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Lutsch AG, Baumeister H, Paganini S, Sander LB, Terhorst Y, Domhardt M. Mechanisms of change in digital cognitive behavioral therapy for depression in patients with chronic back pain: A mediation analysis of a multicenter randomized clinical trial. Behav Res Ther 2023; 168:104369. [PMID: 37531807 DOI: 10.1016/j.brat.2023.104369] [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: 03/31/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND While there is evolving knowledge on change processes of digital cognitive behavioral therapy (CBT) in the treatment of depression, little is known about how these interventions produce therapeutic change in the comorbid constellation of chronic back pain (CBP). Here, we examined whether the effects of a digital intervention to treat depression in patients with CBP are mediated by three pain-related variables (i.e., pain self-efficacy, pain-related disability, pain intensity). METHODS This study is a secondary analysis of a randomized clinical trial conducted in routine care at 82 orthopedic clinics across Germany. In total, 209 adults with CBP and diagnosed depression (SCID interview) were randomly assigned to the intervention (n = 104) or treatment-as-usual (n = 105). Cross-lagged mediation models were estimated to investigate longitudinal mediation effects of putative mediators with depression symptom severity (PHQ-9) as primary outcome at post-treatment. RESULTS Longitudinal mediation effects were observed for pain self-efficacy (ß = -0.094, 95%-CI [-0.174, -0.014], p = 0.021) and pain-related disability (ß = -0.068, 95%-CI [-0.130, -0.001], p = 0.047). Furthermore, the hypothesized direction of the mediation effects was supported, reversed causation did not occur. Pain intensity did not reveal a mediation effect. CONCLUSIONS The results suggest a relevant role of pain self-efficacy and pain-related disability as change processes in the treatment of depression for patients with CBP in routine care. However, further research is needed to disclose potential reciprocal relationships of mediators, and to extend and specify our knowledge of the mechanisms of change in digital CBT for depression.
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Affiliation(s)
- Arne G Lutsch
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Germany
| | - Lasse B Sander
- Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
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2
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Han JJ, Graham JH, Snyder DI, Alfieri T. Long-term Use of Wearable Health Technology by Chronic Pain Patients. Clin J Pain 2022; 38:701-710. [PMID: 36198095 PMCID: PMC9645546 DOI: 10.1097/ajp.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES People living with chronic pain may use wearable health technology (WHT) in conjunction with an expert-directed pain management program for up to 1 year. WHT use may be associated with improvements in key patient outcomes. METHODS A 12-month study of WHT use among people with chronic pain was conducted, consisting of iPhone and Apple Watch applications to measure movement, sleep, and self-reported pain. Clinical outcomes among 105 patients enrolled in a multidisciplinary pain program that included WHT use were compared with 146 patients in the same program but without WHT, and to 161 patients receiving medical pain management without WHT. RESULTS Participants used the WHT on average 143.0 (SD: 117.6) out of 365 days. Mixed-effects models revealed participants who used WHT had decreases in depression scores (-7.83, P <0.01) and prescribed morphine milligram equivalents (-21.55, P =0.04) over 1 year. Control groups also showed decreases in depression scores (-5.08, P =0.01; -5.68, P <0.01) and morphine milligram equivalents (-18.67, P =0.01; -10.99, ns). The estimated slope of change among the WHT was not statistically different than control groups. DISCUSSION Patients who used WHT as part of their pain management program demonstrated a willingness to do so for extended periods of time despite living with chronic pain and other comorbidities. Data trends suggest that WHT use may positively impact depression and prescribed medication. Additional research is warranted to investigate the potential of WHT to improve the negative consequences of chronic pain.
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Affiliation(s)
- John J. Han
- Department of Pain Medicine, Geisinger Danville, PA
| | - Jove H. Graham
- Center for Pharmacy Innovation and Outcomes Geisinger, Danville, PA
| | | | - Thomas Alfieri
- Medical Affairs Strategic Research, Purdue Pharma L.P., Stamford, CT
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3
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Smith WR, McClish DK, Bovbjerg VE, Singh HK. Development and validation of the sickle cell stress scale-adult. Eur J Haematol Suppl 2022; 109:215-225. [PMID: 35585659 PMCID: PMC9531901 DOI: 10.1111/ejh.13789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Disease‐specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD‐specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3‐item Likert‐scale adapted from a previous disease stress measure and a 10‐item Likert‐scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health‐related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self‐defined vaso‐occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three‐item and 10‐item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6‐month stress for the 10‐item scale. Cronbach's alpha was high for both the 3‐item (0.73) and 10‐item (0.83) SCD stress scales, test–retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary‐measured healthcare utilization over 6 months. The correlations with the 3‐item scale were stronger, but only statistically significant for depression‐anxiety. The correlation between the two stress scales was 0.59. Both the 3‐item and the 10‐item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test–retest reliability. Further scale validation should determine population norms and response to interventions.
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Affiliation(s)
- Wally R Smith
- Section of Research, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Viktor E Bovbjerg
- College of Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Harjot K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
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4
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Kanzler KE, Robinson PJ, McGeary DD, Mintz J, Kilpela LS, Finley EP, McGeary C, Lopez EJ, Velligan D, Munante M, Tsevat J, Houston B, Mathias CW, Potter JS, Pugh J. Addressing chronic pain with Focused Acceptance and Commitment Therapy in integrated primary care: findings from a mixed methods pilot randomized controlled trial. BMC PRIMARY CARE 2022; 23:77. [PMID: 35421949 PMCID: PMC9011950 DOI: 10.1186/s12875-022-01690-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/30/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Over 100 million Americans have chronic pain and most obtain their treatment in primary care clinics. However, evidence-based behavioral treatments targeting pain-related disability are not typically provided in these settings. Therefore, this study sought to: 1) evaluate implementation of a brief evidence-based treatment, Focused Acceptance and Commitment Therapy (FACT-CP), delivered by an integrated behavioral health consultant (BHC) in primary care; and 2) preliminarily explore primary (self-reported physical disability) and secondary treatment outcomes (chronic pain acceptance and engagement in valued activities). METHODS This mixed-methods pilot randomized controlled trial included twenty-six participants with non-cancer chronic pain being treated in primary care (54% women; 46% Hispanic/Latino). Active participants completed a 30-min individual FACT-CP visit followed by 3 weekly 60-min group visits and a booster visit 2 months later. An enhanced treatment as usual (ETAU) control group received 4 handouts about pain management based in cognitive-behavioral science. Follow-up research visits occurred during and after treatment, at 12 weeks (booster visit), and at 6 months. Semi-structured interviews were conducted to collect qualitative data after the last research visit. General linear mixed regression models with repeated measures explored primary and secondary outcomes. RESULTS The study design and FACT-CP intervention were feasible and acceptable. Quantitative analyses indicate at 6-month follow-up, self-reported physical disability significantly improved pre-post within the FACT-CP arm (d = 0.64); engagement in valued activities significantly improved within both the FACT-CP (d = 0.70) and ETAU arms (d = 0.51); and chronic pain acceptance was the only outcome significantly different between arms (d = 1.04), increased in the FACT-CP arm and decreased in the ETAU arm. Qualitative data analyses reflected that FACT-CP participants reported acquiring skills for learning to live with pain, consistent with increased chronic pain acceptance. CONCLUSION Findings support that FACT-CP was acceptable for patients with chronic pain and feasible for delivery in a primary care setting by a BHC. Results provide preliminary evidence for improved physical functioning after FACT-CP treatment. A larger pragmatic trial is warranted, with a design based on data gathered in this pilot. TRIAL REGISTRATION clinicaltrials.gov, NCT04978961 (27/07/2021).
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Affiliation(s)
- Kathryn E Kanzler
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., Mail Code 7768, San Antonio, TX, 78229, USA. .,Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. .,Department of Family & Community Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Donald D McGeary
- Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Family & Community Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jim Mintz
- Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lisa Smith Kilpela
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., Mail Code 7768, San Antonio, TX, 78229, USA.,Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Erin P Finley
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., Mail Code 7768, San Antonio, TX, 78229, USA.,Los Angeles Veterans Health Care System, Los Angeles, CA, USA.,Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Cindy McGeary
- Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Eliot J Lopez
- Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dawn Velligan
- Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mariana Munante
- U.S. Army Medical Department (AMEDD) Quality and Safety Center, US Army Medical Command, San Antonio, TX, USA
| | - Joel Tsevat
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., Mail Code 7768, San Antonio, TX, 78229, USA.,Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.,Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Brittany Houston
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Charles W Mathias
- Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jennifer Sharpe Potter
- Department of Psychiatry & Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jacqueline Pugh
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Amjad F, Mohseni-Bandpei MA, Gilani SA, Ahmad A, Hanif A. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:255. [PMID: 35296293 PMCID: PMC8924735 DOI: 10.1186/s12891-022-05196-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/08/2022] [Indexed: 01/16/2023] Open
Abstract
Background Lumbar radiculopathy is an extensively common complaint reported by patients of low back pain (LBP), resulting in several impairments. A comparatively novel technique, non-surgical spinal decompression (NSD), is introduced, which uses a sensitive computerized feedback mechanism and decompresses the spinal nerve roots through segmental distraction. The objective of this study was to determine the effects of NSD therapy in addition to routine physical therapy on pain, lumbar range of motion (ROM), functional disability, back muscle endurance (BME), and quality of life (QOL) in patients with lumbar radiculopathy. Methods A total of sixty patients with lumbar radiculopathy were randomly allocated into two groups, an experimental (n = 30) and a control (n = 30) group, through a computer-generated random number table. Baseline values were recorded before providing any treatment by using a visual analogue scale (VAS), Urdu version of Oswestry disability index (ODI-U), modified-modified Schober’s test (MMST), prone isometric chest raise test, and Short Form 36-Item Survey (SF-36) for measuring the pain at rest, functional disability, lumbar ROM, BME, and QOL, respectively. All patients received twelve treatment sessions over 4 weeks, and then all outcome measures were again recorded. Results By using the ANCOVA test, a statistically significant (p < 0.05) between-group improvement was observed in VAS, ODI-U, BME, lumbar ROM, role physical (RP), and bodily pain (BP) domains of SF-36, which was in favour of NSD therapy group. The between-group difference was 1.07 ± 0.32 cm (p < .001) for VAS, 5.65 ± 1.48 points (p < .001) for ODI-U, 13.93 ± 5.85 s (p = 0.002) for BME, 2.62 ± 0.27 cm (p < .001) for lumbar flexion, 0.96 ± 0.28 (p < .001) for lumbar extension, 5.77 ± 2.39 (p = 0.019) for RP and 6.33 ± 2.52 (p = 0.016) for BP domain of SF-36. For these outcomes, a medium to large effect size (d = 0.61–2.47, 95% CI: 0.09–3.14) was observed. Conclusion It was concluded that a combination of non-surgical spinal decompression therapy with routine physical therapy is more effective, statistically and clinically, than routine physical therapy alone in terms of improving pain, lumbar range of motion, back muscle endurance, functional disability, and physical role domain of quality of life, in patients with lumbar radiculopathy, following 4 weeks of treatment. Trial registration WHO Iranian registry of clinical trials (IRCT20190717044238N1) Dated: 23.12.2019.
