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Custers P, Van de Kelft E, Eeckhaut B, Sabbe W, Hofman A, Debuysscher A, Van Acker G, Maes G. Clinical Examination, Diagnosis, and Conservative Treatment of Chronic Low Back Pain: A Narrative Review. Life (Basel) 2024; 14:1090. [PMID: 39337874 DOI: 10.3390/life14091090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/30/2024] Open
Abstract
Chronic low back pain is one of the most frequent reasons for medical consultation. It is important to make the correct diagnosis to select the most appropriate treatment in a stepwise approach. In this narrative review, we focus on the clinical examination, the diagnosis, and the conservative treatment of chronic non-specific low back pain. Belgian guidelines for low back pain were used as a basis, followed by a snowball search starting from two articles. Besides that, the Cochrane database was consulted using the following research areas: "multidisciplinary biopsychosocial rehabilitation", "physical examination of lumbar spine", and "rehabilitation back pain". Lastly, we took information from three handbooks. The diagnosis of low back pain starts with a thorough history, including red, yellow, orange, black, and blue flags. Physical, neurological, sensory, and motor testing is performed and complemented with specific tests for low back pain. With a focus on the conservative treatment, pharmacological and non-pharmacological treatments are possible. For CNSLBP, conservative management is advised, starting with reassurance and clear patient education about the condition. While additional treatments, such as manipulation, massage, and acupuncture, can be considered, their effectiveness is not well supported by evidence. Our center emphasizes exercise within a multidisciplinary biopsychosocial rehabilitation program, and although evidence for this approach is limited, we have seen positive outcomes, including improved mobility, strength, and higher return-to-work rates, particularly with the David Spine Concept (DSC).
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Affiliation(s)
- Paulien Custers
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Erik Van de Kelft
- Department of Neurosurgery, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Bart Eeckhaut
- Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Wouter Sabbe
- Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - An Hofman
- Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Annick Debuysscher
- Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Gilles Van Acker
- Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Gaethan Maes
- Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
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Volinn E. When Patients' Assessments of Treatment for Subjective Symptoms are At Odds with Authoritative Assessments in the Biomedical Literature: The Case of Patients Treated with Acupuncture for Low Back Pain in a Traditional Chinese Medicine Clinic in China (and Story of a Bewildered Chicken). J Eval Clin Pract 2023; 29:1073-1082. [PMID: 36647197 DOI: 10.1111/jep.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/27/2022] [Accepted: 10/04/2022] [Indexed: 01/18/2023]
Abstract
Assessments of treatments for 'subjective symptoms' are problematic and potentially contentious. These are symptoms without ascertainable pathophysiology, also referred to as 'medically unexplained.' Treatments of them may be assessed from different perspectives, and an assessment as seen from one perspective may be discrepant with an assessment as seen from another perspective. The observational study described in the paper represents one perspective. Patients in the study were treated with acupuncture for the subjective symptom of low back pain in a Traditional Chinese Medicine Clinic in China; acupuncture is a form of TCM, which is indigenous to China. Shortly after treatment began and six months afterward, patients reported 'clinically important improvements' on a variety of standard, cross-culturally validated outcome measures, including pain intensity, physical functioning, and emotional functioning; this assessment is consistent with numerous assessments of acupuncture in China and other Southeastern Asian countries. On the other hand, clinical trials represent another perspective from which to assess acupuncture. Although assessments based on trials are not uniform, several assessments based on them, including those published in journals such as Lancet and New England Journal of Medicine, conclude that acupuncture is not effective. These trials, however, were mainly situated in the U.S., western European countries, and other WEIRD (Western, Educated, Industrialized, Rich, Democratic) countries. This is notable, because the population of China, the indigenous context of acupuncture, is greater than populations of WEIRD countries combined. Patients' expectations of a treatment such as acupuncture and their prior familiarity with it vary among contexts, and patients' experiences of treatment outcomes may vary accordingly. In short, although clinical trials constitute a test of truth in biomedicine and inform authoritative assessments in WEIRD countries, they do not necessarily represent the truth from the perspective of those experiencing outcomes of especially indigenous treatments for subjective symptoms in non-WEIRD contexts.
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Langford DJ, Sharma S, McDermott MP, Beeram A, Besherat S, France FO, Mark R, Park M, Nishtar M, Turk DC, Dworkin RH, Gewandter JS. Covariate Adjustment in Chronic Pain Trials: An Oft-Missed Opportunity. THE JOURNAL OF PAIN 2023; 24:1555-1569. [PMID: 37327942 PMCID: PMC11261744 DOI: 10.1016/j.jpain.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
Self-reported pain intensity, frequently used as an outcome in randomized clinical trials (RCTs) of chronic pain, is often highly variable and could be associated with multiple baseline factors. Thus, the assay sensitivity of pain trials (ie, the ability of the trial to detect a true treatment effect) could be improved by including prespecified baseline factors in the primary statistical model. The objective of this focus article was to characterize the baseline factors included in statistical analyses of chronic pain RCTs. Seventy-three RCTs published between 2016 and 2021 that investigated interventions for chronic pain were included. The majority of trials identified a single primary analysis (72.6%; n = 53). Of these, 60.4% (n = 32) included one or more covariates in the primary statistical model, most commonly baseline value of the primary outcome, study site, sex, and age. Only one of the trials reported information regarding associations between covariates and outcomes (ie, information that could inform prioritization of covariates for prespecification in future analyses). These findings demonstrate inconsistent use of covariates in the statistical models in chronic pain clinical trials. Prespecified adjustments for baseline covariates that could increase precision and assay sensitivity should be considered in future clinical trials of chronic pain treatments. PERSPECTIVE: This review demonstrates inconsistent inclusion and potential underutilization of covariate adjustment in analyses of chronic pain RCTs. This article highlights areas for possible improvement in design and reporting related to covariate adjustment to improve efficiency in future RCTs.
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Affiliation(s)
- Dale J. Langford
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Sonia Sharma
- Neuro Pain Management Center, Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael P. McDermott
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Avinash Beeram
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Soroush Besherat
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Fallon O. France
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Remington Mark
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Meghan Park
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mahd Nishtar
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Robert H. Dworkin
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jennifer S. Gewandter
- Department of Anesthesiology & Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Jonely H, Jayaseelan D, Costello E, Signorino J, Wooten L, Murray D, Woolstenhulme J. Changes in pulmonary function following thoracic spine manipulation in a healthy inactive older adult population-a pilot study. J Phys Ther Sci 2023; 35:492-496. [PMID: 37405180 PMCID: PMC10315198 DOI: 10.1589/jpts.35.492] [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: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 07/06/2023] Open
Abstract
[Purpose] Pulmonary function pathology is primarily treated pharmacologically, with a range of medication side effects. Few studies have systematically examined non-pharmacologic approaches such as joint manipulation effects on pulmonary function. This study examined the immediate and short-term effects of thoracic manipulation on pulmonary function. [Participants and Methods] Twenty-one physically inactive otherwise healthy participants aged 50 years or older were randomly assigned to either receive three sessions of thoracic manipulation (n=10) or three sessions of "sham intercostal training" (n=11). Outcome measures included forced vital capacity, maximal voluntary ventilation and thoracic excursion during maximal inhalation and exhalation. [Results] There was a statistically significant difference in maximal voluntary ventilation in the manipulation group, when measured within a week of the third intervention session and immediate effects in thoracic excursion during exhalation in the sham group following a single intervention session. There were no significant changes in other measures. [Conclusion] Spinal manipulation had no immediate effect on pulmonary function, however, affected an improvement in maximal voluntary ventilation within 7 days following a third session. The sham intervention showed a change in thoracic excursion during exhalation after the first session. Future research is necessary to further explore the relationship between thoracic manipulation and pulmonary function.
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Affiliation(s)
- Holly Jonely
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Dhinu Jayaseelan
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Ellen Costello
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Joseph Signorino
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
- Division of Physical Therapy, Shenandoah University,
USA
| | - Liana Wooten
- Department of Public Health and Community Medicine, School
of Medicine, Doctor of Physical Therapy Program, Tufts University, USA
| | - Donal Murray
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Josh Woolstenhulme
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
- Department of Physical Therapy and Athletic Training,
Meridian Health Sciences Center, Idaho State University, USA
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Roseen EJ, Pinheiro A, Lemaster CM, Plumb D, Wang S, Elwy AR, Streeter CC, Lynch S, Groessl E, Sherman KJ, Weinberg J, Saper RB. Yoga Versus Education for Veterans with Chronic Low Back Pain: a Randomized Controlled Trial. J Gen Intern Med 2023; 38:2113-2122. [PMID: 36650329 PMCID: PMC10361953 DOI: 10.1007/s11606-023-08037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Yoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans. OBJECTIVE Determine whether yoga is more effective than an educational book for improving disability and pain among Veterans with cLBP. DESIGN, SETTING, AND PARTICIPANTS Veterans diagnosed with cLBP at a VA medical center enrolled in a randomized controlled trial from March to December of 2015. INTERVENTIONS Twelve weekly hatha yoga classes or education using The Back Pain Helpbook. MEASURES Co-primary outcomes were changes from baseline at 12 weeks in back-related disability on the modified Roland Morris Disability Questionnaire and pain on the Defense & Veterans Pain Rating Scale. Secondary outcomes were global improvement, patient satisfaction, pain medication use, and post-traumatic stress symptoms. An intention-to-treat approach was used in primary analyses. RESULTS One hundred twenty Veterans (mean age, 55.5 [SD = 16.9]; 11 [9%] women; mean number of chronic conditions, 5.5) were randomized to yoga (n = 62) and education (n = 58). At 12 weeks, reductions in back-related disability in yoga (mean difference [MD] = - 3.50, 95% CI: - 5.03, - 1.97) were not significantly different than education (MD = - 2.55, 95% CI: - 4.10, - 0.99; between-group difference: - 0.95 [95% CI: - 3.14, 1.23], p = 0.39). For pain, there was no significant difference between yoga (MD = - 1.01, 95% CI: - 1.67, - 0.35) and education (MD = - 0.81, 95% CI: - 1.36, - 0.27; between-group difference: - 0.20, 95% CI: - 1.06, 0.66, p = 0.65). More yoga than education participants reported being very much or extremely improved (39% vs 19%, OR = 3.71, 95% CI: 1.37, 10.02, p = 0.01) and very satisfied with treatment (60% vs 31%, OR = 4.28, 95% CI: 1.70, 10.77, p = 0.002). No differences in pain medication use or post-traumatic stress symptoms were observed at 12 weeks. No serious adverse events were reported in either group. CONCLUSION Twelve weekly yoga classes were not more effective than an education intervention for improving pain or disability outcomes among mostly older male Veterans with cLBP and multiple comorbid health conditions. CLINICALTRIALS GOV IDENTIFIER NCT02224183.
