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Valenza-Peña G, Martín-Núñez J, Heredia-Ciuró A, Granados-Santiago M, López-López L, Valenza MC, Cabrera-Martos I. Relationship between Pain Intensity, Physical Factors, Pronociceptive Pain Modulation Profile and Psychological Vulnerability on Upper Limb Disability in Older Patients with Chronic Shoulder Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15006. [PMID: 36429726 PMCID: PMC9690165 DOI: 10.3390/ijerph192215006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Chronic shoulder pain is a very prevalent condition causing disability and functional impairment. The purpose of the study was to evaluate the relationship between pain intensity, physical variables, psychological vulnerability, pronociceptive pain modulation profile and disability in older people with chronic shoulder pain. METHODS A cross-sectional study was carried out. A total of 56 participants with non-specific chronic shoulder pain of the "Complejo Hospitalario Universitario" (Granada) and 56 healthy controls were included. The outcomes evaluated were pain intensity (visual analogue scale), physical factors (dynamometry for grip strength), psychological vulnerability (Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia), pronociceptive pain modulation profile (pain pressure algometry) and disability (Quick Disability Arm Shoulder Hand questionnaire). RESULTS Disability showed a positive correlation with pain and psychological vulnerability (p < 0.05) and a negative correlation with pronociceptive pain variables and dynamometry (p < 0.001). Psychological vulnerability also presented a strong negative correlation with proprioceptive pain variables and dynamometry and a positive correlation with pain (p < 0.05). In regard to the pronociceptive pain modulation profile, a strong negative correlation with pain (p < 0.001) and a positive moderate correlation with dynamometry (p < 0.001) were shown. CONCLUSIONS Our results support a strong association between disability, psychological vulnerability and pronociceptive pain modulation profile in older adults with chronic shoulder pain.
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Affiliation(s)
- Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - María Granados-Santiago
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18001 Granada, Spain
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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Kamonseki DH, Pott-Junior H, Haik MN, Almeida LAD, Camargo PR. Pain-related fear phenotypes are associated with function of the upper limbs in individuals with shoulder pain. Musculoskelet Sci Pract 2021; 55:102416. [PMID: 34175789 DOI: 10.1016/j.msksp.2021.102416] [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: 12/16/2020] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify and describe phenotypes related to kinesiophobia, fear-avoidance, and pain catastrophizing, and determine clinical and demographic characteristics related to each phenotype as a function of self-reported function of the upper limbs in individuals with shoulder pain. METHODS One hundred and seventy-seven individuals with shoulder pain participated in this study. Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Numerical Pain of Rating Scale, and the angular onset of pain during the elevation of the arm were measured in all participants. A cluster analysis was performed considering kinesiophobia, fear-avoidance, and pain catastrophizing, then clinical and demographic characteristics of clusters were used to model individual's chance to belong to one of the clusters as a function of DASH. RESULTS Two clusters were identified based on kinesiophobia, fear-avoidance, and pain catastrophizing. The cluster with worse pain-related fear profile presented (p < 0.05) higher age, worse function, and higher pain intensity. This same cluster was also associated with involvement of the dominant side (OR = 2.10, 95% CI = 1.03, 4.41) and worse function (OR = 0.96, 95% CI = 0.94, 0.98). CONCLUSION This study identified that individuals with worse pain-related fear profile were older, with worse function, and higher pain intensity. Worse function and involvement of the dominant side were associated with the phenotype with a worse pain-related fear condition.
