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Saltan A, Mert S, Topbaş Ö, Aksu B. The investigation of effect on foot plantar massage on functional recovery in older adults with general surgery, randomized clinical trial. Aging Clin Exp Res 2024; 36:118. [PMID: 38780814 PMCID: PMC11116172 DOI: 10.1007/s40520-024-02770-2] [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] [Received: 02/15/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Foot massage is known to be effective on the emotional state (anxiety, depression, etc.) in the postoperative period. However, studies on its effect on functional level are insufficient. AIM The study aimed to investigate the impact of foot plantar massage on functional recovery in older adults undergoing general surgery, employing a randomized clinical trial design. METHODS A total of 70 older adults aged 65 years and above who underwent abdominal surgery were included. Various assessments were conducted, including pain levels (Visual Analogue Scale), fear of mobility (Tampa Scale for Kinesiophobia), functional independence (Functional Independence Measure), balance (Berg Balance Scale), basic mobility (Rivermead Mobility Index), mental function status (Standardized Mini-Mental State Examination), and delirium (Nu-DESC). RESULTS Statistically significant differences were observed in some assessment parameters within the groups during the 2nd and 3rd measurement times, with the intervention group demonstrating significant mean differences. DISCUSSIONS The literature underscores the increase in kinesiophobia scores post-general/abdominal surgery in older adults, emphasizing the importance of evaluating functional level and kinesiophobia to expedite discharge processes and potentially plan early post-discharge rehabilitation to mitigate readmissions for functional reasons. CONCLUSIONS Ultimately, foot massage was found to be effective in reducing kinesiophobia, improving balance, mobility, daily living skills, and mental status in older adults post-abdominal surgery, thereby advocating for the facilitation of post-discharge rehabilitation programs or the reduction of readmission rates. THE CLINICAL TRIALS NUMBER NCT05534490.
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Affiliation(s)
- Asuman Saltan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yalova University, Yalova, Turkey.
| | - Selda Mert
- Department of Nursing, Faculty of Health Sciences, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Önder Topbaş
- Department of Medical Services and Techniques, Kocaeli Vocational School of Health Services, Kocaeli University, Kocaeli, Turkey
| | - Beyza Aksu
- Vocational School of Health Services, Kocaeli University Hospital, Kocaeli University, Kocaeli, Turkey
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Eckenrode BJ, Kietrys DM, Brown A, Parrott JS, Noehren B. The relationship of behavioral and psychological traits with pain sensitivity in females with patellofemoral pain: A cross-sectional study. Phys Ther Sport 2024; 66:43-52. [PMID: 38290271 DOI: 10.1016/j.ptsp.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The purpose of this study was to describe the relationship between behavioral and psychological traits with indicators of central sensitization in female runners with patellofemoral pain (PFP), and to determine if behavioral and psychological traits improve with strength training. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Twenty-eight active females (mean age 32 ± 8.1 years) with PFP completed testing at baseline, 8 weeks (post intervention), and 12 weeks. MAIN OUTCOME MEASURES Behavioral and psychological questionnaires included the General Anxiety Disorder-7, Patient Health Questionairre-9, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia-11, and Central Sensitization Inventory. Quantitative sensory testing (QST) measures were also collected. After baseline testing, subjects were instructed in a hip and knee strengthening intervention to be completed twice daily over 8 weeks. RESULTS A statistically significant improvement was found at 12 weeks for anxiety (p = .015; ηp (Boling et al., 2010) = 0.099) and kinesiophobia (p = .041; ηp (Boling et al., 2010) = 0.076). There was no significant improvement for depression, catastrophizing, or subjective central sensitization. No significant correlations were found between any of the behavioral and psychological questionnaires with baseline QST variables. CONCLUSIONS No relationship was found for behavioral and psychological characteristics with QST measures in female runners with persistent PFP.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, Department of Physical Therapy, Glenside, PA, 19038, USA.
| | - David M Kietrys
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences, Blackwood, NJ, 08012, USA
| | - Allison Brown
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences, Newark, NJ, 07101, USA
| | - J Scott Parrott
- Rutgers School of Health Professions, Department of Interdisciplinary Studies, Blackwood, NJ, 08012, USA
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, KY, 40536, USA
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Sanchis-Alfonso V, Beser-Robles M, Navarro-Calvo A, López-Company L, Roselló-Añón A, Domenech-Fernández J. Central sensitization negatively influences the level of disability in female patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 2023; 31:5381-5387. [PMID: 37749394 DOI: 10.1007/s00167-023-07591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To define the prevalence of Central Sensitization (CS) in patients with Anterior Knee Pain (AKP) and determine whether there is an association between CS and the magnitude of pain, disability, quality-of-life and psychological impairment. METHODS The data of a total of 44 AKP female patients with a mean age of 27.7 years (15-50) recruited consecutively from hospital outpatient knee clinics were prospectively included in this study. The patients had no antecedents of knee trauma or surgery and no history of injury or disease of the nervous system. There were also 50 healthy female controls with a mean age of 26.1 years (16-46). CS was evaluated using the Central Sensitization Inventory (CSI). Quality-of-life was evaluated using the EuroQoL-5D questionnaire. Self-reporting of clinical pain intensity was obtained using the Visual Analogue Scale. The Kujala Knee Scale and IKDC form were used to evaluate disability. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Subscale (HAD). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK-11) and catastrophizing by means of the Pain Catastrophizing Scale (PCS). RESULTS Sixteen AKP patients (36%), and 2 (4%) of the healthy controls presented with central sensitization (p < 0.01). AKP patients with CS have a greater degree of disability based on the Kujala Scale and higher levels of anxiety and depression than AKP patients without CS. The score of AKP patients in the CSI correlated weakly with disability and quality of life and moderately with anxiety and depression. However, no association was seen between CSI score and pain intensity, nor with catastrophizing and kinesiophobia. A multivariate logistic regression analysis showed that only depression was statistically significant in the prediction of the presence of CS (odds ratio 1.45; 95% CI 1.07 to 1.96). CONCLUSIONS AKP patients have a significantly higher prevalence of CS in comparison with what has been reported for the general population. This finding suggests the presence of altered pain modulation in a subgroup of AKP patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Vicente Sanchis-Alfonso
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/San Clemente 12, 46015, Valencia, Spain.
| | - María Beser-Robles
- GIBI230 Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Ana Navarro-Calvo
- Department of Rehabilitation and Physical Therapy, Hospital Arnau de Vilanova, Valencia, Spain
| | - Laura López-Company
- Department of Rehabilitation and Physical Therapy, Hospital Arnau de Vilanova, Valencia, Spain
| | - Alejandro Roselló-Añón
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/San Clemente 12, 46015, Valencia, Spain
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Hassan IMI, Keblawy ME, Elsalam MA, Embaby EA. Sagittal trunk excursion and lumbar repositioning error between female and male patients with patellofemoral pain syndrome. Hong Kong Physiother J 2023; 43:81-91. [PMID: 37583919 PMCID: PMC10423672 DOI: 10.1142/s1013702523500051] [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: 06/22/2022] [Accepted: 01/04/2023] [Indexed: 08/17/2023] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is a challenging clinical problem affecting adults, adolescents, and physically active populations. PFPS impacts the patient's trunk kinematics in the frontal plane. Previous studies have found gender-based biomechanical differences in patients with PFPS; however, sagittal trunk kinematics during mini-squats and lumbar proprioception in PFPS have not been studied previously. Objectives To investigate sagittal trunk excursion (It is defined as the sagittal trunk flexion angle from the start to the end of the mini squat) during mini-squats as well as lumbar repositioning error between individuals with and without PFPS, and determine gender differences in the outcome variables. Methods A sample of 56 participants aged 18-25 years was enrolled; 30 with PFPS (13 males, 17 females) and 26 asymptomatic controls (11 males, 15 females). The sagittal trunk excursion during mini-squats was examined by two-dimensional (2D) photographic analysis using Surgimap software. Active lumbar flexion repositioning error was assessed using an isokinetic dynamometer. Results For sagittal trunk excursion, no significant main effect of group was observed (p = 0 . 136 ). On the other hand, the main effect was significant for gender (p = 0 . 005 ), as was the interaction effect. Compared to the control group, the PFPS group showed significantly (p = 0 . 01 ) lower sagittal trunk excursion in females than in males during mini-squats. For active lumbar flexion repositioning error, no evidence was found for significant main or interaction effects (p > 0 . 05 ). Conclusion Females with PFPS exhibit a more erect sagittal trunk posture than males during mini-squats. Trunk posture should be considered during weight-bearing activities in PFPS, and gender-specific assessment protocols should be developed.
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Yan Z, Liu M, Wang X, Wang J, Wang Z, Liu J, Wu S, Luan X. Construction and Validation of Machine Learning Algorithms to Predict Chronic Post-Surgical Pain Among Patients Undergoing Total Knee Arthroplasty. Pain Manag Nurs 2023; 24:627-633. [PMID: 37156678 DOI: 10.1016/j.pmn.2023.04.008] [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: 03/07/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) is a common but undertreated condition with a high prevalence among patients undergoing total knee arthroplasty (TKA). An effective model for CPSP prediction has not been established yet. AIMS To construct and validate machine learning models for the early prediction of CPSP among patients undergoing TKA. DESIGN A prospective cohort study. PARTICIPANTS/SUBJECTS A total of 320 patients in the modeling group and 150 patients in the validation group were recruited from two independent hospitals between December 2021 and July 2022. They were followed up for 6 months to determine the outcomes of CPSP through telephone interviews. METHODS Four machine learning algorithms were developed through 10-fold cross-validation for five times. In the validation group, the discrimination and calibration of the machine learning algorithms were compared by the logistic regression model. The importance of the variables in the best model identified was ranked. RESULTS The incidence of CPSP in the modeling group was 25.3%, and that in the validation group was 27.6%. Compared with other models, the random forest model achieved the best performance with the highest C-statistic of 0.897 and the lowest Brier score of 0.119 in the validation group. The top three important factors for predicting CPSP were knee joint function, fear of movement, and pain at rest in the baseline. CONCLUSIONS The random forest model demonstrated good discrimination and calibration capacity for identifying patients undergoing TKA at high risk for CPSP. Clinical nurses would screen out high-risk patients for CPSP by using the risk factors identified in the random forest model, and efficiently distribute preventive strategy.
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Affiliation(s)
- Zeping Yan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China; University of Health and Rehabilitation Sciences, Qingdao, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Mengqi Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoli Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiurui Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhiwei Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jian Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shicai Wu
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Xiaorong Luan
- School of Nursing and Rehabilitation, Qilu Hospital, Shandong University, Jinan, China.