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Affiliation(s)
- Eric J. Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston University Medical Campus, 801 Massachusetts Ave, Second Floor, Boston, MA 02131 USA
- Department of Physical Medicine and Rehabilitation and New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA USA
| | - Adlin Pinheiro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Chelsey M. Lemaster
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ USA
| | - Dorothy Plumb
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
| | - Shihwe Wang
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Chris C. Streeter
- Department of Psychiatry and Neurology, Boston University School of Medicine, Boston, MA USA
- Department of Psychiatry, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | | | - Erik Groessl
- Herbert Wertheim School of Public Health, University of California San Diego and VA San Diego Health Care System, San Diego, CA USA
| | - Karen J. Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle WA and Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Robert B. Saper
- Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH USA
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Ma Y, Li B, Cui Y, Zhang Z, Jiang S, Yan X, He J, Du Y. The Top 100 Cited Articles on Acupuncture in the Last 20 Years: A Bibliometric Analysis. Complement Med Res 2023; 30:393-407. [PMID: 37263232 DOI: 10.1159/000530778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/14/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Acupuncture has gained increasing international attention in recent decades. The act of incorporating acupuncture treatment into the routine treatment of COVID-19 in China drove us to review the 100 most influential articles of the last 20 years to learn about the current status and trends of acupuncture. METHOD Articles related to acupuncture from January 1, 2001, to July 4, 2022, were searched in the Clarivate Analytics Web of Science Core Collection database. The top 100 most cited publications were selected, and information was extracted. Software such as VOSviewer, GraphPad Prism, Scimago Graphica, and CiteSpace were used to visualize and analyze the extracted data. RESULT The 100 most cited articles were identified, with an average of 218 citations (range: 131-625). The majority of the top 100 articles were from the USA (n = 53). The institution that published the most highly cited papers was Harvard University (n = 16). The most influential team was Klaus Linde's group. Pain was the top-ranked journal in terms of the number of publications. The largest clusters for co-occurrence keyword analysis focused on acupuncture and electroacupuncture analgesia and brain imaging responses to acupuncture stimulation via functional MRI. The two highest strength burst keywords were "randomized controlled trials" and "osteoarthritis," with "randomized controlled trials" being a consistent burst keyword from 2011 to the present. CONCLUSION This study provides insight into articles of historical significance in the field of acupuncture through bibliometric analysis. These data should provide clinicians and researchers with insight into future directions related to acupuncture. Hintergrund Die Akupunktur hat in den vergangenen Jahrzehnten zunehmend die internationale Aufmerksamkeit auf sich gezogen. Die Einbeziehung der Akupunktur in die Routinebehandlung von COVID-19 in China hat uns dazu veranlasst, die 100 einflussreichsten Artikel der letzten 20 Jahre zu überprüfen, um etwas über den aktuellen Stand und die Trends in der Akupunktur zu erfahren. Methode Artikel mit Bezug zu Akupunktur vom 1. Januar 2001 bis 4. Juli 2022 wurden in der Clarivate Analytics Web of Science Core Collection Datenbank gesucht. Die 100 am häufigsten zitierten Veröffentlichungen wurden ausgewählt und die Informationen wurden extrahiert. Visualisierung und Analyse der extrahierten Daten erfolgten mithilfe der Software VOSviewer, GraphPad Prism, Scimago Graphica und CiteSpace. Ergebnis Es wurden die 100 am häufigsten zitierten Artikel ermittelt mit durchschnittlich 218 Zitierungen (Spanne: 131 bis 625). Der Großteil der 100 meistzitierten Artikel stammte aus den Vereinigten Staaten ( n = 53). Die Institution, die die meisten zitierten Artikel veröffentlichte, war die Harvard-Universität ( n = 16). Das einflussreichste Team war die Gruppe von Klaus Linde. Was die Zahl der Veröffentlichungen betrifft, war Pain die am häufigsten zitierte Zeitschrift. Bei der Analyse der Koinzidenz von Schlüsselwörtern lag der Fokus der größten Cluster auf Akupunktur-und Elektroakupunktur-Analgesie sowie auf den Reaktionen auf Akupunkturstimulation in den bildgebenden Untersuchungen des Gehirns mittels funktioneller MRT. Die beiden stärksten Burst-Schlüsselwörter waren “randomisierte kontrollierte Studien” und “Osteoarthritis,” wobei “randomisierte kontrollierte Studien” von 2011 bis heute durchgängig ein Burst-Schlüsselwort ist. Schlussfolgerung Diese Studie bietet einen Einblick in historisch bedeutsame Artikel auf dem Gebiet der Akupunktur mittels bibliometrischer analyse. Diese Daten sollen Klinikern und Forschern einen Einblick in zukünftige Richtungen im Zusammenhang mit Akupunktur geben.
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Affiliation(s)
- Yuping Ma
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China,
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China,
| | - Bo Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Ying Cui
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zixing Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shiyi Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xiong Yan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Junpeng He
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuzheng Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Almeida MO, Narciso Garcia A, Menezes Costa LC, van Tulder MW, Lin CWC, Machado LA. The McKenzie method for (sub)acute non-specific low back pain. Cochrane Database Syst Rev 2023; 4:CD009711. [PMID: 37017272 PMCID: PMC10076480 DOI: 10.1002/14651858.cd009711.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND There is widespread agreement amongst clinicians that people with non-specific low back pain (NSLBP) comprise a heterogeneous group and that their management should be individually tailored. One treatment known by its tailored design is the McKenzie method (e.g. an individualized program of exercises based on clinical clues observed during assessment). OBJECTIVES To evaluate the effectiveness of the McKenzie method in people with (sub)acute non-specific low back pain. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two trials registers up to 15 August 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) investigating the effectiveness of the McKenzie method in adults with (sub)acute (less than 12 weeks) NSLBP. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review included five RCTs with a total of 563 participants recruited from primary or tertiary care. Three trials were conducted in the USA, one in Australia, and one in Scotland. Three trials received financial support from non-commercial funders and two did not provide information on funding sources. All trials were at high risk of performance and detection bias. None of the included trials measured adverse events. McKenzie method versus minimal intervention (educational booklet; McKenzie method as a supplement to other intervention - main comparison) There is low-certainty evidence that the McKenzie method may result in a slight reduction in pain in the short term (MD -7.3, 95% CI -12.0 to -2.56; 2 trials, 377 participants) but not in the intermediate term (MD -5.0, 95% CI -14.3 to 4.3; 1 trial, 180 participants). There is low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD -2.5, 95% CI -7.5 to 2.0; 2 trials, 328 participants) nor in the intermediate term (MD -0.9, 95% CI -7.3 to 5.6; 1 trial, 180 participants). McKenzie method versus manual therapy There is low-certainty evidence that the McKenzie method may not reduce pain in the short term (MD -8.7, 95% CI -27.4 to 10.0; 3 trials, 298 participants) and may result in a slight increase in pain in the intermediate term (MD 7.0, 95% CI 0.7 to 13.3; 1 trial, 235 participants). There is low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD -5.0, 95% CI -15.0 to 5.0; 3 trials, 298 participants) nor in the intermediate term (MD 4.3, 95% CI -0.7 to 9.3; 1 trial, 235 participants). McKenzie method versus other interventions (massage and advice) There is very low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD 4.0, 95% CI -15.4 to 23.4; 1 trial, 30 participants) nor in the intermediate term (MD 10.0, 95% CI -8.9 to 28.9; 1 trial, 30 participants). AUTHORS' CONCLUSIONS Based on low- to very low-certainty evidence, the treatment effects for pain and disability found in our review were not clinically important. Thus, we can conclude that the McKenzie method is not an effective treatment for (sub)acute NSLBP.
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Affiliation(s)
- Matheus O Almeida
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Alessandra Narciso Garcia
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Luciola C Menezes Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Chung-Wei Christine Lin
- Musculoskeletal Health Sydney, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Luciana Ac Machado
- Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Langford DJ, Lou R, Sheen S, Amtmann D, Colloca L, Edwards RR, Farrar JT, Katz NP, McDermott MP, Reeve BB, Wasan AD, Turk DC, Dworkin RH, Gewandter JS. Expectations for Improvement: A Neglected but Potentially Important Covariate or Moderator for Chronic Pain Clinical Trials. THE JOURNAL OF PAIN 2023; 24:575-581. [PMID: 36577461 PMCID: PMC10079631 DOI: 10.1016/j.jpain.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
Variability in pain-related outcomes can hamper assay sensitivity of chronic pain clinical trials. Expectations of outcome in such trials may account for some of this variability, and thereby impede development of novel pain treatments. Measurement of participants' expectations prior to initiating study treatment (active or placebo) is infrequent, variable, and often unvalidated. Efforts to optimize and standardize measurement, analysis, and management of expectations are needed. In this Focus Article, we provide an overview of research findings on the relationship between baseline expectations and pain-related outcomes in clinical trials of pharmacological and nonpharmacological pain treatments. We highlight the potential benefit of adjusting for participants' expectations in clinical trial analyses and draw on findings from patient interviews to discuss critical issues related to measurement of expectations. We conclude with suggestions regarding future studies focused on better understanding the utility of incorporating these measures into clinical trial analyses. PERSPECTIVE: This focus article provides an overview of the relationship between participants' baseline expectations and pain-related outcomes in the setting of clinical trials of chronic pain treatments. Systematic research focused on the measurement of expectations and the impact of adjusting for expectations in clinical trial analyses may improve assay sensitivity.
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Affiliation(s)
- Dale J Langford
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York; Department of Anesthesiology & Pain Medicine/Division of Pain Medicine, University of Washington, Seattle Washington.
| | - Raissa Lou
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Soun Sheen
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Dagmar Amtmann
- Department of Anesthesiology & Pain Medicine/Division of Pain Medicine, University of Washington, Seattle Washington
| | - Luana Colloca
- Department of Pain & Translational Symptom Science, University of Maryland, Baltimore, Maryland
| | - Robert R Edwards
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - John T Farrar
- Departments of Epidemiology, Neurology, and Anesthesia, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nathaniel P Katz
- Department of Anesthesiology & Perioperative Medicine, Tufts University and Ein Sof Innovation, Boston, Massachusetts
| | - Michael P McDermott
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Bryce B Reeve
- Department of Population Health Sciences, Center for Health Measurement, Duke University School of Medicine, Durham, North Carolina
| | - Ajay D Wasan
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine/Division of Pain Medicine, University of Washington, Seattle Washington
| | - Robert H Dworkin
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Jennifer S Gewandter
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
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Alsaif H, Goodwin PC, Callaghan MJ, Sudell L, O'Neill TW, Yeowell G. Patient and healthcare provider experience and perceptions of a preoperative rehabilitation class for lumbar discectomy: A qualitative study. Musculoskelet Sci Pract 2023; 64:102740. [PMID: 36958123 DOI: 10.1016/j.msksp.2023.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/29/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Lumbar disc disease is a leading cause of low back pain. Lumbar discectomy (LD) may be indicated if symptoms are not managed conservatively. Rehabilitation has traditionally been delivered postoperatively; however, there is increasing delivery preoperatively. There are few data concerning perceptions and experiences of preoperative rehabilitation. Exploring experiences of preoperative rehabilitation may help in the development and delivery of effective care for patients. OBJECTIVES To develop an understanding of patient and healthcare provider (HCP) experiences, perspectives and preferences of preoperative LD rehabilitation, including why patients do not attend. DESIGN A qualitative interpretive approach using focus groups and individual interviews. METHODS Data were collected from; a) patients listed for surgery and attended the preoperative rehabilitation (October 2019 to March 2020), b) patients listed for surgery but did not attend rehabilitation, and c) HCPs involved in the delivery of rehabilitation. Data were transcribed verbatim and analysed using thematic analysis. RESULTS/FINDINGS Twenty participants were included, twelve patients and eight HCPs. The preoperative class was a valuable service for both patients and HCPs. It provided a solution to staffing and time pressures. It provided the required education and exercise content helping the patients along their surgery pathway. Travel distance, transportation links, parking difficulty and cost, lack of knowledge about the class aims, and previous negative experiences were barriers to patient attendance. CONCLUSIONS For most patients and HCPs, the preoperative class was valuable. Addressing the challenges and barriers could improve attendance. Future research should focus on management of patient expectations and preferences preoperatively.
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Affiliation(s)
- Hanan Alsaif
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Physiotherapy, King Fahad Military Medical Complex - KFMMC Dhahran, Kingdom of Saudi Arabia
| | - Peter C Goodwin
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Health and Professions, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Michael J Callaghan
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Health and Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Lindsay Sudell
- Department of Physiotherapy, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Gillian Yeowell
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Health and Professions, Manchester Metropolitan University, Manchester, United Kingdom
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Romero SAD, Emard N, Baser RE, Panageas K, MacLeod J, Walker D, Barton-Burke M, Liou K, Deng G, Farrar J, Xiao H, Mao JJ, Epstein A. Acupuncture versus massage for pain in patients living with advanced cancer: a protocol for the IMPACT randomised clinical trial. BMJ Open 2022; 12:e058281. [PMID: 36581960 PMCID: PMC9438082 DOI: 10.1136/bmjopen-2021-058281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/06/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Pain, comorbid fatigue and sleep disturbances are common and distressing symptoms for patients with advanced cancer, negatively impacting their quality of life. Clinical guidelines recommend non-pharmacological interventions, including acupuncture and massage, for pain management in adult patients with cancer in adjunct to conventional care. However, high-quality evidence about the comparative effectiveness and long-term durability of these therapies for symptom management is limited. METHODS AND ANALYSIS We describe the design of a two-arm, parallel group, multicentre randomised controlled trial that investigates the use of acupuncture versus massage for musculoskeletal pain among 300 patients with diverse types of advanced cancer. The primary aim is to evaluate the long-term effectiveness (26 weeks from randomisation) of acupuncture vs massage for pain (primary outcome) and comorbid symptoms (fatigue, sleep disturbance and quality of life). The secondary aim is to identify patient-level demographic characteristics (eg, sex, race, age), clinical factors (eg, insomnia, pain severity) and psychological attributes that are associated with a greater reduction in pain for either acupuncture or massage. Patients will receive weekly acupuncture or massage treatments for 10 weeks, followed by monthly booster sessions up to 26 weeks. The primary endpoint will be the change in worst pain intensity score from baseline to 26 weeks. We will collect validated patient-reported outcomes at multiple time points over 26 weeks. ETHICS AND DISSEMINATION The Institutional Review Board at Memorial Sloan Kettering Cancer Center in New York approved this protocol. Results will be disseminated via peer-reviewed scientific journals and conference presentations. Our findings will help patients and healthcare providers make informed decisions about incorporating non-pharmacological treatments to manage pain for patients with advanced cancer. TRIAL REGISTRATION NUMBER NCT04095234.
