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Silvestri A, Ruscello B, Rosazza C, Briotti G, Gabrielli PR, Tudisco C, D'Ottavio S. Acute Effects of Whole-Body Electrostimulation Combined with Stretching on Lower Back Pain. Int J Sports Med 2023; 44:820-829. [PMID: 37094810 DOI: 10.1055/a-2080-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Data from recent studies suggest that whole-body electromyostimulation (WB-EMS) is a time-effective and tailored intervention for chronic lower back pain (CLBP). The aim of this non-randomized controlled study was to compare the efficacy of a WB-EMS training and the association between WB-EMS specific training with passive stretching (Well Back System, [WBS]) on CLBP. Forty patients with CLBP, 43-81 years old, were assigned to one of the two groups: WB-EMS (n=20) and WB-EMS+WBS (n=20). Both groups completed 12 sessions (8 weeks) of the WB-EMS protocol (2×20 minutes/week). The second group performed core-specific exercises with WB-EMS plus 6 extra stretching sessions (30 minutes each). Primary study endpoints were based on changes on the visual analogue scale (VAS) and changes on the Oswestry Low Back Disability Questionnaire (ODI). Secondary study endpoints were percentage changes of maximum trunk flexion (Sit & Reach, [SR]) and changes in consumption of painkillers. Both interventions significantly improved VAS, ODI, and SR values (p range: 0.04;<0.001). However, the change of VAS (-46% vs. -17%, p<0.001), ODI (-53% vs. -17%, p<0.001), and SR (+ 7 vs.+3 cm, p=0.001) were significantly higher in the WB-EMS+WBS group compared to the WB-EMS group. The working method with WB-EMS+WBS can be a joint-friendly, individualized form to decrease CLBP.
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Affiliation(s)
- Adriano Silvestri
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Bruno Ruscello
- Department of Human Sciences and Promotion of the Quality of Life, Telematic University San Raffaele Rome Srl, Rome, Italy
| | - Cristina Rosazza
- Department of Humanistic Studies, University of Urbino Carlo Bo, Urbino, Italy
| | - Gianluca Briotti
- Department of Clinical Sciences and Translational Medicine, Universita degli Studi di Roma Tor Vergata, Roma, Italy
| | - Paolo Roberto Gabrielli
- Department of Clinical Sciences and Translational Medicine, Universita degli Studi di Roma Tor Vergata, Roma, Italy
| | - Cosimo Tudisco
- Department of the Faculty of Medicine, UniCamillus, Rome, Italy
| | - Stefano D'Ottavio
- Scienze Cliniche e Medicina Traslazionale, Università degli Studi di Roma Tor Vergata, Roma, Italy
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Karaduman C, Ataş Balci L. The effects of in-person-supervised, tele-supervised, and unsupervised stabilization exercises on pain, functionality, and kinesiophobia in patients with chronic low back pain: a randomized, single-blind trial. Physiother Theory Pract 2023:1-11. [PMID: 37776297 DOI: 10.1080/09593985.2023.2263554] [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: 06/27/2023] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The efficacy of various supervision methods for stabilization exercises in patients with chronic low back pain (CLBP) remains uncertain. OBJECTIVE To evaluate the impact of supervised and unsupervised stabilization exercises in patients with CLBP. METHODS Sixty-six participants were assigned to the in-person-supervised, tele-supervised, or unsupervised groups. All participants received a 20-30-minute exercise program three times a week for 4 weeks. We assessed functionality (Oswestry Disability Index), pain intensity (Numeric Rating Scale), and kinesiophobia (Tampa Scale of Kinesiophobia) before and after the 4 weeks. The outcomes were analyzed using effect size, minimum clinically important difference (MCID), minimal detectable change (MDC), Wilcoxon test, and post hoc analyses. RESULTS While the unsupervised group improved in all measures (p < .05) both the tele-supervised (p = .001) and in-person-supervised (p < .001) groups achieved superior functionality exceeding MDC. The in-person-supervised group demonstrated greater functionality (p < .001) than the tele-supervised group, exceeding MCID. Pain intensity decreased in the tele-supervised (p = .011) and in-person-supervised groups (p < .001) compared to the unsupervised group, exceeding MCID and MDC. No significant difference was found in post-treatment NRS score changes between the supervised groups (p = .071). The in-person-supervised group displayed a greater reduction in kinesiophobia than the tele-supervised (p < .001) and unsupervised groups (p < .001) but not exceeding MCID or MDC. Effect sizes were large within and between groups except for a small effect size between the tele-supervised and unsupervised groups in kinesiophobia. CONCLUSION While tele-supervised stabilization exercises alleviate pain and enhance functionality, in-person-supervised exercises may be more effective in improving functionality and reducing kinesiophobia in patients with CLBP.