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Sanchis-Alfonso V, Beser-Robles M, Ten-Esteve A, Ramírez-Fuentes C, Alberich-Bayarri Á, Espert R, García-Larrea L, Martí-Bonmatí L. Brain network functional connectivity changes in patients with anterior knee pain: a resting-state fMRI exploratory study. Eur Radiol Exp 2023; 7:60. [PMID: 37806998 PMCID: PMC10560652 DOI: 10.1186/s41747-023-00378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND This study investigates the functional brain connectivity in patients with anterior knee pain (AKP). While biomechanical models are frequently employed to investigate AKP, it is important to recognize that pain can manifest even in the absence of structural abnormalities. Leveraging the capabilities of functional magnetic resonance imaging (fMRI), this research aims to investigate the brain mechanisms present in AKP patients. METHODS Forty-five female subjects (24 AKP patients, 21 controls) underwent resting-state fMRI and T1-weighted structural MRI. Functional brain connectivity patterns were analyzed, focusing on pain network areas, and the influence of catastrophizing thoughts was evaluated. RESULTS Comparing patients and controls, several findings emerged. First, patients with AKP exhibited increased correlation between the right supplementary motor area and cerebellum I, as well as decreased correlation between the right insula and the left rostral prefrontal cortex and superior frontal gyrus. Second, in AKP patients with catastrophizing thoughts, there was increased correlation of the left lateral parietal cortex with two regions of the right cerebellum (II and VII) and the right pallidum, and decreased correlation between the left medial frontal gyrus and the right thalamus. Furthermore, the correlation between these regions showed promising results for discriminating AKP patients from controls, achieving a cross-validation accuracy of 80.5%. CONCLUSIONS Resting-state fMRI revealed correlation differences in AKP patients compared to controls and based on catastrophizing thoughts levels. These findings shed light on neural correlates of chronic pain in AKP, suggesting that functional brain connectivity alterations may be linked to pain experience in this population. RELEVANCE STATEMENT Etiopathogenesis of pain in anterior knee pain patients might not be limited to the knee, but also to underlying alterations in the central nervous system: cortical changes might lead a perpetuation of pain. KEY POINTS • Anterior knee pain patients exhibit distinct functional brain connectivity compared to controls, and among catastrophizing subgroups. • Resting-state fMRI reveals potential for discriminating anterior knee pain patients with 80.5% accuracy. • Functional brain connectivity differences improve understanding of pain pathogenesis and objective anterior knee pain identification.
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Affiliation(s)
| | - María Beser-Robles
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Amadeo Ten-Esteve
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Technologies for Health and Well-Being, Polytechnic University of Valencia, Valencia, Spain
| | | | - Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain
| | - Raúl Espert
- Departamento de Psicobiología, Unidad de Neuropsicología, Hospital Clinic Universitari, Universidad de Valencia, Valencia, Spain
| | - Luis García-Larrea
- Center for Neuroscience Research of Lyon (CRNL), NeuroPain Team, U 1028, INSERM, Lyon-1 University, Bron, France
| | - Luis Martí-Bonmatí
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario Y Politécnico E Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Radiology Department, Hospital Universitario Y Politécnico La Fe, Valencia, Spain
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Selhorst M, Hoehn J, Schmitt L, Benedict J, Fernandez-Fernandez A. The Effect of a Psychologically Informed Video Series to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:634–642. [PMID: 37706686 DOI: 10.2519/jospt.2023.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain. The secondary aims were to assess pain and psychological beliefs. DESIGN: A double-blinded randomized controlled trial. METHODS: Sixty-eight adolescents with patellofemoral pain were randomly assigned to view brief, psychologically informed videos (n = 34) or control videos (n = 34) in addition to usual care physical therapy. The psychologically informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, 3 weeks, 6 weeks (primary end point), and 3 months. The primary outcome was change in the Anterior Knee Pain Scale. Secondary outcomes were changes in Numeric Pain-Rating Scale and psychological beliefs (Modified Fear-Avoidance Beliefs Questionnaire-Physical Activity, Tampa Kinesiophobia Scale-11, and Pain Catastrophizing Scale-Child). RESULTS: Adolescents in the psychologically informed group experienced significantly greater improvements in function (Anterior Knee Pain Scale mean difference = 8 points; 95% CI: 2.2, 13.2; P = .01) and pain (Numeric Pain-Rating Scale mean difference = 1.2 points; 95% CI: 0.1, 2.4; P = .04) at 6 weeks compared to the control group. The psychologically informed group had significantly greater reductions in psychological beliefs over time than the control group (P≤.001; partial η2 = 0.32). CONCLUSION: Incorporating psychologically informed education into physical therapy care improved function, pain, and psychological beliefs to a greater extent than the control group. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 14 September 2023. doi:10.2519/jospt.2023.12041.
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Jaffri A, Baellow A. Poor Mental Health Indicators in Individuals With Patellofemoral Pain. J Athl Train 2023; 58:849-854. [PMID: 37965988 PMCID: PMC11215708 DOI: 10.4085/1062-6050-0584.22] [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] [Indexed: 11/16/2023]
Abstract
CONTEXT Patellofemoral pain (PFP) is a common source of knee pain in active individuals, accounting for a large number of knee injuries examined in sports medicine clinics. As a chronic condition, PFP can affect mental health. However, this effect has not yet been studied in individuals with PFP. OBJECTIVE To determine how subjective physical and mental health measures in individuals with PFP differed from those measures in pain-free individuals. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Volunteers for the study were 30 people with PFP (19 women, 11 men; age = 20.23 ± 3.32 years, height = 166.69 ± 6.41 cm, mass = 69.55 ± 13.15 kg) and 30 matched pain-free individuals (19 women, 11 men; age = 20.33 ± 3.37 years, height = 169.31 ± 9.30 cm, mass = 64.02 ± 11.00 kg). MAIN OUTCOME MEASURE(S) Current and worst pain levels in the past 24 hours were determined using a visual analog scale (VAS). The Anterior Knee Pain Scale, Fear Avoidance Belief Questionnaire, and Lower Extremity Functional Scale were administered. Physical and mental health measures were obtained using a modified 12-item Short Form Health Survey. Scores for 2 subscales on the modified Short Form-12 were weighted and calculated: physical component and mental component.Independent t tests were calculated to compare variables between groups. Coefficient correlations were used to measure the associations between the variables. RESULTS Individuals with PFP reported lower levels of physical (pain free: 56.13 ± 1.63, PFP: 50.54 ± 7.10, P < .001) and mental (pain-free: 53.32 ± 4.71, PFP: 48.64 ± 10.53, P = .03) health. In the PFP group, we found moderate negative correlations between the VAS score for current pain and mental health (r = -0.52, P < .01) and between the VAS score for worst pain in the past 24 hours and mental health (r = -0.46, P = .01) and between activity limitations in individuals with PFP and fear avoidance beliefs (r = -0.61, P < .01). CONCLUSIONS Our results should encourage clinicians, especially musculoskeletal rehabilitation professionals, to acknowledge the importance of a whole-person approach when treating or planning rehabilitation programs for individuals with PFP.
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Affiliation(s)
- Abbis Jaffri
- Department of Physical Therapy, Creighton University, Omaha, NE
| | - Andrea Baellow
- Department of Kinesiology, University of Virginia, Charlottesville
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Rethman KK, Mansfield CJ, Moeller J, De Oliveira Silva D, Stephens JA, Di Stasi S, Briggs MS. Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis. Phys Ther 2023; 103:pzad074. [PMID: 37354454 PMCID: PMC10517194 DOI: 10.1093/ptj/pzad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 02/27/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP. METHODS Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible. RESULTS Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = -0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15). CONCLUSION Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low. IMPACT Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.
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Affiliation(s)
- Katherine K Rethman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody J Mansfield
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Josh Moeller
- Department of Biology, The Ohio State University, Columbus, Ohio, USA
| | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Julie A Stephens
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Division of Physical Therapy, School of Health & Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Matthew S Briggs
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Priore LBD, Perez VO, Briani RV, Farinelli LALB, da Silva JDCP, Martins OMG, Lopes FA, Amorim AB, Pappas E, de Azevedo FM. Effects of an online program including mindfulness, exercise therapy and patient education compared to online exercise therapy and patient education for people with Patellofemoral Pain: protocol for a randomized clinical trial. BMC Musculoskelet Disord 2023; 24:372. [PMID: 37170262 PMCID: PMC10173555 DOI: 10.1186/s12891-023-06491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common knee disorder that causes persistent pain, lower self-reported function and quality of life. People with PFP also present with altered psychological factors, which are associated with higher levels of pain and dysfunction. Mindfulness-based interventions (MBI) generally consist of meditative practices developed to provide a holistic approach to chronic conditions. However, the effects of MBI on clinical and psychological outcomes for people with PFP remains understudied. METHODS This assessor-blinded, parallel, two-arm randomized clinical trial aims to investigate the effects of adding an 8-week online MBI program to exercise therapy and patient education on clinical and psychological factors for people with PFP. We also aim to investigate whether psychological factors mediate changes in pain and function. Sixty-two participants with PFP will be recruited and randomized into one of two treatment groups (Mindfulness or Control group). Both groups will receive an 8-week intervention involving exercise therapy and education delivered through an online platform. The Mindfulness group will additionally receive a MBI component including formal and informal practices. Outcomes will be assessed online at baseline, intervention endpoint (follow-up 1) and 12 months after intervention completion (follow-up 2). Comparisons between groups will be performed at all time points with linear mixed models. A mediation analysis will be performed using a 3-variable framework. DISCUSSION Exercise therapy and patient education are considered the "best management" options for PFP. However, unsatisfactory long-term prognosis remains an issue. It is known that people with PFP present with altered psychological factors, which should be considered during the evaluation and treatment of people with PFP. Adding a MBI to the current best treatment for PFP may improve short and long-term effects by addressing the underlying psychological factors. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-4yhbqwk, registered in April 6, 2021.
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Affiliation(s)
- Liliam Barbuglio Del Priore
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil.
| | - Vitoria Ozores Perez
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Ronaldo Valdir Briani
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Lucca Andre Liporoni Bego Farinelli
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Júlia de Cássia Pinto da Silva
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Odisséia Marli Gimenes Martins
- Brazilian Center for Mindfulness and Health Promotion - Mente Aberta, Federal University of Sao Paulo (Unifesp), Sao Paulo, Brazil
| | - Fábio Arruda Lopes
- Department of Computer Engineering, Virtual University of Sao Paulo State (UNIVESP), Dracena, Brazil
| | - Anita Barros Amorim
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Evangelos Pappas
- School of Medicine and Illawarra Medical and Health Research Institute, University of Wollongong, Wollongong, Australia
| | - Fábio Mícolis de Azevedo
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
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11
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DiBartola AC, Magnussen RA, Everhart JS, Milliron E, Emery CF, Schiele SE, Harris KM, Schmitt L, Flanigan DC. Athletes and Nonathletes Show No Difference in Symptoms or Function Prior to Knee Surgery, but Those With Chronic Symptoms Show Increased Pain Catastrophizing and Kinesiophobia. Arthroscopy 2023; 39:1028-1034. [PMID: 36872027 DOI: 10.1016/j.arthro.2022.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine whether preoperative psychological status before outpatient knee surgery is influenced by athletic status, symptom chronicity, or prior surgical history. METHODS International Knee Documentation Committee subjective scores (IKDC-S), Tegner Activity Scale scores, and Marx Activity Rating Scale scores were collected. Psychological and pain surveys included the McGill pain scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia 11, Patient Health Questionnaire 9, Perceived Stress Scale, New General Self-Efficacy Scale, and Life Orientation Test-Revised for optimism. Linear regression was used to determine the effects of athlete status, symptom chronicity (>6 months or ≤6 months), and history of prior surgery on preoperative knee function, pain, and psychological status after matching for age, sex, and surgical procedure. RESULTS In total, 497 knee surgery patients (247 athletes, 250 nonathletes) completed a preoperative electronic survey. All patients were age 14 years and older and had knee pathology requiring surgical treatment. Athletes were younger than nonathletes on average (mean [SD], 27.7 [11.4] vs 41.6 [13.5] years; P < .001). The most frequently reported level of play among athletes was intramural or recreational (n = 110, 44.5%). Athletes had higher preoperative IKDC-S scores (mean [SE], 2.5 [1.0] points higher; P = .015) and lower McGill pain scores compared to nonathletes (mean [SE] 2.0 [0.85] points lower; P = .017). After matching for age, sex, athlete status, prior surgery, and procedure type, having chronic symptoms resulted in higher preoperative IKDC-S (P < .001), pain catastrophizing (P < .001), and kinesiophobia scores (P = .044). CONCLUSIONS Athletes demonstrate no difference in symptom/pain and function scores preoperatively when compared to nonathletes of similar age, sex, and knee pathology, as well as no difference in multiple psychological distress outcomes measures. Patients with chronic symptoms have more pain catastrophizing and kinesiophobia, while those who have had prior knee surgeries have slightly higher preoperative McGill pain score. LEVEL OF EVIDENCE Level III, cross-sectional analysis of prospective cohort study data.
