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Liu J, Chen J, Tian L, Tang C, Shuai W, Lin F, Luo S, Xu X, An J. Translation, cultural adaptation, and validation of Numerical Pain Rating Scale and Global Rating of Change in Tibetan musculoskeletal trauma patients. Sci Rep 2024; 14:11961. [PMID: 38796571 PMCID: PMC11127991 DOI: 10.1038/s41598-024-62777-7] [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: 11/21/2023] [Accepted: 05/21/2024] [Indexed: 05/28/2024] Open
Abstract
Tibetan-speaking patients seeking care in predominantly Mandarin-speaking healthcare settings frequently face communication barriers, leading to potential disparities and difficulties in accessing care. To address this issue, we translated, culturally adapted, and validated the Numerical Pain Rating Scale (NPRS) and the Global Rating of Change (GRoC) into Tibetan (NPRS-Tib and GRoC-Tib), aiming to facilitate cross-linguistic and cross-cultural interactions while examining potential challenges in the adaptation process. Using standard translation-backward translation methods, expert review, pilot testing, and validation through a cross-sectional study with a short-term longitudinal component, we engaged 100 Tibetan patients with musculoskeletal trauma for psychometric validation, including 37 women (aged 22-60 years, mean age 39.1 years). The NPRS-Tib and GRoC-Tib exhibited outstanding psychometric properties, with an Intraclass Correlation Coefficient (ICC) of 0.983 for NPRS-Tib indicating superb test-retest reliability, and expert review confirming good content validity for both instruments. A Spearman's correlation coefficient (Rho) of -0.261 (P = 0.0087) revealed a significant, albeit weak, correlation between changes in NPRS-Tib scores and GRoC-Tib scores. The adaptation process also presented notable challenges, including translation discrepancies from translators' diverse backgrounds and levels of expertise, ambiguity in scale options, and the lack of established tools for criterion validity assessment in Tibetan.
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Affiliation(s)
- Jinling Liu
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Juncheng Chen
- Southwest Minzu University, No. 16 Section 4 First Ring Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Leilei Tian
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Chuan Tang
- CCU Department of Cardiology, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Wenbin Shuai
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Fang Lin
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Shilin Luo
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xinxin Xu
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jingjing An
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Eckenrode BJ, Kietrys DM, Brown A, Parrott JS, Noehren B. Effects of high frequency strengthening on pain sensitivity and function in female runners with chronic patellofemoral pain. Phys Ther Sport 2024; 67:31-40. [PMID: 38471409 DOI: 10.1016/j.ptsp.2024.02.007] [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: 10/16/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of a high frequency strengthening program on function, pain, and pain sensitization in female runners with chronic patellofemoral pain (PFP). DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty female runners (mean age 32 ± 8.1 years) with chronic PFP completed an 8-week home strengthening program. MAIN OUTCOME MEASURES Variables assessed at baseline, 8-weeks, and 12 weeks included single leg step down test (SLSD), pain, Anterior Knee Pain Scale (AKPS), University of Wisconsin Running Injury and Recovery Index (UWRI), and quantitative sensory testing. RESULTS There was large and statistically significant improvement at 8 and 12 weeks for average knee pain (ηp2 = 0.334, p < 0.001), worst knee pain (ηp2 = 0.351, p < 0.001), SLSD (ηp2 = 0.161, p = 0.001), AKPS (ηp2 = 0.463, p < 0.001), and UWRI (ηp2 = 0.366, p < 0.001). A medium to large effect and statistically significant improvement in pressure pain threshold testing was found for all local and remote structures (ηp2 range, 0.110 to 0.293, range p < 0.001 to p = 0.009) at 8 and 12 weeks. CONCLUSIONS There was a significant decrease in local and remote hyperalgesia via mechanical and thermal pain sensitivity testing in female runners with chronic PFP. There was a large effect and significant improvement in self-reported pain and function.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, Department of Physical Therapy, Glenside, PA, 19038, USA.
| | - David M Kietrys
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences, Blackwood, NJ, 08012, USA
| | - Allison Brown
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences Newark, NJ, 07101, USA
| | - J Scott Parrott
- Rutgers School of Health Professions, Department of Interdisciplinary Studies, Blackwood, NJ, 08012, USA
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, KY, 40536, USA
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Harris LK, Troelsen A, Terluin B, Gromov K, Ingelsrud LH. Minimal important change thresholds change over time after knee and hip arthroplasty. J Clin Epidemiol 2024; 169:111316. [PMID: 38458544 DOI: 10.1016/j.jclinepi.2024.111316] [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: 12/12/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES The minimal important change (MIC) reflects what patients, on average, consider the smallest improvement in a score that is important to them. MIC thresholds may vary across patient populations, interventions used, posttreatment time points and derivation methods. We determine and compare MIC thresholds for the Oxford Knee Score and Oxford Hip Score (OKS/OHS) at 3 months postoperatively to 12- and 24-month thresholds in patients undergoing knee or hip arthroplasty. STUDY DESIGN AND SETTING This cohort study used data from patients undergoing total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or total hip arthroplasty (THA) at a public hospital between February 2016 and February 2023. At 3, 12, and 24 months postoperatively, patients responded to the OKS/OHS and a 7-point anchor question determining experienced changes in knee or hip pain and functional limitations. We used the adjusted predictive modeling method that accounts for the proportion improved and the reliability of the anchor question to determine MIC thresholds and their mean differences between time points. RESULTS Complete data were obtained from 695/957 (73%), 1179/1703 (69%), and 1080/1607 (67%) patients undergoing TKA, 474/610 (78%), 438/603 (73%), and 355/507 (70%) patients undergoing UKA, and 965/1315 (73%), 978/1409 (69%), and 1059/1536 (69%) patients undergoing THA at 3, 12, and 24 months, respectively. The median age ranged from 68 to 70 years and 55% to 60% were females. The proportions improved ranged between 83% and 95%. The OKS/OHS MIC thresholds were 0.1, 4.2, and 5.1 for TKA, 1.8, 5.6, and 3.4 for UKA, and 1.3, 6.1, and 6.0 for THA at 3, 12, and 24 months postoperatively, respectively. The reliability ranged between 0.64 and 0.82, and the MIC values increased between three and 12 months but not between 12 and 24 months. CONCLUSION Any absence of deterioration in pain and function is considered important at 3 months after knee or hip arthroplasty. Increasing thresholds over time suggest patients raise their standards for what constitutes a minimal important improvement over the first postoperative year. Besides improving our understanding of patients' views on postoperative outcomes, these clinical thresholds may aid in interpreting registry-based treatment outcome evaluations.
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Affiliation(s)
- Lasse K Harris
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Berend Terluin
- Department of General Practice, Amsterdam UMC Location, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lina H Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Arcolin I, Giardini M, Corna S, Sartorio F, Caligari M, Godi M. Construct validity, responsiveness and minimal important difference of the cumulated ambulation score in older adults with hip fracture in sub-acute rehabilitation facility. Clin Rehabil 2024:2692155241249351. [PMID: 38656174 DOI: 10.1177/02692155241249351] [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: 04/26/2024]
Abstract
OBJECTIVE To assess the construct validity, responsiveness and minimal important difference of the cumulated ambulation score in patients with hip fracture in sub-acute rehabilitation facility. DESIGN Observational, prospective, monocenter, cohort study. SETTING Rehabilitation Institute. PARTICIPANTS 456 older adults with hip fracture (≥65 years) admitted for inpatient rehabilitation. MAIN OUTCOME MEASURES Cumulated ambulation score, functional independence measure and functional ambulation category were collected at admission and discharge. Construct validity and responsiveness were assessed through hypothesis testing and minimal important difference was determined using the anchor-based method; floor and ceiling effects were also assessed. RESULTS The cumulated ambulation score showed strong correlations with the functional independence measure and functional ambulation category scores at both admission and discharge, satisfying all the hypotheses for construct validity. The effect size of cumulated ambulation score was 1.63. Changes in cumulated ambulation score had a moderate-to-strong correlation with changes of other instruments and were able to discriminate patients improved from those not-improved, and patients classified as independent ambulators from those dependent. A ceiling effect was found only at discharge. The estimated minimal important difference was 2 points. CONCLUSIONS The cumulated ambulation score showed high levels of construct validity and responsiveness according to the hypothesis testing. A two points improvement at the end of rehabilitation was found to be clinically important in people with hip fracture in the sub-acute phase. The ceiling effect found at discharge suggested the limitation of the scale in assessing people with a partially recovered autonomy in performing postural changes and gait.