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Affiliation(s)
| | - Leyla Ataş Balci
- Department of Physiotherapy and Rehabilitation, Bahcesehir University, Istanbul, Turkey
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Smitheman HP, Lundberg M, Härnesand M, Gelfgren S, Grävare Silbernagel K. Putting the fear-avoidance model into practice - what can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa? Braz J Phys Ther 2023; 27:100557. [PMID: 37952338 PMCID: PMC10682544 DOI: 10.1016/j.bjpt.2023.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/02/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Fear-avoidance variables are present in patients with musculoskeletal pain conditions, such as chronic low back pain (CLBP) and Achilles tendinopathy (AT) and can lead to reduced function and recovery. It is unknown how these variables relate in populations with different etiologies but similar pain provocation mechanisms. OBJECTIVE To compare kinesiophobia, pain catastrophizing, and disability between these two groups. METHODS Patients with CLBP and those with AT were included. Tampa Scale of Kinesiophobia (TSK-17) and Pain Catastrophizing Scale (PCS-13) were evaluated in both groups. The CLBP group completed the Oswestry Disability Index (ODI) and the AT group completed the PROMIS-29 questionnaire. Gait speed was calculated for each group. Disability outcomes were normalized between groups. RESULTS 119 patients in the CLBP group (64 female, 46 ± 8 years) and 83 patients in the AT group (42 female, 48 ± 12 years) were included. Both groups (CLBP, AT) presented with high prevalence of kinesiophobia (67%, 55%) but the CLBP group presented with higher prevalence of pain catastrophizing (22%, 2%). The CLBP group demonstrated higher levels of disability via normalized ODI (MD= 12.4, 95% CI: 9.2, 15.5) but the AT group demonstrated slower gait speed (MD= 0.1 m/s, 95% CI: 0.0, 0.2). CONCLUSION Similarly high prevalence of kinesiophobia was found in patients with CLBP and patients with AT. While the CLBP group reported greater prevalence of catastrophizing thoughts and greater disability, the AT group had slower gait speed. Overall, these findings demonstrate that CLBP and AT have similarities that may allow clinicians to learn from one to inform treatment of the other. CLINICAL TRIAL REGISTRATION NUMBERS NCT03523325, ISRCTN17115599.
