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Chang CH, McClellan TM, Lopez KD, Wasser T, Hemtasilpa S. Tolerability of electrodiagnostic studies in patients: a prospective study. BMJ Neurol Open 2024; 6:e000706. [PMID: 38736582 PMCID: PMC11085985 DOI: 10.1136/bmjno-2024-000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Nerve conduction study (NCS) and electromyography (EMG) are electrodiagnostic studies that are highly tolerated by patients despite their nature of causing pain and discomfort. However, few studies have focused on the true tolerability of these procedures in patients. This study aimed to determine the true tolerance rate of NCS and EMG in patient populations and the factors that might be associated with them. Methods Participants scheduled for electrodiagnostic studies were prospectively recruited between March 2023 and September 2023. After completion of the study, the physicians completed a questionnaire on each patient's tolerance of the studies. Results Of the 103 patients enrolled in the study, 98 were able to tolerate both tests, and 5 patients were intolerant to 1 or both tests. The overall tolerance rate of NCS and EMG was 95.1% (0.951, 95% CI 0.897 to 0.981). Age, sex, ethnicity, the type of NCS performed and the type of EMG performed were not associated with NCS or EMG intolerance. Conclusion Most patients tolerated the NCS and EMG; however, a small percentage of patients were intolerant. Clinicians should recognise the intolerance of certain patients when introducing and performing electrodiagnostic tests.
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Affiliation(s)
- Chin-Hen Chang
- Physical Medicine and Rehabilitation, Tower Health, West Reading, Pennsylvania, USA
| | | | - Kevin David Lopez
- Physical Medicine and Rehabilitation, Tower Health, West Reading, Pennsylvania, USA
| | - Thomas Wasser
- Consult-Stat: Complete Statistical Service, Wernersville, Pennsylvania, USA
| | - Somkiat Hemtasilpa
- Physical Medicine and Rehabilitation, Tower Health, West Reading, Pennsylvania, USA
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Krausewitz P, Schmeller H, Spitzer C, Ellinger J, Ritter M, Petrowski K, Conrad R. Emotion-centered versus fact-centered medical information to alleviate pain and anxiety in prostate biopsy: A randomized trial. Prostate 2024; 84:389-394. [PMID: 38116739 DOI: 10.1002/pros.24659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND To test the efficacy of emotion-centered (EC) versus fact-centered (FC) written medical information for prostate biopsy to alleviate pain and anxiety in a randomized controlled trial. METHODS In a single-center, single-blinded study participants were randomized to receive FC or EC (DRKS00022361; 2020). In the EC, the focus was on possible stress reactions and stress-reducing strategies. Participants were asked to complete questionnaires on the day of MRI acquisition (T0) directly before (T1) and after the procedure (T2). The primary outcome measure was the assessment of worst pain in the last 2 h measured by the adapted brief pain inventory. Secondary outcome measures included state anxiety measured by the state-trait anxiety inventory and the subjective evaluation of the impact of the written medical information at T2. For statistical analysis, mixed models were calculated. RESULTS Of 137 eligible patients, 108 (79%) could be recruited and were randomized. There was a significant effect for time for the outcome variables pain and anxiety. Regarding the comparison for the primary outcome variable worst pain there was a significantly lower increase from T1 to T2 after FC compared to EC (p < 0.004). The course of anxiety displayed no overall group differences. The FC was evaluated as significantly more helpful regarding stress, pain, and anxiety with moderate effect sizes. CONCLUSIONS FC was favorable with regard to worst experienced pain, assuming that the brief introduction of emotional issues such as stress and coping in written information might be counterproductive particularly in men not used to these subjects.