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Affiliation(s)
- Sally A D Romero
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA
| | - Nicholas Emard
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine Panageas
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jodi MacLeod
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Desiree Walker
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret Barton-Burke
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary Deng
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Han Xiao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Giandomenico D, Nuria R, Alessandro A, Matteo G, Mattia I, Marco T, Francesco C. Differences between experimental and placebo arms in manual therapy trials: a methodological review. BMC Med Res Methodol 2022; 22:219. [PMID: 35941533 PMCID: PMC9358888 DOI: 10.1186/s12874-022-01704-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To measure the specific effectiveness of a given treatment in a randomised controlled trial, the intervention and control groups have to be similar in all factors not distinctive to the experimental treatment. The similarity of these non-specific factors can be defined as an equality assumption. The purpose of this review was to evaluate the equality assumptions in manual therapy trials. METHODS Relevant studies were identified through the following databases: EMBASE, MEDLINE, SCOPUS, WEB OF SCIENCE, Scholar Google, clinicaltrial.gov, the Cochrane Library, chiloras/MANTIS, PubMed Europe, Allied and Complementary Medicine (AMED), Physiotherapy Evidence Database (PEDro) and Sciencedirect. Studies investigating the effect of any manual intervention compared to at least one type of manual control were included. Data extraction and qualitative assessment were carried out independently by four reviewers, and the summary of results was reported following the PRISMA statement. RESULT Out of 108,903 retrieved studies, 311, enrolling a total of 17,308 patients, were included and divided into eight manual therapy trials categories. Equality assumption elements were grouped in three macro areas: patient-related, context-related and practitioner-related items. Results showed good quality in the reporting of context-related equality assumption items, potentially because largely included in pre-existent guidelines. There was a general lack of attention to the patient- and practitioner-related equality assumption items. CONCLUSION Our results showed that the similarity between experimental and sham interventions is limited, affecting, therefore, the strength of the evidence. Based on the results, methodological aspects for planning future trials were discussed and recommendations to control for equality assumption were provided.
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Affiliation(s)
- D.’Alessandro Giandomenico
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,Centre Pour L’Etude, La Recherche Et La Diffusion Ostéopathiques “C.E.R.D.O”, 00199 Rome, Italy
| | - Ruffini Nuria
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,Foundation C.O.ME. Collaboration, National Centre Germany, 10825 Berlin, Germany
| | - Aquino Alessandro
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,grid.4708.b0000 0004 1757 2822Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Galli Matteo
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy ,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Innocenti Mattia
- Centre Pour L’Etude, La Recherche Et La Diffusion Ostéopathiques “C.E.R.D.O”, 00199 Rome, Italy
| | - Tramontano Marco
- grid.417778.a0000 0001 0692 3437Fondazione Santa Lucia IRCCS, 00179 Rome, Italy
| | - Cerritelli Francesco
- Clinical-Based Human Research Department, Foundation C.O.ME. Collaboration, 65121 Pescara, Italy
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12
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Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis. J Orthop Surg Res 2022; 17:319. [PMID: 35725480 PMCID: PMC9208133 DOI: 10.1186/s13018-022-03212-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background This Bayesian network meta-analysis investigated the available randomized control trials (RCTs) to point out which acupuncture protocol is the most effective for chronic aspecific low back pain (LBP). Efficacy was measured in terms of pain (Visual Analogic Scale, VAS) and disability (Roland Morris Disability Questionnaire, RMQ), Transcutaneous Electrical Nerve Stimulation (TENS). Methods PubMed, Google scholar, Embase, and Scopus were accessed in March 2022. All the RCTs comparing two or more acupuncture modalities for aspecific chronic LBP were accessed. Only studies which investigated the efficacy of acupuncture on patients with symptoms lasting a minimum of 1.5 months, or with at least three episodes in the previous 12 months, were considered eligible. The Review Manager Software (The Nordic Cochrane Collaboration, Copenhagen) was used for the methodological quality assessment. The STATA Software/MP, Version 14.1 (StataCorporation, College Station, Texas, USA), was used for the statistical analyses. The NMA was performed through the STATA routine for Bayesian hierarchical random-effects model analysis. Results Data from 44 RCTs (8338 procedures) were retrieved. 56% of patients were women. The mean age of the patients was 48 ± 10.6 years. The mean BMI was 26.3 ± 2.2 kg/m2. The individual group (95% confidence interval (CI) 2.02, 7.98) and the standard combined with TENS (95% CI 2.03, 7.97) demonstrated the highest improvement of the RMQ. The VAS score was lower in the standard combined with TENS group (95% CI 3.28, 4.56). Considering the standard acupuncture group, different studies used similar protocols and acupuncture points and the results could thus be compared. The equation for global linearity did not find any statistically significant inconsistency in any of the network comparison. Conclusion Verum acupuncture is more effective than sham treatment for the non-pharmacological management of LBP. Among the verum protocols, individualized acupuncture and standard acupuncture with TENS were the protocols that resulted in the highest improvement in pain and quality of life. Level of Evidence Level I, Bayesian network meta-analysis of RCTs.
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13
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Egli M, Deforth M, Keiser S, Meyenberger P, Muff S, Witt CM, Barth J. Effectiveness of a Brief Hypnotic Induction in Third Molar Extraction: A Randomized Controlled Trial (HypMol). THE JOURNAL OF PAIN 2022; 23:1071-1081. [PMID: 35108620 DOI: 10.1016/j.jpain.2021.12.015] [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: 08/03/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Third molar extraction is a painful treatment for patients, and thus, it can be used to investigate the effects of analgesics on pain. Hypnosis can help to reduce pain and to decrease the intake of postoperative systemic analgesics. In this study, the effectiveness of a brief hypnotic induction for patients undergoing third molar extractions was investigated. Data were collected from 33 patients with third molar extractions on the right and left sides. Patients received 2 different types of pain interventions in this monocentric randomized crossover trial. Third molar extraction was conducted on 1 side with reduced preoperative local anesthetics and an additional brief hypnotic induction (Dave Elman technique). The other side was conducted with regular preoperative local anesthetics without a brief hypnotic induction (standard care). Intake of postoperative systemic analgesics was allowed in both treatments. Patients' expectations about hypnosis were assessed at baseline. The primary outcome was the area under the curve with respect to ground of pain intensity after the treatment. Secondary outcomes were the amount of postoperative analgesics consumed and the preferred treatment. There was no evidence that the area under the curve with respect to ground of pain differed between the 2 interventions (controlling for gender), but the patients' expectations affected the effectiveness of the brief hypnotic induction. This means that patients with high expectations about hypnosis benefit more from treatment with reduced preoperative local anesthetics and additional brief hypnotic induction. PERSPECTIVE: Hypnosis is used as a treatment to reduce pain in general and dental settings. In this study, additional a brief hypnotic induction with reduced preoperative local anesthetic use did not generally reduce posttreatment pain after third molar extraction more than regular local anesthetics. The expectation of the patients about the effectiveness of hypnosis affected the effectiveness of the brief hypnotic induction so that patients with high expectations had a larger benefit from a brief hypnotic induction than patients with low expectations.
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Affiliation(s)
- Mathias Egli
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Praxis Meyenberger, Wil, Switzerland
| | - Manja Deforth
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stefanie Keiser
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Stefanie Muff
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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14
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Do patients’ pre-treatment expectations about acupuncture effectiveness predict treatment outcome in patients with chronic low back pain? A secondary analysis of data from a randomised controlled clinical trial. PLoS One 2022; 17:e0268646. [PMID: 35594274 PMCID: PMC9122231 DOI: 10.1371/journal.pone.0268646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/14/2022] [Indexed: 12/05/2022] Open
Abstract
Objective This secondary analysis of a randomised controlled patient-blinded trial comparing effectiveness and side effect briefings in patients with chronic low back pain (CLBP) investigated the association between patients’ pre-treatment expectations about minimal acupuncture treatment and pain intensity as outcome during and after the end of the treatment. Methods Chronic low back pain patients with a pain intensity of at least 4 on a numeric rating scale from 0 to 10 received eight sessions of minimal acupuncture treatment over 4 weeks. The primary outcome was change in pain intensity rated on a Numerical Rating Scale (NRS 0–10) from inclusion visit to treatment session 4 and to the end of the treatment. Patients’ expectations about the effectiveness of acupuncture were assessed using the Expectation for Treatment Scale (ETS) before randomization. Linear regression was applied to investigate whether patients’ pre-treatment expectations predicted changes in pain intensity during and after treatment. Results A total of 142 CLBP patients (40.1 ± 12.5 years; 65.5% female) were included in our analysis. Patients’ pre-treatment expectations about acupuncture treatment were associated with changes in pain intensity after four sessions of minimal acupuncture treatment (b = -0.264, p = 0.002), but not after the end of the treatment. This association was found in females and males. Conclusions Our results imply that higher pre-treatment expectations only lead to larger reductions in pain intensity in the initial phase of a treatment, with a similar magnitude for both females and males. As the treatment progresses in the second half of the treatment, adapted expectations or other non-specific effects might play a more important role in predicting treatment outcome.
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Wassinger CA, Edwards DC, Bourassa M, Reagan D, Weyant EC, Walden RR. The Role of Patient Recovery Expectations in the Outcomes of Physical Therapist Intervention: A Systematic Review. Phys Ther 2022; 102:6535413. [PMID: 35224644 DOI: 10.1093/ptj/pzac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/22/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the association between baseline patient recovery expectations and outcomes following physical therapy care. METHODS PubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from inception to February 2021. Concepts represented in the search included physical therapy, patient expectations, patient outcomes, and their relevant synonyms. Two reviewers independently screened studies of article abstracts and full texts. Eligibility criteria included English language studies that evaluated adults seeking physical therapist intervention for any health condition where both patient outcome (recovery) expectations and functional or other outcome measures were reported. Methodologic standards were assessed using the Critical Appraisal Skills Program criteria. Data were extracted using a custom template for this review with planned descriptive reporting of results. Vote counting was used to measure reported outcomes. RESULTS Twenty-one studies were included in this review, representing 4879 individuals. Studies were most commonly prospective cohort studies or secondary analyses of controlled trials. Varied expectation, outcome, and statistical measures that generally link patient recovery expectations with self-reported outcomes in musculoskeletal practice were used. CONCLUSION Patient recovery expectations are commonly associated with patient outcomes in musculoskeletal physical therapy. IMPACT Evidence supports measuring baseline patient expectations as part of a holistic examination process.
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Affiliation(s)
- Craig A Wassinger
- Doctor of Physical Therapy Program, Tufts University, School of Medicine, Boston, Massachusetts, USA.,Physical Therapy Program, East Tennessee State University, Johnson City, Tennessee, USA
| | - D Chase Edwards
- Department of Physical Therapy, Rural Health Services Consortium, Rogersville, Tennessee, USA
| | - Michael Bourassa
- Physical Therapy Program, East Tennessee State University, Johnson City, Tennessee, USA
| | - Don Reagan
- Physical Therapist Assistant Department, South College, Knoxville, Tennessee, USA
| | - Emily C Weyant
- Quillen College of Medicine, Medical Library, Biomedical Communications, and Information Technology, East Tennessee State University, Mountain Home, Tennessee, USA
| | - Rachel R Walden
- Quillen College of Medicine, Medical Library, Biomedical Communications, and Information Technology, East Tennessee State University, Mountain Home, Tennessee, USA
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Long CR, Salsbury SA, Vining RD, Lisi AJ, Corber L, Twist E, Abrams T, Wallace RB, Goertz CM. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain. Pilot Feasibility Stud 2022; 8:54. [PMID: 35256010 PMCID: PMC8900358 DOI: 10.1186/s40814-022-01008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial. Methods This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10-week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables. Results We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial. Conclusions We demonstrated the feasibility of participant recruitment, retention, and electronic data collection for conducting a pragmatic clinical trial of chiropractic care in a Veterans Health Administration facility. Using the pilot data and lessons learned, we modified and refined a protocol for a full-scale, multisite, pragmatic, National Institutes of Health-funded randomized trial of multimodal chiropractic care for veterans with chronic LBP that began recruitment in February 2021. Trial registration ClinicalTrials.gov NCT03254719 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01008-0.
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Yang X, Wang T, Jiang Y, Ren F, Jiang H. Patients' Expectancies to Acupuncture: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:202-217. [PMID: 35294303 DOI: 10.1089/jicm.2021.0128] [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] [Indexed: 06/14/2023]
Abstract
Objective: This systematic review aimed to document and describe how and when to assess patients' expectancies to acupuncture and the relationship between patients' expectancies and clinical effects. Materials and Methods: Three English databases, including PubMed, Cochrane Central Register of Controlled Trials, and EMBASE, and four Chinese databases, including the Chinese Biomedicine Literature Database, Chinese Journal Full-text Database, Chinese Scientific Journal Full-text Database, and Wanfang Database, were searched up to February 2020. Studies involving patients' expectancies to acupuncture were included. Based on the detailed situations of patients' expectancies, we made a standardized data extraction table that included the basic information of articles, study design details, and measurement of expectations. Based on the data, a descriptive analysis was performed, covering the characteristics of studies, measuring methods of expectations and the relationship between patients' expectancies and clinical effects. Methodology quality assessment was also performed by the risk of bias and the standards for reporting interventions in controlled trials of acupuncture. Results: There were 61 randomized controlled trials included in our analysis. The number of articles increased gradually over time and grew significantly after 2008. About half of trials focused on pain alleviation. Expectancies were measured before the treatment (N = 43), after the treatment (N = 3), and both before and after the treatment (N = 10), and five studies did not mention it. The measurement of expectancies used self-made questionnaires or scales (N = 27), the Acupuncture Expectations Scale (N = 6), and other scales (N = 11), while 17 studies did not describe what scale they used. The used questionnaires or scales mostly tried to ascertain the strength of confidence that acupuncture would help. Patients' expectancies and clinical effects were relevant in 19 studies, irrelevant in 21 studies, and were not mentioned in 21 studies. Conclusions: Patients' expectations to acupuncture have received increasing attention in recent years, but there is still no recognized measurement time and methods. It is critical to develop questions and answers regarding patients' expectations with better discrimination and reliability to accurately assess expectations and to explore the relationship between patients' expectations and acupuncture outcomes in future trials.