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Affiliation(s)
- Ilaria Arcolin
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Marica Giardini
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Stefano Corna
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Francesco Sartorio
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
- Department of Scientific Research Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Budapest, Hungary
| | - Marco Caligari
- Integrated Laboratory of Assistive Solutions and Translational Research (LISART), Istituti Clinici Scientifici Maugeri IRCCS, Institute of Pavia, Pavia, Italy
| | - Marco Godi
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
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La Touche R, Pardo-Montero J, Grande-Alonso M, Paris-Alemany A, Miñambres-Martín D, Nouvilas-Pallejà E. Psychological, Pain, and Disability Factors Influencing the Perception of Improvement/Recovery from Physiotherapy in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study. Healthcare (Basel) 2023; 12:12. [PMID: 38200918 PMCID: PMC10778840 DOI: 10.3390/healthcare12010012] [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: 10/22/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES The aim of this study was to identify the possible relationships between psychological, pain, and disability variables with respect to the perception of change/recovery from physiotherapy in patients with chronic musculoskeletal pain (CMP). METHODS A cross-sectional observational study was performed with 150 patients. All patients completed a series of self-administered questionnaires and a series of self-reports to quantify the perception of change with respect to the physiotherapy they underwent, the level of disability and pain intensity, the level of fear of movement, the level of catastrophism, the degree of self-efficacy, the level of therapeutic alliance and their adherence to the physiotherapy. RESULTS The strongest correlations were between the subjective perception of change and the number of sessions, treatment beliefs, self-efficacy, pain intensity, collaboration, and bonding. The linear regression model showed that the number of sessions, treatment beliefs, self-efficacy, compliance, pain intensity, and bonding were predictors of subjective perception of improvement, with 50% of the variance. CONCLUSIONS Treatment beliefs, therapeutic alliance, degree of self-efficacy, and pain intensity have been shown to be predictors of a subjective perception of improvement in patients with CMP. In turn, multimodal treatments had the greatest positive impact on the subjective perception of improvement.
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Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain; (R.L.T.)
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain; (R.L.T.)
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
| | - Mónica Grande-Alonso
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina, Universidad de Alcalá, 28871 Alcalá de Henares, Spain;
- Grupo de Investigación Clínico-Docente Sobre Ciencias de la Rehabilitación (INDOCLIN), Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Diego Miñambres-Martín
- Premium Madrid Global Health Care, 28016 Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Encarnación Nouvilas-Pallejà
- Department of Social and Organizational Psychology, National University of Distance Education, 28040 Madrid, Spain
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Failla MJ, Mintken PE, McDevitt AW, Michener LA. Trajectory of patient-rated outcomes and association with patient acceptable symptom state in patients with musculoskeletal shoulder pain. J Man Manip Ther 2023; 31:279-286. [PMID: 36300352 PMCID: PMC10324443 DOI: 10.1080/10669817.2022.2137350] [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] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Characterize trajectory and predictors of patient acceptable symptom state (PASS) defined recovery at 6 months. METHODS Individuals with musculoskeletal shoulder pain (n = 140) completed patient-reported disability and PASS at baseline, 1 and 6 months. The PASS was categorized into 3 trajectory groups; 1.) Early Recovery (answered yes to PASS at 1 and 6-months), 2.) Delayed Recovery (PASS-yes only at 6-months), and 3.) Unrecovered. Mixed models characterized the trajectory between PASS-groups using SPADI and QDASH disability change scores. Logistic regression identified predictors of Early Recovery versus Delayed+Unrecovered groups. RESULTS PASS-defined recovery rates by group were Early Recovery (58%), Delayed Recovery (22%), and Unrecovered (20%). A group main effect indicated lower disability over time in the Early Recovery versus Unrecovered (QDASH mean difference = 11(2.4); p = 0.001; SPADI mean difference = 12(3); p < 0.001). The odds of an Early Recovery slightly increased with greater change scores on the SPADI (odds ratio = 1.06, 95%CI:1.02,1.11; p = 0.004) and QDASH (odds ratio = 1.08, 95%CI:1.03,1.13; p = 0.003) over the first month of treatment. CONCLUSION Recovery trajectories of patients indicate differing responses to treatment despite overall improvements over the first month of treatment. Incorporating both patient-reported disability (SPADI, QDASH) and acceptable satisfaction (PASS) may aid in determining recovery trajectory, but more evidence is needed to be clinically useful.
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Affiliation(s)
- Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont 5, Burlington, VT, USA
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Paul E. Mintken
- Physical Therapy Program, University of Colorado School of Medicine, Colorado, USA
- Wardenburg Health Center, University of Colorado-Boulder, Boulder, Colorad
| | - Amy W. McDevitt
- Physical Therapy Program, University of Colorado School of Medicine, Colorado, USA
- Sports Physical Therapy and Rehabilitation, University of Colorado Health, Denver, Colorad
| | - Lori A. Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Kalsi-Ryan S, Balbinot G, Wang JZ, Abel R, Bolliger M, Curt A, Fehlings MG, Jin D, Verrier M, Velstra IM. Minimal Clinically Important Difference of Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 in Acute Cervical Traumatic Spinal Cord Injury. J Neurotrauma 2022; 39:1645-1653. [PMID: 35652348 DOI: 10.1089/neu.2021.0500] [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: 01/06/2023] Open
Abstract
The Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 (GRASSP v1) is a validated measure of upper extremity impairment shown to be sensitive and responsive for traumatic cervical spinal cord injury (SCI) in both North American (NA) and European (EU) cohorts. The minimal clinically important difference (MCID) is the quantitative change in an assessment scale that patients perceive as being beneficial. Our aim was to establish the MCID of all subtests of the GRASSP v1 for cervical SCI. We prospectively analyzed 127 patients from NA and EU for up to six months after motor complete and incomplete cervical SCI using the GRASSP v1, Spinal Cord Independence Measure, and International Standards of Neurological Classification of Spinal Cord Injury. We used a patient global rating of change and the anchor-based method to calculate MCID of GRASSP v1 at six months post-injury. The MCID was established for the whole group, dividing the sample by "better" and "much better." Improvement in GRASSP v1 Strength and Prehension Performance scores of 13 and 3 are the MCID for the better category, and 19 and 7 are the MCID for the much better category, respectively. The MCID was also established for the motor complete and incomplete groups. Improvement in GRASSP v1 Strength and Prehension Performance scores of 12 and 6 are the MCID for the motor complete group, and 17 and 12 are the MCID for the motor incomplete group, respectively. The GRASSP v1 Strength subscore is the most sensitive for detecting meaningful clinical change in patients and is most closely related to measures of independence. Thus, use of GRASSP v1 Strength and Prehension Performance as measures of change is substantiated by this study.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Toronto, Ontario, Canada
| | | | - Justin Zhang Wang
- University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Toronto, Ontario, Canada
| | - Rainer Abel
- Spinal Cord Injury Centre, Hohe Warte, Bayreuth, Germany.,European Multicenter Study about Human Spinal Cord Injury, Zurich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
| | - Michael G Fehlings
- University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Toronto, Ontario, Canada.,Krembil Neuroscience Centre, Toronto, Ontario, Canada
| | - Daniel Jin
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Verrier
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Toronto, Ontario, Canada
| | - Inge-Marie Velstra
- European Multicenter Study about Human Spinal Cord Injury, Zurich, Switzerland.,Swiss Paraplegic Centre, Knotwil, Switzerland
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Predicting the success of multimodal rehabilitation in chronic ankle instability based on patient-reported outcomes. BMC Musculoskelet Disord 2022; 23:706. [PMID: 35879757 PMCID: PMC9310506 DOI: 10.1186/s12891-022-05676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to identify potential indicators to predict the success of multimodal rehabilitation in chronic ankle instability (CAI) patients based on patient-reported outcomes. Methods Sixty patients with self-reported CAI participated. Their demographic information, injury history, and symptoms were recorded. Physical examinations and dynamic posture control tests were performed. The participants underwent sixteen 30-min treatment sessions of multimodal rehabilitation over 8 weeks. Fifty-one patients (85.0%) were available for follow-up after 8 weeks of the intervention. Treatment success was defined based on the participants’ perceived recovery using the global rating of change (GRC). Potential predictor variables were entered into a stepwise logistic regression model to identify variables for the prediction of treatment success. Results Forty of 51 participants (78.4%) were considered to have a successful outcome. Of the variables assessed, time since last sprain ≤ 8 months was a predictor of treatment success (p < 0.05). If a patient met the criteria, there was an 88.03% probability of successful multimodal rehabilitation. Conclusion A time since the last sprain ≤ 8 months may predict successful patient-reported outcomes after multimodal rehabilitation in CAI patients. Level of evidence Prospective study, Level 2. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05676-0.
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Jones SM, Unger JM. Feasibility of a patient-centered method to determine meaningful change in pain intensity on a survey of patients with a history of cancer. Pain Rep 2022; 7:e1015. [PMID: 38304398 PMCID: PMC10833635 DOI: 10.1097/pr9.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Current methods of determining minimally important differences (MIDs) in patient-reported outcomes (PROs) do not incorporate individual patient values. Objectives This study tested the feasibility of having cancer patients define a personally meaningful change in pain intensity, a method we have termed Precision PROs. Methods Adults with cancer and pain (n = 231) completed an electronic questionnaire twice over 2 weeks. Participants were then given their pain intensity scores with an explanation of score meaning. Participants then defined their own MIDs for an increase and decrease in pain intensity. Participants also answered 3 questions testing their understanding of the MID concept. Results The majority of participants could define an individually meaningful increase (97% [n = 223]) and individually meaningful decrease (98% [n = 226]) in pain intensity. Seventy-two percent of participants (n = 166) answered all test questions correctly and 26% (n = 60) answered 2 of 3 correctly. Using the individual MID, 32% (95% CI: 25.3, 40.0) of the sample experienced a meaningful change between the 2 surveys, more than other methods (z-test: 14%, 95% CI: 9.4, 20.6; distribution-based method: 24%, 95% CI: 17.7, 31.1). Conclusions This study showed the feasibility of the Precision PRO individual MID, which could be used in clinical care or clinical trials. Further studies are needed to compare the individual MID to current methods.
