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Núñez-Cortés R, Salazar-Méndez J, Calatayud J, Lluch E, López-Bueno R, Horment-Lara G, Cruz-Montecinos C, Suso-Martí L. How do the target concepts of pain science education combined with exercise contribute to the effect on pain intensity and disability in patients with chronic spinal pain? A systematic review and meta-analysis with moderator analysis. Neurosci Biobehav Rev 2024; 163:105740. [PMID: 38852291 DOI: 10.1016/j.neubiorev.2024.105740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
The aim of this study was to assess the moderator effect of the target concepts covered in the Pain science education (PSE) sessions, including both the total amount of target concepts and each individual target concept, on changes in pain intensity and disability in patients with chronic spinal pain (CSP). A systematic search of PubMed, Scopus, Embase, Web of Science and CENTRAL was conducted from inception to March 10, 2024. A random effects model was used for meta-regression analysis. A total of 11 studies were included. The total amount of target concepts of PSE showed a significant correlation with changes in pain intensity (k=11; F=4.45; p=0.04; R2=26.07 %). In terms of each target content, only a significant effect on pain intensity was obtained for 'transfer knowledge about pain to an adaptive behavioural change' (z=-2.35, P =0.019, 95 %CI -3.42 to -0.31) and 'reconceptualization of pain' (z=-2.43, P =0.015, 95 %CI -3.70 to -0.39). No significant effect on disability was found. These results may be useful for optimising the effectiveness of PSE programmes.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380286, Chile; Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Joaquín Salazar-Méndez
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca 3460000, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; National Research Centre for the Working Environment, Copenhagen 2100, Denmark
| | - Enrique Lluch
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; National Research Centre for the Working Environment, Copenhagen 2100, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Spain
| | - Giselle Horment-Lara
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380286, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380286, Chile; Section of Research, Innovation and Development in kinesiology, Kinesiology Unit, San José Hospital, Santiago 8380286, Chile.
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain
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Núñez-Cortés R, Salazar-Méndez J, Calatayud J, Malfliet A, Lluch E, Mendez-Rebolledo G, Guzmán-Muñoz E, López-Bueno R, Suso-Martí L. The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: a systematic review and dose-response meta-analysis. Pain 2024; 165:1196-1206. [PMID: 38047772 DOI: 10.1097/j.pain.0000000000003126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023]
Abstract
ABSTRACT Pain neuroscience education (PNE) has shown promising results in the management of patients with chronic spinal pain (CSP). However, no previous review has determined the optimal dose of PNE added to an exercise programme to achieve clinically relevant improvements. The aim was to determine the dose-response association between PNE added to an exercise programme and improvements in pain intensity and disability in patients with CSP. A systematic search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Library was conducted from inception to April 19, 2023. The exposure variable (dosage) was the total minutes of PNE. Outcome measures included pain intensity, disability, quality of life, pressure pain thresholds, and central sensitization inventory. Data extraction, risk-of-bias assessment, and certainty of evidence were performed by 2 independent reviewers. The dose-response relationship was assessed using a restricted cubic spline model. Twenty-six randomised controlled trials with 1852 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain intensity and disability. In addition, a dose of 200 and 150 minutes of PNE added to an exercise programme was estimated to exceed the minimum clinically important difference described in the literature for pain intensity (-2.61 points, 95% CI = -3.12 to -2.10) and disability (-6.84 points, 95% CI = -7.98 to -5.70), respectively. The pooled effect of the isolated exercise was small. These findings may be useful in optimising the most appropriate PNE dose to achieve clinically relevant improvements in patients with CSP.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Research Foundation, Flanders (FWO), Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Enrique Lluch
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | - Guillermo Mendez-Rebolledo
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Corrêa LA, Mathieson S, Hancock M, Verhagen A, Nogueira LAC, Young A, Pate JW, French SD. Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review. J Clin Epidemiol 2024; 172:111398. [PMID: 38810841 DOI: 10.1016/j.jclinepi.2024.111398] [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: 01/04/2024] [Revised: 04/21/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions. STUDY DESIGN AND SETTING A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM. RESULTS The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use. CONCLUSION No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.
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Affiliation(s)
- Leticia Amaral Corrêa
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Stephanie Mathieson
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark Hancock
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | | | - Annie Young
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Joshua W Pate
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Lorimer Moseley G, Leake HB, Beetsma AJ, Watson JA, Butler DS, van der Mee A, Stinson JN, Harvie D, Palermo TM, Meeus M, Ryan CG. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. THE JOURNAL OF PAIN 2024; 25:104425. [PMID: 37984510 DOI: 10.1016/j.jpain.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
Since it emerged in the early 2000's, intensive education about 'how pain works', widely known as pain neuroscience education or explaining pain, has evolved into a new educational approach, with new content and new strategies. The substantial differences from the original have led the PETAL collaboration to call the current iteration 'Pain Science Education'. This review presents a brief historical context for Pain Science Education, the clinical trials, consumer perspective, and real-world clinical data that have pushed the field to update both content and method. We describe the key role of educational psychology in driving this change, the central role of constructivism, and the constructivist learning frameworks around which Pain Science Education is now planned and delivered. We integrate terminology and concepts from the learning frameworks currently being used across the PETAL collaboration in both research and practice-the Interactive, Constructive, Active, Passive framework, transformative learning theory, and dynamic model of conceptual change. We then discuss strategies that are being used to enhance learning within clinical encounters, which focus on the skill, will, and thrill of learning. Finally, we provide practical examples of these strategies so as to assist the reader to drive their own patient pain education offerings towards more effective learning. PERSPECTIVE: Rapid progress in several fields and research groups has led to the emergence 'Pain Science Education'. This PETAL review describes challenges that have spurred the field forward, the learning frameworks and educational strategies that are addressing those challenges, and some easy wins to implement and mistakes to avoid.
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Affiliation(s)
- G Lorimer Moseley
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia.
| | - Hayley B Leake
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Anneke J Beetsma
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - James A Watson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK; Integrated Musculoskeletal Service, Community Pain Management, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David S Butler
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Annika van der Mee
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Consumer Representative, Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Jennifer N Stinson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Child Health Evaluative Sciences, The Research Institute, The Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, The University of Toronto, Toronto, Ontario, Canada
| | - Daniel Harvie
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Tonya M Palermo
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Mira Meeus
- The Pain Education Team to Advance Learning (PETAL) Collaboration; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Cormac G Ryan
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Ehrström J, Pöyhiä R, Kettunen J, Pyörälä E. What do Finnish physiotherapists and physiotherapy students know about the neurophysiology of pain? The Finnish version of the revised Neurophysiology of Pain Questionnaire. Physiother Theory Pract 2024; 40:828-842. [PMID: 36475565 DOI: 10.1080/09593985.2022.2154626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Understanding the concept of pain and its underlying biological mechanisms is an essential part of physiotherapists' professional knowledge. OBJECTIVES The first aim of the study was to translate and cross-culturally adapt the revised Neurophysiology of Pain Questionnaire into Finnish (RNPQ-FI) and to evaluate its reliability (internal consistency and test-retest reliability) in a sample of Finnish physiotherapists and physiotherapy students. The second aim was to compare the knowledge of pain neurophysiology between these two groups. METHODS Translation and cross-cultural adaptation followed the COSMIN Study Design checklist. Participants (202 physiotherapists and 97 physiotherapy students) completed an online survey containing RNPQ-FI. Internal consistency was assessed with Cronbach's alpha and test-retest reliability using Intraclass correlation coefficient (ICC3,1). RESULTS Cronbach's alpha was 0.44 and ICC was 0.70 (p < .001). The mean percentage of correct responses was 61.4% for physiotherapists and 62.1% for students. Forty-seven percent of the physiotherapists and 35.1% of the students reported difficulties in understanding the items. A higher amount of pain education was associated with higher RNPQ-FI scores. CONCLUSIONS The RNPQ-FI showed low internal consistency and moderate test-retest reliability among Finnish physiotherapists and physiotherapy students. Physiotherapists and students had equal amount of pain neurophysiology knowledge. Pain education is encouraged.
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Affiliation(s)
- Jolanda Ehrström
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Reino Pöyhiä
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Kettunen
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland
| | - Eeva Pyörälä
- Centre for University Teaching and Learning, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
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Justribó-Manion C, Mesa-Jiménez J, Bara-Casaus J, Zuil-Escobar JC, Wachowska K, Álvarez-Bustins G. Additional effects of therapeutic exercise and education on manual therapy for chronic temporomandibular disorders treatment: a randomized clinical trial. Physiother Theory Pract 2024:1-16. [PMID: 38353484 DOI: 10.1080/09593985.2024.2316305] [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: 10/06/2023] [Accepted: 01/25/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Previous studies have evaluated the implementation of behavioral approaches in individuals with chronic temporomandibular disorders (TMDs). OBJECTIVE To evaluate the benefits of a behavioral approach to craniofacial pain. Second, we assessed the benefits of kinesiophobia, catastrophizing, mouth opening without pain, and forward head posture. METHODS Individuals with chronic TMDs were treated for five weeks. The intervention group (n = 17) underwent pain neuroscience education, manual therapy, and therapeutic exercise, whereas the control group (n = 17) underwent manual therapy only. Outcomes were evaluated immediately, at seven and 19 weeks follow-up. The assessment tools used were the Craniofacial Pain Disability Inventory, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Mandibular Range of Motion Scale, and Cervical Range of Motion Tool. RESULTS The interventions did not influence the differences in the improvements between the groups observed for craniofacial pain disability (inter-subject p 0.4). The intervention had a moderate influence on the improvement of kinesiophobia and catastrophizing (Inter-subject p 0.09 and 0.1 respectively) with a clinically significant effect size (Estimated mean (EM) -8.6 standard deviation (SD) ±3.48 p 0.019; and EM -7.6 SD ± 5.11 p 0.15 respectively). CONCLUSION The behavioral approach improved catastrophizing and kinesiophobia outcomes in individuals with chronic TMDs.