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Affiliation(s)
- Philipp Krausewitz
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Helene Schmeller
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, Rostock, Germany
| | - Jörg Ellinger
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
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Ros LA, Sleutjes BT, Stikvoort García DJ, Goedee HS, Asselman FL, van den Berg LH, van der Pol WL, Wadman RI. Feasibility and tolerability of multimodal peripheral electrophysiological techniques in a cohort of patients with spinal muscular atrophy. Clin Neurophysiol Pract 2023; 8:123-131. [PMID: 37554725 PMCID: PMC10404501 DOI: 10.1016/j.cnp.2023.06.001] [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: 02/19/2023] [Revised: 05/27/2023] [Accepted: 06/17/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE Electrophysiological techniques are emerging as an aid in identifying prognostic or therapeutic biomarkers in patients with spinal muscular atrophy (SMA), but electrophysiological assessments may be burdensome for patients. We, therefore, assessed feasibility and tolerability of multimodal peripheral non-invasive electrophysiological techniques in a cohort of patients with SMA. METHODS We conducted a single center, longitudinal cohort study investigating the feasibility and tolerability of applying multimodal electrophysiological techniques to the median nerve unilaterally. Techniques consisted of the compound muscle action potential scan, motor nerve excitability tests, repetitive nerve stimulation and sensory nerve action potential. We assessed tolerability using the numeric rating scale (NRS), ranging from 0 (no pain) to 10 (worst possible pain), and defined the protocol to be tolerable if the NRS score ≤ 3. The protocol was considered feasible if it could be performed according to test and quality standards. RESULTS We included 71 patients with SMA types 1-4 (median 39 years; range 13-67) and 63 patients at follow-up. The protocol was feasible in 98% of patients and was well-tolerated in up to 90% of patients. Median NRS score was 2 (range 0-6 at baseline and range 0-4 at follow-up (p < 0.01)). None of the patients declined follow-up assessment. CONCLUSIONS Multimodal, peripheral, non-invasive, electrophysiological techniques applied to the median nerve are feasible and well-tolerated in adolescents and adults with SMA types 1-4. SIGNIFICANCE Our study supports the use of non-invasive multimodal electrophysiological assessments in adolescents and adults with SMA types 1-4.
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Affiliation(s)
- Leandra A.A. Ros
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Boudewijn T.H.M. Sleutjes
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Diederik J.L. Stikvoort García
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - H. Stephan Goedee
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Leonard H. van den Berg
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | | | - Renske I. Wadman
- Corresponding author at: Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
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Paiz F, Midroni G, Kassardjian CD. Pain perception during electrodiagnostic studies and the impact of learners. Muscle Nerve 2022; 66:621-624. [PMID: 36059146 DOI: 10.1002/mus.27712] [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: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/28/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS Electrodiagnostic testing (EDX) may be perceived as painful, which may influence patient expectations and test completion. Our aim was to characterize which component of the EDX was more painful, and to determine if any factors, particularly performance by a learner, influenced this perception. METHODS Participants were prospectively recruited and completed a brief questionnaire to rate their perception of pain before and after each component of the EDX. Demographic information and information about the test itself was collected. RESULTS A total of 251 participants were recruited, 55.3% female, with a mean age of 52.9 years. Most participants rated pain after nerve conduction studies (NCS) and needle electromyography (EMG) as mild to moderate with a similar number rating each component as more painful than the other. There was no effect of sex on overall ratings, although females felt that the test was more painful than anticipated more often than males. If a learner performed the EMG, it was more likely that the test would be rated as moderately to severely painful, and more likely for the EMG to be rated as more painful than the NCS (p<0.05). DISCUSSION The finding that NCS and EMG perceived pain were similar may help accurately inform patients of test expectations, guide test planning and help reduce the likelihood of incomplete or canceled testing. More effort might be required to help mitigate EMG pain when learners are involved.