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Affiliation(s)
- Fareeha Amjad
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.
| | - Mohammad A Mohseni-Bandpei
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.,Pediatric Neurorehabilitation Research Center, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Ashfaq Ahmad
- Department University Institute of Physical Therapy, Faculty of Allied Health Sciences, Lahore, Pakistan
| | - Asif Hanif
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
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6
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Bablis P, Pollard H, Rosner AL. Stress reduction via neuro-emotional technique to achieve the simultaneous resolution of chronic low back pain with multiple inflammatory and biobehavioural indicators: A randomized, double-blinded, placebo-controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:135-144. [PMID: 34924332 DOI: 10.1016/j.joim.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Beginning with the concepts of stress developed by Selye, an approach to stress and pain management, known as neuro-emotional technique (NET), has been developed. It is a treatment approach based on the principle that the stressor effects of dormant and/or current unresolved issues or trauma are what determine one's bodily responses. These responses are relatively personalized to the conditioned, experiential and emotional reality of the individual. OBJECTIVE To determine the effect of NET on patients with chronic low back pain (CLBP) over time. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS In a randomized, double-blinded, placebo-controlled study conducted in a single clinic, NET or control treatments were given twice weekly for 4 weeks in a population of 112 patients. MAIN OUTCOME MEASURES Outcome measures, including Oswestry Disability Index, Quadruple Visual Analogue Scale, the psychoneuroimmunology markers of blood serum levels of C-reactive protein, tumour necrosis factor-α, interleukin-1 (IL-1), IL-6, and IL-10, and 10 dimensions of the Short Form Health Survey scale, were assessed at baseline and at 1, 3 and 6 months following the intervention period. RESULTS Compared to placebo, NET produced clinical and statistical significance (P < 0.001) via declines of virtually all physiological, pain and disability markers, accompanied by gains in quality-of-life indicators at 0 (baseline), 1, 3 and 6 months. Reductions of the percentages of patients whose 5 biomarkers lay outside the normative range were achieved at 1, 3 and 6 months by NET but not control interventions. CONCLUSION A randomized, controlled trial of CLBP patients indicated that 8 NET interventions, compared to placebo, produced clinically and statistically significant reductions in pain, disability and inflammatory biomarkers, and improvements in quality-of-life measures. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry (No. ACTRN12608000002381).
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Affiliation(s)
- Peter Bablis
- Universal Health, New South Wales 2028, Australia
| | - Henry Pollard
- School of Medical and Applied Sciences, University of Central Queensland, Brisbane, New South Wales 4000, Australia
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7
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Therapeutic and Preventive Efficacy of an Intervention on Workers in a Back School. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19021000. [PMID: 35055822 PMCID: PMC8775863 DOI: 10.3390/ijerph19021000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023]
Abstract
Back pain and its ailments are the main cause of absenteeism and sick leave. Furthermore, the cause of pain and disability in a large number of workers is unknown, and treatments are not effective in controlling it. For this reason, the Back Schools (BSs) provide theoretical and practical training to workers so that they can acquire knowledge and skills that will allow them to adequately manage their back problems, enabling them to recover their autonomy and prevent relapses. The aim of the study is to analyse the efficacy of a BS by means of the evaluation of pain and disability scales in workers in different sectors and in construction. The most important clinical benefits obtained after the intervention of a BS are the reduction of pain and disability. Statistically significant and clinically relevant results have been observed between the initial assessment and the 6-month review. BS has been shown to be effective in reducing low back and neck pain and disability during the first 6 months of follow-up. Construction workers have pain and disability rates at the overall mean and with improvements between the initial assessment and the 6-month review. Their rates of improvement are clinically more relevant than for the overall population analysed.
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8
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Siette J, Knaggs GT, Zurynski Y, Ratcliffe J, Dodds L, Westbrook J. Systematic review of 29 self-report instruments for assessing quality of life in older adults receiving aged care services. BMJ Open 2021; 11:e050892. [PMID: 34794991 PMCID: PMC8603300 DOI: 10.1136/bmjopen-2021-050892] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Quality of life (QoL) outcomes are used to monitor quality of care for older adults accessing aged care services, yet it remains unclear which QoL instruments best meet older adults', providers' and policymakers' needs. This review aimed to (1) identify QoL instruments used in aged care and describe them in terms of QoL domains measured and logistical details; (2) summarise in which aged care settings the instruments have been used and (3) discuss factors to consider in deciding on the suitability of QoL instruments for use in aged care services. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, Cochrane Library and CINAHL from inception to 2021. ELIGIBILITY CRITERIA Instruments were included if they were designed for adults (>18 years), available in English, been applied in a peer-reviewed research study examining QoL outcomes in adults >65 years accessing aged care (including home/social care, residential/long-term care) and had reported psychometrics. DATA EXTRACTION AND SYNTHESIS Two researchers independently reviewed the measures and extracted the data. Data synthesis was performed via narrative review of eligible instruments. RESULTS 292 articles reporting on 29 QoL instruments were included. Eight domains of QoL were addressed: physical health, mental health, emotional state, social connection, environment, autonomy and overall QoL. The period between 1990 and 2000 produced the greatest number of newly developed instruments. The EuroQoL-5 Dimensions (EQ-5D) and Short Form-series were used across multiple aged care contexts including home and residential care. More recent instruments (eg, ICEpop CAPability measure for Older people (ICECAP-O) and Adult Social Care Outcomes Toolkit (ASCOT)) tend to capture emotional sentiment towards personal circumstances and higher order care needs, in comparison with more established instruments (eg, EQ-5D) which are largely focused on health status. CONCLUSIONS A comprehensive list of QoL instruments and their characteristics is provided to inform instrument choice for use in research or for care quality assurance in aged care settings, depending on needs and interests of users.
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Affiliation(s)
- Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- NHMRC Partnership Centre for Health Systems Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- NHMRC Partnership Centre for Health Systems Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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9
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Sisco-Taylor BL, Magel JS, McFadden M, Greene T, Shen J, Fritz JM. Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial. PAIN MEDICINE 2021; 23:1127-1137. [PMID: 34613379 PMCID: PMC9157170 DOI: 10.1093/pm/pnab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/25/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Fear-Avoidance Model of chronic pain (FAM) posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT's effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. SUBJECTS Participants were 204 patients with low-back pain of < 16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks. METHODS Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales) and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. RESULTS Early PT led to improvements in disability and pain over 3 months, but not 1 year. In the single mediator model, four-week reductions in pain catastrophizing mediated early PT's effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. CONCLUSIONS In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients' catastrophizing.
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Affiliation(s)
| | - John S Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT.,Department of Physical Therapy, Intermountain Healthcare, Salt Lake City, UT
| | - Molly McFadden
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT.,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jincheng Shen
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT.,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
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10
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Odonkor CA, Taraben S, Tomkins-Lane C, Zhang W, Muaremi A, Leutheuser H, Sun R, Smuck M. Examining the Association Between Self-Reported Estimates of Function and Objective Measures of Gait and Physical Capacity in Lumbar Stenosis. Arch Rehabil Res Clin Transl 2021; 3:100147. [PMID: 34589697 PMCID: PMC8463455 DOI: 10.1016/j.arrct.2021.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: To evaluate the association of self-reported physical function with subjective and objective measures as well as temporospatial gait features in lumbar spinal stenosis (LSS). Design: Cross-sectional pilot study. Setting: Outpatient multispecialty clinic. Participants: Participants with LSS and matched controls without LSS (n=10 per group; N=20). Interventions: Not applicable. Main Outcome Measures: Self-reported physical function (36-Item Short Form Health Survey [SF-36] physical functioning domain), Oswestry Disability Index, Swiss Spinal Stenosis Questionnaire, the Neurogenic Claudication Outcome Score, and inertia measurement unit (IMU)-derived temporospatial gait features Results: Higher self-reported physical function scores (SF-36 physical functioning) correlated with lower disability ratings, neurogenic claudication, and symptom severity ratings in patients with LSS (P<.05). Compared with controls without LSS, patients with LSS have lower scores on physical capacity measures (median total distance traveled on 6-minute walk test: controls 505 m vs LSS 316 m; median total distance traveled on self-paced walking test: controls 718 m vs LSS 174 m). Observed differences in IMU-derived gait features, physical capacity measures, disability ratings, and neurogenic claudication scores between populations with and without LSS were statistically significant. Conclusions: Further evaluation of the association of IMU-derived temporospatial gait with self-reported physical function, pain related-disability, neurogenic claudication, and spinal stenosis symptom severity score in LSS would help clarify their role in tracking LSS outcomes.
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Affiliation(s)
- Charles A Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, New Haven, CT.,Orthopedics and Rehabilitation, Interventional Pain Medicine and Physiatry, Yale New Haven Hospital, New Haven, CT
| | - Salam Taraben
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Wei Zhang
- Department of Essential Medicine and Health Product, World Health Organization, Geneva, Switzerland
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Heike Leutheuser
- Central Institute for Medical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ruopeng Sun
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
| | - Matthew Smuck
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
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Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain. J Hand Ther 2021; 33:562-570.e1. [PMID: 31481341 DOI: 10.1016/j.jht.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/09/2019] [Accepted: 06/18/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional. INTRODUCTION Pain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. PURPOSE OF THE STUDY The purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. METHODS Measures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. RESULTS The best-fitting regression model with DASH scores entered as the dependent variable (F4,50 = 28.8, P < .01) included MPI Pain Interference (β = -0.54), Life Control (β = -0.16), Purdue pegboard scores (β = -0.32), and Stroop test times (β = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R2 = 0.67, P < .01). CONCLUSION Pain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.
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Heiberg Agerbeck A, Martiny FHJ, Jauernik CP, Due Bruun K, Rahbek OJ, Bissenbakker KH, Brodersen J. Validity of Current Assessment Tools Aiming to Measure the Affective Component of Pain: A Systematic Review. PATIENT-RELATED OUTCOME MEASURES 2021; 12:213-226. [PMID: 34262380 PMCID: PMC8274708 DOI: 10.2147/prom.s304950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/04/2021] [Indexed: 01/01/2023]
Abstract
The objective of this study was to identify patient-reported outcome measures (PROMs), which aim to measure the affective component of pain and to assess their content validity, unidimensionality, measurement invariance, and Internal consistency in patients with chronic pain. The study was reported according to the PRISMA guidelines. A protocol of the review was submitted to PROSPERO before data extraction. Eligible studies were any type of study that investigated at least one of the domains: PROM development, content validity, dimensionality, internal consistency, or measurement invariance of any type of scale that claimed to measure the affective component of pain among patients with chronic pain. The databases Medline, Embase, PsycINFO, and the Cochrane Library were searched for eligible studies. The database search was supplemented by looking for relevant articles in the reference list of included studies, ie backtracking. All included studies were assessed independently by two authors according to the “COSMIN methodology on Systematic Reviews of Patient-Reported Outcome Measures”. Descriptive data synthesis of the identified PROMs was conducted. The search yielded 11,242 titles of which 283 were assessed at the full-text level. Full-text screening led to the inclusion of 11 studies and an additional 28 studies were identified via backtracking, leading to the inclusion of 39 studies in total in the review. Included studies described the development and validity of 10 unique PROMs, all of which we assessed to have potentially inadequate content validity and doubtful psychometric properties. No studies reported whether the PROMs possessed invariant measurement properties. The existing PROMs measuring affective components of chronic pain potentially lack content validity and have inadequate psychometric measurement properties. There is a need for new PROMs measuring the affective component of chronic pain that possess high content validity and adequate psychometric measurement properties.