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Affiliation(s)
- Cristian Justribó-Manion
- Escuela Internacional de Doctorado (CEINDO), Universitat Abat Oliva CEU, CEU Universities, Barcelona, Spain
- Spain National Centre, Foundation COME Collaboration, Barcelona, Spain
- Craniofacial Disorder Academy, Barcelona, Spain
| | - Juan Mesa-Jiménez
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
- Integrative Craniofacial Therapy (Incraft Lab), Madrid, Spain
| | - Javier Bara-Casaus
- Group Quiron Salud, Sagrado Corazón University Hospital, Barcelona, Spain
| | - Juan-Carlos Zuil-Escobar
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
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Roose E, Nijs J, Moseley GL. Striving for better outcomes of treating chronic pain: integrating behavioural change strategies before, during, and after modern pain science education. Braz J Phys Ther 2023; 27:100578. [PMID: 38096753 PMCID: PMC10727936 DOI: 10.1016/j.bjpt.2023.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/22/2023] Open
Affiliation(s)
- Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium; Rehabilitation Research Group, Department of Physical Therapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; REVAL, Universiteit Hasselt, Agoralaan-gebouw A, 3590 Diepenbeek, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physical Therapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Huvudbyggnad Vasaparken, Universitetsplatsen 1, 41345 Gothenburg, Sweden.
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country GPO Box 2471, Adelaide, South Australia 5001, Australia; The Pain Education Team to Advance Learning (PETAL) Collaboration, Australia
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Murillo C, Galán-Martín MÁ, Montero-Cuadrado F, Lluch E, Meeus M, Loh WW. Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care. Pain 2023; 164:2296-2305. [PMID: 37289577 DOI: 10.1097/j.pain.0000000000002929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
ABSTRACT Pain neuroscience education combined with exercise (PNE + exercise) is an effective treatment for patients with chronic spinal pain. Yet, however, little is known about its underlying therapeutic mechanisms. Thus, this study aimed to provide the first insights by performing a novel mediation analysis approach in a published randomized controlled trial in primary care where PNE + exercise was compared with standard physiotherapy. Four mediators (catastrophizing, kinesiophobia, central sensitization-related distress, and pain intensity) measured at postintervention and 3 outcomes (disability, health-related quality of life, and pain medication intake) measured at 6-month follow-up were included into the analysis. The postintervention measure of each outcome was also introduced as a competing candidate mediator in each respective model. In addition, we repeated the analysis by including all pairwise mediator-mediator interactions to allow the effect of each mediator to differ based on the other mediators' values. Postintervention improvements in disability, medication intake, and health-related quality of life strongly mediated PNE + exercise effects on each of these outcomes at 6-month follow-up, respectively. Reductions in disability and medication intake were also mediated by reductions in kinesiophobia and central sensitization-related distress. Reductions in kinesiophobia also mediated gains in the quality of life. Changes in catastrophizing and pain intensity did not mediate improvements in any outcome. The mediation analyses with mediator-mediator interactions suggested a potential effect modification rather than causal independence among the mediators. The current results, therefore, support the PNE framework to some extent as well as highlight the need for implementing the recent approaches for mediation analysis to accommodate dependencies among the mediators.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Miguel Ángel Galán-Martín
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and León Public Health System (Sacyl), Valladolid, Spain
| | - Federico Montero-Cuadrado
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and León Public Health System (Sacyl), Valladolid, Spain
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Mira Meeus
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Wen Wei Loh
- Department of Data Analysis, Ghent University, Ghent, Belgium
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Salazar-Méndez J, Núñez-Cortés R, Suso-Martí L, Ribeiro IL, Garrido-Castillo M, Gacitúa J, Mendez-Rebolledo G, Cruz-Montecinos C, López-Bueno R, Calatayud J. Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis. Neurosci Biobehav Rev 2023; 153:105328. [PMID: 37516218 DOI: 10.1016/j.neubiorev.2023.105328] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
The aim was to examine the moderator effect of duration of PNE (total minutes) on changes in psychosocial variables after treatment in people with chronic musculoskeletal pain. PubMed/MEDLINE, Embase, Web of Science, Scopus and CINHAL databases were systematically searched from inception to 6 February 2023. A mixed-effects meta-regression was performed to determine the moderator effect of PNE duration. Twenty-three studies involving 2352 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain neurophysiology knowledge, anxiety symptoms, catastrophizing and kinesiophobia. The total duration of PNE ranged from 40 to 720 min. A linear relationship was observed between longer duration of PNE (total minutes) and changes of psychosocial variables. In addition, a dose of 100, 200 and 400 min of PNE was estimated to exceed the minimum clinically important difference described in the literature for kinesiophobia (mean difference = -8.53 points), anxiety symptoms (mean difference = -1.88 points) and catastrophizing (mean difference = -7.17 points). Clinicians should provide a more tailored PNE to address psychosocial variables.
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Affiliation(s)
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain
| | - Ivana Leão Ribeiro
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | | | - José Gacitúa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Guillermo Mendez-Rebolledo
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile; Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
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10
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Emerson AJ, Einhorn L, Groover M, Naze G, Baxter GD. Clinical conversations in the management of chronic musculoskeletal pain in vulnerable patient populations: a meta-ethnography. Disabil Rehabil 2023; 45:3409-3434. [PMID: 36205554 DOI: 10.1080/09638288.2022.2130447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this meta-ethnography was to synthesize the research exploring patient/provider perceptions of clinical conversations (CC) centered on chronic musculoskeletal pain (CMP) in vulnerable adult populations. MATERIALS AND METHODS A systematic search for qualitative/mixed method studies in CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRIMSA-P guidelines. Data synthesis used eMERGe guidelines; findings were presented in nested hierarchal theoretical frameworks. RESULTS The included studies explored patients' (n = 18), providers' (n = 2), or patients' and providers' perspectives (n = 5) with diversity in patient participants represented (n = 415): immigrants, indigenous people, women, and veterans. Themes for each level of the nested hierarchal models revealed greater complexity in patients' perceptions about the CC in CMP relative to clinicians' perceptions. A unique finding was sociopolitical/historical factors can influence CC for vulnerable populations. CONCLUSION The combined nested hierarchical models provided insight into the need for clinicians to be aware of the broader array of influences on the CC. Key themes indicated that improving continuity of care and cultural training are needed to improve the CC. Additionally, due to patients' perception of how healthcare systems' policies influence the CC, patients should be consulted to guide the change needed to improve inequitable outcomes.IMPLICATIONS FOR REHABILITATIONHealthcare providers wishing to improve the clinical conversation in chronic musculoskeletal pain can more broadly explore potential factors influencing patients' experiences and perceptions.Screening during the clinical conversation can include assessing for sociopolitical and historical influences on patients' experiences with chronic musculoskeletal pain.Healthcare providers can explore how to minimize disjointed care in an effort to improve the clinical conversation and outcomes in chronic musculoskeletal pain.Healthcare providers and patients can work together to improve inequitable outcomes for vulnerable adults with chronic musculoskeletal pain.This may include cultural training for healthcare providers that is informed by patients.
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Affiliation(s)
- Alicia J Emerson
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
- School of Physiotherapy, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | | | - Morgan Groover
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Garrett Naze
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - G David Baxter
- School of Physiotherapy, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
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11
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Díaz-Fernández Á, Ortega-Martínez AR, Cortés-Pérez I, Ibáñez-Vera AJ, Obrero-Gaitán E, Lomas-Vega R. Transcultural Adaptation and Psychometric Validation of the Spanish Version of the Pain Attitudes and Beliefs Scale for Physiotherapists. J Clin Med 2023; 12:6045. [PMID: 37762985 PMCID: PMC10531514 DOI: 10.3390/jcm12186045] [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: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP) is one of the main musculoskeletal pain conditions, and it affects 23-28% of the global population. Strong evidence supports the absence of a direct relationship between the intensity of pain and tissue damage, with psychosocial factors also playing a crucial role. In this context, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) is a useful tool for evaluating physiotherapists' treatment orientations and beliefs regarding the management of low back pain (LBP). It helps identify practitioners who may benefit from additional education in modern pain neuroscience. However, there is not a Spanish validation of this scale for physiotherapists. Thus, the aims of this study were to translate and culturally adapt the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) into Spanish and to evaluate its psychometric properties. This validation study used three convenience samples of physiotherapists (PTs) (n = 22 for the pilot study, n = 529 for the validity study and n = 53 for assessing the instrument's responsiveness). The process of translating and adapting the PABS-PT into Spanish followed international guidelines and produced a satisfactory pre-final version of the questionnaire. Factor analysis confirmed the two-factor structure of the original version, with the biomedical (BM) factor explaining 39.4% of the variance and the biopsychosocial (BPS) factor explaining 13.8% of the variance. Cronbach's alpha values were excellent for the BM factor (0.86) and good for the BPS factor (0.77), indicating good internal consistency. Test-retest reliability was excellent for both factors, with intraclass correlation coefficients (ICCs) of 0.84 for BM and 0.82 for BPS. The standard error of measurement (SEM) was acceptable for both factors (3.9 points for BM and 2.4 points for BPS). Concurrent validity was moderate and in the expected direction and had significant correlations with the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Revised Neurophysiology Pain Questionnaire (R-NPQ). Sensitivity to change was demonstrated by significant improvements in both factors after an educational intervention, with medium-to-large effect sizes. The PABS-PT also showed good discriminative ability, as it was able to distinguish between physiotherapists with and without pain education. Cut-off values for the BM and BPS factors were determined. In conclusion, the translated and adapted Spanish version of the PABS-PT demonstrated good psychometric properties and can be reliably used to assess the attitudes and beliefs of Spanish-speaking physiotherapists regarding LBP. The questionnaire is recommended for use in clinical and educational research in the Spanish language context.
