F. Ewais
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt;
| | - Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
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15
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Berger SE, Baria AT. Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches. FRONTIERS IN PAIN RESEARCH 2022; 3:896276. [PMID: 35721658 PMCID: PMC9201034 DOI: 10.3389/fpain.2022.896276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Pain research traverses many disciplines and methodologies. Yet, despite our understanding and field-wide acceptance of the multifactorial essence of pain as a sensory perception, emotional experience, and biopsychosocial condition, pain scientists and practitioners often remain siloed within their domain expertise and associated techniques. The context in which the field finds itself today-with increasing reliance on digital technologies, an on-going pandemic, and continued disparities in pain care-requires new collaborations and different approaches to measuring pain. Here, we review the state-of-the-art in human pain research, summarizing emerging practices and cutting-edge techniques across multiple methods and technologies. For each, we outline foreseeable technosocial considerations, reflecting on implications for standards of care, pain management, research, and societal impact. Through overviewing alternative data sources and varied ways of measuring pain and by reflecting on the concerns, limitations, and challenges facing the field, we hope to create critical dialogues, inspire more collaborations, and foster new ideas for future pain research methods.
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Affiliation(s)
- Sara E. Berger
- Responsible and Inclusive Technologies Research, Exploratory Sciences Division, IBM Thomas J. Watson Research Center, Yorktown Heights, NY, United States
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16
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Chang CT, Jeng CJ, Long CY, Chuang LT, Shen J. High-intensity focused ultrasound treatment for large and small solitary uterine fibroids. Int J Hyperthermia 2022; 39:485-489. [DOI: 10.1080/02656736.2022.2039788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Chih-Ting Chang
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cherng-Jye Jeng
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Show Chwan Hospital, Taipei, Taiwan
- Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Linus T. Chuang
- Department of Obstetrics and Gynecology, Western Connecticut Health Network, Larner College of Medicine at The University of Vermont, Danbury, CT, USA
| | - Jenta Shen
- Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, CA, USA
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17
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Opicapone Improves Global Non-Motor Symptoms Burden in Parkinson's Disease: An Open-Label Prospective Study. Brain Sci 2022; 12:brainsci12030383. [PMID: 35326339 PMCID: PMC8945982 DOI: 10.3390/brainsci12030383] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/23/2022] Open
Abstract
Patients with Parkinson’s disease (PD) can improve some non-motor symptoms (NMS) after starting treatment with opicapone. The aim of this study was to analyze the effectiveness of opicapone on global NMS burden in PD. OPEN-PD (Opicapone Effectiveness on Non-motor symptoms in Parkinson’s Disease) is a prospective open-label single-arm study conducted in 5 centers from Spain. The primary efficacy outcome was the change from baseline (V0) to the end of the observational period (6 months ± 30 days) (V2) in the Non-Motor Symptoms Scale (NMSS) total score. Different scales were used for analyzing the change in motor, NMS, quality of life (QoL), and disability. Thirty-three patients were included between JUL/2019 and JUN/2021 (age 63.3 ± 7.91; 60.6% males; 7.48 ± 4.22 years from symptoms onset). At 6 months, 30 patients completed the follow-up (90.9%). The NMSS total score was reduced by 27.3% (from 71.67 ± 37.12 at V0 to 52.1 ± 34.76 at V2; Cohen’s effect size = −0.97; p = 0.002). By domains, improvement was observed in sleep/fatigue (−40.1%; p < 0.0001), mood/apathy (−46.6%; p = 0.001), gastrointestinal symptoms (−20.7%; p = 0.029), and miscellaneous (−44.94%; p = 0.021). QoL also improved with a 18.4% reduction in the 39-item Parkinson’s Disease Quality of Life Questionnaire Summary Index (from 26.67 ± 17.61 at V0 to 21.75 ± 14.9 at V2; p = 0.001). A total of 13 adverse events in 11 patients (33.3%) were reported, 1 of which was severe (not related to opicapone). Dyskinesias and nausea were the most frequent (6.1%). Opicapone is well tolerated and improves global NMS burden and QoL in PD patients at 6 months.
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18
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Railton P, Delaney AJ, Goodyear BG, Matyas J, Lama S, Sutherland GR, Powell JN. Altered activity of pain processing brain regions in association with hip osteoarthritis. Sci Rep 2022; 12:2791. [PMID: 35181675 PMCID: PMC8857252 DOI: 10.1038/s41598-022-06499-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/17/2022] [Indexed: 12/25/2022] Open
Abstract
Hip osteoarthritis (OA) is characterized by chronic pain, but there remains a mismatch between symptoms and radiological findings. Recently, brain connectivity has been implicated in the modulation of chronic peripheral pain, however its association with perceived pain in hip OA is not understood. We used resting-state functional magnetic resonance imaging (fMRI) to examine functional connectivity associated with pain in hip OA patients. Thirty participants with hip OA and 10 non-OA controls were recruited. Using the visual analogue scale (VAS), pain scores were obtained before and after performing a painful hip activity. All participants underwent 3.0 T resting-state fMRI, and functional connectivity of brain regions associated with pain was determined and compared between participants, and before and after hip activity. Relative to controls, functional connectivity between the secondary somatosensory cortex and left posterior insula was increased, and functional connectivity between the bilateral posterior insula and motor cortices was significantly decreased in hip OA participants. In response to painful hip activity, functional connectivity increased between the thalamus, periaqueductal grey matter and brainstem. Functional connections between brain regions associated with pain are altered in hip OA patients, and several connections are modulated by performing painful activity. Unique lateralization of left posterior insula and linked brain functional connectivity patterns allows assessment of pain perception in hip OA providing an unbiased method to evaluate pain perception and pain modulation strategies.
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Affiliation(s)
- P Railton
- School of Biomedical Sciences, Charles Sturt University, Orange, Australia
| | - A J Delaney
- School of Dentistry and Medical Science, Charles Sturt University, Orange, Australia
| | - B G Goodyear
- Cumming School of Medicine, Calgary, AB, Canada.,Departments of Radiology, Clinical Neurosciences and Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - J Matyas
- Cumming School of Medicine, Calgary, AB, Canada
| | - S Lama
- Cumming School of Medicine, Calgary, AB, Canada.,Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - G R Sutherland
- Cumming School of Medicine, Calgary, AB, Canada.,Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - J N Powell
- Cumming School of Medicine, Calgary, AB, Canada.
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19
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A Cross-Sectional Survey of Labor Pain Control and Women's Satisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031741. [PMID: 35162764 PMCID: PMC8835069 DOI: 10.3390/ijerph19031741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
Abstract
Introduction: Pain experienced during labor is a symptom of contractile activity and is a physiological feature of the uterus that occurs at the appropriate stages of labor. For the majority of women, labor pain is the most severe pain they will ever experience, and therefore should be relieved. Objective: (1) To evaluate labor pain intensity before and after using non-pharmacological and pharmacological interventions; (2) to assess women’s satisfaction of labor pain management. Methods: A multicenter cross-sectional survey study was performed on 500 women who gave birth in different reference level hospitals (i.e., I, II, III). Pain intensity was assessed according the Numeric Rating Scale (range 0–10), whereas women’s satisfaction was measured with a 5 point Likert scale. Results: The use of both non-pharmacological (median 6.7 (5; 8) vs. 4.5 (3.3; 5.5)) and pharmacological methods (median 8 (7; 9) vs. 5 (3; 6)) resulted in a significant reduction in pain (p < 0.01). Water immersion and epidural anesthesia proved to be the most effective non-pharmacological and pharmacological methods, respectively. In hospitals of reference I, analgesic management was based primarily on the use of non-pharmacological techniques, less often mixed, i.e., non-pharmacological and pharmacological techniques (27.5%). On the other hand, in hospitals with higher referentiality, mixed methods were used more often (level II—65.8%; level III—81.2%). Pain intensity was significantly higher (p < 0.0001) in hospitals with reference level I (median 5 (4; 6)) than in the hospitals with reference level II (median 4.2 (3; 5)) or level III (median 4.2 (3.3; 5.4)). Epidural anesthesia was most often performed (60%) in the hospital of reference II. Women’s satisfaction (median 4 (3; 5)), inter alia, was associated with the effectiveness of applied methods. Conclusions: The study findings suggest that women giving birth in hospitals of higher referentiality have better control of labor pain due to access to pharmacological methods. Epidural anesthesia remains the gold standard for relieving labor pain. The choice of a specific method is determined by the degree of hospital and associated with the pain referentiality.