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Affiliation(s)
| | - Mari Lundberg
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Malin Härnesand
- Department of Health and Rehabilitation, University of Gothenburg, Göteborg, Sweden
| | - Sara Gelfgren
- Department of Health and Rehabilitation, University of Gothenburg, Göteborg, Sweden
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Mikkonen J, Luomajoki H, Airaksinen O, Goubert L, Leinonen V. Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up. BMC Musculoskelet Disord 2023; 24:354. [PMID: 37147638 PMCID: PMC10161472 DOI: 10.1186/s12891-023-06434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/15/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a leading cause of disability globally. Exercise therapies are one of the commonly prescribed treatment options for CLBP. The specific exercise therapies for CLBP most commonly target movement dysfunction, but seldom brain-based pain modulation. Exercise therapies with specific breathing techniques (SBTs) have been shown to influence and enhance brain-based structural and functional pain modulation. AIMS AND OBJECTIVES To assess the feasibility of the SBTs protocol, eligibility criteria, randomization, and dropout rates. To quantify the changes in patient outcome measures and choose the most relevant measure for larger-scale study. To quantify self-adherence levels to home exercise and monitor and record possible pain medication and other treatment modality usage, and adverse events during exercise. DESIGN A parallel randomised analyst-blinded feasibility trial with two-month follow-up. OUTCOME MEASURES Feasibility related to aims and objectives. Multiple pain- and health-related patient-reported outcome measures of pain intensity, disability, central sensitization, anxiety, kinesiophobia, catastrophising, self-efficacy, sleep quality, quality of life, and health and well-being status. Exercise adherence, pain medication and other treatment modality usage, and possible adverse events related to exercises will be monitored and recorded. METHODS Thirty participants will be randomized to movement control exercise with SBTs (15 subjects in experimental group) or movement control exercise without SBTs (15 subjects in control group) in private chiropractic practice setting with two-month follow-up. Trial registration number; NCT05268822. DISCUSSION The clinical difference in effectiveness between practically identical exercise programs in uniform study settings with or without SBTs has not been studied before. This study aims to inform feasibility and help determine whether progression to a full-scale trial is worthwhile.
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Affiliation(s)
- Jani Mikkonen
- Private Practice, Mikonkatu 11, 00100, Helsinki, Finland.
- Department of Surgery (Incl. Physiatry), Institute of Clinical Medicine, University of Eastern Finland, 70211, Kuopio, Finland.
| | - Hannu Luomajoki
- ZHAW School of Health Professions, Zurich University of Applied Sciences, CH-8401, Winterthur, Switzerland
| | - Olavi Airaksinen
- Department of Surgery (Incl. Physiatry), Institute of Clinical Medicine, University of Eastern Finland, 70211, Kuopio, Finland
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, 9000, Ghent, Belgium
| | - Ville Leinonen
- Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, 70211, Kuopio, Finland
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ALMohiza MA, Reddy RS, Asiri F, Alshahrani A, Tedla JS, Dixit S, Gular K, Kakaraparthi VN. The Mediation Effect of Pain on the Relationship between Kinesiophobia and Lumbar Joint Position Sense in Chronic Low Back Pain Individuals: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20065193. [PMID: 36982105 PMCID: PMC10049448 DOI: 10.3390/ijerph20065193] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 06/10/2023]
Abstract
(1) Background: Fear of movement (kinesiophobia) and impaired lumbar joint position sense (LJPS) play a vital role in developing and maintaining non-specific chronic low back pain (CLBP). However, how kinesiophobia impacts LJPS is still being determined. The aims of this study are to (1) assess the correlation between kinesiophobia and LJPS in individuals with chronic low back pain; (2) compare LJPS between individuals with CLBP and those who are asymptomatic; and (3) evaluate if pain can mediate the relationship between kinesiophobia and LJPS in CLBP individuals. (2) Methods: Eighty-three individuals (mean age = 48.9 ± 7.5 years) with a diagnosis of CLBP and 95 asymptomatic individuals (mean age = 49.4 ± 7.0 years) were recruited into this cross-sectional study. Fear of movement in CLBP individuals was assessed using the Tampa Scale for Kinesiophobia (TSK). LJPS was determined using the active target repositioning technique using a dual-digital inclinometer. LJPS was evaluated in lumbar flexion, extension, and side-bending left and right directions, and the repositioning accuracy was determined in degrees using a dual digital inclinometer. (3) Results: Kinesiophobia showed a significant (p < 0.001) moderate positive correlation with LJPS (flexion: r = 0.51, extension: r = 0.41, side-bending left: r = 0.37 and side-bending right: r = 0.34). LJPS errors were larger in CLBP individuals compared to asymptomatic individuals (p < 0.05). Mediation analyses showed that pain significantly mediated the relationship between kinesiophobia and LJPS (p < 0.05) in CLBP individuals. (4) Conclusions: Kinesiophobia and LJPS were positively associated. LJPS is impaired in CLBP individuals compared to asymptomatic individuals. Pain may mediate adverse effects on LJPS. These factors must be taken into account when assessing and developing treatment plans for those with CLBP.