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Armijo-Olivo S, de Castro-Carletti EM, Calixtre LB, de Oliveira-Souza AIS, Mohamad N, Fuentes J. Understanding Clinical Significance in Rehabilitation: A Primer for Researchers and Clinicians. Am J Phys Med Rehabil 2022; 101:64-77. [PMID: 34091470 DOI: 10.1097/phm.0000000000001799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The objective of this review was to summarize the concept of clinical significance and associated methods focusing on the area of rehabilitation to provide a resource to rehabilitation researchers and clinicians. Studies were searched on electronic databases from inception until July 28, 2020, with no date or language limits. Manual searches as well as Scopus forward citation for relevant references were performed. Narrative synthesis of study results was performed. Definitions of the concepts related to clinical significance, ways of calculating, and interpreting each method were provided using rehabilitation examples. An explanation of methods to evaluate clinical significance (distribution, anchor, and opinion-based methods) and their advantages and disadvantages were also provided. Considering the limitations of statistical significance in assuring meaningfulness of results, clinical interpretation of research outcomes and the report of clinical significance in intervention trials should be a priority in rehabilitation research. When possible, the use of multiple methods (distribution, anchor, and opinion based) is recommended. Thus, clinical researchers are encouraged to present results in a manner that allow the rehabilitation professionals to easily interpret and implement those results in their clinical practice.
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Affiliation(s)
- Susan Armijo-Olivo
- From the University of Applied Sciences Osnabrück, Faculty of Economics and Social Sciences, Osnabrück, Germany (SA-O, AISO-S); Faculties of Rehabilitation Medicine and Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (SA-O); Postgraduate Program in Human Movement Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, Brazil (EMC-C); Department of Dental Materials and Prosthodontics, Araraquara Dental School, São Paulo State University (UNESP), Araraquara, Brazil (LBC); Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Pernambuco, Brazil (AISO-S); Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada (NM); Faculty of Health Science, Center of Physiotherapy, Universiti Teknologi MARA, Puncak Alam, Malaysia (NM); and Faculty of Health Sciences, Department of Physical Therapy, Clinical Research Lab, Catholic University of Maule, Talca, Chile (JF)
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Terluin B, Griffiths P, Trigg A, Terwee CB, Bjorner JB. Present state bias in transition ratings was accurately estimated in simulated and real data. J Clin Epidemiol 2021; 143:128-136. [PMID: 34965478 DOI: 10.1016/j.jclinepi.2021.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/14/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Patient-reported transition ratings are supposed to reflect the change between a previous baseline health state and a present follow-up state, but may reflect the present state to a greater extent. This so-called 'present state bias' (PSB) potentially threatens the validity of transition ratings. Several criteria have been proposed to assess PSB. We examined how well these criteria perform and to which extent confirmatory factor analysis (CFA) for categorical data provides an accurate assessment of the degree of PSB. STUDY DESIGN AND SETTING We simulated a multiple samples with baseline and follow-up item responses to a hypothetical questionnaire, and transition ratings. The samples varied with respect to various distributional characteristics and the degree of PSB. The performance of criteria proposed in the literature, and a new CFA-based criterion, were evaluated by the proportion of explained variance in PSB. In addition, four real datasets were analyzed. RESULTS The known criteria explained 36-74% of the variance in PSB. A new CFA-based criterion, namely the ratio of the factor loadings of the transition ratings plus one, explained 81-98% of the variance in PSB across the samples. CONCLUSION Present state bias in transition ratings can be estimated accurately using CFA.
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Affiliation(s)
- Berend Terluin
- Department of General Practice, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | | | - Andrew Trigg
- Patient-Centered Outcomes, Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB United Kingdom.
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Jakob B Bjorner
- QualityMetric, Johnston, Rhode Island, USA; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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12
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Salihu D, Wong EML, Bello UM, Kwan RYC. Effects of dance intervention on agitation and cognitive functioning of people living with dementia in institutional care facilities: Systematic review. Geriatr Nurs 2021; 42:1332-1340. [PMID: 34560528 DOI: 10.1016/j.gerinurse.2021.08.015] [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: 05/26/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Agitation and impaired cognitive functioning are common symptoms of dementia, which require costly medication regimens that are associated with adverse effects. This study investigates the effects of dance interventions on agitation and cognitive function in people living with dementia in institutional care facilities. METHODS Five electronic databases were searched for eligible studies on dance interventions for people living with dementia published between 2002 and 2021. Standard deviation and post mean values were extracted. Within-group Hedges' g was computed for individual studies. RESULTS Six randomised controlled trials and three non-randomised studies of satisfactory quality, with a total of 610 participants, were included. Statistical analysis found significant improvements in agitation and cognitive functioning with dance interventions. DISCUSSION This review provided favourable evidence on the effects of dance interventions on agitation and cognitive functions in people with dementia. However, given the limited evidence, more studies are needed to confirm the effects.
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Affiliation(s)
- Dauda Salihu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Eliza Mi Ling Wong
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Umar Muhammad Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Rick Yiu Cho Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong).
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Sheehan RC, Fain AC, Wilson JB, Wilken JM, Rábago CA. Inclusion of a Military-specific, Virtual Reality-based Rehabilitation Intervention Improved Measured Function, but Not Perceived Function, in Individuals with Lower Limb Trauma. Mil Med 2021; 186:e777-e783. [PMID: 33201245 DOI: 10.1093/milmed/usaa483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/12/2020] [Accepted: 10/28/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Lower extremity injury is common in the military and can lead to instability, pain, and decreased function. Military service also places high physical demands on service members (SMs). Standard treatment interventions often fail to align with these unique demands. Thus, the goal of the study was to evaluate the effectiveness of a military-specific virtual reality-based rehabilitation (VR) intervention supplemental to standard care (SC) in improving military performance in SMs with lower extremity injuries. MATERIALS AND METHODS As part of an institutional review board-approved randomized control trial, SMs receiving care at an advanced rehabilitation center were randomized to receive either SC or VR in addition to SC (VR+SC). Participants were evaluated before treatment and ∼3 weeks later using a previously developed and validated military-specific assessment. Perceived improvement in physical function was measured using a Global Rating of Change (GROC) questionnaire. A repeated measures ANOVA was used to evaluate the effects of adding VR on the military-specific assessment measures. Linear regression was used to determine the relationship between perceived improvement, measured improvement, and VR volume. RESULTS The VR+SC group was able to traverse a greater distance in the assessment following the VR intervention. There was no significant difference in GROC between groups. For the VR+SC group, change in distance completed was not correlated with GROC, but GROC was correlated with VR volume. CONCLUSION VR improved the distance that participants were able to traverse in the assessment. However, the VR+SC group demonstrated a disconnect between their perceived functional improvement as measured by the GROC and functional improvement as measured by the change in the distance completed. Rather, the perceived improvement appears to be more correlated with the volume of VR received. The way in which the treatment progression is structured and communicated may influence how patients perceive their change in physical function.
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Affiliation(s)
- Riley C Sheehan
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - AuraLea C Fain
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
| | - Jonathan B Wilson
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Jason M Wilken
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
| | - Christopher A Rábago
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
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14
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Riley SP, Harris J, O'Halloran BJ, Showalter CR, Learman KE. Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1914. [PMID: 34028940 DOI: 10.1002/pri.1914] [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: 11/20/2020] [Revised: 03/20/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery. METHODS This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up. RESULTS The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4 weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (rpb (112) = 0.27, p = 0.004). CONCLUSION Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.
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Affiliation(s)
- Sean P Riley
- Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut, USA
| | - Jonathan Harris
- Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut, USA
| | | | | | - Kenneth E Learman
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, Youngstown, Ohio, USA
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Jayaseelan DJ, T Faller B, H Avery M. The utilization and effects of filiform dry needling in the management of tendinopathy: a systematic review. Physiother Theory Pract 2021; 38:1876-1888. [PMID: 33904812 DOI: 10.1080/09593985.2021.1920076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Tendinopathy is frequently associated with pain, soft tissue impairments and muscle performance limitations. Dry needling (DN) incorporates a fine filiform needle to penetrate the skin and underlying soft tissue in an effort to decrease pain and improve function. While injectable interventions and gauged-needle tendon fenestration for tendinopathy has been reviewed, DN for tendinopathy has yet to be synthesized.Objective: To systematically review the utilization and effects of DN for tendinopathy.Methods: Six electronic databases (PubMed, CINAHL, Scopus, SportDiscus, PEDro and the Cochrane Library) were searched from inception through August 15, 2020, using appropriate keywords and relevant synonyms.Results: After screening 462 articles, 10 studies met inclusion criteria. Study designs included case reports, case series, and randomized clinical trials. DN was used in isolation in 3/10 studies and as part of a multimodal approach in 7/10 studies. DN was associated with improved pain, function, muscle performance and perceived improvement in each study evaluating the relevant outcome. Conflicting results were found in comparative studies evaluating DN.Conclusions: DN may be a useful adjunctive treatment in the conservative management of tendinopathy, although its discrete effect is unclear. Very Low-quality evidence and methodological limitations suggest further investigation is warranted.