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Affiliation(s)
- Alex C DiBartola
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Robert A Magnussen
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A; Department of Orthopaedics Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | | | - Eric Milliron
- The Ohio State University College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Charles F Emery
- Department of Psychology, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Steve E Schiele
- Department of Psychology, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kristie M Harris
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University and Jameson Crane Sports Medicine Research Institute, Ohio State University, Columbus, Ohio, U.S.A
| | - David C Flanigan
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A; Department of Orthopaedics Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A; Cartilage Restoration Program, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
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12
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Botta AFB, Waiteman MC, Ducatti MHM, Garcia CLG, Farinelli LALB, Bazett-Jones DM, Briani RV, de Azevedo FM. Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features. Front Sports Act Living 2023; 4:1081943. [PMID: 36713948 PMCID: PMC9875135 DOI: 10.3389/fspor.2022.1081943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Background This is a protocol for a prospective longitudinal study that aims to investigate: (1) group-by-time changes over a minimum of 15 months follow-up in patellofemoral pain (PFP) symptoms, biomechanical, muscle function, pain processing, and psychological features; (2) the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, health-related quality of life (HRQOL), and physical activity level. Methods Individuals with PFP (n = 144) and control individuals (n = 85) without PFP were assessed at baseline. Outcomes assessed included: 3D kinematics and kinetics during single leg squat, step-down and single leg hop; maximal torque and rate of torque development of hip abductors and knee extensors/flexors; force steadiness of hip abductors and knee extensors; anterior and lateral trunk endurance; pressure pain thresholds at the center of patella and contralateral shoulder; kinesiophobia (Tampa Scale for Kinesiophobia); pain catastrophizing (Pain Catastrophizing Scale); worst self-reported pain (Visual Analogue Scale); physical performance measures (Single Leg Hop Test and Forward Step-Down Test); self-reported function (Anterior Knee Pain Scale); HRQOL (Medical Outcome Short-Form 36), and physical activity level (Baecke's Questionnaire). Follow-up assessments will be identical to the baseline and will be performed after a minimum of 15 months. Generalized linear mixed model (GLMM) will be used to investigate group-by-time differences. Linear regression models will be used to determine the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, HRQOL, and physical activity level. Discussion Physical and non-physical features have been previously associated with PFP. However, the present study will be the first to investigate their integrated evolution as part of the natural history of PFP and its progression. In doing so, we will be able to determine their behavior in the long-term, as well as how they prospectively associate with each other and with clinical outcomes. Ultimately, this will provide a greater understanding of predictors of long-term outcome and possible targets for interventions.
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Affiliation(s)
- Ana Flavia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil,Correspondence: Ana Flavia Balotari Botta
| | - Marina Cabral Waiteman
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Matheus Henrique Maiolini Ducatti
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Carmen Lúcia Gomes Garcia
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Lucca André Liporoni Bego Farinelli
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | | | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
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13
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Arslan T, Gültekin MZ. The effect of a supervised online group exercise program on symptoms associated with patellofemoral pain syndrome in women. Technol Health Care 2023; 31:771-782. [PMID: 36442169 DOI: 10.3233/thc-220533] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is one of the musculoskeletal system pathologies frequently encountered especially in women. OBJECTIVE The aim of the current study was to compare the efficacy of an online exercise program with a home exercise program including the same exercises, and a control group planned for females with PFPS. METHODS The study included 60 females with PFPS aged 33.17 ± 6.84. Participants were randomly divided into 3 groups. One of the groups was given a 6-week home program consisting of evidence-based exercises. Exercises consisting of the same exercises were supervised online to another group. The third group did not receive any intervention. Pain, knee joint range of motion, muscle strength in flexion and extension and hip posterolateral muscle group, patellofemoral joint functionality, quality of life, recurrence of injury and fear of movement were measured at preintervention and postintervention. RESULTS Participation in the online supervised exercise group was seen to result in a greater decrease in pain during activity and kinesiophobia, and a greater increase in the quality of life mental health sub-dimension compared to the home exercise group. CONCLUSION Online supervised exercise groups could be an alternative telerehabilitation method for exercise programs established for women with PFPS.
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Affiliation(s)
- Tuğba Arslan
- Faculty of Health Sciences, Karatekin University, Çankırı, Turkey
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14
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Are Physical Function and Fear of Movement Risk Factors for Patellofemoral Pain? A 2-Year Prospective Study. J Sport Rehabil 2023; 32:24-30. [PMID: 35894902 DOI: 10.1123/jsr.2021-0392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT To determine (1) whether physical function and fear of movement are prospectively associated with the risk of females developing patellofemoral pain (PFP) and (2) whether they change following development of PFP. DESIGN Prospective observational study. METHODS A total of 114 asymptomatic females (18-22 y old) completed assessment of physical function (forward step-down test and single-leg hop for distance) and fear of movement using the Tampa Scale for Kinesiophobia at baseline and 2-year follow-up. Presence of symptoms of PFP was monitored bimonthly. RESULTS Ninety participants (retention rate = 79%) completed the 2-year follow-up assessment, with 27 (24% of the cohort) developing PFP. Physical function, including forward step-down test (P = .659) and single-leg hop for distance (P = .825), and fear of movement (P = .479) were not associated with the risk of developing PFP. Females who developed PFP presented with reduced forward step-down repetitions (mean difference = 2.8; 95% confidence interval, 0.2 to 5.3) and single-leg hop for distance (10.2; 95% confidence interval, 2.7 to 17.7 cm) at 2-year follow-up. There was no statistically significant difference between those who did and did not develop PFP for fear of movement (-3.4; 95% confidence interval, -7.0 to 0.2). CONCLUSIONS Physical function and fear of movement were not associated with the risk of developing PFP in young females. However, the change over time in the step-down and single-leg hop for distance tests may suggest that, even in the early stages of PFP, young females present impaired physical function compared with females who did not develop symptoms. Fear of movement may develop due to persistent PFP, and does not appear to be a risk factor or key feature in females with PFP of short symptoms duration.
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15
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Hashimoto K, Takeuchi T, Hiiragi M, Koyama A, Nakamura Y, Hashizume M. Utility and optimal cut-off point of the Somatic Symptom Scale-8 for central sensitization syndrome among outpatients with somatic symptoms and related disorders. Biopsychosoc Med 2022; 16:24. [PMID: 36434700 PMCID: PMC9694559 DOI: 10.1186/s13030-022-00253-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Central sensitization syndrome (CSS) involves severe functional symptoms due to central sensitization. for patients with severe somatic symptoms and related disorders (SSRDs), central sensitization may be responsible for their functional symptoms. We hypothesized that screening for CSS in patients with SSRDs would identify those with severe disease. The Somatic Symptom Scale-8 (SSS-8) is a simple tool to assess medical conditions related to SSRDs, but the cut-off point to identify severe cases of comorbid CSS is unknown. This study aimed to determine the optimal cut-off point of SSS-8 for screening the CSS of patients with severe SSRDs. METHODS In total, 143 patients with SSRDs attending outpatient clinics of a university hospital in Japan were included in the study. The participants were evaluated using the SSS-8 for somatic symptoms, Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms, Pain Catastrophizing Scale (PCS) for catastrophic thoughts, and Central Sensitization Inventory (CSI-A, B) for CSS. Receiver operating characteristic (ROC) curve analysis was performed using the propensity score. The area under the curve (AUC) was calculated using a propensity score considering PCS, age, sex, HADS, and CSI-B as confounders of SSS-8 and CSS to evaluate differences in diagnostic accuracy between patients with and without SSS-8. The sensitivity and specificity of the ROC analysis were then used to determine the cut-off point for discriminating severe cases of SSS-8. RESULTS Of the 143 participants, 126 responded (51 CSS group and 75 non-CSS group), with a valid response rate of 88.1 percent. In the ROC analysis, the propensity score including SSS-8 was statistically more accurate. The optimal cut-off point was 13, with an AUC of 0.88, sensitivity of 84.3 percent, and specificity of 77.3 percent. CONCLUSIONS The SSS-8 is a useful tool for discriminating severe cases of SSRDs comorbid with CSS.
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Affiliation(s)
- Kazuaki Hashimoto
- grid.265050.40000 0000 9290 9879Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku 143-8541 Tokyo, Japan
| | - Takeaki Takeuchi
- grid.265050.40000 0000 9290 9879Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku 143-8541 Tokyo, Japan
| | - Miki Hiiragi
- grid.265050.40000 0000 9290 9879Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku 143-8541 Tokyo, Japan
| | - Akiko Koyama
- grid.265050.40000 0000 9290 9879Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku 143-8541 Tokyo, Japan
| | - Yuzo Nakamura
- grid.265050.40000 0000 9290 9879Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku 143-8541 Tokyo, Japan
| | - Masahiro Hashizume
- grid.265050.40000 0000 9290 9879Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku 143-8541 Tokyo, Japan
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16
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Rhon DI, Greenlee TA, Carreño PK, Patzkowski JC, Highland KB. Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery: A Secondary Analysis of Trial Participants with Spine and Lower-Extremity Disorders. J Bone Joint Surg Am 2022; 104:1447-1454. [PMID: 35700089 DOI: 10.2106/jbjs.22.00177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use. METHODS This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days' supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration. RESULTS Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days' supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = -1.25 [95% CI, -2.38 to -0.12]; p = 0.03) were associated with greater 12-month postsurgical days' supply of opioids. Presurgical opioid days' supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = -0.17 [95% CI, -0.24 to -0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization. CONCLUSIONS Greater presurgical days' supply of opioids and pain catastrophizing accounted for greater postsurgical days' supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.,Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, Maryland
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Patricia K Carreño
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland
| | - Jeanne C Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, Maryland
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17
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Fidelis-de-Paula-Gomes CA, Dibai-Filho AV, Ferreira CSB, da Silva ACB, de Oliveira AR, Politti F, Biasotto-Gonzalez DA. Correlation Among Pain Intensity, Catastrophizing, and Falls in Older Individuals With Unilateral Knee Osteoarthritis: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:196-201. [PMID: 35879126 DOI: 10.1016/j.jmpt.2022.06.004] [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: 11/28/2019] [Revised: 04/15/2022] [Accepted: 06/09/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether pain intensity and catastrophizing are associated with fear of falls and the number of falls in older persons with knee osteoarthritis (OA). METHODS A cross-sectional study was conducted involving 100 volunteers (male and female participants), 60 to 80 years old, with a diagnosis of knee OA. Patients were recruited from a physical therapy clinic in the city of São Paulo, Brazil, from March 2019 to November 2019. The following measures were used for the evaluations: Numerical Rating Pain Scale (NRPS), Pain-Related Self-Statement Scale (PRSS), and Falls Efficacy Scale. In statistical analysis, histograms were created to determine the distribution of data. Spearman's correlation coefficients (rs) were then calculated to determine the strength of the associations among the variables. The receiver operating characteristic curve was used to identify the accuracy of PRSS and NRPS in differentiating participants with a history of falls from those without. RESULTS No significant correlation was found among the pain intensity, pain catastrophizing, fear of falling, and number of falls (rs value ranging from -0.033 to -0.167; P value ranging from .096-.743). The accuracy of PRSS and NRPS in differentiating participants with falls from those without was insufficient, with area under the curve values of 0.46 and 0.42, respectively. CONCLUSION Pain catastrophizing and intensity were not significantly associated with fear of falling and numbers of falls in older individuals with unilateral knee OA.
