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Cross LM, Warren-Findlow J, Bowling J, Reeve CL, Issel LM. A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression. CHILD ABUSE & NEGLECT 2023; 140:106158. [PMID: 36996592 DOI: 10.1016/j.chiabu.2023.106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Recent ACE research proposed items to assess ACE dimensions, such as the frequency or timing of adverse events, that can be added to the original ACE-Study Questionnaire. OBJECTIVE The goal of our study was to pilot-test the refined ACE-Dimensions Questionnaire (ACE-DQ) to determine its predictive validity and compare scoring approaches. PARTICIPANTS AND SETTING Cross-sectional online survey via MTurk with U.S. adults to collect data on the ACE-Study Questionnaire and the newly developed ACE dimension items, and mental health outcomes. METHODS We compared ACE exposure by assessment approach and their associations with depression outcomes. We used logistic regression to compare the predictive validity of different ACE scoring approaches for depression outcomes. RESULTS Participants (n = 450) were on average 36 years old, half were female, and the majority was White. Almost half reported depressive symptoms; approximately two-thirds had experienced ACEs. Participants reporting depression had significantly higher ACE scores. Using the ACE index, participants with ACEs were 45 % more likely to report depression symptoms than participants without ACEs (OR 1.45, 95%CI 1.33-1.58). When using perception-weighted scores, participants had smaller, yet significant odds of reporting depression outcomes. CONCLUSIONS Our results suggest that the ACE index may overestimate the impact of ACEs and the effects of ACEs on depression. Adding the comprehensive set of conceptual dimensions to more fully weigh participants' experience of adverse events can increase the accuracy of ACE measurement but will also increase participant burden considerably. We recommend including items to assess a person's perception of each adverse event for improved screening efforts and in research focused on cumulative adversity.
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Affiliation(s)
- Lisa M Cross
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, 333 S Columbia St, Chapel Hill, NC 27516, United States of America.
| | - Jan Warren-Findlow
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Charlie L Reeve
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - L Michele Issel
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
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2
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Hobby J, Ring D, Larson D. The mind and the hand. J Hand Surg Eur Vol 2023; 48:269-275. [PMID: 36638068 DOI: 10.1177/17531934221143502] [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] [Indexed: 01/14/2023]
Abstract
Symptoms are determined in large part by mindsets. Feelings of distress and unhelpful thoughts (misinterpretations) of symptoms account for much of the variability in comfort and capability with the severity of the underlying pathophysiology making a more limited contribution. Incorporating this experimental evidence into the daily practice of hand surgery will help us find ways to develop healthy mindsets, to prioritize the alleviation of distress and the gentle redirection of unhelpful thoughts, to avoid unnecessary surgery, and to provide better psychological and social support for people recovering from injury and surgery.
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Affiliation(s)
- Jonathan Hobby
- Department of Trauma and Orthopaedics, North Hampshire Hospital, Basingstoke, UK
| | - David Ring
- University of Texas at Austin Dell Medical School, Austin, TX, USA
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3
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Zhang K, Sun J, Zhang Q, Zhang J, He L, Wang Z, Hu L. The association between childhood trauma and pain symptoms in depressed adults: The moderating role of anxious attachment. Clin Psychol Psychother 2023. [PMID: 36630316 DOI: 10.1002/cpp.2824] [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: 12/09/2021] [Revised: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Studies have previously demonstrated that anxious attachment shapes the association between childhood traumatic experiences and somatic pain; however, it remains unclear how this relationship is influenced by anxious attachment in patients with depression. This study investigated how anxious attachment influences the relationship between childhood traumatic experiences and pain symptoms in depressed patients from a social psychological perspective. A total of 139 adult patients with depression participated in this study; the level of depression was assessed by a psychiatric professional. Childhood trauma, pain symptoms, and attachment dimensions were tested by various questionnaires. The moderating role of anxious attachment in the trauma-pain association was examined using the PROCESS Model 1. Our findings showed that in depressed patients, childhood maltreatment had a significant positive impact on the severity of pain ratings. Moreover, anxious attachment influenced the relationship between childhood trauma and pain symptoms. Our study indicated that anxious attachment is not necessarily a negative outcome for depressed patients; moderate levels of anxious attachment alleviate childhood trauma-related pain symptoms in individuals with highly traumatic experiences. Understanding the traumatic experiences and attachment styles of depressed patients with pain complaints can help to develop intervention strategies.