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Affiliation(s)
- Dhinu J Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Brian T Faller
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Melinda H Avery
- International Spine Pain and Performance Center, Washington DC, USA
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16
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Jacobsen JS, Lind M, Hansen MG, Rasmussen RG, Blaabjerg B, Oestergaaard LG. Translation, cross‐cultural adaptation, and measurement properties of a Danish version of the Tegner Activity Scale. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Julie Sandell Jacobsen
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus N Denmark
- Research Centre for Health and Welfare Technology Programme for Rehabilitation VIA University College Aarhus N Denmark
- Research Unit for General Practice Aarhus C Denmark
| | - Martin Lind
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus N Denmark
| | | | - Randi Gram Rasmussen
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus N Denmark
| | - Birgitte Blaabjerg
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus N Denmark
| | - Lisa Gregersen Oestergaaard
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus N Denmark
- DEFACTUM Aarhus N Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
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17
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Nordqvist JM, Holmgren TM, Adolfsson LE, Öberg BE, Johansson KM. The minimal important change for the seven-item disability of the arm, shoulder, and hand (DASH 7) questionnaire - Assessing shoulder function in patients with subacromial pain. JSES Int 2021; 5:474-479. [PMID: 34136857 PMCID: PMC8178623 DOI: 10.1016/j.jseint.2021.01.008] [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] [Indexed: 11/13/2022] Open
Abstract
Background The DASH 7 is a recently published activity-related 7-item short form of the disability of the arm, shoulder, and hand (DASH) questionnaire developed to assess shoulder function in patients with subacromial pain. Before implementation in both intervention studies and in clinical practice, it is essential to evaluate its responsiveness. The objective of this study was to determine the minimal important change (MIC) in the DASH 7 questionnaire for patients with subacromial pain after a 3 months exercise intervention in a primary care context. Methods In this psychometric study the anchor-based MIC-distribution method was used to establish the MIC. The Patient Global Impression of Change (PGIC) was used as external criterion. Data from a clinical implementation study, aimed to implement a specific exercise strategy for patients with subacromial pain among physiotherapists in primary care, were used. Data from 70 patients were included in the analyses. Results The correlation coefficient between Patient Global Impression of Change and the DASH 7 score change was 0.67 and the area under the curve was 0.94 (95% confidence interval: 0.88-1.0). The MICROC for improvement was detected at a mean change in 6.5 points with the sensitivity at 0.98 (98%) and the specificity at 0.78 (78%), and the MIC95% limit for improvement was detected at a mean change of 25.7 points. There were 77% of the patients who reached at least this MICROC and 51% who reached at least the MIC95% limit after 3 months of exercise intervention. Conclusion The DASH 7 is responsive to change over time and can discriminate between patients considered to be improved and patients considered not improved. These MIC values for patients with subacromial pain in the primary care setting can be used in clinical practice and in intervention studies as an indication on the patients clinically important level of score change for improvement.
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Affiliation(s)
- Jenny M Nordqvist
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Theresa M Holmgren
- Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology, Linköping University Hospital, Linköping, Sweden
| | - Lars E Adolfsson
- Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology, Linköping University Hospital, Linköping, Sweden
| | - Birgitta E Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Kajsa M Johansson
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
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18
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Petersen AK, Jacobsen JS, Hansen MG, Rasmussen RG, Blaabjerg B, Lind M, Oestergaard LG. Translation, reproducibility, and responsiveness of a Danish version of the International Knee Documentation Committee Subjective Knee Form. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
- Centre of Research in Rehabilitation (CORIR) Institute of Clinical Medicine Aarhus University Aarhus Denmark
| | - Julie Sandell Jacobsen
- Department of Physiotherapy and Research Centre for Health and Welfare Technology Programme for Rehabilitation VIA University College Horsens Denmark
| | | | - Randi G. Rasmussen
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
| | - Birgitte Blaabjerg
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
| | - Martin Lind
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
- Centre of Research in Rehabilitation (CORIR) Institute of Clinical Medicine Aarhus University Aarhus Denmark
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19
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Jones SMW, Du Y, Bell-Brown A, Bolt K, Unger JM. Feasibility and Validity of Asking Patients to Define Individual Levels of Meaningful Change on Patient-Reported Outcomes. J Patient Cent Res Rev 2020; 7:239-248. [PMID: 32760755 DOI: 10.17294/2330-0698.1742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Patient-reported outcomes (PROs) are frequently used in clinical care to monitor treatment response. However, most guidelines on PRO use treat all patients the same. This study tested the feasibility and validity of a method for determining individually meaningful change in PRO measures. Methods Participants (n=398) completed 12 pain and distress questions to define individually meaningful change. This mixed-methods study used both quantitative and qualitative analyses, including descriptive statistics, inferential statistics, and content analysis. Results Two-thirds (67%) of the sample reported at least one medical condition, including depression and back pain. Most participants (70%-90%) were able to answer the questions as intended. Participants varied widely in the amount of change they considered meaningful (coefficients of variation: 40%-99%). Higher symptom levels were associated with larger amounts of change considered meaningful and with greater likelihood of answering questions as intended. Participants reported a variety of reasons for why they considered an amount of change in pain or distress meaningful. The hypothetical nature of the questions and the need to reference previous questions was found to be confusing. Conclusions Asking patients to define an individual level for meaningful change on PROs was feasible and valid. Having patients define their own goals on PROs for treatment of pain or distress could make treatment more patient-centered.
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Affiliation(s)
| | - Yuxian Du
- Fred Hutchinson Cancer Research Center, Seattle, WA.,Data Generation and Observational Studies, Bayer HealthCare LLC, Whippany, NJ
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20
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Walton DM, Marsh J. Reliability, Discriminative, and Prognostic Validity of the Multidimensional Symptom Index in Musculoskeletal Trauma. Clin J Pain 2020; 36:700-706. [PMID: 32520818 DOI: 10.1097/ajp.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Multidimensional Symptom Index (MSI) is a 10-item parallel score frequency×interference patient-reported outcome for use in clinical pain research. This manuscript describes results related to measurement stability, discriminative accuracy when screening for major depressive disorder (MDD), and prognostic validity when predicting recovery trajectories after acute musculoskeletal (MSK) trauma. METHODS Data were drawn from a longitudinal cohort study of adults with acute MSK trauma, supplemented by a secondary sample of adults with chronic pain. RESULTS In a sample of n=23 stable participants over a 1-month period, reliability metrics indicated good stability for all 5 subscales (ICC3,1: 0.70 to 0.91). In a mixed acute/chronic sample (n=148), the Number of Symptoms and Nonsomatic Symptoms subscales showed clinically useful discriminative accuracy for MDD screening (area under the curve=0.86 and 0.88, respectively). In n=129 with acute MSK trauma, the Mean Interference and Nonsomatic Symptoms subscales showed significant prognostic validity for classifying participants into "recovery expected" or "recovery not expected" groups with 72.5% and 92.2% accuracy, respectively. DISCUSSION The MSI holds promise as a tool for evaluating change, screening for MDD, and identifying those at high or low risk of poor recovery. The results favor sensitivity over specificity. The labile nature of the acute pain symptoms and a truncated distribution of Nonsomatic Symptoms scores in that group both require some caution in interpretation. The MSI appears to be a potentially useful tool for rapid pain phenotyping, evaluation, and quick screening purposes in clinical practice.
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Affiliation(s)
- David M Walton
- School of Physical Therapy.,Bone and Joint Institute, Western University, London, ON, Canada
| | - Jacquelyn Marsh
- School of Physical Therapy.,Bone and Joint Institute, Western University, London, ON, Canada
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21
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Bobos P, Ziebart C, Furtado R, Lu Z, MacDermid JC. Psychometric properties of the global rating of change scales in patients with low back pain, upper and lower extremity disorders. A systematic review with meta-analysis. J Orthop 2020; 21:40-48. [PMID: 32082038 DOI: 10.1016/j.jor.2020.01.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Objective The purpose of this systematic review was to critically appraise and synthesize the psychometric properties of the Global Rating of Change (GRoC) scales on the assessment of patients with low back pain (LBP), upper extremity and lower extremity disorders. Methods A search was performed in 4 databases (MEDLINE, EMBASE, CINAHL, SCOPUS) until February 2019. Eligible articles were appraised using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form. Results The 8 eligible studies included participants with orthopedic lumbar spine impairments (n = 52,767), patients with work-related musculoskeletal disorders (n = 1944), patients with low back pain (n = 183) and individuals with upper extremity disorders (n = 151). Risk of bias was ranging from "adequate" to "very good" and quality was found excellent for all studies. Based on pooled data, test-retest reliability of 11-item GRoC for patients with low back pain was found excellent ICC = 0.84, 95% CI: 0.65 to 0.94. Test-retest reliability in patients with shoulder pain was found fair to good ICC of 0.62 in a 15-point GRoC scale. Seven studies (n = 7) examined the convergent validity between GRoC and another outcome measure. Minimum important change on the Portuguese version of Global Perceived Effect (GPE) for patients with LBP was 2.5 points out of 11 points. Conclusions The current pool of clinical measurement studies indicates that the GRoC has excellent test-retest reliability for patients with low back pain, shoulder pain and with lumbar spine disorders. However, the validity of it as a reference standard in responsiveness studies or as an accurate overall assessment of change has been questioned. While future studies might provide more insight into its measurement properties, this limitation is unlikely to change. Therefore, we suggest that future responsiveness in the studies that want a global indicator measure need to use an additional measure to mitigate recall bias. Prospero registration number CRD 42020149122.
