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Lee FS, Cruz CJ, Allen KD, Wachs RA. Gait assessment in a female rat Sprague Dawley model of disc-associated low back pain. Connect Tissue Res 2024:1-14. [PMID: 39287332 DOI: 10.1080/03008207.2024.2395287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 08/11/2024] [Accepted: 08/18/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE Gait disturbances are common in human low back pain (LBP) patients, suggesting potential applicability to rodent LBP models. This study aims to assess the influence of disc-associated LBP on gait in female Sprague Dawley rats and explore the utility of the open-source Gait Analysis Instrumentation and Technology Optimized for Rodents (GAITOR) suite as a potential alternative tool for spontaneous pain assessment in a previously established LBP model. MATERIALS AND METHODS Disc degeneration was surgically induced using a one-level disc scrape injury method, and microcomputed tomography was used to assess disc volume loss. After disc injury, axial hypersensitivity was evaluated using the grip strength assay, and an open field test was used to detect spontaneous pain-like behavior. RESULTS Results demonstrated that injured animals exhibit a significant loss in disc volume and reduced grip strength. Open field test did not detect significant differences in distance traveled between sham and injured animals. Concurrently, animals with injured discs did not display significant gait abnormalities in stance time imbalance, temporal symmetry, spatial symmetry, step width, stride length, and duty factor compared to sham. However, comparisons with reference values of normal gait reported in prior literature reveal that injured animals exhibit mild deviations in forelimb and hindlimb stance time imbalance, forelimb temporal symmetry, and hindlimb spatial symmetry at some time points. CONCLUSIONS This study concludes that the disc injury may have very mild effects on gait in female rats within 9 weeks post-injury and recommends future in depth dynamic gait analysis and longer studies beyond 9 weeks to potentially detect gait.
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Affiliation(s)
- Fei San Lee
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Carlos J Cruz
- J. Crayton Pruitt Family Department of Biomedical Engineering, Biomedical Sciences Building, University of Florida, Gainesville, FL, USA
| | - Kyle D Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, Biomedical Sciences Building, University of Florida, Gainesville, FL, USA
| | - Rebecca A Wachs
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
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Shaygan M, Tehranineshat B, Teshnizi SH, Mohammadi A. The predicting factors of chronic pain among nursing students: a national study in Iran. BMC Psychol 2024; 12:297. [PMID: 38802966 PMCID: PMC11129415 DOI: 10.1186/s40359-024-01803-9] [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: 08/07/2023] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Nursing students are faced with a variety of challenges that demand effective cognitive and emotional resources. The physical and psychological well-being of the students plays a key part in the public health of the community. Despite the special lifestyle of nursing students, few studies have addressed chronic pain in this population. Accordingly, the present study aims to identify the predictors of chronic pain among nursing students. METHODS This cross-sectional study was conducted on 1,719 nursing students aged 18-42 years, between February and November 2019. Sampling was carried out in several stages. Data were collected using seven instruments, namely a demographics survey, the characteristics of chronic pain form, Spielberger State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire-9 (PHQ-9), the Bar-on Emotional Quotient Inventory, Academic Satisfaction Scale, and Procidano and Heller Social Support Scale. Descriptive statistics, multinomial logistic regression, and regression models were used to describe the characteristics of the pain and its predictive factors. RESULTS The average age of the participants was 22.4 ± 2.96 years. The results of univariate analysis showed that gender (P = 0.506), mother's education (P = 0.056, P = 0.278, P = 0.278), father's education (P = 0.817, P = 0.597, P = 0.41), place of residence (P = 0.215), depression (P = 0.501), grade point average (P = 0.488), academic satisfaction (P = 0.183) and chronic pain weren't significantly correlated with chronic pain in nursing students. The results of the multiple logistic regression models showed that chronic pain was positively correlated with age, social support, state anxiety, and trait anxiety (OR = 1.07, 95% CI: 1.02-1.12; OR = 0.95, 95% CI: 0.93-0.97; OR = 1.03, 95% CI: 1.02-1.05; and OR = 1.97, 95% CI: 0.95-1.99; respectively). CONCLUSION The prevalence of chronic pain was relatively high in these students. In addition, age, social support, and anxiety could be important factors in the development or persistence of chronic pain in nursing students. The results also provided basic and essential information about the contributing factors in this area. However, consideration of factors such as referral for treatment, home medications for pain relief, and outcomes of chronic pain are suggested in future longitudinal studies.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Banafsheh Tehranineshat
- Department of Nursing, Faculty of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Saeed Hosseini Teshnizi
- Department of Community Medicine, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Agrin Mohammadi
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Construct validity of movement-evoked pain operational definitions in older adults with chronic low back pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:985-992. [PMID: 36944266 PMCID: PMC10391587 DOI: 10.1093/pm/pnad034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. DESIGN Cross-sectional analysis of an observational study. SETTING Clinical research laboratory. SUBJECTS 226 older adults with chronic LBP. METHODS This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. RESULTS Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = -0.870, t = -3.110, P = .002), and physical function (b = -0.017, t = -2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050). CONCLUSIONS Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC 27710, United States
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE 19713, United States
- Biostatistics Core, University of Delaware, Newark, DE 19713, United States
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies. THE JOURNAL OF PAIN 2023; 24:980-990. [PMID: 36706887 PMCID: PMC10257757 DOI: 10.1016/j.jpain.2023.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP. PERSPECTIVE: This article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, North Carolina
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware; Biostatistics Core, University of Delaware, Newark, Delaware
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware.