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Affiliation(s)
- Danilo Harudy Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Henrique Pott-Junior
- Department of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Melina Nevoeiro Haik
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Lucas Araújo de Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
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Griffin AR, Leaver AM, Arora M, Walton DM, Peek A, Bandong AN, Sterling M, Rebbeck T. Clinimetric Properties of Self-reported Disability Scales for Whiplash: A Systematic Review for the Whiplash Core Outcome Set (CATWAD). Clin J Pain 2021; 37:766-787. [PMID: 34282060 DOI: 10.1097/ajp.0000000000000968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES A core outcomes set (COS) for whiplash-associated disorders (WADs) has been proposed to improve consistency of outcome reporting in clinical trials. Patient-reported disability was one outcome of interest within this COS. The aim of this review was to identify the most suitable tools for measuring self-reported disability in WAD based on clinimetric performance. METHODS Database searches took place in 2 stages. The first identified outcome measures used to assess self-reported disability in WAD, and the second identified studies assessing the clinimetric properties of these outcome measures in WAD. Data on the study, population and outcome measure characteristics were extracted, along with clinimetric data. Quality and clinimetric performance were assessed in accordance with the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN). RESULTS Of 19,663 records identified in stage 1 searches, 32 were retained following stage 2 searches and screening. Both the Whiplash Disability Questionnaire and Neck Disability Index performed well in reliability (intraclass correlation coefficient=0.84 to 0.98), construct validity (74% to 82% of hypotheses accepted), and responsiveness (majority of correlations in accordance with hypotheses). Both received Category B recommendations due to a lack of evidence for content validity. DISCUSSION This review identified the Neck Disability Index and Whiplash Disability Questionnaire as the most appropriate patient-reported outcome measures (PROMs) for assessing self-reported disability in WAD based on moderate to high-quality evidence for sufficient reliability, construct validity and responsiveness. However, the content validity of these PROMs has yet to be established in WAD, and until this is undertaken, it is not possible to recommend 1 PROM over the other for inclusion in the WAD COS.
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Affiliation(s)
- Alexandra R Griffin
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- John Walsh Centre for Rehabilitation Research, Level 12, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards
| | - Andrew M Leaver
- Faculty of Medicine and Health, The University of Sydney, Camperdown
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Level 12, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Aimie Peek
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland
| | - Aila N Bandong
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- College of Allied Medical Professions, The University of the Philippines Manila, Philippines
| | - Michele Sterling
- NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland
- Recover Injury Research Centre, Level 7, UQ Oral Health Centre, The University of Queensland, Herston, QLD, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- John Walsh Centre for Rehabilitation Research, Level 12, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards
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Lee JY, Walton DM, Tremblay P, May C, Millard W, Elliott JM, MacDermid JC. Defining pain and interference recovery trajectories after acute non-catastrophic musculoskeletal trauma through growth mixture modeling. BMC Musculoskelet Disord 2020; 21:615. [PMID: 32943021 PMCID: PMC7495896 DOI: 10.1186/s12891-020-03621-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/31/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample. METHODS A prospective longitudinal cohort (n = 241) was formed from patients identified within four weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the Neck Disability Index (Chicago cohort). Pain severity was captured in both cohorts using the numeric pain rating scale. Growth mixture modeling and RM repeated measures ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data. RESULTS For pain interference, the three trajectories were labeled accordingly: Class 1 = Rapid recovery (lowest intercept, full or near full recovery by 3 months, 32.0% of the sample); Class 2 = Delayed recovery (higher intercept, recovery by 12 months, 26.7% of the sample); Class 3 = Minimal or no recovery (higher intercept, persistently high interference scores at 12 months, 41.3% of the sample). For pain severity, the two trajectories were labeled: Class 1 = Rapid recovery (lower intercept, recovery by 3 months, 81.3% of the sample); and Class 2 = Minimal or no recovery (higher intercept, flat curve, 18.7% of the sample). The "Minimal or No Recovery" trajectory could be predicted by female sex and axial (vs. peripheral) region of trauma with 74.3% accuracy across the 3 classes for the % Interference outcome. For the Pain Severity outcome, only region (axial trauma, 81.3% accuracy) predicted the "Minimal or No Recovery" trajectory. CONCLUSIONS These results suggest that three meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and two recovery trajectories emerge when pain severity is the outcome. Females in the sample or people who suffered axial injuries (head, neck, or low back) were more likely to be classed in poor outcome trajectories. TRIAL REGISTRATION National Institutes of Health - clinicaltrials.gov ( NCT02711085 ; Retrospectively registered Mar 17, 2016).