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Affiliation(s)
- Ángeles Díaz-Fernández
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | - Ana Raquel Ortega-Martínez
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
- Department of Psychology, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | | | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
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12
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Abstract
Chronic pain in children is a relatively prevalent cause of functional disability. Contributing factors to this pain are best viewed through the biopsychosocial model. Although evidence is lacking for individual aspects of treatment, interdisciplinary care is considered the best treatment approach for children with chronic pain. Interdisciplinary care can include medication management with daily and as-needed medications, physical and occupational therapy focusing on function and movement, and psychological treatment with cognitive-behavioral therapy and acceptance focused treatment. In children with severe pain and disability, intensive interdisciplinary pain treatment may be needed to improve pain and function.
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Affiliation(s)
- Andrew B Collins
- Department of Pediatrics, University of Cincinnati College of Medicine; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine; Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4009, Cincinnati, OH 45229, USA; Division of Pediatric Pain Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2001, Cincinnati, OH 45229, USA.
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13
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Aguiar ADS, Moseley GL, Bataglion C, Azevedo B, Chaves TC. Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2023; 24:251-263. [PMID: 36220481 DOI: 10.1016/j.jpain.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/29/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.
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Affiliation(s)
- Aroldo D S Aguiar
- Ph.D. in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - G Lorimer Moseley
- DSc Ph.D, Bradley Distinguished Professor, IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Cesar Bataglion
- Ph.D in Dental Sciences, Professor and Researcher from the Department of Restorative Dentistry at Ribeirão Preto Dental School (FORP), University of São Paulo-USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Beatriz Azevedo
- Master's Degree in Progress in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thaís C Chaves
- Ph.D, Adjunct Professor and Researcher from the Department of Physical Therapy, University Federal of São Carlos, UFSCar, São Carlos, Brazil; Researcher from the Graduate Program on Rehabilitation and Functional Performance, Laboratory of Research on Movement and Pain (LabMovePain), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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14
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Pate JW, Harrison LE, Hess CW, Moseley GL, Rush G, Heathcote LC, Simons LE. Targeting Pain Science Education in Youth With Chronic Pain: What Are the Sticking Points for Youth and Their Parents? Clin J Pain 2023; 39:60-67. [PMID: 36453624 DOI: 10.1097/ajp.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize the concept of pain in care-seeking youth and their parents, to examine its clinical and demographic correlates, and to identify conceptual gaps. MATERIALS AND METHODS Following an initial interdisciplinary evaluation, a cohort of 127 youth aged 8 to 18 years, and their parents, completed a series of questionnaires. RESULTS Parents had slightly higher COPI scores than youth did, reflecting parents' greater alignment with contemporary pain science. The moderate positive association with older age among youth ( r =.32) suggests that COPI is sensitive to cognitive development and life experiences. Youth and parent COPI responses were weakly associated ( r =0.24), highlighting the importance of targeting the concept of pain in both groups. For both parents and youth, 'Learning about pain can help you feel less pain' was the least endorsed concept. This conceptual 'gap' is a key point of intervention that could potentially lead to greater engagement with multidisciplinary pain treatment. DISCUSSION The COPI appears useful for identifying conceptual gaps or 'sticking points'; this may be an important step to pre-emptively address misconceptions about pain through pain science education. Future research should determine the utility of COPI in assessing and treating youth seeking care for pain. The COPI may be a useful tool for tailoring pain science education to youth and their parents.
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Affiliation(s)
- Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, NSW
| | - Lauren E Harrison
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Courtney W Hess
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - G Lorimer Moseley
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gillian Rush
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura E Simons
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
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15
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Are Improvements in Pain Neurophysiology Knowledge Following Pain Science Education Associated With Improved Outcomes in People With Chronic Pain?: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:41-52. [PMID: 36524771 DOI: 10.1097/ajp.0000000000001086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to determine the association between changes in patients' pain knowledge after pain science education (PSE) with treatment outcomes in people with chronic pain. METHODS Six electronic databases and 2 clinical trial registries were searched from inception to September 15, 2021 for studies where participants received PSE and had their pain knowledge and clinical outcomes assessed before and after PSE. Meta-analyses were performed for pain intensity, kinesiophobia, and pain catastrophizing. Physical function and quality of life outcomes were synthesized narratively. Risk of bias was assessed using the Cochrane tool for nonrandomized studies and the quality of evidence was assessed using GRADE. RESULTS Fourteen studies (n=1500 participants) were included. Meta-analyses revealed no significant associations between short-term (<12 wk) changes in pain neurophysiology knowledge with changes in pain intensity (n=1075, r=-0.01, 95% CI =-0.14 to 0.13, very low certainty), kinesiophobia (n=152, r=0.02, 95% CI =-0.27 to 0.24, very low certainty) and pain catastrophizing (n=976, r=-0.03, 95% CI=-0.18 to 0.11, low certainty). No significant associations were found between short-term changes in pain neurophysiology knowledge and physical function or quality of life either. DISCUSSION These findings do not support a short-term association between improvements in pain neurophysiology knowledge and better treatment outcomes in people with chronic pain. Increased understanding of how PSE works, as well as better ways to measure it, may help clinicians deliver more targeted education to help patients reconceptualize pain and promote engagement in active treatment strategies (eg, exercise).
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16
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Moens M, Goudman L, Van de Velde D, Godderis L, Putman K, Callens J, Lavreysen O, Ceulemans D, Leysen L, De Smedt A. Personalised rehabilitation to improve return to work in patients with persistent spinal pain syndrome type II after spinal cord stimulation implantation: a study protocol for a 12-month randomised controlled trial-the OPERA study. Trials 2022; 23:974. [PMID: 36471349 PMCID: PMC9721015 DOI: 10.1186/s13063-022-06895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND For patients with therapy-refractory persistent spinal pain syndrome type II (PSPS-T2), spinal cord stimulation (SCS) may serve as an effective minimally invasive treatment. Despite the evidence that SCS can improve return to work (RTW), only 9.5 to 14% of patients implanted with SCS are effectively capable of returning to work. Thus, it seems that current post-operative interventions are not effective for achieving RTW after SCS implantation in clinical practice. The current objective is to examine whether a personalised biopsychosocial rehabilitation programme specifically targeting RTW alters the work ability in PSPS-T2 patients after SCS implantation compared to usual care. METHODS A two-arm, parallel-group multicentre randomised controlled trial will be conducted including 112 patients who will be randomised (1:1) to either (a) a personalised biopsychosocial RTW rehabilitation programme of 14 weeks or (b) a usual care arm, both with a follow-up period until 12 months after the intervention. The primary outcome is work ability. The secondary outcomes are work status and participation, pain intensity, health-related quality of life, physical activity and functional disability, functional capacities, sleep quality, kinesiophobia, self-management, anxiety, depression and healthcare expenditure. DISCUSSION Within the OPERA project, we propose a multidisciplinary personalised biopsychosocial rehabilitation programme specifically targeting RTW for patients implanted with SCS, to tackle the high socio-economic burden of patients that are not re-entering the labour market. The awareness is growing that the burden of PSPS-T2 on our society is expected to increase over time due to the annual increase of spinal surgeries. However, innovative and methodologically rigorous trials exploring the potential to decrease the socio-economic burden when patients initiate a trajectory with SCS are essentially lacking. TRIAL REGISTRATION ClinicalTrials.gov NCT05269212. Registered on 7 March 2022.
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Affiliation(s)
- Maarten Moens
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | - Lisa Goudman
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.434261.60000 0000 8597 7208Research Foundation Flanders (FWO), Egmontstraat 5, Brussels, 1000 Belgium
| | - Dominique Van de Velde
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, 9000 Belgium
| | - Lode Godderis
- grid.5596.f0000 0001 0668 7884Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, 3000 Belgium ,IDEWE, External Service for Prevention and Protection at Work, Heverlee, 3001 Belgium
| | - Koen Putman
- grid.8767.e0000 0001 2290 8069Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | - Jonas Callens
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | - Olivia Lavreysen
- grid.5596.f0000 0001 0668 7884Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, 3000 Belgium
| | - Dries Ceulemans
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, 9000 Belgium
| | - Laurence Leysen
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | | | - Ann De Smedt
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium
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17
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The effect of exercise engagement on low back disability at 12-months is mediated by pain and catastrophizing in a community sample of people with chronic low back pain. Behav Res Ther 2022; 159:104205. [PMID: 36215852 DOI: 10.1016/j.brat.2022.104205] [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: 04/04/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
Despite being a first-line treatment recommendation, there is uncertainly for how exercise helps people with chronic low back pain. We designed this study to examine how exercise might help people with chronic low back pain by following a large community sample for 1-year. Qualitative questionnaires and self-report measures were collected every 3-months for 1-year in 400 people with chronic low back pain. People were not provided any specific treatment advice as part of this study but were allowed to engage with any normal physical activity, treatment, or medication as part of their normal life. Exercise engagement was defined from inspection of participant qualitative responses, according to minimum acceptable levels of exercise that elicit symptom reduction. Multiple mediation analysis was performed to examine the effect of exercise engagement on disability through the proposed mediators (pain, fear, catastrophizing, depression, anxiety, self-efficacy). The significant effect of exercise engagement on reductions in disability at 6- and 12-months was explained through pain and catastrophizing. People with chronic low back pain who reported worsening of symptoms over the year had similar reporting of exercise throughout the 12-months to people who had improvements in disability. Exercise can reduce disability through the effect on pain and catastrophizing, but how this effect occurs (i.e., an active or passive component of exercise) is unclear.
