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Cabell GH, Kwon NF, Sutton KF, Lentz TA, Lewis BD, Olson S, Mather RC. Pain-Associated Psychological Distress Is of High Prevalence in Patients With Hip Pain: Characterizing Psychological Distress and Phenotypes. Arthrosc Sports Med Rehabil 2024; 6:100846. [PMID: 38260823 PMCID: PMC10801259 DOI: 10.1016/j.asmr.2023.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/11/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose To identify common pain-related psychological factors among patients seeking care for athletic hip pain, as well as characterize psychological distress phenotypes and compare hip-specific quality-of-life measures across those phenotypes. Methods A total of 721 patients were recruited from hip preservation clinics. The Optimal Screening for Prediction of Referral and Outcome-Yellow Flag Assessment Tool (OSPRO-YF) was used to identify the presence or absence of 11 different pain-associated psychological distress characteristics (yellow flags), while the International Hip Outcome Tool-12 (iHOT-12) was used to assess hip-related quality of life. Latent class analysis identified patient subgroups (phenotypes) based on naturally occurring combinations of distress characteristics. An analysis of variance was used to compare demographics, number of yellow flags, and iHOT-12 scores across phenotypes. Results The median (interquartile range) number of yellow flags was 6 (3-9), with 13.5% of the sample reporting 11 yellow flags. Latent class analysis (L2 = 543.3, classification errors = 0.082) resulted in 4 phenotypes: high distress (n = 299, 41.5%), low distress (n = 172, 23.9%), low self-efficacy and acceptance (n = 74, 10.3%), and negative pain coping (n = 276, 24.4%). Significant differences in mean yellow flags existed between all phenotypes except low self-efficacy and negative pain coping. There were no differences in demographics between phenotypes. The high distress class had the lowest mean iHOT-12 score (mean [SD], 23.5 [17.6]), with significant differences found between each phenotypic class. Conclusions There was a high prevalence of pain-associated psychological distress in patients presenting to tertiary hip arthroscopy clinics with hip pain. Furthermore, hip quality-of-life outcome scores were uniformly lower in patients with higher levels of psychological distress. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Grant H Cabell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Nicholas F Kwon
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, California, U.S.A
| | - Kent F Sutton
- Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
- Duke Clinical Research Institute, Durham, North Carolina, U.S.A
| | - Brian D Lewis
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Steven Olson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Richard C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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Ghio D, Brookes N, Preece S, Walsh N. From sceptic to believer: Acceptability of cognitive muscular therapy TM , a new intervention for knee osteoarthritis. Musculoskeletal Care 2023; 21:1639-1650. [PMID: 37971188 DOI: 10.1002/msc.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Cognitive Muscular TherapyTM (CMT) is an integrated behavioural intervention developed for knee osteoarthritis. CMT teaches patients to reconceptualise the condition, integrates muscle biofeedback and aims to reduce muscle overactivity, both in response to pain and during daily activities. This nested qualitative study explored patient and physiotherapist perspectives and experiences of CMT. METHODS Five physiotherapists were trained to follow a well-defined protocol and then delivered CMT to at least two patients with knee osteoarthritis. Each patient received seven individual clinical sessions and was provided with access to online learning materials incorporating animated videos. Semi-structured interviews took place after delivery/completion of the intervention and data were analysed at the patient and physiotherapist level. RESULTS Five physiotherapists and five patients were interviewed. All described a process of changing beliefs throughout their engagement with CMT. A framework with three phases was developed to organise the data according to how osteoarthritis was conceptualised and how this changed throughout their interactions with CMT. Firstly, was an identification of pain beliefs to be challenged and recognition of how current beliefs can misalign with daily experiences. Secondly was a process of challenging and changing beliefs, validated through new experiences. Finally, there was an embedding of changed beliefs into self-management to continue with activities. CONCLUSION This study identified a range of psychological changes which occur during exposure to CMT. These changes enabled patients to reconceptualise their condition, develop a new understanding of their body, understand psychological processes, and make sense of their knee pain.
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Affiliation(s)
- Daniela Ghio
- Division of Psychology and Mental Health, Faculty of Biology, School of Health Sciences, Medicine, and Health, University of Manchester, Manchester, UK
| | - Nathan Brookes
- School of Health and Society, Health Sciences, University of Salford, Manchester, UK
| | - Stephen Preece
- School of Health and Society, Health Sciences, University of Salford, Manchester, UK
| | - Nicola Walsh
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
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3
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Ariie T, Takasaki H, Okoba R, Chiba H, Handa Y, Miki T, Taito S, Tsutsumi Y, Morita M. The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis. PM R 2023; 15:1012-1025. [PMID: 36152318 DOI: 10.1002/pmrj.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/17/2022] [Accepted: 08/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this systematic review with meta-analysis was to examine the effectiveness of exercise with behavior change techniques (BCTs) on core outcome sets in people with knee osteoarthritis. LITERATURE SURVEY We searched randomized controlled trials (RCTs) in eight databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, ICTRP, and ClinicalTrials.gov) up to November 4, 2021. METHODOLOGY Eligible participants were people with knee osteoarthritis. The intervention was exercise with BCTs. Primary outcomes included physical function, quality of life (QOL) 6 to 12 months after intervention, and adverse events. Secondary outcomes were knee pain, exercise adherence, mobility, and self-efficacy 3 months or more after intervention. The bias risk was assessed using the Risk of Bias 2 tool. The random-effects model was used for the meta-analysis. SYNTHESIS We found 16 individual BCTs, and 37.7% of trials used a single BCT. For meta-analysis, we included 21 RCTs (n = 1623). Most outcomes had a very low certainty of evidence, and the risk of bias was the consistent reason for downgrading evidence levels. The standardized mean difference (SMD) with 95% confidence interval (95% CI) was 0.00 (-0.24, 0.24) in physical function, 0.33 (-0.51, 1.17) in exercise adherence, and 0.04 (-0.39, 0.47) in self-efficacy. The risk ratio (95% CI) of adverse events was 3.6 (0.79, 16.45). QOL was not pooled due to insufficient data (very low certainty of evidence). In contrast, the SMD (95% CI) for knee pain reduction and mobility improvement was -0.33 (-0.53, -0.13) and 0.21 (-0.05, 0.47) with moderate and low certainty of evidence, respectively. CONCLUSION The evidence is inconclusive regarding the effectiveness of BCTs with exercises on core outcome sets. Further research should explore the effectiveness of BCTs with valid design. PROTOCOL REGISTRATION PROSPERO (CRD42020212904).
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Affiliation(s)
- Takashi Ariie
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Saitama, Japan
| | - Ryota Okoba
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Hiroki Chiba
- Graduate school of Rehabilitation Science, Saitama Prefectural University, Saitama, Japan
| | - Yusuke Handa
- Graduate school of Rehabilitation Science, Saitama Prefectural University, Saitama, Japan
| | - Takahiro Miki
- Graduate school of Rehabilitation Science, Saitama Prefectural University, Saitama, Japan
| | - Shunsuke Taito
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yusuke Tsutsumi
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Masaharu Morita
- Department of Physical Therapy, Health Sciences at Odawara, International University of Health and Welfare, Kanagawa, Japan
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Smith KM, Massey BJ, Young JL, Rhon DI. What are the unsupervised exercise adherence rates in clinical trials for knee osteoarthritis? A systematic review. Braz J Phys Ther 2023; 27:100533. [PMID: 37597491 PMCID: PMC10462806 DOI: 10.1016/j.bjpt.2023.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/11/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Exercise is an effective intervention for knee osteoarthritis (OA), and unsupervised exercise programs should be a common adjunct to most treatments. However, it is unknown if current clinical trials are capturing information regarding adherence. OBJECTIVE To summarize the extent and quality of reporting of unsupervised exercise adherence in clinical trials for knee OA. METHODS Reviewers searched five databases (PubMed, CINAHL, Medline (OVID), EMBASE and Cochrane). Randomized controlled trials where participants with knee OA engaged in an unsupervised exercise program were included. The extent to which exercise adherence was monitored and reported was assessed and findings were subgrouped according to method for tracking adherence. The types of adherence measurement categories were synthesized. A quality assessment was completed using the Physiotherapy Evidence Database (PEDro) scores. RESULTS Of 3622 abstracts screened, 176 studies met criteria for inclusion. PEDro scores for study quality ranged from two to ten (mean=6.3). Exercise adherence data was reported in 72 (40.9%) studies. Twenty-six (14.8%) studies only mentioned collection of adherence. Adherence rates ranged from 3.7 to 100% in trials that reported adherence. For 18 studies (10.2%) that tracked acceptable adherence, there was no clear superiority in treatment effect based on adherence rates. CONCLUSIONS Clinical trials for knee OA do not consistently collect or report adherence with unsupervised exercise programs. Slightly more than half of the studies reported collecting adherence data while only 40.9% reported findings with substantial heterogeneity in tracking methodology. The clinical relevance of these programs cannot be properly contextualized without this information.
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Affiliation(s)
- Kristin M Smith
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA.
| | - B James Massey
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA; Department of Physical Therapy, Wingate University, Wingate, NC, USA
| | - Jodi L Young
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA; Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Hamada K, Tamura H, Hirohama K, Mitsutake T, Imura T, Tanaka S, Tanaka R. The effectiveness of group education in people over 50 years old with knee pain: A systematic review and meta-analysis of randomized control trials. Musculoskelet Sci Pract 2022; 62:102627. [PMID: 35926473 DOI: 10.1016/j.msksp.2022.102627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND International guidelines recommend educational intervention to treat knee osteoarthritis. However, they do not specify the type of intervention and the effectiveness of group educational intervention for knee pain is unclear. OBJECTIVES We aimed to examine the effectiveness of group educational interventions for people over 50 years old with knee pain compared with a control group. DESIGN A systematic review and meta-analysis of randomized controlled trials (RCTs). METHOD We searched Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature and screened for RCTs involving participants over 50 years old that reported the effects of group education on knee pain. We performed meta-analyses and evaluated the methodological quality and evidence quality using the Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively. RESULTS The search retrieved 1,177 studies. Seven RCTs were ultimately included, four of which were subjected to meta-analysis, showing standardized mean differences of -0.22 (95% confidence interval [CI]: -0.42 to -0.02, n = 423; I2 = 0% GRADE: low). All studies included in the meta-analysis involved exercise without individualized instruction in addition to group educational intervention. CONCLUSIONS Group education, when delivered in addition to exercises, significantly reduces knee pain in people over 50 years old.