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20
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Santos García D, Canfield H, de Deus Fonticoba T, Cores Bartolomé C, Naya Ríos L, García Roca L, Martínez Miró C, Jesús S, Aguilar M, Pastor P, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Parkinson's Disease Motor Subtypes Change with the Progression of the Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up. JOURNAL OF PARKINSON'S DISEASE 2022; 12:935-955. [PMID: 34957949 DOI: 10.3233/jpd-213004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Motor phenotype (MP) can be associated with a different prognosis in Parkinson's disease (PD), but it is not fixed and can change over time. OBJECTIVE Our aim was to analyze how the MP changed over time and to identify factors associated with the changes in PD patients from a multicenter Spanish PD cohort. METHODS PD patients who were recruited from January-2016 to November-2017 (baseline visit; V0) and evaluated again at a 2-year±30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort, were included in this study.MP was calculated at both visits based on Jankovic classification in TD (tremor dominant), IND (indeterminate), or PIGD (postural instability and gait difficulty). Sociodemographic and clinical data were collected, including serum biomarkers. RESULTS Five hundred eleven patients (62.57±8.59 years old; 59.2%males) were included in the study. At V0, MP was: 47.4%(242/511) TD; 36.6%(187/511) PIGD; 16%(82/511) IND. Up to 38%(194/511) of the patients changed their phenotype from V0 to V2, being the most frequent from TD to IND (8.4%) and from TD to PIGD (6.7%). A worse cognitive status (OR = 0.966) and less autonomy for activities of daily living (OR = 0.937) at V0 and a greater increase in the globalNMS burden (OR = 1.011) from V0 to V2 were associated with changing from TD to another phenotype after 2-year follow-up. CONCLUSION The MP in PD can change over time. With disease progression, the percentage of cases with non-tremoric MP increases. PD patients who changed from TD to postural instability and gait difficulty increased NMS burden significantly.
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Affiliation(s)
| | - Hector Canfield
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | | | - Lucía Naya Ríos
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Lucía García Roca
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Inés Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Isabel González Aramburu
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Julio Dotor
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Berta Solano Vila
- Institut d'Assistència Sanitària (IAS) - Institut Català de la Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | | | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | | | - Maria G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
- Hospital de Sant Pau, Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | - Carlos Ordás
- Hospital Rey Juan Carlos, Madrid, Spain, Madrid, Spain
| | | | - Darrian McAfee
- Univeristy of Maryland School of Medicine, Baltimore, MD, USA
| | - Pablo Martinez-Martin
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Spain
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21
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Cubo E, Garcia-Bustillo A, Arnaiz-Gonzalez A, Ramirez-Sanz JM, Garrido-Labrador JL, Valiñas F, Allende M, Gonzalez-Bernal JJ, Gonzalez-Santos J, Diez-Pastor JF, Jahouh M, Arribas J, Trejo J. Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial. PLoS One 2021; 16:e0260889. [PMID: 34932580 PMCID: PMC8691608 DOI: 10.1371/journal.pone.0260889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.
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Affiliation(s)
- Esther Cubo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
- * E-mail:
| | - Alvaro Garcia-Bustillo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | | | | | | | | | | | | | | | - Maha Jahouh
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - Jose Trejo
- Hospital Universitario Burgos, Burgos, Spain
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22
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Predictors of clinically significant quality of life impairment in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:118. [PMID: 34916528 PMCID: PMC8677846 DOI: 10.1038/s41531-021-00256-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
Quality of life (QOL) plays an important role in independent living in Parkinson's disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829-0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422-12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053-1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027-1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer-Lemeshow test, p = 0.665; R2 = 0.655). An increase in ≥5 and ≥10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663-17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975-22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patients.
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23
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Chiang SH, Xu X, Cheung DST, Hsu YH, Chen CE, Lin CH, Smith R, Lin CC. Comparison between Aquacel and Aquacel Foam dressing on split-thickness skin graft donor site. J Wound Care 2021; 30:S14-S20. [PMID: 34882003 DOI: 10.12968/jowc.2021.30.sup12.s14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the effectiveness of two commonly used moist dressings, Aquacel and Aquacel Foam (both ConvaTec Ltd., UK), in managing split-thickness skin graft (STSG) donor site wounds. METHOD Patients undergoing STSG harvesting for reconstruction were eligible for this quasi-experimental study. After reconstruction surgery, the Aquacel (A) or Aquacel Foam (AF) dressings were applied on the donor site wound. The STSG donor site was assessed by two trained research nurses daily. Clinical outcomes including pain on dressing removal, use of intravenous analgesics, signs and symptoms of wound infection, incidence of exudate leakage and percentage healed were recorded in a standardised form. Cost of the dressing change was retrieved from the hospital billing system. RESULTS Of 50 patients recruited, 25 received dressing A and 25 received the AF dressing for their STSG donor site wound. The average pain score on dressing removal was significantly lower in the AF dressing group compared with the A dressing group (0.8±0.8 versus 3.1±1.5, respectively (p=0.04)). Regression analysis demonstrated that compared with dressing A, the AF dressing was associated with a lower average pain score (beta: -2.27, standard error: 0.33; p<0.001), lower likelihood of pro re nata (PRN) intravenous analgesic use (odds ratio (OR)=0.21, 95% confidence interval: 0.06-0.71; p=0.01) and lower likelihood of exudate leakage (OR=0.11, p=0.01). The differences in time to wound healing, infection and cost were not statistically significant between the two groups. CONCLUSION In this study, the AF dressing demonstrated superior performance in pain response on dressing removal for STSG donor site wounds compared with dressing A. Large-scale randomised controlled trials should be conducted to confirm the findings.