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18
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Wallwork SB, Noel M, Moseley GL. Communicating with children about 'everyday' pain and injury: A Delphi study. Eur J Pain 2022; 26:1863-1872. [PMID: 35829711 PMCID: PMC9545644 DOI: 10.1002/ejp.2008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND 'Everyday' pain experiences are potentially critical in shaping our beliefs and behaviours around injury and pain. Influenced by social, cultural and environmental contexts, they form the foundation of one's understanding of pain and injury that is taken into adulthood. How to best communicate to young children about their everyday pain experiences, in order to foster adaptive beliefs and behaviours, is unknown. METHODS In this Delphi survey, we sought expert opinion on the key messages and strategies that parents/caregivers can consider when communicating with young children (aged 2-7 years) about 'everyday' pain that is most likely to promote recovery, resilience and adaptive pain behaviours. Eighteen experts participated including specialists in paediatric pain, trauma, child development, and psychology; educators and parents. The survey included three rounds. RESULTS Response rate was over 88%. Two hundred fifty-three items were raised; 187 reached 'consensus' (≥80% agreement among experts). Key messages that the experts agreed to be 'very important' were aligned with current evidence-based understandings of pain and injury. Strategies to communicate messages included parent/caregiver role-modelling, responses to child pain, and discussion during and/or after a painful experience. Other key themes included promoting emotional development, empowering children to use active coping strategies, and resilience building. CONCLUSIONS This diverse set of childhood, pain and parenting experts reached consensus on 187 items, yielding 12 key themes to consider when using everyday pain experiences to promote adaptive pain beliefs and behaviours in young children.
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Affiliation(s)
- S B Wallwork
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - M Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - G L Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
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19
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Pulling BW, Braithwaite FA, Moseley GL, Jensen MP, Burke ALJ, Collins KL, Hull MJ, Jones HG, Cyna AM, Ferencz N, Stanton TR. Suggestions in Hypnosis to Aid Pain Education (SHAPE) in People with Chronic Low-Back Pain: A Pilot Feasibility Randomized, Controlled Trial. Int J Clin Exp Hypn 2022; 70:251-276. [PMID: 35969169 DOI: 10.1080/00207144.2022.2105147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic low back pain (CLBP) is a debilitating and burdensome condition, and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants. A priori feasibility and intervention acceptability criteria were set. Twenty participants with CLBP were recruited and randomized to receive: (1) hypnotically delivered pain science education that utilizes hypnotic suggestions to enhance uptake of pain science concepts; or (2) pain science education with progressive muscle relaxation as an attention control. Twenty participants were recruited, however, not solely from the hospital waitlist as intended; community sampling was required (13 hospital, 7 community). Most criteria were met in the community sample but not the hospital sample. Protocol modifications are needed before progressing to a full scale randomized controlled trial for hypnotically reinforced pain science education. Improvements in relevant secondary outcomes paired with moderate-high treatment acceptability ratings are promising.
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Affiliation(s)
- Brian W Pulling
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - Felicity A Braithwaite
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Anne L J Burke
- Psychology Department, Central Adelaide Local Health Network, South Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Kathryn L Collins
- Psychology Department, Central Adelaide Local Health Network, South Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Melissa J Hull
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide
| | - Hannah G Jones
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide.,Institute of Psychiatry, Psychology & Neuroscience, Kings College London, England, United Kingdom
| | - Allan M Cyna
- Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia
| | - Nicki Ferencz
- Paediatric Chronic Pain Service, Women's and Children's Hospital, Adelaide, South Australia
| | - Tasha R Stanton
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
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Murillo C, Vo TT, Vansteelandt S, Harrison LE, Cagnie B, Coppieters I, Chys M, Timmers I, Meeus M. How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment. Clin Psychol Rev 2022; 94:102160. [PMID: 35561510 PMCID: PMC11146991 DOI: 10.1016/j.cpr.2022.102160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: -0.07; 95% confidence interval [CI]: -0.11, -0.04) and catastrophizing (IE: -0.07; 95%CI: -0.14, -0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: -0.11, -0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: -0.31, -0.03) and psychological flexibility (IE: -0.30; 95%CI: -0.41, -0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium
| | - Tat-Thang Vo
- Department of Statistics, The Wharton School, University of Pennsylvania, Pennsylvania, United States; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Iris Coppieters
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Marjolein Chys
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States; Department of Rehabilitation Medicine, Maastricht University, Netherlands
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Belgium.
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21
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Goksör C, Mannerkorpi K, Bergenheim A. Experiences with an educational program for patients with chronic widespread pain: a qualitative interview study. Scand J Pain 2022; 22:279-287. [PMID: 34592074 DOI: 10.1515/sjpain-2021-0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/09/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Chronic widespread pain (CWP) is a common problem in primary health care, with a prevalence of 10-15%. An educational program called Pain School has been developed for use in primary health care, comprising four educational group sessions and 10 weeks of physical activity. The purpose of this study was to explore patients' experiences with participating in an educational program that aims to increase their understanding of pain, self-efficacy, tools in daily life, and physical activity. METHODS Twelve women (age 25-72 years) with CWP were included in this qualitative interview study set in primary health care. Semi-structured individual interviews were held 10 weeks after the completion of the four educational group sessions. Data was analyzed through the established method of content analysis, and the results are presented as a theme with categories and subcategories. RESULTS An overarching theme that described the participants' experiences with the educational program was evolvement of skills and perspectives to master pain. This theme covered four categories: understanding one's body and mind, experiencing the value of participation, applying strategies and ways of thinking, and evaluating and adding to one's personal framework. Participation contributed to an increased understanding of one's body and mind and to experiencing the individual and social value of participation. The participants applied new strategies and ways of thinking related to pain and physical activity. An evaluation of the relevance for the individual and the value of being in the group could reinforce or add to the participants' personal framework. CONCLUSIONS The educational program Pain School that was used in this study appears to give knowledge and support for women with CWP in primary health care and provide them with applicable skills and perspectives to manage pain.
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Affiliation(s)
- Clara Goksör
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bergenheim
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
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22
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Gül H, Erel S, Demir P, Çubukçu Fırat S. Cross-cultural adaptation of the Revised Neurophysiology of Pain Questionnaire into the Turkish language based on Rasch analysis. Physiother Theory Pract 2022:1-9. [PMID: 35260038 DOI: 10.1080/09593985.2022.2048425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Revised Neurophysiology of Pain Questionnaire (Revised-NPQ-Tr) is used to evaluate the chain in pain knowledge. No study has explored its validity and reliability for the Turkish language. OBJECTIVES : This study aims to determine the psychometric properties of the Turkish version of the Revised-NPQ-Tr in chronic spinal pain patients. METHODS A total of 182 chronic spinal pain patients were included in the study. The Revised-NPQ-Tr results were analyzed using Rasch analysis to measure the psychometric properties. RESULTS The Revised-NPQ-Tr indicates misfit to the Rasch model, as evidenced by the borderline significant p value (LR test = 27.626; df = 11; p = .004; Bonferroni-adjusted α = 0.004). Two items were differentially affected by educational status. Removal of poor-functioning items did not improve the psychometric properties of the questionnaire. The Revised-NPQ-Tr is unidimensional and there was no local dependence between items. The questionnaire exhibits known group validity. Test-retest reliability of the questionnaire was moderate [intraclass correlation coefficient (ICC) = 0.629]; however, the internal consistency of the questionnaire was found to be low (Cronbach's α = 0.330; person separation index = 0.373). CONCLUSION Although the internal validity of the Revised-NPQ-Tr version was acceptable, its reliability was found to be low. Consequently, the results of Revised-NPQ-Tr should be interpreted carefully in the clinic.
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Affiliation(s)
- Hatice Gül
- Vocational School of Health Services, Akdeniz University, Antalya, Turkey
| | - Suat Erel
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Pervin Demir
- Department of Biostatistics and Medical Informatics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Sibel Çubukçu Fırat
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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23
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Sisco-Taylor BL, Magel JS, McFadden M, Greene T, Shen J, Fritz JM. Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial. PAIN MEDICINE 2021; 23:1127-1137. [PMID: 34613379 PMCID: PMC9157170 DOI: 10.1093/pm/pnab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/25/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Fear-Avoidance Model of chronic pain (FAM) posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT's effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. SUBJECTS Participants were 204 patients with low-back pain of < 16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks. METHODS Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales) and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. RESULTS Early PT led to improvements in disability and pain over 3 months, but not 1 year. In the single mediator model, four-week reductions in pain catastrophizing mediated early PT's effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. CONCLUSIONS In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients' catastrophizing.