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Affiliation(s)
- Kazuaki Hamada
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Wako Orthopedic Clinic, Hiroshima, Japan.
| | - Hiroyuki Tamura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; NEC Livex,Ltd., Karada Care Business Promotion Office, Tokyo, Japan
| | - Kenta Hirohama
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Sakamidorii Hospital, Hiroshima, Japan
| | - Tsubasa Mitsutake
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Department of Physical Therapy, Fukuoka International University of Health and Welfare, Japan
| | - Takeshi Imura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Shigeharu Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan.
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6
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Nagasawa Y, Shibata A, Fukamachi H, Ishii K, Oka K. Physical therapist-delivered acceptance and commitment therapy and exercise for older outpatients with knee osteoarthritis: a pilot randomized controlled trial. J Phys Ther Sci 2022; 34:784-790. [PMID: 36507082 PMCID: PMC9711971 DOI: 10.1589/jpts.34.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
[Purpose] In this pilot study, we investigated the effectiveness of physical therapist-delivered acceptance and commitment therapy in older outpatients with knee osteoarthritis and chronic pain. [Participants and Methods] This single-center, open-label, parallel-group pilot randomized controlled trial included 30 patients assigned to the physical therapist-delivered acceptance and commitment therapy group (n=15) and the usual care physical therapy-only group (n=15). Both treatments were administered once a week for 8 weeks. Evaluation was performed 4 weeks before intervention, pre-intervention, post-intervention, and 4 weeks after intervention. The primary outcome was diagnosis of a physical disability, and secondary outcomes included psychological inflexibility, pain intensity, anxiety, depression, physical function, and objectively measured physical activity. [Results] Physical therapist-delivered acceptance and commitment therapy had a limited effect on physical disability, although we observed a favorable tendency. With regard to secondary outcomes, physical therapist-delivered acceptance and commitment therapy did not show significant effects. Notably, 15 patients withdrew from this study and 6 were diagnosed with coronavirus disease. [Conclusion] Physical therapist-delivered acceptance and commitment therapy did not appear to show significant effects in the present study. It is necessary to correct these issues in this study, and future studies are warranted to investigate the effects of this therapy.
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Affiliation(s)
- Yasuhiro Nagasawa
- Department of Rehabilitation, Hasegawa Hospital: 85
Yachimatani, Yachimata, Chiba 289-1103, Japan, Graduate School of Sport Sciences, Waseda University,
Japan,Corresponding author. Yasuhiro Nagasawa (E-mail: ) (Supplementary
materials: refer to PMC https://www.ncbi.nlm.nih.gov/pmc/journals/2193/)
| | - Ai Shibata
- Faculty of Health and Sports Sciences, University of
Tsukuba, Japan
| | | | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Japan
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Knee Osteoarthritis Education Interventions in Published Trials Are Typically Unclear, Not Comprehensive Enough, and Lack Robust Development: Ancillary Analysis of a Systematic Review. J Orthop Sports Phys Ther 2022; 52:276-286. [PMID: 34905960 DOI: 10.2519/jospt.2022.10771] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To summarize the content, development, and delivery of education interventions in clinical trials for people with knee osteoarthritis (OA). DESIGN Ancillary analysis of a systematic review. LITERATURE SEARCH MEDLINE, EMBASE, SPORTDiscus, CINAHL, and Web of Science were searched from inception to April 2020. STUDY SELECTION CRITERIA Randomized controlled trials involving patient education for people with knee OA. DATA SYNTHESIS Content of education interventions was matched against a predefined topic list (n = 14) and categorized as accurate and clear, partially accurate/lacks clarity, or not reported. We examined whether education interventions included skill development or stated learning objectives and if they were developed based on theory, previous research, or codesign principles. Delivery methods and mode(s) were also identified. Data were summarized descriptively. RESULTS Thirty-eight education interventions (30 trials) were included. Interventions lacked comprehensiveness (median topics per intervention = 3/14, range = 0-11). Few topics were accurately and clearly described (10%, 13/136). Sixty-one percent (n = 23/38) of interventions targeted skill development, and 34% (n = 13/38) identified learning objectives. Forty-two percent (n = 16/38) were based on theory; 45% (n = 17/38) were based on research for chronic conditions, including 32% (n = 12/38) based on OA. Eleven percent of interventions (n = 4/38) were codesigned. Education was typically facilitated through face-to-face sessions (median = 9, range = 0-55), supplemented with telephone calls and/or written materials. CONCLUSION Education interventions for people with knee OA lacked comprehensiveness plus accurate and clear descriptions of topics covered. Most interventions failed to identify learning objectives and were not based on theory, previous research, or codesign principles. J Orthop Sports Phys Ther 2022;52(5):276-286. Epub 14 Dec 2021. doi:10.2519/jospt.2022.10771.
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Rognsvåg T, Lindberg MF, Lerdal A, Stubberud J, Furnes O, Holm I, Indrekvam K, Lau B, Rudsengen D, Skou ST, Badawy M. Development of an internet-delivered cognitive behavioral therapy program for use in combination with exercise therapy and education by patients at increased risk of chronic pain following total knee arthroplasty. BMC Health Serv Res 2021; 21:1151. [PMID: 34696785 PMCID: PMC8546935 DOI: 10.1186/s12913-021-07177-7] [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: 05/19/2021] [Accepted: 10/14/2021] [Indexed: 12/27/2022] Open
Abstract
Background Approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Due to the growing number of TKA procedures, this will affect an increasing number of people worldwide. Catastrophic thinking, dysfunctional illness perception, poor mental health, anxiety and depression characterize these non-improvers, and indicate that these patients may need individualized treatment using a treatment approach based on the bio-psycho-social health model. The present study developed an internet-delivered cognitive behavioral therapy (iCBT) program to be combined with exercise therapy and education for patients with knee osteoarthritis (OA) at increased risk of chronic pain after TKA. Methods The development process followed the first two phases of the UK Medical Research Council framework for complex interventions. In the development phase, the first prototype of the iCBT program was developed based on literature review, established iCBT programs and multidisciplinary workshops. The feasibility phase consisted of testing the program, interviewing users, condensing the program, and tailoring it to the patient group. A physiotherapist manual was developed and adapted to physiotherapists who will serve as mentors. Results The development process resulted in an iCBT program consisting of 10 modules with educational texts, videos and exercises related to relevant topics such as goalsetting, stress and pain, lifestyle, automatic thoughts, mindfulness, selective attention, worry and rumination. A physiotherapist manual was developed to guide the physiotherapists in supporting the patients through the program and to optimize adherence to the program. Conclusions The iCBT program is tailored to patients at risk of chronic pain following TKA, and may be useful as a supplement to surgery and/or exercise therapy. A multicentre RCT will evaluate the iCBT program in combination with an exercise therapy and education program. This novel intervention may be a valuable contribution to the treatment of OA patients at risk of chronic pain after TKA. Trial registration The RCT is pre-registered at ClinicalTrials.gov: NCT03771430 11/12/2018.
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Affiliation(s)
- Turid Rognsvåg
- Coastal Hospital in Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Hagaviksbakken 25, N-5217, Hagavik, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Maren Falch Lindberg
- Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Inger Holm
- Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.,Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kari Indrekvam
- Coastal Hospital in Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Hagaviksbakken 25, N-5217, Hagavik, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bjørn Lau
- Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Daniil Rudsengen
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mona Badawy
- Coastal Hospital in Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Hagaviksbakken 25, N-5217, Hagavik, Norway
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Pitsillides A, Stasinopoulos D, Giannakou K. The effects of cognitive behavioural therapy delivered by physical therapists in knee osteoarthritis pain: A systematic review and meta-analysis of randomized controlled trials. J Bodyw Mov Ther 2020; 25:157-164. [PMID: 33714488 DOI: 10.1016/j.jbmt.2020.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/14/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent evidence suggests that knee osteoarthritis (KOA) chronic pain can result in brain structural and organizational changes. Thus, patients' pain level, emotional status, and perception of their condition might be negatively altered. An approach to reverse such adaptations to chronic pain is cognitive behavioural therapy (CBT). Combining CBT with exercise might enhance therapy outcomes. OBJECTIVES To identify the effect of combining exercise and CBT when delivered by a physical therapist in KOA pain. METHODS A systematic search in PubMed, Cochrane, and Medline Complete (EBSCO) databases was conducted from their inception to March 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study risk of bias and quality were assessed through the Risk-of-bias 2 (ROB2) and PEDro scales. RESULTS Six primary studies met eligibility criteria. All studies had a low risk of bias and were divided into two sub-groups, in-person interventions and distance interventions. Both groups of studies showed within group participant improvements. In regards of WOMAC pain subscale, our meta-analysis revealed an overall deduction of -1.42 (95% CI: -1.76, -1.09; I2 = 58%), -1.62 (95% CI: -1.97, -1.27; I2 = 0%) in centre-based intervention, and -1.28 (95% CI: -1.75, -0.81; I2 = 73%) in distance delivered intervention. CONCLUSION Combining exercise and CBT seems to be an effective method to reduce KOA pain, although it is based on a small number of studies. Further studies are needed to reveal any differences when each intervention is applied separately.
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Affiliation(s)
- Alexios Pitsillides
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus.
