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Westergren J, Sjöberg V, Vixner L, Nyberg RG, Moulaee Conradsson D, Monnier A, LoMartire R, Enthoven P, Äng BO. Acute exercise as active inference in chronic musculoskeletal pain, effects on gait kinematics and muscular activity in patients and healthy participants: a study protocol for a randomised controlled laboratory trial. BMJ Open 2023; 13:e069747. [PMID: 37258077 PMCID: PMC10255138 DOI: 10.1136/bmjopen-2022-069747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain is a highly prevalent, complex and distressing condition that may negatively affect all domains of life. In view of an active inference framework, and resting on the concept of allostasis, human movement per se becomes a prerequisite for health and well-being while chronic pain becomes a sign of a system unable to attenuate an allostatic load. Previous studies on different subgroups of chronic pain conditions have demonstrated alterations in gait kinematics and muscle activity, indicating shared disturbances in the motor system from long-term allostatic load. We hypothesise that such alterations exist in heterogenous populations with chronic musculoskeletal pain, and that exposure to acute and controlled exercise may attenuate these alterations. Therefore, the main aim of this study is to investigate the acute effects of exercise on gait kinematics and activity of the back and neck muscles during diverse walking conditions in patients with chronic musculoskeletal pain compared with a reference sample consisting of healthy participants. METHODS AND ANALYSIS This two-sample two-armed parallel randomised controlled laboratory trial will include 40 participants with chronic musculoskeletal pain (>3 months) and 40 healthy participants. Participants will be randomly allocated to either 30 min of aerobic exercise or rest. Primary outcomes are gait kinematics (walking speed, step frequency, stride length, lumbar rotation, gait stability) and muscular activity (spatial and temporal) of the back and neck during diverse walking conditions. Secondary outcomes are variability of gait kinematics and muscle activity and subjective pain ratings assessed regularly during the trial. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethics Review Board in Uppsala, Sweden (#2018/307). Findings will be disseminated via conference presentations, publications in peer-reviewed journals and engagement with patient support groups and clinicians. TRIAL REGISTRATION NUMBER NCT03882333.
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Affiliation(s)
- Jens Westergren
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Roger G Nyberg
- School of Information and Engineering, Dalarna University, Borlänge, Sweden
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Medical unit Occupational therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Monnier
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Riccardo LoMartire
- Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Björn O Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
- Regional Board Administration, Region Dalarna, Falun, Sweden
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Probert-Lindström S, Perrin S. An examination of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in adults in routine psychiatric care. Acta Psychol (Amst) 2023; 235:103902. [PMID: 37004421 DOI: 10.1016/j.actpsy.2023.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
AIM A person's ability to tolerate negative emotional states (Distress Tolerance - DT), uncertainty in their everyday lives (Intolerance of Uncertainty - IU), and a tendency to appraise their own feelings of anxiety as harmful (Anxiety Sensitivity - AS) have all been identified as vulnerability factors for anxiety and depressive disorders. However, the relationship between these variables and broader aspects of psychiatric symptom severity in participants recruited from routine care remains unclear. METHOD The Distress Tolerance Scale (DTS), Anxiety Sensitivity Scale-3 (ASI-3), and Intolerance of Uncertainty Scale-Short Form (IUS-12) were administered to 91 patients receiving treatment at the Lund Outpatient Psychiatric Clinic. Data was collected from their medical records about their psychiatric history and scores on the Brief Symptom Inventory (BSI). The relationship between total scores on the DTS, ASI-3, IUS-12 and BSI were evaluated via correlations and regression analyses. RESULTS DTS, ASI-3, and IUS-12 total scores correlated in the moderate to large range, and consistent with previous literature, were moderately to strongly correlated with the severity of self-reported depression, anxiety and overall symptoms (BSI). Regression analyses indicated that together, scores on the DTS, ASI-3 and IUS-12 explained moderate levels of variance in BSI symptom scores, with DTS scores showing the strongest associations. These findings suggest that further studies are needed to examine the construct and criterion validity of the three scales. Further validation of these Swedish-language are also warranted.
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Gupta A, Van de Velde M, Magnuson A, von Heymann C, Guasch E, Alahuhta S, Mercier FJ, Schyns-van den Berg AMJV. Factors associated with failed epidural blood patch after accidental dural puncture in obstetrics: a prospective, multicentre, international cohort study. Br J Anaesth 2022; 129:758-766. [PMID: 36064491 DOI: 10.1016/j.bja.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Epidural blood patch is commonly used for management of post-dural puncture headache after accidental dural puncture. The primary aim was to determine factors associated with failed epidural blood patch. METHODS In this prospective, multicentre, international cohort study, parturients ≥18 yr receiving an epidural blood patch for treatment of post-dural puncture headache were included. Failed epidural blood patch was defined as headache intensity numeric rating scale (NRS) score ≥7 in the upright position at 4, 24, or 48 h, or the need for a second epidural blood patch, and complete success by NRS=0 at 0-48 h after epidural blood patch. All others were considered partial success. Multinominal logistic regression was used for statistical analyses with P<0.01 considered statistically significant. RESULTS In all, 643 women received an epidural blood patch. Complete data to classify failure were available in 591 (91.9%) women. Failed epidural blood patch occurred in 167 (28.3%) patients; 195 (33.0%) were completely successful and 229 (38.7%) partially successful. A total of 126 women (19.8%) received a second epidural blood patch. A statistically significant association with failure was observed in patients with a history of migraine, when the accidental dural puncture occurred between lumbar levels L1/L3 compared with L3/L5 and when epidural blood patch was performed <48 h compared with ≥48 h after accidental dural puncture. In patients having radiological investigations, three intracranial bleeds were diagnosed. CONCLUSIONS Failed epidural blood patch occurred in 28.3% of women. Independent modifiable factors associated with failure were higher lumbar level of accidental dural puncture and short interval between accidental dural puncture and epidural blood patch. A history of migraine was associated with a higher risk of second epidural blood patch. CLINICAL TRIAL REGISTRATION NCT02362828.
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Affiliation(s)
- Anil Gupta
- Department of Perioperative Medicine and Intensive Care and Institution of Physiology and Pharmacology, Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden.
| | - Marc Van de Velde
- Department of Cardiovascular Sciences, KZ Leuven, Belgium; Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christian von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - Emilia Guasch
- Department of Anaesthesia and Reanimation, Hospital Universitario La Paz, Madrid, Spain
| | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Centre Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Frédéric J Mercier
- Departement of Anaesthesia, Hôpital Antoine Béclère, AP-HP Université Paris-Saclay, France
| | - Alexandra M J V Schyns-van den Berg
- Department of Anesthesiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; Department of Anesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
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