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Affiliation(s)
- Freddy Paiz
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gyl Midroni
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles D Kassardjian
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Vogt L, Klasen M, Rossaint R, Goeretz U, Ebus P, Sopka S. Virtual Reality Tour to Reduce Perioperative Anxiety in an Operating Setting Before Anesthesia: Randomized Clinical Trial. J Med Internet Res 2021; 23:e28018. [PMID: 34252034 PMCID: PMC8444035 DOI: 10.2196/28018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perioperative anxiety is a major burden to patients undergoing surgeries with general anesthesia. OBJECTIVE This study investigated whether a virtual operating room tour (VORT) before surgery can be used to ameliorate perioperative anxiety. METHODS We employed a randomized parallel-group design with 2 study arms to compare VORT to the standard operation preparation procedure. The study included 84 patients. A validated inventory (state-trait operation anxiety-state) was used to assess perioperative state anxiety before (T1) and after (T2) surgery. In addition, trait operation anxiety was evaluated with an additional validated inventory (state-trait operation anxiety-trait). Moreover, user ratings on the usefulness of VORT were assessed with an evaluation questionnaire. Study arms were compared for perioperative state anxiety with two-tailed independent samples t tests. Subjective ratings were correlated with STOA-Trait values to investigate possible associations between perioperative anxiety with perceived usefulness. RESULTS There were no significant differences in perioperative state anxiety between VORT and standard operation preparation procedures before and after the surgery. Nonetheless, patients' ratings of VORT overall were positive. The tour was perceived as useful and, therefore, showed acceptance for VR use. These ratings were unrelated to the degree of perioperative anxiety. CONCLUSIONS The subjective benefit of VORT could not be explained by a reduction of perioperative anxiety. Instead, VORT appears to serve the need for information and reduce uncertainty. In addition, VORT is perceived as beneficial regardless of the age of the patients. Considering this effect and the manageable organizational and financial effort toward implementation, the general use of VORT can be recommended. TRIAL REGISTRATION ClinicalTrials.gov NCT04579354; https://clinicaltrials.gov/ct2/show/NCT04579354.
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Affiliation(s)
- Lina Vogt
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Martin Klasen
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Ute Goeretz
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Peter Ebus
- Faculty of Educational Science, Open University, Heerlen, Netherlands
| | - Sasa Sopka
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
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Bryce S, Cooke M, Yuen HP, Allott K. Acceptability, safety and perceived impact of providing a fact sheet to young people about cognitive symptoms in depression. Early Interv Psychiatry 2021; 15:328-334. [PMID: 32043813 DOI: 10.1111/eip.12945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/24/2022]
Abstract
AIM Cognitive deficits are common in young people, aged 15-25, with depression. Nevertheless, these symptoms are not routinely addressed in clinical care. This study examined the acceptability, safety, and reported impact on cognitive knowledge and strategy use, of a newly developed fact sheet (Thinking about Thinking Skills in Depression) for young people with depression. METHOD Twenty-three participants, aged 15-25 years old (M = 19.6, SD = 3.2), receiving community-based treatment for a depressive disorder were delivered the fact sheet by their case manager and completed pre- and post-assessments conducted 3 weeks apart. Primary outcomes included: acceptability, safety, subjective distress, knowledge of cognition and use of, and confidence in using, cognitive strategies. Exploratory outcomes included depression symptoms, perceived cognitive difficulties, self-efficacy and self-esteem. Case manager perspectives were obtained using an anonymous online survey. RESULTS Participant experiences of the fact sheet were favourable. Most reported that the amount of content provided was appropriate (91%), looked at the fact sheet again after receiving it (83%), and tried at least one strategy (57%). Participants reported significant improvements in their knowledge of cognitive difficulties and a greater use of, and confidence in using, cognitive strategies. Distress did not change following fact sheet delivery, supporting safety. Perceived improvements in depression symptoms and cognitive deficits, but not self-esteem or self-efficacy, were revealed. Case manager perspectives were also positive. CONCLUSION Written fact sheet resources are an acceptable, safe and pragmatic method of delivering information about cognitive difficulties to young people with depression.
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Affiliation(s)
- Shayden Bryce
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Melanie Cooke
- Orygen, Parkville, Victoria, Australia.,Melbourne Health, Parkville, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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