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10
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Wang L, Zhang L, Yang L, Cheng-Qi H. Effectiveness of pain coping skills training on pain, physical function, and psychological outcomes in patients with osteoarthritis: A systemic review and meta-analysis. Clin Rehabil 2020; 35:342-355. [PMID: 33103915 DOI: 10.1177/0269215520968251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effectiveness of pain coping skills training in pain, function, and psychological outcomes for patients with osteoarthritis, compared to the control group; and to compare the effectiveness of pain coping skills training between the intervention involving and without involving exercise. DATA SOURCES PubMed, Embase, the Cochrane Library, PEDro, Clinical Trials, and the WHO Clinical Trials Registry Platform (to 30 September 2020). REVIEW METHODS To calculate the results, we used standardized mean difference, and mean difference for the outcomes of continuous variables, risk difference for the risk of adverse events. Heterogeneity was identified with I2 test, and publication bias was identified with Egger's test. RESULTS A total of 1195 patients with osteoarthritis underwent ten trials were included. The intervention group had significant differences in pain (SMD = -0.18; 95% CI -0.29 to -0.06), function (SMD = -0.19; -0.30 to -0.07), coping attempts (SMD = 0.37; 0.24 to 0.49), pain catastrophizing (SMD = -0.16; -0.29 to -0.02), and self-efficacy (SMD = 0.27; 0.07 to 0.46) than the control group. Between-group differences measured by the McMaster Universities Osteoarthritis Index subscales of pain (MD = -0.62; -1.48 to 0.24) or function (MD = -3.01; -6.26 to 0.24) were not statistically significant and did not reach the minimal clinically important differences that have been established. Subgroup analyses revealed no significant subgroup differences. Besides, no specific intervention-related adverse events were identified. CONCLUSION Our results supported the effectiveness and safety of pain coping skills training for managing osteoarthritis in pain, function, and psychological aspects. Besides, exercise could not add benefits when combined with pain coping skills training.
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Affiliation(s)
- Lin Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Liming Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Lin Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - He Cheng-Qi
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
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Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials. Pain Rep 2020; 5:e847. [PMID: 33490842 PMCID: PMC7808677 DOI: 10.1097/pr9.0000000000000847] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Randomized trials have examined the efficacy of psychologically informed physical therapy methods including graded activity or graded exposure, cognitive-behavioral-based physical therapy, acceptance and commitment-based physical therapy, and internet-based psychological programs compared to traditional physical therapy approaches for musculoskeletal pain. Summary findings suggest that psychologically informed physical therapy is a promising care model; however, more convincing evidence is needed to support widespread adoption, especially in light of clinician training demands. Psychologically informed physical therapy (PIPT) blends psychological strategies within a physical therapist's treatment approach for the prevention and management of chronic musculoskeletal pain. Several randomized trials have been conducted examining the efficacy of PIPT compared to standard physical therapy on important patient-reported outcomes of disability, physical function, and pain. In this review, we examine recent trials published since 2012 to describe current PIPT methods, discuss implications from findings, and offer future directions. Twenty-two studies, representing 18 trials, were identified. The studied PIPT interventions included (1) graded activity or graded exposure (n = 6), (2) cognitive-behavioral-based physical therapy (n = 9), (3) acceptance and commitment-based physical therapy (n = 1), and (4) internet-based psychological programs with physical therapy (n = 2). Consistent with prior reviews, graded activity is not superior to other forms of physical activity or exercise. In a few recent studies, cognitive-behavioral-based physical therapy had short-term efficacy when compared to a program of standardized exercise. There is a need to further examine approaches integrating alternative strategies including acceptance-based therapies (ie, acceptance and commitment therapy or mindfulness) or internet-based cognitive-behavioral programs within physical therapy. Although PIPT remains a promising care model, more convincing evidence is needed to support widespread adoption, especially in light of training demands and implementation challenges.
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12
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van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care 2020; 18:575-595. [PMID: 32643252 DOI: 10.1002/msc.1492] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this paper is to revise the 2010 Dutch guideline for physical therapy (PT) in patients with hip or knee osteoarthritis (OA), issued by the Royal Dutch Society for Physical Therapy (KNGF). METHOD This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation (AGREE) and Guidelines International Network (G-I-N) standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers to current care. A narrative or systematic literature review was undertaken in response to each clinical question. The panel formulated recommendations based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence-to-Decision framework. RESULTS A comprehensive assessment should be based on the International Classification of Functioning Disability and Health (ICF) core set for OA, including the identification of OA-related red flags. Based on the assessment, four treatment profiles were distinguished: (1) education and instructions for unsupervised exercises, (2) education and short-term supervised exercise therapy, (3) education and longer term supervised exercise therapy, and (4) education and exercise therapy before and/or after total hip or knee surgery. Education included individualized information, advice, instructions, and self-management support. Exercise programs were tailored to individual OA-related issues, were adequately dosed, and were in line with public health recommendations for physical activity. Recommended measurement instruments included the Patient-Specific Complaints Instrument, the Numeric Pain Rating Scale, the Hip Disability and Osteoarthritis Outcome Score/the Knee Injury Osteoarthritis Outcome Score, and the Six Minute Walk Test. CONCLUSION An evidence-based PT guideline for the management of patients with hip or knee OA was developed. To improve quality of care for these patients, an extensive implementation strategy is necessary.
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Affiliation(s)
| | - Guus A Meerhoff
- Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, The Netherlands.,Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
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13
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Schulz JM, Birmingham TB, Atkinson HF, Woehrle E, Primeau CA, Lukacs MJ, Al-Khazraji BK, Khan MCM, Zomar BO, Petrella RJ, Beier F, Appleton CT, Shoemaker JK, Bryant DM. Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2019; 54:771-775. [DOI: 10.1136/bjsports-2018-100231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesWe systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.Data sourcesPubMed, CINAHL, Scopus; inception to January 2019.Eligibility criteriaRandomised clinical trials (RCT), cohort studies, case series.DesignWe summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models.ResultsInterventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (−3.56 beats per minute; 95% CI −5.60 to −1.52) and DBP (−4.10 mm Hg; 95% CI −4.82 to −3.38) and no change in SBP (−0.36 mm Hg; 95% CI −3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI −0.11 to 0.85). Within-group differences were also small to moderate.ConclusionsIn studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.PROSPERO registration numberCRD42018087859.
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A Systematic Review and Meta-Analysis of the Effectiveness of Psychological Interventions Delivered by Physiotherapists on Pain, Disability and Psychological Outcomes in Musculoskeletal Pain Conditions. Clin J Pain 2019; 34:838-857. [PMID: 29554030 DOI: 10.1097/ajp.0000000000000601] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis examined the effectiveness of physiotherapist delivered psychological interventions combined with physiotherapy on pain, disability, and psychological outcomes for patients with musculoskeletal pain conditions. METHODS The review was conducted in accordance with the (PRISMA) guidelines. Five databases were systematically searched for randomized controlled trials from inception to May 2016. Studies were required to compare a psychological intervention delivered by physiotherapists combined with physiotherapy to physiotherapy alone or usual care. Physiotherapists delivering the interventions must have undergone training by a psychologist or a health professional trained in the delivery of psychological interventions. RESULTS A total of 34 articles met the eligibility criteria, of those, 30 were suitable for meta-analysis. There was low to high quality evidence that physiotherapist delivered psychological intervention combined with physiotherapy decreased pain in the short (26 studies, mean difference=-0.37; 95% confidence interval [CI], -0.65 to -0.09) and long term (22 studies, mean difference=-0.38; 95% CI, -0.67 to -0.10) and decreased disability in the short term (29 studies, standardized mean difference =-0.14; 95% CI, -0.26 to -0.01). Effect sizes were small. Low to high quality evidence demonstrated small to medium effects for some psychological outcomes at short-term and long-term follow-ups. DISCUSSION The results indicate that psychological interventions delivered by physiotherapist show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions.
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Willett M, Duda J, Fenton S, Gautrey C, Greig C, Rushton A. Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: A systematic review. PLoS One 2019; 14:e0219482. [PMID: 31291326 PMCID: PMC6619772 DOI: 10.1371/journal.pone.0219482] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/25/2019] [Indexed: 01/02/2023] Open
Abstract
Background Lower limb osteoarthritis (OA) causes high levels of individual pain and disability and is an increasing socio-economic burden to global healthcare systems. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms. Objective To identify and evaluate the effectiveness of behavioural change techniques (BCTs) within physiotherapy interventions to increase physical activity (PA) adherence in patients with lower limb OA. Design A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted searches, determined eligibility, assessed risk of bias (Cochrane tool), intervention fidelity (NIHBCC checklist), and coded randomised controlled trials (RCTs) for BCTs (V1 taxonomy). BCT effectiveness ratios were calculated and RCT risk of bias and intervention fidelity were summarised narratively. Data sources A highly sensitive search strategy was conducted on Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro and grey literature databases from inception to January 2nd, 2018. Reference lists of included RCTs and relevant articles were reviewed, and a citation search was conducted using Web of Science. Eligibility criteria for selecting studies RCTs that evaluated the effectiveness of a physiotherapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower limb osteoarthritis. Results Twenty-four RCTs (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included. Heterogeneity of intervention BCTs and PA adherence outcome measures precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions across RCTs. In general, BCTs demonstrated higher effectiveness ratios for short-term and long-term PA adherence compared with medium-term outcomes. The BCTs ‘behavioural contract’, ‘non-specific reward’, ‘patient-led goal setting’ (behaviour), ‘self-monitoring of behaviour’, and ‘social support (unspecified) demonstrated the highest effectiveness ratios across time points to promote PA adherence. Conclusions BCTs demonstrate higher short and long-term than medium-term effectiveness ratios. Further research involving low RoB RCTs incorporating transparently reported interventions with pre-specified BCTs aimed at optimising lower limb OA patient PA adherence is required.