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Affiliation(s)
- Su-Hua Chiang
- Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Xinyi Xu
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | | | - Ying-Hsuan Hsu
- Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Ching-En Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan
| | - Chin-Hsun Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan
| | - Robert Smith
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Chia-Chin Lin
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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24
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Fernández-Jimenez E, Diz-Arias E, Peral A. Improving ocular surface comfort in contact lens wearers. Cont Lens Anterior Eye 2021; 45:101544. [PMID: 34840071 DOI: 10.1016/j.clae.2021.101544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Contact lens discomfort (CLD) is a major concern that can lead to the decreased or abandoned use of contact lenses. Contact lens users with dry eye disease are more likely to present with CLD. This study was conducted to evaluate the efficacy of a bioprotective preservative free, hypotonic, 0.15% hyaluronic acid (HA)-3% Trehalose artificial tear in managing dry eye symptoms in contact lens wearers. METHODS A prospective, single-arm, observational pilot study to evaluate the effectiveness of treatment with HA-Trehalose artificial tears in contact lens wearers (N = 33) aged 18-45 years with symptoms of ocular discomfort. Participants used a preservative-free, hypotonic HA-Trehalose artificial tear (1 drop/4 times per day) for 84 days. Participants were assessed using Visual Analogue Scale (VAS) for dry eye symptoms (pain, photophobia, dry eye sensation, blurry vision, foreign body sensation, itching, tingling/burning, and sticky eye feeling), Ocular Surface Disease Index (OSDI), Contact Lens Dry Eye questionnaire (CLDEQ-8), Berkley Dry Eye Flow-Chart (DEFC) on Day 0 and Day 84 and tear break-up time (TBUT), ocular surface staining with fluorescein and lissamine green, tear meniscus evaluation, and visual acuity on Day 0, 35, and 84. RESULTS All VAS symptoms (except tingling/burning and sticky eye feeling), OSDI, CLEDQ-8, and DEFC showed statistically significant (p < 0.05) improvement from baseline (Day 0) to Day 84. Similarly, corneal (fluorescein) and conjunctival (lissamine green) quality improved during the study (p < 0.05 at Day 84 versus baseline). Tear break-up time (TBUT), conjunctival (lissamine green) staining, and tear meniscus decreased but the changes were not statistically significant. Visual acuity did not change during the study. There were no ocular or systemic adverse events. CONCLUSIONS This study showed that the instillation of a preservative-free, hypotonic, HA-Trehalose artificial tear in contact lenses wearers with dry eye syndrome significantly improved symptoms and reduced associated signs such as corneal and conjunctival staining.
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Affiliation(s)
| | - Elena Diz-Arias
- Faculty of Optics and Optometry, Universidad Complutense de Madrid, Spain
| | - Assumpta Peral
- Faculty of Optics and Optometry, Universidad Complutense de Madrid, Spain.
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25
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Luk JW, Bond AE, Gabrielli J, LaCroix JM, Perera KU, Lee-Tauler SY, Goldston DB, Soumoff A, Ghahramanlou-Holloway M. A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients. J Psychiatr Res 2021; 142:9-16. [PMID: 34311282 DOI: 10.1016/j.jpsychires.2021.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual). METHODS Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis. RESULTS Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average). CONCLUSION Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.
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Affiliation(s)
- Jeremy W Luk
- National Institute on Alcohol Abuse and Alcoholism, Office of the Clinical Director, Building 10 - CRC, Room 1-5340, Bethesda, MD, 20892, USA
| | - Allison E Bond
- The University of Southern Mississippi, Department of Psychology, 118 College Dr., Hattiesburg, MS, 39406, USA
| | - Joy Gabrielli
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Rm. 3130, Gainesville, FL, 32610-0165, USA
| | - Jessica M LaCroix
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kanchana U Perera
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Su Yeon Lee-Tauler
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - David B Goldston
- Duke University School of Medicine, Box 3527 Med Ctr, Durham, NC, 27710, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | - Marjan Ghahramanlou-Holloway
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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26
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Cubo E, Martínez-Martín P, González-Bernal J, Casas E, Arnaiz S, Miranda J, Gámez P, Santos-García D. Effects of Motor Symptom Laterality on Clinical Manifestations and Quality of Life in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:1611-1620. [PMID: 32741839 DOI: 10.3233/jpd-202067] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The asymmetry of motor manifestations present in Parkinson's disease (PD) suggests the existence of differences between both hemispheres. As a consequence, this asymmetry might contribute to different PD clinical phenotypes. OBJECTIVE To study the relationship between motor symptom laterality with motor, non-motor symptoms (NMS), freezing of gait (FOG), and quality of life (QoL) impairment in PD. METHODS In this cross-sectional study, we measured motor symptoms severity and complications with the Unified Parkinsons' disease Rating Scale (UPDRS), FOG with the FOG questionnaire, QoL with the 39-item PD Quality of Life Questionnaire Summary Index, and NMS with the NMS, Visual Analogue Scales for Pain and Fatigue, Beck Depression Inventory-II, Impulsive-Compulsive Disorders, and PD Sleep and Cognitive Rating scales. We defined left and right motor laterality using the UPDRS part III. We used comparative, regression, and effect size analyses to evaluate the impact of asymmetry on motor and NMS, FOG, and QoL. RESULTS 342 left (LPD) and 310 right (RPD) patients, with a mean age of 62.0±8.8 years, were included. In multivariate regression analysis, LPD was associated with a greater motor (OR = 1,50, 95% CI 1.02-2.21), FOG (OR = 1.56, 95% CI 1.01-2.41), and overall NMS impairment (OR = 1.43, 95% CI 1.001-2.06), and better QoL (OR = 0.52 95% CI 0.32-0.85). Overall, only a mild effect size was found for all comparisons in which significant differences were present. CONCLUSION In this large multicenter study, motor symptom laterality seems to carry a mild but significant impact on PD clinical manifestations, and QoL.
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Affiliation(s)
- Esther Cubo
- Department of Neurology, Hospital Universitario Burgos, Burgos, Spain
| | - Pablo Martínez-Martín
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Elena Casas
- Department of Neurology, Hospital Universitario Burgos, Burgos, Spain
| | - Sandra Arnaiz
- Department of Neurology, Hospital Universitario Burgos, Burgos, Spain
| | - Javier Miranda
- Department of Neurology, Hospital Universitario Burgos, Burgos, Spain
| | - Pedro Gámez
- Department of Neurology, Hospital Universitario Burgos, Burgos, Spain
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Tang F, Gajewski BJ. Comparative Effectiveness Research using Bayesian Adaptive Designs for Rare Diseases: Response Adaptive Randomization Reusing Participants. Stat Biopharm Res 2021; 15:154-163. [PMID: 36875290 PMCID: PMC9979780 DOI: 10.1080/19466315.2021.1961854] [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: 03/09/2020] [Revised: 04/23/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Slow accrual rate is a major challenge in clinical trials for rare diseases and is identified as the most frequent reason for clinical trials to fail. This challenge is amplified in comparative effectiveness research where multiple treatments are compared to identify the best treatment. Novel efficient clinical trial designs are in urgent need in these areas. Our proposed response adaptive randomization (RAR) reusing participants trial design mimics the real-world clinical practice that allows patients to switch treatments when desired outcome is not achieved. The proposed design increases efficiency by two strategies: 1) Allowing participants to switch treatments so that each participant can have more than one observation and hence it is possible to control for participant specific variability to increase statistical power; and 2) Utilizing RAR to allocate more participants to the promising arms such that ethical and efficient studies will be achieved. Extensive simulations were conducted and showed that, compared with trials where each participant receives one treatment, the proposed participants reusing RAR design can achieve comparable power with a smaller sample size and a shorter trial duration, especially when the accrual rate is low. The efficiency gain decreases as the accrual rate increases.
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Affiliation(s)
- Fengming Tang
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, 66160
- Saint Luke’s Health System, Kansas City, MO, 64111
| | - Byron J. Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, 66160
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28
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Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain. J Hand Ther 2021; 33:562-570.e1. [PMID: 31481341 DOI: 10.1016/j.jht.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/09/2019] [Accepted: 06/18/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional. INTRODUCTION Pain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. PURPOSE OF THE STUDY The purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. METHODS Measures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. RESULTS The best-fitting regression model with DASH scores entered as the dependent variable (F4,50 = 28.8, P < .01) included MPI Pain Interference (β = -0.54), Life Control (β = -0.16), Purdue pegboard scores (β = -0.32), and Stroop test times (β = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R2 = 0.67, P < .01). CONCLUSION Pain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.