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Affiliation(s)
| | | | | | | | | | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
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18
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Glaviano NR, Holden S, Bazett-Jones DM, Singe SM, Rathleff MS. Living well (or not) with patellofemoral pain: A qualitative study. Phys Ther Sport 2022; 56:1-7. [DOI: 10.1016/j.ptsp.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
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Hott A, Pripp AH, Juel NG, Liavaag S, Brox JI. Self-efficacy and Emotional Distress in a Cohort With Patellofemoral Pain. Orthop J Sports Med 2022; 10:23259671221079672. [PMID: 35284585 PMCID: PMC8908394 DOI: 10.1177/23259671221079672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patellofemoral pain (PFP) is commonly described and approached in biomechanical terms despite strong evidence that psychosocial factors such as kinesiophobia, emotional distress, and self-efficacy are important in long-standing musculoskeletal pain. Purpose: To describe levels of self-efficacy, emotional distress, kinesiophobia, and widespread pain in a cohort with long-standing PFP and determine their association with measures of pain, function, and health-related quality of life. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 112 patients with PFP (age range, 16-40 years) who had been recruited to a randomized controlled trial. Seven baseline factors (patient sex, pain duration, number of pain sites throughout the body, kinesiophobia [Tampa Scale of Kinesiophobia], emotional distress [Hopkins Symptom Checklist], self-efficacy, and knee extension strength) were investigated for associations with the following outcomes: symptoms of PFP (Anterior Knee Pain Scale), pain (worst and usual), and health-related quality of life (5-level EuroQol-5 Dimensions [EQ-5D-5L]). We used bivariate models and multivariable linear regression models with a stepwise backward removal method to find associations with the outcomes. Internal validation was conducted, and adjusted coefficients after shrinkage are presented. Results: Of the study patients, 28% reported emotional distress (Hopkins Symptom Checklist ≥1.75), 69% reported multiple pain sites, and 33% had widespread pain. The kinesiophobia score was elevated, with a mean score of 35.4 ± 8.2. Self-efficacy was strongly associated with better function (Anterior Knee Pain Scale) and health-related quality of life (EQ-5D-5L) as well as lower pain scores in bivariate and multivariable models. Self-efficacy and emotional distress explained 50% of the variance in health-related quality of life (EQ-5D-5L). Conclusion: Our findings support other studies of PFP suggesting elevated levels of kinesiophobia and emotional distress and higher rates of widespread pain compared with the general population or pain-free controls. Higher self-efficacy was associated with better function and health-related quality of life. Together with emotional distress, it explained half the variance of health-related life quality. The results underline the importance of approaching these patients in a biopsychosocial model. Registration: NCT02114294 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Are Hugo Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Jens Ivar Brox
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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20
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Manojlović D, Šarabon N, Prosen M. The influence of an 8-week therapeutic exercise program on the patient experience of patellofemoral pain: a qualitative descriptive study. Physiother Theory Pract 2022:1-9. [PMID: 35238271 DOI: 10.1080/09593985.2022.2045410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to explore patients' experience of patellofemoral pain (PFP), in order to help improve the mutual understanding between the patient and the physiotherapist and consequently enhance the efficacy of treatment. METHODS A qualitative study design with focus groups was used to explore patient experience prior to the implementation of the therapeutic exercise program, during its duration, and up to twelve months after its conclusion. RESULTS Patients provided a detailed description of their lifestyle prior to the enrollment in the therapeutic exercise program, their experience of the therapeutic exercise program and the behavioral changes that remained after its conclusion. Three main themes emerged from our data: 1) PFP characteristics and the impact of PFP on daily life; 2) experience with the therapeutic exercise program; and 3) changes in PFP and daily behaviors following the therapeutic exercise program. CONCLUSION Our findings suggest that a targeted therapeutic exercise program effectively reduces short- and long-term PFP and enhance overall well-being. Further research is needed to investigate the effects of different therapeutic exercise programs with a focus on the role of self-motivation.
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Affiliation(s)
- Denisa Manojlović
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Human Health Department, InnoRenew CoE, Izola, Slovenia.,S2P, Science to Practice, Ltd. Laboratory for Motor Control and Motor Behaviour, Ljubljana, Slovenia
| | - Mirko Prosen
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
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Cotchett M, Frescos N, Whittaker GA, Bonanno DR. Psychological factors associated with foot and ankle pain: a mixed methods systematic review. J Foot Ankle Res 2022; 15:10. [PMID: 35115024 PMCID: PMC8812226 DOI: 10.1186/s13047-021-00506-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background Foot and ankle pain is common, and generally viewed through a biomedical lens rather than applying a biopsychosocial model. The objectives of this review were to evaluate: (1) the psychosocial characteristics of participants with foot/ankle pain compared to participants without foot/ankle pain; (2) the association between psychosocial factors with pain and function in people with foot/ankle pain; and (3) understand the psychosocial factors associated with the lived experience of foot/ankle pain. Methods A mixed methods systematic review was conducted according to the PRISMA guidelines and guided by the Joanna Briggs Institute methodology for mixed methods systematic reviews. The databases MEDLINE, Embase, CINAHL, SPORTDiscus, PsychInfo, and Scopus were searched. The Mixed Methods Assessment Tool was used to evaluate study quality. A convergent segregated approach was used to synthesise and integrate quantitative and qualitative data. Results Eighteen studies were included, consisting of 13 quantitative, 4 qualitative and 1 mixed methods study. The overall quality of the studies was considered high. Integration of the quantitative and qualitative data were not possible due to the disparate nature of the included studies. A narrative synthesis of the quantitative data revealed that negative emotional and cognitive factors were more common in people with foot/ankle pain compared to those without foot/ankle pain. A significant association was also found between emotional distress with foot pain and foot function in some people with plantar heel pain. In addition, kinesiophobia and pain catastrophising were significantly associated with impaired foot function, and pain catastrophising was significantly associated with first step pain in people with plantar heel pain. The qualitative data revealed emotional impacts, physical challenges, and a loss of self which was individual and unpredictable. Conclusions This review provides evidence that negative psychological constructs are greater in participants with foot/ankle pain compared to those without foot/ankle pain, although the cross-sectional nature of the study designs included in this review reduces the certainty of the evidence. These findings indicate that psychological constructs are associated with foot/ankle pain. Further research should evaluate the predictive ability of multidimensional screening tools to identify patients at risk of developing persistent foot/ankle pain. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00506-3.
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Affiliation(s)
- Matthew Cotchett
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia. .,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Nicoletta Frescos
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Glen A Whittaker
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Daniel R Bonanno
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, 3086, Australia
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22
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Alshahrani MS, Reddy RS, Tedla JS, Asiri F, Alshahrani A. Association between Kinesiophobia and Knee Pain Intensity, Joint Position Sense, and Functional Performance in Individuals with Bilateral Knee Osteoarthritis. Healthcare (Basel) 2022; 10:healthcare10010120. [PMID: 35052284 PMCID: PMC8775958 DOI: 10.3390/healthcare10010120] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 12/27/2022] Open
Abstract
In current clinical practice, fear of movement has been considered a significant factor affecting patient disability and needs to be evaluated and addressed to accomplish successful rehabilitation strategies. Therefore, the study aims (1) to establish the association between kinesiophobia and knee pain intensity, joint position sense (JPS), and functional performance, and (2) to determine whether kinesiophobia predicts pain intensity, JPS, and functional performance among individuals with bilateral knee osteoarthritis (KOA). This cross-sectional study included 50 participants (mean age: 67.10 ± 4.36 years) with KOA. Outcome measures: The level of kinesiophobia was assessed using the Tampa Scale of Kinesiophobia, pain intensity using a visual analog scale (VAS), knee JPS using a digital inclinometer, and functional performance using five times sit-to-stand test. Knee JPS was assessed in target angles of 15°, 30°, and 60°. Pearson’s correlation coefficients and simple linear regressions were used to analyze the data. Significant moderate positive correlations were observed between kinesiophobia and pain intensity (r = 0.55, p < 0.001), JPS (r ranged between 0.38 to 0.5, p < 0.05), and functional performance (r = 0.49, p < 0.001). Simple linear regression analysis showed kinesiophobia significantly predicted pain intensity (B = 1.05, p < 0.001), knee JPS (B ranged between 0.96 (0° of knee flexion, right side) to 1.30 (15° of knee flexion, right side)), and functional performance (B = 0.57, p < 0.001). We can conclude that kinesiophobia is significantly correlated and predicted pain intensity, JPS, and functional performance in individuals with KOA. Kinesiophobia is a significant aspect of the recovery process and may be taken into account when planning and implementing rehabilitation programs for KOA individuals.
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Affiliation(s)
- Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia; (M.S.A.); (J.S.T.); (F.A.)
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia; (M.S.A.); (J.S.T.); (F.A.)
- Correspondence:
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia; (M.S.A.); (J.S.T.); (F.A.)
| | - Faisal Asiri
- Department of Medical Rehabilitation Sciences, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia; (M.S.A.); (J.S.T.); (F.A.)
| | - Adel Alshahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Najran University, P.O. Box 1988, Najran 11001, Saudi Arabia;
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23
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Stone AV, Murphy ML, Jacobs CA, Lattermann C, Hawk GS, Thompson KL, Conley CEW. Mood Disorders Are Associated with Increased Perioperative Opioid Usage and Health Care Costs in Patients Undergoing Knee Cartilage Restoration Procedure. Cartilage 2022; 13:19476035221087703. [PMID: 35333656 PMCID: PMC9137305 DOI: 10.1177/19476035221087703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/19/2022] [Accepted: 02/16/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify the prevalence of mood disorder diagnoses in patients undergoing cartilage transplantation procedures and determine the relationship between mood disorders, opioid usage, and postoperative health care costs. DESIGN Patients with current procedural terminology (CPT) codes for osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI) were identified in the Truven Health Marketscan database (January 2009-September 2014). Patients were grouped based on having a preoperative mood disorder diagnosis (preMDD). Preoperative opioids, postoperative opioids ≥90 days, and health care costs within the year postoperative were compared for those with and without mood disorders. Costs were analyzed, adjusting for preoperative cost, sex, age, and opioid usage, for those with and without mood disorders. RESULTS A total of 3,682 patients were analyzed (ACI: 690, OAT: 1,294, OCA: 1,698). A quarter of patients had preMDD (ACI: 25.4%, OAT: 20.6%, OCA: 22.7%). Postoperative opioid use was more prevalent in preMDD patients (OAT: 37.1% vs. 24.1%, P < 0.001; OCA: 30.4% vs. 24.8%, P = 0.032; ACI: 33.7% vs. 26.2%, P = 0.070) (odds ratio [OR] ranged from 1.29 to 1.86). First-year postoperative log-transformed costs were significantly greater for preMDD patients (ACI: $7,733 vs. $5,689*, P = 0.012; OAT: $5,221 vs. $3,823*, P < 0.001; OCA: $6,973 vs. $3,992*, P < 0.001; *medians reported). The estimated adjusted first postoperative year cost increase for preMDD OCA patients was 41.7% (P < 0.001) and 28.0% for OAT patients (P = 0.034). There was no statistical difference for ACI patients (P = 0.654). CONCLUSION Cartilage transplantation patients have a high prevalence of preoperative mood disorders. Opioid use and health care costs were significantly greater for patients with preoperative mood disorder diagnoses. LEVEL OF EVIDENCE Level III, retrospective therapeutic study.