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Affiliation(s)
- Pavlos Bobos
- Western's Bone and Joint Institute, School of Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Canada
| | - Christina Ziebart
- Western's Bone and Joint Institute, School of Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Rochelle Furtado
- Western's Bone and Joint Institute, School of Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Ze Lu
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Joy C MacDermid
- Western's Bone and Joint Institute, School of Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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22
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Jones DM, Webster KE, Crossley KM, Ackerman IN, Hart HF, Singh PJ, Pritchard MG, Gamboa G, Kemp JL. Psychometric Properties of the Hip-Return to Sport After Injury Scale (Short Form) for Evaluating Psychological Readiness to Return to Sports After Arthroscopic Hip Surgery. Am J Sports Med 2020; 48:376-384. [PMID: 31800298 DOI: 10.1177/0363546519888644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Successful return to sports activity after surgery requires both physical and psychological readiness. The Hip-Return to Sport After Injury (Short Form) has been developed to assess psychological readiness to return to sports after hip injury and hip surgery, including hip arthroscopy. PURPOSE To evaluate the reliability, validity, responsiveness, and interpretability of the scale for a cohort of patients after hip arthroscopy with a range of sports participation levels. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Invitations to participate were sent to 145 patients from 3 specialist surgeons. The study included 77 participants 1 to 24 months after hip arthroscopy (mean ± SD age, 35 ± 9 years; 62% women) and 33 healthy age-matched controls (age, 37 ± 7 years; 52% women). The scale was administered electronically on 3 occasions to patients: baseline (≥1 month postarthroscopy), 1 week later, and 6 months later. In addition to the scale, participants were asked about sports participation status and their global rating of postsurgical change. The scale was administered to healthy controls on 1 occasion. The minimal detectable difference, discriminant validity, floor and ceiling effects, responsiveness, and interpretability (minimally important change) were determined for the scale. RESULTS Among the postarthroscopy group, excellent test-retest reliability was found (intraclass correlation coefficient = 0.869; 95% CI, 0.756-0.932) with a minimal detectable difference of 26 points out of 100 at the individual level and 4 points out of 100 at the group level. At baseline discriminant validity was evident between those who had returned to sports (median = 69, n = 35) and those who had not returned to sports (median = 30, n = 42; Mann-Whitney U score = 232.5, z = -5.141, P < .001) and between the returned-to-sports postarthroscopy group and healthy controls (median = 96, n = 33; Mann-Whitney U score = 165.500, z = 5.666, P < .001). No floor or ceiling effects were evident. Responsiveness was demonstrated for the scale in relation to sports status. With sports status as an anchor, a minimally important change of 26 points was identified. CONCLUSION Assessment of the Hip-Return to Sport After Injury (Short Form) supports its use as a reliable and valid measure of psychological readiness to return to sports in patients after hip arthroscopy.
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Affiliation(s)
- Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kate E Webster
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | | | - Harvi F Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Department of Physical Therapy, The University of Western Ontario, London, Canada
| | - Parminder J Singh
- Monash University, Melbourne, Australia.,Deakin University, Melbourne, Australia
| | | | - Gauguin Gamboa
- Queensland Hips and Knees, Brisbane Private Hospital, Queensland, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Bobos P, MacDermid J, Nazari G, Furtado R. Psychometric properties of the global rating of change scales in patients with neck disorders: a systematic review with meta-analysis and meta-regression. BMJ Open 2019; 9:e033909. [PMID: 31772112 PMCID: PMC6886942 DOI: 10.1136/bmjopen-2019-033909] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to critically appraise and synthesise the psychometric properties of Global Rating of Change (GROC) scales for assessment of patients with neck pain. DESIGN Systematic review. DATA SOURCES A search was performed in four databases (MEDLINE, EMBASE, CINAHL, SCOPUS) until February 2019. DATA EXTRACTION AND SYNTHESIS Eligible articles were appraised using Consensus-based Standards for the selection of health Measurement Instruments checklist and the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form. RESULTS The search obtained 16 eligible studies and included in total 1533 patients with neck pain. Test-retest reliability of global perceived effect (GPE) was very high (intraclass correlation coefficient=0.80 to 0.92) for patients with whiplash. Pooled data of Pearson's r indicated that GROC scores were moderately correlated with neck disability change scores (0.53, 95% CI: 0.47 to 0.59). Pooled data of Spearman's correlations indicated that GROC scores were moderately correlated with neck disability change scores (0.56, 95% CI: 0.41 to 0.68). CONCLUSIONS This study found excellent quality evidence of very good-to-excellent test-retest reliability of GPE for patients with whiplash-associated disorders. Evidence from very good-to-excellent quality studies found that GROC scores are moderately correlated to an external criterion patient-reported outcome measure evaluated pre-post treatment in patients with neck pain. No studies were found that addressed the optimal form of GROC scales for patients with neck disorders or compared the GROC to other options for single-item global assessment. PROSPERO REGISTRATION NUMBER CRD42018117874.
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Affiliation(s)
- Pavlos Bobos
- Western's Bone and Joint Institute, School of Physical Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, Ontario, Canada
| | - Joy MacDermid
- Western's Bone and Joint Institute, School of Physical Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Goris Nazari
- Western's Bone and Joint Institute, School of Physical Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Rochelle Furtado
- Western's Bone and Joint Institute, School of Physical Physical Therapy, Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
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Thorp JN, Willson J. Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1824. [PMID: 31729114 DOI: 10.1002/pri.1824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/24/2019] [Accepted: 11/01/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Temporomandibular joint disorders (TMD) have a prevalence of more than 5% in the general population. A positive correlation exists between temporomandibular joint mobility and cervical spine mobility. Similarly, a relationship exists between thoracic and cervical spine mobility. However, it is unknown if interventions to improve the mobility of the thoracic spine positively impact temporomandibular joint motion and pain. This study tested the hypothesis that a single thoracic thrust joint manipulation (TJM) would improve maximum mouth opening (MMO) compared with participants without TMD as well as decrease TMD symptoms. METHODS Forty-eight people with TMD (30.9 years old ±11.3) and 55 people without TMD (28.5 years old ±9.2) participated. Both groups received a seated upper thoracic TJM and were measured for MMO before and immediately following the TJM. The duration of TMD symptoms and pre-thrust current pain, using the 11-point Verbal Pain Rating Scale (VPRS), was recorded in the TMD group. Participants in the TMD group were contacted 2-3 days after TJM to report current VPRS and improvement utilizing the Global Rating of Change (GROC) scale. RESULTS No difference in MMO treatment response over time was observed between groups (p = .56). The MMO in the TMD group improved from 40 to 41.3 mm, and the non-TMD similarly improved from 44.5 to 45.4 mm. The VPRS decreased from 2.4 (±1.8) to 1.3 (±1.5) following thoracic TJM (p < .001), and the average GROC score was 1.8 (±2.25), which was statistically different than zero (no change; p < .001). The duration of TMD symptoms prior to TJM was not associated with GROC scores (r = .018, p = .90) or VPRS change scores (r = -.07, p = .64). CONCLUSION The observed treatment effects did not exceed previously reported standards for clinical relevance (5 mm and 2 points, respectively).
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Affiliation(s)
- Jacob N Thorp
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA.,Department of Physical Therapy, Charleston Southern University, Charleston, SC, USA
| | - John Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
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Abstract
BACKGROUND Runners experience a high proportion of overuse injuries, with extended recovery periods involving a gradual, progressive return to preinjury status. A running-specific patient-reported outcome (PRO) measure does not exist, and a questionnaire assessing critical elements of runners' recovery processes may have excellent psychometric properties. OBJECTIVES To develop a valid, reliable, and responsive evaluative PRO measure to assess longitudinal change in running ability after running-related injury (RRI) for clinical practice and research applications. METHODS Self-identified runners and selected experts participated in an iterative, 6-step development process of the University of Wisconsin Running Injury and Recovery Index (UWRI) in this longitudinal clinical measurement study. Content-related validity was assessed using open comments. Reproducibility was assessed using Cronbach's alpha, the intraclass correlation coefficient (ICC), and standard error of measurement (SEM). An anchor-based construct validity assessment measured the association between the change in UWRI score and global rating of change (GROC). Responsiveness assessments included floor and ceiling effects. RESULTS The 9-item UWRI assesses running ability following an RRI, with the maximum score of 36 indicating a return to preinjury running ability. The UWRI demonstrated acceptable internal consistency (α = .82), test-retest reliability (ICC = 0.93), and SEM (1.47 points). Change in UWRI score was moderately correlated with the GROC (r = 0.61; 95% confidence interval: 0.4, 0.76). Floor and ceiling effects were absent. Completion required 3 minutes 15 seconds. CONCLUSION The UWRI is a reliable PRO measure and is responsive to changes in running function following an RRI, with minimal administrative burden. LEVEL OF EVIDENCE Therapy, level 2c. J Orthop Sports Phys Ther 2019;49(10):751-760. Epub 3 Aug 2019. doi:10.2519/jospt.2019.8868.
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Domingues L, Pimentel-Santos FM, Cruz EB, Sousa AC, Santos A, Cordovil A, Correia A, Torres LS, Silva A, Branco PS, Branco JC. Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial. Clin Rehabil 2019; 33:1908-1918. [PMID: 31549519 DOI: 10.1177/0269215519876675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP). DESIGN Randomized controlled trial. SETTING Outpatient care units. SUBJECTS Sixty-four non-specific CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups. INTERVENTIONS Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy. MAIN MEASURES The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up. RESULTS Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P25-P75): 6 (3.25-9.81) vs. 15.5 (11.28-20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P25-P75): 2 (1-2.51) vs. 5 (3.33-6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up (P = 0.001), favouring the MET group. CONCLUSION This study's findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.