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29
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Santos García D, Yáñez Baña R, Labandeira Guerra C, Cimas Hernando MI, Cabo López I, Paz González JM, Alonso Losada MG, Gonzalez Palmás MJ, Cores Bartolomé C, Martínez Miró C. Pain Improvement in Parkinson's Disease Patients Treated with Safinamide: Results from the SAFINONMOTOR Study. J Pers Med 2021; 11:jpm11080798. [PMID: 34442442 PMCID: PMC8402181 DOI: 10.3390/jpm11080798] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/30/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background and objective: Pain is a frequent and disabling symptom in Parkinson’s disease (PD) patients. Our aim was to analyze the effectiveness of safinamide on pain in PD patients from the SAFINONMOTOR (an open-label study of the effectiveness of SAFInamide on NON-MOTOR symptoms in Parkinson´s disease patients) study. Material and Methods: SAFINONMOTOR is a prospective open-label single-arm study conducted in five centers from Spain. In this analysis, a secondary objective of the study, the score in the KPPS (King´s Parkinson´s Disease Pain Scale) at V1 (baseline) and V4 (6 months ± 1 month) were compared. Wilcoxon´s rank sum test was performed to test the changes from V1 to V4. Results: Forty-four (88%) out of 50 PD patients (age 68.5 ± 9.12 years; 58% women; 6.4 ± 5.1 years from diagnosis) completed the study. The KPPS total score was reduced by 43.6% (from 40.04 ± 36.18 in V1 to 22.60 ± 21.42 in V4; p < 0.0001). By domains, improvement was observed in musculoskeletal (−35.9%; p = 0.009), fluctuation-related (−51.7%; p = 0.020), nocturnal (−46.1%; p = 0.001), discoloration and/or edema/swelling (−50.4%; p = 0.009) and radicular pain (−40.1%; p = 0.048). A total of 21 adverse events in 11 patients (22%) were reported, five being severe, but not related to safinamide. Conclusion: Safinamide is well tolerated and improves pain in PD patients at 6 months. Future studies are necessary to analyze the possible beneficial effect of safinamide on pain in PD patients.
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Affiliation(s)
- Diego Santos García
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
- Correspondence: ; Tel.: +34-646173341
| | - Rosa Yáñez Baña
- Department of Neurology, CHUO, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Carmen Labandeira Guerra
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | | | - Iria Cabo López
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Jose Manuel Paz González
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
| | - Maria Gema Alonso Losada
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - Maria José Gonzalez Palmás
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Carlos Cores Bartolomé
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
| | - Cristina Martínez Miró
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
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Intraperitoneal Subdiaphragmatic Ropivacaine Instillation for Prevention of Shoulder Tip Pain After Laparoscopic Surgery in High-Risk Patients: A Randomized Controlled Trial. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Sobejana M, van den Hoek J, Metsios GS, Kitas GD, Jorstad HT, van der Leeden M, Pijnappels M, Lems WF, Nurmohamed MT, van der Esch M. Cardiorespiratory fitness and physical activity in people who have rheumatoid arthritis at an increased risk of cardiovascular disease: a cross-sectional study. Rheumatol Int 2021; 41:2177-2183. [PMID: 34331578 DOI: 10.1007/s00296-021-04903-6] [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: 12/17/2020] [Accepted: 05/22/2021] [Indexed: 10/20/2022]
Abstract
Lower cardiorespiratory fitness (CRF) and physical activity (PA) associate with higher cardiovascular disease (CVD) risk, but the relationship between CRF and PA in people who have rheumatoid arthritis (RA) at an increased CVD risk (CVD-RA) is not known. The objectives of this study were to determine the levels of CRF and PA in people who have CVD-RA and to investigate the association of CRF with PA in people who have CVD-RA. A total of 24 consecutive patients (19 women) with CVD-RA (> 4% for 10-year risk of fatal CVD development as calculated using the Systematic Coronary Risk Evaluation)-were included in the study. CRF was assessed with a graded maximal exercise test determining maximal oxygen uptake (VO2max). PA was assessed with an accelerometer to determine the amount of step count, sedentary, light and moderate-to-vigorous physical activity (MVPA) minutes per day. Mean age of patients was 65.3 ± 8.3 years. CRF mean values were 16.3 ± 1.2 ml·kg-1 min-1, mean step count per day was 6033 ± 2256, and the mean MVPA time was 16.7 min per day. Significant positive associations were found for CRF with step count (B = 0.001, P = 0.01) and MVPA time (B = 0.15, P = 0.02); a negative association was found for CRF with sedentary time (B = - 0.02, P = 0.03). CRF is low and is associated with step count, sedentary time and MVPA time in people who have RA at an increased CVD risk.
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Affiliation(s)
- M Sobejana
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Center
- Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - J van den Hoek
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Center
- Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - G S Metsios
- Faculty of Education, Health and Wellbeing, UK Department of Rheumatology, University of Wolverhampton, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK.,School of Physical Education and Sport Science, University of Thessaly, Volos, Greece.,Clinical Research Unit, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK
| | - G D Kitas
- Clinical Research Unit, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - M van der Leeden
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Center
- Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M Pijnappels
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - W F Lems
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Center
- Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Center
- Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M van der Esch
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Center
- Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands. .,Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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Wah SW, Puntumetakul R, Boucaut R. Effects of Proprioceptive and Craniocervical Flexor Training on Static Balance in University Student Smartphone Users with Balance Impairment: A Randomized Controlled Trial. J Pain Res 2021; 14:1935-1947. [PMID: 34234540 PMCID: PMC8242145 DOI: 10.2147/jpr.s312202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose University student smartphone users adopt flexed neck postures during smartphone use, creating an increased compressive load on their neck structures. This study was conducted to compare the effects of proprioceptive and craniocervical flexor training with a control group on static balance in a group of university student smartphone users with balance impairment. Methods A double-blinded, randomized controlled trial was conducted involving 42 university students (19.67±1.68 years old) with balance impairment. Participants were randomized into a proprioceptive training (ProT) group (n=14), a craniocervical flexor training (CCFT) group (n=14), and a control group (CG; n=14) for a 6-week intervention. The balance error scoring system (BESS), cervical joint position sense (CJPS), craniocervical flexion (CCF) test, and visual analog scale (VAS) for neck pain were evaluated using univariate analysis of covariance (ANCOVA). Results After 6 weeks of intervention, the ProT group showed significantly greater improvement of CJPS than the CG (p=0.000) and the CCFT group significantly improved of CCF test than CG (p=0.002). Findings, at 4 weeks after intervention, were (i) the ProT group had significantly more improvement in BESS than the CCFT group (p=0.014) and CG (p=0.003), (ii) the ProT group had significantly more improvement of CJPS than the CG (right and left rotate) (p=0.001, p=0.016, respectively) and CCFT group (right rotate) (p=0.004), (iii) the CCFT group had significantly more improvement of craniocervical flexor strength than CG (p=0.004), and (iv) the ProT group and CCFT group had significantly more decreased pain than CG (p=0.015, p=0.033, respectively). No adverse effects occurred during or after training in any group. Conclusion ProT is important for regaining static balance and CJPS, while CCFT improved craniocervical flexor strength. Moreover, both ProT and CCFT can reduce neck pain. We recommend performing ProT to improve static balance, CJPS and to reduce neck pain in smartphone users with static balance impairment. Clinical Trail Registration Number TCTR20190909003.
