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Taniguchi T, Tanaka S, Nishigami T, Imai R, Mibu A, Yoshimoto T. Relationship between Fear-Avoidance Beliefs and Muscle Co-Contraction in People with Knee Osteoarthritis. SENSORS (BASEL, SWITZERLAND) 2024; 24:5137. [PMID: 39204834 PMCID: PMC11359681 DOI: 10.3390/s24165137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
Excessive muscle co-contraction is one of the factors related to the progression of knee osteoarthritis (OA). A previous study demonstrated that pain, joint instability, lateral thrust, weight, and lower extremity alignment were listed as factors affecting excessive co-contraction in knee OA. However, this study aimed to assess the association between fear-avoidance beliefs and muscle co-contraction during gait and stair climbing in people with knee OA. Twenty-four participants with knee OA participated in this cross-sectional study. Co-contraction ratios (CCRs) were used to calculate muscle co-contraction during walking and stair climbing, using surface electromyography. Fear-avoidance beliefs were assessed by the Tampa Scale for Kinesiophobia-11 (TSK-11) for kinesiophobia and the Pain Catastrophizing Scale (PCS) for pain catastrophizing. Secondary parameters that may influence co-contraction, such as degree of pain, lateral thrust, weight, and lower extremity alignment, were measured. The relationships between the CCR during each movement, TSK-11, and PSC were evaluated using Spearman's rank correlation coefficient and partial correlation analysis, adjusted by weight and lower extremity alignment. Partial correlation analysis showed a significant correlation only between medial muscles CCR and TSK-11 during stair descent (r = 0.54, p < 0.05). Our study revealed that kinesiophobia could be associated with co-contraction during stair descent in people with knee OA.
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Affiliation(s)
- Takanori Taniguchi
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka 814-0001, Japan;
| | - So Tanaka
- Department of Clinical Research Center, Fukuoka Orthopaedic Hospital, Fukuoka 815-0063, Japan;
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima 723-005, Japan
| | - Ryota Imai
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka 597-0104, Japan;
| | - Akira Mibu
- Department of Physical Therapy, Konan Women’s University, Hyogo 658-0001, Japan;
| | - Takaaki Yoshimoto
- Department of Orthopaedic, Fukuoka Orthopaedic Hospital, Fukuoka 815-0063, Japan;
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Rouse PC, Ingram T, Standage M, Sengupta R. Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey. Rheumatol Int 2024; 44:933-941. [PMID: 38506923 PMCID: PMC10980646 DOI: 10.1007/s00296-024-05557-w] [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: 11/17/2023] [Accepted: 02/09/2024] [Indexed: 03/22/2024]
Abstract
The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient's physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020-May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030-0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005-0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014-0.309) but not through fear of movement (β = 0.062, 95% PBCI = - 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure.
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Affiliation(s)
- Peter C Rouse
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Thomas Ingram
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Martyn Standage
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Combe Park, Bath, Avon, BA1 3NG, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
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Window P, Raymer M, McPhail SM, Vicenzino B, Hislop A, Vallini A, Elwell B, O'Gorman H, Phillips B, Wake A, Cush A, McCaskill S, Garsden L, Dillon M, McLennan A, O'Leary S. Prospective validity of a clinical prediction rule for response to non-surgical multidisciplinary management of knee osteoarthritis in tertiary care: a multisite prospective longitudinal study. BMJ Open 2024; 14:e078531. [PMID: 38521532 PMCID: PMC10961565 DOI: 10.1136/bmjopen-2023-078531] [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: 08/05/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVES We tested a previously developed clinical prediction tool-a nomogram consisting of four patient measures (lower patient-expected benefit, lower patient-reported knee function, greater knee varus angle and severe medial knee radiological degeneration) that were related to poor response to non-surgical management of knee osteoarthritis. This study sought to prospectively evaluate the predictive validity of this nomogram to identify patients most likely to respond poorly to non-surgical management of knee osteoarthritis. DESIGN Multisite prospective longitudinal study. SETTING Advanced practice physiotherapist-led multidisciplinary service across six tertiary hospitals. PARTICIPANTS Participants with knee osteoarthritis deemed appropriate for trial of non-surgical management following an initial assessment from an advanced practice physiotherapist were eligible for inclusion. INTERVENTIONS Baseline clinical nomogram scores were collected before a trial of individualised non-surgical management commenced. PRIMARY OUTCOME MEASURE Clinical outcome (Global Rating of Change) was collected 6 months following commencement of non-surgical management and dichotomised to responder (a little better to a very great deal better) or poor responder (almost the same to a very great deal worse). Clinical nomogram accuracy was evaluated from receiver operating characteristics curve analysis and area under the curve, and sensitivity/specificity and positive/negative likelihood ratios were calculated. RESULTS A total of 242 participants enrolled. Follow-up scores were obtained from 210 participants (87% response rate). The clinical nomogram demonstrated an area under the curve of 0.70 (p<0.001), with greatest combined sensitivity 0.65 and specificity 0.64. The positive likelihood ratio was 1.81 (95% CI 1.32 to 2.36) and negative likelihood ratio 0.55 (95% CI 0.41 to 0.75). CONCLUSIONS The knee osteoarthritis clinical nomogram prediction tool may have capacity to identify patients at risk of poor response to non-surgical management. Further work is required to determine the implications for service delivery, feasibility and impact of implementing the nomogram in clinical practice.
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Affiliation(s)
- Peter Window
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, Metro North Health and University of Queensland, Brisbane, Queensland, Australia
| | - Maree Raymer
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation and School of Public Health & Social Work, Faculty of Health, QUT, Brisbane, Queensland, Australia
| | - Bill Vicenzino
- The University of Queensland School of Health and Rehabilitation Sciences, Saint Lucia, Queensland, Australia
| | - Andrew Hislop
- The University of Queensland School of Health and Rehabilitation Sciences, Saint Lucia, Queensland, Australia
- Physiotherapy Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Alex Vallini
- Physiotherapy Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Bula Elwell
- Physiotherapy Department, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Helen O'Gorman
- Physiotherapy Department, Mater Hospital, South Brisbane, Queensland, Australia
| | - Ben Phillips
- Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
| | - Anneke Wake
- Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
| | - Adrian Cush
- Physiotherapy Department, Queen Elizabeth II Hospital, Coopers Plains, Queensland, Australia
| | - Stuart McCaskill
- Physiotherapy Department, Queen Elizabeth II Hospital, Coopers Plains, Queensland, Australia
| | - Linda Garsden
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Miriam Dillon
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Andrew McLennan
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Shaun O'Leary
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland School of Health and Rehabilitation Sciences, Saint Lucia, Queensland, Australia
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Baez S, Harkey M, Birchmeier T, Triplett A, Collins K, Kuenze C. Psychological Readiness, Injury-Related Fear, and Persistent Knee Symptoms After Anterior Cruciate Ligament Reconstruction. J Athl Train 2023; 58:998-1003. [PMID: 38104626 PMCID: PMC10784889 DOI: 10.4085/1062-6050-0229.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Poor psychological responses after anterior cruciate ligament reconstruction (ACLR) have been associated with a failure to return to sport and increased secondary injury risk. However, we do not know whether poor psychological responses after ACLR influence patient-reported knee function and knee symptoms. OBJECTIVE To examine the association between psychological factors (ie, psychological readiness and injury-related fear) and the presence of persistent knee symptoms in individuals 6 to 12 months after ACLR. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS In total, 101 participants, aged 13 to 25 years old, between 6 and 12 months after primary unilateral ACLR were enrolled in the study. MAIN OUTCOME MEASURE(S) Persistent knee symptoms were identified using an established criterion based on the subscales of the Knee injury and Osteoarthritis Outcome Score. Participants also completed the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) and the Tampa Scale of Kinesiophobia-11 (TSK-11) to assess psychological readiness and injury-related fear, respectively. Higher ACL-RSI scores indicate higher psychological readiness, and higher TSK-11 scores indicate higher injury-related fear. RESULTS Twenty-nine participants (29%) met the criteria for persistent knee symptoms. For every 1 SD lower in the ACL-RSI score, participants had 2.1 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.3, 3.6). For every 1 SD higher in the TSK-11 score, participants had 1.9 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.1, 3.3). Both the ACL-RSI and TSK-11 were considered good at classifying persistent knee symptoms, as the areas under the curve were 0.78 and 0.73, respectively. CONCLUSIONS Individuals with a lower level of psychological readiness and more injury-related fear after ACLR had greater odds of persistent knee symptoms. Overall, these results highlight the potential clinical benefit of a comprehensive, biopsychosocial approach to managing health and wellness for individuals after ACLR.
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Affiliation(s)
- Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | - Thomas Birchmeier
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Ashley Triplett
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Christopher Kuenze
- Department of Kinesiology, University of Virginia, Charlottesville; Katherine Collins is now at Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Berger M, Bertrand AM, Robert T, Chèze L. Measuring objective physical activity in people with chronic low back pain using accelerometers: a scoping review. Front Sports Act Living 2023; 5:1236143. [PMID: 38022769 PMCID: PMC10646390 DOI: 10.3389/fspor.2023.1236143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Accelerometers can be used to objectively measure physical activity. They could be offered to people with chronic low back pain (CLBP) who are encouraged to maintain an active lifestyle. The aim of this study was to examine the use of accelerometers in studies of people with CLBP and to synthesize the main results regarding the measurement of objective physical activity. Methods A scoping review was conducted following Arksey and O'Malley's framework. Relevant studies were collected from 4 electronic databases (PubMed, Embase, CINHAL, Web of Science) between January 2000 and July 2023. Two reviewers independently screened all studies and extracted data. Results 40 publications out of 810 citations were included for analysis. The use of accelerometers in people with CLBP differed across studies; the duration of measurement, physical activity outcomes and models varied, and several limitations of accelerometry were reported. The main results of objective physical activity measures varied and were sometimes contradictory. Thus, they question the validity of measurement methods and provide the opportunity to discuss the objective physical activity of people with CLBP. Conclusions Accelerometers have the potential to monitor physical performance in people with CLBP; however, important technical limitations must be overcome.