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Affiliation(s)
- Xingyue Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Tianlin Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Jiang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Feihong Ren
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Honglin Jiang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Zhang M, Shi Z, Zhang S, Gao J. A Database on Mycorrhizal Traits of Chinese Medicinal Plants. FRONTIERS IN PLANT SCIENCE 2022; 13:840343. [PMID: 35300014 PMCID: PMC8921535 DOI: 10.3389/fpls.2022.840343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
The mycorrhizal traits of plants have been widely reported based on different scales or plant functional groups. To better utilize mycorrhizae to improve the cultivation yield and active ingredient accumulation of medicinal plants, a database of medicinal plant mycorrhizal characteristics is needed. A database on mycorrhizal traits including mycorrhizal type or status of Chinese medicinal plant species was assembled. In this study, the mycorrhizal type or status of a total of 3,230 medicinal plants was presented. Among them, the mycorrhizal traits of 1,321 species were ascertained. These medicinal plants had three mycorrhizal statuses, both single mycorrhiza (SM) and multi-mycorrhiza (MM) contained four mycorrhizal types. The majority of medicinal plants were obligatorily symbiotic with mycorrhizal fungi with 926 (70.10%) species. The most widespread mycorrhizal type is AM, which is associated with 842 medicinal plant species (90.93% of mycorrhiza has an obligatorily symbiotic relationship with Chinese medicinal plants). Another broadly studied mycorrhizal type is ECM, which is associated with 15 medicinal plant species. This study is the first exclusive database on mycorrhizal traits of medicinal plants, which provides both mycorrhizal type and status. This database provides valuable resources for identifying the mycorrhizal information of medicinal plants and enriching the theory of mycorrhizal traits, which will greatly benefit the production or management of medicinal plants.
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Affiliation(s)
- Menghan Zhang
- College of Agriculture, Henan University of Science and Technology, Luoyang, China
- Henan Engineering Research Center for Rural Human Settlement, Luoyang, China
- Luoyang Key Laboratory of Symbiotic Microorganism and Green Development, Luoyang, China
| | - Zhaoyong Shi
- College of Agriculture, Henan University of Science and Technology, Luoyang, China
- Henan Engineering Research Center for Rural Human Settlement, Luoyang, China
- Luoyang Key Laboratory of Symbiotic Microorganism and Green Development, Luoyang, China
| | - Shan Zhang
- College of Agriculture, Henan University of Science and Technology, Luoyang, China
- Henan Engineering Research Center for Rural Human Settlement, Luoyang, China
- Luoyang Key Laboratory of Symbiotic Microorganism and Green Development, Luoyang, China
| | - Jiakai Gao
- College of Agriculture, Henan University of Science and Technology, Luoyang, China
- Henan Engineering Research Center for Rural Human Settlement, Luoyang, China
- Luoyang Key Laboratory of Symbiotic Microorganism and Green Development, Luoyang, China
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What does the patient with back pain want? A comparison of patient preferences and physician assumptions. Spine J 2022; 22:207-213. [PMID: 34551322 DOI: 10.1016/j.spinee.2021.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUD CONTEXT Low back pain can be difficult to diagnose, leaving patients frustrated and confused after medical visits. PURPOSE To evaluate the importance of reasons for seeking care in patients with back pain, and to compare this to physicians' assumptions about these patients' reasons. STUDY DESIGN/SETTING Prospective survey study carried out at two academic spine centers. PATIENT SAMPLE A sum of 419 patients with back pain upon initial presentation to a spine clinic, and 198 physicians; all volunteered to complete a survey. OUTCOME MEASURES Variance in mean values between patient and physician responders with significance determined by non-overlapping 95% confidence intervals. METHODS Patients were asked to "rate each of the following with regard to their importance to you" (answering between 0 "not important" to 4 "extremely important"): improvement in level of pain, improvement in ability to perform daily tasks, explanation of what is causing your problem, thorough physical examination, diagnostic testing, medication, physical therapy, surgery. Physicians were asked to rate each of these "with regard to their importance to your patients." RESULTS Patients indicated the following items were the most important (mean values): explanation of what is causing your problem (3.27), improvement in level of pain (3.48) and improvement in ability to perform daily tasks (3.31). Patients attributed the least importance and lowest scores to: surgery (1.07) and medication (1.89). Comparing the mean values to each item by patient and physician responders revealed statistically significant differences in certain items. Specifically, physicians underestimated the importance of an explanation of what is causing the problem (2.78±0.119 vs. 3.28±0.098, 95% CI) and overvalued diagnostic tests (2.64±0.120 vs. 2.30±0.147, 95% CI), medications (2.38±0.118 vs. 1.89± 0.143, 95% CI) and surgery (1.60±0.126 vs. 1.07±0.140, 95% CI). CONCLUSION Patients did not place as much importance on diagnostic tests, medications and surgery as the physicians assumed. Physicians understand that back pain patients want improvement in both pain and function, but they underestimate the importance of an explanation for the pain.
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A comparative study of suction blister epidermal grafting and automated blister epidermal micrograft in stable vitiligo. Sci Rep 2022; 12:393. [PMID: 35013472 PMCID: PMC8748709 DOI: 10.1038/s41598-021-04299-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/13/2021] [Indexed: 11/11/2022] Open
Abstract
The automated blister epidermal micrograft (ABEM) is a newly introduced surgical transplantation for refractory vitiligo. Comparative analysis of other surgical methods is lacking. We conducted a retrospective study to compare the efficacy, safety, and experience of ABEM with conventional suction blister epidermal graft (SBEG). A total of 118 anatomically based vitiligo lesions from 75 patients were included. The primary outcome was the degree of repigmentation; the patient and operator experience were evaluated. SBEG had a significantly greater incidence of repigmentation (p < 0.001), as measured by the Physician Global Assessment, as well as improvements in the Vitiligo Area Scoring Index, particularly on the face/neck area (p < 0.001). ABEM, on the contrary, had reduced donor harvest time, a better patient operative experience, and more significant Dermatology Life Quality Index improvements. In a subgroup of 38 lesions from ten patients who received both SBEG and ABEM concomitantly, there was no difference in the degree of repigmentation in the same recipient area. Overall, the degree of repigmentation for SBEG is higher than ABEM, especially in the mobilized region, and the cost is less expensive. On the contrary, ABEM requires less procedure learning curve and can supply a greater transplanting zone with shorter donor site recovery. Understanding the benefits and drawbacks of two blister grafting procedures is essential for optimal surgical outcomes for vitiligo grafting.
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Unnithan AS, Chidgey BA. Pre-Visit Education on Pain Management Options Prior to the First Clinic Visit Improves Chronic Pain Patient Satisfaction with Proposed Treatment Plans. PAIN MEDICINE 2021; 22:2566-2574. [PMID: 34180994 DOI: 10.1093/pm/pnab198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study sought to evaluate if actively informing new chronic pain patients about treatment options and setting realistic expectations for care, through the use of a pre-visit informational handout prior to the first clinic visit, improved patient satisfaction with subsequently proposed treatment plans. METHODS The study was divided into two 3-month periods. During the first 3 months, with our current pain clinic practices in place, new patients (n = 147) were given surveys to establish a baseline of patient satisfaction with treatment plans proposed on their first visit. During the second 3 months, a different group of new patients (n = 156) was given a detailed informational handout which described our clinic's multimodal approach to pain management and therapeutic expectations prior to their visit with a provider. Patient satisfaction with subsequently proposed treatment plans was then assessed and compared with the baseline group. RESULTS The average patient satisfaction score for the group of patients given the informational handout was 4.21 (on a 5-point Likert scale), compared to an average score of 3.25 for the baseline group (P < .0001, unpaired t-test). 77.6% of patients given the informational handout said their proposed treatment plan met their expectations compared to 46.3% of patients in the baseline group (χ2= 31.61, two-tailed P < .0001). CONCLUSIONS Patient satisfaction with proposed chronic pain treatment plans was improved when clinic approaches to pain were explicitly outlined and therapeutic expectations were clearly established in the form of an informational handout at the outset of the first visit.
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Affiliation(s)
- Ajay S Unnithan
- Department of Anesthesiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brooke A Chidgey
- Department of Anesthesiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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22
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Dragomanovich HM, Dhruva A, Ekman E, Schoenbeck KL, Kubo A, Van Blarigan EL, Borno HT, Esquivel M, Chee B, Campanella M, Philip EJ, Rettger JP, Rosenthal B, Van Loon K, Venook AP, Boscardin C, Moran P, Hecht FM, Atreya CE. Being Present 2.0: Online Mindfulness-Based Program for Metastatic Gastrointestinal Cancer Patients and Caregivers. Glob Adv Health Med 2021; 10:21649561211044693. [PMID: 35174001 PMCID: PMC8842457 DOI: 10.1177/21649561211044693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers, which may be alleviated by mindfulness interventions. Research on scalable, tailored, online mindfulness training programs is needed. We sought to test the feasibility and acceptability of a remotely delivered 8-week mindfulness-based intervention, Being Present 2.0 (BP2.0). METHODS We performed a single-arm feasibility study of BP2.0 among patients with any metastatic gastrointestinal cancer receiving chemotherapy, with or without an informal caregiver. Participants were instructed to practice mindfulness using pre-recorded guided meditations 5 times per week using a study-specific website and to attend a weekly live, interactive virtual meeting facilitated by a trained instructor. The web-based platform enabled direct measurement of adherence. RESULTS The study enrolled 46 of 74 (62%) patients contacted, together with 23 caregivers (69 participants total), from May to October 2018. Median patient age was 52 (range 20-70 years), 39% were male, 67% non-Hispanic white, 65% had colorectal cancer, and 78% lived outside of San Francisco. The top reasons cited for participation were to reduce stress/anxiety and learn how to meditate. Mean baseline National Comprehensive Cancer Network Distress Thermometer (NCCN DT) scores were 4.7 (patients) and 5.8 (caregivers). The study discontinuation rate was 20% (eight patients and six caregivers). Among the remaining 55 participants, 43 (78%) listened to at least one audio recording and/or attended at least one virtual meeting, although adherence data was incomplete. The retention rate was 71%, with 39 participants completing at least one follow-up assessment. In post-intervention qualitative interviews, 88% of respondents reported a positive experience. Compared to baseline, participants reported significantly reduced post-intervention NCCN DT scores (mean 3.1; P = .012). CONCLUSION The BP2.0 online mindfulness-based program is feasible and acceptable for patients with metastatic gastrointestinal cancer and caregivers. These results will guide plans for a follow-up efficacy study. ClinicalTrials.gov Identifier: NCT03528863.