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Affiliation(s)
- Kai Zhang
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Psychology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Junyuan Sun
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China
| | - Qunlei Zhang
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, China
| | - Jianwei Zhang
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, China
| | - Long He
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ziyang Wang
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Hu
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, China
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4
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Broekman MM, Brinkman N, Ramtin S, Ngoue M, Ring D, Jayakumar P. Magnitude of Incapability and Pain Intensity are Associated More with Unhelpful Thoughts Than Stressful Life Events. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231179644. [PMID: 37313448 PMCID: PMC10259122 DOI: 10.1177/24705470231179644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 06/15/2023]
Abstract
Prior studies show that stressful life events are associated with greater magnitude of incapability and symptom intensity. We sought to understand the association of such events (i.e., both adverse childhood experiences and recent difficult life events [DLEs]) alongside feelings of worry or despair and unhelpful, on the magnitude of incapability and symptom intensity in musculoskeletal patients. One hundred and thirty-six patients presenting for musculoskeletal specialty care completed measures of incapability, pain intensity, adverse childhood experiences, DLEs in the last year, unhelpful thoughts, symptoms of anxiety and depression, and sociodemographic factors. Factors associated with the magnitude of incapability and pain intensity were sought in multivariable analysis. Accounting for potential confounders, greater incapability was associated with greater unhelpful thoughts (RC = -0.81; 95% CI = -1.2 to -0.42; P ≤ .001), but not with stressful life events (either during childhood or more recently). Greater pain intensity was associated with greater unhelpful thoughts(RC = 0.25; 95% CI = 0.16 to 0.35; P ≤ .001) and being divorced or widowed (RC = 1.8; 96% CI = 0.43 to 3.2; P = .011), but again, not with stressful life events. The strong association of unhelpful thoughts with magnitude of incapability and pain intensity can motivate musculoskeletal specialists to anticipate patients expressing negative pain thoughts and behaviors. Future studies might account for social and environmental context behind stressful life events and the influence of resiliency and pain-coping strategies on these interactions. Level of Evidence Level III, prognostic study.
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Affiliation(s)
- Melle M Broekman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Marielle Ngoue
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Al Salman A, Khatiri MZ, Cremers T, Ring D, Thomas JE, Fatehi A. Difficult life events affect lower extremity illness. Arch Orthop Trauma Surg 2022; 142:599-605. [PMID: 33216183 DOI: 10.1007/s00402-020-03686-y] [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: 09/15/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Given the relationship between psychological distress and activity tolerance (capability), a stressful life event might diminish accommodation, increase symptoms, and induce a person to seek specialty care. As a first step to investigate this possibility, this study addressed whether difficult life events are associated with greater activity intolerance and pain intensity. METHODS A cohort of 127 patients seeking specialty care for lower extremity symptoms completed questionnaires that inquired about difficult life events within the last 12 months as derived from the Holmes Rahe Life Stress Inventory, and recorded pain intensity on an 11-point ordinal scale, activity tolerance [Patient Reported Outcomes Measurement Information System Physical Function Computer Adaptive Test (CAT)], symptoms of anxiety (GAD-2; 2 item version of the Generalized Anxiety Disorder questionnaire), symptoms of depression (PROMIS Depression CAT), self-efficacy when in pain (Pain Self-Efficacy Questionnaire, 2 question version), and demographics. The treating clinician indicated if the disease was established (e.g. arthritis) or relatively new (e.g. sprain/strain). Bivariate and multivariable analyses sought factors associated with activity intolerance and pain intensity. RESULTS Greater activity intolerance was associated with difficult life events in bivariate analyses (t = 2.13, MD = 3.18, 95% C.I. = 0.22-6.13, p = 0.04) and in multivariable analyses that excluded symptoms of depression. Greater pain intensity was not associated with difficult life events, but was associated with surgeon rating of established disease (β = 1.20, 95% C.I. = 0.33-2.08, p < 0.01), greater symptoms of anxiety (MD = 3.35, s = 1.72; ρ = 0.30, p < 0.01), and less education (β = - 1.06, 95% C.I. = - 1.94- - 0.18, p = 0.02) (no college degree). CONCLUSION When a musculoskeletal specialist identifies less activity tolerance (less capability) than anticipated for a given injury or pathology, they can anticipate a potential difficult life event, and expect alleviation of symptoms and improved capability as the stress is ameliorated with time and support. Specialists can be prepared to direct people to community or professional support if requested.