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Affiliation(s)
- Austin V. Stone
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Meredith L. Murphy
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Cale A. Jacobs
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Christian Lattermann
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory S. Hawk
- Department of Statistics, University of Kentucky, Lexington, KY, USA
| | | | - Caitlin E. W. Conley
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
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24
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Slawek DE, Syed M, Cunningham CO, Zhang C, Ross J, Herman M, Sohler N, Minami H, Levin FR, Arnsten JH, Starrels JL. Pain catastrophizing and mental health phenotypes in adults with refractory chronic pain: A latent class analysis. J Psychiatr Res 2021; 145:102-110. [PMID: 34890916 PMCID: PMC9160202 DOI: 10.1016/j.jpsychires.2021.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 01/12/2023]
Abstract
Chronic pain, pain catastrophizing, and mental health disorders such as anxiety or depression frequently occur together and are challenging to treat. To help understand the relationship between these conditions, we sought to identify distinct phenotypes associated with worse pain and function. In a cohort of people with chronic pain on opioids seeking medical cannabis in New York, we conducted latent class analysis to identify clusters of participants based on pain catastrophizing and mental health symptoms of depression, anxiety, post-traumatic stress disorder (PTSD) and attention deficit/hyperactivity disorder (ADHD). We then compared clusters with respect to sociodemographic and clinical characteristics using descriptive statistics. Among 185 participants, we identified four discrete groups: low pain catastrophizing and low mental health symptoms (49% of participants), low pain catastrophizing and ADHD-predominant mental health symptoms (11%), high pain catastrophizing and anxiety-predominant mental health symptoms (11%), and high pain catastrophizing and high mental health symptoms (30%). The group with high pain catastrophizing and high mental health symptoms had the worst pain intensity and interference, disability, insomnia, and quality of life, compared to the two groups with lower pain catastrophizing, though not all differences were statistically significant. Our findings highlight the importance of identifying and addressing pain catastrophizing in patients with comorbid chronic pain and mental health symptoms.
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Affiliation(s)
- Deepika E Slawek
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA.
| | - Madiha Syed
- Department of Psychiatry and Behavioral Sciences, Montefiore Health System, Bronx, NY, USA
| | | | - Chenshu Zhang
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Jonathan Ross
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Merrill Herman
- Department of Psychiatry and Behavioral Sciences, Montefiore Health System, Bronx, NY, USA
| | - Nancy Sohler
- School of Medicine, City University of New York, New York, NY, USA
| | - Haruka Minami
- Psychology Department, Fordham University, Bronx, NY, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Joanna L Starrels
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
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25
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How Do Hip Exercises Improve Pain in Individuals With Patellofemoral Pain? Secondary Mediation Analysis of Strength and Psychological Factors as Mechanisms. J Orthop Sports Phys Ther 2021; 51:602-610. [PMID: 34847699 DOI: 10.2519/jospt.2021.10674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether the effect of hip exercise on patellofemoral pain is mediated through changes in hip muscle strength or psychological factors. DESIGN Secondary mediation analysis of a randomized clinical trial, in which 218 participants with patellofemoral pain were randomly assigned to receive foot orthoses or hip exercises. METHODS Pain (Knee injury and Osteoarthritis Outcome Score pain subscale) and number of pain-free squats at 12 weeks were the outcomes for this mediation analysis, as they are pathognomonic of patellofemoral pain. Hip strength dynamometry (abduction, adduction, and external rotation) and psychological characteristics (pain catastrophizing, kinesiophobia, and anxiety) measured at 6 weeks were considered as potential mediators. We used mediation analysis to decompose the total effect of treatment on the outcome into (1) the "indirect effect" (ie, the portion acting through the mediator) and (2) the "direct effect." RESULTS The effect of hip exercise on pain and squats was not mediated by any of the strength or psychological mediators analyzed. All indirect effects were small and showed wide 95% confidence intervals (CIs) that contained zero (eg, for pain-free squats: abduction strength, -0.13; 95% CI: -0.49, 0.23; Tampa Scale of Kinesiophobia, -0.17; 95% CI: -0.64, 0.30). CONCLUSION Hip strength improved after hip exercise, yet strength did not mediate improvements in pain and pain-free squats, and alternative psychological mediators were not implicated. J Orthop Sports Phys Ther 2021;51(12):602-610. doi:10.2519/jospt.2021.10674.
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26
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Su Y, Huang L, Liu H, Chen S, Peng L. The Effect of Exercise Intervention on Disability and Kinesiophobia in a Retired Athlete With Old Patella Fracture: A Case Report. Front Psychol 2021; 12:744433. [PMID: 34867625 PMCID: PMC8633896 DOI: 10.3389/fpsyg.2021.744433] [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: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To evaluate the effect of exercise intervention on disability, pain, and kinesiophobia in a retired athlete with old patella fracture. Methods: A 34-year-old retired football player with old patella fracture conducted the exercise intervention for 12 weeks, 1 h each time, three times a week. the retired football player completed the Lysholm Knee Score (LKS), Visual Analog Scale (VAS), and the Tampa Scale for Kinesiophobia (TSK) were measured at pre-intervention, mid-intervention, and post-intervention. Results: Based on the functional training perspective, the retired athlete was subjected to two stages of exercise intervention for a total of 12 weeks. The patient's LKS score increased from 76 to 95, and the pain level of various physical states was relieved. When walking, the VAS score was reduced from 3 to 1, and when running, the VAS score was reduced from 5 to 2. Jumping VAS score for actions was reduced from 6 to 3, and the VAS score for of daily life activities was reduced from 3 points to 2. The patient's TSK score from 50 to 37. Conclusion: A 12-week exercise intervention could improve knee joint function, relieve pain and relieve kinesiophobia.
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Affiliation(s)
- Yuqin Su
- College of Physical Education, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Li Huang
- College of Physical Education, Southwest University, Chongqing, China
| | - Haowei Liu
- College of Physical Education, Southwest University, Chongqing, China
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
| | - Shifan Chen
- Electrical Engineering and Automation Department, College of Automation, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Li Peng
- College of Physical Education, Southwest University, Chongqing, China
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
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27
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de Vasconcelos GS, Nunes GS, Barton CJ, Munhoz RF, da Silva MECB, Pisani GK, Luz BC, Serrão FV. Adding muscle power exercises to a strength training program for people with patellofemoral pain: protocol of a randomized controlled trial. Trials 2021; 22:777. [PMID: 34742328 PMCID: PMC8572497 DOI: 10.1186/s13063-021-05748-x] [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: 04/09/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Strong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and it remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles comprising power and strength exercises are greater than those of a program consisting of strength exercises only. Method This study will be a randomized controlled trial that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after 6 weeks, 12 weeks, 3 months, 6 months, and 1 year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation. Discussion This randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP. Trial registration ClinicalTrials.gov NCT 03985254. Registered on 26 August 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05748-x.
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Affiliation(s)
- Gabriela Souza de Vasconcelos
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil.
| | - Guilherme Silva Nunes
- Physiotherapy and Rehabilitation Department, Federal University of Santa Maria (UFSM), Av Roraima 1000, Santa Maria, Rio Grande do Sul, CEP 97105-900, Brazil
| | - Christian John Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Raquel Fantinelli Munhoz
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
| | | | - Giulia Keppe Pisani
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
| | - Bruna Calazans Luz
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
| | - Fábio Viadanna Serrão
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
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28
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Giorgino R, Maggioni DM, Viganò M, Verdoni F, Pandini E, Balbino C, Manta N, D'Anchise R, Mangiavini L. Knee Pathology before and after SARS-CoV-2 Pandemic: An Analysis of 1139 Patients. Healthcare (Basel) 2021; 9:1311. [PMID: 34682991 PMCID: PMC8544530 DOI: 10.3390/healthcare9101311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic drastically changed daily life activities and medical practice, leading to a reorganization of healthcare activities. People spent two months in home-isolation, changing their daily habits and undertaking a more sedentary lifestyle. Change in lifestyle is related to important consequences in knee pathologies. The aim of this study was to evaluate the outpatient activity for knee pathologies before and after lockdown in terms of incidence, severity, diagnosis, and treatment. METHODS Medical records of patients with knee pathology in outpatient follow-up at IRCCS Istituto Ortopedico Galeazzi in Milan (Italy) were analyzed in the time frame 4 May-4 September 2020 and compared with patients examined between 4 May and 4 September 2019. RESULTS A significant increase of knee diagnoses associated to patellofemoral disorders in 2020 was found (p = 0.004). In addition, physiotherapy was significantly more prescribed in 2020 than in 2019 (p = 0.012). CONCLUSIONS The SARS-CoV-2 pandemic lockdown did not drastically change knee pathology, but it may have had an impact on it, highlighting a summary worsening of patellofemoral disorders associated with other knee diagnoses. Further studies are required to validate this result.
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Affiliation(s)
- Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy
| | - Davide Maria Maggioni
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Fabio Verdoni
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Elisa Pandini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | | | - Nicola Manta
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | | | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
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29
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Browning RB, Clapp IM, Alter TD, Nwachukwu BU, Nho SJ. Pain Catastrophizing and Kinesiophobia Affect Return to Sport in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement. Arthrosc Sports Med Rehabil 2021; 3:e1087-e1095. [PMID: 34430888 PMCID: PMC8365207 DOI: 10.1016/j.asmr.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess whether pain catastrophizing and kinesiophobia affect return to sport (RTS) or clinically significant outcome (CSO) achievement in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI). Methods Patients undergoing primary hip arthroscopy at a single institution between January 2017 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Patients also received the Hip Outcome Score Sport-Specific (HOS-SS) questionnaire preoperatively and 1 year and 2 years' postoperatively. An RTS questionnaire was completed at final follow-up. Bivariate correlations were conducted between PCS and TSK-11 scores and RTS status and achievement of CSOs of HOS-SS, based on patient acceptable symptom state (PASS) and substantial clinical benefit (SCB). Results Fifty-eight patients with an average age of 31.9 ± 12.2 and body mass index of 24.0 ± 3.8 participated in sport prior to surgery and were included in the study. Forty-two (72.4%) patients returned to sport at 10.5 ± 7.1 months following surgery. There was a significant reduction in TSK-11 and PCS scores at 1-year follow-up (TSK-11, 26.1 ± 6.0 vs 18.6 ± 6.1, P < .001; PCS, 17.7 ± 10.5 vs 4.3 ± 6.8, P < .001) as well as a significant improvement in HOS-SS (P < .001). At 1 year, fair correlations were demonstrated between PCS (r = -0.446, P = .010) and TSK (r = -0.330, P = .029) scores and RTS. Patient who returned to sport had lower PCS (8.5 ± 11.7 vs 3.0 ± 3.7, P = .010) and TSK-11 (21.8 ± 8.5 vs 17.6 ± 4.8, P = .029) scores at 1 year. At 1-year follow-up, PCS (r = -0.572, P = .001) and TSK-11 (r = -0.441, P = .012) scores demonstrated fair correlations with achieving PASS for HOS-SS at 2-year follow-up. Conclusions Patient kinesiophobia and pain catastrophizing at 1-year follow-up were negatively correlated with RTS and achievement of a CSO in sport-related activities at 2-year follow-up. Level of Evidence III, prospective cohort study.