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Affiliation(s)
| | - John S Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT.,Department of Physical Therapy, Intermountain Healthcare, Salt Lake City, UT
| | - Molly McFadden
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT.,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jincheng Shen
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT.,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
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24
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Alhowimel A, Alodiabi F, Alamam D, Alotaibi M, Fritz J. Current Understanding of Pain Neurophysiology among Physiotherapists Practicing in Saudi Arabia. Healthcare (Basel) 2021; 9:healthcare9091242. [PMID: 34575016 PMCID: PMC8469164 DOI: 10.3390/healthcare9091242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
To ensure the effective management of patients’ pain, it is important that physiotherapists have a good understanding of the neuroscience behind pain. A major barrier to adequate pain management is that, for patients, there is limited access to clinicians who are knowledgeable about pain. This study examined the level of knowledge regarding pain neurophysiology among physiotherapists currently practicing in Saudi Arabia. Method: The study was a cross-sectional web-based survey that utilized the 12-item Revised Neurophysiology of Pain Questionnaire. Descriptive and inferential statistics were used to describe levels of knowledge regarding pain neurophysiology and to examine differences in knowledge based on the characteristics of the participating physiotherapists (gender, educational level, experience, practice region, and country where their highest educational level was attained). Results: One hundred and eleven physiotherapists (58.6% male) from various regions and educational backgrounds participated in the study. Out of a maximum Revised Neurophysiology of Pain Questionnaire score of 12, the mean ± standard deviation (SD) was 6.7 ± 2.2; 90% of physiotherapists scored 9 (75%) or less. None of the examined characteristics of the participants were associated with knowledge. Conclusion: Physiotherapists in Saudi Arabia showed limited knowledge of the neurophysiology of pain; however, this was not related to the personal characteristics that were examined. The continuation of education in modern pain science is recommended for physiotherapists, especially those dealing with patients suffering from chronic pain. Clinical Relevance: The physiotherapists who took part in this study displayed limited knowledge of pain neuroscience; this limited knowledge might suggest the need for a more bio-anatomical approach to pain management. There is a need for tailored medical education to address pain neuroscience knowledge in current physiotherapist practitioners.
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Affiliation(s)
- Ahmed Alhowimel
- Department of Health and Rehabilitation Science, Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia;
- Correspondence:
| | - Faris Alodiabi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (D.A.)
| | - Dalyah Alamam
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (D.A.)
| | - Mazyad Alotaibi
- Department of Health and Rehabilitation Science, Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia;
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84112, USA;
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25
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Aldabe D, Lawrenson P, Sullivan J, Hyland G, Bussey M, Hammer N, Bryant K, Woodley S. Management of women with pregnancy-related pelvic girdle pain: an international Delphi study. Physiotherapy 2021; 115:66-84. [DOI: 10.1016/j.physio.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022]
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26
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Cashin AG, Lee H, Traeger AC, Moseley GL, Hübscher M, Kamper SJ, Skinner IW, McAuley JH. Producing Clinically Meaningful Reductions in Disability: A Causal Mediation Analysis of a Patient Education Intervention. THE JOURNAL OF PAIN 2021; 23:236-247. [PMID: 34411745 DOI: 10.1016/j.jpain.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Patient education is recommended as first-line care for low back pain (LBP), although its efficacy for providing clinically meaningful reductions in disability has been questioned. One way to improve treatment effects is to identify and improve targeting of treatment mechanisms. We conducted a pre-planned causal mediation analysis of a randomized, placebo-controlled trial investigating the effectiveness of patient education for patients with acute LBP. 202 patients who had fewer than six-weeks' duration of LBP and were at high-risk of developing chronic LBP completed two, one-hour treatment sessions of either intensive patient education, or placebo patient education. 189 participants provided data for the outcome self-reported disability at three-months and the mediators, pain self-efficacy, pain catastrophizing, and back beliefs at one-week post treatment. This causal mediation analysis found that pain catastrophizing (mediated effect, -0.64; 95% Confidence Interval [CI], -1.31 to -0.15) and back beliefs (mediated effect, -0.51; 95% CI, -1.15 to -0.02) partly explained the effect of patient education on disability but pain self-efficacy did not (mediated effect, -0.40; 95% CI -1.13 to 0.28). Considering the mediator-outcome relationship, patient education would need to induce an 8 point difference on the pain self-efficacy questionnaire (0-60); an 11 point difference on the back beliefs questionnaire (9-45); and a 21 point difference on the pain catastrophizing scale (0-52) to achieve a minimally clinically important difference of 2 points on the Roland Morris Disability Questionnaire (0-24). PERSPECTIVE: Understanding the mechanisms of patient education can inform how this treatment can be adapted to provide clinically meaningful reductions in disability. Our findings suggest that adapting patient education to better target back beliefs and pain self-efficacy could result in clinically meaningful reductions in disability whereas the role of pain catastrophizing in acute LBP is less clear.
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Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Steven J Kamper
- School of Health Sciences, The University of Sydney, Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Ian W Skinner
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Health Sciences, University of New South Wales, Sydney, Australia.
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27
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Emerson AJ, Oxendine RH, Chandler LE, Huff CM, Harris GM, Baxter GD, Jones ECW. Patient and Provider Attitudes, Beliefs, and Biases That Contribute to a Marginalized Process of Care and Outcomes in Chronic Musculoskeletal Pain. A Systematic Review. Part I: Clinical Care. PAIN MEDICINE 2021; 23:655-668. [PMID: 34297104 DOI: 10.1093/pm/pnab195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Chronic musculoskeletal pain (CMP) outcomes are affected by numerous variables including the clinical conversation. When good therapeutic/working alliances are formed, congruent clinical conversations can lead to improved CMP outcomes. Identifying patient/provider attitudes, beliefs, and biases in CMP that can influence the clinical conversation, and thus clinical management decisions, is foundationally important. DESIGN The aims of this systematic review were to 1) summarize the evidence of the attitudes and beliefs of patients and healthcare providers (HCPs) involved in the clinical conversation of CMP; 2) examine if/how these perceptions impacted the process of care. METHODS A systematic search of CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRISMA guidelines. Included studies: vulnerable adult populations with chronic pain. Study bias was examined using the Downs and Black tool. RESULTS Seven retrospective studies were included. HCPs demonstrated negative implicit biases toward minorities and women when making pharmaceutical management decisions. HCPs demonstrated negative implicit biases toward lower educated women when making referrals to multidisciplinary care. Unmet patient expectations resulted in higher drop-out rates at multidisciplinary pain management programs. Patients' trust was influenced by healthcare setting and patients often had limited options secondary to health insurance type/status. CONCLUSION These findings suggest that patients with CMP may experience a marginalized process of care due to HCPs' negative implicit biases, unmet patient expectations, and healthcare setting. Results suggest several factors may contribute to inequitable care and the recalcitrant nature of CMP, particularly in vulnerable populations with limited healthcare choices.
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Affiliation(s)
- Alicia J Emerson
- High Point University, Department of Physical Therapy, Congdon School of Health Sciences, One University Parkway, High Point, NC, 27268.,Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin 9056, New Zealand
| | - Riley H Oxendine
- High Point University, Department of Physical Therapy, Congdon School of Health Sciences, One University Parkway, High Point, NC, 27268
| | - Lauren E Chandler
- High Point University, Department of Physical Therapy, Congdon School of Health Sciences, One University Parkway, High Point, NC, 27268
| | - Corey M Huff
- High Point University, Department of Physical Therapy, Congdon School of Health Sciences, One University Parkway, High Point, NC, 27268
| | - Gabrielle M Harris
- High Point University, Department of Physical Therapy, Congdon School of Health Sciences, One University Parkway, High Point, NC, 27268
| | - G David Baxter
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin 9056, New Zealand
| | - Elizabeth C Wonsetler Jones
- High Point University, Department of Physical Therapy, Congdon School of Health Sciences, One University Parkway, High Point, NC, 27268.,Tufts University, Department of Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA, 02111
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28
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The Effect of Literacy-Adapted Psychosocial Treatments on Biomedical and Biopsychosocial Pain Conceptualization. THE JOURNAL OF PAIN 2021; 22:1396-1407. [PMID: 34004347 DOI: 10.1016/j.jpain.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 03/03/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022]
Abstract
This is a secondary data analysis of a subgroup of participants who received the Learning About My Pain (LAMP) intervention (clinicaltrials.gov identifier NCT01967342). We examined the effects of LAMP on pre-to-post changes in biomedical and biopsychosocial pain conceptualization and whether those changes in pain conceptualization were associated with physical and psychological functioning. Participants were randomized into three conditions: Cognitive Behavioral Therapy (CBT), Pain Psychoeducation (EDU), or Usual Medical Care (UC). Results based on 225 participants who completed the Pain Concepts Questionnaire (PCQ) showed a pre-to-post reduction in biomedical pain conceptualization (BM), an increase in biopsychosocial pain conceptualization (BPS), and an increase in BPS/BM ratio for CBT and EDU but not UC. There were no differences between CBT and EDU in post-treatment PCQ scores. Compared to those with lower BM pain beliefs scores at post-treatment, participants endorsing higher BM pain beliefs scores reported greater pain intensity and greater pain interference. Furthermore, higher BM pain beliefs scores at post-treatment and lower BPS/BM ratio were associated with higher levels of pain catastrophizing. Overall, results of this study suggest the need for targeting specific pain beliefs that influence pain-related outcomes. PERSPECTIVE: This article presents the potential benefits of providing literacy-adapted psychosocial treatments to expand pain conceptualization beyond a biomedical-only understanding and toward a biopsychosocial conceptualization of the experience of pain. Furthermore, the association of changes in pain conceptualization and pain-related functioning argues for its potential clinical relevance.
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29
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Reis F, Palermo TM, Acalantis L, Nogueira LC, Meziat-Filho N, Louw A, Ickmans K. "A journey to learn about pain": the development and validation of a comic book about pain neuroscience education for children. Braz J Phys Ther 2021; 26:100348. [PMID: 34001422 DOI: 10.1016/j.bjpt.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pain education resources for children using appropriate language and illustrations remain scarce. OBJECTIVES We aimed to summarize the development process and testing for face and content validity of a structured comic book about pain education for children. METHODS A first draft of a comic book was developed (Portuguese and English) based on pain education concepts. Experts in pediatric pain from different countries analyzed content, objectives, language, illustrations, layout, motivation, and cultural adjustment. A third draft developed in Portuguese considering experts' suggestions was presented to children and parents in Brazil. The total adequacy score was calculated from the sum of the scores obtained in each domain, divided by the maximum total score. Descriptive analysis is presented. RESULTS The expert panel was composed of 11 (64.7%) physical therapists, and 6 (35.3%) psychologists. The total adequacy score (0-100%) was 87.74%. The third draft version of the comic book was presented to 28 children and the final version was presented to 16 children with a mean age of 9.6 years. Children were totally satisfied (n=4; 26.7%) or satisfied (n=9; 56.2%) with the story of the comic book. The readability of the comic book was considered suitable for grades 4 to 6 educational level. CONCLUSION The comic book "A Journey to Learn about Pain" was validated for face and content validity by the expert panel and the Brazilian target population. This comic book is available in Portuguese and English and can be a potentially useful resource for children.