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Affiliation(s)
- Joshua Y Lee
- Faculty of Health Sciences, Western University, London, ON, Canada.
| | - David M Walton
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Paul Tremblay
- Department of Psychology, Western University, London, ON, Canada
| | - Curtis May
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Wanda Millard
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - James M Elliott
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, & the Northern Sydney Local Health District; The Kolling Research Institute, St. Leonards, NSW, Australia
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joy C MacDermid
- Faculty of Health Sciences, Western University, London, ON, Canada
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Wiangkham T, Duda J, Haque MS, Price J, Rushton A. A cluster randomised, double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute whiplash-associated disorder (WAD)II. PLoS One 2019; 14:e0215803. [PMID: 31071100 PMCID: PMC6508700 DOI: 10.1371/journal.pone.0215803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/31/2019] [Indexed: 12/18/2022] Open
Abstract
Whiplash-associated disorder (WAD) causes substantial social and economic burden, with ≥70% patients classified as WADII (neck complaint and musculoskeletal sign(s)). Effective management in the acute stage is required to prevent development of chronicity; an issue for 60% of patients. An Active Behavioural Physiotherapy Intervention (ABPI) was developed to address both physical and psychological components of WAD. The ABPI is a novel complex intervention designed through a rigorous sequential multiphase project to prevent transition of acute WAD to chronicity. An external pilot and feasibility cluster randomised double-blind (assessor, participants) parallel two-arm clinical trial was conducted in the UK private sector. The trial compared ABPI versus standard physiotherapy to evaluate trial procedures and feasibility of the ABPI for managing acute WADII in preparation for a future definitive trial. Six private physiotherapy clinics were recruited and cluster randomised using a computer-generated randomisation sequence. Twenty-eight (20 ABPI, 8 standard physiotherapy) participants [median age 38.00 (IQR = 21.50) years] were recruited. Data were analysed descriptively with a priori establishment of success criteria. Ninety-five percent of participants in the ABPI arm fully recovered (Neck Disability Index ≤4, compared to 17% in the standard physiotherapy arm); required fewer treatment sessions; and demonstrated greater improvement in all outcome measures (pain intensity, Cervical Range of Motion, Pressure Pain Threshold, EuroQol-5 Dimensions) except for the Impact of Events Scale and Fear Avoidance Beliefs Questionnaire. The findings support the potential value of the ABPI, and that an adequately powered definitive trial to evaluate effectiveness (clinical, cost) is feasible with minor modifications to procedures.
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Affiliation(s)
- Taweewat Wiangkham
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, West Midlands, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Exercise and Rehabilitation Sciences Research Unit, Naresuan University, Phitsanulok, Thailand
- Department of Physical Therapy, Naresuan University, Phitsanulok, Thailand
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - M. Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Jonathan Price
- Physiotherapy Department, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, West Midlands, United Kingdom
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, West Midlands, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- * E-mail:
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Pedersen MM, Fink P, Kasch H, Frostholm L. Development of an Internet-delivered educational video for acute whiplash injuries. Pilot Feasibility Stud 2019; 5:60. [PMID: 31061715 PMCID: PMC6487037 DOI: 10.1186/s40814-019-0445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/09/2019] [Indexed: 11/12/2022] Open
Abstract
Objective To describe the development of a preventive educational video for patients exposed to whiplash trauma following motor vehicle accidents. Methods The development followed a systematic approach and was theory-driven supplemented with available empirical knowledge. The specific content was developed by a multidisciplinary group involving health professionals and visual production specialists. Results A 14-min educational video was created. The video content focuses on stimulating adaptive recovery expectations and preventing maladaptive illness beliefs. The video presents a multifactorial model for pain incorporating physiological and cognitive-behavioural aspects, advice on pain relief, and exercises. Subjects interviewed for a qualitative evaluation found the video reassuring and that it aligned well with verbal information received in the hospital. Conclusions The development of the visual educational intervention benefitted from a systematic development approach entailing both theoretical and research-based knowledge. The sparse evidence on educational information for acute whiplash trauma posed a challenge for creating content. Further knowledge is required regarding what assists recovery in the early stages of whiplash injuries in order to improve the development of educational interventions.