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Affiliation(s)
- Mathilde Berger
- Occupational Therapy Department (HETSL | HES-SO), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Anne Martine Bertrand
- Occupational Therapy Department (HETSL | HES-SO), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Thomas Robert
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Laurence Chèze
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
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de Zoete RMJ, Nikles J, Coombes JS, Onghena P, Sterling M. The effectiveness of aerobic versus strengthening exercise therapy in individuals with chronic whiplash-associated disorder: a randomised single case experimental design study. Disabil Rehabil 2023; 45:3519-3528. [PMID: 36173391 DOI: 10.1080/09638288.2022.2127937] [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: 12/19/2021] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Recent RCTs and meta-analyses compare the effectiveness of different types of exercise for chronic whiplash associated disorder (WAD). This study aimed to verify whether the results of these studies translate to statistically significant and clinically meaningful effects in individual participants. MATERIALS AND METHODS A series of replicated randomised single case experimental design studies (SCEDs) with A-B design (A: baseline, B: intervention). Eight participants with chronic WAD (8 female, mean [SD] age 47 [10] years) were randomised into one of four baseline durations (5, 8, 11, and 14 days) and to one of two eight-week exercise interventions (aerobic or strengthening). Daily measures of pain intensity, bothersomeness, and interference were collected during the baseline phase and the intervention phase. RESULTS Visual analyses indicated that three participants in the aerobic exercise group meaningfully improved. No improvements were found in the strengthening group. Effect sizes favoured the aerobic exercise group, yet randomisation tests of pooled effects did not show a difference in between-intervention effectiveness. CONCLUSION Contrary to our expectations, three out of four participants were nearly pain-free at the end of the aerobic exercise intervention, whereas none of the participants in the strengthening group improved meaningfully. This suggests that aerobic exercise may be favourable for WAD.Implications for RehabilitationOur results suggest that aerobic exercises are favourable over strengthening exercises and may be the preferred option for patients with chronic WAD.We found substantial variability in self-reported outcomes within participants, clinicians should be aware of this in the judgement of treatment effectiveness.
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Affiliation(s)
- Rutger M J de Zoete
- Recover Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, Australia
| | - Jane Nikles
- Recover Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Patrick Onghena
- Research Unit on Methods, Individual and Cultural Differences, Affect and Social Behaviour, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
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Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep 2023; 8:e1092. [PMID: 37719924 PMCID: PMC10501475 DOI: 10.1097/pr9.0000000000001092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/19/2023] [Accepted: 06/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome. This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP. Methods Data from a randomized controlled trial with 2 treatment arms (exposure treatment based on the FAM with/without in-session exposure) was pooled, including only participants with complete data (N = 69). Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses. Results Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure. The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled. Conclusions The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C. Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Tankha H, Lumley MA, Gordon A, Schubiner H, Uipi C, Wager TD, Harris J, Ashar YK. "I don't have chronic back pain anymore": Patient Experiences in Pain Reprocessing Therapy for Chronic Back Pain. THE JOURNAL OF PAIN 2023; 24:1582-1593. [PMID: 37094744 PMCID: PMC11020878 DOI: 10.1016/j.jpain.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
In a recently published randomized controlled trial, two-thirds of the patients receiving a novel psychological treatment, pain reprocessing therapy (PRT), reported elimination or near-elimination of chronic back pain. The mechanisms of PRT and related treatments remain poorly understood but are hypothesized to center on pain reappraisal, fear reduction, and exposure-potentiated extinction. Here, we investigated treatment mechanisms from the participants' perspective. A sample of 32 adults with chronic back pain who received PRT completed semi-structured posttreatment interviews about their treatment experiences. The interviews were analyzed with multiphase thematic analysis. The analyses identified 3 major themes reflecting participants' understanding of how PRT led to pain relief: 1) reappraisal to reduce fear of pain, which included guiding participants to relate to pain as a helpful indicator, overcoming pain-related fear and avoidance, and reconceptualizing pain as a "sensation;" 2) the link between pain, emotions, and, stress, which included gaining insight into these connections and resolving difficult emotions; and 3) social connections, which included patient-provider alliance, therapist belief in the treatment model, and peer models of recovery from chronic pain. Our findings support the hypothesized mechanisms of PRT centered on pain reappraisal and fear reduction, but also highlight additional processes from the participants' perspective, including a focus on emotions and relationships. This study underscores the value of qualitative research methods in illuminating the mechanisms of novel pain therapies. PERSPECTIVE: This article presents participants' perspectives on their experience engaging in a novel psychotherapy for chronic pain, PRT. Through pain reappraisal, linking pain, emotions, and stress, and connecting with their therapist and peers, many participants reported an elimination or near-elimination of their chronic back pain with therapy.
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Affiliation(s)
- Hallie Tankha
- Department of Psychology, Wayne State University, Detroit, MI
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, MI
| | | | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI
| | | | - Tor D. Wager
- Department of Brain and Psychological Sciences, Dartmouth College, Hanover, NH
| | - James Harris
- Division of General Internal Medicine, Department of Medicine and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - Yoni K. Ashar
- Division of General Internal Medicine, Department of Medicine and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
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Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr 2023; 23:385. [PMID: 37353752 PMCID: PMC10288814 DOI: 10.1186/s12877-023-03855-9] [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: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? METHODS A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the 'Risk of Bias Tool for Prevalence Studies', 'COSMIN Risk of Bias checklist for Patient-reported outcome measures', modified version of the 'Appraisal Tool for Cross-sectional studies', and the 'Cochrane Risk of Bias 2' tools for each research question, respectively. RESULTS 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The 'Falls Efficacy Scale - International' (FES-I) and 'Fear of Falling Questionnaire - Revised' (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. CONCLUSION FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice. TRIAL REGISTRATION PROSPERO registration: CRD42020221836.
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Affiliation(s)
- Chandini Gadhvi
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Allied Health - Physiotherapy, Te Whatu Ora Health New Zealand - Te Toka Tumai, Auckland, New Zealand
| | - Debbie Bean
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand.
| | - David Rice
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand
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10
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Fullwood D, Means S, Paxton R, Wells B, Riley JL, Stickley Z, Tucker C, You L, Elie M, Thomas C, Anton S, Pahor M, Wilkie DJ. Avoidance-Endurance Model in Older Black Men with Low Back Pain: Exploring Relationships. J Racial Ethn Health Disparities 2023; 10:1310-1318. [PMID: 35501598 PMCID: PMC10597575 DOI: 10.1007/s40615-022-01316-4] [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: 01/13/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to investigate functional performance and pain intensity outcomes for associations with negative cognitive orientations, avoidance behaviors, and fear of pain in older Black men with low back pain (LBP). METHODS Sixty Black men aged 60 and older (70 years[Formula: see text]) with LBP completed the Short Physical Performance Battery (SPPB), the 400-m walk test, and subjective measures of avoidance behaviors, back performance, pain intensity, and pain catastrophizing (i.e., rumination, magnification, and helplessness). Multiple regression models were used to examine associations. RESULTS Higher helplessness scores were associated with worse back performance (ß = 0.55, p = 0.02), slower walking speed (ß = 0.30, p = 0.02), and higher average pain intensity (ß = 0.22, [Formula: see text] p = 0.03). Higher rumination scores were associated with better back performance (ß = - 0.36, p = 0.04). Avoidance behaviors, fear of pain, and magnification were not significantly associated with any of the variables included in the tested models. CONCLUSION Negative cognitive internalization is associated with limitations in functional performance in older Black men with LBP. Additional research is needed to further examine the cognitive orientations for understanding experienced pain and function in this population. Such research may inform the development of interventions for improving functional performance outcomes of older Black men with LBP.
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Affiliation(s)
- Dottington Fullwood
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA.
| | - Sydney Means
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA
| | - Raheem Paxton
- Department of Community Medicine and Population Health, University of Alabama, Tuscaloosa, AL, USA
| | - Brandi Wells
- Jacksonville Aging Studies Center, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Joseph L Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Zachary Stickley
- Department of Educational Psychology, Leadership, & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Carolyn Tucker
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Lu You
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Marie Elie
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Carol Thomas
- Y Healthy Living Center, Johnson Family YMCA, Jacksonville, FL, USA
| | - Stephen Anton
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA
| | - Marco Pahor
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, USA
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11
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Hidaka R, Tanaka T, Hashikura K, Oka H, Matsudaira K, Moro T, Matsuda K, Kawano H, Tanaka S. Association of high kinesiophobia and pain catastrophizing with quality of life in severe hip osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:388. [PMID: 37194069 DOI: 10.1186/s12891-023-06496-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND While fear of movement is an important predictor of pain and disability in osteoarthritis (OA), its impact on patients with hip OA remains uncertain. This study aimed to determine whether fear of movement, evaluated by the Tampa Scale for Kinesiophobia (TSK)-11, and pain catastrophizing, evaluated by the Pain Catastrophizing Scale (PCS), were associated with quality of life (QOL) in patients with hip OA. METHODS This cross-sectional study was conducted between November 2017 and December 2018. Ninety-one consecutively enrolled patients with severe hip OA were scheduled for primary unilateral total hip arthroplasty. The EuroQOL-5 Dimensions questionnaire was used to measure general QOL. The Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to assess disease-specific QOL. The covariates included age, sex, body mass index (BMI), pain intensity, high pain catastrophizing (PCS ≥ 30), and high kinesiophobia (TSK-11 ≥ 25). Variables were subjected to multivariate analysis using each QOL scale. RESULTS In multiple regression analysis, pain intensity, high pain catastrophizing, and BMI were independently correlated with the disease-specific QOL scale. High pain catastrophizing, pain intensity, and high kinesiophobia were independently correlated with the general QOL scale. CONCLUSIONS High pain catastrophizing (PCS ≥ 30) was independently associated with disease and general QOL scales. High kinesiophobia (TSK-11 ≥ 25) was independently associated with the general QOL scale in preoperative patients with severe hip OA.