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Affiliation(s)
- Anders Heiberg Agerbeck
- The Section of General Practice and Research Unit for General Practice in Copenhagen, Copenhagen, Denmark.,The Research Unit for General Practice in Region Zealand, Copenhagen, Denmark.,Pain Research Group, Pain Centre, Odense University Hospital, Odense, Denmark
| | - Frederik Handberg Juul Martiny
- The Section of General Practice and Research Unit for General Practice in Copenhagen, Copenhagen, Denmark.,The Research Unit for General Practice in Region Zealand, Copenhagen, Denmark
| | - Christian Patrick Jauernik
- The Section of General Practice and Research Unit for General Practice in Copenhagen, Copenhagen, Denmark.,The Research Unit for General Practice in Region Zealand, Copenhagen, Denmark
| | - Karin Due Bruun
- Pain Research Group, Pain Centre, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Or Joseph Rahbek
- The Section of General Practice and Research Unit for General Practice in Copenhagen, Copenhagen, Denmark.,The Research Unit for General Practice in Region Zealand, Copenhagen, Denmark
| | - Kristine H Bissenbakker
- The Section of General Practice and Research Unit for General Practice in Copenhagen, Copenhagen, Denmark.,The Research Unit for General Practice in Region Zealand, Copenhagen, Denmark
| | - John Brodersen
- The Section of General Practice and Research Unit for General Practice in Copenhagen, Copenhagen, Denmark.,The Research Unit for General Practice in Region Zealand, Copenhagen, Denmark
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Benz T, Lehmann S, Elfering A, Sandor PS, Angst F. Comprehensiveness and validity of a multidimensional assessment in patients with chronic low back pain: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:291. [PMID: 33743669 PMCID: PMC7981999 DOI: 10.1186/s12891-021-04130-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background Chronic low back pain is a multidimensional syndrome affecting physical activity and function, health-related quality of life and employment status. The aim of the study was to quantify the cross-sectional and longitudinal validity of single measurement scales in specific construct domains and to examine how they combine to build a comprehensive outcome, covering the complex construct of chronic low back pain before and after a standardized interdisciplinary pain program. Methods This prospective cohort study assessed 177 patients using the Short Form 36 (SF-36), the Multidimensional Pain Inventory (MPI), the Symptom Checklist-90-Revised (SCL-90-R), the Oswestry Disability Index (ODI), and 2 functional performance tests, the Back Performance Scale (BPS) and the 6-Minute Walking Distance (6MWD). The comprehensiveness and overlap of the constructs used were quantified cross-sectionally and longitudinally by bivariate correlations, exploratory factor analysis, and effect sizes. Results The mean age of the participants was 48.0 years (+/− 12.7); 59.3% were female. Correlations of baseline scores ranged from r = − 0.01 (BPS with MPI Life control) to r = 0.76 (SF-36 Mental health with MPI Negative mood). SF-36 Physical functioning correlated highest with the functional performance tests (r = 0.58 BPS, 0.67 6MWD) and ODI (0.56). Correlations of change scores (difference of follow-up – baseline score) were consistent but weaker. Factor analysis revealed 2 factors: “psychosocial” and “pain & function” (totally explained variance 44.0–60.9%). Psychosocial factors loaded strongest (up to 0.89 SCL-90-R) on the first factor, covering 2/3 of the explained variance. Pain and function (ing) loaded more strongly on the second factor (up to 0.81 SF-36 Physical functioning at follow-up). All scales showed improvements, with effect sizes ranging from 0.16–0.67. Conclusions Our results confirm previous findings that the chronic low back pain syndrome is highly multifactorial and comprises many more dimensions of health and quality of life than merely back-related functioning. A comprehensive outcome measurement should include the predominant psychosocial domain and a broad spectrum of measurement constructs in order to assess the full complexity of the chronic low back syndrome. Convergence and divergence of the scales capture the overlapping contents and nuances within the constructs.
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Affiliation(s)
- Thomas Benz
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland. .,Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, Switzerland. .,Graduate School for Health Sciences, University of Bern, Bern, Switzerland. .,Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.
| | - Susanne Lehmann
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland
| | - Achim Elfering
- Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, Switzerland
| | - Peter S Sandor
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland
| | - Felix Angst
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland
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Chen M, Patel T, Chang F. The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain-A Pilot Study. PHARMACY 2020; 8:pharmacy8030113. [PMID: 32650605 PMCID: PMC7559158 DOI: 10.3390/pharmacy8030113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists' extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.
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Affiliation(s)
| | | | - Feng Chang
- Correspondence: ; Tel.: +1-519-888-4567 (ext. 21321)
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15
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Schlicker S, Baumeister H, Buntrock C, Sander L, Paganini S, Lin J, Berking M, Lehr D, Ebert DD. A Web- and Mobile-Based Intervention for Comorbid, Recurrent Depression in Patients With Chronic Back Pain on Sick Leave (Get.Back): Pilot Randomized Controlled Trial on Feasibility, User Satisfaction, and Effectiveness. JMIR Ment Health 2020; 7:e16398. [PMID: 32293577 PMCID: PMC7191351 DOI: 10.2196/16398] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/11/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic back pain (CBP) is linked to a higher prevalence and higher occurrence of major depressive disorder (MDD) and can lead to reduced quality of life. Unfortunately, individuals with both CBP and recurrent MDD are underidentified. Utilizing health care insurance data may provide a possibility to better identify this complex population. In addition, internet- and mobile-based interventions might enhance the availability of existing treatments and provide help to those highly burdened individuals. OBJECTIVE This pilot randomized controlled trial investigated the feasibility of recruitment via the health records of a German health insurance company. The study also examined user satisfaction and effectiveness of a 9-week cognitive behavioral therapy and Web- and mobile-based guided self-help intervention Get.Back in CBP patients with recurrent MDD on sick leave compared with a waitlist control condition. METHODS Health records from a German health insurance company were used to identify and recruit participants (N=76) via invitation letters. Study outcomes were measured using Web-based self-report assessments at baseline, posttreatment (9 weeks), and a 6-month follow-up. The primary outcome was depressive symptom severity (Center for Epidemiological Studies-Depression); secondary outcomes included anxiety (Hamilton Anxiety and Depression Scale), quality of life (Assessment of Quality of Life), pain-related variables (Oswestry Disability Index, Pain Self-Efficacy Questionnaire, and pain intensity), and negative effects (Inventory for the Assessment of Negative Effects of Psychotherapy). RESULTS The total enrollment rate with the recruitment strategy used was 1.26% (76/6000). Participants completed 4.8 modules (SD 2.6, range 0-7) of Get.Back. The overall user satisfaction was favorable (mean Client Satisfaction Questionnaire score=24.5, SD 5.2). Covariance analyses showed a small but statistically significant reduction in depressive symptom severity in the intervention group (n=40) at posttreatment compared with the waitlist control group (n=36; F1,76=3.62, P=.03; d=0.28, 95% CI -0.17 to 0.74). Similar findings were noted for the reduction of anxiety symptoms (F1,76=10.45; P=.001; d=0.14, 95% CI -0.31 to 0.60) at posttreatment. Other secondary outcomes were nonsignificant (.06≤P≤.44). At the 6-month follow-up, the difference between the groups with regard to reduction in depressive symptom severity was no longer statistically significant (F1,76=1.50, P=.11; d=0.10, 95% CI -0.34 to 0.46). The between-group difference in anxiety at posttreatment was maintained to follow-up (F1,76=2.94, P=.04; d=0.38, 95% CI -0.07 to 0.83). There were no statistically significant differences across groups regarding other secondary outcomes at the 6-month follow-up (.08≤P≤.42). CONCLUSIONS These results suggest that participants with comorbid depression and CBP on sick leave may benefit from internet- and mobile-based interventions, as exemplified with the positive user satisfaction ratings. The recruitment strategy via health insurance letter invitations appeared feasible, but more research is needed to understand how response rates in untreated individuals with CBP and comorbid depression can be increased. TRIAL REGISTRATION German Clinical Trials Register DRKS00010820; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010820.
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Affiliation(s)
- Sandra Schlicker
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Lasse Sander
- Department of Rehabilitationpsychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Sarah Paganini
- Department of Sport and Sport Science, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jiaxi Lin
- Department of Psychiatry and Psychotherapy Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Lehr
- Health Psychology and Applied Biological Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Faculty of Behavioural and Movement Sciences, Section of Clinical Psychology, Vrije University Amsterdam, Amsterdam, Netherlands
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16
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Pomares Avalos AJ, López Fernández R, Zaldívar Pérez DF. [Validation of the Oswestry disability scale for low back pain in patients with chronic back pain. Cienfuegos, 2017-2018]. Rehabilitacion (Madr) 2020; 54:25-30. [PMID: 32007179 DOI: 10.1016/j.rh.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/23/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A large number of patients have chronic back pain, producing disability. Consequently, there is a need to validate instruments for pain measurement. The aim of this study was to determine the validity and reliability of the Oswestry Disability Scale for Low Back Pain in the population with chronic back pain in Cienfuegos. MATERIAL AND METHOD The investigation consisted of the development of an instrument to validate the scale through content validity, construct validity and reliability analysis. The validation included linguistic and cultural adaptation of the instrument. The study was conducted at the Dr. Gustavo Aldereguía Lima University Hospital in Cienfuegos, Cuba, from September 2017 to October 2018. Systematic randomised sampling was used. The sample included 162 patients. The statistical analysis was performed with the SPSS statistical package. RESULTS The experts considered that the instrument should remain unchanged. Factorial analysis identified the presence of three intercorrelated factors that represented 63% of the total. A global Cronbach α of 0.801 was obtained and the temporal stability of the instrument was demonstrated. CONCLUSIONS The results confirm the validity and reliability of the Oswestry Disability Scale for Low Back Pain in the Cienfuegan population with chronic back pain.
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Affiliation(s)
- A J Pomares Avalos
- Hospital General Universitario «Dr. Gustavo Aldereguía» Lima, Cienfuegos, Cuba.
| | - R López Fernández
- Universidad Metropolitana de Ecuador, Guayaquil, Ecuador; Universidad Carlos Rafael Rodríguez, Cienfuegos, Cuba
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Stedenfeldt M, Kvarstein G, Nilsen TIL, Schjødt B, Borchgrevink PC, Halsteinli V. Pre-consultation biopsychosocial data from patients admitted for management at pain centers in Norway. Scand J Pain 2020; 20:363-373. [DOI: 10.1515/sjpain-2019-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/12/2019] [Indexed: 01/13/2023]
Abstract
Abstract
Background and aims
A bio-psycho-social approach has been recommended in multidisciplinary pain clinics, and in Norway patients with severe chronic nonmalignant pain (CNMP, defined as pain that has persisted for more than 3 months) might be treated at a regional multidisciplinary pain center. The specific aims of this study were (1) to describe characteristics of a sample of outpatients referred and accepted for treatment/management to three regional multidisciplinary pain centers in Norway, (2) to examine patient differences between the centers and (3) to study associations between symptom scores (insomnia, fatigue, depression, anxiety) and patient characteristics.
Methods
Patients, aged 17 years or older with CNMP admitted to and given a date for first consultation at one of three tertiary, multidisciplinary pain centers: St. Olavs Hospital Trondheim University Hospital (STO), Haukeland University Hospital (HUS) and University Hospital of North Norway (UNN), were included in the study. Data on demographics, physical activity, characteristics of pain, previous traumatic events, social network, Insomnia Severity Index (ISI), Chalder Fatigue Questionnaire (CFQ), Hopkins Symptom Checklist-25 (HSCL-25) and SF-36v2® were retrieved from the local quality registry at each pain center.
Results
Data from 1563 patients [mean age 42 (SD 15) years and 63% females] were available for analyses. Average years with pain were 9.3 (SD 9.1). Primary education as highest level of education was reported by 20%, being actively working/student/military by 32%, and no physical activity by 31%. Further, 48% reported widespread pain, 61% reported being exposed to serious life event(s), and 77% reported having a close friend to talk to. Non-worker status, no physical activity, lack of social network, reports of being exposed to serious life event(s) and widespread pain were all characteristics repeatedly associated with clinically high symptom scores. No significant differences between the centers were found in the proportions of patients reporting fatigue nor mean levels of insomnia symptoms. However, the proportion of patients reporting symptoms of anxiety and depression was a little lower at UNN compared with STO and HUS.
Conclusions
Analyses of registry data from three tertiary multidisciplinary pain centers in Norway support previous findings from other registry studies regarding patient characterized: A large proportion being women, many years of pain, low employment rate, low physical activity rate, and a large proportion reporting previous traumatic event(s). Characteristics such as non-work participation, no physical activity, lack of social network, have been exposed to serious life event(s), and chronic widespread pain were all associated with high clinical score levels of insomnia, fatigue, and mental distress. Health related quality of life was low compared to what has been reported for a general population and a range of other patient groups.
Implications
The findings of this study indicate that physical activity and work participation might be two important factors to address in the rehabilitation of patients with chronic non-malignant pain. Future studies should also explore whether pre consultation self-reported data might give direction to rehabilitation modalities.