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Peiris CL, Shields N, Lowe A, Tan G, Taylor NF. Functional status of community-dwelling older adults after inpatient rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims: Factors that influence functional ability in older adults after rehabilitation are not well understood. The aim of this study was to investigate how older people function in their community after being discharged from inpatient rehabilitation. Methods A cross-sectional study was undertaken of community-dwelling older adults (n=86, 75 ± 6 years) discharged from rehabilitation in the previous 12 months. Basic functional independence was assessed using the Functional Independence Measure and complex functional independence was assessed using the Frenchay Activities Index. Multiple regression analyses were conducted to assess any association between predetermined factors and function. Results Functional Independence Measure scores and physical activity levels after being discharged accounted for 50% of the variance in basic function (R2=0.50, F=40.75, P<0.001). Frenchay Activities Index scores, physical activity, age, sex and migrant status accounted for 68% of variance in complex function (R2=0.68, F=29.75, P<0.001). Conclusions Clinicians are encouraged to implement strategies to improve function at discharge from rehabilitation and to promote physical activity among older people at risk of poor function following rehabilitation.
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Affiliation(s)
- Casey L Peiris
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
| | - Nora Shields
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
| | - Anna Lowe
- National Centre for Sport & Exercise Medicine, Sheffield-Hallam University, Sheffield, UK
| | - Germaine Tan
- Northern Health, Northern Centre for Health Education and Research, Epping, Australia
| | - Nicholas F Taylor
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
- Eastern Health, Allied Health Clinical Research Office, Melbourne, Australia
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Identifying Epidermolysis Bullosa Patient Needs and Perceived Treatment Benefits: An Explorative Study Using the Patient Benefit Index. J Clin Med 2021; 10:jcm10245836. [PMID: 34945131 PMCID: PMC8709493 DOI: 10.3390/jcm10245836] [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: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Abstract
Epidermolysis bullosa (EB) is a genetic blistering skin condition for which no cure exists. Symptom alleviation and quality of life are therefore central to EB care. This study aimed to gain insight into EB patient needs and benefits from current clinical care. Two questionnaires were administered cross-sectionally to adult EB patients at the Dutch expertise centre for blistering diseases. Patient needs and benefits were analyzed using the patient benefit index survey (PBI-S). Ancillary data were compiled pertaining to self-reported EB severity, pain and pruritus, as well as current and previous treatments. In total, 104 participants were included (response rate 69.8%). Sixty-eight participants comprised the analyzed cohort (n = 36 omitted from analysis). The needs given the highest importance were to get better skin quickly (64.7%) and to be healed of all skin alterations (61.8%). A positive correlation between pain and EB severity and the importance of most needs was observed. Minimal clinically important differences within the PBI-S, relating to reported benefits from clinical care, were reported by 60.3% of the cohort. This study highlights a discrepancy between patient needs and feasible treatment outcomes. Utilizing the PBI-S in conjunction with well-established multidisciplinary care may catalyze the process of tailoring treatments to the needs of individual patients.