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Affiliation(s)
- Ryo Hidaka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itahashi-ku, Tokyo, 173-8606, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, , The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Takeyuki Tanaka
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuaki Hashikura
- Department of Orthopaedic Surgery, Faculty of Medicine, , The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Moro
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenta Matsuda
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itahashi-ku, Tokyo, 173-8606, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itahashi-ku, Tokyo, 173-8606, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, , The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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12
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Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt L, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:198-219. [PMID: 37130279 PMCID: PMC10176847 DOI: 10.4085/1062-6050-0504.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN Consensus process. SETTING Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S) The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.
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Affiliation(s)
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Thomas H. Trojian
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Shelby Baez
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - David J. Berkoff
- Department of Kinesiology, Michigan State University, East Lansing
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - Madison Franek
- University of North Carolina Therapy Services, UNC Wellness Center at Meadowmont, Chapel Hill
| | - Yvonne M. Golightly
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | | | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, NYU Grossman School of Medicine, New York, NY
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Matthew Salzler
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
| | - Monette Williams
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
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13
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Leung T, Hess CW, Choate ES, Van Orden AR, Tremblay-McGaw AG, Menendez M, Boothroyd DB, Parvathinathan G, Griffin A, Caruso TJ, Stinson J, Weisman A, Liu T, Koeppen K, Koeppen K. Virtual Reality-Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced With a Single-Case Experimental Design. JMIR Res Protoc 2022; 11:e40705. [PMID: 36508251 PMCID: PMC9793297 DOI: 10.2196/40705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain. OBJECTIVE This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design. METHODS This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice. RESULTS The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024. CONCLUSIONS Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR. TRIAL REGISTRATION ClinicalTrials.gov NCT04636177; https://clinicaltrials.gov/ct2/show/NCT04636177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40705.
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Affiliation(s)
| | - Courtney W Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ellison S Choate
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Amanda R Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexandra G Tremblay-McGaw
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Derek B Boothroyd
- Quantitative Statistical Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Gomathy Parvathinathan
- Quantitative Statistical Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer Stinson
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,The Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Amy Weisman
- Department of Rehabilitation, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Timothy Liu
- Department of Rehabilitation, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Kurt Koeppen
- California Rehabilitation & Sports Therapy, Palo Alto, CA, United States
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14
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Abbey H. Communication strategies in psychologically informed osteopathic practice: A case report. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Harrison LE, Webster SN, Van Orden AR, Choate E, Jehl N, Stinson J, Wicksell RK, Darnall BD, Simons LE. Agile development of a digital exposure treatment for youth with chronic musculoskeletal pain: protocol of a user-centred design approach and examination of feasibility and preliminary efficacy. BMJ Open 2022; 12:e065997. [PMID: 36109029 PMCID: PMC9478845 DOI: 10.1136/bmjopen-2022-065997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chronic pain affects a significant number of children and impacts multiple domains including social, emotional and behavioural functioning, and negatively impacts family functioning. Roughly 5% of youth with chronic pain experience moderate to severe pain-related disability, with pain-related fear and avoidance of activities being identified as substantial barriers to treatment engagement. Evidence supports targeted psychological and physical interventions to address these barriers (eg, graded-exposure treatment), but accessibility to intervention is undermined by a shortage of services outside of urban areas, high treatment-related costs, and long provider waitlists; highlighting the need to develop digitally delivered behavioural intervention, using agile and iterative study designs that support rapid development and timely dissemination. METHODS AND ANALYSIS This study seeks to develop an effective and scalable intervention for youth with chronic pain and their caregivers. This paper presents a user-centred protocol for the development and refinement of a digital exposure treatment for youth and caregivers, as well as the study design to examine feasibility and preliminary efficacy of the treatment using single-case experimental design (SCED). Assessments include daily diaries, completed from baseline and daily throughout the intervention (~6 weeks), and at 3-month follow-up, as well as self-report measures completed at baseline, end of intervention and 3-month follow-up. Primary outcomes include treatment satisfaction, treatment expectancy, adherence to daily dairies and functional disability. Secondary outcomes are pain-related fear and avoidance of activities, pain catastrophising and pain acceptance. We will present descriptive and model-based inference analyses, based on SCED reporting guidelines. We will calculate effect sizes for each individual on each outcome. We will examine mean treatment expectancy, credibility and satisfaction scores, and patient drop-out percentage. ETHICS AND DISSEMINATION This study is approved by the Institutional Review Board at Stanford University (protocol #53323). Findings will be actively disseminated through peer-reviewed journals, conference presentations and social media. TRIAL REGISTRATION NUMBER NCT05079984.
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Affiliation(s)
- Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sarah N Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amanda R Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ellison Choate
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Nicole Jehl
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer Stinson
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Pain Clinic, Capio St. Goran Hospital, Stockholm, Sweden
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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16
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Rogers AH, Farris SG. A Meta-analysis of the Associations of Elements of the Fear-Avoidance Model of Chronic Pain with Negative Affect, Depression, Anxiety, Pain-related Disability and Pain Intensity. Eur J Pain 2022; 26:1611-1635. [PMID: 35727200 PMCID: PMC9541898 DOI: 10.1002/ejp.1994] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/17/2022] [Accepted: 06/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE Biopsychosocial conceptualizations of clinical pain conditions recognize the multi-faceted nature of pain experience and its intersection with mental health. A primary cognitive-behavioral framework is the Fear-Avoidance Model, which posits that pain catastrophizing and fear of pain (including avoidance, cognitions, and physiological reactivity) are key antecedents to, and drivers of, pain intensity and disability, in addition to pain-related psychological distress. This study aimed to provide a comprehensive analysis of the magnitude of the cross-sectional association between the primary components of the Fear-Avoidance Model (pain catastrophizing, fear of pain, pain vigilance) with negative affect, anxiety, depression, pain intensity, and disabilities in studies of clinical pain. DATABASES AND DATA TREATMENT A search of MEDLINE and PubMed databases resulted in 335 studies that were evaluated in this meta-analytic review, which represented 65,340 participants. RESULTS Results from the random effect models indicated a positive, medium- to large-sized association between fear of pain, pain catastrophizing, and pain vigilance measures and outcomes (pain-related negative affect, anxiety, depression and pain-related disability), and medium-sized associations with pain intensity. Fear of pain measurement type was a significant moderator of effects across all outcomes. CONCLUSIONS These findings provide empirical support, aligned with the components of the Fear-Avoidance Model, for the relevance of both pain catastrophizing and fear of pain to the pain experience and its intersection with mental health. Implications for the conceptualization of the pain catastrophizing and fear of pain construct and its measurement are discussed.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Samantha G Farris
- Department of Psychology, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
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17
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Harrison LE, Heathcote LC, Khazendar Z, Richardson PA, Simons LE. Measuring Clinically Meaningful Change in Outcomes for Youth With Chronic Pain Following Graded Exposure Treatment. Clin J Pain 2022; 38:334-342. [PMID: 35276700 PMCID: PMC9012214 DOI: 10.1097/ajp.0000000000001031] [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: 06/18/2021] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Functional improvement is a critical outcome for individuals living with chronic pain. Graded exposure treatment (GET) has been associated with statistically significant improvements in functional outcomes for youth with chronic pain by targeting pain-related fear and avoidance. OBJECTIVE The aim of the present study was to explore clinically meaningful change in outcomes in adolescents with chronic pain following participation in a GET, and to then classify patients as treatment responders versus nonresponders. MATERIALS AND METHODS Participants included 27 youth (Mage=13.5) with chronic pain enrolled in a recently published single-arm randomized baseline trial of GET Living. Reliable change at the individual level was assessed using the Reliable Change Index (RCI). Adolescents were classified as treatment responders if they achieved a reliable change in outcomes across time points and also demonstrated a change in clinical severity range in the expected direction (ie, from severe to moderate). RESULTS Reliable and clinically significant improvements in pain-related fear and avoidance, functional disability, and school functioning were demonstrated at discharge, with improvements maintained at 3-month and 6-month follow-up. Among core outcomes, 48% (n=13) of patients were classified as treatment responders in one or more outcomes at discharge, with this increasing to 76% (n=19) at 3-month follow-up. DISCUSSION Examining reliable and clinically meaningful change (vs. statistical significance alone) provides a way to examine treatment response to an intervention and to enhance the interpretability of findings, helping to bridge the gap between clinical trials and clinical practice by providing guidelines for interpretation.
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Affiliation(s)
- Lauren E. Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London
| | - Zeena Khazendar
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Patricia A. Richardson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
- Departments of Pediatric Psychology and Pediatric Pain and Palliative Medicine, Helen DeVos Children’s Hospital, Grand Rapids
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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18
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Bontinck J, den Hollander M, Kaas AL, De Jong JR, Timmers I. Individual Patterns and Temporal Trajectories of Changes in Fear and Pain during Exposure In Vivo: A Multiple Single-Case Experimental Design in Patients with Chronic Pain. J Clin Med 2022; 11:1360. [PMID: 35268453 PMCID: PMC8911417 DOI: 10.3390/jcm11051360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Exposure in vivo (EXP) is an effective treatment to reduce pain-related fear and disability in chronic pain populations. Yet, it remains unclear how reductions in fear and pain relate to each other. This single-case experimental design study attempted to identify patterns in the individual responses to EXP and to unravel temporal trajectories of fear and pain. Daily diaries were completed before, during and after EXP. Multilevel modelling analyses were performed to evaluate the overall effect. Temporal effects were scrutinized by individual regression analyses and determination of the time to reach a minimal clinically important difference. Furthermore, individual graphs were visually inspected for potential patterns. Twenty patients with chronic low back pain and complex regional pain syndrome type I were included. On a group level, both fear and pain were reduced following EXP. Individually, fear was significantly reduced in 65% of the patients, while pain in only 20%. A decrease in fear was seen mostly in the first weeks, while pain levels reduced later or remained unchanged. Daily measurements provided rich data on temporal trajectories of reductions in fear and pain. Overall, reductions in fear preceded pain relief and seemed to be essential to achieve pain reductions.