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Affiliation(s)
- Mona Stedenfeldt
- Regional Center for Health Care Improvement, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway , Phone: 0047 – 97676008
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
- National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, UiT , The Arctic University of Norway , Tromsø , Norway
- Department of Pain Management , University Hospital of Northern Norway , Tromsø , Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing , Norwegian University of Science and Technology , Trondheim , Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Borrik Schjødt
- Centre for Pain Management and Palliative Care, Haukeland University Hospital , Bergen , Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
- National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Vidar Halsteinli
- Regional Center for Health Care Improvement, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway , Phone: 0047 – 97676008
- Department of Public Health and Nursing , Norwegian University of Science and Technology , Trondheim , Norway
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Kanzler KE, Pugh JA, McGeary DD, Hale WJ, Mathias CW, Kilpela LS, Karns-Wright TE, Robinson PJ, Dixon SA, Bryan CJ, Moring JC, McCracken LM. Mitigating the Effect of Pain Severity on Activity and Disability in Patients with Chronic Pain: The Crucial Context of Acceptance. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1509-1518. [PMID: 30590737 PMCID: PMC6686120 DOI: 10.1093/pm/pny197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effect of pain severity on activity levels and physical disability in the context of high pain acceptance. We hypothesized that pain acceptance moderates the effect of pain severity on general activity and physical disability, such that at higher levels of acceptance, the deleterious effect of pain is mitigated. METHODS Two hundred seven patients with chronic pain were recruited from three clinics in a large southwestern military treatment facility. Participants completed an anonymous self-report battery of standardized measures, including the Chronic Pain Acceptance Questionnaire, modified Oswestry Disability Index, and Pain Severity and General Activity subscales of the West Haven-Yale Multidimensional Pain Inventory. RESULTS Chronic pain acceptance was found to significantly moderate relations between pain severity and general activity (b = 0.0061, t(198) = 2.75, P = 0.007, 95% confidence interval [CI] = 0.002 to 0.011) and pain severity and disability (b = 0.036, t(193) = -2.564, P = 0.011, 95% CI = -0.063 to -0.008). In the context of higher acceptance, the negative effect of pain on activity and disability appeared reduced. Conversely, in the context of low acceptance, the effect of pain on disability appeared accentuated at all levels of pain severity. CONCLUSIONS Higher acceptance mitigated both activity level and disability in a military-affiliated clinical sample of patients with chronic pain. Results further establish the role of acceptance in relation to functioning in a unique sample of people with chronic pain. These findings have implications for understanding and enhancing functioning in chronic pain populations.
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Affiliation(s)
- Kathryn E Kanzler
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Jacqueline A Pugh
- South Texas Veterans Health Care System
- Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Donald D McGeary
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Charles W Mathias
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Lisa S Kilpela
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Tara E Karns-Wright
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | | | - Sara A Dixon
- 81 DS/SGD Orofacial Pain, Keesler Air Force Base
| | - Craig J Bryan
- National Center for Veterans Studies and Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | | | - Lance M McCracken
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Kashikar-Zuck S, Cunningham N, Peugh J, Black WR, Nelson S, Lynch-Jordan AM, Pfeiffer M, Tran ST, Ting TV, Arnold LM, Carle A, Noll J, Powers SW, Lovell DJ. Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time. Pain 2019; 160:433-441. [PMID: 30335681 PMCID: PMC6344278 DOI: 10.1097/j.pain.0000000000001415] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Juvenile-onset fibromyalgia (JFM) is typically diagnosed in adolescence and characterized by widespread pain and marked functional impairment. The long-term impact of JFM into adulthood is poorly understood. The objectives of this study were to describe physical and psychosocial outcomes of youth diagnosed with JFM in early adulthood (∼8-year follow-up), examine longitudinal trajectories of pain and depressive symptoms from adolescence to young adulthood, and examine the impact of pain and depressive symptoms on physical functioning over time. Participants were 97 youth with JFM enrolled in a prospective longitudinal study in which pain symptoms, and physical and psychosocial functioning were assessed at 4 time points over approximately 8 years. At the time 4 follow-up (Mage = 24.2 years), the majority continued to suffer from pain and impairment in physical, social, and psychological domains. However, trajectories of pain and emotional symptoms showed varying patterns. Longitudinal analysis using growth mixture modeling revealed 2 pain trajectories (Steady Improvement and Rapid Rebounding Improvement), whereas depressive symptoms followed 3 distinct trajectories (Low-Stable, Improving, and Worsening). Membership in the Worsening Depressive symptoms group was associated with poorer physical functioning over time (P < 0.001) compared with the Low-Stable and Improving groups. This study offers evidence that although JFM symptoms persist for most individuals, pain severity tends to decrease over time. However, depressive symptoms follow distinct trajectories that indicate subgroups of JFM. In particular, JFM patients with worsening depressive symptoms showed decreasing physical functioning and may require more intensive and consistent intervention to prevent long-term disability.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Natoshia Cunningham
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - James Peugh
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - William R. Black
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Sarah Nelson
- Department of Anesthesia, Pain and Perioperative Medicine, Boston Children’s Hospital
- Department of Psychiatry, Harvard Medical School
| | - Anne M. Lynch-Jordan
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Megan Pfeiffer
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | | | - Tracy V. Ting
- Department of Pediatrics, University of Cincinnati College of Medicine
- Department of Psychology, DePaul University, Chicago
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center
| | - Lesley M. Arnold
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine
| | - Adam Carle
- Department of Pediatrics, University of Cincinnati College of Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center
| | - Jennie Noll
- Department of Human Development and Family Studies, The Pennsylvania State University
| | - Scott W. Powers
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Daniel J. Lovell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center
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20
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Kanera IM, van Laake-Geelen CCM, Ruijgrok JM, Goossens MEJB, de Jong JR, Verbunt JA, Geerts M, Smeets RJEM, Kindermans HPJ. Living with painful diabetic neuropathy: insights from focus groups into fears and coping strategies. Psychol Health 2018; 34:84-105. [PMID: 30320508 DOI: 10.1080/08870446.2018.1518526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Painful diabetic neuropathy (PDN) is known to negatively affect quality of life. Being physically active is a crucial part of successful diabetes self-management, but regimen adherence is often low. Coping strategies and fears have shown to be related to less physical activity (PA). The aim of the present study was to obtain more in-depth information on psychological risk factors leading to less PA in persons with PDN. DESIGN Three semi-structured focus group interviews were conducted with a representative sample of persons with PDN (N = 12). Data were transcribed verbatim and analysed using a hybrid method of thematic analyses and a grounded theory approach. MAIN OUTCOME MEASURES Fears and coping strategies related to PA in persons with PDN. RESULTS Several specific fears were identified; fear of hypoglycaemia, fear of pain increase, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity, and fear of negative evaluation by others. To cope with these fears, avoidance, remaining active, cognitive distraction, and acceptance strategies were described. CONCLUSION In persons with PDN, diabetes-related fears and pain-related fears play a role in less engagement in PA, indicating the need for new methods for improving self-management in persons with PDN.
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Affiliation(s)
- Iris M Kanera
- a Research Centre for Nutrition, Lifestyle, and Exercise, Faculty of Health , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands
| | - Charlotte C M van Laake-Geelen
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,c Department of Rehabilitation Medicine , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.,d Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , The Netherlands
| | - Joop M Ruijgrok
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,e Neurorehabilitation Centre , Klinik Bethesda Tschugg , Tschugg , Switzerland
| | - Marielle E J B Goossens
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands
| | - Jeroen R de Jong
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,c Department of Rehabilitation Medicine , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Jeanine A Verbunt
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,c Department of Rehabilitation Medicine , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.,d Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , The Netherlands
| | - Margot Geerts
- f Department of Neurology , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Rob J E M Smeets
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,g Libra Rehabilitation and Audiology , Eindhoven , The Netherlands
| | - Hanne P J Kindermans
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,h Department of Clinical Psychological Science , Maastricht University , Maastricht , The Netherlands
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21
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Goldsmith ES, Taylor BC, Greer N, Murdoch M, MacDonald R, McKenzie L, Rosebush CE, Wilt TJ. Focused Evidence Review: Psychometric Properties of Patient-Reported Outcome Measures for Chronic Musculoskeletal Pain. J Gen Intern Med 2018; 33:61-70. [PMID: 29633142 PMCID: PMC5902346 DOI: 10.1007/s11606-018-4327-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Developing successful interventions for chronic musculoskeletal pain requires valid, responsive, and reliable outcome measures. The Minneapolis VA Evidence-based Synthesis Program completed a focused evidence review on key psychometric properties of 17 self-report measures of pain severity and pain-related functional impairment suitable for clinical research on chronic musculoskeletal pain. METHODS Pain experts of the VA Pain Measurement Outcomes Workgroup identified 17 pain measures to undergo systematic review. In addition to a MEDLINE search on these 17 measures (1/2000-1/2017), we hand-searched (without publication date limits) the reference lists of all included studies, prior systematic reviews, and-when available-Web sites dedicated to each measure (PROSPERO registration CRD42017056610). Our primary outcome was the measure's minimal important difference (MID). Secondary outcomes included responsiveness, validity, and test-retest reliability. Outcomes were synthesized through evidence mapping and qualitative comparison. RESULTS Of 1635 abstracts identified, 331 articles underwent full-text review, and 43 met inclusion criteria. Five measures (Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), SF-36 Bodily Pain Scale (SF-36 BPS), Numeric Rating Scale (NRS), and Visual Analog Scale (VAS)) had data reported on MID, responsiveness, validity, and test-retest reliability. Seven measures had data reported on three of the four psychometric outcomes. Eight measures had reported MIDs, though estimation methods differed substantially and often were not clinically anchored. CONCLUSIONS In this focused evidence review, the most evidence on key psychometric properties in chronic musculoskeletal pain populations was found for the ODI, RMDQ, SF-36 BPS, NRS, and VAS. Key limitations in the field include substantial variation in methods of estimating psychometric properties, defining chronic musculoskeletal pain, and reporting patient demographics. TRIAL REGISTRATION Registered in the PROSPERO database: CRD42017056610.
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Affiliation(s)
- Elizabeth S Goldsmith
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA. .,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA. .,University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota School of Public Health, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Maureen Murdoch
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Roderick MacDonald
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Christina E Rosebush
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
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22
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Lin J, Sander L, Paganini S, Schlicker S, Ebert D, Berking M, Bengel J, Nobis S, Lehr D, Mittag O, Riper H, Baumeister H. Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial. BMJ Open 2017; 7:e015226. [PMID: 29288172 PMCID: PMC5770830 DOI: 10.1136/bmjopen-2016-015226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Depression often co-occurs with chronic back pain (CBP). Internet and mobile-based interventions (IMIs) might be a promising approach for effectively treating depression in this patient group. In the present study, we will evaluate the effectiveness and cost-effectiveness of a guided depression IMI for individuals with CBP (eSano BackCare-D) integrated into orthopaedic healthcare. METHODS AND ANALYSIS In this multicentre randomised controlled trial of parallel design, the groups eSano BackCare-D versus treatment as usual will be compared. 210 participants with CBP and diagnosed depression will be recruited subsequent to orthopaedic rehabilitation care. Assessments will be conducted prior to randomisation and 9 weeks (post-treatment) and 6 months after randomisation. The primary outcome is depression severity (Hamilton Rating Scale for Depression-17). Secondary outcomes are depression remission and response, health-related quality of life, pain intensity, pain-related disability, self-efficacy and work capacity. Demographic and medical variables as well as internet affinity, intervention adherence, intervention satisfaction and negative effects will also be assessed. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Moreover, a cost-effectiveness and cost-utility analysis will be conducted from a societal perspective after 6 months. ETHICS AND DISSEMINATION All procedures are approved by the ethics committee of the Albert-Ludwigs-University of Freiburg and the data security committee of the German Pension Insurance (Deutsche Rentenversicherung). The results will be published in peer-reviewed journals and presented on international conferences. TRIAL REGISTRATION NUMBER DRKS00009272; Pre-results.