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Affiliation(s)
- Hannah M. Dragomanovich
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
| | - Anand Dhruva
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Osher Center for Integrative Medicine, CA, USA
- UCSF Department of Medicine, CA, USA
| | - Eve Ekman
- UCSF Osher Center for Integrative Medicine, CA, USA
- Greater Good Science Center, University of California Berkeley, Berkeley, CA, USA
| | - Kelly L. Schoenbeck
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, CA, USA
| | - Ai Kubo
- Kaiser Permanente Division of Research, CA, USA
| | | | - Hala T. Borno
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, CA, USA
| | - Mikaela Esquivel
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Bryant Chee
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
| | - Matthew Campanella
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | - John P. Rettger
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Blake Rosenthal
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Benioff Children’s Hospital Oakland, CA, USA
| | - Katherine Van Loon
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, CA, USA
| | - Alan P. Venook
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, CA, USA
| | | | - Patricia Moran
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Osher Center for Integrative Medicine, CA, USA
| | - Frederick M. Hecht
- UCSF Osher Center for Integrative Medicine, CA, USA
- UCSF Department of Medicine, CA, USA
| | - Chloe E. Atreya
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Osher Center for Integrative Medicine, CA, USA
- UCSF Department of Medicine, CA, USA
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Barth J, Muff S, Kern A, Zieger A, Keiser S, Zoller M, Rosemann T, Brinkhaus B, Held L, Witt CM. Effect of Briefing on Acupuncture Treatment Outcome Expectations, Pain, and Adverse Side Effects Among Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2121418. [PMID: 34505889 PMCID: PMC8433606 DOI: 10.1001/jamanetworkopen.2021.21418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE In observational studies, patients' treatment outcome expectations have been associated with better outcomes (ie, a placebo response), whereas concerns about adverse side effects have been associated with an in increase in the negative effects of treatments (ie, a nocebo response). Some randomized trials have suggested that communication from clinicians could affect the treatment outcomes by changing patients' expectations. OBJECTIVE To investigate whether treatment outcome expectations and reported adverse side effects could be affected by different briefing contents before a minimal acupuncture treatment in patients with chronic low back pain (CLBP). DESIGN, SETTING, AND PARTICIPANTS This randomized single-blinded clinical trial was conducted among patients with CLBP at 1 outpatient clinic in Switzerland who had a pain intensity of at least 4 on a numeric rating scale from 0 to 10. Different recruitment channels were used to enroll patients. Data were collected from May 2016 to December 2017 and were analyzed from June to November 2018. INTERVENTIONS Patients were randomized to receive either a regular expectation briefing or a high expectation briefing (effectiveness) and either a regular adverse side effect briefing or an intense adverse side effect briefing (adverse side effect) in a 2 × 2 factorial design. The intervention (briefing sessions and written materials) was standardized and delivered before the acupuncture treatment, with additional booster informative emails provided during the 4-week, 8-session acupuncture course. MAIN OUTCOMES AND MEASURES The primary end point was the patients' expectations regarding the effectiveness of the acupuncture treatment (Expectation for Treatment Scale [ETS]) after the briefing and the subsequent pain intensity (numeric rating scale). The primary end point for the adverse side effect briefing was the adverse side effect score at the end of the acupuncture treatment, derived from session-by-session assessments of adverse side effects. RESULTS A total of 152 patients with CLBP (mean [SD] age, 39.54 [12.52] years; 100 [65.8%] women) were included. The estimated group difference (regular vs high) for the ETS was -0.16 (95% CI -0.81 to 0.50, P = .64), indicating no evidence for a difference between intervention groups. There was also no evidence for a difference in pain intensity at the end of the acupuncture treatment between the groups with different expectation briefings. The adverse side effects score in the group with the intense adverse side effect briefing were estimated to be 1.31 times higher (95% CI, 0.94 to 1.82; P = .11) than after a regular adverse side effect briefing, but the finding was not statistically significant. CONCLUSIONS AND RELEVANCE In this study, suggestions regarding treatment benefits (placebo) and adverse side effects (nocebo) did not affect treatment expectations or adverse side effects. Information regarding adverse side effects might require more research to understand nocebo responses. TRIAL REGISTRATION German Clinical Trials Register Identifier: DRKS00010191.
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Affiliation(s)
- Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefanie Muff
- Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexandra Kern
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anja Zieger
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefanie Keiser
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marco Zoller
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, Zurich, Switzerland
| | - Benno Brinkhaus
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Leonhard Held
- Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Claudia M. Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- Center for Integrative Medicine, University of Maryland, School of Medicine, Baltimore
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Butry L, Förster A, Thiel C, Kopkow C. Erwartungen von Patient*innen mit unspezifischen Kreuzschmerzen an die physiotherapeutische Behandlung im ambulanten Setting. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1331-6569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Zusammenfassung
Hintergrund Physiotherapeutische Behandlungen sollten die Erwartungen von Patient*innen berücksichtigen. Es ist unklar, welche Erwartungen Menschen mit unspezifischen Kreuzschmerzen an die physiotherapeutische Behandlung in Deutschland haben.
Ziel Ermittlung der Erwartungen von erwachsenen Patient*innen mit unspezifischen Kreuzschmerzen bezüglich physiotherapeutischer Therapieziele und -inhalte in Deutschland.
Methode Im Rahmen einer Querschnittsstudie wurden Patient*innen mit unspezifischen Kreuzschmerzen mittels Fragebogen befragt. Es wurden Erfahrungen mit der bisherigen physiotherapeutischen Behandlung und Erwartungen an die Therapieinhalte mit einer 6-Punkte-Likert-Skala, Erwartungen an den posttherapeutischen Gesundheitszustand mit einer numerischen Rating-Skala (NRS) erhoben.
Ergebnisse In die deskriptive Analyse flossen 224 Datensätze ein. Die Befragten stimmten eher bis sehr zu, eine klinische Untersuchung, gemeinsame Zielsetzung, Edukation über die Ursache des Gesundheitsproblems, den Beschwerdeverlauf und das Selbstmanagement zu erwarten. Nach Behandlungsabschluss erwarteten sie eine niedrige Schmerzintensität, eine geringe Einschränkung der ADL und beruflichen Teilhabe sowie keine Einschränkung der sozialen Teilhabe.
Schlussfolgerung Patient*innen mit unspezifischen Kreuzschmerzen haben hohe Erwartungen an den posttherapeutischen Gesundheitszustand. Es gibt eindeutige Erwartungen an Therapieinhalte.
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Affiliation(s)
- Lionel Butry
- Hochschule für Gesundheit, Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Bochum, Deutschland
| | - Annemarie Förster
- Hochschule für Gesundheit, Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Bochum, Deutschland
| | - Christian Thiel
- Hochschule für Gesundheit, Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Bochum, Deutschland
| | - Christian Kopkow
- Brandenburgische Technische Universität Cottbus-Senftenberg, Fachgebiet Therapiewissenschaft I, Senftenberg, Deutschland
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Plank A, Rushton A, Ping Y, Mei R, Falla D, Heneghan NR. Exploring expectations and perceptions of different manual therapy techniques in chronic low back pain: a qualitative study. BMC Musculoskelet Disord 2021; 22:444. [PMID: 33990196 PMCID: PMC8122532 DOI: 10.1186/s12891-021-04251-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) prevalence has steadily increased over the last two decades. Manual therapy (MT) is recommended within a multimodal management approach to improve pain and disability although evidence investigating the patients' experience of MT is scarce. OBJECTIVE To explore expectations and perceptions of MT techniques in people with CLBP. METHODS A qualitative study embedded sequential to an experimental trial using semi-structured interviews (SSI) explored participants' experiences of thrust, non-thrust and sham technique. Purposive sampling enabled variance in age and CLBP duration. An evidence informed topic guide was used. Data were analysed using thematic analysis (TA). Respondent validation and peer debriefing enhanced trustworthiness. The Consolidating Criteria for Reporting Qualitative Studies (COREQ) reported methodological rigour. FINDINGS Ten participants (50% male) with a mean age of 29.1 years (Standard Deviation (SD): 7.9, range: 19-43), a mean pain intensity of 4.5 on a Numeric Rating Scale (NRS) 0-10 (SD: 1.5, range: 2-7), a mean Oswestry Disability Score (ODI) of 9 (SD: 4.6, range: 2-17) and a mean Tampa Scale of Kinesiophobia (TSK) score of 38.6 (SD: 4.8, range: 30-45) participated. Four themes were identified: understanding of pain; forming expectations; perception of care; re-evaluation of body awareness and management. Understanding of CLBP is formed by an individuals' pain perception and exchange with social environment. This, combined with communication with physiotherapist influenced expectations regarding the MT technique. CONCLUSION Expectations for MT were formed by an individual's social environment and previous experience. A treatment technique is perceived as positive if its characteristics are aligned with the individual's understanding of pain and if care is delivered in an informative and reassuring manner.
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Affiliation(s)
- A Plank
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - A Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,School of Physical Therapy, Western University, London, Ontario, Canada
| | - Y Ping
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - R Mei
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - N R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
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Coste J, Medkour T, Maigne JY, Pérez M, Laroche F, Perrot S. Osteopathic medicine for fibromyalgia: a sham-controlled randomized clinical trial. Ther Adv Musculoskelet Dis 2021; 13:1759720X211009017. [PMID: 33948127 PMCID: PMC8053754 DOI: 10.1177/1759720x211009017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Patients with fibromyalgia (FM) frequently resort to osteopathic or chiropractic treatment, despite very weak supporting evidence. We aimed to assess the efficacy of osteopathic manipulation in FM in a properly controlled and powered randomized clinical trial. Methods: Patients were randomized to osteopathic or sham treatment. Treatment was administered by experienced physical medicine physicians, and consisted of six sessions per patient, over 6 weeks. Treatment credibility and expectancy were repeatedly evaluated. Patients completed standardized questionnaires at baseline, during treatment, and at 6, 12, 24, and 52 weeks after randomization. The primary outcome was pain intensity (100-mm visual analog scale) during the treatment period. Secondary outcomes included fatigue, functioning, and health-related quality of life. We performed primarily intention-to-treat analyses adjusted for credibility, using multiple imputation for missing data. Results: In total, 101 patients (94% women) were included. Osteopathic treatment did not significantly decrease pain relative to sham treatment (mean difference during treatment: −2.2 mm; 95% confidence interval, −9.1 to 4.6 mm). No significant differences were observed for secondary outcomes. No serious adverse events were observed, despite a likely rebound in pain and altered functioning at week 12 in patients treated by osteopathy. Patient expectancy was predictive of pain during treatment, with a decrease of 12.9 mm (4.4–21.5 mm) per 10 points on the 0–30 scale. Treatment credibility and expectancy were also predictive of several secondary outcomes. Conclusion: Osteopathy conferred no benefit over sham treatment for pain, fatigue, functioning, and quality of life in patients with FM. These findings do not support the use of osteopathy to treat these patients. More attention should be paid to the expectancy of patients in FM management.
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Affiliation(s)
- Joël Coste
- Biostatistics and Epidemiology Unit, Cochin Hospital, Paris University, 27 rue du faubourg Saint-Jacques, Paris, 75014, France
| | - Terkia Medkour
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Jean-Yves Maigne
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Marc Pérez
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Françoise Laroche
- Pain Department, Saint-Antoine University Hospital and Medical University Sorbonne, Paris, France
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
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Yang Z, Li Y, Zou Z, Zhao Y, Zhang W, Jiang H, Hou Y, Li Y, Zheng Q. Does patient's expectation benefit acupuncture treatment?: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24178. [PMID: 33429804 PMCID: PMC7793409 DOI: 10.1097/md.0000000000024178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients' expectation to treatment response is one source of placebo effects. A number of randomized controlled trials (RCTs) reported that expectation benefits to acupuncture treatment, while some did not. Previous systematic reviews failed to draw a confirmative conclusion due to the methodological heterogeneity. It is necessary to conduct a new systematic review to find out whether expectation can influence acupuncture outcomes. METHODS We systematically search English and Chinese databases from their inception to 3rd October, 2020, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese BioMedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP). RCTs that evaluated the relationship between expectation and treatment response following acupuncture for adults will be included. Study selection, data extraction, and risk of bias assessment will be conducted independently. Risk of bias will be assessed by the Cochrane risk of bias assessment tool. Data synthesis will be performed by Review Manager (RevMan) software if the data is suitable for synthesis. RESULTS This systematic review will provide evidence that whether patients' expectation impacts on the therapeutic effects of acupuncture. This protocol will be performed and reported according to the Preferred Reporting Items from Systematic Reviews and Meta-analysis Protocols (PRISMA-P) statement. The findings of this review will be disseminated through peer-reviewed publications and conference presentations. CONCLUSION This systematic review aims to assess whether a higher level of patient's expectation contributes to a better outcome after acupuncture treatment, and in which medical condition this contribution will be more significant. INPLASY REGISTRATION NUMBER INPLASY2020100020 on International Platform of Registered Systematic Review and Meta-analysis Protocols.
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Affiliation(s)
- Zuoqin Yang
- Department of Acupuncture and Moxibustion, Chengdu Pidu District Hospital of Traditional Chinese Medicine/the 3rd Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (West District), No. 169, 1st Section of Zhongxin Avenue
| | - Yan Li
- Department of Central Transportation Center, West China Hospital, Sichuan University, No. 28, Dianxin South Road
| | - Zihao Zou
- School of Acupuncture–Moxibustion and Tuina
| | - Ying Zhao
- School of Acupuncture–Moxibustion and Tuina
| | - Wei Zhang
- School of Acupuncture–Moxibustion and Tuina
| | | | - Yujun Hou
- School of Acupuncture–Moxibustion and Tuina
| | - Ying Li
- Graduate School, Chengdu University of Traditional Chinese Medicine, No. 37 Shi’er Qiao Road, Chengdu, China
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Färnqvist K. Treating tendinopathies – are we searching for a needle in a haystack, when we should include the whole haystack? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1773921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fruijtier AD, Visser LN, Bouwman FH, Lutz R, Schoonenboom N, Kalisvaart K, Hempenius L, Roks G, Boelaarts L, Claus JJ, Kleijer M, de Beer M, van der Flier WM, Smets EM. What patients want to know, and what we actually tell them: The ABIDE project. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12113. [PMID: 33344753 PMCID: PMC7744024 DOI: 10.1002/trc2.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We studied to what degree and at whose initiative 25 informational topics, formerly identified as important, are discussed in diagnostic consultations. METHODS Audio recordings of clinician-patient consultations of 71 patients and 32 clinicians, collected in eight Dutch memory clinics, were independently content-coded by two coders. The coding scheme encompassed 25 informational topics. RESULTS Approximately half (Mdn = 12) of the 25 topics were discussed per patient during the diagnostic process, with a higher frequency among individuals receiving a dementia diagnosis (Mdn = 14) compared to others (Mdn = 11). Individual topics ranged from being discussed with 2/71 (3%) to 70/71 (99%) of patients. Patients and/or care partners rarely initiated topic discussion (10%). When they did, they often enquired about one of the least frequently addressed topics. CONCLUSION Most patients received information on approximately half of the important informational topics. Providing the topic list to patients and care partners beforehand could allow consultation preparation and stimulate participation.