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Affiliation(s)
- Robert B Browning
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ian M Clapp
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
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30
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Sertel M, Aydoğan Arslan S, Tütün Yümin E, Demirci CS, Tarsuslu Şimşek T. Investigation of the relationship between physical activity, kinesiophobia and fear of falling in older adults with chronic pain. Somatosens Mot Res 2021; 38:241-247. [PMID: 34334097 DOI: 10.1080/08990220.2021.1958774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS This study aims to investigate the relationship between physical activity, fear of movement and fear of falling in older adults with chronic pain. MATERIALS AND METHODS The study includes 163 older adults aged 65 years and over, who live in a private nursing home. The cognitive functions of the individuals who participated in the study were evaluated with the mini-mental examination scale (MMES), fears of movement with the Tampa Scale of Kinesiophobia (TSK), fear-avoidance behaviour with the Fear-avoidance Beliefs Questionnaire (FABQ), physical activity levels with the Physical Activity Scale for Older (PASE), and the fears of falling were assessed with Tinetti's Falls Efficacy Scale (FES). RESULTS In the correlation analysis, there was a weak correlation between age and fall risk (r = 0.349, p < 0.001), and PASETotal score (r = -0.020, p = 0.011). There was a weak positive correlation between Tinetti FES and FABQ scores (r = 0.349, p < 0.001), and kinesiophobia value (r = 0.259, p < 0.001), there was a weak negative correlation between Tinetti FES and PASETotal (r = -0.241, p = 0.002). A positive mid correlation was determined between kinesiophobia and the FABQ scores (r = 0.41, p < 0.001). The established regression model was found to be significant (F = 12.175; p < 0.001). Among the independent variables included in the model, FABQTotal (t = 3.589; p < 0.0001) and PASETotal (t = -3.325; p < 0.0001) significantly affected the fear of falling. CONCLUSION The presence of chronic pain in older adults who have problems related to physical activity, fear of falling, and kinesiophobia due to advancing age may affect social participation, functional level, and quality of life significantly. Therefore, pain should be addressed in older adults and should be considered as an important issue in rehabilitation programs.
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Affiliation(s)
- Meral Sertel
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Saniye Aydoğan Arslan
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Eylem Tütün Yümin
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Abant Izzet Baysal University, Bolu, Turkey
| | - Cevher Savcun Demirci
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Balıkesir University, Balıkesir, Turkey
| | - Tülay Tarsuslu Şimşek
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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Bagheri S, Naderi A, Mirali S, Calmeiro L, Brewer BW. Adding Mindfulness Practice to Exercise Therapy for Female Recreational Runners With Patellofemoral Pain: A Randomized Controlled Trial. J Athl Train 2021; 56:902-911. [PMID: 33237990 DOI: 10.4085/1062-6050-0214.20] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Considering current models that highlight the role of psychological components in pain management, mindfulness practice may be an effective strategy in the management of pain. OBJECTIVE To examine the effects of adding an 8-week mindfulness program to exercise therapy on the perceptions of pain severity, knee function, fear of movement, and pain catastrophizing of female recreational runners with patellofemoral pain (PFP). DESIGN Randomized controlled clinical trial. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty female runners (age = 28.3 ± 7.08 years) with PFP were randomly assigned to the exercise or mindfulness-exercise group. INTERVENTION(S) The exercise-only group followed a protocol (18 weeks, 3 sessions/wk) that featured training modifications to help control injury-related symptoms. The mindfulness-exercise group received an 8-week mindfulness intervention in addition to the exercise protocol. The mindfulness component started 4 weeks before the exercise component; therefore, the 2 components overlapped during the first 4 weeks of the intervention. MAIN OUTCOME MEASURE(S) Usual pain, pain during stepping, and pain during running were assessed using visual analog scales. Functional limitations of the knee were assessed using the Knee Outcome Survey. Fear of movement, pain catastrophizing, and coping strategies were measured via the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Coping Strategies Questionnaire, respectively. These outcomes were assessed at baseline, at week 9, and after 18 weeks. RESULTS Pain during running, pain during stepping, and functional limitations of the knee were less for the mindfulness-exercise group than for the exercise-only group (P values < .05). The mindfulness-exercise group reported greater perceived treatment effects than the exercise-only group (P < .05). Pain catastrophizing was less and coping strategies were more favorable for mindfulness-exercise participants than for exercise-only participants (P values < .05). CONCLUSIONS Mindfulness practice can be an effective adjunct to exercise therapy in the rehabilitation of PFP in recreational female runners.
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Affiliation(s)
| | - Aynollah Naderi
- School of Sport Sciences, Shahrood University of Technology, Iran
| | - Samira Mirali
- Department of Sport Science, University College of Omran and Tosseeh, Hamedan, Iran
| | - Luís Calmeiro
- School of Social and Health Sciences, Abertay University, Dundee, UK
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Alghamdi NH, Pohlig RT, Lundberg M, Silbernagel KG. The Impact of the Degree of Kinesiophobia on Recovery in Patients With Achilles Tendinopathy. Phys Ther 2021; 101:6324957. [PMID: 34289066 PMCID: PMC8801001 DOI: 10.1093/ptj/pzab178] [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: 10/26/2020] [Revised: 04/28/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Kinesiophobia has been proposed to influence recovery in individuals with Achilles tendinopathy. However, whether there are differences in outcomes in individuals with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in individuals with Achilles tendinopathy and various levels of kinesiophobia. METHODS This study was a secondary analysis of a prospective observational cohort study of 59 individuals with Achilles tendinopathy. The participants were divided into 3 groups on the basis of scores on the Tampa Scale for Kinesiophobia (TSK) (those with low TSK scores [≤33; low TSK group], those with medium TSK scores [34-41; medium TSK group], and those with high TSK scores [≥42; high TSK group]). All participants were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period. RESULTS There were 16 participants (8 women) in the low TSK group (age = 51.9 [SD = 15.3] years, body mass index [BMI] = 24.3 [22.3-25.4]), 28 participants (13 women) in the medium TSK group (age = 52.7 [SD = 15.2] years, BMI = 26.4 [22.5-30.8]), and 15 participants (8 women) in the high TSK group (age = 61.1 [SD = 11.1] years, BMI = 28.1 [25.2-33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group. CONCLUSION Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months. IMPACT Evaluating the degree of kinesiophobia in individuals with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery.
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Affiliation(s)
- Nabeel Hamdan Alghamdi
- Department of Physical Therapy, King Abdulaziz University, Jeddah, Saudi Arabia,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ryan T Pohlig
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Mari Lundberg
- Department of Health and Rehabilitation, University of Gothenburg, Göteborg, Sweden,Department of Health Promotion Sciences, Sophiahemmet University, Stockholm, Sweden
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Alsaleem MK, Alkhars AM, Alalwan HA, Almutairi A, Alonayzan A, AlYaeesh IA. Kinesiophobia Post Total Hip Arthroplasty: A Retrospective Study. Cureus 2021; 13:e15991. [PMID: 34336482 PMCID: PMC8318043 DOI: 10.7759/cureus.15991] [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] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction One of the major psychological factors that can affect the outcome of hip arthroplasty is postoperative kinesiophobia, which is defined as a fear of movement. The effect of kinesiophobia and excruciating pain has not been widely explored in hip arthroplasty literature especially in Saudi Arabia. Aim This study aimed to investigate kinesiophobia and pain catastrophizing after total hip arthroplasty (THA) in King Fahad Hospital, Hofuf, Saudi Arabia. Materials and methods This is a retrospective cross-sectional study conducted at King Fahad Hospital, Hofuf, Saudi Arabia. Using a validated self-administered questionnaire, participants were questioned telephonically. Questionnaires included basic demographic characteristics, Tampa Scale of Kinesiophobia (TSK), and Numerical Analogue Scale (NAS). Data were tabulated in MS Excel and all statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY). Results Seventy-four patients were recruited (60.8% females vs 39.2% males). The TSK mean score was 40.7 (SD 8.88) while the mean NAS score was 5.45 (SD 2.79). The prevalence of kinesiophobia was 62.2%. The statistical test revealed that there was a statistically significant positive correlation between TSK score and NAS score (r=460; p<0.001). Furthermore, kinesiophobia was widely prevalent among patients who had avascular necrosis (p<0.001) and among those who underwent physiotherapy (p=0.044). Conclusion There was a high prevalence of kinesiophobia among patients who underwent THA. Pain intensity directly correlated with the presence of kinesophobia.
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Affiliation(s)
| | | | | | - Adia Almutairi
- Orthopedic Surgery, King Abdulaziz Hospital, Al-Ahsa, SAU
| | - Arwa Alonayzan
- Orthopedic Surgery, King Abdulaziz Airbase Armed Forces Hospital, Dhahran, SAU
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Tanaka Y, Shigetoh H, Sato G, Fujii R, Imai R, Osumi M, Morioka S. Classification of circadian pain rhythms and pain characteristics in chronic pain patients: An observational study. Medicine (Baltimore) 2021; 100:e26500. [PMID: 34160466 PMCID: PMC8238338 DOI: 10.1097/md.0000000000026500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to perform cluster analysis in patients with chronic pain to extract groups with similar circadian rhythms and compare neuropathic pain and psychological factors among these groups to identify differences in pain-related outcomes. A total of 63 community-dwellers with pain lasting at least 3 months and Numerical Rating Scale scores of ≥2 were recruited from 3 medical institutions. Their pain circadian rhythms were evaluated over 7 days by measuring pain intensity at 6-time points per day using a 10-cm visual analog scale. Cluster analysis was performed using 6 variables with standardized visual analog scale values at 6-time points for individual participants to extract groups with similar pain circadian rhythms. The results of the Neuropathic Pain Symptom Inventory and psychological evaluations in each group were compared using the Kruskal-Wallis test. The results revealed 3 clusters with different circadian rhythms of pain. The total and evoked pain subscale Neuropathic Pain Symptom Inventory scores differed among the 3 clusters. The results suggest that a thorough understanding of circadian pain rhythms in chronic pain patients may facilitate the performance of activities of daily living and physical exercise from the perspective of pain management.