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Koerich MHADL, Meirelles BHS, Echevaría-Guanilo ME, Danielewicz AL, Schwertner DS, Knabben RJ. Disability in people with chronic low back pain treated in primary care. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Low back pain is a common musculoskeletal problem and can become chronic, with varying degrees of disability. Objective: Analyze the factors associated with disability in individuals with chronic low back pain (CLBP), treated in primary care. Methods: Cross-sectional study with 82 basic health unit (BHU) users in the municipality of Florianópolis (Brazil) with CLBP. Sociodemographic and clinical variables, health status, lifestyle and treatment were investigated. Self-rated disability was investigated using the Roland Morris questionnaire (≥ 14 points). The χ2 or Fisher’s exact tests were used in inferential analysis for univariate association and the presence of disability. Multivariate association was analyzed by logistical regression, estimating the crude and adjusted odds ratios (OR) and their respective confidence intervals (95%CI). Results: Adults aged 40-59 years had a greater chance of developing disability (OR: 8.17; 95%: 1.21 - 55.0), while professionally active individuals (OR: 0.08; 95%CI: 0.02 - 0.33) who reported engaging in physical activity ≥ 3 times a week (OR: 0.19; IC95%: 0.04 - 0.83) had less chance of the same outcome when compared to the other participants. Conclusion: Factors related to disability were age, employment status and frequency of physical activity. Incentive strategies to return to work and engage in regular physical activity and exercise should be encouraged.
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Pelletier R, Purcell-Levesque L, Girard MC, Roy PM, Leonard G. Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study. J Pain Res 2020; 13:2013-2021. [PMID: 32821153 PMCID: PMC7423354 DOI: 10.2147/jpr.s256700] [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: 04/03/2020] [Accepted: 06/17/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Older adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program. Patients and Methods A retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤0.01 was considered as statistically significant. Results The TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= −0.16 to 0.15, all p-values >0.10). Conclusion These results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.
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Affiliation(s)
- R Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - L Purcell-Levesque
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada
| | - M-C Girard
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada
| | - P-M Roy
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada
| | - G Leonard
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Yiengprugsawan VS, Piggott J, Witoelar F, Blyth FM, Cumming RG. Pain and Its Impact on Functional Health: 7-Year Longitudinal Findings among Middle-Aged and Older Adults in Indonesia. Geriatrics (Basel) 2020; 5:geriatrics5020039. [PMID: 32580285 PMCID: PMC7345182 DOI: 10.3390/geriatrics5020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
Pain is a growing public health issue worldwide, but there is limited population-based evidence in low- and middle-income country settings. Using nationwide Indonesian Family Life Survey (IFLS) data in 2007 and 2014, this research sets out to investigate the associations between changes in pain status between two time points and its impact on functional health outcomes among middle-aged and older adults in Indonesia. Analyses focused on 7936 adults aged 50 years and older in 2014 who responded to both waves. Functional health was assessed using a composite score of functional limitations (range 20–100), representing difficulty in performing activities of daily living, and grip strength (kilograms). Multivariate linear regression models were used to analyse associations between pain measured in 2007 and 2014 and functional health in 2014. Severe pain in the latest wave of IFLS was associated with older age, female, lower education, having chronic conditions or depressive symptoms. Notably, those who reported ‘low–medium’ pain in 2007 and ‘severe’ pain in 2014 belonged to the most vulnerable group with worst functional health outcomes (4.96 points higher limitation scores and 1.17 kg weaker average grip strength). Findings have implications for public health policy in monitoring and management of pain including related co-morbidities as an increasingly critical component of population ageing.
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Affiliation(s)
- Vasoontara Sbirakos Yiengprugsawan
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), Business School, University of New South Wales, Kensington 2033, Australia;
- Correspondence: or ; Tel.: +61-2-9385-5298
| | - John Piggott
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), Business School, University of New South Wales, Kensington 2033, Australia;
| | - Firman Witoelar
- Crawford School of Public Policy, The Australian National University, Canberra 2601, Australia;
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (F.M.B.); (R.G.C.)
- Centre for Education and Research on Ageing (CERA), Concord Repatriation General Hospital, Sydney 2139, Australia
| | - Robert G Cumming
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (F.M.B.); (R.G.C.)