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Affiliation(s)
- Saw Wah Wah
- Human Movement Sciences, School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Rungthip Puntumetakul
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, 40002, Thailand.,School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Rose Boucaut
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, 5001, Australia.,University of South Australia: Allied Health and Human Performance, Adelaide, SA, 5001, Australia
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Russu OM, Pop TS, Feier AM, Trâmbițaș C, Incze-Bartha Z, Borodi PG, Gergely I, Zuh SG. Treatment Efficacy with a Novel Hyaluronic Acid-Based Hydrogel for Osteoarthritis of the Knee. J Pers Med 2021; 11:jpm11040303. [PMID: 33920879 PMCID: PMC8071312 DOI: 10.3390/jpm11040303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Prior trials investigating the treatment of symptomatic osteoarthritis (OA) with hyaluronic-acid-derived products injections have provided optimistic results. The study was directed to assess the effectiveness of an innovative hyaluronic-acid-based hydrogel (Hymovis®) in the treatment of symptomatic knee OA. Methods: A prospective, single-center, clinical trial was performed. Thirty-five patients with degenerative knee OA were included. Inclusion criteria were: age between 45–80, radiographic Kellgren grade II or III osteoarthritis, minimum 35 mm score on the Visual Analogue Scale (VAS), pain for at least 6 months and agreement to participate in the study. Patients received two injections at a one-week interval. The evaluator assessed the patients using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and VAS. Evaluation was performed before, at 2 and 6 months after the injections. Results: A significant improvement on the WOMAC Index pain subscale was observed at 6 months after the injection. At two months, pain subscale score decreased from 10.34 to 9.34. At six months, a significant decrement in pain parameters compared to baseline was observed (from 10.34 to 7.72; p = 0.0004). Median points on VAS significantly ameliorated after 6 months (from 74.2 to 57.3 cm; p < 0.0001). Regarding physical function, a statistically significant difference compared to baseline was observed at the end of the study (from 29.74 to 25.18; p = 0.0025). WOMAC Index stiffness component did not differ from baseline at any time during follow-up. Conclusions: Pain relief installed with a delayed on-set but had a prolonged duration. The novel hyaluronic acid-based hydrogel (Hymovis®) had effective results, particularly after six months post-injections and offers a therapeutic advancement in the treatment of moderate to severe osteoarthritis.
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Affiliation(s)
- Octav Marius Russu
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Tudor Sorin Pop
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Andrei Marian Feier
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
- Correspondence: ; Tel.: +40-2652-13720
| | - Cristian Trâmbițaș
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Department of Anatomy and Embriology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Zsuzsanna Incze-Bartha
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Department of Anatomy and Embriology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Paul Gabriel Borodi
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - István Gergely
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Sándor-György Zuh
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (C.T.); (Z.I.-B.); (I.G.); (S.-G.Z.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
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Santos García D, Labandeira Guerra C, Yáñez Baña R, Cimas Hernando MI, Cabo López I, Paz Gonález JM, Alonso Losada MG, González Palmás MJ, Martínez Miró C. Safinamide Improves Non-Motor Symptoms Burden in Parkinson's Disease: An Open-Label Prospective Study. Brain Sci 2021; 11:316. [PMID: 33801565 PMCID: PMC7999475 DOI: 10.3390/brainsci11030316] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Some studies observed a benefit of Parkinson's disease (PD) patients after treatment with safinamide in some non-motor symptoms (NMSs). The aim of this study was to analyze the effectiveness of safinamide on NMS burden in PD. SAFINONMOTOR (an open-label study of the effectiveness of safinamide on non-motor symptoms in Parkinson's disease patients) is a prospective open-label single-arm study conducted in five centers from Spain. The primary efficacy outcome was the change from baseline (V1) to the end of the observational period (6 months) (V4) in the non-motor symptoms scale (NMSS) total score. Between May/2019 and February/2020 50 patients were included (age 68.5 ± 9.12 years; 58% females; 6.4 ± 5.1 years from diagnosis). At 6 months, 44 patients completed the follow-up (88%). The NMSS total score was reduced by 38.5% (from 97.5 ± 43.7 in V1 to 59.9 ± 35.5 in V4; p < 0.0001). By domains, improvement was observed in sleep/fatigue (-35.8%; p = 0.002), mood/apathy (-57.9%; p < 0.0001), attention/memory (-23.9%; p = 0.026), gastrointestinal symptoms (-33%; p = 0.010), urinary symptoms (-28.3%; p = 0.003), and pain/miscellaneous (-43%; p < 0.0001). Quality of life (QoL) also improved with a 29.4% reduction in the PDQ-39SI (from 30.1 ± 17.6 in V1 to 21.2 ± 13.5 in V4; p < 0.0001). A total of 21 adverse events in 16 patients (32%) were reported, 5 of which were severe (not related to safinamide). Dyskinesias and nausea were the most frequent (6%). Safinamide is well tolerated and improves NMS burden and QoL in PD patients with severe or very severe NMS burden at 6 months.
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Affiliation(s)
- Diego Santos García
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
| | - Carmen Labandeira Guerra
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - Rosa Yáñez Baña
- Department of Neurology, CHUO, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | | | - Iria Cabo López
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Jose Manuel Paz Gonález
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
| | - Maria Gemma Alonso Losada
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - María José González Palmás
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Cristina Martínez Miró
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
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Brunell AB, Buelow MT, Trost Z. Narcissism and the experience of pain. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.109852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Li HZ, Yu C, Zhang ZT, Yan S, Liao YJ, Lu DF. Arthroscopic Reconstruction of Posterior Cruciate Ligament with Embedded Tibial Tendon Bolt. Orthop Surg 2021; 13:592-598. [PMID: 33474839 PMCID: PMC7957385 DOI: 10.1111/os.12855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/18/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the effect of newly designed arthroscopic reconstruction of posterior cruciate ligament (PCL) using tibial tendon bolt. METHODS The effects of embedded tendon pin were observed by X-ray of knee joint. From October 2010 to September 2015, 51 PCL injury patients who met the inclusion criteria were enrolled in this retrospective study. The arthroscopically assisted reconstruction of the PCL with tibial tendon bolt was performed on all patients. Visual Analog Scale (VAS) pain score, Tegner activity score, Lysholm score, International Knee Documentation Committee (IKDC) assessment, posterior drawer test (PDT), and KT-1000 activity score were evaluated preoperatively and at 1-year postoperative and 3-year postoperative. RESULTS The preoperative, 1-year postoperative, and 3-year postoperative IKDC score (15.8% ± 14.8%, 89.6% ± 5.8%, and 86.8% ± 5.4%), Lysholm score (17.4 ± 10.7, 91.2 ± 2.8, and 88.2 ± 3.1), VAS score (5.8 ± 1.2, 1.3 ± 0.5, and 0.6 ± 0.5), Tegner activity score (1.2 ± 0.8, 8.1 ± 0.8, and 7.4 ± 0.8), and KT-1000 score (15.6 ± 3.6, 4.5 ± 2.4, and 5.4 ± 1.8) were obtained. There were significant differences in these outcomes among preoperative, 1-year postoperative, and 3-year postoperative (all P < 0.0001). After 1- and 3-year surgery, 31 (60.8%) and 26 (51.0%) patients had the negative PDT, indicating that the PCL injury was improved. There were no postoperative complications. CONCLUSION The application of tendon pin fixed by tibial inlay 8-shaped tibial tunnel to reconstruct PCL was an effective, simple, and safe surgical procedure for PCL injury.