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Affiliation(s)
- Majbritt Mostrup Pedersen
- 1The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Bygn. 2C, 8000 Aarhus, Denmark
| | - Per Fink
- 1The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Bygn. 2C, 8000 Aarhus, Denmark.,3Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Helge Kasch
- The Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Regional Hospital of Viborg, 8800 Viborg, Denmark.,3Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Lisbeth Frostholm
- 1The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Bygn. 2C, 8000 Aarhus, Denmark.,3Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
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Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med 2018; 53:554-559. [DOI: 10.1136/bjsports-2017-098673] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/04/2022]
Abstract
Objective(1) To explore the level of association between kinesiophobia and pain, disability and quality of life in people with chronic musculoskeletal pain (CMP) detected via cross-sectional analysis and (2) to analyse the prognostic value of kinesiophobia on pain, disability and quality of life in this population detected via longitudinal analyses.DesignA systematic review of the literature including an appraisal of the risk of bias using the adapted Newcastle Ottawa Scale. A synthesis of the evidence was carried out.Data sourcesAn electronic search of PubMed, AMED, CINAHL, PsycINFO, PubPsych and grey literature was undertaken from inception to July 2017.Eligibility criteria for selecting studiesObservational studies exploring the role of kinesiophobia (measured with the Tampa Scale for Kinesiophobia) on pain, disability and quality of life in people with CMP.ResultsSixty-three articles (mostly cross-sectional) (total sample=10 726) were included. We found strong evidence for an association between a greater degree of kinesiophobia and greater levels of pain intensity and disability and moderate evidence between a greater degree of kinesiophobia and higher levels of pain severity and low quality of life. A greater degree of kinesiophobia predicts the progression of disability overtime, with moderate evidence. A greater degree of kinesiophobia also predicts greater levels of pain severity and low levels of quality of life at 6 months, but with limited evidence. Kinesiophobia does not predict changes in pain intensity.Summary/conclusionsThe results of this review encourage clinicians to consider kinesiophobia in their preliminary assessment. More longitudinal studies are needed, as most of the included studies were cross-sectional in nature.Trial registration numberCRD42016042641.
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Wiangkham T, Duda J, Haque MS, Price J, Rushton A. Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an Active Behavioural Physiotherapy Intervention in an insurance private setting. BMJ Open 2016; 6:e011336. [PMID: 27412105 PMCID: PMC4947766 DOI: 10.1136/bmjopen-2016-011336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Whiplash-associated disorder (WAD) causes substantial social and economic burden internationally. Up to 60% of patients with WAD progress to chronicity. Research therefore needs to focus on effective management in the acute stage to prevent the development of chronicity. Approximately 93% of patients are classified as WADII (neck complaint and musculoskeletal sign(s)), and in the UK, most are managed in the private sector. In our recent systematic review, a combination of active and behavioural physiotherapy was identified as potentially effective in the acute stage. An Active Behavioural Physiotherapy Intervention (ABPI) was developed through combining empirical (modified Delphi study) and theoretical (social cognitive theory focusing on self-efficacy) evidence. This pilot and feasibility trial has been designed to inform the design of an adequately powered definitive randomised controlled trial. METHODS AND ANALYSIS Two parallel phases. (1) An external pilot and feasibility cluster randomised double-blind (assessor and participants), parallel two-arm (ABPI vs standard physiotherapy) clinical trial to evaluate procedures and feasibility. Six UK private physiotherapy clinics will be recruited and cluster randomised by a computer-generated randomisation sequence. Sixty participants (30 each arm) will be assessed at recruitment (baseline) and at 3 months postbaseline. The planned primary outcome measure is the neck disability index. (2) An embedded exploratory qualitative study using semistructured indepth interviews (n=3-4 physiotherapists) and a focus group (n=6-8 patients) and entailing the recruitment of purposive samples will explore perceptions of the ABPI. Quantitative data will be analysed descriptively. Qualitative data will be coded and analysed deductively (identify themes) and inductively (identify additional themes). ETHICS AND DISSEMINATION This trial is approved by the University of Birmingham Ethics Committee (ERN_15-0542). TRIAL REGISTRATION NUMBER ISRCTN84528320.