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Affiliation(s)
- Jente Bontinck
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium;
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Marlies den Hollander
- Department of Rehabilitation Medicine, Maastricht University, 6211 LK Maastricht, The Netherlands; (M.d.H.); (J.R.D.J.)
- Adelante Centre of Expertise in Rehabilitation and Audiology, 6430 AB Hoensbroek, The Netherlands
| | - Amanda L. Kaas
- Department of Cognitive Neuroscience, Maastricht University, 6229 EV Maastricht, The Netherlands;
| | - Jeroen R. De Jong
- Department of Rehabilitation Medicine, Maastricht University, 6211 LK Maastricht, The Netherlands; (M.d.H.); (J.R.D.J.)
- Intergrin Academy for Specialized Healthcare, 6167 AC Geleen, The Netherlands
| | - Inge Timmers
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Department of Rehabilitation Medicine, Maastricht University, 6211 LK Maastricht, The Netherlands; (M.d.H.); (J.R.D.J.)
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19
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Lundberg M, Archer KR. Fear of Movement: Past, Present, and Future for Rehabilitation and Health. Phys Ther 2022; 102:6533377. [PMID: 35188966 DOI: 10.1093/ptj/pzac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Mari Lundberg
- Professor and Head of Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,Visiting Professor, Pain in Motion Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kristin R Archer
- Professor and Vice Chair of Orthopaedic Surgery, Professor of Physical Medicine and Rehabilitation, Director of the Vanderbilt Center for Musculoskeletal Research, and Director of Research for the Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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20
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Culture and musculoskeletal pain: strategies, challenges, and future directions to develop culturally sensitive physical therapy care. Braz J Phys Ther 2022; 26:100442. [PMID: 36209626 PMCID: PMC9550611 DOI: 10.1016/j.bjpt.2022.100442] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/13/2022] [Accepted: 08/25/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Pain experience has a multidimensional nature. Assessment and treatment recommendations for pain conditions suggest clinicians use biopsychosocial approaches to treat pain and disability. The current pain research is overwhelmingly skewed towards the study of biological and psychological factors including interventions, whereas, cultural factors are often ignored. OBJECTIVE The aims of this Masterclass is threefold: (1) to discuss cultural influences on pain, (2) to provide strategies for delivering appropriate pain education and exercises in culturally diverse people with chronic pain, and (3) to present challenges and future directions to clinicians and researchers. DISCUSSION Cultural factors have a relevant influence on the way individuals experience and manage health and illness. Thus, people with different cultural experience perceive, respond, communicate and manage their pain in different ways. In this aspect, the contents of pain education should be presented using different culturally appropriate examples, metaphors, images, and delivery methods that may enhance the impact of the message. Efforts should be made to produce and spread culturally adapted evidence-based materials and resources. In addition, a culturally sensitive approach may help to introduce patients to graded activities, so that they can apply these strategies in culturally acceptable and meaningful ways. Future studies should investigate the effectiveness of culturally-adapted interventions in pain-related outcomes in different pain conditions in patients with different cultural backgrounds.
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Jaén I, Escrig MA, Wieser MJ, García-Palacios A, Pastor MC. Cognitive reappraisal is not always successful during pain anticipation: Stimulus-focused and goal-based reappraisal effects on self-reports and peripheral psychophysiology. Int J Psychophysiol 2021; 170:210-217. [PMID: 34767839 DOI: 10.1016/j.ijpsycho.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
The present study aims at comparing the effects of two subtypes of cognitive reappraisal (i.e., stimulus-focused vs. goal-based reappraisal) to reduce anticipatory anxiety of pain. Affective ratings, startle reflex, and autonomic measures (electrodermal and heart rate changes) were used as a measure of emotion regulation success. A total of 86 undergraduate students completed an anticipatory task in which they had to regulate their negative emotions or react naturally when faced with the possibility of receiving a painful thermal stimulus. Participants were randomly assigned to two experimental groups to compare the stimulus-focused and goal-based strategies explored here. Our results revealed enhanced self-reported anxiety, electrodermal activity and eyeblink response when participants tried to voluntarily down-regulate their negative emotions, compared to the control instruction. Differences between both cognitive reappraisal groups were not found. These unexpected findings suggest that brief reappraisal instructions may not necessarily be favorable for regulating emotions during anticipation of aversive events. Moreover, these results are further explained in terms of the pain expectation, the painful stimuli modality, and emotion regulation instructions.
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Baez S, Cormier M, Andreatta R, Gribble P, Hoch JM. Implementation of In vivo exposure therapy to decrease injury-related fear in females with a history of ACL-Reconstruction: A pilot study. Phys Ther Sport 2021; 52:217-223. [PMID: 34626890 DOI: 10.1016/j.ptsp.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this pilot study was to examine the preliminary feasibility and efficacy of in vivo exposure therapy (IVET) to decrease injury-related fear in females with history of ACLR. DESIGN Pilot Study. SETTING Sports Medicine Research Laboratory. PARTICIPANTS 12 female participants with history of ACLR (≥ 1 year post-operative) were randomized into a 5-week IVET group (n = 6) or 5-week sham physical activity (PA) monitoring group (n = 6). MAIN OUTCOME MEASURES The independent variables were Group and Time. The dependent variables were the Photographic Series of Sports Activities for ACLR (PHOSA-ACLR) and the Tampa Scale of Kinesiophobia-11 (TSK-11) scores. A Group x Time repeated measures two-way analysis of variance was completed for the PHOSA-ACLR and the TSK-11. Partial η2 effect sizes were used to examine clinically meaningful differences. RESULTS High retention and adherence rates were observed in the intervention group. The PHOSA-ACLR exhibited a significant main effect for Time (F1,10 = 9.92, p = 0.01, partial η2 = 0.50), but not for Group. No statistically significant or clinically meaningful differences were observed for the TSK-11. CONCLUSION Both groups exhibited decreased injury-related fear for specific functional tasks. Future research should further examine the efficacy of IVET and PA monitoring to decrease injury-related fear in patients after ACLR.
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Affiliation(s)
- Shelby Baez
- Department of Kinesiology at Michigan State University in East Lansing, Michigan, USA.
| | - Marc Cormier
- Department of Kinesiology and Health Promotion at the University of Kentucky in Lexington, Kentucky, USA.
| | - Richard Andreatta
- Department of Communication Sciences and Disorders at the University of Kentucky in Lexington, Kentucky, USA.
| | - Phillip Gribble
- Department of Athletic Training and Clinical Nutrition at the University of Kentucky in Lexington, Kentucky, USA.
| | - Johanna M Hoch
- Department of Athletic Training and Clinical Nutrition at the University of Kentucky in Lexington, Kentucky, USA.
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Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet 2021; 398:78-92. [PMID: 34115979 DOI: 10.1016/s0140-6736(21)00733-9] [Citation(s) in RCA: 440] [Impact Index Per Article: 146.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/23/2020] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
Low back pain covers a spectrum of different types of pain (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine (eg, soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures) are prone to different stressors, and each of these, alone or in combination, can contribute to low back pain. Due to numerous factors related to low back pain, and the low specificity of imaging and diagnostic injections, diagnostic methods for this condition continue to be a subject of controversy. The biopsychosocial model posits low back pain to be a dynamic interaction between social, psychological, and biological factors that can both predispose to and result from injury, and should be considered when devising interdisciplinary treatment plans. Prevention of low back pain is recognised as a pivotal challenge in high-risk populations to help tackle high health-care costs related to therapy and rehabilitation. To a large extent, therapy depends on pain classification, and usually starts with self-care and pharmacotherapy in combination with non-pharmacological methods, such as physical therapies and psychological treatments in appropriate patients. For refractory low back pain, a wide range of non-surgical (eg, epidural steroid injections and spinal cord stimulation for neuropathic pain, and radiofrequency ablation and intra-articular steroid injections for mechanical pain) and surgical (eg, decompression for neuropathic pain, disc replacement, and fusion for mechanical causes) treatment options are available in carefully selected patients. Most treatment options address only single, solitary causes and given the complex nature of low back pain, a multimodal interdisciplinary approach is necessary. Although globally recognised as an important health and socioeconomic challenge with an expected increase in prevalence, low back pain continues to have tremendous potential for improvement in both diagnostic and therapeutic aspects. Future research on low back pain should focus on improving the accuracy and objectivity of diagnostic assessments, and devising treatment algorithms that consider unique biological, psychological, and social factors. High-quality comparative-effectiveness and randomised controlled trials with longer follow-up periods that aim to establish the efficacy and cost-effectiveness of low back pain management are warranted.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA.
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Leuven, Belgium; Research Group Experimental Health Psychology, Maastricht University, Maastricht, Netherlands; TRACE Center for Translational Health Research, KU, Leuven-Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Neurology, Physical Medicine and Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Lavefjord A, Sundström FT, Buhrman M, McCracken LM. Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Conway D, Bliss A, Patterson SD. The influence of pain, kinesiophobia and psychological comorbidities on the accuracy of rating of perceived exertion in UK military spinal rehabilitation. BMJ Mil Health 2021; 168:292-298. [PMID: 34131066 DOI: 10.1136/bmjmilitary-2021-001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a leading cause of disability in the UK Military. Pain and psychological comorbidities have been reported to influence the rating of perceived exertion (RPE). Exercise rehabilitation can be monitored using RPE; however, the accuracy of RPE in inpatient CLBP rehabilitation is unknown. METHODS A prospective cohort correlation study of 40 UK Military inpatients with CLBP was completed. Disability (ODI), kinesiophobia (TSK), anxiety (GAD-7) and depression (PHQ-9) were subjectively reported at the beginning and end of a 3 week intervention. Pain (VAS) and HR were recorded in the first aerobic exercise (AE) session (T1) and the final aerobic exercise session (T2). RPE was reported for each AE session. RESULTS At T1, a positive correlation was observed between RPE accuracy (-7.2±20.9), and pre-exercise pain (2.7 mm ±1.6 mm) (p>0.001) and ODI (31.0±16.9) (p>0.05), and a negative relationship between RPE accuracy and average HR (135 bpm ±22 bpm) (p>0.001) was observed. At T2, there was no significant correlation between RPE accuracy (-4.4±22.6) and pre-exercise pain (2.8 mm ±1.6 mm) or ODI (34.0±16.5) (p>0.05). The strong negative relationship between RPE accuracy and average HR (137 bpm ±20 bpm) remained at T2. Improved RPE accuracy over the 3-week rehabilitation programme was correlated to the change in average HR (r=-0.314, p<0.05). CONCLUSIONS Comorbidities may negatively affect RPE accuracy in CLBP, but the magnitude of the influence reduces over intensive rehabilitation.