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Affiliation(s)
- Hua-Zhe Li
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Cong Yu
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhi-Tao Zhang
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Shi Yan
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yun-Jian Liao
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Dai-Feng Lu
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
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Miao Z, Tong Z, Ye J, Leng S, Wang M, Hu A, Zhang J, Dai X, Liang J, Geng Y, Chen L, Ye B, Dong Y. Tuina for lumbar disc herniation: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e24203. [PMID: 33429811 PMCID: PMC7793356 DOI: 10.1097/md.0000000000024203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is an important factor of causing leg pain and numbness. As a secondary discipline of Traditional Chinese Medicine, tuina is widely used for the treatment of LDH in China even in other nations while its clinical value is not acknowledged universally. So, we focus on this article aims to evaluate its efficacy and safety of LDH. METHODS Electronic databases involving Cochrane Library, PubMed, Web of Science, EMBASE, China Science and Technology Journal, China National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Database will be pertained with appropriate search strategy. And RevMan V.5.3.5 software will be conducted as the assessment tool for bias risk, data synthesis, subgroup analysis as well as meta-analyses. RESULTS This systematic review will provide a high-quality synthesis of current evidence of tuina for LDH. CONCLUSION This protocol will determine whether Tuina is an effective and safe treatment method for LDH.
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Affiliation(s)
- Zuoxiong Miao
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Zhenglan Tong
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Jinfei Ye
- The first Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shihan Leng
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Min Wang
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Anli Hu
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Jingyu Zhang
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Xingze Dai
- Clinical Medical college, Yunnan University of Chinese Medicine
| | - Jiarong Liang
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Yunlong Geng
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Liang Chen
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming
| | - Bin Ye
- Yunnan St.John's Hospital
| | - Youkang Dong
- The first Affiliated Hospital, Yunnan University of Chinese Medicine/Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China
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White SJ, Butlin M, Brown A, White R. Correlation of patient- and clinician-assessment of pain: comparing physiotherapy and general practice. Aust J Prim Health 2021; 27:291-296. [PMID: 33773606 DOI: 10.1071/py20214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022]
Abstract
The clinical work of GPs and physiotherapists frequently involves the assessment of patient pain. In this study, we aimed to determine the correlation of patient- and clinician-assessment of severity of pain through quantitative analysis of patient- and clinician-assessed pain scores collected at metropolitan general practice and physiotherapy clinics. Prior to a consultation, 30 patients were asked to complete a short general health survey within which they answered questions regarding current pain and, if in pain, the severity of that pain on the visual analogue scale. Following the consultation, their clinicians were asked questions on their observation of the patients, including whether they observed that their patients were in pain and, if so, how severe on the visual analogue scale. Statistical analysis of these data showed that although there was a correlation between the physiotherapist- and patient-assessed pain scores, there was no correlation between the GP- and patient-assessed pain scores. Accurately establishing the severity of patient pain can be difficult. These results suggest that GPs routinely underestimate the severity of patient pain. If the severity of patient pain is clinically relevant, GPs could improve the accuracy of assessment by asking patients directly about that aspect of pain.
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Affiliation(s)
- Sarah J White
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia; and Corresponding author.
| | - Mark Butlin
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia
| | - Alicia Brown
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia
| | - Ross White
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia
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Abstract
INTRODUCTION Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa. CASE'S DESCRIPTION We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension. DIAGNOSIS The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy. INTERVENTIONS After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis. OUTCOME At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores. CONCLUSION This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.
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Affiliation(s)
| | - Gregory Cunningham
- Department of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Switzerland, Rue Gabrielle-Perret-Gentil 4
- Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland
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Pereira HM, de Lima FF, Silva BM, Kohn AF. Sex differences in fatigability after ischemic preconditioning of non-exercising limbs. Biol Sex Differ 2020; 11:59. [PMID: 33109241 PMCID: PMC7590792 DOI: 10.1186/s13293-020-00338-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Ischemic preconditioning (IPC) is suggested to decrease fatigability in some individuals but not others. Sex differences in response to IPC may account for this variability and few studies systematically investigated the effects of IPC in men and women. The goal of this study was to determine if time to task failure, perception of pain, and neuromuscular mechanisms of fatigability were altered by IPC in men and women. Methods Ten women (29 ± 5 years old) and 10 men (28 ± 6 years old) performed isometric contractions with the plantar flexor muscles of the dominant leg at 20% of maximal voluntary contraction until task failure. We used a repeated measures design where each individual performed 3 randomized and counterbalanced test sessions: (A) IPC session, cuff inflation and deflation (5 min each repeated 3 times) performed before the exercise by inflating cuffs to the non-dominant leg and arm; (B) sham session, cuffs were inflated for a short period (1 min); and (C) control session, no cuffs were involved. Results Compared with control, IPC increased time to task failure in men (mean difference, 5 min; confidence interval (CI) of mean difference, 2.2; 7.8 min; P = 0.01) but not women (mean difference, − 0.6 min; CI of mean difference, − 3.5; 2.4 min; P = 0.51). In men, but not women, the IPC-induced increase in time to task failure was associated with lower response to pressure pain (r = − 0.79). IPC further exposed sex differences in arterial pressure during fatiguing contractions (session × sex: P < 0.05). Voluntary activation, estimated with the twitch interpolation technique, and presynaptic inhibition of leg Ia afferents were not altered after IPC for men and women. The tested variables were not altered with sham. Conclusions The ergogenic effect of IPC on time to task failure was observed only in men and it was associated with reductions in the perception of pain. This pilot data suggest the previously reported inter-individual variability in exercise-induced fatigability after IPC could be a consequence of the sex and individual response to pain.
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Affiliation(s)
- Hugo M Pereira
- Department of Health and Exercise Science, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, USA.
| | - Felipe F de Lima
- Biomedical Engineering Laboratory/EPUSP, University of São Paulo, São Paulo, SP, Brazil
| | - Bruno M Silva
- Department of Physiology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - André F Kohn
- Biomedical Engineering Laboratory/EPUSP, University of São Paulo, São Paulo, SP, Brazil
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Longobardi P, Hartwig V, Santarella L, Hoxha K, Campos J, Laurino M, Salvo P, Trivella MG, Coceani F, Rocco M, L'Abbate A. Potential markers of healing from near infrared spectroscopy imaging of venous leg ulcer. A randomized controlled clinical trial comparing conventional with hyperbaric oxygen treatment. Wound Repair Regen 2020; 28:856-866. [DOI: 10.1111/wrr.12853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/19/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Flavio Coceani
- Istituto Scienze della Vita, Scuola Superiore Sant'Anna Pisa Italy
| | - Monica Rocco
- Dipartimento di Scienze Medico‐Chirurgiche e di Medicina Traslazionale Università degli Studi di Roma “La Sapienza” Roma Italy
| | - Antonio L'Abbate
- Istituto di Fisiologia Clinica‐CNR Pisa Italy
- Istituto Scienze della Vita, Scuola Superiore Sant'Anna Pisa Italy
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42
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Exploring Fear of Falling and Exercise Self-Efficacy in Older Women With Vertebral Fractures. J Aging Phys Act 2020; 29:219-224. [PMID: 32820138 DOI: 10.1123/japa.2019-0485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/28/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Abstract
Fear of falling is a common issue among older adults, which decreases quality of life and leads to an avoidance of activities they are still able to do. The goal of this secondary data analysis was to explore the relationship between fear of falling and exercise self-efficacy in 141 women with at least one nontraumatic Genant Grade 2 vertebral fracture. Fear of falling, exercise self-efficacy, history of falling, the number of falls, the use of assisting devices, and pain at rest or during movement were obtained using medical history and health status questionnaires. There was a negative association between fear of falling and exercise self-efficacy (pseudo R2 = .253; p = .004), which persisted when the analysis was adjusted for history and number of falls, use of assistive devices, and pain at rest (pseudo R2 = .329; p < .0001) or during movement (pseudo R2 = .321; p < .0001). Fear of falling may be negatively associated with exercise self-efficacy in older women with vertebral fracture.