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Affiliation(s)
- Lucia Domingues
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fernando Manuel Pimentel-Santos
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology Department CHLO, Hospital Egas Moniz, Lisboa, Portugal
| | - Eduardo Brazete Cruz
- Department of Physiotherapy, Escola Superior de Saúde - Instituto Politecnico de Setúbal, Setúbal, Portugal
| | - Ana Cristina Sousa
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Ana Santos
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Ana Cordovil
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Anabela Correia
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Laura Sa Torres
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Antonio Silva
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Soares Branco
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Jaime Cunha Branco
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology Department CHLO, Hospital Egas Moniz, Lisboa, Portugal
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Dunning J, Butts R, Henry N, Mourad F, Brannon A, Rodriguez H, Young I, Arias-Buría JL, Fernández-de-las-Peñas C. Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial. PLoS One 2018; 13:e0205405. [PMID: 30379937 PMCID: PMC6209187 DOI: 10.1371/journal.pone.0205405] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022] Open
Abstract
Study Design Randomized, single-blinded, multi-center, parallel-group trial. Objectives To compare the effects of adding electrical dry needling into a program of manual therapy, exercise and ultrasound on pain, function and related-disability in individuals with plantar fasciitis (PF). Background The isolated application of electrical dry needling, manual therapy, exercise, and ultrasound has been found to be effective for PF. However, no previous study has investigated the combined effect of these interventions in this population. Methods One hundred and eleven participants (n = 111) with plantar fasciitis were randomized to receive electrical dry needling, manual therapy, exercise and ultrasound (n = 58) or manual therapy, exercise and ultrasound (n = 53). The primary outcome was first-step pain in the morning as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included resting foot pain (NPRS), pain during activity (NPRS), the Lower Extremity Functional Scale (LEFS), the Foot Functional Index (FFI), medication intake, and the Global Rating of Change (GROC). The treatment period was 4 weeks with follow-up assessments at 1 week, 4 weeks, and 3 months after the first treatment session. Both groups received 6 sessions of impairment-based manual therapy directed to the lower limb, self-stretching of the plantar fascia and the Achilles tendon, strengthening exercises for the intrinsic muscles of the foot, and therapeutic ultrasound. In addition, the dry needling group also received 6 sessions of electrical dry needling using a standardized 8-point protocol for 20 minutes. The primary aim was examined with a 2-way mixed-model analysis of covariance (ANCOVA) with treatment group as the between-subjects variable and time as the within-subjects variable after adjusting for baseline outcomes. Results The 2X4 ANCOVA revealed that individuals with PF who received electrical dry needling, manual therapy, exercise and ultrasound experienced significantly greater improvements in first-step morning pain (F = 22.021; P<0.001), resting foot pain (F = 23.931; P<0.001), pain during activity (F = 7.629; P = 0.007), LEFS (F = 13.081; P<0.001), FFI Pain Subscale (F = 13.547; P<0.001), FFI Disability Subscale (F = 8.746; P = 0.004), and FFI Total Score (F = 10.65; P<0.001) than those who received manual therapy, exercise and ultrasound at 3 months. No differences in FFI Activity Limitation Subscale (F = 2.687; P = 0.104) were observed. Significantly (X2 = 9.512; P = 0.023) more patients in the electrical dry needling group completely stopped taking medication for their pain compared to the manual therapy, exercise and ultrasound group at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X2 = 45.582; P<0.001) more patients within the electrical dry needling group (n = 45, 78%) achieved a successful outcome compared to the manual therapy, exercise and ultrasound group (n = 11, 21%). Effect sizes ranged from medium to large (0.53<SMD<0.85) at 3 months in favor of the electrical dry needling group. Conclusion The inclusion of electrical dry needling into a program of manual therapy, exercise and ultrasound was more effective for improving pain, function and related-disability than the application of manual therapy, exercise and ultrasound alone in individuals with PF at mid-term (3 months). Level of evidence Therapy, Level 1b.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- * E-mail:
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- Research Physical Therapy Specialists, Columbia, South Carolina, United States of America
| | - Nathan Henry
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- Troop Medical Clinic, Eglin Air Force Base, Florida, United States of America
| | - Firas Mourad
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Universita di Roma Tor Vergata, Italy
| | - Amy Brannon
- TOPS Physical Therapy and Orthopaedics, Phoenix, Arizona, United States of America
| | - Hector Rodriguez
- Manual Physical Therapy Specialists, El Paso, Texas, United States of America
| | - Ian Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- CORA Physical Therapy, Savannah, Georgia, United States of America
| | - Jose L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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Variables Describing Individuals With Improved Pain and Function With a Primary Complaint of Low Back Pain: A Secondary Analysis. J Manipulative Physiol Ther 2018; 41:467-474. [PMID: 30100096 DOI: 10.1016/j.jmpt.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/25/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to identify descriptive factors in individuals with a primary complaint of low back pain (LBP) associated with improved pain and function after receiving physical therapy for LBP with or without manual therapy and exercise directed at the femoroacetabular joints. METHODS Participants were enrolled in a randomized clinical trial investigating physical therapy interventions for their LBP, with or without interventions directed at the femoroacetabular joints (hips). A participant was deemed recovered if all of the following were met: Numeric Pain Rating Scale (NPRS) score of ≤2 points, ≤10% on the modified Oswestry Disability Index at discharge, and a global rating of change score of +4 at both 2 weeks and discharge. Logistic regression modelling determined descriptor variables that best predicted treatment recovery. RESULTS Data from 90 participants were included in the analysis, with 44% (n = 40) achieving recovery by discharge from physical therapy (average 7.95 [±4.68]) visits. The variables of concurrent hip problems, lower body mass index ≤25.4, an irritable condition, and a baseline NPRS score of 4 points or less were retained in the final model (R2 = .384). Having a concurrent hip problem had the highest odds of achieving recovery in the model (odds ratio: 5.34, 95 % confidence interval: 1.31-21.8). CONCLUSIONS The findings for the patients in this study suggest that those with a concurrent hip problem, a lower body mass index, irritable symptoms, and a baseline NPRS score of 4 points or less were associated with greater odds of achieving recovery with multimodal physical therapy interventions. Further research should continue to investigate the interplay between the lumbar spine and hip joints.
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Cross-cultural Adaptation and Validation of the Nepali Translation of the Patient-Specific Functional Scale. J Orthop Sports Phys Ther 2018; 48:659-664. [PMID: 29625533 DOI: 10.2519/jospt.2018.7925] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The Patient-Specific Functional Scale (PSFS) is among the most commonly used measures to assess physical function. Objectives We aimed to translate and cross-culturally validate the PSFS to Nepali and further assess its psychometric properties. Methods This longitudinal, single-arm cohort study translated and cross-culturally adapted the PSFS to Nepali (PSFS-NP) following recommended guidelines. A sample of 104 Nepalese with musculoskeletal pain was recruited to evaluate the psychometric properties of the PSFS-NP. We assessed the internal consistency (Cronbach alpha), 2-week test-retest reliability (intraclass correlation coefficient [ICC3,2]), the smallest detectable change at the 90% confidence interval (CI), and construct validity. Concurrent validity was assessed against the Nepali versions of the Oswestry Disability Index, global rating of change, and numeric pain-rating scale. Receiver operating characteristic curves were plotted to measure responsiveness and area under the curve, and the minimum important change (MIC) was estimated. Results The PSFS-NP showed good reliability, with a Cronbach alpha of .75, an ICC of 0.89 (95% CI: 0.78, 0.94), and a smallest detectable change at the 90% CI of 1.46. It demonstrated significant correlations with the Nepali versions of the Oswestry Disability Index (r = -0.47, P = .001), global rating of change (r = 0.71, P<.001), and numeric pain-rating scale (r = -0.32 and -0.55, P<.001). Areas under the curve ranged from 0.72 to 0.99. The MIC was 2.00 in the main analysis. Secondary analyses revealed MICs of 0.50, 0.66, and 2.00 for small, medium, and large improvement, respectively. Conclusion The PSFS-NP is a reliable, valid, and responsive measure. It can be used in clinical practice and research in Nepalese with musculoskeletal pain. J Orthop Sports Phys Ther 2018;48(8):659-664. Epub 6 Apr 2018. doi:10.2519/jospt.2018.7925.