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Affiliation(s)
- Matthew Willett
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Sally Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Charlotte Gautrey
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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16
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Marris D, Theophanous K, Cabezon P, Dunlap Z, Donaldson M. The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials. Physiother Theory Pract 2019; 37:461-472. [PMID: 31250682 DOI: 10.1080/09593985.2019.1633714] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Study Design: Systematic Review with meta-analysis.Background: Rehabilitation providers have begun to incorporate pain education into their treatment protocols to influence the patient's experience and knowledge to improve their condition. The purpose of this systematic review is to determine if the addition of pain education strategies to physical therapy treatments is beneficial in reducing pain intensity and disability for those with chronic musculoskeletal pain.Methods: A systematic database search was conducted for randomized control trials that investigated the concurrent use of pain education and physical therapy. Standardized methods for article identification, inclusion, and quality appraisal was utilized. Where possible, studies were pooled for meta-analysis, with pain and disability as the primary outcomes.Results: Fourteen articles were included in this review, of which all fourteen were rated as high quality using the PEDro scale of quality assessment. Meta-analyses were conducted on pain and disability constructs at short term (< 12 weeks) and long-term (≥ 12 weeks) for the studies that allowed for quantitative pooling of effect sizes. Thirteen out of the fourteen included studies demonstrated a decrease in pain and disability with the use of combined interventions. There was a large effect on short-term pain (SMD 0.837), long-term pain (SMD 0.964), and long-term disability (SMD 1.374). A moderate effect on with short-term disability (SMD 0.791).Conclusion: The results of this systematic review support the conclusion that utilizing pain education strategies in conjunction with interventions provided by physical therapists demonstrates a moderate to large effect sizes on pain and disability constructs but lack pooled statistical significance.
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Affiliation(s)
- Danielle Marris
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | | | - Pablo Cabezon
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | - Zachary Dunlap
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | - Megan Donaldson
- School of Medicine, Public Health and Community Medicine, Tufts University, Boston, MA, USA
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Abstract
Rheumatic diseases usually progress towards morphological and functional deficits and thus cause impairment of physical health and function. Based on this fact, physiotherapeutic options are elementary and indispensable. This article focuses on the significance and importance of physiotherapy in inflammatory and degenerative rheumatic diseases. Furthermore, an overview is presented on the consequences of rheumatic diseases, the reality of supply of physiotherapy, the principles and therapeutic options, and the evidence.
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18
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Gatchel RJ, Reuben DB, Dagenais S, Turk DC, Chou R, Hershey AD, Hicks GE, Licciardone JC, Horn SD. Research Agenda for the Prevention of Pain and Its Impact: Report of the Work Group on the Prevention of Acute and Chronic Pain of the Federal Pain Research Strategy. THE JOURNAL OF PAIN 2018; 19:837-851. [DOI: 10.1016/j.jpain.2018.02.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 01/13/2023]
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19
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Lluch E, Dueñas L, Falla D, Baert I, Meeus M, Sánchez-Frutos J, Nijs J. Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial. Clin J Pain 2018; 34:44-52. [PMID: 28514231 DOI: 10.1097/ajp.0000000000000511] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables. MATERIALS AND METHODS Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery. RESULTS Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery. DISCUSSION Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.
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Affiliation(s)
- Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain.,Departments of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel.,Pain in Motion International Research Group
| | - Lirios Dueñas
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Isabel Baert
- Pain in Motion International Research Group.,MovAnt, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp
| | - Mira Meeus
- Pain in Motion International Research Group.,MovAnt, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Jo Nijs
- Departments of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel.,Pain in Motion International Research Group
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20
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Niknejad B, Bolier R, Henderson CR, Delgado D, Kozlov E, Löckenhoff CE, Reid MC. Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:830-839. [PMID: 29801109 PMCID: PMC6145761 DOI: 10.1001/jamainternmed.2018.0756] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Chronic noncancer pain (hereafter referred to as chronic pain) is common among older adults and managed frequently with pharmacotherapies that produce suboptimal outcomes. Psychological treatments are recommended, but little information is available regarding their efficacy in older adults. OBJECTIVE To determine the efficacy of psychological interventions in older adults with chronic pain and whether treatment effects vary by participant, intervention, and study characteristics. DATA SOURCES MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from inception to March 29, 2017. STUDY SELECTION Analysis included studies that (1) used a randomized trial design, (2) evaluated a psychological intervention that used cognitive behavioral modalities alone or in combination with another strategy, (3) enrolled individuals with chronic pain (pain ≥3 months) with a sample mean age of 60 years or older, and (4) reported preintervention and postintervention quantitative data. DATA EXTRACTION AND SYNTHESIS Two of the authors independently extracted data. A mixed-model meta-analysis tested the effects of treatment on outcomes. Analyses were performed to investigate the association between participant (eg, age), intervention (eg, treatment mode delivery), and study (eg, methodologic quality) characteristics with outcomes. MAIN OUTCOMES AND MEASURES Pain intensity was the primary outcome; secondary outcomes included pain interference, depressive symptoms, anxiety, catastrophizing beliefs, self-efficacy for managing pain, physical function, and physical health. RESULTS Twenty-two studies with 2608 participants (1799 [69.0%] women) were analyzed. Participants' mean (SD) age was 71.9 (7.1) years. Differences of standardized mean differences (dD) at posttreatment were pain intensity (dD = -0.181, P = .006), pain interference (dD = -0.133, P = .12), depressive symptoms (dD = -0.128, P = .14), anxiety (dD = -0.205, P = .09), catastrophizing beliefs (dD = -0.184, P = .046), self-efficacy (dD = 0.193, P = .02), physical function (dD = 0.006, P = .96), and physical health (dD = 0.160, P = .24). There was evidence of effects persisting beyond the posttreatment assessment only for pain (dD = -0.251, P = .002). In moderator analyses, only mode of therapy (group vs individual) demonstrated a consistent effect in favor of group-based therapy. CONCLUSIONS AND RELEVANCE Psychological interventions for the treatment of chronic pain in older adults have small benefits, including reducing pain and catastrophizing beliefs and improving pain self-efficacy for managing pain. These results were strongest when delivered using group-based approaches. Research is needed to develop and test strategies that enhance the efficacy of psychological approaches and sustainability of treatment effects among older adults with chronic pain.
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Affiliation(s)
- Bahar Niknejad
- Department of Medicine, Eastern Virginia Medical School, Norfolk
| | - Ruth Bolier
- GERION, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Diana Delgado
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York
| | - Elissa Kozlov
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Hoglund LT, Pontiggia L, Kelly JD. A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study. Pilot Feasibility Stud 2018; 4:70. [PMID: 29636983 PMCID: PMC5889597 DOI: 10.1186/s40814-018-0262-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Background Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA. Methods Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate. Results At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention. Conclusions PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise. Trial registration ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).
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Affiliation(s)
- Lisa T Hoglund
- 1Department of Physical Therapy, Thomas Jefferson University, 901 Walnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Laura Pontiggia
- 2Department of Mathematics, Physics and Statistics, University of the Sciences, Philadelphia, PA USA
| | - John D Kelly
- 3Department of Sports Medicine and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
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22
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Briani RV, Ferreira AS, Pazzinatto MF, Pappas E, De Oliveira Silva D, Azevedo FMD. What interventions can improve quality of life or psychosocial factors of individuals with knee osteoarthritis? A systematic review with meta-analysis of primary outcomes from randomised controlled trials. Br J Sports Med 2018; 52:1031-1038. [PMID: 29549150 DOI: 10.1136/bjsports-2017-098099] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review evidence of primary outcomes from randomised controlled trials (RCTs) examining the effect of treatment strategies on quality of life (QoL) or psychosocial factors in individuals with knee osteoarthritis (OA). DESIGN Systematic review with meta-analysis. DATA SOURCES Medline, Embase, SPORTDiscus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from inception to November 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included RCTs investigating the effect of conservative interventions on QoL or psychosocial factors in individuals with knee OA. Only RCTs considering these outcomes as primary were included. RESULTS Pooled data supported the use of exercise therapy compared with controls for improving health-related and knee-related QoL. There was limited evidence that a combined treatment of yoga, transcutaneous electrical stimulation and ultrasound may be effective in improving QoL. Limited evidence supported the use of cognitive behavioural therapies (with or without being combined with exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress. SUMMARY/CONCLUSION Exercise therapy (with or without being combined with other interventions) seems to be effective in improving health-related and knee-related QoL or psychosocial factors of individuals with knee OA. In addition, evidence supports the use of cognitive behavioural therapies (with or without exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress in individuals with knee OA. PROSPERO REGISTRATION NUMBER CRD42016047602.
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Affiliation(s)
- Ronaldo Valdir Briani
- School of Science and Technology, Laboratory of Biomechanics and Motor Control (LABCOM), São Paulo State University, Presidente Prudente, Brazil
| | - Amanda Schenatto Ferreira
- School of Science and Technology, Laboratory of Biomechanics and Motor Control (LABCOM), São Paulo State University, Presidente Prudente, Brazil
| | - Marcella Ferraz Pazzinatto
- School of Science and Technology, Laboratory of Biomechanics and Motor Control (LABCOM), São Paulo State University, Presidente Prudente, Brazil
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Danilo De Oliveira Silva
- La Trobe Sports and Exercise Medicine Research Centre (LASEM), La Trobe University, School of Allied Health, Melbourne, Victoria, Australia
| | - Fábio Mícolis de Azevedo
- School of Science and Technology, Laboratory of Biomechanics and Motor Control (LABCOM), São Paulo State University, Presidente Prudente, Brazil
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23
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Weiser S, Lis A, Ziemke G, Hiebert R, Faulkner D, Brennan T, Iveson B, Campello M. Feasibility of Training Physical Therapists to Implement a Psychologically Informed Physical Therapy Program for Deployed U.S. Sailors and Marines with Musculoskeletal Injuries. Mil Med 2018; 183:503-509. [PMID: 29635612 DOI: 10.1093/milmed/usx229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/12/2018] [Indexed: 11/14/2022] Open
Abstract
This study assesses the feasibility of training U.S. Navy Physical Therapy staff members (PT staff) aboard a U.S. Navy Aircraft Carrier in psychologically informed physical therapy (PiPT). Training was conducted prior to deployment over 3 d and included background information, skills development, and application in the form of role playing and case studies. During deployment, nine phone conferences were conducted to reinforce training, assess skills, and discuss implementation. PiPT knowledge was assessed by a written test and role-playing skills. The adoption of the training was determined by analysis of clinical notes and verbal responses of the PT staff during phone conferences. There were two PT staff members on the carrier. Both received passing knowledge test scores and demonstrated role-playing proficiency. Clinical note assessment and discussions during conference calls also indicated successful implementation. The feasibility of training Navy PT staff to implement PiPT was demonstrated. PT staff successfully translated training into practice. This is significant, since PiPT has the potential to limit attrition due to musculoskeletal injuries in Navy personnel. Factors believed to be associated with the success of the training include adoption of the PiPT model by PT staff and reinforcement of changes in clinical practice during deployment.