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Lentz TA, Rhon DI, George SZ. Predicting Opioid Use, Increased Health Care Utilization and High Costs for Musculoskeletal Pain: What Factors Mediate Pain Intensity and Disability? THE JOURNAL OF PAIN 2020; 21:135-145. [PMID: 31201989 PMCID: PMC6908782 DOI: 10.1016/j.jpain.2019.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/29/2019] [Accepted: 06/01/2019] [Indexed: 12/28/2022]
Abstract
This study determined the predictive capabilities of pain intensity and disability on health care utilization (number of condition-specific health care visits, incident, and chronic opioid use) and costs (total condition-specific and overall medical costs) in the year following an initial evaluation for musculoskeletal pain. We explored pain catastrophizing and spatial distribution of symptoms (ie, body diagram symptom score) as mediators of these relationships. Two hundred eighty-three military service members receiving initial care for a musculoskeletal injury completed a region-specific disability measure, numeric pain rating scale, Pain Catastrophizing Scale, and body pain diagram. Pain intensity predicted all outcomes, while disability predicted incident opioid use only. No mediation effects were observed for either opioid use outcome, while pain catastrophizing partially mediated the relationship between pain intensity and number of health care visits. Pain catastrophizing and spatial distribution of symptoms fully mediated the relationship between pain intensity and both cost outcomes. The mediation effects of pain catastrophizing and spatial distribution of symptoms are outcome specific, and more consistently observed for cost outcomes. Higher pain intensity may drive more condition-specific health care utilization and use of opioids, while higher catastrophizing and larger spatial distribution of symptoms may drive higher costs for services received. PERSPECTIVE: This article examines underlying characteristics that help explain relationships between pain intensity and disability, and the outcomes of health care utilization and costs. Health care systems can use these findings to refine value-based prediction models by considering factors that differentially influence outcomes for health care use and cost of services.
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Affiliation(s)
- Trevor A Lentz
- Department of Orthopaedic Surgery Duke University, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
| | - Daniel I Rhon
- Department of Orthopaedic Surgery Duke University, Duke Clinical Research Institute, Duke University, Durham, North Carolina; Brooke Army Medical Center, San Antonio, Texas; Physical Performance Service Line, G3/5/7, Army Office of the Surgeon General, Falls Church, Virginia
| | - Steven Z George
- Department of Orthopaedic Surgery Duke University, Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Orthopeadic Surgery, Duke University, Durham, North Carolina
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Fayão JG, Libardoni TDC, Martins J, Souza CDS, Oliveira ASD. Queixas musculoesqueléticas no ombro: características dos usuários e dos atendimentos na atenção primária. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18016826012019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A dor no ombro representa a terceira principal queixa musculoesquelética da população. Afeta fatores físicos, psicológicos e econômicos do indivíduo. A atenção primária à saúde é essencial para a eficácia do cuidado dos pacientes acometidos. Este estudo é observacional transversal e obteve um perfil dos usuários e das consultas médicas com relato de dor no ombro durante um ano na atenção primária do município de Ribeirão Preto (SP). Foram analisados em prontuários os registros das consultas médicas agendadas e sem agendamento prévio. Nestes registros foram coletados dados dos pacientes que apresentaram queixas de dor musculoesquelética no ombro (dados sociodemográficos e características das consultas), que foram analisados de forma descritiva e pelos testes qui-quadrado de Pearson, razão de chance e regressão logística múltipla. A frequência de consultas médicas por queixa de dor no ombro foi de 9,2%. O perfil dos indivíduos que se queixaram de dor no ombro se caracterizava por mulheres, com idade avançada, casadas, alfabetizadas e que apresentavam alguma ocupação. As consultas em sua maioria tiveram retornos agendados, oferecimento de orientações terapêuticas e poucos encaminhamentos.
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Jung SH, Kwon OY, Yi CH, Cho SH, Jeon HS, Weon JH, Hwang UJ. Predictors of dysfunction and health-related quality of life in the flexion pattern subgroup of patients with chronic lower back pain: The STROBE study. Medicine (Baltimore) 2018; 97:e11363. [PMID: 30024508 PMCID: PMC6086501 DOI: 10.1097/md.0000000000011363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Findings about predictors of chronic lower-back pain (CLBP) were inconsistent and inconclusive in previous studies because patients with CLBP are heterogeneous. Subgrouping patients with CLBP, according to a CLBP classification system, might thus clarify the research findings. CLBP in the direction of lumbar flexion movement, that is, the flexion pattern, is common in clinical situations. Therefore, the purpose of this study was to determine the predictors of dysfunction (pain, disability) and health-related quality of life in the flexion pattern subgroup of patients with CLBP.A cross-sectional study of prospectively collected data. One hundred eight subjects in the flexion pattern subgroup of CLBP. Thirteen variables were measured: the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Short Form-36 (SF-36), the Beck Depression Inventory (BDI), hip internal rotation range of motion, hip flexion range of motion, knee extension range of motion, knee extension with dorsiflexion range of motion, ratio forward flexion, knee extension strength, hip extension strength, hip flexion strength, and lumbopelvic stability.The models for predictors of lower-back pain in the CLBP flexion pattern subgroup included knee extension and the BDI as predictor variables that accounted for 8.1% of the variance in the VAS (P < .05); predictors for disability included the BDI, age, and hip flexion strength, which accounted for 21.2% of the variance in the ODI (P < .05); predictors for health-related quality of life included the BDI, sex, knee extension with dorsiflexion range of motion, and age, which accounted for 38.8% of the variance in the SF-36 (P < .05) in multiple regression models with a stepwise selection procedure.The current results suggest that knee extension, the BDI, age, hip flexion strength, knee extension with dorsiflexion, and sex should be considered when determining appropriate prediction, prevention, and intervention in the flexion pattern subgroup of patients with CLBP.