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Affiliation(s)
- Agnetha D. Fruijtier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Leonie N.C. Visser
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Femke H. Bouwman
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Rogier Lutz
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Niki Schoonenboom
- Department of Clinical GeriatricsSpaarne GasthuisHaarlemthe Netherlands
| | - Kees Kalisvaart
- Department of Clinical GeriatricsSpaarne GasthuisHaarlemthe Netherlands
| | | | - Gerwin Roks
- Department of NeurologyETZ HospitalTilburgthe Netherlands
| | - Leo Boelaarts
- Geriatric DepartmentNoordWest Ziekenhuis GroepAlkmaarthe Netherlands
| | - Jules J. Claus
- Department of NeurologyTergooi Hospital, Blaricumthe Netherlands
| | - Mariska Kleijer
- Department of NeurologyLangeLand ZiekenhuisZoetermeerthe Netherlands
| | - Marlijn de Beer
- Department of NeurologyReinier de Graaf GasthuisDelftthe Netherlands
| | - Wiesje M. van der Flier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam NeuroscienceVU University Medical CenterAmsterdamthe Netherlands
| | - Ellen M.A. Smets
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
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Abstract
BACKGROUND Chronic nonspecific low back pain (LBP) is very common; it is defined as pain without a recognizable etiology that lasts for more than three months. Some clinical practice guidelines suggest that acupuncture can offer an effective alternative therapy. This review is a split from an earlier Cochrane review and it focuses on chronic LBP. OBJECTIVES To assess the effects of acupuncture compared to sham intervention, no treatment, or usual care for chronic nonspecific LBP. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, two Chinese databases, and two trial registers to 29 August 2019 without restrictions on language or publication status. We also screened reference lists and LBP guidelines to identify potentially relevant studies. SELECTION CRITERIA We included only randomized controlled trials (RCTs) of acupuncture for chronic nonspecific LBP in adults. We excluded RCTs that investigated LBP with a specific etiology. We included trials comparing acupuncture with sham intervention, no treatment, and usual care. The primary outcomes were pain, back-specific functional status, and quality of life; the secondary outcomes were pain-related disability, global assessment, or adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies, assessed the risk of bias and extracted the data. We meta-analyzed data that were clinically homogeneous using a random-effects model in Review Manager 5.3. Otherwise, we reported the data qualitatively. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 33 studies (37 articles) with 8270 participants. The majority of studies were carried out in Europe, Asia, North and South America. Seven studies (5572 participants) conducted in Germany accounted for 67% of the participants. Sixteen trials compared acupuncture with sham intervention, usual care, or no treatment. Most studies had high risk of performance bias due to lack of blinding of the acupuncturist. A few studies were found to have high risk of detection, attrition, reporting or selection bias. We found low-certainty evidence (seven trials, 1403 participants) that acupuncture may relieve pain in the immediate term (up to seven days) compared to sham intervention (mean difference (MD) -9.22, 95% confidence interval (CI) -13.82 to -4.61, visual analogue scale (VAS) 0-100). The difference did not meet the clinically important threshold of 15 points or 30% relative change. Very low-certainty evidence from five trials (1481 participants) showed that acupuncture was not more effective than sham in improving back-specific function in the immediate term (standardized mean difference (SMD) -0.16, 95% CI -0.38 to 0.06; corresponding to the Hannover Function Ability Questionnaire (HFAQ, 0 to 100, higher values better) change (MD 3.33 points; 95% CI -1.25 to 7.90)). Three trials (1068 participants) yielded low-certainty evidence that acupuncture seemed not to be more effective clinically in the short term for quality of life (SMD 0.24, 95% CI 0.03 to 0.45; corresponding to the physical 12-item Short Form Health Survey (SF-12, 0-100, higher values better) change (MD 2.33 points; 95% CI 0.29 to 4.37)). The reasons for downgrading the certainty of the evidence to either low to very low were risk of bias, inconsistency, and imprecision. We found moderate-certainty evidence that acupuncture produced greater and clinically important pain relief (MD -20.32, 95% CI -24.50 to -16.14; four trials, 366 participants; (VAS, 0 to 100), and improved back function (SMD -0.53, 95% CI -0.73 to -0.34; five trials, 2960 participants; corresponding to the HFAQ change (MD 11.50 points; 95% CI 7.38 to 15.84)) in the immediate term compared to no treatment. The evidence was downgraded to moderate certainty due to risk of bias. No studies reported on quality of life in the short term or adverse events. Low-certainty evidence (five trials, 1054 participants) suggested that acupuncture may reduce pain (MD -10.26, 95% CI -17.11 to -3.40; not clinically important on 0 to 100 VAS), and improve back-specific function immediately after treatment (SMD: -0.47; 95% CI: -0.77 to -0.17; five trials, 1381 participants; corresponding to the HFAQ change (MD 9.78 points, 95% CI 3.54 to 16.02)) compared to usual care. Moderate-certainty evidence from one trial (731 participants) found that acupuncture was more effective in improving physical quality of life (MD 4.20, 95% CI 2.82 to 5.58) but not mental quality of life in the short term (MD 1.90, 95% CI 0.25 to 3.55). The certainty of evidence was downgraded to moderate to low because of risk of bias, inconsistency, and imprecision. Low-certainty evidence suggested a similar incidence of adverse events immediately after treatment in the acupuncture and sham intervention groups (four trials, 465 participants) (RR 0.68 95% CI 0.46 to 1.01), and the acupuncture and usual care groups (one trial, 74 participants) (RR 3.34, 95% CI 0.36 to 30.68). The certainty of the evidence was downgraded due to risk of bias and imprecision. No trial reported adverse events for acupuncture when compared to no treatment. The most commonly reported adverse events in the acupuncture groups were insertion point pain, bruising, hematoma, bleeding, worsening of LBP, and pain other than LBP (pain in leg and shoulder). AUTHORS' CONCLUSIONS We found that acupuncture may not play a more clinically meaningful role than sham in relieving pain immediately after treatment or in improving quality of life in the short term, and acupuncture possibly did not improve back function compared to sham in the immediate term. However, acupuncture was more effective than no treatment in improving pain and function in the immediate term. Trials with usual care as the control showed acupuncture may not reduce pain clinically, but the therapy may improve function immediately after sessions as well as physical but not mental quality of life in the short term. The evidence was downgraded to moderate to very low-certainty considering most of studies had high risk of bias, inconsistency, and small sample size introducing imprecision. The decision to use acupuncture to treat chronic low back pain might depend on the availability, cost and patient's preferences.
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Affiliation(s)
- Jinglan Mu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Andrea D Furlan
- Institute for Work & Health, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wai Yee Lam
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Marcos Y Hsu
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zhipeng Ning
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Virginia University of Integrative Medicine, Fairfax, Virginia, USA
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Dhruva A, Wu C, Miaskowski C, Hartogensis W, Rugo HS, Adler SR, Kaptchuk TJ, Kelkar R, Agarawal S, Vadodaria A, Garris E, Hecht FM. A 4-Month Whole-Systems Ayurvedic Medicine Nutrition and Lifestyle Intervention Is Feasible and Acceptable for Breast Cancer Survivors: Results of a Single-Arm Pilot Clinical Trial. Glob Adv Health Med 2020; 9:2164956120964712. [PMID: 33312762 PMCID: PMC7716077 DOI: 10.1177/2164956120964712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Ongoing symptoms and impairments in quality of life (QOL) among breast cancer survivors remain a significant problem. We tested the feasibility and acceptability of a manualized Ayurvedic nutrition and lifestyle intervention for breast cancer survivors. METHODS Eligible participants had Stage I-III breast cancer, underwent treatment within the past year that included chemotherapy, and were without active disease. The 4-month individualized Ayurvedic intervention included counseling on nutrition, lifestyle, yoga, and marma (like acupressure) during 8 one-on-one visits with an Ayurvedic practitioner. Feasibility and acceptability were the primary outcomes. QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ C30]) and symptoms-sleep disturbance (General Sleep Disturbance Scale [GSDS]), fatigue (Lee Fatigue Scale [LFS]), depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI-S, STAI-T]), and stress (Perceived Stress Scale [PSS])-were measured prior to, at midpoint, and at the end of the 4-month intervention. Effect sizes (Cohen's d) were calculated along with paired t tests comparing baseline to end of month 4 time points. Mixed effects models were used for repeated measures analyses. RESULTS Participants (n = 32) had a mean age of 48 years (SD = 10). Retention at the end of the intervention was 84%. Among those who completed the intervention (n = 27), adherence was high (99.5% of visits with practitioners attended). Large improvements were seen in QLQ-C30 emotional functioning (d = 0.84, P < 0.001), QLQ-C30 cognitive functioning (d = 0.86, P < 0.001), GSDS (d = -1.23, P < 0.001), and CES-D (d = -1.21, P < 0.001). Moderate improvements were seen in QLQ-C30 global health (d = 0.65, p = 0.003), LFS (d = -0.68, P = 0.002), and PSS (d = -0.75, P < 0.001). No adverse events were observed due to the intervention. CONCLUSION This 4-month Ayurvedic whole-systems multimodal nutrition and lifestyle intervention was feasible and acceptable for breast cancer survivors. Promise of clinical benefit was seen in terms of improvements in symptoms and QOL that warrants further investigation.
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Affiliation(s)
- Anand Dhruva
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Cairn Wu
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
| | - Christine Miaskowski
- School of Nursing, Department of Physiologic Nursing, University of California San Francisco, San Francisco, California
- Department of Anesthesiology, University of California San Francisco, San Francisco, California
| | - Wendy Hartogensis
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Shelley R Adler
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
- Department of Anesthesiology, University of California San Francisco, San Francisco, California
| | - Ted J Kaptchuk
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Rucha Kelkar
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
| | - Sangeeta Agarawal
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
| | - Amisha Vadodaria
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
| | - Ellen Garris
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California
- Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts
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Suen LKP, Yeh CH, Yeung SKW, Yeung JWF. Is the combined auriculotherapy approach superior to magneto-auriculotherapy alone in aging males with lower urinary tract symptoms? A randomized controlled trial. Aging Male 2020; 23:544-555. [PMID: 30651007 DOI: 10.1080/13685538.2018.1542673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The negative impact of lower urinary tract symptoms (LUTS) on affected males is substantial. This study aims to assess whether a combined auriculotherapy (AT) using laser AT (LAT) and magneto-AT (MAT) is more effective than using MAT alone or placebo for managing LUTS of aging males.Methods: A randomized controlled, double-blinded trial was conducted. Sixty-two aging males with moderate or severe LUTS symptoms were randomly allocated into groups: Group 1, placebo LAT plus placebo MAT (n = 20); Group 2, combined AT approach using LAT plus MAT (n = 20); and Group 3, placebo LAT followed by MAT (n = 22). Six ear acupoints assumed to be suitable for alleviating LUTS were used. The total treatment period was 4 weeks, with follow-up visits till 3 months. Generalized estimating equations model was used for the examination of the interactions among the groups over time.Results: A combined AT approach exhibited a stronger treatment effect in relieving voiding problems, improving the peak urinary flow rate, and reducing the post-void residual urine than the placebo group or MAT alone.Conclusions: This study demonstrates that the AT protocol used in this study for aging males with LUTS is feasible and can be adopted in future study of increased scale.
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Affiliation(s)
- Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong
| | - Chao Hsing Yeh
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Simon K W Yeung
- School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong
| | - Jerry W F Yeung
- School of Nursing, The Hong Kong Polytechnic University, HungHom, Hong Kong
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Mohamed Mohamed WJ, Joseph L, Canby G, Paungmali A, Sitilertpisan P, Pirunsan U. Are patient expectations associated with treatment outcomes in individuals with chronic low back pain? A systematic review of randomised controlled trials. Int J Clin Pract 2020; 74:e13680. [PMID: 33166045 DOI: 10.1111/ijcp.13680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022] Open
Abstract
AIM The importance of patient expectations (PEs) on treatment outcomes is poorly understood in clinical practice. The aim of this review is to investigate the evidence behind association between pre-treatment PEs and treatment outcomes such as pain intensity (PI), level of function (LF) and health-related quality of life (HRQoL) among individuals with chronic low back pain (CLBP). METHODS A systematic search was conducted for randomised controlled trials published between 1946 and May 2019 across major databases using the key MeSH terminologies. The association between PEs and PI, LF and HRQoL were extracted and categorised into positive, negative or no association for analysing the data. A descriptive synthesis was conducted and the association between PEs and PI, LF and HRQoL were reported. RESULTS Among the total of seven trials, two trials demonstrated a positive association between PEs and PI in short (≤6 weeks) and long term (>6 months), while another two trials demonstrated no association at medium term (>6 weeks-≤6 months). About four trials demonstrated a positive significant association between PEs and LF, 2 at medium and 2 at long terms. The only available trial demonstrated no association between PEs and HRQoL at medium term. CONCLUSION PEs is associated with PI at short and long terms. Also, evidence suggests association between PEs and LF at medium and long terms. Currently, there is no evidence of association between PEs and HRQoL. Further studies with valid tools to measure PE are warranted among individuals with CLBP.