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Affiliation(s)
- Taweewat Wiangkham
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - M Sayeed Haque
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Guzy G, Polczyk R, Szpitalak M, Vernon H. Age Moderates the Relationships between Family Functioning and Neck Pain/Disability. PLoS One 2016; 11:e0153606. [PMID: 27078854 PMCID: PMC4831820 DOI: 10.1371/journal.pone.0153606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/31/2016] [Indexed: 11/21/2022] Open
Abstract
This cross-sectional clinical study was designed to explore the relationships between family functioning, coping styles, and neck pain and neck disability. It was hypothesized that better family functioning and more effective coping styles would be associated with less pain and pain-related disability. It also was hypothesized that these relationships would be stronger in older people because they have fewer resources, more limited coping styles, and may depend more on their family for support. In this study, 88 women with chronic non-traumatic neck pain completed the Family Assessment Measure (FAM), Coping Inventory for Stressful Situations (CISS), Neck Disability Index (NDI), and a Visual-Analogue Scale (VAS) measuring the subjective intensity of neck pain. Zero-order and partial correlations and hierarchical stepwise regression were performed. CISS was not correlated with the NDI orVAS. Good family functioning was correlated with lower NDI and VAS scores. Age was found to moderate the relationship between the FAM and both NDI and VAS. This relationship was significant and positive in older patients, but non-significant in younger patients. It was concluded that better family functioning is associated with lower neck disability and pain intensity, especially in the case of older women suffering from non-traumatic neck pain.
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Affiliation(s)
- Grażyna Guzy
- Department of Physiotherapy, University of Physical Education, Cracow, Poland
- * E-mail:
| | - Romuald Polczyk
- Institute of Psychology, Jagiellonian University, Cracow, Poland
| | | | - Howard Vernon
- Canadian Memorial Chiropractic College, Toronto, Canada
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Peterson GE, Landén Ludvigsson MH, O'Leary SP, Dedering ÅM, Wallman T, Jönsson MIN, Peolsson ALC. The effect of 3 different exercise approaches on neck muscle endurance, kinesiophobia, exercise compliance, and patient satisfaction in chronic whiplash. J Manipulative Physiol Ther 2015; 38:465-476.e4. [PMID: 26387858 DOI: 10.1016/j.jmpt.2015.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of 3 different exercise approaches on neck muscle endurance (NME), kinesiophobia, exercise compliance, and patient satisfaction in patients with chronic whiplash. METHODS This prospective randomized clinical trial included 216 individuals with chronic whiplash. Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise (NSE), NSE combined with a behavioral approach (NSEB), or prescribed physical activity (PPA). Measures of ventral and dorsal NME (endurance time in seconds), perceived pain after NME testing, kinesiophobia, exercise compliance, and patient satisfaction were recorded at baseline and at the 3- and 6-month follow-ups. RESULTS Compared with individuals in the prescribed physical activity group, participants in the NSE and NSEB groups exhibited greater gains in dorsal NME (P = .003), greater reductions in pain after NME testing (P = .03), and more satisfaction with treatment (P < .001). Kinesiophobia and exercise compliance did not significantly differ between groups (P > .07). CONCLUSION Among patients with chronic whiplash, a neck-specific exercise intervention (with or without a behavioral approach) appears to improve NME. Participants were more satisfied with intervention including neck-specific exercises than with the prescription of general exercise.