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Affiliation(s)
- Felipe Reis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ); Pain in Motion research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel.
| | | | - Louise Acalantis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ)
| | - Leandro Calazans Nogueira
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ); Postgraduate Program in Rehabilitation Sciences - Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences - Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | | | - Kelly Ickmans
- Pain in Motion research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel; Research Foundation - Flanders (FWO), Brussels, Belgium
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30
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Murphy L, Ng K, Isaac P, Swidrovich J, Zhang M, Sproule BA. The Role of the Pharmacist in the Care of Patients with Chronic Pain. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:33-41. [PMID: 33959490 PMCID: PMC8096635 DOI: 10.2147/iprp.s248699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Pharmacists across the healthcare continuum are well positioned to collaborate with patients to effectively manage their chronic pain. Evidence supports positive outcomes when pharmacists undertake these roles; however, there are barriers preventing uptake across the profession. This paper aims to expand awareness of the breadth of these roles, including pharmaceutical care provision, interprofessional collaboration, pain and medication education, support for patients in self-management and acceptance of responsibility to be culturally responsive and decrease stigma. Pharmacists are accessible healthcare professionals and can improve the care of patients with chronic pain.
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Affiliation(s)
- Laura Murphy
- Department of Pharmacy, University Health Network, Toronto, ON, Canada
| | - Karen Ng
- Toronto Academic Pain Medicine Institute, Toronto, ON, Canada
| | - Pearl Isaac
- Pharmacy Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jaris Swidrovich
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Maria Zhang
- Pharmacy Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Beth A Sproule
- Pharmacy Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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31
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Chen T, Zhu J, Zhao Y, Li H, Li P, Fan J, Wei X. The global state of research in pain management of osteoarthritis (2000-2019): A 20-year visualized analysis. Medicine (Baltimore) 2021; 100:e23944. [PMID: 33466135 PMCID: PMC7808549 DOI: 10.1097/md.0000000000023944] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
There has been a highly active area in the pain management of osteoarthritis (OA) over the past 2 decades. The study aims to unmask the global status and trends in this field.Publications on pain management of OA from 2000 to 2019 were retrieved from the Web of Science (WOS) database. The data were analyzed using bibliometric statistical methodology. The software VOS viewer was used for bibliographic coupling, co-authorship, co-citation, co-occurrence analysis and to investigate the publication trends in pain management of OA.A total of 8207 researches in amount were included. The relative research interests and number of publications indicated a rising trend. The USA made the greatest contribution to this field, with the most publications, total citations and the highest H-index, while Sweden had the highest average citation per publication. The most contributive organization was Boston University. The journal OA and Cartilage published the most relative articles. Researches could be grouped into 5 clusters based on co-occurrence network map: Health and Epidemiology; Sport Medicine; Clinical Study; Mechanism Research and Medical Technology and Science. Medical Technology and Science was predicted as the next research topic in this field.The number of publications about pain management of OA would be increasing based on current global trends. The USA made the largest contribution to this field. The development of Medical Technology and Science may be the next popular topics in the pain management of OA research.
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Affiliation(s)
- Taoyu Chen
- Department of Orthopedics, The first affiliated hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia
- Department of Orthopedics, Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair
| | - Jiaying Zhu
- Department of Pharmacy; Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yu Zhao
- Department of Orthopedics, Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair
| | - Haoqian Li
- Department of Orthopedics, Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair
| | - Pengcui Li
- Department of Orthopedics, Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair
| | - Jianjun Fan
- Department of Orthopedics, The first affiliated hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia
| | - Xiaochun Wei
- Department of Orthopedics, Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair
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Richter M, Rauscher C, Kluttig A, Mallwitz J, Delank KS. Effect of Additional Pain Neuroscience Education in Interdisciplinary Multimodal Pain Therapy on Current Pain. A Non-Randomized, Controlled Intervention Study. J Pain Res 2020; 13:2947-2957. [PMID: 33235493 PMCID: PMC7678472 DOI: 10.2147/jpr.s272943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Interdisciplinary multimodal pain therapy (IMPT) programs for chronic back pain are effective and recommended. The patient-centered and biopsychosocial nature of IMPT is grounded in contemporary understanding that chronic pain states reflect heightened sensitization of the nervous system rather than an issue in the tissue. Teaching patients about pain is part of IMPT programs, though a clinical guideline is lacking. This study aims to answer the following question: Does the addition of an evidence-based pain neuroscience education (PNE) lecture for patients, into an IMPT program, produce superior results than the IMPT program itself? Patients and Methods A non-randomized, controlled intervention study was performed with 179 back pain patients indicated for IMPT. Intervention group (N=102) received a four-week IMPT program, which contained 4 one-hour sessions PNE. Control group (N=77) received the same IMPT without the additional PNE. Primary outcome was current pain after intervention. Pain knowledge, physical function, depression, anxiety, stress, quality of life and fear-avoidance were analyzed as secondary outcomes. Outcomes were defined as change of the parameter measured before and immediately after the four-week IMPT. For each outcome, linear regression models were used to estimate the raw and adjusted (sex, age and BMI) effect of additional PNE. Results Despite improvement in all outcomes for both groups during the treatment phase, the implemented PNE did not result in additional pain reduction (regression coefficient for PNE effect on pain level 0.34; 95% CI −6.23–6.97). Between-group differences could only be shown for pain-related knowledge in favor for the intervention group (0.78; 95% CI 0.35–1.20). Conclusion The additional PNE lecture did not lead to pain reduction beyond the usual IMPT. However, the PNE did increase pain-related knowledge and, therefore, might be helpful in coping with pain after the IMPT program.
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Affiliation(s)
| | | | - Alexander Kluttig
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Joachim Mallwitz
- Rückenzentrum Am Michel, Praxis Für Orthopädie, Hamburg, Germany
| | - Karl-Stefan Delank
- Universitätsklinikum (Halle), Department Für Orthopädie, Unfall- Und Wiederherstellungschirurgie, Martin-Luther-Universität, Halle-Wittenberg, Halle, Germany
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33
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Pimentel SD, Adams H, Ellis T, Clark R, Sully C, Paré C, Sullivan MJ. The Sequential Relation Between Changes in Catastrophizing and Changes in Posttraumatic Stress Disorder Symptom Severity. J Trauma Stress 2020; 33:731-740. [PMID: 32479704 DOI: 10.1002/jts.22519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022]
Abstract
Catastrophizing has been discussed as a cognitive precursor to the emergence of posttraumatic stress disorder (PTSD) symptoms following the experience of stressful events. Implicit in cognitive models of PTSD is that treatment-related reductions in catastrophizing should yield reductions in PTSD symptoms. The tenability of this prediction has yet to be tested. The present study investigated the sequential relation between changes in a specific form of catastrophizing-symptom catastrophizing-and changes in PTSD symptom severity in a sample of 73 work-disabled individuals enrolled in a 10-week behavioral activation intervention. Measures of symptom catastrophizing and PTSD symptom severity were completed at pre-, mid-, and posttreatment assessment points. Cross-sectional analyses of pretreatment data revealed that symptom catastrophizing accounted for significant variance in PTSD symptom severity, β = .40, p < .001, sr = .28 (medium effect size), even when controlling for known correlates of symptom catastrophizing, such as pain and depression. Significant reductions in symptom catastrophizing and PTSD symptoms were observed during treatment, with large effect sizes, ds = 1.42 and 0.94, respectively, ps < .001. Cross-lagged analyses revealed that early change in symptom catastrophizing predicted later change in PTSD symptoms; early changes in PTSD symptom severity did not predict later change in symptom catastrophizing. These findings are consistent with the conceptual models that posit a causal relation between catastrophizing and PTSD symptom severity. The clinical implications of the findings are discussed.