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Affiliation(s)
- Jiaxi Lin
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
- Psychology Department, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, United Kingdom
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sarah Paganini
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sandra Schlicker
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - David Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Stephanie Nobis
- Department of Gerontology, University of Vechta, Vechta, Germany
| | - Dirk Lehr
- Department of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Oskar Mittag
- Section of Health Care Research and Rehabilitation, Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Ulm, Ulm, Germany
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23
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Depression, quality of life, and medical resource utilization in sickle cell disease. Blood Adv 2017; 1:1983-1992. [PMID: 29296845 DOI: 10.1182/bloodadvances.2017006940] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023] Open
Abstract
Sickle cell disease (SCD) is a chronic, debilitating disorder. Chronically ill patients are at risk for depression, which can affect health-related quality of life (HRQoL), health care utilization, and cost. We performed an analytic epidemiologic prospective study to determine the prevalence of depression in adult patients with SCD and its association with HRQoL and medical resource utilization. Depression was measured by the Beck Depression Inventory and clinical history in adult SCD outpatients at a comprehensive SCD center. HRQoL was assessed using the SF36 form, and data were collected on medical resource utilization and corresponding cost. Neurocognitive functions were assessed using the CNS Vital Signs tool. Pain diaries were used to record daily pain. Out of 142 enrolled patients, 42 (35.2%) had depression. Depression was associated with worse physical and mental HRQoL scores (P < .0001 and P < .0001, respectively). Mean total inpatient costs ($25 000 vs $7487, P = .02) and total health care costs ($30 665 vs $13 016, P = .01) were significantly higher in patients with depression during the 12 months preceding diagnosis. Similarly, during the 6 months following diagnosis, mean total health care costs were significantly higher in depressed patients than in nondepressed patients ($13 766 vs $8670, P = .04). Depression is prevalent in adult patients with SCD and is associated with worse HRQoL and higher total health care costs. Efforts should focus on prevention, early diagnosis, and therapy for depression in SCD.
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24
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Nelson S, Cunningham N, Peugh J, Jagpal A, Arnold LM, Lynch-Jordan A, Kashikar-Zuck S. Clinical Profiles of Young Adults With Juvenile-Onset Fibromyalgia With and Without a History of Trauma. Arthritis Care Res (Hoboken) 2017; 69:1636-1643. [PMID: 28085990 DOI: 10.1002/acr.23192] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the differential presentation(s) of psychological and health-related outcomes in young adults with juvenile-onset fibromyalgia (FM) with and without a history of trauma, compared to healthy controls. METHODS In total, 110 participants (86 with juvenile-onset FM and 24 healthy controls, with a mean age of 23.4 years) completed a structured clinical interview to assess for trauma and psychological comorbidities, as well as self-report questionnaires on pain, physical functioning, and health care utilization. RESULTS Of the juvenile-onset FM participants, 37% (n = 32) reported a history of trauma. Three group comparisons (i.e., juvenile-onset FM with trauma versus juvenile-onset FM with no trauma versus healthy controls) revealed that juvenile-onset FM participants significantly differed from healthy controls on all psychological and health-related outcomes. Further, although juvenile-onset FM participants with and without a history of trauma did not significantly differ on pain and physical functioning, juvenile-onset FM participants with a history of trauma were significantly more likely to have psychological comorbidities. CONCLUSION This is the first controlled study to examine the differential outcomes between juvenile-onset FM participants with and without a history of trauma. Group comparisons between juvenile-onset FM participants and healthy controls were consistent with previous research. Further, our findings indicate that juvenile-onset FM participants with a history of trauma experience greater psychological, but not physical, impairment than juvenile-onset FM participants without a history of trauma.
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Affiliation(s)
- Sarah Nelson
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Natoshia Cunningham
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James Peugh
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Leslie M Arnold
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anne Lynch-Jordan
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susmita Kashikar-Zuck
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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25
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Correlations Between the SF-36, the Oswestry-Disability Index and Rolland-Morris Disability Questionnaire in Patients Undergoing Lumbar Decompression According to Types of Spine Origin Pain. Clin Spine Surg 2017; 30:E804-E808. [PMID: 27662270 DOI: 10.1097/bsd.0000000000000438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To determine the correlation between SF-36 (a measure for overall health status in patients) and Oswestry-Disability Index (ODI) or Rolland-Morris Disability Questionnaire (RMDQ) confined to spine according to the type of pain from the spine. SUMMARY OF BACKGROUND DATA Data showed moderate correlation between ODI and SF-36 Physical Component Score (PCS), Physical Functioning (PF) (r=-0.46), Physical Role Functioning (RP) (r=-0.284), Bodily Pain (BP) (r=-0.327), and Mental Component Score (MCS), Emotional Role Functioning (r=-0.250), Social Role Functioning (r=0.254), Vitality (r=0.296). MATERIALS AND METHODS Between January 1, 2008 and December 31, 2013, a total of 69 patients were enrolled in this study. They were diagnosed with lumbar spinal stenosis and underwent decompression surgery such as laminotomy in this hospital. The 3 standardized questionnaires (ODI, RMDQ, and SF-36) were given to these patients, at least 1 year after the surgery. RESULTS ODI and SF-36 had a statistically significant (P=0.001) and moderate correlation. Small correlations were also seen between Physical Functioning (r=-0.46), Physical Role Functioning (r=-0.284), and Bodily Pain (r=-0.327) of SF-36 PCS and ODI, and between Emotional Role Functioning (r=-0.250), Social Role Functioning (r=-0.254), and Vitality (r=-0.296) of SF-36 Mental Component Score and ODI. Items in ODI for the level of pain while standing and traveling were mostly related to axial back pain, while item of lifting was related to referred buttock pain. Sleeping disturbance section in the ODI was mainly caused by radiated leg pain. In addition, RMDQ was also associated to the 3 types of pain. CONCLUSIONS Moderate correlation was found between ODI or RMDQ as a condition-specific outcome and the SF-36, indicating overall health status. ODI was found to be a more adequate measure to evaluate axial back pain rather than referred pain or radiating pain. RMDQ was adequate to measure the health status and to evaluate the 3 types of spine pain. These 3 instruments could therefore provide the clinician with complementary information about the patient's status.
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26
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Perry J, VanDenKerkhof EG, Wilson R, Tripp DA. Guided Internet-based Psycho-educational Intervention Using Cognitive Behavioral Therapy and Self-management for Individuals with Chronic Pain: A Feasibility Study. Pain Manag Nurs 2017; 18:179-189. [PMID: 28433488 DOI: 10.1016/j.pmn.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/06/2016] [Accepted: 12/23/2016] [Indexed: 01/22/2023]
Abstract
When considering barriers to chronic pain treatment, there is a need to deliver nonpharmacological therapies in a way that is accessible to all individuals who may benefit. To conduct feasibility testing using a guided, Internet-based intervention for individuals with chronic pain, a novel, Internet-based, chronic pain intervention (ICPI) was developed, using concepts proven effective in face-to-face interventions. This study was designed to assess usability of the ICPI and feasibility of conducting larger-scale research, and to collect preliminary data on effectiveness of the intervention. Data were collected at baseline, after each of the six intervention modules, and 12 weeks after intervention completion. Forty-one participants completed baseline questionnaires, and 15 completed the 12-week postintervention questionnaires. At baseline, all participants reported satisfaction with the structure of the intervention and ease of use. Internet-based platforms such as Facebook aided in accrual of participants, making further large-scale study of the ICPI feasible. There is preliminary evidence suggesting that the ICPI improves emotional function but not physical function, with a small but significant decrease in pain intensity and pain interference. Most participants felt they benefited at least minimally as a result of using the ICPI. The ICPI was well received by participants and demonstrated positive outcomes in this preliminary study. Further research with more participants is feasible and necessary to fully assess the effect of this intervention.
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Affiliation(s)
- Jennifer Perry
- School of Nursing, Queen's University, Kingston, Ontario, Canada; School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada.
| | - Elizabeth G VanDenKerkhof
- Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Rosemary Wilson
- Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Dean A Tripp
- Departments of Psychology, Anesthesiology, and Urology, Queen's University, Kingston, Ontario, Canada
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27
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Comorbidity, Pain, Utilization, and Psychosocial Outcomes in Older versus Younger Sickle Cell Adults: The PiSCES Project. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4070547. [PMID: 28459058 PMCID: PMC5387810 DOI: 10.1155/2017/4070547] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/08/2017] [Indexed: 01/24/2023]
Abstract
Background. Patients with SCD now usually live well into adulthood. Whereas transitions into adulthood are now often studied, little is published about aging beyond the transition period. We therefore studied age-associated SCD differences in utilization, pain, and psychosocial variables. Methods. Subjects were 232 adults in the Pain in Sickle Cell Epidemiology Study (PiSCES). Data included demographics, comorbidity, and psychosocial measures. SCD-related pain and health care utilization were recorded in diaries. We compared 3 age groups: 16–25 (transition), 26–36 (younger adults), and 37–64 (older adults) years. Results. Compared to the 2 adult groups, the transition group reported fewer physical challenges via comorbidities, somatic complaints, and pain frequency, though pain intensity did not differ on crisis or noncrisis pain days. The transition group utilized opioids less often, made fewer ambulatory visits, and had better quality of life, but these differences disappeared after adjusting for pain and comorbidities. However, the transition group reported more use of behavioral coping strategies. Conclusion. We found fewer biological challenges, visits, and better quality of life, in transition-aged versus older adults with SCD, but more behavioral coping. Further study is required to determine whether age-appropriate health care, behavioral, or other interventions could improve age-specific life challenges of patients with SCD.
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28
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Park J, Newman D, Engstrom G, Hammar LM, Swall A. The moderating and covarying effects of social support and pain intensity on depressive symptomology among racially and ethnically diverse older adults. Pain Manag 2017; 7:19-32. [DOI: 10.2217/pmt-2016-0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To examine the interplay of social support, pain intensity and ethnicity as moderators and covariates of relationship on depressive symptomatology. Methods: Racially and ethnically diverse elders responded to measures of depressive symptomatology and social support. Results: Hispanics reported significantly higher prevalence of moderate pain intensity and depressive symptomology, and lower prevalence of high social support compared with other ethnic groups. Although social support showed reduced depressive symptomatology among those with high pain intensity, it did not play a significant role in decreasing depressive symptomatology among those with low/moderate pain intensity. Conclusion: Social support in decreasing depressive symptomatology is more effective in older adults with high pain intensity than those with moderate or low levels of pain intensity.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University School of Social Work, 777 Glades Road, Boca Raton, FL 33431, USA
| | - David Newman
- Florida Atlantic University Christine E Lynn College of Nursing, 777 Glades Road, Boca Raton, FL 33431, USA
| | - Gabriella Engstrom
- Florida Atlantic University Charles E Schmidt College of Medicine, 777 Glades Rd, Boca Raton, FL 33431, USA
| | - Lena M Hammar
- Dalarna University, School of Education, Health & Social Studies, Högskolegatan 2, Sweden
| | - Anna Swall
- Dalarna University, School of Education, Health & Social Studies, Högskolegatan 2, Sweden
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29
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Hill JC, Afolabi EK, Lewis M, Dunn KM, Roddy E, van der Windt DA, Foster NE. Does a modified STarT Back Tool predict outcome with a broader group of musculoskeletal patients than back pain? A secondary analysis of cohort data. BMJ Open 2016; 6:e012445. [PMID: 27742627 PMCID: PMC5073547 DOI: 10.1136/bmjopen-2016-012445] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The STarT Back Tool has good predictive performance for non-specific low back pain in primary care. We therefore aimed to investigate whether a modified STarT Back Tool predicted outcome with a broader group of musculoskeletal patients, and assessed the consequences of using existing risk-group cut-points across different pain regions. SETTING Secondary analysis of prospective data from 2 cohorts: (1) outpatient musculoskeletal physiotherapy services (PhysioDirect trial n=1887) and (2) musculoskeletal primary-secondary care interface services (SAMBA study n=1082). PARTICIPANTS Patients with back, neck, upper limb, lower limb or multisite pain with a completed modified STarT Back Tool (baseline) and 6-month physical health outcome (Short Form 36 (SF-36)). OUTCOMES Area under the receiving operator curve (AUCs) tested discriminative abilities of the tool's baseline score for identifying poor 6-month outcome (SF-36 lower tertile Physical Component Score). Risk-group cut-points were tested using sensitivity and specificity for identifying poor outcome using (1) Youden's J statistic and (2) a clinically determined rule that specificity should not fall below 0.7 (false-positive rate <30%). RESULTS In PhysioDirect and SAMBA, poor 6-month physical health was 18.5% and 28.2%, respectively. Modified STarT Back Tool score AUCs for predicting outcome in back pain were 0.72 and 0.79, neck 0.82 and 0.88, upper limb 0.79 and 0.86, lower limb 0.77 and 0.83, and multisite pain 0.83 and 0.82 in PhysioDirect and SAMBA, respectively. Differences between pain region AUCs were non-significant. Optimal cut-points to discriminate low-risk and medium-risk/high-risk groups depended on pain region and clinical services. CONCLUSIONS A modified STarT Back Tool similarly predicts 6-month physical health outcome across 5 musculoskeletal pain regions. However, the use of consistent risk-group cut-points was not possible and resulted in poor sensitivity (too many with long-term disability being missed) or specificity (too many with good outcome inaccurately classified as 'at risk') for some pain regions. The draft tool is now being refined and validated within a new programme of research for a broader musculoskeletal population. TRIAL REGISTRATION NUMBER ISRCTN55666618; Post results.