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Affiliation(s)
- Dean Conway
- Complex Trauma Department, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A Bliss
- The Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, Twickenham, London, UK
| | - S D Patterson
- The Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, Twickenham, London, UK
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Ronald Melzack Award Lecture: Putting the brain to work in cognitive behavioral therapy for chronic pain. Pain 2021; 161 Suppl 1:S27-S35. [PMID: 33090737 DOI: 10.1097/j.pain.0000000000001839] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Baez S, Andersen A, Andreatta R, Cormier M, Gribble PA, Hoch JM. Neuroplasticity in Corticolimbic Brain Regions in Patients After Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 56:418-426. [PMID: 33064807 DOI: 10.4085/jat0042-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Fear has been cited as the primary barrier to return to sport (RTS) by athletes after anterior cruciate ligament reconstruction (ACLR). Understanding the neural factors that contribute to fear after ACLR may help us to identify interventions for this population. OBJECTIVE To characterize the underlying neural substrate of injury-related fear in patients after ACLR versus healthy matched control individuals during a picture imagination task (PIT) consisting of sport-specific images and images of activities of daily living (ADL). DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 24 right-hand-dominant participants (12 with left-sided ACLR and 12 control individuals) were enrolled. Participants underwent full-brain functional magnetic resonance imaging. MAIN OUTCOME MEASURE(S) Functional data were acquired using blood oxygen level-dependent (BOLD) echoplanar imaging. Independent t tests were conducted to identify between-groups differences in BOLD signal changes during all images of the PIT. Paired t tests were computed to examine differences in BOLD signal change between sport-specific and ADL images in the ACLR group. RESULTS Increased activation in the inferior parietal lobule and the mediodorsal thalamus was observed during PIT in the ACLR group. An inability to suppress the default mode network in the ACLR group was noted. The ACLR group exhibited increased activation in the cerebellum and inferior occipital regions during the sport-specific images versus the ADL images, but no other regions of interest demonstrated differences. CONCLUSION After ACLR, patients may be more predisposed to fear, anxiety, and pain during sport-specific activities and ADLs. Psychosocial interventions may be warranted after ACLR to reduce injury-related fear and mitigate potentially maladaptive neuroplasticity.
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Affiliation(s)
- Shelby Baez
- Department of Kinesiology, Michigan State University, East Lansing
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Abbey H, Nanke L, Brownhill K. Developing a psychologically-informed pain management course for use in osteopathic practice: The OsteoMAP cohort study. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Avoid or engage? Outcomes of graded exposure in youth with chronic pain using a sequential replicated single-case randomized design. Pain 2021; 161:520-531. [PMID: 31693541 DOI: 10.1097/j.pain.0000000000001735] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pain-related fear is typically associated with avoidance behavior and pain-related disability in youth with chronic pain. Youth with elevated pain-related fear have attenuated treatment responses; thus, targeted treatment is highly warranted. Evidence supporting graded in vivo exposure treatment (GET) for adults with chronic pain is considerable, but just emerging for youth. The current investigation represents the first sequential replicated and randomized single-case experimental phase design with multiple measures evaluating GET for youth with chronic pain, entitled GET Living. A cohort of 27 youth (81% female) with mixed chronic pain completed GET Living. For each participant, a no-treatment randomized baseline period was compared with GET Living and 3- and 6-month follow-ups. Daily changes in primary outcomes fear and avoidance and secondary outcomes pain catastrophizing, pain intensity, and pain acceptance were assessed using electronic diaries and subjected to descriptive and model-based inference analyses. Based on individual effect size calculations, a third of participants significantly improved by the end of treatment on fear, avoidance, and pain acceptance. By follow-up, over 80% of participants had improved across all primary and secondary outcomes. Model-based inference analysis results to examine the series of replicated cases were generally consistent. Improvements during GET Living was superior to the no-treatment randomized baseline period for avoidance, pain acceptance, and pain intensity, whereas fear and pain catastrophizing did not improve. All 5 outcomes emerged as significantly improved at 3- and 6-month follow-ups. The results of this replicated single-case experimental phase design support the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance.
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Abstract
Approximately 1.7 million youth suffer from debilitating chronic pain in the US alone, conferring risk of continued pain in adulthood. Aberrations in threat-safety (T-S) discrimination are proposed to contribute to pain chronicity in adults and youth by interacting with pain-related distress. Yet, few studies have examined the neural circuitry underlying T-S discrimination in patients with chronic pain or how T-S discrimination relates to pain-related distress. In this study, 91 adolescents (10-24 years; 78 females) including 30 chronic pain patients with high pain-related distress, 29 chronic pain patients with low pain-related distress, and 32 healthy peers without chronic pain completed a developmentally appropriate T-S learning paradigm. We measured self-reported fear, psychophysiology (skin conductance response), and functional magnetic resonance imaging responses (N = 72 after functional magnetic resonance imaging exclusions). After controlling for age and anxiety symptoms, patients with high pain-related distress showed altered self-reported fear and frontolimbic activity in response to learned threat and safety cues compared with both patients with low pain-related distress and healthy controls. Specifically, adolescent patients with high pain-related distress reported elevated fear and showed elevated limbic (hippocampus and amygdala) activation in response to a learned threat cue (CS+). In addition, they showed decreased frontal (vmPFC) activation and aberrant frontolimbic connectivity in response to a learned safety cue (CS-). Patients with low pain-related distress and healthy controls appeared strikingly similar across brain and behavior. These findings indicate that altered T-S discrimination, mediated by frontolimbic activation and connectivity, may be one mechanism maintaining pain chronicity in adolescents with high levels of pain-related distress.
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Reducing the use of opioids by patients with chronic pain: an effectiveness study with long-term follow-up. Pain 2021; 161:509-519. [PMID: 31764391 DOI: 10.1097/j.pain.0000000000001763] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study addresses the problem of long-term opioid use by chronic pain patients. The study involved a secondary analysis of unanalyzed data from a published study of 2 versions of cognitive-behavioural therapy-based interdisciplinary treatment for chronic pain. In this study, we examined whether the use of opioids by 140 chronic pain patients could be ceased sustainably over 12 months after participation in the comprehensive interdisciplinary pain management program aimed at enhancing pain self-management. On admission to the treatment, there were no significant differences between those patients taking or not taking opioids on usual pain, pain interference in daily activities, pain-related disability, depression severity, as well as in pain cognitions. After the treatment, the use of opioids was significantly reduced, both in numbers taking any and in mean doses, and these gains were maintained over the 12-month follow-up. Finally, cessation of opioids during treatment was associated with more substantial and consistent improvements in usual pain, depression severity, pain interference, pain-related disability, and pain cognitions, relative to those who reduced their opioids but did not cease them. These findings support the idea of using training in pain self-management strategies as a viable alternative to long-term opioid use by patients with chronic pain.
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Ibrahim AA, Akindele MO, Kaka B, Mukhtar NB. Development of the Hausa version of the Pain Catastrophizing Scale: translation, cross-cultural adaptation and psychometric evaluation in mixed urban and rural patients with chronic low back pain. Health Qual Life Outcomes 2021; 19:44. [PMID: 33546701 PMCID: PMC7863472 DOI: 10.1186/s12955-020-01644-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Background Catastrophizing has been recognized as an important contributor to chronicity in individuals with chronic pain syndromes including low back pain (LBP). The Pain Catastrophizing Scale (PCS) is perhaps the most widely used tool to evaluate the degree of pain catastrophizing. However, its use is limited in Hausa-speaking countries due to the lack of a validated translated version. Objective To translate and cross-culturally adapt the PCS into Hausa (Hausa-PCS), and evaluate its psychometric properties in mixed urban and rural patients with chronic LBP. Methods The PCS was translated and cross-culturally adapted into Hausa in accordance with established guidelines. To evaluate its psychometric properties, a consecutive sample of 200 patients with chronic LBP was recruited from urban and rural Nigerian hospitals. Validity was evaluated by exploring content validity, factorial structure (confirmatory factor analysis [CFA]), construct validity (Spearman’s rho for a priori hypotheses) and known-groups validity. Reliability was evaluated by calculating internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement with 95% confidence interval (LOA95%). Results The Hausa-PCS was comprehensible with good content validity. The CFA confirmed a 3-factor structure similar to the original English version. The concurrent validity was supported as 83% (5/6) of the a priori hypotheses were confirmed. Known-groups comparison showed that the questionnaire was unable to differentiate between male and female or urban and rural patients (p > 0.05). Internal consistency and ICC were adequate for the Hausa-PCS total score (α = 0.84; ICC = 0.90) and the subscale helplessness (α = 0.78; ICC = 0.89) but for the subscales rumination (α = 0.69; ICC = 0.68) and magnification (α = 0.41; ICC = 0.43). The LOA95% for the Hausa-PCS total score was between − 8.10 and + 9.75, with SEM and MDC of 3.47 and 9.62 respectively. Conclusion The Hausa-PCS was successfully developed and psychometrically adequate in terms of factorial structure, construct validity, internal consistency and test–retest reliability when applied in mixed urban and rural patients with chronic LBP. However, the internal consistency and reliability coefficients (ICC) for the individual subscales are inadequate. Thus, we support the use of the total score when evaluating pain catastrophizing for clinical or research purposes.