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Affiliation(s)
- Yoichi Tanaka
- Graduate School of Health Sciences, Kio University
- Department of Rehabilitation, Nara Prefecture General Rehabilitation Center
| | | | - Gosuke Sato
- Neuro Rehabilitation Research Center, Kio University, Nara
| | - Ren Fujii
- Graduate School of Health Sciences, Kio University
| | - Ryota Imai
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan
| | | | - Shu Morioka
- Graduate School of Health Sciences, Kio University
- Neuro Rehabilitation Research Center, Kio University, Nara
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Scafoglieri A, Van den Broeck J, Willems S, Tamminga R, van der Hoeven H, Engelsma Y, Haverkamp S. Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:446. [PMID: 33992100 PMCID: PMC8126114 DOI: 10.1186/s12891-021-04310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps in PFPS patients. Methods Forty-three patients with PFPS were randomly assigned to a local exercise or spinal manual therapy group. The local exercise group received six sessions (one session per week) of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions (one intervention per week) of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. All patients were also asked to do home exercises. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and after 6 weeks of follow-up. Between-group differences at assessments were analysed by way of analysis of covariance with Bonferroni correction. Results Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and − 12.4 [95% CI: − 20.2, − 4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and − 11.5 [95% CI: − 19.9, − 3.3; ES: − 0.87] for the AKPS. Conclusions This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. We suggest for future research to investigate whether combining local exercise therapy and spinal manual therapy is more effective than either single intervention on its own. This clinical trial study was approved by the Medical Ethics Committee METC Z under registration number NL57207.096. and registered retrospectively in ClinicalTrials.gov PRS with registration ID number NCT04748692 on the 10th of February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04310-9.
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Affiliation(s)
- Aldo Scafoglieri
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium. .,SOMT University of Physiotherapy, Softwareweg 5, Amersfoort, BN, 3821, The Netherlands.
| | - Jona Van den Broeck
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium
| | - Stijn Willems
- Department of Neuroscience, VU University Medical Center, Amsterdam, HV, 1081, The Netherlands
| | - Rob Tamminga
- Fysioholland, Medicort, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | | | - Yde Engelsma
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | - Stijn Haverkamp
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
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Selhorst M, Fernandez-Fernandez A, Schmitt L, Hoehn J. Effect of a Psychologically Informed Intervention to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:1267-1273. [PMID: 33838141 DOI: 10.1016/j.apmr.2021.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether the addition of a brief psychologically informed video to traditional physical therapy influenced function (primary aim), pain, and psychological beliefs (secondary aims) among adolescents with patellofemoral pain (PFP). DESIGN Double-blind randomized controlled trial. SETTING Outpatient physical therapy clinics of a single pediatric hospital. PARTICIPANTS Sixty-six adolescents with PFP (14.8±1.7 years old, 65% female). INTERVENTION Adolescents were randomly assigned to view a brief psychologically informed video (n=34) or control video (n=32). The psychologically informed video targeted pain-related fear and pain catastrophizing, and the control video related basic anatomy and factors involved in PFP. MAIN OUTCOME MEASURES The primary outcome was change in function (Anterior Knee Pain Scale). Secondary outcomes were change in psychological beliefs (fear-avoidance beliefs, kinesiophobia, pain catastrophizing) and pain. Outcomes were assessed at baseline, immediately post intervention, at 2 weeks, at 6 weeks, and at 3 months. RESULTS Using a 2-way mixed analysis of variance, change in function in the intervention group was greater than the control group, with a moderate treatment effect noted (P=.001, partial η2=0.1). Post hoc testing revealed that there was a significant interaction between the intervention and time from baseline to 2 weeks, but no interaction was noted between 2 weeks and 3 months. The psychologically informed video significantly reduced maladaptive psychological beliefs (P=.01, η2=0.32). No significant between-group differences in pain were noted. CONCLUSIONS Incorporating a brief one-time psychologically informed video into standard physical therapy care significantly reduced pain-related fear, reduced pain catastrophizing, and improved function among adolescents with PFP. The immediate effect noted on function did not continue throughout the course of care.
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Affiliation(s)
- Mitchell Selhorst
- Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH.
| | | | - Laura Schmitt
- Jameson Crane Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, OH; Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH
| | - Jessica Hoehn
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, United States
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Functional evaluation of patients with mastectomy lymphedema. Turk J Phys Med Rehabil 2021; 67:56-61. [PMID: 33948544 PMCID: PMC8088808 DOI: 10.5606/tftrd.2021.4616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 01/12/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives
In this study, we aimed to investigate the availability of the Timed Up and Go (TUG) test in daily practice instead of the Tampa Scale for Kinesiophobia (TSK) test for the evaluation of fear of movement and to assess the functionality of the upper extremity in postmastectomy lymphedema patients.
Patients and methods
Between March 2018 and July 2018, a total of 30 female patients (mean age 53.8±12.3 years; range, 35 to 80 years) with postmastectomy lymphedema were included in this study. The severity of lymphedema of the patients was measured circumferentially at 5-cm intervals. All patients were evaluated for upper extremity functionality using the Timed Functional Arm and Shoulder Test, hand grip strength using a hand dynamometer, and pinch strength using a pinchmeter. The TSK test was used for the evaluation of fear of movement and TUG test was used for the evaluation of functional status of lower extremity.
Results
There was a significant difference in functionality between the affected and unaffected side of upper extremity (p<0.05). According to the TSK results, all patients described themselves as kinesiophobic, and advanced fear of movement was found in 66.67% of the patients. However, according to the TUG scores, lower extremity functionality of all patients was normal.
Conclusion
Our study results showed that, independently of the severity of lymphedema, fear of movement was seen in every patient and functionality of upper extremity decreased on the affected side. On the other hand, the TUG test may not be useful to asses fear of movement in daily practice regarding to functional scores of these patients.
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Ibrahim AA, Akindele MO, Kaka B, Mukhtar NB. Development of the Hausa version of the Pain Catastrophizing Scale: translation, cross-cultural adaptation and psychometric evaluation in mixed urban and rural patients with chronic low back pain. Health Qual Life Outcomes 2021; 19:44. [PMID: 33546701 PMCID: PMC7863472 DOI: 10.1186/s12955-020-01644-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Background Catastrophizing has been recognized as an important contributor to chronicity in individuals with chronic pain syndromes including low back pain (LBP). The Pain Catastrophizing Scale (PCS) is perhaps the most widely used tool to evaluate the degree of pain catastrophizing. However, its use is limited in Hausa-speaking countries due to the lack of a validated translated version. Objective To translate and cross-culturally adapt the PCS into Hausa (Hausa-PCS), and evaluate its psychometric properties in mixed urban and rural patients with chronic LBP. Methods The PCS was translated and cross-culturally adapted into Hausa in accordance with established guidelines. To evaluate its psychometric properties, a consecutive sample of 200 patients with chronic LBP was recruited from urban and rural Nigerian hospitals. Validity was evaluated by exploring content validity, factorial structure (confirmatory factor analysis [CFA]), construct validity (Spearman’s rho for a priori hypotheses) and known-groups validity. Reliability was evaluated by calculating internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement with 95% confidence interval (LOA95%). Results The Hausa-PCS was comprehensible with good content validity. The CFA confirmed a 3-factor structure similar to the original English version. The concurrent validity was supported as 83% (5/6) of the a priori hypotheses were confirmed. Known-groups comparison showed that the questionnaire was unable to differentiate between male and female or urban and rural patients (p > 0.05). Internal consistency and ICC were adequate for the Hausa-PCS total score (α = 0.84; ICC = 0.90) and the subscale helplessness (α = 0.78; ICC = 0.89) but for the subscales rumination (α = 0.69; ICC = 0.68) and magnification (α = 0.41; ICC = 0.43). The LOA95% for the Hausa-PCS total score was between − 8.10 and + 9.75, with SEM and MDC of 3.47 and 9.62 respectively. Conclusion The Hausa-PCS was successfully developed and psychometrically adequate in terms of factorial structure, construct validity, internal consistency and test–retest reliability when applied in mixed urban and rural patients with chronic LBP. However, the internal consistency and reliability coefficients (ICC) for the individual subscales are inadequate. Thus, we support the use of the total score when evaluating pain catastrophizing for clinical or research purposes.
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Affiliation(s)
- Aminu A Ibrahim
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria. .,Department of Physiotherapy, Muhammad Abdullahi Wase Teaching Hospital, Hospitals Management Board, P.M.B 3160, Kano, Kano State, Nigeria.
| | - Mukadas O Akindele
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria
| | - Bashir Kaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria
| | - Naziru B Mukhtar
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria
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Grantham B, Korakakis V, O'Sullivan K. Does blood flow restriction training enhance clinical outcomes in knee osteoarthritis: A systematic review and meta-analysis. Phys Ther Sport 2021; 49:37-49. [PMID: 33582442 DOI: 10.1016/j.ptsp.2021.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically review the efficacy of blood flow restriction training (BFRT) on individuals with knee osteoarthritis (OA). DESIGN Systematic review with meta-analysis. LITERATURE SEARCH Eight electronic databases were searched by one researcher. STUDY SELECTION CRITERIA Randomised clinical trials (RCTs) comparing BFRT to regular resistance training (RT) for knee OA. DATA SYNTHESIS One reviewer selected the eligible RCTs and exported the data. Two reviewers evaluated study quality using the PEDro scale. We performed meta-analysis where appropriate using a random-effects model. We rated the quality of evidence using GRADE. RESULTS Five studies were eligible. The key outcomes analysed were pain, self-reported function, objective physical function, strength and muscle size. Across all comparisons, there was low to moderate quality evidence of no difference between BFRT and traditional RT. CONCLUSION The limited available evidence does not suggest that BFRT enhances outcomes for people with knee OA. These findings do not support clinicians using BFRT in people with knee OA. Instead, evidence-based messages regarding exercise and education should remain the mainstay of rehabilitation. Additional studies should clarify whether some people with knee OA who cannot complete an adequate exercise programme due to pain, might still benefit from BFRT to facilitate less painful exercise.
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Affiliation(s)
- Brayden Grantham
- School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland
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Thoma LM, Rethorn TJ, Best TM, Flanigan DC, Schmitt LC. High kinesiophobia and pain catastrophizing in people with articular cartilage defects in the knee and associations with knee function. Knee 2021; 28:17-24. [PMID: 33278739 DOI: 10.1016/j.knee.2020.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/06/2020] [Accepted: 10/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the extent to which individuals with knee articular cartilage defects (ACDs) have kinesiophobia and pain catastrophizing, and how these psychological factors relate to self-reported knee outcomes. METHODS Thirty-five individuals seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls without history of knee injury participated in the study. Kinesiophobia was measured with the Tampa Scale of Kinesiophobia (TSK), and scored using the modified 11-item (TSK-11) methods. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS). Data were analyzed using descriptive statistics, independent t-tests, chi-squared tests and Spearman's correlation coefficients, as appropriate (α = 0.05). RESULTS Participants with ACDs reported higher TSK-11 scores (median 27 [IQR 25-29]) and higher PCS scores (median 10 [IQR 4-18]) than controls (median TSK-11 16 [IQR 14-17], p < 0.001; median PCS 0 [IQR 0-9], p < 0.001). Within those with knee ACDs, higher TSK-11 scores were associated with worse knee pain, function on activities of daily living, sports/recreation, and knee-related quality of life scores (rho = -0.38 to -0.61). Higher pain catastrophizing was associated with worse function with activities of daily living and knee-related quality of life (rho = -0.37 to -0.40). CONCLUSIONS Kinesiophobia and pain catastrophizing in people with knee ACDs were higher than controls. Higher kinesiophobia and pain catastrophizing were associated with worse function and quality of life. Further study of the impact of these psychological factors on outcomes and prognosis in people with knee ACDs is warranted.