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Affiliation(s)
- Gunnel E Peterson
- PhD Student, Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; PhD Student, Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Maria H Landén Ludvigsson
- PhD Student, Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Registered Physical Therapist, Rehab Väst, County Council of Östergötland, Östergötland, Sweden
| | - Shaun P O'Leary
- Principal Research Fellow, NHMRC CCRE (Spinal Pain, Injury and Health), the University of Queensland, Brisbane, Australia; Principal Research Fellow, Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia
| | - Åsa M Dedering
- Associate Professor, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet; Associate Professor, Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Thorne Wallman
- Deputy Director, Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Adjunct Senior Lecturer, Public Health & Caring Sciences, Family Medicine & Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Margaretha I N Jönsson
- Registered Physical Therapist, Prima Rehab, Herrgärdet Health Care Center, County Council of Västmanland, Västmanland, Sweden
| | - Anneli L C Peolsson
- Associate Professor, Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Associate Professor, NHMRC CCRE (Spinal Pain, Injury and Health), the University of Queensland, Brisbane, Australia
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Monticone M, Vernon H, Brunati R, Rocca B, Ferrante S. The NeckPix©: development of an evaluation tool for assessing kinesiophobia in subjects with chronic neck pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:72-9. [DOI: 10.1007/s00586-014-3509-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/03/2014] [Accepted: 08/03/2014] [Indexed: 11/30/2022]
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Jackson T, Wang Y, Fan H. Associations Between Pain Appraisals and Pain Outcomes: Meta-Analyses of Laboratory Pain and Chronic Pain Literatures. THE JOURNAL OF PAIN 2014; 15:586-601. [DOI: 10.1016/j.jpain.2014.01.499] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
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Physical dysfunction and nonorganic signs in patients with chronic neck pain: exploratory study into interobserver reliability and construct validity. J Orthop Sports Phys Ther 2014; 44:366-76. [PMID: 24730436 DOI: 10.2519/jospt.2014.4715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Repeated-measurement design. OBJECTIVES To explore interobserver reliability of the modified physical dysfunction severity (mPDS) as a measure for impairment of the cervical spine and the modified cervical nonorganic signs (mcNOS) as a measure for behavioral signs, and to explore construct validity of the mPDS and mcNOS. BACKGROUND The PDS has been used for evaluation of treatment efficacy in controlled trials in primary care. The cervical nonorganic signs were developed to assess illness behavior in patients with neck pain. METHODS Two observers independently assessed the mPDS and mcNOS in 51 patients with chronic neck pain in an outpatient tertiary rehabilitation setting, with a 3-week interval between assessments. Interobserver reliability for total scores of the mPDS and mcNOS was expressed as an intraclass correlation coefficient. Interobserver agreement for individual mcNOS tests was calculated as absolute agreement and Cohen kappa. Construct validity was expressed as Spearman correlation between the mPDS and mcNOS with the Neck Pain and Disability Scale and numeric pain rating scale for pain. RESULTS The interobserver reliability of the mPDS and mcNOS had intraclass correlation coefficients of 0.72 and 0.78, respectively. Agreement for individual mcNOS tests ranged from 63% to 88%, and kappa values ranged from 0.14 to 0.54. Correlation with the Neck Pain and Disability Scale was 0.26 for the mPDS and 0.49 for the mcNOS, and the correlation with the numeric pain rating scale was 0.32 for the mPDS and 0.37 for the mcNOS. CONCLUSION Interobserver reliability of both the mPDS and mcNOS was acceptable. The interobserver agreement for the individual mcNOS tests ranged from poor to acceptable. Construct validity of the mPDS and mcNOS appeared satisfactory.
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Clinical, physical, and neurophysiological impairments associated with decreased function in women with carpal tunnel syndrome. J Orthop Sports Phys Ther 2013; 43:641-9. [PMID: 23886648 DOI: 10.2519/jospt.2013.4830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To examine the associations between clinical (pain), physical (cervical range of motion [ROM] and pinch grip force), and neurophysiological (pressure pain thresholds) outcomes and self-reported function and disability in women with carpal tunnel syndrome (CTS). BACKGROUND The association of physical and physiological variables with self-rated function and disability in patients with CTS has not been fully determined. A better understanding of the association between potentially modifiable risk factors, such as limited cervical ROM, could assist clinicians in optimizing therapeutic programs for this group of patients. METHODS One hundred fifty-four women with CTS were recruited. Demographic information and data on duration of symptoms, pain intensity, depression, cervical ROM, pinch grip force, and pressure pain thresholds over the neck, hand, and leg were collected. Self-reported function and disability were measured with the functional status subscale of the Boston Carpal Tunnel Questionnaire. Correlation and regression analyses were performed to determine associations between variables. RESULTS There were significant positive correlations between the functional status subscale score and pain intensity (r = 0.36, P<.001), depression (r = 0.32, P<.001), and duration of symptoms (r = 0.23, P = .005). Significant negative correlations were also observed between the functional status subscale score and pinch grip force of the index finger (r = -0.25, P = .002) and little finger (r = -0.28, P<.001), ROM in cervical flexion (r = -0.22, P = .003) and lateral flexion away from the side of CTS (r = -0.24, P = .002) and toward the side of CTS (r = -0.16, P = .045), and pressure pain threshold over C5-6 (r = -0.34, P<.001), the carpal tunnel (r = -0.35, P<.001), and the tibialis anterior muscle (r = -0.26, P<.001). Stepwise regression analyses revealed that pain intensity, thumb and little finger pinch grip force, severity of depression, and cervical ROM in lateral flexion away from the side of CTS explained 38.2% of the variance in functional status (R2 = 0.411, adjusted R2 = 0.382, F = 15.42, P<.001). CONCLUSION This study found that a number of modifiable factors are associated with self-reported function in women with CTS. Future longitudinal studies will help to determine the clinical implications of these findings.