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Affiliation(s)
- Sherri Weiser
- Department of Orthopedics, Occupational and Industrial Orthopedics Center, New York University Hospital for Joint Diseases, 63 Downing Street, New York, NY 10014
| | - Angela Lis
- Department of Orthopedics, Occupational and Industrial Orthopedics Center, New York University Hospital for Joint Diseases, 63 Downing Street, New York, NY 10014
| | - Gregg Ziemke
- Department of Kinesiology, BADER Consortium, University of Delaware STAR Campus, 540 South College Avenue, Suite 102, Newark, DE 19713
| | - Rudi Hiebert
- Department of Kinesiology, BADER Consortium, University of Delaware STAR Campus, 540 South College Avenue, Suite 102, Newark, DE 19713
| | - Danielle Faulkner
- Department of Kinesiology, BADER Consortium, University of Delaware STAR Campus, 540 South College Avenue, Suite 102, Newark, DE 19713
| | - Tara Brennan
- Department of Orthopedics, Occupational and Industrial Orthopedics Center, New York University Hospital for Joint Diseases, 63 Downing Street, New York, NY 10014
| | - Brian Iveson
- Department of Physical Therapy, Naval Medical Center Portsmouth 620 John Paul Jones Circle, Norfolk, VA 23704
| | - Marco Campello
- Department of Orthopedics, Occupational and Industrial Orthopedics Center, New York University Hospital for Joint Diseases, 63 Downing Street, New York, NY 10014
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The Chronic Knee Pain Program: A self-management model. Int J Orthop Trauma Nurs 2018; 29:10-15. [PMID: 29409721 DOI: 10.1016/j.ijotn.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/24/2017] [Accepted: 01/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is vital that patients take an active role in self-management of their chronic knee pain condition. The Chronic Knee Pain Program was developed to assist patients in managing their chronic condition and to improve their overall well-being. PURPOSE The purpose of this pilot study was to determine the feasibility of a six-week self-management program and to explore whether it may assist in decreasing body mass index (BMI) and depression symptom severity and increase physical activity levels in obese adults with chronic knee pain. DESIGN A one group, pre-test/post-test pilot study. SETTING A pain management clinic in the northeastern United States. SAMPLE Convenience sample of twelve adult patients with chronic knee pain and a BMI of 30 or greater were recruited, however, six participants completed the full program. RESULTS This type of intervention has potential value to improve the lifestyles of those individuals with chronic knee pain, including improvements in BMI, depression symptom severity and physical activity levels. In this study there was a decrease in mean BMI overtime; 41.2 (at week 1), 40.8 (at week 6), and 40.7 (at week 10). CONCLUSIONS The Chronic Knee Pain Program had a small sample size and high attrition rate, though yielded positive outcomes for some participants. Future research could focus on depression management, using conservative measures to help manage pain, and increasing pain coping skills. Implementing this program with a larger sample size is recommended to see if BMI, depression symptom severity and physical activity levels reach statistical significance.
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25
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Tanaka R, Hirohama K. Association of Pain Quality with Pain Catastrophizing and Self-efficacy in People with Knee Osteoarthritis. Prog Rehabil Med 2018; 3:20180002. [PMID: 32789227 DOI: 10.2490/prm.20180002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/21/2018] [Indexed: 01/31/2023] Open
Abstract
Objective Patients with chronic pain often have symptoms similar to neuropathic pain (NeP). Such symptoms are also frequently observed in people with knee osteoarthritis (OA). However, pain quality may be related to psychological problems such as high pain catastrophizing and/or low self-efficacy. The objective of the current study was to investigate whether pain quality is associated with pain catastrophizing and self-efficacy in individuals with symptomatic knee OA. Methods This was a cross-sectional study in which 50 subjects with symptomatic knee OA were enrolled. NeP scores were evaluated using the painDETECT questionnaire (PDQ), the pain catastrophizing scores were evaluated using the coping strategy questionnaire, and the self-efficacy scores were evaluated using the self-efficacy scale for rheumatoid arthritis (SERA). Participants were classified as members of the unlikely NeP group (PDQ score ≤12) or the uncertain/likely NeP group (PDQ score >12). The pain catastrophizing scores and the self-efficacy scores were compared between the two groups. Results Of the 50 participants, 17 (34%) were classified in the uncertain/likely NeP group. The pain catastrophizing score was higher for the uncertain/likely NeP group (6.2 ± 3.3) than for the unlikely NeP group (4.5 ± 2.8; P=0.03). On the SERA scale, the self-efficacy for pain score was lower for the uncertain/likely NeP group (21.9 ± 3.1) than for the unlikely NeP group (24.2 ± 3.1; P=0.03). Conclusion High pain catastrophizing and low self-efficacy for pain control are significantly associated with the existence of an NeP component on PDQ in people with symptomatic knee OA.
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Affiliation(s)
- Ryo Tanaka
- Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan
| | - Kenta Hirohama
- Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan
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26
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The Role of Psychologically Informed Physical Therapy for Musculoskeletal Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0169-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Nagasawa Y, Oka K, Shibata A. [The effects of pain coping skills training among older outpatients with osteoarthritis]. Nihon Ronen Igakkai Zasshi 2017; 54:546-554. [PMID: 29212997 DOI: 10.3143/geriatrics.54.546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The present study examined the effects of individual pain coping-skills training (PCST) on knee pain, pain coping strategies, physical functions, and daily physical activity among older outpatients with osteoarthritis. METHODS Twenty-five older adults who suffered from knee pain and had been diagnosed to have knee osteoarthritis (men: n=4; 75.4±6.3 years) were assigned to either a PCST group (n=13) or a general health education group (n=12) according to their wishes. Both groups attended 20-minutes sessions once a week for 8 weeks. At the baseline, the basic attributes (e.g. gender, age, duration of knee pain, and medical history), BMI, and the severity of knee osteoarthritis were obtained. Additionally, knee pain and limitations in mobility, pain coping strategies, pain self-efficacy, exercise self-efficacy, lower muscle strength, mobility, accelerometer -based time spent in physical activity and sedentary behavior were assessed before and after the 8-week intervention period. Analyses were performed using an intention-to-treat principle. Differences in each variable between the groups were examined using an analysis of covariance. Each participant's baseline value was used as the covariate. RESULTS Even after controlling for the baseline attributes and values, only the PCST group exhibited a significant improvement in pain self-efficacy (p=0.005), exercise self-efficacy (p=0.042), lower muscle strength (p=0.004) and mobility (p=0.027). Furthermore, the PCST showed a significant increase in moderate-to vigorous-intensity physical activity (p=0.052) and a decrease in medical behaviors as one of pain coping strategies (p=0.073). CONCLUSION The present study showed that PCST therefore appears to be a feasible and effective therapeutic strategy which improves self-efficacy for controlling knee pain, which may also result in increasing the self-efficacy for exercise, physical functions, and daily physical activities.
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Affiliation(s)
| | | | - Ai Shibata
- Faculty of Health and Sport Sciences, University of Tsukuba
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28
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Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model. Pain 2017; 157:2628-2639. [PMID: 27380502 DOI: 10.1097/j.pain.0000000000000637] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.
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Coronado RA, Bird ML, Van Hoy EE, Huston LJ, Spindler KP, Archer KR. Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review. Clin Rehabil 2017; 32:287-298. [DOI: 10.1177/0269215517728562] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mackenzie L Bird
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin E Van Hoy
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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Lowry V, Ouellet P, Vendittoli PA, Carlesso LC, Wideman TH, Desmeules F. Determinants of pain, disability, health-related quality of life and physical performance in patients with knee osteoarthritis awaiting total joint arthroplasty. Disabil Rehabil 2017; 40:2734-2744. [PMID: 28728444 DOI: 10.1080/09638288.2017.1355412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance. MATERIAL AND METHODS Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteoarthritis Index, (2) Lower Extremity Functional Scale (LEFS) and (3) Short-Form 36 (SF-36). Physical performance was also assessed with four validated performance tests. Demographic, socioeconomic, psychosocial and clinical characteristics of the participants were also measured. Multivariate regression analyses were used to evaluate potential associations. RESULTS Higher fear-avoidance beliefs, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse pain, function or HRQOL (p < 0.05) and explained 12%-35% of the variances of the self-reported measure scores. Pretest pain and change in pain during posttest, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse performance on the physical tests (p < 0.05) and explained 41%-59% of the variances of the different physical tests results. CONCLUSIONS Several determinants were significantly associated with worse pain, disability, health-related quality of life or physical performance. Several of these associations may be considered clinically important, including psychosocial determinants in relation to self-reported measures, but to physical performance as well. Implications for rehabilitation Knee osteoarthritis is a highly prevalent and disabling condition incurring important socioeconomic costs. Several modifiable determinants have been shown to contribute to pain and disability in individuals suffering from knee OA awaiting TKA. Recent studies demonstrated the efficacy of education and rehabilitation (prehabilitation) in individuals awaiting TKA.