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Affiliation(s)
| | - Heather Adams
- University Centre for Research on Pain and Disability, Halifax, Nova Scotia, Canada
| | - Tamara Ellis
- Centre for Rehabilitation and Health, Toronto, Ontario, Canada
| | - Robin Clark
- Kootenay Health Services, Nelson, British Columbia, Canada
| | - Craig Sully
- Kootenay Health Services, Nelson, British Columbia, Canada
| | - Catherine Paré
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Emerson AJ, Hegedus T, Mani R, Baxter GD. Chronic musculoskeletal pain experiences in marginalized populations: a mixed methods study protocol to understand the influence of geopolitical, historical, and societal factors. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1807803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alicia J. Emerson
- High Point University, High Point, NC, USA
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | | | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - G. David Baxter
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
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35
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Aure O, Kvåle A. Do pain, function, range of motion, fear and distress differ according to symptom duration and work status in patients with low back pain? A cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1801834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Alice Kvåle
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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36
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Pate JW, Heathcote LC, Simons LE, Leake H, Moseley GL. Creating online animated videos to reach and engage youth: Lessons learned from pain science education and a call to action. ACTA ACUST UNITED AC 2020; 2:131-138. [PMID: 35548258 PMCID: PMC8975222 DOI: 10.1002/pne2.12015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Joshua W. Pate
- Graduate School of Health University of Technology Sydney Sydney NSW Australia
| | - Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine Stanford CA USA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine Stanford CA USA
| | - Hayley Leake
- IIMPACT in Health University of South Australia Adelaide SA Australia
| | - G. Lorimer Moseley
- IIMPACT in Health University of South Australia Adelaide SA Australia
- Neuroscience Research Australia Sydney NSW Australia
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37
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Cresswell C, Galantino ML, Myezwa H. The prevalence of fear avoidance and pain catastrophising amongst patients with chronic neck pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1326. [PMID: 32161823 PMCID: PMC7059507 DOI: 10.4102/sajp.v76i1.1326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 11/14/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cognitive factors impact chronic pain, but the prevalence of fear avoidance (FA) and pain catastrophising (PC) in individuals suffering from chronic neck pain (CNP) has not been investigated in South Africa. Objectives To determine the prevalence of FA and PC in patients with CNP at private physiotherapy practices in Johannesburg. Method The Tampa Scale for Kinesiophobia-11 (TSK-11) (α = 0.80) and Pain Catastrophising Scale (α = 0.87) self-report questionnaires were used in a cross-sectional study to determine the prevalence of FA and PC, respectively. Descriptive statistics and correlations using Pearson’s or Spearman’s coefficient were conducted between demographic variables and FA and PC. Non-parametric data were tested using the Wilcoxon rank-sum or Kruskal–Wallis test. Cohen’s d-value or r-value measured strength of associations. Results A sample of 106 CNP patients with a mean age of 48.7 years (± 14.8) from 25 randomly selected private practices participated in the study. Of the participants, 81% were women (n = 86). Fear avoidance and PC had a prevalence of 25.5% (n = 27) and 15.1% (n = 16), respectively. A positive correlation was found between FA-11-Total and PC-Total (r = 0.684; p = 0.0001) and between FA (TSK-11-Total and TSK-SF (somatic focus)) and PC and its subscales (r ≥ 0.602; p = 0.0001). Participants with a secondary education (26.0 ± 3.4) showed a higher FA than those with tertiary education (21.9 ± 1.5). Effect size was moderate (Cohen’s d = 0.60). Pain intensity correlated positively with both FA (Pearson’s correlation: r = 0.33; p = 0.001) and PC (Spearman’s correlation; r = 0.39; p = 0.0001). Conclusion FA and PC affect a number of patients with CNP. A lower level of education was associated with FA and a higher pain intensity was associated with higher FA and PC. Clinical implications Identifying FA and PC in patients with CNP is important to facilitate holistic management.
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Affiliation(s)
- Clare Cresswell
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary L Galantino
- School of Health Sciences, Stockton University, Galloway, United States
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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38
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Kemp JL, Risberg MA, Mosler A, Harris-Hayes M, Serner A, Moksnes H, Bloom N, Crossley KM, Gojanovic B, Hunt MA, Ishøi L, Mathieu N, Mayes S, Scholes MJ, Gimpel M, Friedman D, Ageberg E, Agricola R, Casartelli NC, Diamond LE, Dijkstra HP, Di Stasi S, Drew M, Freke M, Griffin D, Heerey J, Hölmich P, Impellizzeri FM, Jones DM, Kassarjian A, Khan KM, King MG, Lawrenson PR, Leunig M, Lewis CL, Warholm KM, Reiman MP, Semciw A, Thorborg K, van Klij P, Wörner T, Bizzini M. Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2019; 54:504-511. [PMID: 31732651 DOI: 10.1136/bjsports-2019-101458] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 11/04/2022]
Abstract
The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.
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Affiliation(s)
- Joanne L Kemp
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Andrea Mosler
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Marcie Harris-Hayes
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Nancy Bloom
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Kay M Crossley
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,SportAdo consultation, University Hospital of Lausanne (CHUV) Multidisciplinary Unit of Adolescent Health, Lausanne, Switzerland
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Leukerbad, Valais, Switzerland
| | - Sue Mayes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,The Australian Ballet, Southbank, Victoria, Australia
| | - Mark J Scholes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Mo Gimpel
- Performance Science, Southampton Football Club, Southampton, Hampshire, UK
| | - Daniel Friedman
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Rintje Agricola
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE, Menzies Health Institute Queensland Griffith University, School of Allied Health Sciences, Gold Coast, Queensland, Australia
| | - H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, Oxfordshire, UK.,Aspetar Sports Medicine Hospital, Doha, Qatar
| | - Stephanie Di Stasi
- Division of Physical Therapy, The Ohio State Univesity, Columbus, Ohio, USA
| | - Michael Drew
- University of Canberra Research into Sport and Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Matthew Freke
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Damian Griffin
- Warwick Orthopaedics, University of Warwick, Coventry, Warwick, UK
| | - Joshua Heerey
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Denise M Jones
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Ara Kassarjian
- Musculoskeletal Radiology, Corades, LLC, Brookline, Massachusetts, USA.,Musculoskeletal Radiology, Elite Sports Imaging, SL, Madrid, Spain
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew G King
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | | | - Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Adam Semciw
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Pim van Klij
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tobias Wörner
- Department of Health Sciences, Lunds University, Lund, Sweden
| | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
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Ferreira PS, Corrêa LA, Bittencourt JV, Reis FJJ, Meziat-Filho N, Nogueira LAC. Patients with chronic musculoskeletal pain present low level of the knowledge about the neurophysiology of pain. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1676307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Paula S. Ferreira
- Physiotherapy Department, Federal Institute of Rio De Janeiro (IFRJ), Rio De Janeiro, Brazil
| | - Leticia A. Corrêa
- Rehabilitation Science Postgraduate Department at Augusto, Motta University Centre (UNISUAM), Rio De Janeiro, Brazil
| | - Juliana V. Bittencourt
- Rehabilitation Science Postgraduate Department at Augusto, Motta University Centre (UNISUAM), Rio De Janeiro, Brazil
| | - Felipe J. J. Reis
- Physiotherapy Department, Federal Institute of Rio De Janeiro (IFRJ), Rio De Janeiro, Brazil
| | - Ney Meziat-Filho
- Rehabilitation Science Postgraduate Department at Augusto, Motta University Centre (UNISUAM), Rio De Janeiro, Brazil
| | - Leandro A. C. Nogueira
- Physiotherapy Department, Federal Institute of Rio De Janeiro (IFRJ), Rio De Janeiro, Brazil
- Rehabilitation Science Postgraduate Department at Augusto, Motta University Centre (UNISUAM), Rio De Janeiro, Brazil
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Abstract
Joint pain attributable to osteoarthritis (OA) is complex and influenced by a myriad of factors beyond local joint pathology. Current practice continues to predominantly adopt a biomedical approach to OA despite emerging evidence of the importance of a more holistic approach. This paper will summarise evidence for the presence of multidimensional pain profiles in knee joint pain and the presence of subgroups characterized by systemic features such as psychological distress, high comorbidity load or sensitisation of the nervous system. These factors have the potential to influence patient outcomes making them relevant for clinicians and highlighting the necessity of a broader multifactorial approach to assessment and treatment. This review describes the current state of the evidence for treatments of people with knee OA-related pain, including those receiving strong recommendations from current clinical guidelines, namely exercise, weight loss, self-management advice and pharmacological approaches. Other pain-modulating treatment options are emerging such as sleep and psychological interventions, pain education and multisensory retraining. The evidence and rationale for these newer therapeutic approaches is discussed. Finally, this review will highlight some of the limitations of current international guidelines for the management of OA and make recommendations for future research.
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Affiliation(s)
- K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - M Hübscher
- Neuroscience Research Australia, Barker Street, Randwick, NSW 2031, Sydney, Australia.
| | - H O'Leary
- Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - N Moloney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Thrive Physiotherapy, Guernsey, Channel Islands, UK
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41
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Fletcher R, Braithwaite FA, Woodhouse M, MacInnes A, Stanton TR. Does readiness to change influence pain-related outcomes after an educational intervention for people with chronic pain? A pragmatic, preliminary study. Physiother Theory Pract 2019; 37:608-619. [PMID: 31267821 DOI: 10.1080/09593985.2019.1636436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: There is a strong association between chronic pain and unhelpful pain cognitions. Educating patients on pain neuroscience has been shown to reduce pain catastrophization, kinesiophobia, and self-perceived disability. This study investigated whether a group-based pain neuroscience education (PNE) session influenced pain-related outcomes, and whether readiness to change moderated these outcomes.Method: In a pragmatic pre-post-intervention study using a convenience sample, adults with chronic pain participated in one, 90-120 minute PNE session. Pain-related outcomes (i.e. pain catastrophization, kinesiophobia, disability, and pain neuroscience knowledge) and the Pain Stage of Change Questionnaire (PSOCQ) were assessed at baseline and immediately post-intervention. Paired t-tests evaluated pre-post changes in outcomes, and linear regression examined the impact of PSOCQ score changes on PNE-induced changes in clinical outcomes.Results: Sixty-five participants were recruited. All outcomes showed positive intervention effects (p < .01). Relationships between changes in PSOCQ subscale scores and change in post-intervention pain-related outcomes were found; 'Pre-Contemplation' was positively associated with pain catastrophization (p = .01), and 'Action' was negatively associated with kinesiophobia (p = .03).Conclusion: Consistent with previous research, there were improvements in outcomes associated with chronic pain after PNE. Some of these improvements were predicted by changes in PSOCQ scores, however, these findings are preliminary and require further investigation using controlled research designs.