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Affiliation(s)
- Louise M Thoma
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Timothy J Rethorn
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, Columbus, OH, USA
| | - Thomas M Best
- University of Miami Sports Medicine Institute, Departments of Orthopedic Surgery, Family Medicine, Biomedical Engineering, Kinesiology, Miami, FL, USA
| | - David C Flanigan
- Jameson Crane Sports Medicine Institute, Columbus, OH, USA; The Ohio State University, College of Medicine, Department of Orthopedic Surgery, Columbus, OH, USA
| | - Laura C Schmitt
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, Columbus, OH, USA; Jameson Crane Sports Medicine Institute, Columbus, OH, USA.
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Varallo G, Giusti EM, Scarpina F, Cattivelli R, Capodaglio P, Castelnuovo G. The Association of Kinesiophobia and Pain Catastrophizing with Pain-Related Disability and Pain Intensity in Obesity and Chronic Lower-Back Pain. Brain Sci 2020; 11:brainsci11010011. [PMID: 33374178 PMCID: PMC7823580 DOI: 10.3390/brainsci11010011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 12/21/2022] Open
Abstract
Individuals affected by chronic lower-back pain and obesity have an increased risk of long-lasting disability. In this study, we aimed to explore the contribution of kinesiophobia and pain catastrophizing in explaining pain intensity and pain-related disability in chronic lower-back pain associated to obesity. A cross-sectional study on 106 participants with obesity and chronic lower-back pain was performed. We assessed pain intensity, pain disability, pain catastrophizing, and kinesiophobia levels through self-reporting questionnaire. Hierarchical regressions were performed to assess the role of pain catastrophizing and kinesiophobia on pain intensity and pain disability. According to the results, kinesiophobia, but not pain catastrophing, significantly explained both pain intensity and pain-related disability. Kinesiophobia might play a significant role in enhancing pain-related disability and the pain intensity in individuals with chronic lower-back pain and obesity. We encourage future studies in which beliefs and cognition towards pain might be a therapeutic target in interdisciplinary pain management interventions.
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Affiliation(s)
- Giorgia Varallo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
- Correspondence: ; Tel.: +39-338-94-84-148
| | - Emanuele Maria Giusti
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
| | - Federica Scarpina
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, 10124 Turin, Italy;
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
| | - Roberto Cattivelli
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
| | - Paolo Capodaglio
- Istituto Auxologico Italiano, U.O. di U.O. Riabilitazione Osteoarticolare, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy;
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, 10121 Turin, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
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McClinton SM, Cobian DG, Heiderscheit BC. Physical Therapist Management of Anterior Knee Pain. Curr Rev Musculoskelet Med 2020; 13:776-787. [PMID: 33128200 PMCID: PMC7661565 DOI: 10.1007/s12178-020-09678-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors. RECENT FINDINGS The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.
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Affiliation(s)
- Shane M. McClinton
- Doctor of Physical Therapy Program, Des Moines University, Des Moines, IA USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI USA
| | - Bryan C. Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA
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Central Sensitivity Is Associated with Poor Recovery of Pain: Prediction, Cluster, and Decision Tree Analyses. Pain Res Manag 2020; 2020:8844219. [PMID: 33178373 PMCID: PMC7647749 DOI: 10.1155/2020/8844219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
The process of pain recovery varies and can include the recovery, maintenance, or worsening of symptoms. Many cases of patients with pain show a tendency of recovering as predicted; however, some do not. The characteristics of cases that do not fit the prediction of pain recovery remain unclear. We performed cluster and decision tree analyses to reveal the characteristics in cases that do not fit the prediction of pain recovery. A total of 43 patients with musculoskeletal pain (nonoperative: 22 patients, operative: 13 patients) and central pain (brain disease: 5 patients, spinal cord disease: 3 patients) were included in this longitudinal study. Central sensitivity syndrome (CSS) outcome measures (Central Sensitisation Inventory), pain intensity-related outcome measures (Short-Form McGill Pain Questionnaire-2 (SFMPQ-2)), and cognitive-emotional outcome measures (Hospital Anxiety and Depression Scale and Pain Catastrophising Scale-4) of all patients were assessed at baseline and after 1-2 months. Regression analysis was used to calculate pain recovery prediction values. A hierarchical cluster analysis based on the predicted change of SFMPQ-2 and the observed change of SFMPQ-2 was used to extract subgroups that fit and those that do not fit pain recovery prediction. To extract the characteristics of subgroups that do not fit the prediction of pain recovery, a decision tree analysis was performed. The level of significance was set at 5%. In the results of cluster analysis, patients were classified into three subgroups. Cluster 1 was characterised by worse pain intensity from baseline, cluster 2 by pain, having recovered less and mildly than the predicted value, and Cluster 3 by a marked recovery of pain. In the results of the decision tree analysis, the CSI change was extracted as an indicator related to the classification of all clusters. Our findings suggest that the poor improvement of CSS is characteristic in cases that do not fit the prediction of pain recovery.
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Vorderer Knieschmerz. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pazzinatto MF, Silva DDO, Willy RW, Azevedo FM, Barton CJ. Fear of movement and (re)injury is associated with condition specific outcomes and health-related quality of life in women with patellofemoral pain. Physiother Theory Pract 2020; 38:1254-1263. [PMID: 33106118 DOI: 10.1080/09593985.2020.1830323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Investigate the association of fear of movement and (re)injury with clinical outcomes in women with patellofemoral pain (PFP). METHODS This cross-sectional study included 92 women with PFP who completed the TAMPA scale for kinesiophobia. The TAMPA score and its two subscales - activity avoidance and somatic focus were correlated with BMI, physical activity level, pain catastrophizing scale, health-related quality of life, pain sensitivity via pressure pain threshold, self-reported disability, and worst knee pain in last month. RESULTS Greater fear of movement and (re)injury, activity avoidance, and somatic focus were correlated with lower local pain sensitivity (rho = -0.29 to -0.55), lower health-related quality of life (rho = -0.38 to -0.42), greater pain catastrophizing (rho = 0.41 to 0.47), and greater self-reported disability (rho = -0.31 to -0.52). Greater fear of movement and (re)injury and activity avoidance were correlated with adjacent and remote pain sensitivity (rho = -0.24 to -0.39). Greater fear of movement and (re)injury and somatic focus were correlated with greater worst knee pain in last month (rho = 0.21 to 0.32). Fear of movement and (re)injury predicted pain measures, disability, and health-related quality of life (p ≤ 0.010). CONCLUSION The relationship of greater fear of movement and (re)injury with greater disability, pain catastrophizing, pain sensitization, and poorer health-related quality of life highlights the potential importance of considering this psychological feature of PFP during assessment and management.
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Affiliation(s)
- Marcella F Pazzinatto
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Danilo De Oliveira Silva
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA
| | - Fábio M Azevedo
- Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Christian J Barton
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Australia
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CORR Insights®: Does a Patient's Approach to Achieving Goals Influence His or Her Recovery Trajectory After Musculoskeletal Illness? Clin Orthop Relat Res 2020; 478:2077-2078. [PMID: 32667749 PMCID: PMC7431227 DOI: 10.1097/corr.0000000000001405] [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: 01/31/2023]
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De Oliveira Silva D, Willy RW, Barton CJ, Christensen K, Pazzinatto MF, Azevedo FM. Pain and disability in women with patellofemoral pain relate to kinesiophobia, but not to patellofemoral joint loading variables. Scand J Med Sci Sports 2020; 30:2215-2221. [DOI: 10.1111/sms.13767] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
| | - Richard W. Willy
- School of Physical Therapy and Movement Sciences University of Montana Missoula MT USA
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Surgery St Vincent's Hospital University of Melbourne Melbourne Australia
| | - Kelly Christensen
- School of Physical Therapy and Movement Sciences University of Montana Missoula MT USA
| | - Marcella F. Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
| | - Fábio M. Azevedo
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
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Adolescent psychological beliefs, but not parent beliefs, associated with pain and function in adolescents with patellofemoral pain. Phys Ther Sport 2020; 45:155-160. [PMID: 32781268 DOI: 10.1016/j.ptsp.2020.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the association of adolescent and parent psychological beliefs with 1) self-reported functional ability, 2) pain and 3) objective measures of function. STUDY DESIGN Cross-sectional study. SETTING Pediatric Outpatient Hospital. PARTICIPANTS Eighty-six adolescents with patellofemoral pain (PFP) (14.6 ± 1.7 years old, 62% female) and 72 parents. MAIN OUTCOME MEASURES Patient questionnaires were used to describe pain, knee function, fear avoidance (Fear Avoidance Beliefs Questionnaire-Physical Activity; FABQ-PA), kinesiophobia (Tampa Scale for Kinesiophobia-11; TSK-11), and pain catastrophizing (Pain Catastrophizing Scale; PCS) in adolescents with PFP. Parents (n = 72) completed FABQ-PA, TSK-11, and PCS questionnaires. Hip and knee strength, quadriceps and dorsiflexion motion, the single-leg hop for distance and lateral-step down test measured physical performance. RESULTS Adolescent psychological beliefs were significantly associated with pain (FABQ-PA r = 0.33, and PCS r = 0.34), function (FABQ-PA r = -0.59,TSK-11 r = -0.33), hip strength (FABQ-PA r = -0.41, TSK-11 r = -0.32), and single leg hop for distance (FABQ-PA r = -0.38). Parent psychological beliefs were not associated with the adolescent's beliefs, pain or function. CONCLUSIONS Adolescent, but not parent, psychological beliefs were associated with pain, self-reported function and objective measures of function.
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Erdoğanoğlu Y, Sayaca Ç, Çalık M, Noyan CO, Çetin A, Yertutanol DK, Taşcılar LN, Kaya D. Evaluation of Plantar Foot Sensation, Balance, Physical Performance, and Fear of Movement in Substance Use Disorders. J Am Podiatr Med Assoc 2020; 110:436239. [PMID: 31566442 DOI: 10.7547/18-194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neuropathologic changes may occur in the nervous system due to long-term substance use, leading to functional disability with altering of balance. We know little about substance-related mechanisms that can cause movement disorders. This study investigated the effects of plantar foot sensation and balance on physical performance as an effect of substance use in detoxified patients. METHODS Twenty-three users of cannabis, volatile agents, or narcotic/stimulant agents alone or in combination for at least 1 year (mean age, 27.6 years) and 20 healthy volunteers (mean age, 24.6 years) were included. Participant evaluations were implemented immediately after the detoxification process with psychiatrist approval. Depression, state-trait anxiety, and fear of movement levels were evaluated with the Beck Depression Inventory, State-Trait Anxiety Inventory, and Tampa Scale for Kinesiophobia, respectively. Plantar foot sensations were evaluated with light touch, two-point discrimination, and vibration examinations. Balance was assessed with balance software and a balance board and force platform. Balance path, balance path distance, and center of pressure were recorded. Physical performance was evaluated with the Timed Up and Go (TUG) test in the final step. RESULTS There was a significant difference in two-point discrimination of patients versus controls (P < .05). Significant differences were also found in balance values, particularly in the sagittal direction (P < .05). TUG test results of patients compared with controls showed a negative influence on physical function (P < .05). CONCLUSIONS Detailed examination should be performed to understand movement disorders in substance users. Herein, substance users had impaired two-point discrimination and sagittal balance reciprocally. Thus, customized physiotherapy approaches to substance users should be considered to improve their movement disorders.
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Priore LB, Lack S, Garcia C, Azevedo FM, de Oliveira Silva D. Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:613-623. [DOI: 10.1016/j.apmr.2019.10.190] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/27/2019] [Indexed: 12/22/2022]
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