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Affiliation(s)
- Aminu A Ibrahim
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria. .,Department of Physiotherapy, Muhammad Abdullahi Wase Teaching Hospital, Hospitals Management Board, P.M.B 3160, Kano, Kano State, Nigeria.
| | - Mukadas O Akindele
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria
| | - Bashir Kaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria
| | - Naziru B Mukhtar
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, P.M.B 3011, Kano, Kano State, Nigeria
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Black WR, DiCesare CA, Thomas S, Pfeiffer M, Williams SE, Kitchen K, Ting TV, Myer GD, Kashikar-Zuck S. Preliminary Evidence for the Fibromyalgia Integrative Training Program (FIT Teens) Improving Strength and Movement Biomechanics in Juvenile Fibromyalgia: Secondary Analysis and Results from a Pilot Randomized Clinical Trial. Clin J Pain 2021; 37:51-60. [PMID: 33093338 PMCID: PMC7708442 DOI: 10.1097/ajp.0000000000000888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Current therapies for juvenile fibromyalgia (JFM), such as cognitive-behavioral therapy (CBT), improve pain coping but are less effective for pain reduction or engagement in physical activity. The Fibromyalgia Integrative Training for Teens (FIT Teens) program combines CBT with specialized neuromuscular exercise training for adolescents with JFM. The current investigation examined the effects of FIT Teens versus CBT on secondary outcomes of strength and functional biomechanics, utilizing 3D Motion capture technology. This study aimed to explore improvements in strength and biomechanics in both a CBT-only group and the FIT Teens intervention. MATERIALS AND METHODS Forty adolescents with JFM (12 to 18 y) were randomized to an 8-week, group-based protocol of either FIT Teens or CBT only. Assessments occurred pretreatment and posttreatment. Hip and knee strength were assessed with dynamometry, dynamic postural stability was measured using the Star Excursion Balance Test, and movement biomechanics were assessed with 3D motion analyses during a drop vertical jump (DVJ) task. RESULTS The FIT Teens group exhibited improvements in hip abduction strength and greater external hip rotation during the DVJ task. Some differences between the FIT Teens and CBT groups were observed in peak hip internal moment in the transverse plane. Decreased hip adduction during the DVJ was also observed in the FIT Teens group. DISCUSSION Results suggest that the FIT Teens program shows promise in improving hip abduction strength and body biomechanics, indicating improvements in stability during functional movements. These improvements may facilitate ability to initiate and maintain regular physical activity in youth with widespread musculoskeletal pain.
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Affiliation(s)
| | | | - Staci Thomas
- Cincinnati Children's Hospital, Division of Sports Medicine
| | - Megan Pfeiffer
- Cincinnati Children's Hospital, Division of Behavioral Medicine and Clinical Psychology
| | - Sara E. Williams
- University of Cincinnati College of Medicine, Department of Pediatrics
- Cincinnati Children's Hospital, Division of Behavioral Medicine and Clinical Psychology
| | - Katie Kitchen
- Cincinnati Children's Hospital, Division of Sports Medicine
| | - Tracy V. Ting
- Cincinnati Children's Hospital, Division of Rheumatology
| | | | - Susmita Kashikar-Zuck
- University of Cincinnati College of Medicine, Department of Pediatrics
- Cincinnati Children's Hospital, Division of Behavioral Medicine and Clinical Psychology
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Körfer K, Schemer L, Kube T, Glombiewski JA. An Experimental Analogue Study on the "Dose-Response Relationship" of Different Therapeutic Instructions for Pain Exposures: The More, The Better? J Pain Res 2020; 13:3181-3193. [PMID: 33293855 PMCID: PMC7719044 DOI: 10.2147/jpr.s265709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/20/2020] [Indexed: 01/05/2023] Open
Abstract
Objective Novel suggestions derived from the inhibitory learning model on how to optimize exposure therapy have been debated with enthusiasm in the last few years, particularly with respect to the focus on expectancy violations. However, little is known about how this new approach directly compares to the traditional habituation rationale of exposure therapy. In the present study, we examined these two competing therapeutic instructions among healthy female participants in an experimental heat pain paradigm. Design and Methods Participants (N= 116) received a therapeutic instruction derived from either a habituation-based approach or the inhibitory learning model (expectation violation). Participants were repeatedly exposed to painful thermal stimulations until a predefined exposure goal was reached. Results The expectation violation instruction led to faster goal attainment and higher response rates than the habituation instruction. Both instructions led to increased pain tolerance in the short and long term (one-week follow-up). Conclusion Our results suggest that exposure treatments using an expectation violation instruction are especially time-effective. Although the findings from this analogue design cannot be directly generalized to populations with clinically relevant levels of chronic pain, they do point to some important theoretical and clinical implications for the treatment of pain.
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Affiliation(s)
- Karoline Körfer
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Lea Schemer
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
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Ladlow P, Conway D, Hayhurst D, Suffield C, Cassidy RP, Coppack RJ. Integration of strength training into UK Defence Rehabilitation practice: current trends and future challenges. BMJ Mil Health 2020; 168:314-319. [PMID: 33087537 PMCID: PMC9340023 DOI: 10.1136/bmjmilitary-2020-001590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
The use of strength and conditioning (S&C) in musculoskeletal rehabilitation has gained wide acceptance among the rehabilitation community. However, there is an absence of evidence demonstrating how to best integrate the principles of S&C into rehabilitation practice. This article discusses four broad themes: (1) an overview of the UK Defence Rehabilitation care pathway, (2) the historical and current approaches to physical training to support operational readiness of the British Armed Forces, (3) the current and future challenges of integrating S&C into Defence Rehabilitation practice and (4) research priorities relating to the use of S&C in Defence Rehabilitation. We detail the importance of strength/power-based physical attributes within our military population. We recommend that consideration be given to the benefits of an alternative education/coaching-based model to be used during the current 3-week residential care pathway, which aims to ensure effective implementation of therapeutic S&C over a longer period of care.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Department for Health, University of Bath, Bath, UK
| | - D Conway
- Complex Trauma Department, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - D Hayhurst
- Primary Care Rehabilitation Facility (PCRF) Credenhill, Credinhill, UK
| | - C Suffield
- Physical and Recreational Training Centre, Army Training Centre Pirbright, Pirbright, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
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Andrews NE, Chien CW, Ireland D, Varnfield M. Overactivity assessment in chronic pain: The development and psychometric evaluation of a multifaceted self-report assessment. Eur J Pain 2020; 25:225-242. [PMID: 32965735 PMCID: PMC7821341 DOI: 10.1002/ejp.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
Background Overactivity in the context of chronic pain (i.e. activity engagement that significantly exacerbates pain) is an important clinical issue that has gained empirical attention in the last decade. Current assessment concepts of overactivity tend to focus on frequency to quantify the severity of the pain behaviour. This study aimed to develop and validate a more comprehensive self‐assessment, the Overactivity in Persistent Pain Assessment (OPPA). Methods A sample of 333 individuals with chronic pain completed the OPPA. A subset of 202 individuals also completed a set of existing measures of pain‐related outcomes and activity patterns. The remaining 131 participants were provided with a second copy of the OPPA to fill in one week following their initial assessment. Results A principal component analysis confirmed that the OPPA items were best represented by a single construct. The OPPA was found to correlate with pain‐related measures in an expected way that is supported by both theory and qualitative data. When compared to existing overactivity measures, the OPPA was the only measure to contribute significantly to the regression models predicting higher levels of pain severity, more pain interference and lower levels of activity participation after controlling for age, gender and activity avoidance. In addition, the OPPA scale exhibited acceptable internal consistency and good test–retest reliability. Conclusion The results of this study reinforce the potentially important role of overactivity in the maintenance of pain‐related suffering and supports a corresponding assessment tool with preliminary psychometric evidence for clinical and research applications. Significance This study deconstructs the overactivity concept and develop a corresponding assessment based on five quantifiable severity features: severity of pain exacerbation, maladaptive coping strategies used, impact on occupational performance, recovery time and frequency. Results of the psychometric evaluation indicate that this comprehensive assessment of overactivity severity features may be necessary to understand the impact of overactivity on pain severity and physical functioning from both a clinical and research perspective.