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Alma HJ, de Jong C, Jelusic D, Wittmann M, Schuler M, Kollen BJ, Sanderman R, Schultz K, Kocks JWH, Van der Molen T. Assessing health status over time: impact of recall period and anchor question on the minimal clinically important difference of copd health status tools. Health Qual Life Outcomes 2018; 16:130. [PMID: 29940980 PMCID: PMC6019834 DOI: 10.1186/s12955-018-0950-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background The Minimal Clinically Important Difference (MCID) assesses what change on a measurement tool can be considered minimal clinically relevant. Although the recall period can influence questionnaire scores, it is unclear if it influences the MCID. This study is the first to examine longitudinally the impact of the recall period of an anchor question and its design on the MCID of COPD health status tools using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and the St. George’s Respiratory Questionnaire (SGRQ). Methods Moderate to very severe COPD patients without respiratory co-morbidities were recruited during 3-week Pulmonary Rehabilitation (PR). CAT, CCQ and SGRQ were completed at baseline, discharge, 3, 6, 9 and 12 months. A 15-point Global Rating of Change scale (GRC) was completed at each follow-up. A five-point GRC was used as second anchor at 12 months. Mean change scores of a subset of patients indicating a minimal improvement on each of the anchor questions were considered the MCID. The MCID estimates over different time periods were compared with one another by evaluating the degree of overlap of Confidence Intervals (CI) adjusted for dependency. Results In total 451 patients were included (57.9 ± 6.6 years, 65% male, 50/39/11% GOLD II/III/IV), of which 309 completed follow-up. Baseline health status scores were 20.2 ± 7.3 (CAT), 2.9 ± 1.2 (CCQ) and 50.7 ± 17.3 (SGRQ). MCID estimates for improvement ranged − 3.1 to − 1.4 for CAT, − 0.6 to − 0.3 for CCQ, and − 10.3 to − 7.6 for SGRQ. Absolute higher – though not significant – MCIDs were observed for CAT and CCQ directly after PR. Significantly absolute lower MCID estimates were observed for CAT (difference − 1.4: CI -2.3 to − 0.5) and CCQ (difference − 0.2: CI -0.3 to −0.1) using a five-point GRC. Conclusions The recall period of a 15-point anchor question seemed to have limited impact on the MCID for improvement of CAT, CCQ and SGRQ during PR; although a 3-week MCID estimate directly after PR might lead to absolute higher values. However, the design of the anchor question was likely to influence the MCID of CAT and CCQ. Trial registration RIMTCORE trial #DRKS00004609 and #12107 (Ethik-Kommission der Bayerischen Landesärztekammer). Electronic supplementary material The online version of this article (10.1186/s12955-018-0950-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H J Alma
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
| | - C de Jong
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - D Jelusic
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - M Wittmann
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - M Schuler
- University of Wuerzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Wuerzburg, Germany
| | - B J Kollen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands
| | - R Sanderman
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands.,University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands
| | - K Schultz
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - J W H Kocks
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - T Van der Molen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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Abstract
PURPOSE To determine the feasibility of Headpod use to improve head control in children with cerebral palsy classified as Gross Motor Function Classification System level V. METHODS Children (3-11 years) with poor head control were video recorded before and after 3 and 6 months of Headpod use. Head control without Headpod was measured by active time children could hold head upright and number of head bobs in 5 minutes. RESULTS Fourteen children enrolled with 43% attrition rate. While average active time increased, average head bobs decreased and there were significant improvements in active time, but not head bobs. Active times were higher at 6 months compared with 3 months and baseline. Surveyed parents reported that the changes were apparent, supporting the large quantitative treatment effect. CONCLUSIONS Six months of Headpod use, 45 minutes per day, appears to be feasible, has a large effect on active head control, and merits a larger randomized controlled trial.
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Zafereo J, Wang-Price S, Roddey T, Brizzolara K. Regional manual therapy and motor control exercise for chronic low back pain: a randomized clinical trial. J Man Manip Ther 2018. [DOI: 10.1080/10669817.2018.1433283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University , Dallas, TX, USA
| | - Toni Roddey
- School of Physical Therapy, Texas Woman’s University , Dallas, TX, USA
| | - Kelli Brizzolara
- School of Physical Therapy, Texas Woman’s University , Dallas, TX, USA
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The ShortMAC: Minimum Important Change of a Reduced Version of the Western Ontario and McMaster Universities Osteoarthritis Index. J Orthop Sports Phys Ther 2018; 48:81-86. [PMID: 29056072 DOI: 10.2519/jospt.2018.7676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Clinical measurement study; secondary analysis of randomized clinical trial data. Background A 12-item shortened version (ShortMAC) of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a condition-specific, patient-reported osteoarthritis index, has been derived, published, and validated. The minimum important change (MIC) of the ShortMAC has not been reported or compared with the traditional 24-item WOMAC. Objectives To investigate the MIC of the 12-item ShortMAC and the traditional 24-item WOMAC across 3 levels of patient-perceived global change. Methods The Management of OsteoArthritis Trial cohort of 206 consecutive patients with knee or hip osteoarthritis was assessed at the initial visit and after 9 weeks of physical therapy (n = 155) or usual medical care (n = 51). The global rating of change instrument, assessed at the 9-week visit, provided the anchor. The MIC was calculated using receiver operating characteristic curve methodology for the ShortMAC and the traditional WOMAC, across 3 levels of patient-perceived change (small, medium, and large change) defined by the global rating of change. Results The MICs for the ShortMAC and traditional WOMAC (both transformed to a scale from 0 to 100) were 7.9 and 9.8 points for small change, 8.4 and 9.8 points for medium change, and 12.1 and 10.1 points for large change, respectively. The MICs of the pain and function subscales are also reported for small, medium, and large changes. Conclusion The lower point estimates for the MIC of the ShortMAC compared with that of the traditional WOMAC, using conventional definitions of MIC and half the number of items, indicate greater efficiency for use in clinical trials and reduced patient burden. J Orthop Sports Phys Ther 2018;48(2):81-86. Epub 21 Oct 2017. doi:10.2519/jospt.2018.7676.
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Rysstad T, Røe Y, Haldorsen B, Svege I, Strand LI. Responsiveness and minimal important change of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) in patients with subacromial pain syndrome. BMC Musculoskelet Disord 2017; 18:248. [PMID: 28595612 PMCID: PMC5465524 DOI: 10.1186/s12891-017-1616-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/02/2017] [Indexed: 12/20/2022] Open
Abstract
Background The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) is a valid and reliable patient-reported outcome measure (PROM). It was designed to measure physical disability and symptoms in patients with musculoskeletal disorders of the upper extremity, and is one of the most commonly used PROMs for patients with shoulder pain. The aim of this study was to examine responsiveness, the smallest detectable change (SDC) and the minimal important change (MIC) of the DASH, in line with international (COSMIN) recommendations. Methods The study sample consisted of 50 patients with subacromial pain syndrome, undergoing physical therapy for 3–4 months. Responsiveness to change was examined by calculating area under the receiver operating characteristic curves (AUC) and testing a priori-formulated hypothesis regarding correlations with changes in other instruments that measuring the same construct. The SDC was calculated using a test re-test protocol, and the MIC was calculated by the anchor-based MIC distribution. MIC values for patients with low and high baseline scores were also calculated. Results DASH appeared to be responsive, as it was able to distinguish patients who reported to be improved from those unchanged (AUC 0.77). All of the hypotheses were accepted. The SDC was 11.8, and the MIC was 4.4. Conclusion This study shows that the Norwegian version of the DASH has good responsiveness to change and may thus be recommended to measure outcome in patients with shoulder pain in Norway.
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Affiliation(s)
- Tarjei Rysstad
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4, St Olavs Plass, Oslo, Norway.
| | - Yngve Røe
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4, St Olavs Plass, Oslo, Norway
| | | | - Ida Svege
- Norwegian Research Center for Active Rehabilitation, Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Edmond SL, Enriquez CS, Millner MH, Nasri-Heir C, Heir GM. Is there an association between fear avoidance beliefs, and pain and disability in patients with orofacial pain? J Oral Rehabil 2017; 44:426-433. [PMID: 28295505 DOI: 10.1111/joor.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/29/2022]
Abstract
Numerous psychosocial factors have been shown to contribute to the development and perpetuation of orofacial pain. One well-recognized model for explaining the link between psychosocial factors and chronic pain is the fear avoidance model. To date, this proposed link has not been studied in subjects with orofacial pain. During the initial evaluation of subjects with orofacial pain, we collected data on fear avoidance beliefs using the Fear Avoidance Beliefs Questionnaire, and disability and pain. At between 6 and 8 weeks follow-up, we re-collected these data, as well as data addressing subjects' perceived change in their condition. Data were analyzed using correlation coefficients and linear regression. Fear avoidance beliefs at intake were inversely correlated with intake disability, There were no significant associations between fear avoidance beliefs at initial evaluation or in changes in fear avoidance beliefs during the 6-8 weeks follow-up period; and changes in disability, pain or perceived change in condition at 6-8 weeks follow-up. Of note, fear avoidance beliefs increased over the follow-up period, despite improvements in all outcome measures. There was insufficient evidence to suggest that high levels of fear avoidance beliefs at initial evaluation are associated with higher levels of disability or pain at intake, or with change in disability, pain or perceived change in condition at 6-8 weeks follow-up. Similarly, there was insufficient evidence to suggest that changes in fear avoidance beliefs during treatment are associated with any of these outcome measures.
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Affiliation(s)
- S L Edmond
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - C S Enriquez
- School of Health Sciences, Stockton University, Galloway, NJ, USA
| | - M H Millner
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA.,Professional Physical Therapy and Training, LLC, Madison, NJ, USA
| | - C Nasri-Heir
- Department of Diagnostic Sciences, Rutgers, School of Dental Medicine Center for Temporomandibular Disorders and Orofacial Pain, The State University of New Jersey, Newark, NJ, USA
| | - G M Heir
- Department of Diagnostic Sciences, Rutgers, School of Dental Medicine Center for Temporomandibular Disorders and Orofacial Pain, The State University of New Jersey, Newark, NJ, USA
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Translation, Cross-cultural Adaptation, and Clinimetric Testing of Instruments Used to Assess Patients With Ankle Sprain in the Brazilian Population. J Orthop Sports Phys Ther 2016; 46:1042-1050. [PMID: 27825293 DOI: 10.2519/jospt.2016.6218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Clinical measurement study. Background Ankle sprain is a common condition. Therefore, translated, culturally adapted, and clinimetrically tested instruments for measuring the ankle are needed. Objectives To translate and cross-culturally adapt the Sports Athlete Foot and Ankle Score (SAFAS) and the global rating of change (GROC) into Brazilian Portuguese. This study also aimed to test the measurement properties of the SAFAS, the GROC, and the existing Brazilian-Portuguese versions of the numeric pain-rating scale (NPRS) and the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) in a group with ankle sprain. Methods The SAFAS and GROC instruments were cross-culturally adapted into Brazilian Portuguese and pretested in this population (n = 18). The measurement properties of the SAFAS, GROC, NPRS, and AOFAS (internal consistency, ceiling and floor effects, construct validity, reproducibility, and responsiveness) were tested in a test-retest design in patients with ankle sprain at baseline (n = 63) and at follow-up periods of 48 to 72 hours (n = 53) and 4 weeks (n = 43) after baseline. Results The SAFAS, GROC, NPRS, and AOFAS yielded considerable internal consistency (Cronbach alpha ranging from .76 to .97), moderate reliability (intraclass correlation coefficient model 2,1 ranging from 0.59 to 0.80), and dubious agreement (percentage of the standard error of measurement ranging from 13% to 22.43%). The highest correlations on construct validity were observed among the 4 SAFAS subscales (Pearson r = 0.75 to 0.86, P<.01), but statistically significant values appeared in the intercorrelation of instruments. There were no observed floor or ceiling effects in any of the instruments. All of their scores of change showed moderate correlation with the GROC (r = -0.48 to 0.30, P<.05) and could be classified as responsive. Conclusion The Brazilian-Portuguese versions of the SAFAS, GROC, NPRS, and AOFAS had acceptable measurement properties in high-performing athletes. J Orthop Sports Phys Ther 2016;46(12):1042-1050. Epub 8 Nov 2016. doi:10.2519/jospt.2016.6218.