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Zale EL, Lange KL, Fields SA, Ditre JW. The relation between pain-related fear and disability: a meta-analysis. THE JOURNAL OF PAIN 2013; 14:1019-30. [PMID: 23850095 DOI: 10.1016/j.jpain.2013.05.005] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/24/2013] [Accepted: 05/20/2013] [Indexed: 01/21/2023]
Abstract
UNLABELLED Within a biopsychosocial framework, psychological factors are thought to play an important role in the onset and progression of chronic pain. The cognitive-behavioral fear-avoidance model of chronic pain suggests that pain-related fear contributes to the development and maintenance of pain-related disability. However, investigations of the relation between pain-related fear and disability have demonstrated considerable between-study variation. The main goal of the current meta-analysis was to synthesize findings of studies investigating cross-sectional associations between pain-related fear and disability in order to estimate the magnitude of this relation. We also tested potential moderators, including type of measure used, demographic characteristics, and relevant pain characteristics. Searches in PubMed and PsycINFO yielded a total of 46 independent samples (N = 9,579) that reported correlations between pain-related fear and disability among persons experiencing acute or chronic pain. Effect size estimates were generated using a random-effects model and artifact distribution method. The positive relation between pain-related fear and disability was observed to be moderate to large in magnitude, and stable across demographic and pain characteristics. Although some variability was observed across pain-related fear measures, results were largely consistent with the fear-avoidance model of chronic pain. PERSPECTIVE Results of this meta-analysis indicate a robust, positive association between pain-related fear and disability, which can be classified as moderate to large in magnitude. Consistent with the fear-avoidance model of chronic pain, these findings suggest that pain-related fear may be an important target for treatments intended to reduce pain-related disability.
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Vernon H, Guerriero R, Kavanaugh S, Soave D, Puhl A. Self-rated disability, fear-avoidance beliefs, nonorganic pain behaviors are important mediators of ranges of active motion in chronic whiplash patients. Disabil Rehabil 2013; 35:1954-60. [DOI: 10.3109/09638288.2013.768302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Robinson JP, Theodore BR, Dansie EJ, Wilson HD, Turk DC. The role of fear of movement in subacute whiplash-associated disorders grades I and II. Pain 2012; 154:393-401. [PMID: 23318127 DOI: 10.1016/j.pain.2012.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/22/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
Fear and avoidance of activity may play a role in fostering disability in whiplash-associated disorders (WAD). This study examined the role of fear after WAD and assessed the effectiveness of 3 treatments targeting fear. People still symptomatic from WAD grade I-II injuries approximately 3months previously (n=191) completed questionnaires (eg, Neck Disability Index [NDI]) and were randomized to 1 of the treatments: (1) informational booklet (IB) describing WAD and the importance of resuming activities, (2) IB+didactic discussions (DD) with clinicians reinforcing the booklet, and (3) IB+imaginal and direct exposure desensitization (ET) to feared activities. DD and ET participants received three 2-hour treatment sessions. Absolute improvements in NDI were in predicted direction (ET=14.7, DD=11.9, IB=9.9). ETs reported significantly less posttreatment pain severity compared with the IB (Mean=1.5 vs 2.3, P<.001, d=0.6) and DD (M=1.5 vs 2.0, P=.039, d=0.6) groups. Reduction in fear was the most important predictor of improvement in NDI (β=0.30, P<.001), followed by reductions in pain (β=0.20, P=.003) and depression (β=0.18, P=.004). The mediational analysis confirmed that fear reduction significantly mediated the effect of treatment group on outcome. Results highlight the importance of fear in individuals with subacute WAD and suggest the importance of addressing fear via exposure therapy and/or educational interventions to improve function.
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Affiliation(s)
- James P Robinson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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