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Affiliation(s)
- Véronique Lowry
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada
| | - Philippe Ouellet
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Pascal-André Vendittoli
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,c Department of Surgery, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Lisa C Carlesso
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Timothy H Wideman
- d School of Physical and Occupational Therapy , McGill University , Montreal , Canada
| | - François Desmeules
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
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31
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Birch S, Stilling M, Mechlenburg I, Hansen TB. Effectiveness of a physiotherapist delivered cognitive-behavioral patient education for patients who undergoes operation for total knee arthroplasty: a protocol of a randomized controlled trial. BMC Musculoskelet Disord 2017; 18:116. [PMID: 28320421 PMCID: PMC5359930 DOI: 10.1186/s12891-017-1476-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 03/06/2017] [Indexed: 12/27/2022] Open
Abstract
Background Total Knee Arthroplasty (TKA) is a common and generally effective procedure performed mainly due to advanced osteoarthritis, pain, physical disability and reduced quality of life. However, approximately 20% of the patients respond poorly to the surgery and chronic pain and disability following TKA remains a major health burden for many patients. Among the most well documented and powerful psychological predictors of poor outcome following TKA is pain catastrophizing. Recent research has shown that patients with these thoughts are at higher risk of having persistent pain and lower physical function after the operation than patients with low levels of pain catastrophizing before TKA. There is high need of developing treatments aimed at improving self-management for this group of patients and the aim of this study is to investigate the effectiveness of a patient education in pain coping on physical function and pain among patients with high pain catastrophizing score before a TKA. Methods This study is a two-arm parallel group trial design including 56 patients with high levels of pain catastrophizing referred for total knee arthroplasty due to osteoarthritis. Patients eligible for participation will be randomized into the two arms, usual care or usual care and patient education. Usual care consists of operation and standard rehabilitation. The patient education consists of 7 individual sessions focusing on pain behavior and pain coping managed by a physiotherapist. Three before the operation and four after. Measurements will be taken at baseline before the operation and 3 and 12 months after the operation. Primary outcome will be pain after 12 months measured with VAS (Visual Analogue Scale). Secondary outcomes include physical function and activity, quality of life, pain management and psychological factors. Discussion Only few studies have evaluated the effectiveness of psychological interventions on patients with high levels of pain catastrophizing before the operation. This trial will provide evidence for the effectiveness of a cognitive-behavioral patient education delivered by physiotherapists and may provide better functional outcome and less pain for a vulnerable group of TKA patients. We expect that the results can provide important new knowledge to the current care recommendations. Trial registration Clinical Trials (NCT02587429). Registered 23 October 2015
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Affiliation(s)
- Sara Birch
- Department of Physiotherapy and Occupational therapy, Holstebro Regional Hospital, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.,University Clinic for Hand, Hip and Knee surgery, Holstebro Regional Hospital, Holstebro, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark.,Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Torben Bæk Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.,University Clinic for Hand, Hip and Knee surgery, Holstebro Regional Hospital, Holstebro, Denmark
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Bar-Or D, Rael LT, Brody EN. Use of Saline as a Placebo in Intra-articular Injections in Osteoarthritis: Potential Contributions to Nociceptive Pain Relief. Open Rheumatol J 2017; 11:16-22. [PMID: 28400868 PMCID: PMC5366377 DOI: 10.2174/1874312901711010016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 11/23/2022] Open
Abstract
Background: Osteoarthritis of the knee (OAK) is a severe debilitating condition characterized by joint pain, stiffness, and resultant limited mobility. In recent years, intra-articular (IA) injections have been used to relieve symptoms and have succeeded to varying degrees either with sodium hyaluronate preparations or with a biologic. Objective: The objective of this review is to evaluate multiple studies that demonstrate some relief from the symptoms of OAK in the saline arm of various clinical trials. Method: A thorough literature search (PubMed) was performed assessing the pain efficacy of various compounds compared to saline injections in clinical trials. A total of 73 studies were identified in the literature search including a total of 5,816 patients. These clinical trials all involved the IA injection of a viscosupplement (hyaluronate, platelet rich plasma (PRP), etc.) or a biologic (the low molecular weight fraction (< 5kDa) of human serum albumin (LMWF-5A)). For all of these studies, the control arm was injection of sterile physiological saline that approximates the salt concentration and total solute concentration of blood and most tissues. Results: Based on our review of the current literature, the tested compounds performed with mixed results when compared to saline injections. Moreover, OAK is a variable disease, with severity measured on the Kellgren and Lawrence (KL) scale where various hyaluronate preparations have a therapeutic effect mostly on KL 2-3 patients while a biologic works best on KL 3-4 patients. Conclusion: Since the effect of saline injection is always greater than no treatment, the evaluations of these treatments can be confounded in clinical trials. Therefore, the question of whether there are known therapeutic effects of saline injections might explain these results.
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Affiliation(s)
- David Bar-Or
- Swedish Medical Center, Trauma Research, Englewood, CO 80133, USA; St. Anthony Hospital, Lakewood, CO 80228, USA; The Medical Center of Plano, Plano, TX 75075, USA; Penrose Hospital, Colorado Springs, CO 80907, USA; Ampio Pharmaceuticals Inc., Englewood, CO 80112, USA
| | - Leonard T Rael
- Swedish Medical Center, Trauma Research, Englewood, CO 80133, USA; St. Anthony Hospital, Lakewood, CO 80228, USA; The Medical Center of Plano, Plano, TX 75075, USA; Penrose Hospital, Colorado Springs, CO 80907, USA; Ampio Pharmaceuticals Inc., Englewood, CO 80112, USA
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Huebner JL, Landerman LR, Somers TJ, Keefe FJ, Guilak F, Blumenthal JA, Caldwell DS, Kraus VB. Exploratory secondary analyses of a cognitive-behavioral intervention for knee osteoarthritis demonstrate reduction in biomarkers of adipocyte inflammation. Osteoarthritis Cartilage 2016; 24:1528-34. [PMID: 27090577 PMCID: PMC4992604 DOI: 10.1016/j.joca.2016.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 02/03/2016] [Accepted: 04/02/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effects of pain coping skills training (PCST) and a lifestyle behavioral weight management (BWM) program on inflammatory markers and biomarker associations with pain and function in the OA LIFE study. METHOD Serum samples were available from a subset (N = 169) of the overweight or obese knee OA participants in the OA LIFE study that evaluated: PCST, BWM, combined PCST + BWM, or standard care (SC). Inflammatory markers (hsCRP, IL-1ra, IL-1β, IL-6, IL-8, TNF-α, TNFRI, TNFRII, and hyaluronic acid (HA)), and adipokines (leptin and adiponectin) were measured before and after the 24-week treatment period. Biomarkers were assessed for effects of treatment and for associations with change in weight, pain and disability (unadjusted and adjusted for age, race, sex, baseline body mass index (BMI), and baseline biomarker concentration). RESULTS PCST + BWM was associated with significant reductions in hsCRP (P = 0.0014), IL-6 (P = 0.0075), and leptin (P = 0.0001). After adjustment, there was a significant effect of PCST + BWM on changes in leptin (b = -0.19, P = 0.01) and IL-6 (b = -0.25, P = 0.02) relative to SC. Reductions in leptin and IL-6 were significantly correlated with reductions in weight, BMI and Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain; reductions in IL-6 were correlated with improvements in WOMAC and Arthritis Impact Measurement Scales (AIMS) physical function. By mediation analyses, weight loss was responsible for 54% of the change in IL-6 and all of the change in leptin. CONCLUSIONS OA-related inflammatory markers were reduced by a 24-week combined PCST + BWM intervention. This suggests that the inflammatory state can be successfully modified in the context of a readily instituted clinical intervention with a positive clinical outcome.
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Affiliation(s)
- J L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
| | - L R Landerman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - T J Somers
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
| | - F J Keefe
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
| | - F Guilak
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - J A Blumenthal
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
| | - D S Caldwell
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - V B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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Bennell KL, Ahamed Y, Jull G, Bryant C, Hunt MA, Forbes AB, Kasza J, Akram M, Metcalf B, Harris A, Egerton T, Kenardy JA, Nicholas MK, Keefe FJ. Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2016; 68:590-602. [DOI: 10.1002/acr.22744] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/15/2015] [Accepted: 09/22/2015] [Indexed: 01/22/2023]
Affiliation(s)
| | - Yasmin Ahamed
- University of Melbourne; Melbourne Victoria Australia
| | | | - Christina Bryant
- University of Melbourne and Royal Women's Hospital; Melbourne Victoria Australia
| | - Michael A. Hunt
- University of British Columbia; Vancouver British Columbia Canada
| | | | | | | | - Ben Metcalf
- University of Melbourne; Melbourne Victoria Australia
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Hamilton CB, Wong MK, Gignac MAM, Davis AM, Chesworth BM. Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review. Pain Pract 2016; 17:99-114. [PMID: 26990402 DOI: 10.1111/papr.12448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/17/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. METHODS A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. RESULTS Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. CONCLUSIONS Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis.
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Affiliation(s)
- Clayon B Hamilton
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Ming-Kin Wong
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Monique A M Gignac
- Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Research Institute, Toronto, Ontario, Canada
| | - Aileen M Davis
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network and Institute of Health Policy, Management and Evaluation, Rehabilitation Science Institute, Toronto, Ontario, Canada.,Departments of Physical Therapy and Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bert M Chesworth
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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van Tunen JAC, van der Leeden M, Bos WH, Cheung J, van der Esch M, Gerritsen M, Peter WF, Roorda LD, Tijhuis GJ, Voorneman RE, Lems WF, Dekker J. Optimization of Analgesics for Greater Exercise Therapy Participation Among Patients With Knee Osteoarthritis and Severe Pain: A Feasibility Study. Arthritis Care Res (Hoboken) 2016; 68:332-40. [DOI: 10.1002/acr.22682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/03/2015] [Accepted: 07/21/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, and VU University Medical Center, EMGO Institute; Amsterdam The Netherlands
| | - Wouter H. Bos
- Jan van Breemen Research Institute; Reade, Amsterdam The Netherlands
| | - John Cheung
- Slotervaart Hospital; Amsterdam The Netherlands
| | | | - Martijn Gerritsen
- Jan van Breemen Research Institute; Reade, Amsterdam The Netherlands
| | - Wilfred F. Peter
- Amsterdam Rehabilitation Research Center; Reade, Amsterdam The Netherlands
| | - Leo D. Roorda
- Amsterdam Rehabilitation Research Center; Reade, Amsterdam The Netherlands
| | - Gerard J. Tijhuis
- Jan van Breemen Research Institute; Reade, Amsterdam The Netherlands
| | | | - Willem F. Lems
- Jan van Breemen Research Institute, Reade, and VU University Medical Center; Amsterdam The Netherlands
| | - Joost Dekker
- VU University Medical Center, EMGO Institute; Amsterdam The Netherlands
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Hanscom DA, Brox JI, Bunnage R. Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low Back Pain: An Overview. Global Spine J 2015; 5:496-504. [PMID: 26682100 PMCID: PMC4671906 DOI: 10.1055/s-0035-1567836] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/01/2015] [Indexed: 11/13/2022] Open
Abstract
Study Design Narrative review of the literature. Objectives Determine if the term cognitive behavioral therapy (CBT) is useful in clinical care and research. What literature supports these variables being relevant to the experience of chronic pain? What effects of CBT in treating these factors have been documented? What methods and platforms are available to administer CBT? Methods Chronic low back pain (CLBP) is a complex neurologic disorder with many components. CBT refers to a broad family of therapies that address both maladaptive thoughts and behaviors. There are several ways to deliver it. CLBP was broken into five categories that affect the perception of pain, and the literature was reviewed to see the effects of CBT on these variables. Results The term cognitive behavioral therapy has little use in future research because it covers such a wide range of therapies. CBT should always be defined by the problem it is intended to solve. The format and method of delivery should be defined because they have implications for outcomes. They are readily available even at the primary care level. The effectiveness of CBT is unquestioned regarding its effectiveness in treating each of the variables that affect CLBP. It is unclear why it is not more widely implemented. Conclusions CBT represents a family of therapies that are effective for a wide range of problems, many of which coexist with and influence CLBP. Each of the variables can be improved with focused CBT. Early, widespread adoption of CBT in treating and preventing CLBP is recommended. Future research and clinical care should focus on strategies to operationalize these well-documented treatments utilizing a public health approach.