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Affiliation(s)
- J C Hill
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - E K Afolabi
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - M Lewis
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - K M Dunn
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - E Roddy
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - D A van der Windt
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - N E Foster
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
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Abstract
Recognizing that electrically stimulating the motor cortex could relieve chronic pain sparked development of noninvasive technologies. In transcranial magnetic stimulation (TMS), electromagnetic coils held against the scalp influence underlying cortical firing. Multiday repetitive transcranial magnetic stimulation (rTMS) can induce long-lasting, potentially therapeutic brain plasticity. Nearby ferromagnetic or electronic implants are contraindications. Adverse effects are minimal, primarily headaches. Single provoked seizures are very rare. Transcranial magnetic stimulation devices are marketed for depression and migraine in the United States and for various indications elsewhere. Although multiple studies report that high-frequency rTMS of the motor cortex reduces neuropathic pain, their quality has been insufficient to support Food and Drug Administration application. Harvard's Radcliffe Institute therefore sponsored a workshop to solicit advice from experts in TMS, pain research, and clinical trials. They recommended that researchers standardize and document all TMS parameters and improve strategies for sham and double blinding. Subjects should have common well-characterized pain conditions amenable to motor cortex rTMS and studies should be adequately powered. They recommended standardized assessment tools (eg, NIH's PROMIS) plus validated condition-specific instruments and consensus-recommended metrics (eg, IMMPACT). Outcomes should include pain intensity and qualities, patient and clinician impression of change, and proportions achieving 30% and 50% pain relief. Secondary outcomes could include function, mood, sleep, and/or quality of life. Minimum required elements include sample sources, sizes, and demographics, recruitment methods, inclusion and exclusion criteria, baseline and posttreatment means and SD, adverse effects, safety concerns, discontinuations, and medication-usage records. Outcomes should be monitored for at least 3 months after initiation with prespecified statistical analyses. Multigroup collaborations or registry studies may be needed for pivotal trials.
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Scott W, Hann KEJ, McCracken LM. A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016; 46:139-148. [PMID: 27397934 PMCID: PMC4917588 DOI: 10.1007/s10879-016-9328-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment and pre-treatment to follow-up on each of the treatment outcome and process variables. Regression analyses indicated that change in psychological flexibility processes cumulatively explained 6–27 % of the variance in changes in functioning and depression over both assessment periods, even after controlling for changes in pain intensity. Further research is needed to maximize the effectiveness of ACT for chronic pain, and to determine whether larger improvements in the processes of psychological flexibility under study will produce better patient outcomes, as predicted by the psychological flexibility model.
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Campus, 5th Floor Bermondsey Wing, London, SE1 9RT UK
| | - Katie E J Hann
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Campus, 5th Floor Bermondsey Wing, London, SE1 9RT UK
| | - Lance M McCracken
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Campus, 5th Floor Bermondsey Wing, London, SE1 9RT UK ; INPUT Pain Management, Guy's and St Thomas' NHS Foundation Trust, London, UK
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The Relationship Between Approach to Activity Engagement, Specific Aspects of Physical Function, and Pain Duration in Chronic Pain. Clin J Pain 2016; 32:20-31. [DOI: 10.1097/ajp.0000000000000226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ramineni T, Prusik J, De La Cruz P, Gee L, Kumar V, Wilock ME, Haller J, Fama C, Patel S, Pilitsis JG. The Impact of Peripheral Nerve Stimulation on Disability and Depression. Neuromodulation 2015; 19:306-10. [PMID: 26517020 DOI: 10.1111/ner.12363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/25/2015] [Accepted: 09/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral nerve stimulation (PNS) of the named nerves of the head has been shown to be effective in reducing pain levels in patients with chronic pain refractory to other treatments. However, the impact of cranial PNS on depression and disability has not been well documented. OBJECTIVES We prospectively examine the impact of PNS on quality of life via validated survey scores which assess symptoms of depression and daily functional capacities within patients. METHODS Patients who underwent permanent PNS implantation completed five validated questionnaires: Oswestry Disability Index (ODI), the Beck's Depression Inventory (BDI), the Pain Catastrophizing Scale (PCS), McGill Pain Questionnaire (MPQ), and the visual analog scale (VAS) score. These were completed at baseline, six months, and one year to assess changes in functioning levels. Results were analyzed via repeated measures ANOVA and bivariate analysis. RESULTS Compared with baseline, at six months patients showed significantly less depression on BDI (F = 7.9, p = 0.021), and at one year, a significant decrease in disability was observed on the ODI (F = 6.1, p = 0.036). At both six months and one year, patients showed a significant decrease in pain on VAS (F = 16.5, p = 0.012). We noted a trend for ODI to correlate with BDI at six months (R = 0.616, p = 0.077). DISCUSSION Our prospective data show PNS to be an effective modality in improving overall life quality by limiting depression and disability as well as pain.
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Affiliation(s)
- Tina Ramineni
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Julia Prusik
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | | | - Lucy Gee
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Vignessh Kumar
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Meghan E Wilock
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Jessica Haller
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Chris Fama
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Samik Patel
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
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Cunningham NR, Tran ST, Lynch-Jordan AM, Ting TV, Sil S, Strotman D, Noll JG, Powers SW, Arnold LM, Kashikar-Zuck S. Psychiatric Disorders in Young Adults Diagnosed with Juvenile Fibromyalgia in Adolescence. J Rheumatol 2015; 42:2427-33. [PMID: 26373565 DOI: 10.3899/jrheum.141369] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Adolescents with juvenile-onset fibromyalgia (JFM) have increased rates of psychiatric disorders, but to our knowledge no studies have examined psychiatric disorders in adolescents with JFM when they enter young adulthood. This study examined the prevalence of psychiatric disorders in young adults diagnosed with JFM during adolescence and the relationship between mental health diagnoses and physical functioning. METHODS Ninety-one young adults (mean age 21.60, SD 1.96) with a history of JFM being followed as part of a prospective longitudinal study and 30 matched healthy controls (mean age 21.57, SD 1.55) completed a structured interview of psychiatric diagnoses and a self-report measure of physical impairment. RESULTS Young adults with a history of JFM were more likely to have current and lifetime histories of anxiety disorders (70.3% and 76.9%, respectively) compared with controls (33.3% for both, both p < 0.001). Individuals with JFM were also more likely to have current and lifetime histories of major mood disorders (29.7% and 76.9%, respectively) compared with controls (10% and 40%, p < 0.05). The presence of a current major mood disorder was significantly related to impairment in physical functioning [F (1, 89) = 8.30, p < 0.01] and role limitations attributable to a physical condition [F (1, 89) = 7.09, p < 0.01]. CONCLUSION Psychiatric disorders are prevalent in young adulthood for individuals with a history of JFM, and a current major mood disorder is associated with greater physical impairment. Greater attention to early identification and treatment of mood disorders in patients with JFM is warranted.
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Affiliation(s)
- Natoshia Raishevich Cunningham
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Susan T Tran
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Anne M Lynch-Jordan
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Tracy V Ting
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Soumitri Sil
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Daniel Strotman
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Jennie G Noll
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Scott W Powers
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Lesley M Arnold
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
| | - Susmita Kashikar-Zuck
- From the Division of Behavioral Medicine and Clinical Psychology, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.N.R. Cunningham, PhD, Assistant Professor of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.T. Tran, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and DePaul University; A.M. Lynch- Jordan, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; T.V. Ting, MD, Department of Pediatrics, University of Cincinnati, and Division of Rheumatology, Cincinnati Children's Hospital Medical Center; S. Sil, PhD, Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; D. Strotman, BA, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; J.G. Noll, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; S.W. Powers, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati; L.M. Arnold, MD, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine; S. Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Chil
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Health-Related Quality of Life and Pain Intensity Among Ethnically Diverse Community-Dwelling Older Adults. Pain Manag Nurs 2015. [PMID: 26206611 DOI: 10.1016/j.pmn.2015.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic pain is highly prevalent in older adults and often negatively associated with health-related quality of life (HRQoL). This study compared HRQoL, including physical health and mental health, in persons of differing ethnicities, and identified factors associated with pain intensity and HRQoL in ethnically diverse older adults. Older adults with chronic pain from four ethnic groups (African Americans, Afro-Caribbeans, Hispanics, and European Americans) were recruited from the Florida Atlantic University Healthy Aging Research Initiative (HARI) registry. The Medical Outcomes Study Short Form-36 (SF-36) was used to evaluate HRQoL, including functional status, emotional well-being, and social functioning. Of 593 persons in the four ethnic groups in the registry, 174 met the inclusion criteria (pain level of four or higher on an 11-point scale, lasting 3 months or longer). Among these 174, African Americans reported the highest level of pain intensity, followed by Afro-Caribbeans, Hispanics, and European Americans. Hispanics reported the highest physical health scores and the lowest mental health scores. In contrast, African Americans reported the highest mental health scores and the lowest physical health scores. Multivariate linear regression analysis revealed that ethnicity, lower physical health scores, and lower mental health scores were significantly (p ≤ .01) associated with pain intensity. Understanding ethnic variations in response to pain intensity may address gaps in knowledge about HRQoL to reduce disparities in optimal care. Health care providers should consider ethnic norms and cultural diversity to provide optimal interventions for this population.
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Nieuwenhuizen MG, de Groot S, Janssen TWJ, van der Maas LCC, Beckerman H. Canadian Occupational Performance Measure performance scale: validity and responsiveness in chronic pain. ACTA ACUST UNITED AC 2015; 51:727-46. [PMID: 25357091 DOI: 10.1682/jrrd.2012.12.0221] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 12/23/2013] [Indexed: 11/05/2022]
Abstract
The construct validity and construct responsiveness of the performance scale of the Canadian Occupational Performance Measure (COPM) was measured in 87 newly admitted patients with chronic pain attending an outpatient rehabilitation clinic. At admission and after 12 wk, patients completed a COPM interview, the Pain Disability Index (PDI), and the RAND 36-Item Health Survey (RAND-36). We determined the construct validity of the COPM by correlations between the COPM performance scale (COPM-P), the PDI, and the RAND-36 at admission. Construct responsiveness was assessed by calculating the correlations between the change scores (n = 57). The COPM-P did not significantly correlate with the PDI (r = -0.260) or with any subscale of the RAND-36 (r = -0.007 to 0.248). Only a moderate correlation was found between change scores of the COPM-P and PDI (r = -0.380) and weak to moderate correlations were found between change scores of the COPM-P and the RAND-36 (r = -0.031 to 0.388), with the higher correlations for the physical functioning, social functioning, and role limitations (physical) subscales. In patients with chronic pain attending our rehabilitation program, the COPM-P measures something different than the RAND-36 or PDI. Therefore, construct validity of the COPM-P was not confirmed by our data. We were not able to find support for the COPM-P to detect changes in occupational performance.