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Affiliation(s)
- Mohammad A. ALMohiza
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Faisal Asiri
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Adel Alshahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Najran University, Najran 55461, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
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Christe G, Benaim C, Luthi F, Jolles BM, Favre J. Reduction in pain-related fear is not associated with improvement in spinal biomechanics but with decrease in movement-evoked pain in patients with chronic low back pain. Pain Pract 2023; 23:290-300. [PMID: 36479806 DOI: 10.1111/papr.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS While a causal relationship between pain-related fear and spinal movement avoidance in patients with chronic low back pain (CLBP) has frequently been postulated, evidence supporting this relationship is limited. This study aimed to test if decreases in pain-related fear or catastrophizing were associated with improvements in spinal biomechanics, accounting for possible changes in movement-evoked pain. METHODS Sixty-two patients with CLBP were assessed before and after an interdisciplinary rehabilitation program (IRP). Pain-related fear was assessed with general and task-specific measures. Lower and upper lumbar angular amplitude and velocity as well as paraspinal muscle activity were recorded during five daily-life tasks to evaluate spinal biomechanics. Relationships were tested with multivariable linear regression analyses. RESULTS The large decreases in pain-related fear and catastrophizing following the IRP were scarcely and inconsistently associated with changes in spinal biomechanics (< 3% of the models reported a statistically significant association). Results remained comparable for activities inducing more or less fear, for specific or general measures of pain-related fear, and for analyses performed on the entire population or limited to subgroups of patients with higher levels of task-specific fear. In contrast, reductions in task-specific pain-related fear were significantly associated with decreases in movement-evoked pain in all tasks (r = 0.26-0.62, p ≤ 0.02). CONCLUSION This study does not support an association between pain-related fear and spinal movement avoidance. However, it provides evidence supporting a direct relationship between decreased pain-related fear and decreased movement-evoked pain, possibly explaining some mechanisms of the rehabilitation programs.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Benaim
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland.,Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - François Luthi
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland.,Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
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Association Between Psychosocial Parameters and Response to Chiropractic Care Among Older Adults With Chronic Low Back Pain: Secondary Analysis of a Randomized Clinical Trial. J Manipulative Physiol Ther 2022; 44:675-682. [PMID: 35753883 DOI: 10.1016/j.jmpt.2022.03.001] [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: 10/29/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether baseline self-efficacy, fear of pain with movement (kinesiophobia), or change in either were associated with clinically important improvement in disability among older adults with chronic low back pain after 12 weeks of chiropractic spinal manipulation (CSM) and exercise. METHODS This secondary analysis used randomized trial data from community-dwelling adults aged 65 years or older with chronic spinal disability who received non-pharmacological treatment of CSM and exercise. Those with ≥30% reduction in the Oswestry Disability Index (ODI) after 12 weeks of treatment were considered responders to care. Psychosocial measures included the Pain Self-Efficacy Questionnaire (PSEQ) and the Tampa Scale of Kinesiophobia (TSK). Logistic regression-assessed associations were between psychosocial, demographic, and low back predictors and 30% ODI improvement. RESULTS There were 176 community-dwelling older adults included in this analysis. Mean age was 71 years, 59.7% were women; 176 (96.7%) had complete data. Baseline disability (ODI = 26.1 ± 9.3) and back pain (5.0 ± 1.9, 0-10 scale) were moderate. Baseline PSEQ reflected higher self-efficacy (47.7 ± 7.8, 0-60 scale) with minimal kinesiophobia (TSK 34.3 ± 5.2, 17-68 scale). Seventy-two (40.9%) achieved 30% reduction in ODI (mean -5.4 ± 7.9) after 12 weeks of treatment. Mean self-efficacy improvement was clinically important (2.5 ± 6.5 points); kinesiophobia (-2.7 ± 4.4 points) and LBP (-1.6 points) also improved. Baseline PSEQ and percent improvement in PSEQ and TSK were associated with response to treatment in univariate regression analyses but not in multiple regression models that included low back predictors. LBP duration >4 years negatively impacted recovery. CONCLUSIONS Among this sample of older adults who received chiropractic manipulation and exercise, baseline self-efficacy and improvements in self-efficacy and kinesiophobia were individually associated with clinically important reductions in disability post-intervention, although not in adjusted models when LBP duration was included.