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Affiliation(s)
| | - Leonard Joseph
- School of Health Science, University of Brighton, East Sussex, UK
| | - Guy Canby
- School of Health Science, University of Brighton, East Sussex, UK
| | - Aatit Paungmali
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Patraporn Sitilertpisan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Ubon Pirunsan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
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Mutsaers JHAM, Pool-Goudzwaard AL, Peters R, Koes BW, Verhagen AP. Recovery expectations of neck pain patients do not predict treatments outcome in manual therapy. Sci Rep 2020; 10:18518. [PMID: 33116233 PMCID: PMC7595084 DOI: 10.1038/s41598-020-74962-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/21/2020] [Indexed: 11/20/2022] Open
Abstract
Patient recovery expectations can predict treatment outcome. Little is known about the association of patient recovery expectations on treatment outcome in patients with neck pain consulting a manual therapist. This study evaluates the predictive value of recovery expectations in neck pain patients consulting manual therapists in the Netherlands. The primary outcome measure 'recovery' is defined as 'reduction in pain and perceived improvement'. A prospective cohort study a total of 1195 neck pain patients. Patients completed the Patient Expectancies List (PEL) at baseline (3 item questionnaire, score range from 3 to 12), functional status (NDI), the Global Perceived Effect (GPE) for recovery (7-points Likert scale) post treatment and pain scores (NRS) at baseline and post treatment. The relationship between recovery expectancy and recovery (dichotomized GPE scores) was assessed by logistic regression analysis. Patients generally reported high recovery expectations on all three questions of the PEL (mean sumscores ranging from 11.3 to 11.6). When adjusted for covariates the PEL sum-score did not predict recovery (explained variance was 0.10 for the total PEL). Separately, the first question of the PEL showed predictive potential (OR 3.7; 95%CI 0.19-73.74) for recovery, but failed to reach statistical significance. In this study patient recovery expectations did not predict treatment outcome. Variables predicting recovery were recurrence and duration of pain. The precise relationship between patient recovery expectations and outcome is complex and still inconclusive. Research on patient expectancy would benefit from more consistent use of theoretical expectancy and outcome models.
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Affiliation(s)
- J-H A M Mutsaers
- Institute for Master Education in Manual Therapy, SOMT, Amersfoort, The Netherlands.
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Avans Hogeschool, University of Applied Sciences, P.O. Box 90116, 4800 RA, Breda, The Netherlands.
| | - A L Pool-Goudzwaard
- Institute for Master Education in Manual Therapy, SOMT, Amersfoort, The Netherlands
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat, 9, 1081 BT, Amsterdam, The Netherlands
| | - R Peters
- Institute for Master Education in Manual Therapy, SOMT, Amersfoort, The Netherlands
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - B W Koes
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - A P Verhagen
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Hinkeldey N, Okamoto C, Khan J. Spinal Manipulation and Select Manual Therapies: Current Perspectives. Phys Med Rehabil Clin N Am 2020; 31:593-608. [PMID: 32981581 DOI: 10.1016/j.pmr.2020.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Touch is fundamental to the doctor-patient relationship. Touch can produce neuromodulatory effects that mitigate pain and put patients at ease. Touch begins with a confident handshake and continues throughout the physical examination. Touching patients where they hurt is a clear indication that a provider understands their complaint. Touch often continues as a function of treatment. This article updates evidence surrounding human touch and addresses mechanisms of action for manual therapy, the impact of manual therapy on pain management, health care conditions for which manual therapy may be beneficial, treatment plans with dose-response evidence, and the impact of manual therapy on the health care system.
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Affiliation(s)
- Nathan Hinkeldey
- VA Central Iowa Health Care System, 3600 30th Street, Des Moines, IA 50310, USA; Palmer College of Chiropractic, 1000 Brady Street, Davenport, IA 52803, USA.
| | - Casey Okamoto
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417, USA; Department of Rehabilitation Medicine, 500 Boynton Health Service Bridge, Minneapolis, MN 55455, USA
| | - Jamal Khan
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417, USA; Department of Rehabilitation Medicine, 500 Boynton Health Service Bridge, Minneapolis, MN 55455, USA
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Foster NE, Vertosick EA, Lewith G, Linde K, MacPherson H, Sherman KJ, Witt CM, Vickers AJ. Identifying patients with chronic pain who respond to acupuncture: results from an individual patient data meta-analysis. Acupunct Med 2020; 39:83-90. [PMID: 32571096 DOI: 10.1177/0964528420920303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In a recent individual patient data meta-analysis, acupuncture was found to be superior to sham and non-sham controls in patients with chronic pain. It has been suggested that a subgroup of patients has an exceptional response to acupuncture. We hypothesized the presence of exceptional acupuncture responders would lead to a different distribution of pain scores in acupuncture versus control groups, with the former being skewed to the right. METHODS This individual patient data meta-analysis included 39 high-quality randomized trials of acupuncture for chronic headache, migraine, osteoarthritis, low back pain, neck pain and shoulder pain published before December 2015 (n = 20,827). In all, 25 involved sham acupuncture controls (n = 7097) and 25 non-acupuncture controls (n = 16,041). We analyzed the distribution of change scores and calculated the difference in the skewness statistic-which assesses asymmetry in the data distribution-between acupuncture and either sham or non-acupuncture control groups. We then entered the difference in skewness along with standard error into a meta-analysis. FINDINGS Control groups were more right-skewed than acupuncture groups, although this difference was very small. The difference in skew was 0.124 for non-acupuncture-controlled trials (p = 0.047) and 0.141 for sham-controlled trials (p = 0.029). In a pre-specified sensitivity analysis excluding three trials with outlying results known a priori, the difference in skew between acupuncture and sham was no longer statistically significant (p = 0.2). CONCLUSION We did not find evidence to support the notion that there are exceptional acupuncture responders. The challenge remains to identify features of chronic pain patients that can be used to distinguish those that have a good response to acupuncture treatment.
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Affiliation(s)
- Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | | | - George Lewith
- Faculty of Medicine, Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Klaus Linde
- Institute of General Practice, Technische Universität München, Munich, Germany
| | | | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland.,Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany
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Coste J, Tarquinio C, Rouquette A, Montel S, Pouchot J. Cross-cultural adaptation and validation of the French version of the credibility/expectancy questionnaire. Further insights into the measured concepts and their relationships. PSYCHOLOGIE FRANCAISE 2020. [DOI: 10.1016/j.psfr.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maxwell CM, Lauchlan DT, Dall PM. The effects of spinal manipulative therapy on lower limb neurodynamic test outcomes in adults: a systematic review. J Man Manip Ther 2020; 28:4-14. [PMID: 30935328 PMCID: PMC7006656 DOI: 10.1080/10669817.2019.1569300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Spinal Manipulative Therapy (SMT) is a routinely applied treatment modality for various musculoskeletal conditions, including low back pain. The precise mechanisms by which SMT elicits its effects are largely unknown, but recent research supports a multi-system explanation recognizing both biomechanical and neurophysiological mechanisms. Although the evaluation of changes in clinical presentation is complex, objective neurophysiological measures of sensitivity to movement (e.g. neurodynamic tests) can be a valuable clinical indicator in evaluating the effects of SMT. This review aimed to synthesize current literature investigating the effects of SMT on lower limb neurodynamics.Method: Eight electronic databases were systematically searched for randomized controlled trials (RCT) that applied SMT (against any control) and evaluated lower limb neurodynamics (Passive Straight Leg Raise or Slump Test). Selection and data extraction were conducted by one researcher, reviewed by a second author. Risk of bias (RoB) was assessed using the Cochrane Back Review Group criteria.Results: Eight RCTs were included, one with high RoB. SMT produced a clinically meaningful (≥6⁰) difference in five of these studies compared with inert control, hamstring stretching, and as an adjunct to conventional physiotherapy, but not compared with standard care, as an adjunct to home exercise and advice, or when comparing different SMT techniques. Findings compared to sham were mixed. When reported, effects tentatively lasted up to 6 weeks post-intervention.Conclusion: Limited evidence suggests SMT-improved range of motion and was more effective than some other interventions. Future research, using standardized Neurodynamic tests, should explore technique types and evaluate longer-term effects.Level of Evidence: 1a.
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Bishop MD, Bialosky JE, Alappattu MJ. Riding a Tiger: Maximizing Effects of Manual Therapies for Pelvic Pain. JOURNAL OF WOMEN'S HEALTH PHYSICAL THERAPY 2020; 44:32-38. [PMID: 34163308 PMCID: PMC8218714 DOI: 10.1097/jwh.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Manual therapy interventions are frequently used during the management of pelvic pain conditions. Pain relief after any intervention results from effects unrelated to the intervention, effects specific to the intervention, and effects of context in which the intervention is provided. Understanding these multiple mechanisms allows providers of manual therapy to maximize outcomes by deliberately harnessing each of these core elements of pain relief.
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Affiliation(s)
- Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
| | - Joel E. Bialosky
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
- Brooks-PHHP Research Collaboration, Jacksonville, Florida
| | - Meryl J. Alappattu
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
- Brooks-PHHP Research Collaboration, Jacksonville, Florida
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41
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Zheng Z, Bai L, O'Loughlan M, Li CG, Xue CC. Does Electroacupuncture Have Different Effects on Peripheral and Central Sensitization in Humans: A Randomized Controlled Study. Front Integr Neurosci 2019; 13:61. [PMID: 31680888 PMCID: PMC6804574 DOI: 10.3389/fnint.2019.00061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background Acupuncture is used to reduce chronic musculoskeletal pain. The common mechanism underlying these types of pain are peripheral and/or central sensitization. In the clinical setting, it is difficult to separate the peripheral from the central component of pain. Heat/capsaicin 45°C/0.075%-induced hyperalgesia provides a stable, human central sensitization model in which the peripheral component is also assessed. Aim This randomized, sham-controlled study aimed to investigate the effect of electroacupuncture (EA) on the severity of heat (peripheral sensitization) and mechanical hyperalgesia (central sensitization) in a heat/capsaicin pain model in humans. Methods Twenty-six healthy young participants (24 ± 3.9 years) were recruited. After baseline assessment, heat/capsaicin 45°C/0.075% was applied to the non-dominant forearm to induce hyperalgesia. The primary outcome measures were the size of the area of mechanical hyperalgesia, intensity of pain to heat stimulation and heat pain thresholds. The intensity of pain was recorded using modified 10-cm visual analogues scales (VAS). Participants were assessed at 70 min after the initial application of capsaicin then randomly allocated to receive either real electroacupuncture (REA, n = 14) or sham non-invasive EA (SEA, n = 12) for 30 min. The main outcome measures were assessed again immediately and then 90 min following EA. Credibility of blinding was assessed. Data were analyzed with t-tests or analysis of variance (ANOVA) where appropriate. Results After the model was established, the area of mechanical hyperalgesia was formed (55.64 cm2), as was heat hyperalgesia, as the rating to heat stimulation, increased from 2/10 to 6/10. The REA and SEA groups were comparable. Immediately after the allocated acupuncture treatment, the rating to heat stimulation was statistically significantly lower in the REA group (2.94 ± 1.64) than in the SEA group (4.62 ± 2.26) (p < 0.05). The area of mechanical hyperalgesia reduced significantly without any group difference. No group difference was detected in heat pain threshold. Blinding of the participants was successful. Conclusion Peripheral and central sensitization in the heat/capsaicin 45°C/0.075% model responded to EA differently, suggesting that acupuncture analgesia could vary, depending on the types of pain. This observation may explain some inconsistent findings from clinical trials of acupuncture.