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Affiliation(s)
- Roland Fletcher
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.,Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada
| | - Felicity A Braithwaite
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mellissa Woodhouse
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aaron MacInnes
- Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada.,Faculty of Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tasha R Stanton
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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42
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Chalmers KJ, Madden VJ. Shifting beliefs across society would lay the foundation for truly biopsychosocial care. J Physiother 2019; 65:121-122. [PMID: 31204295 DOI: 10.1016/j.jphys.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/24/2019] [Accepted: 04/08/2019] [Indexed: 01/05/2023] Open
Affiliation(s)
- K Jane Chalmers
- School of Science and Health, Western Sydney University, Sydney, Australia.
| | - Victoria J Madden
- Department of Anaesthesia and Perioperative Medicine, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Pate JW, Veage S, Lee S, Hancock MJ, Hush JM, Pacey V. Which Patients With Chronic Pain Are More Likely to Improve Pain Biology Knowledge Following Education? Pain Pract 2019; 19:363-369. [DOI: 10.1111/papr.12748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/31/2018] [Accepted: 11/14/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Joshua W. Pate
- Department of Health Professions Faculty of Medicine and Health Sciences Macquarie University North Ryde New South WalesAustralia
| | - Stephanie Veage
- The St George Hospital Pain Management Unit Kogarah New South Wales Australia
| | - Susan Lee
- The St George Hospital Pain Management Unit Kogarah New South Wales Australia
| | - Mark J. Hancock
- Department of Health Professions Faculty of Medicine and Health Sciences Macquarie University North Ryde New South WalesAustralia
| | - Julia M. Hush
- Department of Health Professions Faculty of Medicine and Health Sciences Macquarie University North Ryde New South WalesAustralia
| | - Verity Pacey
- Department of Health Professions Faculty of Medicine and Health Sciences Macquarie University North Ryde New South WalesAustralia
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44
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Stevens ML, Boyle E, Hartvigsen J, Mansell G, Søgaard K, Jørgensen MB, Holtermann A, Rasmussen CDN. Mechanisms for reducing low back pain: a mediation analysis of a multifaceted intervention in workers in elderly care. Int Arch Occup Environ Health 2018; 92:49-58. [PMID: 30173369 DOI: 10.1007/s00420-018-1350-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/28/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive-behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. METHODS This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. RESULTS There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [β = - 0.63, 95% CI (1.23, 0.03); β = - 1.03, 95% CI (- 1.70, - 0.34)] and the use of assistive devices [β = - 0.55, 95% CI (- 1.04, - 0.05)], but not on perceived muscle strength [β = - 0.18, 95% CI (- 0.50, 0.13)] or physical exertion [β = - 0.05, 95% CI (- 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [β = 0.14, 95% CI (0.04, 0.23)]. CONCLUSIONS A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP.
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Affiliation(s)
- Matthew L Stevens
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, PO Box M179, Missenden Rd, Sydney, NSW, 2050, Australia.
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Gemma Mansell
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Marie B Jørgensen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Andreas Holtermann
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
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45
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Tüscher J, Burrus C, Vuistiner P, Léger B, Rivier G, Luthi F. Predictive Value of the Fear-Avoidance Model on Functional Capacity Evaluation. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:513-522. [PMID: 29094284 PMCID: PMC6096494 DOI: 10.1007/s10926-017-9737-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose Measuring the predictive value of the Fear-Avoidance Model (FAM) on lifting tasks in Functional Capacity Evaluation (FCE), and on reasons for stopping the evaluation (safe maximal effort, versus self-limited). Methods A monocentric prospective study was conducted on 298 consecutive inpatients. Components of the FAM were analyzed using the Cumulative Psychosocial Factor Index (CPFI: kinesiophobia, catastrophizing, depressive mood) and perceived disability (Hand/Spinal Function Sort: HFS/SFS). Floor-to-waist, waist-to-overhead and dominant-hand lifting tests were measured according to the FCE guidelines. Maximal safe performance was judged by certified FCE assessors. Analyses were conducted with linear multiple regression models. Results The CPFI was significantly associated with the 3 FCE lifting tests: floor-to-waist (ß = - 1.12; p = 0.039), waist-to-overhead (ß = - 0.88; p = 0.011), and dominant-handed lifting (ß = - 1.21; p = 0.027). Higher perceived disability was also related to lower performances: floor-to-waist (ß = 0.09; p < 0.001), waist-to-overhead (ß = 0.04; p < 0.001), and dominant-handed lifting (ß = 0.06; p < 0.001). The CPFI was not related to performances of patients with self-limited effort despite higher psychological scores, while a relationship was found for patients who achieved a safe maximal performance. Higher perceived disability was related to performances in both situations. Conclusions FAM components should be taken into account when interpreting maximal physical performance in FCE. This study also suggests that factors other than pain-related fears may influence patients with self-limited effort.
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Affiliation(s)
- Johanne Tüscher
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Cyrille Burrus
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland.
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland
| | - Gilles Rivier
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland
| | - François Luthi
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
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46
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Moseley GL. Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for? Br J Sports Med 2018; 53:588-589. [PMID: 29982226 DOI: 10.1136/bjsports-2018-099567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 11/03/2022]
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47
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Mediators of Treatment Effect in the Back In Action Trial: Using Latent Growth Modeling to Take Change Over Time Into Account. Clin J Pain 2018; 33:811-819. [PMID: 27930393 PMCID: PMC5638429 DOI: 10.1097/ajp.0000000000000463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objectives: To test whether change in fear-avoidance beliefs was a mediator of the effect of treatment on disability outcome, and to test an analytical approach, latent growth modeling, not often applied to mediation analysis. Methods: Secondary analysis was carried out on a randomized controlled trial designed to compare an intervention addressing fear-avoidance beliefs (n=119) with treatment as usual (n=121) for patients with low back pain, which found the intervention to be effective. Latent growth modelling was used to perform a mediation analysis on the trial data to assess the role of change in fear-avoidance beliefs on disability outcome. The product of coefficients with bias-corrected bootstrapped confidence intervals was used to calculate the mediating effect. Results: A statistically significant mediating effect of fear-avoidance beliefs on the effect of treatment on disability outcome was found (standardized indirect effect −0.35; bias-corrected 95% CI, −0.47 to −0.24). Poor fit of the model to the data suggested that other factors not accounted for in this model are likely to be part of the same mediating pathway. Discussion: Fear-avoidance beliefs were found to mediate the effect of treatment on disability outcome. Measurement of all potential mediator variables in future studies would help to more strongly identify which factors explain observed treatment effects. Latent growth modelling was found to be a useful technique to apply to studies of treatment mediation, suggesting that future studies could use this approach.
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Pate JW, Hush JM, Hancock MJ, Moseley GL, Butler DS, Simons LE, Pacey V. A Child's Concept of Pain: An International Survey of Pediatric Pain Experts. CHILDREN-BASEL 2018; 5:children5010012. [PMID: 29342976 PMCID: PMC5789294 DOI: 10.3390/children5010012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/23/2022]
Abstract
A child's 'concept of pain' refers to how they understand what pain actually is, what function pain serves, and what biological processes are thought to underpin it. We aimed to determine pediatric pain experts' opinions of: (1) the importance and usefulness of assessing a child's concept of pain in clinical and/or research settings; (2) the usefulness of the content of items within currently published adult-targeted resources for assessing a child's concept of pain; and (3) important domains of a child's concept of pain to assess. Forty-nine pediatric pain experts (response rate = 75.4%) completed an online survey. Descriptive statistics and frequency of responses were analyzed. Experts from all included disciplines reported that assessing a child's concept of pain is important and useful both clinically and in a research setting (>80% reported very or extremely useful for each item). Experts considered that the content of 13 items from currently published adult-targeted resources was useful, but the wording was too complex for children aged 8-12 years. Experts considered that all seven of the proposed domains of a child's concept of pain was important to assess. The findings can be used to inform the development of an assessment tool for a child's concept of pain.
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Affiliation(s)
- Joshua W Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - Julia M Hush
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - David S Butler
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Laura E Simons
- Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Verity Pacey
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
- The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
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49
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Black N, Sullivan S, Mani R. A biopsychosocial understanding of lower back pain: Content analysis of online information. Eur J Pain 2017; 22:728-744. [DOI: 10.1002/ejp.1158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/06/2022]
Affiliation(s)
- N.M. Black
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy; University of Otago; Dunedin New Zealand
| | - S.J. Sullivan
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy; University of Otago; Dunedin New Zealand
| | - R. Mani
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy; University of Otago; Dunedin New Zealand
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50
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Mansell G, Storheim K, Løchting I, Werner EL, Grotle M. Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain. Phys Ther 2017; 97:1138-1146. [PMID: 29186635 PMCID: PMC5803786 DOI: 10.1093/ptj/pzx091] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 09/05/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery. OBJECTIVE The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome. DESIGN This study was a secondary analysis of the COPE randomized controlled trial. METHODS Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline - posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis. RESULTS Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. LIMITATIONS This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects. CONCLUSIONS The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment disability could be estimated indicates that these variables may be viable treatment targets for biopsychosocial interventions; however, this finding must be viewed in light of the adjusted analyses, which showed that the indirect effects were significantly reduced through the inclusion of a treatment-mediator interaction term.
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Affiliation(s)
- Gemma Mansell
- G. Mansell, PhD, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom,Address all correspondence to Dr Mansell at:
| | - Kjersti Storheim
- K. Storheim, PT, PhD, Research and Communication Unit for Musculoskeletal Diseases (FORMI), Division for Surgery and Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Ida Løchting
- I. Løchting PhD, FORMI, Division for Surgery and Neurology, Oslo University Hospital, and Department of Clinical Medicine, University of Oslo, Ullevaal, Oslo, Norway
| | - Erik L. Werner
- E.L. Werner, MD, PhD, Department of General Practice, Institute of Health and Society, University of Oslo, and Research Unit for General Practice, Uni Health Research, Uni Research, Bergen, Norway
| | - Margreth Grotle
- M. Grotle, PT, PhD, FORMI, Division for Surgery and Neurology, Oslo University Hospital, and Institute of Physiotherapy, Oslo and Akershus University College for Applied Sciences, Oslo, Norway
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