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Cervicothoracic Manual Therapy Plus Exercise Therapy Versus Exercise Therapy Alone in the Management of Individuals With Shoulder Pain: A Multicenter Randomized Controlled Trial. J Orthop Sports Phys Ther 2016; 46:617-28. [PMID: 27477473 DOI: 10.2519/jospt.2016.6319] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Multicenter randomized controlled trial. Background Cervicothoracic manual therapy has been shown to improve pain and disability in individuals with shoulder pain, but the incremental effects of manual therapy in addition to exercise therapy have not been investigated in a randomized controlled trial. Objectives To compare the effects of cervicothoracic manual therapy and exercise therapy to those of exercise therapy alone in individuals with shoulder pain. Methods Individuals (n = 140) with shoulder pain were randomly assigned to receive 2 sessions of cervicothoracic range-of-motion exercises plus 6 sessions of exercise therapy, or 2 sessions of high-dose cervicothoracic manual therapy and range-of-motion exercises plus 6 sessions of exercise therapy (manual therapy plus exercise). Pain and disability were assessed at baseline, 1 week, 4 weeks, and 6 months. The primary aim (treatment group by time) was examined using linear mixed-model analyses and the repeated measure of time for the Shoulder Pain and Disability Index (SPADI), the numeric pain-rating scale, and the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Patient-perceived success was assessed and analyzed using the global rating of change (GROC) and the Patient Acceptable Symptom State (PASS), using chi-square tests of independence. Results There were no significant 2-way interactions of group by time or main effects by group for pain or disability. Both groups improved significantly on the SPADI, numeric pain-rating scale, and QuickDASH. Secondary outcomes of success on the GROC and PASS significantly favored the manual therapy-plus-exercise group at 4 weeks (P = .03 and P<.01, respectively) and on the GROC at 6 months (P = .04). Conclusion Adding 2 sessions of high-dose cervicothoracic manual therapy to an exercise program did not improve pain or disability in patients with shoulder pain, but did improve patient-perceived success at 4 weeks and 6 months and acceptability of symptoms at 4 weeks. More research is needed on the use of cervicothoracic manual therapy for treating shoulder pain. Level of Evidence Therapy, level 1b. Prospectively registered March 30, 2012 at www.ClinicalTrials.gov (NCT01571674). J Orthop Sports Phys Ther 2016;46(8):617-628. doi:10.2519/jospt.2016.6319.
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Wang-Price S, Zafereo J, Brizzolara K, Sokolowski L, Turner D. Effects of different verbal instructions on change of lumbar multifidus muscle thickness in asymptomatic adults and in patients with low back pain. J Man Manip Ther 2016; 25:22-29. [PMID: 28855789 DOI: 10.1179/2042618615y.0000000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/01/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Spinal stabilisation exercise has been shown to be effective in the rehabilitation of low back pain (LBP). Due to the isometric nature of spinal stabilisation exercise, manual therapists use various verbal instructions to elicit lumbar multifidus muscle contraction. OBJECTIVES The purpose of this study was to assess whether or not three verbal instructions would alter muscle thickness of the lumbar multifidus muscle differently in asymptomatic individuals and patients with LBP. METHODS Three verbal instructions were selected for this study: (1) swell the muscle underneath the transducer, (2) draw your belly button in towards your spinal column and (3) think about tilting your pelvis but without really doing it. Lumbar multifidus muscle thickness was determined using parasagittal ultrasound (US) imaging. Measurements of muscle thickness were collected at rest and during verbal instructions from 21 asymptomatic adults and 21 patients with LBP. Percent changes of muscle thickness during contraction and at rest were compared between groups and across verbal instructions. RESULTS ANOVA results showed no significant interaction for both L4-5 and L5-S1, but a significant main effect of verbal instruction (P = 0.049) at L4-5.Post hoc analysis showed a greater increase with verbal instruction #3 than verbal instruction #2 (P = 0.009). There was no significant main effect of group at either segment. DISCUSSION The results of the study suggest that both groups responded similarly to the three verbal instructions. Verbal instructions may increase lumbar multifidus muscle thickness by different amounts at L4-5, but by the same amount at L5-S1.
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Affiliation(s)
- Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center, TX, USA
| | - Kelli Brizzolara
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Lily Sokolowski
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Dawn Turner
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
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Abstract
The Journal of Orthopaedic & Sports Physical Therapy (JOSPT) requires the use of robust research reporting guidelines for all research report submissions, including the newly adopted RECORD (REporting of studies Conducted using Observational Routinely-collected health Data) statement. We remind authors submitting research to JOSPT to identify the appropriate guideline and checklist for their study design, and to submit a completely and accurately completed checklist with their manuscript. J Orthop Sports Phys Ther 2016;46(3):130. doi:10.2519/jospt.2016.0105.
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Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord 2016; 17:64. [PMID: 26852024 PMCID: PMC4744384 DOI: 10.1186/s12891-016-0912-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/29/2016] [Indexed: 01/03/2023] Open
Abstract
Background Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH. Methods One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable. Results The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001). Conclusions Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months. Trial registration NCT01580280 April 16, 2012.
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Affiliation(s)
- James R Dunning
- Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA. .,Nova Southeastern University, Ft. Lauderdale, FL, USA. .,AAMT Fellowship in Orthopaedic Manual Physical Therapy, Columbia, SC, USA.
| | - Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA.
| | | | | | - Cesar Fernandez-de-Las Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Marshall Hagins
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA.
| | | | | | | | | | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA.
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Jacobsen JS, Knudsen P, Fynbo C, Rolving N, Warming S. Reproducibility and responsiveness of a Danish Pedi-IKDC subjective knee form for children with knee disorders. Scand J Med Sci Sports 2015; 26:1408-1414. [DOI: 10.1111/sms.12589] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J. S. Jacobsen
- Department of Physiotherapy and Occupational Therapy; Aarhus University Hospital; Aarhus Denmark
| | - P. Knudsen
- Department of Physiotherapy and Occupational Therapy; Bispebjerg Hospital; Copenhagen Denmark
| | - C. Fynbo
- Department of Physiotherapy and Occupational Therapy; Aarhus University Hospital; Aarhus Denmark
| | - N. Rolving
- Department of Physiotherapy and Occupational Therapy; Aarhus University Hospital; Aarhus Denmark
- Diagnostic Centre; Regional Hospital Silkeborg; Silkeborg Denmark
| | - S. Warming
- Musculoskeletal Rehabilitation Research Unit; Department of Physiotherapy and Occupational Therapy; Bispebjerg Hospital; Copenhagen Denmark
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Abstract
STUDY DESIGN Case series. BACKGROUND Ankle fractures commonly result in persistent pain, stiffness, and functional impairments. There is insufficient evidence to favor any particular rehabilitation approach after ankle fracture. The purpose of this case series was to describe an impairment-based manual physical therapy approach to treating patients with conservatively managed ankle fractures. CASE DESCRIPTION Patients with stable ankle fractures postimmobilization were treated with manual physical therapy and exercise targeted at associated impairments in the lower limb. The primary outcome measure was the Lower Extremity Functional Scale. Secondary outcome measures included the ankle lunge test, numeric pain-rating scale, and global rating of change. Outcome measures were collected at baseline (performed within 7 days of immobilization removal) and at 4 and 12 weeks postbaseline. OUTCOMES Eleven patients (mean age, 39.6 years; range, 18-64 years; 2 male), after ankle fracture-related immobilization (mean duration, 48 days; range, 21-75 days), were treated for an average of 6.6 sessions (range, 3-10 sessions) over a mean of 46.1 days (range, 13-81 days). Compared to baseline, statistically significant and clinically meaningful improvements were observed in Lower Extremity Functional Scale score (P = .001; mean change, 21.9 points; 95% confidence interval: 10.4, 33.4) and in the ankle lunge test (P = .001; mean change, 7.8 cm; 95% confidence interval: 3.9, 11.7) at 4 weeks. These changes persisted at 12 weeks. DISCUSSION Statistically significant and clinically meaningful improvements in self-reported function and ankle range of motion were observed at 4 and 12 weeks following treatment with impairment-based manual physical therapy. All patients tolerated treatment well. Results suggest that this approach may have efficacy in this population. LEVEL OF EVIDENCE Therapy, level 4.
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