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Affiliation(s)
- Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | | | | | - Chun Guang Li
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Charlie C Xue
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Furman AJ, Thapa T, Summers SJ, Cavaleri R, Fogarty JS, Steiner GZ, Schabrun SM, Seminowicz DA. Cerebral peak alpha frequency reflects average pain severity in a human model of sustained, musculoskeletal pain. J Neurophysiol 2019; 122:1784-1793. [PMID: 31389754 PMCID: PMC6843105 DOI: 10.1152/jn.00279.2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022] Open
Abstract
Heightened pain sensitivity, the amount of pain experienced in response to a noxious event, is a known risk factor for development of chronic pain. We have previously reported that pain-free, sensorimotor peak alpha frequency (PAF) is a reliable biomarker of pain sensitivity for thermal, prolonged pains lasting tens of minutes. To test whether PAF can provide information about pain sensitivity occurring over clinically relevant timescales (i.e., weeks), EEG was recorded before and while participants experienced a long-lasting pain model, repeated intramuscular injection of nerve growth factor (NGF), that produces progressively developing muscle pain for up to 21 days. We demonstrate that pain-free, sensorimotor PAF is negatively correlated with NGF pain sensitivity; increasingly slower PAF is associated with increasingly greater pain sensitivity. Furthermore, PAF remained stable following NGF injection, indicating that the presence of NGF pain for multiple weeks is not sufficient to induce the PAF slowing reported in chronic pain. In total, our results demonstrate that slower pain-free, sensorimotor PAF is associated with heightened sensitivity to a long-lasting musculoskeletal pain and also suggest that the apparent slowing of PAF in chronic pain may reflect predisease pain sensitivity.NEW & NOTEWORTHY Pain sensitivity, the intensity of pain experienced after injury, has been identified as an important risk factor in the development of chronic pain. Biomarkers of pain sensitivity have the potential to ease chronic pain burdens by preventing disease emergence. In the current study, we demonstrate that the speed of pain-free, sensorimotor peak alpha frequency recorded during resting-state EEG predicts pain sensitivity to a clinically-relevant, human model of prolonged pain that persists for weeks.
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Affiliation(s)
- Andrew J Furman
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tribikram Thapa
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Simon J Summers
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Rocco Cavaleri
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Jack S Fogarty
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Siobhan M Schabrun
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
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Comparison of Magnetic Auriculotherapy, Laser Auriculotherapy and Their Combination for Treatment of Insomnia in the Elderly: A Double-Blinded Randomised Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3651268. [PMID: 31239857 PMCID: PMC6556291 DOI: 10.1155/2019/3651268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022]
Abstract
Background Insomnia is common amongst the elderly. With the adverse effects of prolonged use of hypnotics, the exploration of noninvasive and nonpharmacological complementary methods for insomnia is warranted. Auriculotherapy (AT) is a therapeutic approach where specific points on the auricle are stimulated to manage various physiological disorders. The purpose of this study is to determine the desirable treatment modality using AT to improve the sleep conditions of the elderly. Methods A three-arm double-blinded randomised trial was conducted on 145 eligible subjects. This study investigated three minimally invasive procedures, namely, laser auriculotherapy (LAT), magneto-auriculotherapy (MAT), and their combination. Seven auricular points were used. Treatment was performed three times a week, for six weeks. Subjects were assessed at baseline, six weeks, and follow-up after six weeks, three months, and six months. Generalised estimating equations were used to evaluate interactions amongst the groups over time based on the Pittsburgh Sleep Quality Index (PSQI), sleep parameters using actigraphic monitoring, health-related quality of life (HRQOL) using SF-12, and PHQ-9 for depression status. Results The treatment effects of the three procedures were comparable. Significant improvements were found in all of the subjective measures (PSQI, HRQOL, and PHQ-9) for individual groups over time. Improvements in the objective sleep parameters using actigraphic monitoring were detected in subjects who received MAT procedures but not in those who received LAT. The combined MAT and LAT approach did not show any advantage over MAT. Conclusions The treatment effects of the three procedures were comparable in subjective parameters but not by objective measures using actigraphic monitoring. Longer therapeutic course and more frequent administration of LAT may be considered in future trials to achieve the optimal treatment effect. Trial Registration This trial is registered with ClinicalTrials.gov: NCT02970695, registered May 2016.
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Chen H, Yang M, Ning Z, Lam WL, Zhao YK, Yeung WF, Ng BFL, Ziea ETC, Lao L. A Guideline for Randomized Controlled Trials of Acupuncture. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 47:1-18. [PMID: 30612455 DOI: 10.1142/s0192415x19500010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Guidelines for clinical trials of acupuncture are scarce, particularly in their guidance on choosing an adequate control in an acupuncture trial. This guideline was developed to address the research methodology for clinical research in acupuncture which contains the essential elements to be considered in the design, preparation and reporting of an acupuncture RCT. Particularly, investigators focused on the control design because of the unique feature of acupuncture. As one size does not fit all, one single design cannot answer all research questions. Therefore, we recommend that the clinical questions be answered in different stages of trials by choosing the appropriate control or comparator. This concept is adapted from classical drug trials developed by the Food and Drug Administration (FDA) of USA in which trials are staged in four phages in order to address different research questions. From the points listed above, this guideline offers the specific recommendations in an acupuncture RCT.
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Affiliation(s)
- Haiyong Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Mingxiao Yang
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhipeng Ning
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Lok Lam
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Ying Ke Zhao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Eric Tat-Chi Ziea
- The Chinese Medicine Department, Hospital Authority, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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45
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Factors that influence patients’ decisions to discontinue with an acupuncture service—A qualitative study. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Friesen P. Placebos as a Source of Agency: Evidence and Implications. Front Psychiatry 2019; 10:721. [PMID: 31708807 PMCID: PMC6824097 DOI: 10.3389/fpsyt.2019.00721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
Bioethical discussions surrounding the use of placebos in clinical practice have long revolved around the moral permissibility of deceiving a patient if it is likely to benefit them. While these discussions have been insightful and productive, they reinforce the notion that placebo effects can only be induced through deception. This paper challenges this notion, looking beyond the paradigmatic clinical encounter involving deceptive placebos and towards many other routes that bring about placebo effects. After briefly describing the bioethical terrain surrounding the deceptive use of placebos in clinical practice, section 1 offers an examination of the various mechanisms known to contribute to placebo effects: classical conditioning, expectations, affective pathways, open-label placebo treatments, and additional factors that do not fall easily into a single category. The following section explores how each of these routes can be harnessed to bring about clinical benefits without the use of deception. This provides grounding for reconceiving of the placebo effect as a clinical tool that is not always in conflict with patient autonomy and can even be seen as a source of agency. In the final section, implications of the shift away from seeing placebos as necessarily deceptive are discussed. These include the necessity of looking beyond the clinical encounter and mainstream medicine as the primary sites of placebo responses, how important acknowledging the limits of placebo effects will be when we do so, as well as the difficulties of disentangling agency, responsibility, and blame within medicine.
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Affiliation(s)
- Phoebe Friesen
- Biomedical Ethics Unit, Social Studies of Medicine, McGill University, Canada
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47
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Gerger H, Buergler S, Sezer D, Grethler M, Gaab J, Locher C. The Healing Encounters and Attitudes Lists (HEAL): Psychometric Properties of a German Version (HEAL-D) in Comparison With the Original HEAL. Front Psychiatry 2019; 10:897. [PMID: 31998148 PMCID: PMC6965318 DOI: 10.3389/fpsyt.2019.00897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 11/13/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Over the last years, the interest in understanding health improvements that occur due to non-specific treatment effects, rather than in response to the specific active treatment ingredients, increased. Nevertheless, investigations on patients' idiosyncratic perspectives on the non-specific aspects of the healing encounter or of the treatment itself that contribute to placebo effects are still rare. The Healing Encounters and Attitudes Lists (HEAL) offer a unique and parsimonious set of instruments to measure patients' views on a variety of non-specific aspects of the caring encounter. The HEAL items can be administered as computerized adaptive tests or short forms that assess the patient-provider connection, the healthcare environment, treatment expectancy, positive outlook, spirituality, as well as attitudes towards complementary and alternative medicine. So far, no German version of the HEAL exists. Methods: The original 168 HEAL items were translated into German (HEAL-D) applying a translation-back-translation procedure. We examined the psychometric properties of HEAL-D in a sample of 165 participants who reported at least one healthcare visit during the last year. Results: The German short forms of HEAL (HEAL-D-SF) showed good internal consistency and test-retest reliability. The factor structure observed in the English original items showed low to moderate model fit in our sample. Discussion: The development of a German version of HEAL in addition to the original English items offers new possibilities for investigating patients' idiosyncratic perspectives on the non-specific aspects of treatments across language borders. We will close with presenting possible clinical application as well as promising and relevant future research directions using HEAL-D-SF, including for instance large-scale, cross-national investigations.
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Affiliation(s)
- Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Dilan Sezer
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Marc Grethler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,School of Psychology, University of Plymouth, Plymouth, United Kingdom
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Malfliet A, Lluch Girbés E, Pecos-Martin D, Gallego-Izquierdo T, Valera-Calero A. The Influence of Treatment Expectations on Clinical Outcomes and Cortisol Levels in Patients With Chronic Neck Pain: An Experimental Study. Pain Pract 2019; 19:370-381. [PMID: 30457698 DOI: 10.1111/papr.12749] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The role of contextual factors like pre-existing treatment expectations has been established. However, the effect of verbally delivered treatment expectations in patient-therapist communication has not been considered, nor has the role of cortisol changes within the placebo/nocebo response in people with chronic neck pain. OBJECTIVE To examine the effect of verbally delivered treatment expectations on clinical outcomes in physical therapy practice and to determine if changes in cortisol levels are associated with changes in neck pain and disability. METHODS Eighty-three patients with chronic neck pain were randomly allocated to 3 different verbally delivered expectations (positive, negative, neutral) during physical therapy interventions. MAIN OUTCOME MEASURES salivary cortisol, pain and disability, and cervical range of motion. RESULTS Pain significantly improved in the positive (P < 0.001) and neutral (P < 0.001) expectations groups. For salivary cortisol levels, a significant increase was observed in response to treatment in the neutral (P = 0.045) and negative (P < 0.001) expectations groups. No significant correlations were found between changes in salivary cortisol levels and the change in pain in the neutral and negative expectations groups. CONCLUSIONS Physical therapists treating people with chronic neck pain should be attentive when communicating the expected treatment effects to their patients. Whereas verbally delivered positive or neutral expectations may be beneficial for pain-related measures, giving negative expectations may result in a lack of a treatment response on pain. Cortisol levels increased in response to verbally delivered neutral and negative expectations, in the absence of a nocebo effect. This questions the presumed role of cortisol in the nocebo effect.
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Affiliation(s)
- Anneleen Malfliet
- Research Foundation - Flanders (FWO), Brussels, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Enrique Lluch Girbés
- Pain in Motion International Research Group, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Daniel Pecos-Martin
- Physiotherapy and Pain Group, Nursing and Physiotherapy Department, Alcala University, Madrid, Spain
| | - Thomas Gallego-Izquierdo
- Physiotherapy and Pain Group, Nursing and Physiotherapy Department, Alcala University, Madrid, Spain
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Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:168-182. [PMID: 29408484 PMCID: PMC6067990 DOI: 10.1016/j.pnpbp.2018.01.017] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.
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Affiliation(s)
- S M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA.
| | - R R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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50
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Vining R, Minkalis A, Long CR, Corber L, Franklin C, Gudavalli MR, Xia T, Goertz CM. Assessment of chiropractic care on strength, balance, and endurance in active-duty U.S. military personnel with low back pain: a protocol for a randomized controlled trial. Trials 2018; 19:671. [PMID: 30518400 PMCID: PMC6280458 DOI: 10.1186/s13063-018-3041-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a common cause of disability among U.S. military personnel. Approximately 20% of all diagnoses resulting in disability discharges are linked to back-related conditions. Because LBP can negatively influence trunk muscle strength, balance, and endurance, the military readiness of active-duty military personnel with LBP is potentially compromised. Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with LBP. This trial will assess the effects of chiropractic care on strength, balance, and endurance for active-duty military personnel with LBP. METHODS/DESIGN This randomized controlled trial will allocate 110 active-duty military service members aged 18-40 with non-surgical acute, subacute, or chronic LBP with pain severity of ≥2/10 within the past 24 h. All study procedures are conducted at a single military treatment facility within the continental United States. Participants are recruited through recruitment materials approved by the institutional review board, such as posters and flyers, as well as through provider referrals. Group assignment occurs through computer-generated random allocation to either the study intervention (chiropractic care) or the control group (waiting list) for a 4-week period. Chiropractic care consists primarily of spinal manipulation at a frequency and duration determined by a chiropractic practitioner. Strength, balance, and endurance outcomes are obtained at baseline and after 4 weeks. The primary outcome is a change between baseline and 4 weeks of peak isometric strength, which is measured by pulling on a bimanual handle in a semi-squat position. Secondary outcomes include balance time during a single-leg standing test and trunk muscle endurance with the Biering-Sorensen test. Patient-reported outcomes include pain severity, disability measured with the Roland Morris Disability Questionnaire, symptom bothersomeness, PROMIS-29, Fear Avoidance Beliefs Questionnaire, expectations of care, physical activity, and global improvement. DISCUSSION This trial may help inform further research on biological mechanisms related to manual therapies employed by chiropractic practitioners. TRIAL REGISTRATION ClinicalTrials.gov, NCT02670148 Registered on 1 February 2016.
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Affiliation(s)
- Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Amy Minkalis
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Cynthia R. Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Lance Corber
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Crystal Franklin
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - M. Ram Gudavalli
- College of Chiropractic Medicine, Keiser University, 2081 Vista Parkway, West Palm Beach, FL 33411 USA
| | - Ting Xia
- Mechanical Engineering, Northern Illinois University, 590 Garden Rd, DeKalb, IL 60115 USA
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