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Gallo L, Gallo M, Murphy J, Waltho D, Baxter C, Karpinski M, Mowakket S, Copeland A, Thoma A. Reporting Outcomes and Outcome Measures in Cubital Tunnel Syndrome: A Systematic Review. J Hand Surg Am 2020; 45:707-728.e9. [PMID: 32591175 DOI: 10.1016/j.jhsa.2020.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/29/2020] [Accepted: 04/03/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Comparison between studies assessing outcomes after surgical treatment of cubital tunnel syndrome (CuTS) has proven to be difficult owing to variations in outcome reporting. This study aimed to identify outcomes and outcome measures used to evaluate postoperative results for CuTS. METHODS We performed computerized database searches of MEDLINE and EMBASE. Studies with 20 or more patients aged 18 and older who were undergoing medial epicondylectomy, endoscopic decompression, open simple decompression, or decompression with subcutaneous, submuscular, or intramuscular transposition for ulnar neuropathy at the elbow were included. Outcomes and outcome measures were extracted and tabulated. RESULTS Of the 101 studies included, 45 unique outcomes and 31 postoperative outcome measures were identified. These included 7 condition-specific, clinician-reported instruments; 4 condition-specific, clinician-reported instruments; 8 patient-reported, generic instruments; 11 clinician-generated instruments; and one utility measure. Outcome measures were divided into 6 unique domains. Overall, 60% of studies used condition-specific outcome measures. The frequency of any condition-specific outcome measure ranged from 1% to 37% of included studies. CONCLUSIONS There is marked heterogeneity in outcomes and outcome measures used to assess CuTS. A standardized core outcome set is needed to compare results of various techniques of cubital tunnel decompression. CLINICAL RELEVANCE This study builds on the existing literature to support the notion that there is marked heterogeneity in outcomes and outcome measures used to assess CuTS. The authors believe that a future standardized set of core outcomes is needed to limit heterogeneity among studies assessing postoperative outcomes in CuTS to compare these interventions more easily and pool results in the form of systematic reviews and meta-analyses.
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Affiliation(s)
- Lucas Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Waltho
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Charmaine Baxter
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marta Karpinski
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sadek Mowakket
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Copeland
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Taheri AA, Foroughi AA, Mohammadian Y, Ahmadi SM, Heshmati K, Hezarkhani LA, Parvizifard AA. The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial. Diabetes Ther 2020; 11:1695-1708. [PMID: 32533548 PMCID: PMC7376796 DOI: 10.1007/s13300-020-00851-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Neuropathic pain is a complex phenomenon in patients with diabetes. These patients have many problems, such as psychological problems, high-level pain perception, and pain acceptance. This study aimed to evaluate the effectiveness of acceptance and commitment therapy on pain acceptance and pain perception in patients with painful diabetic neuropathy. METHODS This study was performed according to the clinical trial method. The sample size was 50 participants. In this study, participants were divided into interventional and control groups. According to the diagnosis of neurologists, all participants received conventional medications to manage neuropathic pain. The intervention group received acceptance and commitment therapy for eight sessions. The results in the three phases of pre-test, post-test, and follow-up were evaluated. After completing the study, to comply with ethical standards, the control group received psycho-education. The tools used were the McGill Pain Questionnaire (MPQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). Statistical analysis includes mean, standard deviation, and repeated-measures (ANOVA) conducted by SPSS software version 22. RESULTS The results demonstrated that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and reduce pain perception in the intervention group compared to the control group (P < 0.01). CONCLUSION The results indicated that acceptance and commitment therapy could be used as a psychological intervention besides pharmacotherapy to improve pain acceptance and reduce pain perception in patients with painful diabetic neuropathy. CLINICAL TRAIL REGISTRATION This study was registered at the Iranian Registry of Clinical Trials (IRCT20180205038630N4).
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Affiliation(s)
- Amir Abbas Taheri
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Foroughi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Youkhabeh Mohammadian
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Mojtaba Ahmadi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Khatereh Heshmati
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ali Akbar Parvizifard
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Cheng FK. Using Acupuncture in Labor Pain and Childbirth-Related Issues: A Narrative Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDLatent threats, such as prolonged labor duration and postpartum hemorrhage, endanger women and newborns during and post childbirth, which produce burdens on natal care and public health expenditures. Acupuncture, a traditional Chinese medical practice, has increasingly been used for labor delivery in various countries to cope with these problems.METHODThis narrative review searched 29 English and Chinese electronic databases. Thirty-one empirical studies, carried out in Asia, America, Africa, the Middle East, Europe, and Australia were reviewed according to inclusion and exclusion criteria.RESULTSAcupuncture is adopted with positive signs toward labor pain relief, delivery mode, labor duration, postpartum hemorrhage, APGAR score (an evaluation for a neonatal evaluation), and birth weight.DISCUSSIONWith support of earlier studies, the satisfactory effects of acupuncture on labor delivery reviewed in this research have been noted by obstetric researchers and scholars, physicians, nurses, and midwives.CONCLUSIONThis review recommends the use of acupuncture in obstetric profession with respect to maternal-related healthcare.
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Fan Y, Xiao Y, Sabuhi WA, Leape CP, Gil D, Grindy S, Muratoglu OK, Bedair H, Collins JE, Randolph M, Oral E. Longitudinal Model of Periprosthetic Joint Infection in the Rat. J Orthop Res 2020; 38:1101-1112. [PMID: 31808572 DOI: 10.1002/jor.24556] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/30/2019] [Indexed: 02/04/2023]
Abstract
The majority of periprosthetic joint infections occur shortly after primary joint replacement (<3 months) and require the removal of all implant components for the treatment period (~4 months). A clinically relevant animal model of periprosthetic infection should, therefore, establish an infection with implant components in place. Here, we describe a joint replacement model in the rat with ultrahigh molecular weight polyethylene (UHMWPE) and titanium components inoculated at the time of surgery by methicillin-sensitive Staphylococcus aureus (S. aureus), which is one of the main causative microorganisms of periprosthetic joint infections. We monitored the animals for 4 weeks by measuring gait, weight-bearing symmetry, von Frey testing, and micro-CT as our primary endpoint analyses. We also assessed the infection ex vivo using colony counts on the implant surfaces and histology of the surrounding tissues. The results confirmed the presence of a local infection for 4 weeks with osteolysis, loosening of the implants, and clinical infection indicators such as redness, swelling, and increased temperature. The utility of specific gait analysis parameters, especially temporal symmetry, hindlimb duty factor imbalance, and phase dispersion was identified in this model for assessing the longitudinal progression of the infection, and these metrics correlated with weight-bearing asymmetry. We propose to use this model to study the efficacy of using different local delivery regimens of antimicrobials on addressing periprosthetic joint infections. Statement of clinical significance: We have established a preclinical joint surgery model, in which postoperative recovery can be monitored over a multi-week course by assessing gait, weight-bearing, and allodynia. This model can be used to study the efficacy of different combinations of implant materials and medication regimens. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1101-1112, 2020.