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Affiliation(s)
- Nicole E Andrews
- RECOVER Injury Research Centre, The University of Queensland, Herston, Qld., Australia.,Department of Occupational Therapy, The Royal Brisbane and Women's Hospital, Herston, Qld., Australia.,Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Herston, Qld., Australia
| | - Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - David Ireland
- The Australian eHealth Research Centre, CSIRO, Herston, Qld., Australia
| | - Marlien Varnfield
- The Australian eHealth Research Centre, CSIRO, Herston, Qld., Australia
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Ryum T, Hartmann H, Borchgrevink P, de Ridder K, Stiles TC. The effect of in-session exposure in Fear-Avoidance treatment of chronic low back pain: A randomized controlled trial. Eur J Pain 2020; 25:171-188. [PMID: 32964624 DOI: 10.1002/ejp.1659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/18/2020] [Accepted: 09/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Treatment based on the Fear-Avoidance (FA) model has been found to be effective with chronic low back pain (CLBP), and in-vivo exposure of fear evoking movements is proposed as a key change mechanism. Exposure tasks may be conducted in the session (in-session exposure; ISE), in other real-life situations (between sessions exposure) as part of homework assignments, or both. Utilising a randomized, controlled dismantling study design, the aim of this study was to examine the unique effects of ISE in FA-treatment of CLBP. METHODS Patients (N = 90) with CLBP as primary medical complaints were randomized to receive six sessions of either (a) FA-treatment with ISE (FA-ISE) or (b) FA-treatment without ISE (FA), allowing for between sessions exposure in both treatment groups. Patients were assessed with a large battery of outcome measures at four time-points (pre-treatment, post-treatment, after a booster-session and at 1-year follow-up) including pain intensity, pain catastrophising, self-efficacy, physical performance and quality of life. RESULTS Both treatment groups (FA-ISE, FA) demonstrated statistically significant improvements on primary and most secondary outcomes, with mostly non-significant between-group differences. CONCLUSIONS No added benefit was found for the inclusion of ISE of feared movements in FA-treatment for CLBP, delivered in a group format to participants with moderately elevated levels of fear-avoidance beliefs. Clinical trials: NCT01158339. SIGNIFICANCE This study adds to the existing research literature demonstrating FA-treatment to be effective with CLBP, but further experimental studies are needed in order to examine under what circumstances ISE of feared movements may add to positive treatment outcomes.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helge Hartmann
- Department of Physical Medicine and Rehabilitation, Levanger Hospital, Levanger, Norway
| | - Petter Borchgrevink
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karin de Ridder
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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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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Kioskli K, Scott W, Winkley K, Kylakos S, McCracken LM. Psychosocial Factors in Painful Diabetic Neuropathy: A Systematic Review of Treatment Trials and Survey Studies. PAIN MEDICINE 2020; 20:1756-1773. [PMID: 30980660 DOI: 10.1093/pm/pnz071] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Diabetes mellitus is associated with a number of complications that can adversely impact patients' quality of life. A common and often painful complication is painful diabetic neuropathy. The aims of this study were to systematically review and summarize evidence from studies of psychological treatments and psychosocial factors related to painful diabetic neuropathy and assess the methodological quality of these studies. METHODS Electronic databases, related reviews, and associated reference lists were searched. Summaries of participants' data relating to the efficacy of psychological treatments and/or to associations between psychosocial factors and outcomes in painful diabetic neuropathy were extracted from the included studies. The methodological quality of included studies was assessed using two standardized quality assessment tools. RESULTS From 2,921 potentially relevant titles identified, 27 studies were included in this systematic review. The evidence suggests that depression, anxiety, sleep, and quality of life are the most studied variables in relation to pain outcomes in painful diabetic neuropathy and are consistently associated with pain intensity. The magnitude of the associations ranged from small to large. CONCLUSIONS Research into psychosocial factors in painful diabetic neuropathy is unexpectedly limited. The available evidence is inconsistent and leaves a number of questions unanswered, particularly with respect to causal associations between variables. The evidence reviewed indicates that depression, anxiety, low quality of life, and poor sleep are associated with pain in painful diabetic neuropathy. The disproportionate lack of research into psychological treatments for painful diabetic neuropathy represents a significant opportunity for future research.
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Affiliation(s)
- Kitty Kioskli
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Whitney Scott
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Stavros Kylakos
- Department of Computer Science, City, University of London, London, UK
| | - Lance M McCracken
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Psychology, Uppsala University, Uppsala, Sweden
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Moraes ÉBD, Martins Júnior FF, Mattos-Pimenta CAD. In vivo exposure for fear of pain and avoidance of movement in low back pain. Rev Bras Enferm 2020; 73:e20190125. [PMID: 32638936 DOI: 10.1590/0034-7167-2019-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/12/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to verify the effects of hierarchization and in vivo exposure for fear of pain, avoidance of movement, and anxiety in chronic low back pain. METHODS quasi-experimental study. The 27 patients who participated graded the damage associated with the movements in each of the 40 activities of daily living depicted in pictures using a scale from 0 to 100. The patients chose five out of all the activities that received a score higher than 50 to carry out the exposure. The intensities of fear and anxiety were measured before and after each exposure session. RESULTS the frequencies of the gender were equal, and the mean age was 44.9 years. The activities chosen more frequently for the exposure were shoveling (33.3%) and running (33.3%). There was reduction of fear and anxiety before and after exposure (p<0.001). CONCLUSIONS hierarchization and in vivo exposure were effective in reducing fear and anxiety.
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Blanchard L, Goostree S, Duncombe A. Graded exposure and orthopedic manual physical therapy for kinesiophobia and function in chronic temporomandibular dysfunction: A case report. Cranio 2020; 40:454-467. [PMID: 32552574 DOI: 10.1080/08869634.2020.1779483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND This case report describes the successful use of multi-modal physical therapy (PT), including orthopedic manual physical therapy (OMPT) and graded exposure, in a patient with chronic temporomandibular dysfunction (TMD). CLINICAL PRESENTATION A 41-yr old female presented with a five-year history of bilateral chronic myofascial TMD and comorbid neck/right arm pain. The patient was treated for 12 weeks with a focus on OMPT and graded exposure. The patient demonstrated clinically significant improvements on the Tampa Scale of Kinesiophobia-TMD, maximal mouth opening, Global Rating of Change, and Jaw Functional Limitation Scale. CLINICAL RELEVANCE Mechanisms underlying chronic TMD are complex. Current evidence supports PT management of physical impairments; however, neglecting central drivers or psychosocial factors may result in suboptimal outcomes. Physical therapists are able to address both peripheral and central mechanisms of pain, and future research should examine the utilization of multi-modal PT to improve kinesiophobia and function in patients with chronic TMD.
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Affiliation(s)
- Leanna Blanchard
- Department of Rehabilitation Services, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | | | - Alison Duncombe
- Department of Rehabilitation Services, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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AL-Shudifat A, Farah K, Hawamdeh ZM, Alqudah A, Juweid ME. Psychometric testing of a short form, 11-item Tampa Scale of Kinesiophobia-Arabic version: TSK-AV-11. Medicine (Baltimore) 2020; 99:e20292. [PMID: 32541453 PMCID: PMC7302674 DOI: 10.1097/md.0000000000020292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To examine the psychometric properties of a short form TSK-AV in Arabic-speaking patients with chronic low back pain (CLBP).One hundred one CLBP patients recruited from Jordan University Hospital provided demographic information and completed the TSK-AV full version and measures of pain severity and disability. Explorative factor analysis was used to determine whether a generally accepted 2-factor model consisting of fewer TSK items applies to the TSK-AV and exhibits acceptable psychometric properties.A 2-factor model provided an adequate-to-good fit to our data, explaining 46.54% of the variance. Factor 1 (labeled as "activity avoidance") comprised items 1, 2, 7, 9, 14, 15, and 17. Factor 2 was labeled as "somatic focus" and comprised items 3, 6, 11, and 13. The 11-item TSK-AV comprised of the 2 factors (TSK-AV-11) as well as its subscales all remained independent significant (P < .001) predictors of pain disability in Jordanian patients with CLBP after accounting for factors such as age, gender, pain duration, and pain severity.The short, 11-item TSK-AV (TSK-AV-11) appears to be an ideal clinical and research tool for measuring fear of movement/re (injury) in Arabic-speaking patients.
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Affiliation(s)
| | | | | | | | - Malik E. Juweid
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, the University of Jordan, Jordan
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43
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The Relationship Between Injury-Related Fear and Visuomotor Reaction Time in Individuals With a History of Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2020; 30:353-359. [PMID: 32473583 DOI: 10.1123/jsr.2019-0511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/10/2020] [Accepted: 03/21/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Deficits in reaction time, decreased self-reported knee function, and elevated levels of injury-related fear have been observed in individuals who sustain anterior cruciate ligament injury. Understanding the relationship between these variables may provide the impetus to further investigate effective intervention strategies to address these deficits in individuals after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To examine the relationship between injury-related fear and lower-extremity visuomotor reaction time (VMRT) in individuals with a history of ACLR. A secondary purpose was to determine the relationship between self-reported knee function and lower-extremity VMRT in individuals with a history of ACLR. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS Twenty participants between the ages of 18-35 years, with history of unilateral ACLR within the last 10 years, who injured their knee playing or training for organized or recreational sports. MAIN OUTCOME MEASURES Scores on the athlete fear avoidance questionnaire, the fear-avoidance beliefs questionnaire (FABQ), the knee injury and osteoarthritis outcome score, and reaction time (in seconds) on the lower-extremity VMRT task using the FitLight Trainer™, bilaterally. Spearman Rho correlations examined the relationship between the dependent variables. RESULTS There was a moderate positive correlation between VMRT and FABQ-total (r = .62, P < .01), FABQ-sport (r = .56, P = .01), and FABQ-physical activity (r = .64, P < .01) for the injured limb. Correlations between FABQ scores and VMRT for the uninjured limb were weak positive correlations (r = .36-.41, P > .05). Weak correlations between the osteoarthritis outcome score subscales, athlete fear avoidance questionnaire, and VMRT were observed for the injured limb (P > .05). CONCLUSIONS Individuals with a history of ACLR who exhibited elevated levels of injury-related fear demonstrated slower VMRT. There were no relationships between self-reported knee function and VMRT. Future research should explore interventions to address injury-related fear and VMRT in individuals after ACLR.
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44
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D’Ippolito M, Purgato A, Buzzi MG. Pain and Evil: From Local Nociception to Misery Following Social Harm. J Pain Res 2020; 13:1139-1154. [PMID: 32547177 PMCID: PMC7250527 DOI: 10.2147/jpr.s236507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/07/2020] [Indexed: 01/03/2023] Open
Abstract
Experiencing pain, especially when chronic, is an excruciating condition that should be regarded as a syndrome, if not a disease. People suffering from chronic pain tend to develop psychological discomfort mostly due to lack of acceptance, disbelief, blame. The complexity of pain pathophysiology, plus a wide range of negative psychosocial factors, leads to a more complex suffering that deserves attention and multidisciplinary treatments. The possibility that chronic pain may occur following physical aggression, torture, or persecution raises the issue of evil as a major contributor to pain in its worst representation - when individuals or groups are attacked based on racial, social, gender, religious, political, or other grounds. To explore the complex issue of chronic pain following physical or psychological harm, and to underscore the need for a multidisciplinary approach to reduce the burden of chronic pain, we discuss the biological mechanisms underlying pain state. We seek to clarify those factors leading to pain chronification, as well as personal and social attitudes that confound patients with chronic pain. The importance of family and social environment is also investigated, as well as personality traits of chronic pain patients that may further hamper successful treatment. The presence of chronic pain, modulated by, for example, acceptance of being a victim of premeditated physical and social violence, makes the issue more difficult to comprehend.