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Affiliation(s)
- Aresh Al Salman
- Department of Surgery and Perioperative Care, Dell Medical School, 1601 Trinity St Bldg B, Austin, TX, 78712, US
| | - Michael Z Khatiri
- Department of Surgery and Perioperative Care, Dell Medical School, 1601 Trinity St Bldg B, Austin, TX, 78712, US
| | - Teun Cremers
- Department of Surgery and Perioperative Care, Dell Medical School, 1601 Trinity St Bldg B, Austin, TX, 78712, US
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, 1601 Trinity St Bldg B, Austin, TX, 78712, US.
| | - Jacob E Thomas
- Dept. of Kinesiology and Health Education, Health Behavior and Health Education Program, The University of Texas at Austin, Austin, US
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, 1601 Trinity St Bldg B, Austin, TX, 78712, US
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Vera Cruz G, Bucourt E, Réveillère C, Martaillé V, Joncker-Vannier I, Goupille P, Mulleman D, Courtois R. Machine learning reveals the most important psychological and social variables predicting the differential diagnosis of rheumatic and musculoskeletal diseases. Rheumatol Int 2021; 42:1053-1062. [PMID: 34125252 DOI: 10.1007/s00296-021-04916-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/05/2021] [Indexed: 11/28/2022]
Abstract
There is an ongoing debate about the importance and the extent to which psychological and psychopathological factors, adverse childhood experiences, and socio-demographic characteristics are associated with the development of certain types of rheumatic disease. With the aim of contributing to knowledge on the subject, the present study uses machine learning modeling to determine the importance of 20 psychological and social variables in predicting two classes of rheumatic disease: inflammatory rheumatic and musculoskeletal diseases (RMD) (rheumatoid arthritis = RA, spondyloarthritis = SA, and Sjögren's syndrome = SS) versus non-inflammatory RMD, namely fibromyalgia = FM). A total of 165 French women with FM, RA, SA, and SS completed an inventory of personality traits, a psychopathology diagnosis questionnaire, and a fatigue/pain questionnaire. They also answered questions about adverse childhood experiences and socio-demographic characteristics. Random forest and logistic regression machine learning algorithms were used for data analysis. The main findings suggest that mistreatment during childhood ((MDA = 10.22), the agreeableness personality trait (MDA = 3.39), and somatic disorder (MDA = 3.25) are the main psychological and social predictors of the type of rheumatic disease diagnosed. The first two predictors (OR = 18.92 and OR = 6.11) are also more strongly associated with FM than with RA-SA-SS. Overall, adverse childhood experiences seem relatively more important than personality traits, psychopathological or demographic variables. The results of this study suggest that traumatic childhood experiences may lead to psychopathological disorders in adulthood, which in turn might underlie, at least in part, the development of FM. Since there are no imaging or biological markers of FM, the present findings contribute to the scientific literature offering information to help patients with FM understand their pathology. They may also provide physicians with more diagnostic information.
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Affiliation(s)
- Germano Vera Cruz
- QualiPsy, EE 1901, University of Tours, 37000, Tours, France. .,Centre Val de Loire Resource Center for Professionals Working With Sex Offenders, Tours University Hospital, 37000, Tours, France. .,MSHS-Poitiers, 5 rue Théodore Lefebvre, 86073, Poitiers, France.
| | - Emilie Bucourt
- QualiPsy, EE 1901, University of Tours, 37000, Tours, France
| | | | - Virginie Martaillé
- Regional Hospital of Orléans, Rheumatology department, 45000, Orléans, France
| | | | - Philippe Goupille
- University of Tours, Rheumatology department, 37000, Tours, France.,CIC 1415, University Hospital of Tours, 37000, Tours, France
| | - Denis Mulleman
- University of Tours, Rheumatology department, 37000, Tours, France.,CIC 1415, University Hospital of Tours, 37000, Tours, France
| | - Robert Courtois
- QualiPsy, EE 1901, University of Tours, 37000, Tours, France.,Centre Val de Loire Resource Center for Professionals Working With Sex Offenders, Tours University Hospital, 37000, Tours, France
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López-Bueno R, López-Sánchez GF, Casajús JA, Calatayud J, Tully MA, Smith L. Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review. Prev Med 2021; 143:106349. [PMID: 33271236 PMCID: PMC7701882 DOI: 10.1016/j.ypmed.2020.106349] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/25/2020] [Accepted: 11/24/2020] [Indexed: 01/22/2023]
Abstract
As a consequence of the COVID-19 pandemic, different measures have been implemented by governments from each affected country. Such measures usually involve restrictions on the movement of citizens, and have had a profound effect on usual activities and timetables. As a result of school closures and strict restrictions regarding going outside home, children have been one of the most disadvantaged population groups during the lockdown period. We therefore aimed to investigate potential health risk behaviors amongst isolated pre-school and school-aged children. We retrieved relevant articles from MEDLINE, Web of Science, PsycInfo, and Scopus databases to describe identified health-related behaviors (i.e. screen exposure, environmental influence, physical activity and fitness, sedentariness, sleep patterns, eating habits, psychological response, body composition, and injuries) in relation to social isolation and social deprivation of children without previous illness or conditions. This review depicts the potential health-related behaviors according to related literature, and put the focus on future short and long-term sequels of social isolation. Socio-affective complications and insufficient physical activity are underscored as two of the main concerns, particularly among socio-economic deprived children. Both issues could be effectively addressed with either adequate parental or community guidance.