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Affiliation(s)
- David A. Hanscom
- Swedish Medical Center, Seattle, Washington, United States,Address for correspondence David A. Hanscom, MD Swedish Neuroscience Institute, Swedish Medical Center550 17th Avenue, Seattle, WA 98122United States
| | - Jens Ivar Brox
- Swedish Medical Center, Seattle, Washington, United States
| | - Ray Bunnage
- Swedish Medical Center, Seattle, Washington, United States
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Effect of stepped care on health outcomes in patients with osteoarthritis: an observational study in Dutch general practice. Br J Gen Pract 2015; 64:e538-44. [PMID: 25179067 DOI: 10.3399/bjgp14x681337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A stepped care strategy (SCS) to improve adequate healthcare use in patients with osteoarthritis was developed and implemented in a primary care region in the Netherlands. AIM To assess the association between care that is in line with the SCS recommendations and health outcomes. DESIGN AND SETTING Data were used from a 2-year observational study of 313 patients who had consulted their GP because of osteoarthritis. METHOD Care was considered 'SCS-consistent' if all advised modalities of the previous steps of the SCS were offered before more advanced modalities of subsequent steps. Pain and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (range 0-100); active pain coping with the Pain Coping Inventory (range 10-40); and self-efficacy with the Dutch General Self-Efficacy Scale (range 12-48). Crude and adjusted associations between SCS-consistent care and outcomes were estimated with generalised estimating equations. RESULTS No statistically significant differences were found in changes over a 2-year period in pain and physical function between patients who received SCS-inconsistent care (n = 163) and patients who received SCS-consistent care (n = 117). This was also the case after adjusting for possible confounders, that is, -4.3 (95% confidence interval [CI] = -10.3 to 1.7) and -1.9 (95% CI = -7.0 to 3.1), respectively. Furthermore, no differences were found in changes over time between groups in self-efficacy and pain coping. CONCLUSION The results raised several important issues that need to be considered regarding the value of the SCS, such as the reasons that GPs provide SCS-inconsistent care, the long-term effects of the SCS, and the effects on costs and side effects.
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Ferreira de Meneses SR, Hunter DJ, Young Docko E, Pasqual Marques A. Effect of low-level laser therapy (904 nm) and static stretching in patients with knee osteoarthritis: a protocol of randomised controlled trial. BMC Musculoskelet Disord 2015; 16:252. [PMID: 26369333 PMCID: PMC4570668 DOI: 10.1186/s12891-015-0709-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/03/2015] [Indexed: 11/10/2022] Open
Abstract
Background Osteoarthritis (OA) is a highly prevalent and disabling disease. It is estimated that by 2030 the prevalence of symptomatic OA could reach 30 % of the population above 60 years. This randomised controlled trial will investigate the effect of low-level laser therapy (LLLT) and static stretching exercises, as monotherapy and in combination, on pain, quality of life, function, mobility, knee range of motion (KROM) and hamstring shortening in participants with knee OA. Methods This study will involve 145 people aged 50–75 years with symptomatic-radiographic knee OA. It will consist of two types of treatments: Low-level laser therapy (LLLT) and stretching exercises. The patients will be randomly allocated to five groups LLLTACTIVE+Stretch, LLLTPLACEBO+Stretch, Stretch, LLLT and Control (n = 29 each). Treatment frequency will be three sessions/week for all active groups. LLLT will involve the use of a Gallium-Arsenide laser (904 nm, 40 milliwatts, 3 J/point, 27 J/knee) over 24 sessions for the monotherapy group and 9 sessions for the LLLT+Stretch groups. Stretching will consist of seven exercises completed over 24 sessions. The control group will receive a booklet. Participants will be treated for 2 months (Stretch, LLLT and Control groups) or 3 months (LLLT + Stretch groups). Participants and the outcome assessor will be blind to treatment allocation throughout the study. The primary outcome is pain measured by Visual Analogue Scale. Secondary outcomes include quality of life assessed by Western Ontario and McMaster Universities Arthritis Index, function by Lequesne Algofunctional Index, mobility by Timed Up and Go Test, KROM by goniometry of knee flexion and hamstring shortening by popliteal angle. The statistical method will follow the principles of per-protocol analysis. Discussion Although exercise therapy is considered an effective treatment in patients with knee osteoarthritis, the knowledge of which exercise modalities would be the most appropriate for this population is lacking. LLLT has been used as resource to increase the effects of physical therapy. However, the specific dose and treatment frequency need to be better defined. The findings from this randomised controlled trial will provide evidence of the efficacy or otherwise, of LLLT and stretching exercises in the management of knee OA symptoms. Trial registration NCT01738737 at ClinicalTrials.gov.
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Affiliation(s)
- Sarah Rubia Ferreira de Meneses
- Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. .,Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - David John Hunter
- Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - Eunice Young Docko
- Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
| | - Amelia Pasqual Marques
- Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
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Liu R, Damman W, Kaptein AA, Rosendaal FR, Kloppenburg M. Coping styles and disability in patients with hand osteoarthritis. Rheumatology (Oxford) 2015; 55:411-8. [DOI: 10.1093/rheumatology/kev295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Indexed: 11/13/2022] Open
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The substantial personal burden experienced by younger people with hip or knee osteoarthritis. Osteoarthritis Cartilage 2015; 23:1276-84. [PMID: 25887363 DOI: 10.1016/j.joca.2015.04.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/23/2015] [Accepted: 04/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare Health-Related Quality of Life (HRQoL) and psychological distress in younger people with hip or knee osteoarthritis (OA) to age- and sex-matched population norms, and evaluate work limitations in this group. METHOD People aged 20-55 years with hip or knee OA were recruited from major hospitals (n = 126) and community advertisements (n = 21). HRQoL was assessed using the Assessment of Quality of Life (AQoL) instrument (minimal important difference 0.06 AQoL units) and compared to population norms. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10) and the prevalence of high/very high distress (K10 score ≥22) was compared to Australian population data. Work limitations were evaluated using the Workplace Activity Limitations Scale (WALS). RESULTS Considering most participants had a relatively recent OA diagnosis (<5 years), the extent of HRQoL impairment was unexpected. A very large reduction in HRQoL was evident for the overall sample, compared with population norms (mean difference -0.35 AQoL units, 95% CI -0.40 to -0.31). Females, people aged 40-49 years, and those with hip OA reported average HRQoL impairment of almost 40% (mean reductions -0.38 to -0.39 AQoL units). The overall prevalence of high/very high distress was 4 times higher than for the population (relative risk 4.19, 95% CI 3.53-4.98) and 67% reported moderate to considerable OA-related work disability, according to WALS scores. CONCLUSIONS These results clearly demonstrate the substantial personal burden experienced by younger people with hip or knee OA, and support the provision of targeted services to improve HRQoL and maximise work participation in this group.
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Runhaar J, Luijsterburg P, Dekker J, Bierma-Zeinstra SMA. Identifying potential working mechanisms behind the positive effects of exercise therapy on pain and function in osteoarthritis; a systematic review. Osteoarthritis Cartilage 2015; 23:1071-82. [PMID: 25865391 DOI: 10.1016/j.joca.2014.12.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/08/2014] [Accepted: 12/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although physical exercise is the commonly recommended for osteoarthritis (OA) patients, the working mechanism behind the positive effects of physical exercise on pain and function is a black box phenomenon. In the present study we aimed to identify possible mediators in the relation between physical exercise and improvements of pain and function in OA patients. DESIGN A systematic search for all studies evaluating the effects of physical exercise in OA patients and select those that additionally reported the change in any physiological factor from pre-to post-exercise. RESULTS In total, 94 studies evaluating 112 intervention groups were included. Most included studies evaluated subjects with solely knee OA (96 out of 112 groups). Based on the measured physiological factors within the included studies, 12 categories of possible mediators were formed. Muscle strength and ROM/flexibility were the most measured categories of possible mediators with 61 and 21 intervention groups measuring one or more physiological factors within these categories, respectively. 60% (31 out of 52) of the studies showed a significant increase in knee extensor muscle strength and 71% (22 out of 31) in knee flexor muscle strength over the intervention period. All 5 studies evaluating extension impairments and 10 out of 12 studies (83%) measuring proprioception found a significant change from pre-to post-intervention. CONCLUSION An increase of upper leg strength, a decrease of extension impairments and improvement in proprioception were identified as possible mediators in the positive association between physical exercise and OA symptoms.