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Affiliation(s)
| | - Adriano Purgato
- National Health System, Azienda USL Roma 2, Rome00157, Italy
| | - Maria Gabriella Buzzi
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome00179, Italy
- Headache Centre, IRCCS Fondazione Santa Lucia, Rome00179, Italy
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45
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Meierbachtol A, Obermeier M, Yungtum W, Bottoms J, Paur E, Nelson BJ, Tompkins M, Russell HC, Chmielewski TL. Injury-Related Fears During the Return-to-Sport Phase of ACL Reconstruction Rehabilitation. Orthop J Sports Med 2020; 8:2325967120909385. [PMID: 32258182 PMCID: PMC7099672 DOI: 10.1177/2325967120909385] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Fear of reinjury is common after anterior cruciate ligament reconstruction
(ACLR) and often deters a return to preinjury sport participation. A better
understanding of injury-related fear is needed to inform rehabilitation
strategies. Purpose/Hypothesis: The purpose of this study was to (1) identify individual fear-evoking tasks
or situations, (2) compare the intensity and amount of change relative to
other injury-related fears (reinjury, knee giving way, and knee pain) after
completion of a return-to-sport training program, and (3) determine whether
standardized questionnaires can identify the intensity of fear for the
individual fear-evoking task or situation and for fear of reinjury. The
hypothesis was that the task or situation that evokes fear would vary across
patients and the intensity of that fear would be higher and show less change
after return-to-sport training compared with other injury-related fears. Study Design: Case series; Level of evidence, 4. Methods: Participants included 33 patients (15 males; mean age, 18 years) with ACLR
who enrolled in a group-format return-to-sport training program.
Questionnaires completed before and after return-to-sport training included
items to specify fear-evoking tasks or situations, items to rate the
intensity of various injury-related fears, the Anterior Cruciate Ligament
Return to Sport after Injury scale (ACL-RSI), and the Tampa Scale for
Kinesiophobia (TSK-11). Results: The most common fear-evoking task or situation was cutting, followed by
contact, jumping, and other. Intensity of fear-evoking task or situation was
higher than other injury-related fears, but all fears decreased in intensity
after training. The ACL-RSI score better identified the intensity of fear
for the individual fear-evoking task or situation and for fear of reinjury
than did the TSK-11 score. Conclusion: Activities that evoke fear vary across patients, but fear of cutting is
common. The intensity of common fears after ACLR decreased after advanced
group training, and large effect sizes were seen for nearly all examined
fears. Fear of reinjury and intensity of individually feared tasks may be
better reflected in the ACL-RSI score than the TSK-11 score.
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Affiliation(s)
| | | | | | - John Bottoms
- TRIA Orthopedic Center, Bloomington, Minnesota, USA
| | - Eric Paur
- TRIA Orthopedic Center, Bloomington, Minnesota, USA
| | - Bradley J Nelson
- TRIA Orthopedic Center, Bloomington, Minnesota, USA.,Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc Tompkins
- TRIA Orthopedic Center, Bloomington, Minnesota, USA.,Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hayley C Russell
- Gustavus Adolphus College, Department of Health and Exercise Science, St Peter, Minnesota, USA
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Lotzke H, Gutke A, den Hollander M, Smeets R, Lundberg M. Developing an evidence-based prehabilitation programme designed to improve functional outcomes after lumbar fusion surgery - A feasibility study using the Medical Research Council framework. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2018.1553999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hanna Lotzke
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Division of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marlies den Hollander
- Adelante Centre of Expertise in Rehabilitation, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Mari Lundberg
- Department of Health and Rehabilitation, Division of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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47
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Van Lierde E, Goubert L, Vervoort T, Hughes G, Van den Bussche E. Learning to fear pain after observing another's pain: An experimental study in schoolchildren. Eur J Pain 2019; 24:791-806. [PMID: 31886912 DOI: 10.1002/ejp.1529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/14/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children of individuals with chronic pain have an increased vulnerability to experience pain problems, possibly through observation of pain in their parents. As pain-related fear (PRF) is a critical factor in the development and maintenance of chronic pain, the current experimental study examined the acquisition of PRF through observational learning and subsequent extinction after first-hand experience of the feared stimulus. METHODS Healthy children (8-16 years) observed either their mother or a stranger performing two cold pressor tasks (CPT) filled with coloured water. In a differential conditioning procedure, one colour (CS+) was combined with genuine painful facial expressions and the other colour (CS-) with neutral facial expressions. Following this observation phase, children performed both CPTs (10°C) themselves. RESULTS Children expected the CS+ to be more painful than the CS- and they reported being more afraid and hesitant to immerse in the CS+ compared to the CS-. Moreover, this fear was reflected in children's level of arousal in anticipation of CPT performance. This learned association extinguished after performing both CPTs. Effects were not moderated by whether the child observed their mother or a stranger, by the child's pain catastrophizing, trait PRF or trait anxiety. Remarkably, learning effects increased when the child perceived a larger difference between the model's painful and neutral facial expressions. CONCLUSIONS This study provides evidence for observational learning of PRF and subsequent extinction in schoolchildren. This acquisition of PRF by observing parental pain may contribute to vulnerabilities in children of parents with chronic pain. SIGNIFICANCE Children may acquire pain-related fear by observing pain in others and this learned fear can diminish after first-hand experience. Remarkably, observational learning did not depend on the children's relationship with the model, but it did depend on the intensity of pain that is perceived. A better understanding of the impact of observing (parental) pain may help clarify the intergenerational transmission of risk for pain and inform the development of preventive programs.
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Affiliation(s)
- Elke Van Lierde
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Gethin Hughes
- Department of Psychology, University of Essex, Colchester, UK
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Edmond SL, Werneke MW, Young M, Grigsby D, McClenahan B, Harris G, McGill T. Cognitive behavioural interventions, and function and pain outcomes among patients with chronic neck pain managed with the McKenzie approach. Musculoskeletal Care 2019; 18:46-52. [PMID: 31799798 DOI: 10.1002/msc.1440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Graded activity and graded exposure in vivo are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific neck pain. The McKenzie method is a common treatment approach for patients with neck pain. The study objectives were to examine associations between interventions with graded activity and/or graded exposure, as determined by the treating physiotherapist, and function and pain outcomes for patients with chronic nonspecific neck pain managed by clinicians with credentials in the McKenzie approach. METHOD A cohort study was carried out, in which subjects (n = 366) with chronic nonspecific neck pain completed intake surveys (i.e., the Neck Functional Status Computerized Adaptive Test and the Numeric Pain Rating Scale), and questions related to their demographic, lifestyle and health status. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Multivariable models examining associations between patients receiving versus not receiving graded activity/graded exposure, and pain and function outcomes were constructed, controlling for potential confounding effects. RESULTS Despite statistical significance, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and function or pain outcomes. CONCLUSION There is insufficient evidence to suggest that patients being managed with McKenzie methods will attain clinically relevant improvements in function or pain outcomes when augmenting treatment with graded activity and/or graded exposure when the choice to intervene with these cognitive behavioural approaches is determined by the treating physiotherapist.
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Affiliation(s)
| | | | - Michelle Young
- The Valley Health Wellness & Fitness Center, Winchester Medical Center, Winchester, VA
| | | | | | | | - Troy McGill
- Alaska Regional Hospital Anchorage AK, 2801 Debarr Rd, Anchorage, AK
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49
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Viaje S, Crombez G, Lord SR, Close JCT, Sachdev P, Brodaty H, Delbaere K. The role of concern about falling on stepping performance during complex activities. BMC Geriatr 2019; 19:333. [PMID: 31775634 PMCID: PMC6882024 DOI: 10.1186/s12877-019-1356-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is limited understanding of the underlying mechanisms explaining the role of concern about falling on fall risk in older people. Anxiety is known to interact with cognitive resources and, as people get older, they require more cognitive resources to maintain balance. This might affect an individual’s ability to perform cognitive-motor tasks concurrently. The aim of this study was to investigate the effect of a visuospatial dual-task on stepping performance in older people with and without concern about falling and the impact of repeating this task in those with high concern about falling. Methods Three-hundred-eight community-dwelling older people, aged 70 to 90 years old, participated in the study. Participants were asked to perform a Choice Stepping Reaction Time (CSRT) task in two conditions; once without any other tasks (single task condition), and once while simultaneously performing a visuospatial task (dual-task condition). Participants were asked to rate their levels of concern and confidence specifically related to each of the 25 stepping trials (before/after). We also measured general concern about falling, affect, and sensorimotor and cognitive functioning. Results Total stepping reaction times increased when participants also performed the visuospatial task. The relation between general concern about falling and stepping reaction time, was affected by sensorimotor and executive functioning. Generalised linear mixed models showed that the group with moderate to high levels of general concern about falling had slower total stepping reaction times than those with lower levels of concern about falling, especially during the dual-task condition. Individuals with greater general concern about falling showed reduced confidence levels about whether they could do the stepping tasks under both conditions. Repeatedly performing the stepping task reduced the immediate task-specific concern about falling levels and increased confidence in all participants. Conclusions These findings reveal that people with higher general concern about falling experienced more difficulties during a dual-task condition than people with lower levels of concern. Of further interest, better sensorimotor and cognitive functioning reduced this effect. Graded exposure has potential to reduce concern about falling during fear-evoking activities, especially in conjunction with therapies that improve balance, mood and cognitive function.
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Affiliation(s)
- Shaira Viaje
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, PO Box 1165, Sydney, Randwick, NSW, 2031, Australia
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, PO Box 1165, Sydney, Randwick, NSW, 2031, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, PO Box 1165, Sydney, Randwick, NSW, 2031, Australia.,Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South, Sydney, Wales, Australia.,Dementia Centre for Research CollaborationUniversity of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South, Sydney, Wales, Australia.,Dementia Centre for Research CollaborationUniversity of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, PO Box 1165, Sydney, Randwick, NSW, 2031, Australia. .,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
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Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks. Clin J Pain 2019; 35:647-655. [DOI: 10.1097/ajp.0000000000000728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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