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Affiliation(s)
- Rubén López-Bueno
- Depatment of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain.
| | | | - José A Casajús
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Belfast, United Kingdom
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, United Kingdom
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8
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Bussières A, Hartvigsen J, Ferreira ML, Ferreira PH, Hancock MJ, Stone LS, Wideman TH, Boruff J, Elklit A. Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis. Syst Rev 2020; 9:215. [PMID: 32943108 PMCID: PMC7495859 DOI: 10.1186/s13643-020-01474-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/02/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direction of associations. The purpose of this review is to appraise and summarize evidence on the relationship between ACEs and persistent pain and disability outcomes in adulthood. The specific aims are (1) to determine whether there is a relationship between exposure to ACE and persistent pain and disability in adults and (2) to determine whether unique and cumulative ACEs exposures (number and type) increase the risk of developing persistent pain and disability in adulthood. METHOD A systematic review and meta-analysis of observational studies will be conducted. Our eligibility criteria are defined following a PECOS approach: population, adults with persistent (≥ 3 months) musculoskeletal and somatoform painful disorders exposed to single or cumulative direct ACEs alone (i.e., physical, sexual, emotional abuse or neglect) or in combination to indirect types of ACE (e.g., parental death, exposure to domestic violence) in the first 18 years of life; comparators, unexposed individuals; outcomes, measurements for persistent pain (≥ 3 months) and disability using discrete and/or continuous measures; and settings, general population, primary care. A comprehensive search of MEDLINE (Ovid) and nine other pertinent databases was conducted from inception to 29 August 2019 using a combination of key words and MeSh terms (the search will be updated prior to conducting the analyses). Pairs of reviewers will independently screen records and full text articles, and a third reviewer will be consulted in cases of disagreement. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Review Manager (RevMan) Version 5.3. The Scottish Intercollegiate Guidelines Network (SIGN) and the Joanna Briggs Institute (JBI) checklists will be used to assess the quality of the included studies. If heterogeneity is high, the findings will be presented in narrative form. DISCUSSION The present review will help consolidate knowledge on persistent pain and disability by evaluating whether frequency and type of adverse childhood experiences produces the most harm. Findings may help inform practitioners and policy-makers who endeavor to prevent and/or mitigate the consequences of ACEs and promote healthy development and well-being of children, youth, and families. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020150230.
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Affiliation(s)
- André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada. .,Département Chiropratique, Université du Québec à Trois-Rivières, 3351, boul. Des Forges, C. P. 500, Trois-Rivières, Québec, G9A 5H7, Canada.
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230, Odense M, Denmark
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Level 10, Kolling Building, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - Paulo H Ferreira
- Musculoskeletal Health, Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Room 155, O Block, Cumberland Campus C42, Sydney, NSW, 1825, Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
| | - Laura S Stone
- Faculty of Dentistry, McGill University, 2001 Av McGill College #500, Montreal, Quebec, H3A1G1, Canada.,Alan Edwards Centre for Research on Pain, McGill University, 845 Sherbrooke Ouest, Montreal, Quebec, H3A 0G4, Canada.,Faculty of Medicine, Department of Anesthesiology, 420 Delaware Street SE MMC 294, Minneapolis, MN, 55455, USA
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Macdonald-Stewart Library Building, 809 Sherbrooke Street West, Montreal, Quebec, H3A 0C1, Canada
| | - Ask Elklit
- National Centre for Psychotraumatology, Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
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