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Affiliation(s)
- Yingfang Fan
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Yinbo Xiao
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Wali A Sabuhi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Charlotte P Leape
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Dmitry Gil
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Scott Grindy
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Hany Bedair
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark Randolph
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Boggero IA, Rojas Ramirez MV, King CD. Cross-Sectional Associations of Fatigue Subtypes with Pain Interference in Younger, Middle-Aged, and Older Adults with Chronic Orofacial Pain. PAIN MEDICINE 2020; 21:1961-1970. [DOI: 10.1093/pm/pnaa092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractObjectiveMental, emotional, physical, and general fatigue, as well as vigor, have each been associated with pain interference—defined as pain-related disruption of social, recreational, and work-related activities—in patients with chronic orofacial pain (COFP). The objectives of the current study were to compare levels of these fatigue subtypes across younger, middle-aged, and older patients with COFP and test the associations between fatigue subtypes and pain interference in these age groups.DesignA cross-sectional cohort design was used.SettingParticipants self-reported fatigue subtypes (Multidimensional Fatigue Symptom Inventory–Short Form), pain interference (West Haven–Yale Multidimensional Pain Inventory), pain intensity (visual analog scale), pain duration (months), depression (Symptom Checklist 90–Revised), and sleep quality (Pittsburgh Sleep Quality Index) at their initial appointment at a tertiary orofacial pain clinic.SubjectsSixty younger (age 18–39), 134 middle-aged (age 40–59), and 51 older (age 60–79) COFP patients provided data for the study.MethodsAnalysis of variance was used to compare levels of fatigue subtypes between the age groups. Regression with dummy-coding was used to test if the relationship between fatigue subtypes and pain interference varied by age.ResultsOlder COFP patients reported less general fatigue and more vigor than younger or middle-aged adults. Fatigue subtypes were each associated with greater pain interference, but associations became nonsignificant after controlling for depression, sleep, and pain intensity/duration. Age group–by–fatigue subtype interactions were not observed.ConclusionsManaging fatigue may be important to reduce pain interference in COFP populations and may be accomplished in part by improving depression and sleep.
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Affiliation(s)
- Ian A Boggero
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, Kentucky
| | - Marcia V Rojas Ramirez
- Division of Oral Diagnosis, Oral Medicine, and Oral Radiology, College of Dentistry, University of Kentucky, Lexington, Kentucky
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Validating Invalidation: Examining the Construct Validity of the Illness Invalidation Inventory Among Individuals With Chronic Low Back Pain. Clin J Pain 2020; 36:344-351. [PMID: 32068539 DOI: 10.1097/ajp.0000000000000817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Illness Invalidation Inventory (3*I) was designed to assess individuals' perceived invalidation regarding chronic pain experiences. However, no study has yet investigated the psychometric properties of the 3*I among individuals with chronic low back pain (CLBP). Given the personal and societal impact of CLBP and the potential for invalidation associated with this condition, the current study sought to examine the psychometric properties of the 3*I among individuals with CLBP. MATERIALS AND METHODS Community-dwelling adults with CLBP living in the Southwestern United States (N=134) completed the 3*I. In line with previous literature, current analyses focused on the 3*I "family members" subscale. Exploratory and confirmatory factor analysis was performed on participant responses. Hierarchical linear regression analyses examined the relationship between the identified factors and participant self-reported pain severity, disability, and depression. RESULTS Exploratory factor analysis conducted on the 3*I "family members" subscale found 2 factors with high internal consistency (α>0.70) that cumulatively accounted for 49.04% of the variance in scores. Consistent with previous findings, factor loadings suggested that these factors correspond to "discounting" and "lack of understanding." Subsequent confirmatory factor analysis found that this 2-factor model demonstrated a good fit with the data. Greater perceived discounting by family members was associated with greater pain severity, disability, and depression. DISCUSSION The 2-factor model of the 3*I "family members" subscale identified in the current study reflects previous findings and extends the psychometric validity of the 3*I to a US multiethnic sample of individuals with CLBP.
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49
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Gönen Aydın C, Örsçelik A, Gök MC, Akman YE. The Efficacy of Extracorporeal Shock Wave Therapy for Chronic Coccydynia. Med Princ Pract 2020; 29:444-450. [PMID: 31918431 PMCID: PMC7511685 DOI: 10.1159/000505835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/09/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Coccydynia is a disorder that decreases quality of life with significant functional failure. Extra-corporeal shock wave therapy (ESWT) is used to treat several painful musculoskeletal disorders. SUBJECTS AND METHODS The medical records of 34 patients (29 females, 5 males) who had been treated with ESWT between 2017 and 2018 for chronic coccydynia were evaluated. Visual analog scale (VAS) scores were noted at the initial consultation, at each session, and during the initial and follow-up (at 6 months) examinations after the treatment. The 36-item short form (SF-36) quality of life scale survey was conducted at the beginning and end of the treatment. MRI was performed before the start of the procedure and 1 month after the end of the treatment. RESULTS The mean VAS score was 9.6 (9-10) before the treatment and 3.4 (0-2) after the treatment (p < 0.05). The VAS score decreased to ≤3 in 79.4% of patients. Bone marrow edema regressed in 6% of patients. Significant improvement was observed in all of the SF-36 parameters, except for two. CONCLUSION In our patient group, ESWT provided effective pain control. In order to evaluate the efficacy of ESWT more accurately and sensitively, prospective randomized studies with longer follow-up periods, in which ESWT is compared with different energy doses and different treatment methods, are needed.
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Affiliation(s)
- Canan Gönen Aydın
- Department of Sports Medicine, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey,
| | - Aydan Örsçelik
- Department of Sports Medicine, University of Health Sciences Gülhane Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Cantay Gök
- Department of Radiology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Yunus Emre Akman
- Private Practice in Orthopedics and Traumatology, Istanbul, Turkey
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50
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Win MMTM, Fukai K, Nyunt HH, Linn KZ. Hand and foot exercises for diabetic peripheral neuropathy: A randomized controlled trial. Nurs Health Sci 2019; 22:416-426. [PMID: 31876991 DOI: 10.1111/nhs.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/08/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
Exercises for diabetic peripheral neuropathy remain controversial, especially with regard to recommended precautions and weightbearing exercises for individuals. We aimed to investigate the effect of 8 weeks of simple hand, finger, and foot exercises in patients with diabetic peripheral neuropathy. After randomization, exercise (n = 51) and control (n = 53) groups received usual care and diabetic foot care education; only the exercise group performed exercises. Primary outcomes, including activities of daily living (assessed using the Patient Neurotoxicity Questionnaire), neuropathy severity (monofilament and vibration test), and pain (behavioral rating scale and Visual Analog Scale), and secondary outcomes, including physical function of the hand and foot (grip, pinch, finger counting time, and Timed Up and Go tests), were assessed at baseline, after the 8-week intervention, and at the 16-week follow-up. The exercise group showed significantly stronger improvements in motor score and specific activities of daily living, such as climbing stairs and performing work or chores. Our exercises can be used to improve limb function in patients with diabetic neuropathy.
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Affiliation(s)
- Mi Mi Thet Mon Win
- Graduate School of Health Sciences, Okayama University, Okayama, Japan.,Department of Fundamental Nursing, University of Nursing, Yangon, Myanmar
| | - Kiyoko Fukai
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Htwe Htwe Nyunt
- Department of Fundamental Nursing, University of Nursing, Yangon, Myanmar
| | - Khaing Zaw Linn
- Department of Fundamental Nursing, University of Nursing, Yangon, Myanmar
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