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Affiliation(s)
- J Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - P Luijsterburg
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Rini C, Porter LS, Somers TJ, McKee DC, DeVellis RF, Smith M, Winkel G, Ahern DK, Goldman R, Stiller JL, Mariani C, Patterson C, Jordan JM, Caldwell DS, Keefe FJ. Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial. Pain 2015; 156:837-848. [PMID: 25734997 PMCID: PMC4402249 DOI: 10.1097/j.pain.0000000000000121] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we developed an 8-week, automated, Internet-based PCST program called PainCOACH and evaluated its potential efficacy and acceptability in a small-scale, 2-arm randomized controlled feasibility trial. Participants were 113 men and women with clinically confirmed hip or knee OA and associated pain. They were randomized to a group completing PainCOACH or an assessment-only control group. Osteoarthritis pain, pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect were measured before intervention, midway through the intervention, and after intervention. Findings indicated high acceptability and adherence: 91% of participants randomized to complete PainCOACH finished all 8 modules over 8 to 10 weeks. Linear mixed models showed that, after treatment, women who received the PainCOACH intervention reported significantly lower pain than that in women in the control group (Cohen d = 0.33). Intervention effects could not be tested in men because of their low pain and small sample size. Additionally, both men and women demonstrated increases in self-efficacy from baseline to after intervention compared with the control group (d = 0.43). Smaller effects were observed for pain-related anxiety (d = 0.20), pain-related interference with functioning (d = 0.13), negative affect (d = 0.10), and positive affect (d = 0.24). Findings underscore the value of continuing to develop an automated Internet-based approach to disseminate this empirically supported intervention.
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Affiliation(s)
- Christine Rini
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Robert F. DeVellis
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | - Gary Winkel
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - David K. Ahern
- Harvard Medical School/Brigham and Women's Hospital, Boston, MA
| | | | - Jamie L. Stiller
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Cara Mariani
- Duke University Medical Center, Durham, North Carolina
| | - Carol Patterson
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Joanne M. Jordan
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Lluch Girbés E, Meeus M, Baert I, Nijs J. Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis. ACTA ACUST UNITED AC 2015; 20:349-52. [DOI: 10.1016/j.math.2014.07.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
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Maly MR, Robbins SM. Osteoarthritis year in review 2014: rehabilitation and outcomes. Osteoarthritis Cartilage 2014; 22:1958-88. [PMID: 25456293 DOI: 10.1016/j.joca.2014.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/09/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To highlight research studies examining rehabilitation for hip and knee osteoarthritis (OA), as well as the outcome measures used to assess treatment efficacy, published in 2013. DESIGN A systematic search was performed in Medline, CIHAHL and Embase databases from January to December 2013. The search was limited to 2013, human studies, and English. Rehabilitation intervention studies included were prospective controlled designs. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the quality of evidence. First, individual articles were rated for quality. Second, articles were grouped based on outcome: OA disease markers, pain, physical function (self-reported, performance), and health. RESULTS Of 503 titles reviewed, 36 studies were included. The outcome measures related to OA disease markers were organized into subthemes of anthropometrics, biomechanics and physiology. The quality of evidence was of moderate, high, and low quality for anthropometric, biomechanical and physiological measures respectively. These studies supported the use of diet for weight loss combined with exercise. Bodies of evidence that showed the efficacy of exercise and passive strategies (thermal/electrical modalities, traction, manual therapy) for reducing pain were of low and moderate quality respectively. The evidence supporting diet and exercise, physiotherapy, and passive strategies to improve physical function was of moderate quality. Evidence supporting exercise to improve psychological factors was of moderate quality. CONCLUSIONS Exercise combined with diet for weight loss should be the mainstays of rehabilitation for people with knee and hip OA to provide benefit to OA disease markers, pain, physical function, and health.
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Affiliation(s)
- M R Maly
- School of Rehabilitation Science, McMaster University, Canada.
| | - S M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, School of Physical and Occupational Therapy, McGill University, Canada.
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Dobson F, Hinman RS, French S, Rini C, Keefe F, Nelligan R, Abbott JH, Bryant C, Staples MP, Dalwood A, Bennell KL. Internet-mediated physiotherapy and pain coping skills training for people with persistent knee pain (IMPACT - knee pain): a randomised controlled trial protocol. BMC Musculoskelet Disord 2014; 15:279. [PMID: 25125068 PMCID: PMC4137067 DOI: 10.1186/1471-2474-15-279] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/08/2014] [Indexed: 01/22/2023] Open
Abstract
Background Persistent knee pain in people over 50 years of age is often attributable to knee osteoarthritis (OA), a common joint condition that causes physical and psychological dysfunction. Exercise and pain coping skills training (PCST) can help reduce the impact of persistent knee pain, however, access to health professionals who deliver these services can be challenging. With increasing access to the Internet, remotely delivered Internet-based treatment approaches may provide alternatives for healthcare delivery. This pragmatic randomised controlled trial will investigate whether an Internet-delivered intervention that combines PCST and physiotherapist-guided exercise (PCST + Ex) is more effective than online educational material (educational control) in people with persistent knee pain. Methods/Design We will recruit 148 people over 50 years of age with self-reported persistent knee pain consistent with knee OA from the Australian community. Following completion of baseline questionnaires, participants will be randomly allocated to access a 3-month intervention of either (i) online educational material, or (ii) the same online material plus an 8-module (once per week) Internet-based PCST program and seven Internet-delivered physiotherapy sessions with a home exercise programs to be performed 3 times per week. Outcomes will be measured at baseline, 3 months and 9 months with the primary time point at 3 months. Primary outcomes are average knee pain on walking (11-point numeric rating scale) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index subscale). Secondary outcomes include additional measures of knee pain, health-related quality-of-life, perceived global change in symptoms, and potential moderators and mediators of outcomes including self-efficacy for pain management and function, pain coping attempts and pain catastrophising. Other measures of adherence, adverse events, harms, use of health services/co-interventions, and process measures including appropriateness and satisfaction of the intervention, will be collected at 3, 6 and 9 months. Discussion The findings will help determine the effectiveness and acceptability of Internet access to a combination of interventions that are known to be beneficial to people with persistent knee pain. This study has the potential to guide clinical practice towards innovative modes of healthcare provision. Trial registration Australian New Zealand Clinical Trials Registry reference: ACTRN12614000243617. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-279) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building 161 Barry St, Carlton, Vic 3053, Australia.
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Sturgeon JA. Psychological therapies for the management of chronic pain. Psychol Res Behav Manag 2014; 7:115-24. [PMID: 24748826 PMCID: PMC3986332 DOI: 10.2147/prbm.s44762] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, Stanford University, Palo Alto, CA, USA
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48
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Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother 2014; 60:5-12. [PMID: 24856935 DOI: 10.1016/j.jphys.2013.12.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 01/27/2023] Open
Affiliation(s)
- Michele Sterling
- Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland and Griffith University, Australia
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49
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Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists' perceptions and experiences. Phys Ther 2014; 94:197-209. [PMID: 24029300 DOI: 10.2522/ptj.20130047] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The importance of the biopsychosocial model in assessment and management of chronic musculoskeletal conditions is recognized. Physical therapists have been encouraged to develop psychologically informed practice. Little is known about the process of physical therapists' learning and delivering of psychological interventions within the practice context. OBJECTIVE The aim of this study was to investigate physical therapists' experiences and perspectives of a cognitive-behavioral-informed training and intervention process as part of a randomized controlled trial (RCT) involving adults with painful knee osteoarthritis. DESIGN A qualitative design was used. Participants were physical therapists trained to deliver pain coping skills training (PCST). METHODS Eight physical therapists trained to deliver PCST were interviewed by telephone at 4 time points during the 12-month RCT period. Interviews were audiorecorded, transcribed verbatim into computer-readable files, and analyzed using Framework Analysis. RESULTS Thematic categories identified were: training, experience delivering PCST, impact on general clinical practice, and perspectives on PCST and physical therapist practice. Physical therapists reported positive experiences with PCST and program delivery. They thought that their participation in the RCT had enhanced their general practice. Although some components of the PCST program were familiar, the therapists found delivering the program was quite different from regular practice. Physical therapists believed the PCST program, a 3- to 4-day workshop followed by formal mentoring and performance feedback from a psychologist for 3 to 6 months and during the RCT, was critical to their ability to effectively deliver the PCST intervention. They identified a number of challenges in delivering PCST in their normal practice. CONCLUSION Physical therapists can be trained to confidently deliver a PCST program. The physical therapists in this study believed that training enhanced their clinical practice. Comprehensive training and mentoring by psychologists was crucial to ensure treatment fidelity.
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Arthritis self-efficacy scale scores in knee osteoarthritis: a systematic review and meta-analysis comparing arthritis self-management education with or without exercise. J Orthop Sports Phys Ther 2013; 43:895-910. [PMID: 24175602 DOI: 10.2519/jospt.2013.4471] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review and meta-analysis. OBJECTIVE To evaluate studies that used arthritis self-management education alone or with exercise to improve Arthritis Self-Efficacy Scale scores of patients with knee osteoarthritis. BACKGROUND Increasing self-efficacy may improve patient knee osteoarthritis symptom management and function. METHODS MEDLINE (1946-March 2013), CINAHL (1981-March 2013), and PsycINFO (1967-March 2013) databases were searched. RESULTS Twenty-four studies, including 3163 subjects (women, n = 2547 [80.5%]; mean ± SD age, 65.3 ± 6.5 years), met the inclusion criteria. A meta-analysis was performed to compare the standardized mean difference effect sizes (Cohen d) of randomized controlled studies that used the Arthritis Self-Efficacy Scale pain (13 studies, n = 1906), other symptoms (13 studies, n = 1957), and function (5 studies, n = 399) subscales. Cohen d effect sizes were also calculated for cohort studies that used the Arthritis Self-Efficacy Scale pain (10 studies, n = 1035), other symptoms (9 studies, n = 913), and function (3 studies, n = 141) subscales. Both randomized controlled studies and cohort studies were grouped by intervention type (intervention 1, arthritis self-management education alone; intervention 2, arthritis self-management education with exercise), and effect sizes were compared (Mann-Whitney U tests, P<.05). Interventions that used arthritis self-management education with exercise displayed higher methodological quality scale scores (76.8 ± 13.1 versus 61.6 ± 19.6, P = .03). Statistically significant standardized effect-size differences between intervention 1 and intervention 2 were not observed. CONCLUSION Small to moderate effect sizes were observed regardless of whether the intervention included exercise. Exercise interventions used in conjunction with arthritis self-management education programs need to be developed to better enhance the self-efficacy of patients with knee osteoarthritis. LEVEL OF EVIDENCE Therapy, level 2b-.
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