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Affiliation(s)
- Sung-hoon Jung
- Department of Physical Therapy
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju
| | - Oh-yun Kwon
- Department of Physical Therapy
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju
| | | | | | | | - Jong-hyuck Weon
- Department of Physical Therapy, Graduate School, Joongboo University, Geumsan, South Korea
| | - Ui-jae Hwang
- Department of Physical Therapy
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju
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Sribastav SS, Peiheng H, Jun L, Zemin L, Fuxin W, Jianru W, Hui L, Hua W, Zhaomin Z. Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain. PeerJ 2017; 5:e3282. [PMID: 28533953 PMCID: PMC5436560 DOI: 10.7717/peerj.3282] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/07/2017] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain (LBP) is the most common problem worldwide. There are several negative consequences of LBP, such as sleep disorders, work leave, disability, depression, anxiety, and poor quality of life. In this study, we designed to evaluate the prevalence of sleep disturbance in patients with non-specific LBP(NSLBP), and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP. Aim In this study, we designed to evaluate the prevalence of sleep disturbance in patients with NSLBP, and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP. Methods A cross-sectional self-assessment questionnaire survey was carried out in an outpatient clinic. Anonymous assessments were used to characterize the presence of NSLBP, PSQI, VAS, SF-36 form, ODI, BAI and BDI. Cross-correlation among the severity of NSLBP and sleep disturbance, anxiety, depression and life quality were evaluated. Results Patients with NSLBP have a higher incidence of sleep disorder, anxiety and depression, and higher ODI scores than healthy people without LPB (P < 0.01). NSLBP patients with sleep disorders have more severe anxiety, depression, an increased VAS score and poor daily living (P < 0.05). NSLBP patients with anxiety have declined sleep quality, poor daily living, decreased work and social skills, and increased LBP severity (P < 0.05). NSLBP patients with depression have declined sleep quality, poor daily living, decreased work and social skills (P < 0.05). Significant associations were found between the severity of NSLBP and sleep disorders, anxiety and ODI scores. Conclusion Psychological and social factors play an important role in the development of NSLBP. NSLBP leads to sleep disorders, which decrease the sleep quality and increase the unpleasant emotions and memories in return; these can exacerbate the severity of LBP, with the cycle repeating to form a vicious circle.
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Affiliation(s)
- Shilabant Sen Sribastav
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - He Peiheng
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Long Jun
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Li Zemin
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Wei Fuxin
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Wang Jianru
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Liu Hui
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Wang Hua
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Zheng Zhaomin
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China.,Pain Research Center and Department of Physiology, Zhongshan Medical School of Sun Yat-Sen University, Guangzhou, P.R. China
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Jegan NRA, Brugger M, Viniol A, Strauch K, Barth J, Baum E, Leonhardt C, Becker A. Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care. BMC Musculoskelet Disord 2017; 18:114. [PMID: 28320375 PMCID: PMC5360090 DOI: 10.1186/s12891-017-1482-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors. Methods Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together. Results More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability. Conclusions Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more beneficial. Trial registration German Clinical Trial Register, DRKS00003123 (June 28th 2011). Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1482-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nikita Roman A Jegan
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany.