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Abstract
Individuals with chronic pain exhibit a wide range of coping mechanisms, some of which are maladaptive (eg, activity avoidance or overactivity). The authors of this study aimed to investigate whether individuals may be predisposed to develop a particular maladaptive coping mechanism based on their attachment style (dismissing, preoccupied, fearful or secure), which represents a core feature of their personality. BACKGROUND: The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning. OBJECTIVE: To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework. METHODS: A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression). RESULTS: Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing. CONCLUSIONS: These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain.
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Gologorsky Y, Skovrlj B, Steinberger J, Moore M, Arginteanu M, Moore F, Steinberger A. Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis: Clinical article. J Neurosurg Spine 2014; 21:601-7. [PMID: 25084031 DOI: 10.3171/2014.6.spine13488] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECT Transforaminal lumbar interbody fusion (TLIF) with segmental pedicular instrumentation is a well established procedure used to treat lumbar spondylosis with or without spondylolisthesis. Available biomechanical and clinical studies that compared unilateral and bilateral constructs have produced conflicting data regarding patient outcomes and hardware complications. METHODS A prospective cohort study was undertaken by a group of neurosurgeons. They prospectively enrolled 80 patients into either bilateral or unilateral pedicle screw instrumentation groups (40 patients/group). Demographic data collected for each group included sex, age, body mass index, tobacco use, and Workers' Compensation/litigation status. Operative data included segments operated on, number of levels involved, estimated blood loss, length of hospital stay, and perioperative complications. Long-term outcomes (hardware malfunction, wound dehiscence, and pseudarthrosis) were recorded. For all patients, preoperative baseline and 6-month postoperative scores for Medical Outcomes 36-Item Short Form Health Survey (SF-36) outcomes were recorded. RESULTS Patient follow-up times ranged from 37 to 63 months (mean 52 months). No patients were lost to follow-up. The patients who underwent unilateral pedicle screw instrumentation (unilateral cohort) were slightly younger than those who underwent bilateral pedicle screw instrumentation (bilateral cohort) (mean age 42 vs. 47 years, respectively; p = 0.02). No other significant differences were detected between cohorts with regard to demographic data, mean number of lumbar levels operated on, or distribution of the levels operated on. Estimated blood loss was higher for patients in the bilateral cohort, but length of stay was similar for patients in both cohorts. The incidence of pseudarthrosis was significantly higher among patients in the unilateral cohort (7 patients [17.5%]) than among those in the bilateral cohort (1 patient [2.5%]) (p = 0.02). Wound dehiscence occurred for 1 patient in the unilateral cohort. Reoperation was offered to 8 patients in the unilateral cohort and 1 patient in the bilateral cohort (p = 0.03). The physical component scores of the Medical Outcomes SF-36 outcomes improved significantly for all patients (p < 0.001). CONCLUSIONS Transforaminal lumbar interbody fusion with either unilateral or bilateral segmental pedicular instrumentation is an effective treatment for lumbar spondylosis. Because patients with unilateral constructs were 7 times more likely to experience pseudarthrosis and require reoperation, TLIF with bilateral constructs might be the biomechanically superior technique.
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Affiliation(s)
- Yakov Gologorsky
- Department of Neurosurgery, Mount Sinai Medical Center, New York, New York
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Finan PH, Buenaver LF, Coryell VT, Smith MT. Cognitive-Behavioral Therapy for Comorbid Insomnia and Chronic Pain. Sleep Med Clin 2014; 9:261-274. [PMID: 25477769 DOI: 10.1016/j.jsmc.2014.02.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article summarizes the literature on cognitive-behavioral therapy for insomnia (CBT-I) in patients with comorbid insomnia and chronic pain. An empirical rationale for the development of CBT-I in chronic pain is provided. The six randomized controlled trials in this area are described and contrasted. The data suggest that CBT-I for patients with comorbid insomnia and chronic pain produces clinically meaningful improvements in sleep symptoms. Effects on pain are inconsistent, but tend to favor functional measures over pain severity. Hybrid interventions for insomnia and pain have demonstrated feasibility, but larger trials must be conducted to determine efficacy relative to CBT-I alone. Future efforts should employ more comprehensive assessments of pain and psychosocial factors.
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Taber DJ, James GD, Jacon A. Manipulation under anesthesia for lumbopelvic pain: a retrospective review of 18 cases. J Chiropr Med 2014; 13:28-34. [PMID: 24711782 DOI: 10.1016/j.jcm.2014.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this case series is to report the effects of manipulation under anesthesia (MUA) for patients with lumbopelvic (lumbar spine, sacroiliac and/or pelvic, hip) pain in an outpatient ambulatory/hospital-based setting. METHODS A retrospective chart review of cases treated at an outpatient ambulatory surgical center in New York and a general hospital in New York was performed. Patients with pre- and postintervention Oswestry Low Back Pain Disability Index (ODI) scores and lumbopelvic and hip complaints were included (N = 18). No intervention other than MUA was administered between the initial and follow-up ODI scoring. Scores on the ODI were assessed within 1 week prior to MUA and again within 2 weeks postprocedure. RESULTS Patients underwent 2 to 4 chiropractic MUA procedures over the course of 7 to 8 days as per National Academy of Manipulation Under Anesthesia physicians' protocols. Preprocedure ODI scores ranged from 38 to 76, with an average score of 53.4. Postprocedure scores ranged from 0 to 66, with an average score of 32.8. For each patient, ODI scores were lower after MUA, with an average decrease of 20.6. Sixteen of 18 patients experienced a clinically meaningful improvement in ODI score. No adverse reactions were reported. CONCLUSIONS For 16 of the 18 patients with chronic lumbopelvic pain reported in this study, MUA showed clinically meaningful reduction in low back pain disability.
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Affiliation(s)
- Douglas J Taber
- Doctor of Chiropractic, United Health Services, Binghamton, NY
| | - Gary D James
- Professor of Nursing, Anthropology and Bioengineering, Decker School of Nursing, Binghamton University, Binghamton, NY ; Director, Institute for Primary and Preventative Health Care Decker School of Nursing, Binghamton University, Binghamton, NY
| | - Alain Jacon
- Program Assistant, United Health Services Hospitals Graduate Medical Education/Institutional Review Board, Johnson City, NY
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Kashikar-Zuck S, Cunningham N, Sil S, Bromberg MH, Lynch-Jordan AM, Strotman D, Peugh J, Noll J, Ting TV, Powers SW, Lovell DJ, Arnold LM. Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics 2014; 133:e592-600. [PMID: 24567017 PMCID: PMC3934334 DOI: 10.1542/peds.2013-2220] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This prospective longitudinal study examined the long-term physical and psychosocial outcomes of adolescents with juvenile-onset fibromyalgia (JFM), compared with healthy control subjects, into early adulthood. METHODS Adolescent patients with JFM initially seen at a pediatric rheumatology clinic (n = 94) and age- and gender-matched healthy control subjects (n = 33) completed online measures of demographic characteristics, pain, physical functioning, mood symptoms, and health care utilization at ∼6 years' follow-up (mean age: 21 years). A standard in-person tender-point examination was conducted. RESULTS Patients with JFM had significantly higher pain (P < .001), poorer physical function (P < .001), greater anxiety (P < .001) and depressive symptoms (P < .001), and more medical visits (P < .001)than control subjects. The majority (>80%) of JFM patients continued to experience fibromyalgia symptoms into early adulthood, and 51.1% of the JFM sample met American College of Rheumatology criteria for adult fibromyalgia at follow-up. Patients with JFM were more likely than control subjects to be married and less likely to obtain a college education. CONCLUSIONS Adolescent patients with JFM have a high likelihood of continued fibromyalgia symptoms into young adulthood. Those who met criteria for fibromyalgia in adulthood exhibited the highest levels of physical and emotional impairment. Emerging differences in educational attainment and marital status were also found in the JFM group. JFM is likely to be a long-term condition for many patients, and this study for the first time describes the wide-ranging impact of JFM on a variety of physical and psychosocial outcomes that seem to diverge from their same-age peers.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | | | - Soumitri Sil
- Divisions of Behavioral Medicine and Clinical Psychology and
| | | | - Anne M. Lynch-Jordan
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | - Daniel Strotman
- Divisions of Behavioral Medicine and Clinical Psychology and
| | - James Peugh
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | - Jennie Noll
- Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania
| | - Tracy V. Ting
- Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Departments of Pediatrics and
| | - Scott W. Powers
- Divisions of Behavioral Medicine and Clinical Psychology and,Departments of Pediatrics and
| | - Daniel J. Lovell
- Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Departments of Pediatrics and
| | - Lesley M. Arnold
- Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
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Wickert M, John MT, Schierz O, Hirsch C, Aarabi G, Reissmann DR. Sensitivity to change of oral and general health-related quality of life during prosthodontic treatment. Eur J Oral Sci 2013; 122:70-7. [DOI: 10.1111/eos.12104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melanie Wickert
- Department of Prosthodontics and Materials Science; School of Dentistry; University of Leipzig; Leipzig Germany
| | - Mike T. John
- Department of Diagnostic and Biological Sciences; School of Dentistry; University of Minnesota; Minneapolis MN USA
- Division of Epidemiology and Community Health; University of Minnesota; Minneapolis MN USA
| | - Oliver Schierz
- Department of Prosthodontics and Materials Science; School of Dentistry; University of Leipzig; Leipzig Germany
| | - Christian Hirsch
- Department of Pediatric Dentistry; School of Dentistry; University of Leipzig; Leipzig Germany
| | - Ghazal Aarabi
- Department of Prosthetic Dentistry; School of Dentistry; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Daniel R. Reissmann
- Department of Diagnostic and Biological Sciences; School of Dentistry; University of Minnesota; Minneapolis MN USA
- Department of Prosthetic Dentistry; School of Dentistry; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit. Scand J Pain 2013; 4:190-197. [PMID: 29913651 DOI: 10.1016/j.sjpain.2013.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
Background In recent years, multidisciplinary rehabilitation (MDR) became an alternative treatment option for chronic non-cancer pain. MDR is mostly available in specialized pain units, usually at rehabilitation centers where the level of knowledge and therapeutically options to treat pain conditions are considered to be high. There is strong evidence that MDR in specialized pain units is affecting pain and improves the quality of life in a sustainable manner. There are few studies about MDR outcome in primary health care, especially in those units situated in rural areas and with a different population than that encountered in specialized hospitals. That, in spite of the fact that the prevalence of pain in the patients treated in primary care practice is about 30%. The aim of this study is to analyze the effectiveness of MDR for chronic non-cancer patients in a primary health care unit. Methods This study included a total of 51 patients with chronic pain conditions who were admitted and completed the local MDR-program at the primary health care unit in Arvika, Sweden. The major complaint categories were fibromyalgia (53%), pain from neck and shoulder (28%) or low back pain (12%). The inclusion criteria were age between 16 and 67 years and chronic non-cancer pain with at least 3 months duration. The multidisciplinary team consisted of a general practitioner, two physiotherapists, two psychologists and one occupational therapist. The 6-week treatment took place in group sessions with 6-8 members each and included cognitive-behavioral treatment, education on pain physiology, ergonomics, physical exercises and relaxation techniques. Primary outcomes included pain intensity, pain severity, anxiety and depression scores, social and physical activity, and secondary outcomes were sick leave, opioid consumption and health care utilization assessed in the beginning of the treatment and at one year follow-up. Data was taken from the Swedish Quality Register for Pain Rehabilitation (SQRP) and the patients' medical journal. Results One year after MDR treatment, sick leave decreased from 75.6% to 61.5% (p <0.05). Utilization of health-care during one year decreased significantly from 27.4 to 20.1 contacts (p = 0.02). There were significant improvements concerning social activity (p = 0.03) and depression (p <0.05), but not in anxiety (p = 0.1) and physical activity (p = 0.08). Although not statistically significant, some numerical decrease in the mean levels of pain intensity, pain severity and opioid consumption were reported one year after MDR (p > 0.05). Conclusions The results obtained one year after rehabilitation indicated that patients with chronic noncancer pain might benefit from MDR in primary health care settings. Implications This study suggests that MDR in primary care settings as well as MDR at specialized pain units may lead to better coping in chronic non-cancer pain conditions with lower depression scores and higher social activity, leading to lower sick leave. This study demonstrated that there is a place for MDR in primary health care units with the given advantage of local intervention in rural areas allowing the patients to achieve rehabilitation in their home environment.