| | - Markus Brugger
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Annika Viniol
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Konstantin Strauch
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich und University Zurich, Zurich, Switzerland
| | - Erika Baum
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Corinna Leonhardt
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Annette Becker
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
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Chen B, Li L, Donovan C, Gao Y, Ali G, Jiang Y, Xu T, Shan G, Sun W. Prevalence and characteristics of chronic body pain in China: a national study. SPRINGERPLUS 2016; 5:938. [PMID: 27386382 PMCID: PMC4929094 DOI: 10.1186/s40064-016-2581-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/15/2016] [Indexed: 01/20/2023]
Abstract
Background Chinese citizens regularly experience some form of bodily pain, yet little is known regarding the epidemiology of pain. Methods We conducted a nationally representative sample cross sectional study to estimate the prevalence of pain and identify risk factors of pain among 19,665 community residents aged 18–65 years in China. The China Sub-optimal Health Survey (CSHS) data was used to estimate pain prevalence. Body pain was also estimated by self-reports from the sample population. A logistical regression model was applied to estimate the odds ratio and 95 % CIs of acute pain and chronic pain to explore the potential risk factors. Results Women had a higher prevalence of pain than men (39.92 vs. 32.17 % for chronic pain). The prevalence of pain increased with age (29.72 % for ages 18–25 vs. 42.23 % for ages 45–65). The most common complaints were head, neck/shoulder, and waist/back pain. Females (OR 1.57, 95 % CI 1.44–1.71) ages 25 or older (25–45: OR 1.19, 95 % CI 1.04–1.36; 45–65: OR 1.47, 95 % CI 1.26–1.73) were more likely to report having chronic pain. Subjects’ living areas, and their drinking status (OR 1.32, 95 % CI 1.13–1.53) or smoking status (OR 1.01, 95 % CI 0.91–1.11), were also factors that were significantly associated with increased reporting of chronic pain. Conclusion Women had a higher prevalence of chronic pain than men, although both sexes had a high prevalence for chronic pain. There were significant differences between the two sexes and the location of chronic pain in the body, most notably in the shoulders, stomach, abdomen, and waist.
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Affiliation(s)
- Beifeng Chen
- School of Public Health, Wannan Medical College, Wuhu, 241002 China
| | - Linlin Li
- University of California Davis Health System, Sacramento, CA 95817 USA
| | - Connor Donovan
- College of Business, University of Arkansas at Little Rock, Little Rock, AR USA
| | - Yongqing Gao
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, 528458 China
| | - Gholam Ali
- School of Medicine, Tulane University, New Orleans, LA 70112 USA
| | - Yan Jiang
- Infocast Company, Kowloon, Hong Kong
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu Province 215123 China ; Tulane University, School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112 USA
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, 100005 China
| | - Wenjie Sun
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, 528458 China ; Tulane University, School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112 USA
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Avila MJ, Walter CM, Baaj AA. Outcomes and Complications of Minimally Invasive Surgery of the Lumbar Spine in the Elderly. Cureus 2016; 8:e519. [PMID: 27081580 PMCID: PMC4829395 DOI: 10.7759/cureus.519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/23/2016] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Minimally invasive spine (MIS) surgery is gaining popularity in the elderly. With aging population and a strong desire for all patients to remain physically active, this trend will likely continue. Previous studies have reported clinical outcomes in the elderly undergoing MIS surgery; however, most of these studies encompass multiple surgeons at different sites and thus present heterogeneous experiences. In this work, we investigate the clinical outcomes and complications of all lumbar MIS procedures performed in patients over 65 years of age by a single surgeon. METHODS A retrospective analysis of a prospectively maintained database of spine surgeries was performed. Twenty-six patients who underwent 27 procedures were included. RESULTS Mean age at surgery was 72 years (range 64-86). The mean BMI was 30.2 kg/m(2), patients had an average of 5 comorbidities, took 9 medications, and 15% were smokers. The mean symptoms duration was 40.6 months with the numeric rating scale (NRS) and the Oswestry disability index (ODI) prior to surgery of 7.68 and 50% respectively. Six different types of procedures were performed, the most common was the interlaminar decompression and fusion (ILIF) followed by MIS laminectomy, microdiscectomy and MIS lateral fusion (XLIF). 74% of the surgeries were done at a single level. Average blood loss was 43 mL, and the mean length of stay was 1.7 days. There were three complications (11.1%): one urinary tract infection, one pulmonary embolism, and one new, postoperative weakness. At six months follow-up, there was a mean improvement of 27% in ODI, and a 5.6 improvement in NRS (both p<0.05); 90% of patients stated they would have the surgery again. CONCLUSION Minimally invasive lumbar spine surgery is both safe and highly effective in the elderly population. Patient selection is of utmost importance. This data will add to the existing literature on the overall safety and effectiveness of these procedures in the elderly population.
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Affiliation(s)
- Mauricio J Avila
- Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical College
| | | | - Ali A Baaj
- Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical College
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