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Creighton DS, Viti J, Krauss J. Use of Translatoric Mobilization in a Patient with Cervical Spondylotic Degeneration: A Case Report. J Man Manip Ther 2013. [DOI: 10.1179/106698105790835813] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Shuman AG, Terrell JE, Light E, Wolf GT, Bradford CR, Chepeha D, Jiang Y, McLean S, Ghanem TA, Duffy SA. Predictors of pain among patients with head and neck cancer. ACTA ACUST UNITED AC 2013; 138:1147-54. [PMID: 23165353 DOI: 10.1001/jamaoto.2013.853] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine predictors of pain 1 year after the diagnosis of head and neck cancer. DESIGN Prospective, multisite cohort study. SETTING Three academically affiliated medical centers. PATIENTS The study population comprised 374 previously untreated patients with carcinoma of the upper aerodigestive tract. MAIN OUTCOME MEASURES Participants were surveyed before treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the 36-Item Short-Form Instrument (SF-36) bodily pain score 1 year after diagnosis. RESULTS The mean SF-36 bodily pain score at 1 year was 65, compared with 61 at the time of diagnosis (P = .004), and 75, the population norm (lower scores indicate worse pain). Variables independently associated with pain included pretreatment pain score (P < .001), less education (P = .02), neck dissection (P = .001), feeding tube (P = .05), xerostomia (P < .001), depressive symptoms (P < .001), taking more pain medication (P < .001), less physical activity (P = .02), and poor sleep quality (P = .006). The association between head and neck cancer pain and current smoking and problem drinking did not reach significance (P = .07 and P = .08, respectively). CONCLUSIONS Aggressive pain management may be indicated for patients with head and neck cancer who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco use, and alcohol abuse may also reduce pain and improve quality of life among patients with head and neck cancer.
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Persson E, Lexell J, Eklund M, Rivano-Fischer M. Positive effects of a musculoskeletal pain rehabilitation program regardless of pain duration or diagnosis. PM R 2012; 4:355-66. [PMID: 22342820 DOI: 10.1016/j.pmrj.2011.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 11/01/2011] [Accepted: 11/20/2011] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate how sociodemographic and clinical factors are associated with psychosocial functioning and disability at admission to a musculoskeletal pain rehabilitation program and at 1-year follow-up. DESIGN A cohort pre-post study. SETTING A University hospital specialized pain rehabilitation unit. PARTICIPANTS Five hundred nine participants with musculoskeletal pain (neck disorders, 29%; fibromyalgia, 24%; low back pain, 24%; myalgia, 14%; and other pain diagnoses, 8%). INTERVENTION A 5-week outpatient, group-based, and goal-oriented comprehensive musculoskeletal interdisciplinary pain rehabilitation program based on cognitive behavioral principles. MAIN OUTCOME MEASURES The Multidimensional Pain Inventory (MPI), the Disability Rating Index (DRI), and forms including sociodemographic factors (gender, age, ethnicity, marital status, educational level, and vocational situation) and clinical factors (pain duration and pain diagnoses). Data were analyzed with multivariate logistic regression. RESULTS At admission, factors associated with more positive scores on the MPI were being older than 40 years, being at work, being Nordic born, attainment of a higher educational level, and a diagnosis of fibromyalgia (compared with a neck disorder) (P < .05). Being at work and a diagnosis of fibromyalgia (compared with low back pain) were associated with more positive scores on the DRI (P < .05). On the basis of cut points for clinically important change on the MPI, participants rated themselves as most improved on the Affective Distress (52%), Life Control (49%), and Pain Severity (43%) subscales, and on the DRI index, the improvement rate was 22%. At the 1-year follow-up, neither sociodemographic nor clinical factors were associated with clinically important improvements of the MPI and the DRI, but younger age was related to deteriorations in pain severity. CONCLUSIONS The lack of an association between sociodemographic and clinical factors and psychosocial functioning and disability at a 1-year follow-up after a musculoskeletal pain rehabilitation program suggests that the program was effective regardless of the participants' initial characteristics, except for age. The changes at the 1-year follow-up indicate that the program influenced the participants' psychosocial functioning more than their perception of disability.
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Affiliation(s)
- Elisabeth Persson
- Department of Health Sciences, Lund University, SE-221 85 Lund, Sweden
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Kalter J, Apeldoorn AT, Ostelo RW, Henschke N, Knol DL, van Tulder MW. Taping patients with clinical signs of subacromial impingement syndrome: the design of a randomized controlled trial. BMC Musculoskelet Disord 2011; 12:188. [PMID: 21849055 PMCID: PMC3173405 DOI: 10.1186/1471-2474-12-188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/17/2011] [Indexed: 11/26/2022] Open
Abstract
Background Shoulder problems are a common complaint of the musculoskeletal system. Physical therapists treat these patients with different modalities such as exercise, massage, and shoulder taping. Although different techniques have been described, the effectiveness of taping has not yet been established. The aim of this study is to assess the effectiveness and cost-effectiveness of usual physical therapy care in combination with a particular tape technique for subacromial impingement syndrome of the shoulder compared to usual physical therapy care without this tape technique in a primary healthcare setting. Methods and design An economic evaluation alongside a randomized controlled trial will be conducted. A sample of 140 patients between 18 and 65 years of age with a diagnosis of subacromial impingement syndrome (SAIS) as assessed by physical therapists will be recruited. Eligible patients will be randomized to either the intervention group (usual care in combination with the particular tape technique) or the control group (usual care without this tape technique). In both groups, usual care will consist of individualized physical therapy care. The primary outcomes will be shoulder-specific function (the Simple Shoulder Test) and pain severity (11-point numerical rating scale). The economic evaluation will be performed using a societal perspective. All relevant costs will be registered using cost diaries. Utilities (Quality Adjusted Life Years) will be measured using the EuroQol. The data will be collected at baseline, and 4, 12, and 26 weeks follow-up. Discussion This pragmatic study will provide information about the effectiveness and cost-effectiveness of taping in patients presenting with clinical signs of SAIS. Trial registration Trial registration number: NTR2575
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Affiliation(s)
- Joeri Kalter
- Department of Epidemiology & Biostatistics, EMGO Institute for Health & Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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Responsiveness of the Oswestry Disability Index and the Roland Morris Disability Questionnaire in Italian subjects with sub-acute and chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:122-9. [PMID: 21823035 DOI: 10.1007/s00586-011-1959-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 07/06/2011] [Accepted: 07/24/2011] [Indexed: 01/12/2023]
Abstract
INTRODUCTION An ability to assess longitudinal changes in health status is crucial for the outcome measures used in treatment efficacy trials. The aim of this study was to verify the responsiveness of the Italian versions of the Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) in subjects with subacute or chronic low back pain (LBP). MATERIAL AND METHODS At the beginning and end of an 8 week rehabilitation programme, 179 patients completed a booklet containing the ODI, the RMDQ, a 0-10 numerical rating scale (NRS), and the 36-item Short-Form Health Survey (SF-36). A global perception of change scale was also completed at the end of the programme, and collapsed to produce a dichotomous outcome (i.e. improved vs. not improved). Responsiveness was assessed by means of distribution methods [minimum detectable change (MDC); effect size (ES); standardised response mean (SRM)] and anchor-based methods (ROC curves). RESULTS The MDC for the ODI and RMDQ was, respectively, 13.67 and 4.87; the ES was 0.53 and 0.68; and the SRM was 0.80 and 0.81. ROC analysis revealed an area under the curve of 0.71 for the ODI and 0.64 for the RMDQ, thus indicating discriminating capacity; the best cut-off point for the dichotomous outcome was 9.5 for the ODI (sensitivity 76% and specificity 63%) and 2.5 for the RMDQ (sensitivity 62% and specificity 55%). These estimates were comparable between the subacute and chronic subjects. Both the ODI and the RMDQ moderately correlated with the SF-36 and NRS (Spearman's and Pearson's correlation coefficients of >0.30). CONCLUSION The Italian ODI and RMDQ proved to be sensitive in detecting clinical changes after conservative treatment for subacute and chronic LBP. Our findings are consistent with those published in the literature, thus allowing cross-cultural comparisons and stimulating cross-national studies.
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Treatment expectation for pain coping skills training: relationship to osteoarthritis patients' baseline psychosocial characteristics. Clin J Pain 2011; 27:315-22. [PMID: 21178591 DOI: 10.1097/ajp.0b013e3182048549] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study examined predictors of treatment expectation among osteoarthritis (OA) patients in a multisite clinical trial of pain coping skills training (CST). METHODS Patients (N=171) completed a pretreatment assessment battery that asked questions about treatment expectations, pain coping variables, pain, physical function, psychological distress, quality of life, and depression as well as background demographic and medical variables. RESULTS Regression analyses indicated that several variables accounted for 21% of the variance in treatment expectations (P<0.0001). Patients who were classified as adaptive copers, reported higher self-efficacy and social interaction, had higher quality of life, and who had lower levels of affective distress and depression had more positive expectations about engaging in pain CST. Variables that were not associated with treatment expectation were level of pain and physical dysfunction, duration of disease, and disability status as well as demographic variables. DISCUSSION Although many OA patients will approach pain CST with positive expectations, others have lower expectations. This study suggests that a multidimensional assessment of OA patients with chronic pain can identify those who have higher expectations versus lower expectations. The results suggest that patients who are psychologically distressed are less optimistic about engaging in treatment and that these patients, in particular, may benefit from and need pretreatment motivational interviewing to enhance their uptake of pain coping skills.
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Donaldson MB, Learman K, Wright A, Brown C, Howes C, Cook CE. Factor structure and concurrent/convergent validity of the modified somatic perception questionnaire and pain beliefs instrument. J Manipulative Physiol Ther 2011; 34:30-6. [PMID: 21237405 DOI: 10.1016/j.jmpt.2010.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 11/05/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Our goal was to create a parsimonious combination of the Modified Somatic Perception Questionnaire (MSPQ) and the Pain Beliefs Screening Instrument (PBSI) through factorial structural analysis and to investigate the associations of the new scale (if unique) to disability, health condition, and quality of life report in patients with neck and low back pain scheduled for spine fusion surgery. METHODS Factor analysis was used to refine all items within the 2 scales to 4 distinct factors: (1) somatic complaints of the head/neck, (2) somatic complaints of the gastrointestinal symptom, (3) pain beliefs and fear, and (4) self perception of serious problems. Each factor was assessed for concurrent validity with other well-established tools including the Deyo comorbidity index, the Short Form (SF)-36 mental and physical component subscales, and the Oswestry and Neck Disability Indices (ODI/NDI). RESULTS The PBSI was fairly to moderately correlated with assessment tools of quality of life (SF-36) and disability assessment (ODI/NDI). Some of the items in the factor 1 from the MSPQ were slightly associated with the Deyo comorbidity index but not with the ODI/NDI. CONCLUSIONS The items from the MSPQ failed to associate with measures of quality of life and disability and thus may provide only marginal value when assessing the multidimensional aspects associated with neck and low back pain. The PBSI has moderate correlation with disability assessments. Neither tool was found to strongly correlate with disability measures or with SF-36 scales (mental and physical component subscales). Additional tools may be needed to further identify the dimensions associated with chronic pain patients.
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Affiliation(s)
- Megan B Donaldson
- Department of Physical Therapy, Walsh University, North Canton, Ohio 44720, USA.
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