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André M, Lundberg M. Thoughts on Pain, Physical Activity, and Body in Patients With Recurrent Low Back Pain and Fear: An Interview Study. Phys Ther 2022; 102:6533384. [PMID: 35188967 DOI: 10.1093/ptj/pzab275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/03/2021] [Accepted: 11/07/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to explore thoughts and ideas about the body and pain in patients with nonspecific low back pain (LBP) who have a high degree of fear of movement. METHODS Patients with nonspecific LBP and a high degree of fear of movement, as measured using the Tampa Scale of Kinesiophobia, were asked to participate in the study. Individual semistructured in-depth interviews were conducted with 11 participants. The material was analyzed using content analysis with an inductive approach. RESULTS From these patients' stories, an overarching theme-decreased confidence in the body becomes a barrier to living life to the fullest-emerged. This theme was further divided into 4 subthemes: (1) "What is wrong with my body?"-the constant search for an explanation; (2) searching for the right way to move; (3) loss of mobility means a lack of meaning in life; and (4) the message from health care professionals guides feelings, thoughts, and movement behavior. CONCLUSION This study indicates that the message of keeping physically active when experiencing LBP has succeeded, but patients with fear require support to feel secure and have enough confidence in their body to move and exercise. Clinicians need to better incorporate evidence-based practice for patients with fear and support them so that they can apply an understanding of pain to their bodies and their every day life. IMPACT These results offer guidance for health care professionals to enhance their practice by providing more updated information to their patients who have recurrent LBP and fear. With better support, patients may be able to regain confidence in their bodies and live their lives to the fullest. LAY SUMMARY If you have recurrent LBP and fear of moving your body, ask your health care professional to provide you with updated knowledge on pain and to help you regain confidence in your body so that you can live your life to the fullest.
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Affiliation(s)
- Maria André
- Närhälsan Sannegården Rehabilitation Clinic, Gothenburg, Region Västra Götaland, Sweden.,Back in Motion Research Group, Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Mari Lundberg
- Back in Motion Research Group, Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
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9
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Bilterys T, Kregel J, Nijs J, Meeus M, Danneels L, Cagnie B, Van Looveren E, Malfliet A. Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial. Musculoskelet Sci Pract 2022; 57:102494. [PMID: 34953290 DOI: 10.1016/j.msksp.2021.102494] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE]). OBJECTIVE To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients. METHOD A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants. RESULTS No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < .05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < .001). CONCLUSION Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE.
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Affiliation(s)
- Thomas Bilterys
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jeroen Kregel
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Eveline Van Looveren
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium.
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10
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Balicka-Bom J, Golec J, Serafin J, Szczygieł E, Golec J, Sihinkiewicz I. The Level of Kinesiophobia and Its Relationship with Physical Activity in People with
a History of Ankle Sprain. REHABILITACJA MEDYCZNA 2021. [DOI: 10.5604/01.3001.0015.5903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Kinesiophobia is one of the leading clinical factors in recovery from injury. The stressful situation of an ankle joint injury can cause severe withdrawal and fear of the patient to undertake physical activity, resulting in hypokinesia.
Aims: The aim of the study was to demonstrate the relationship between the level of daily physical activity reported by the respondent after an ankle sprain and severity of the kinesiophobia phenomenon.
Material and methods: The study comprised 78 people (mean age 23.1 years ± 3.3) with a history of ankle sprain injury. This population was divided into 2 groups, taking the given level of physical activity into account. GR1 consisted of 34 patients with an activity level of 0-3 hours a week of sports activity, GR2 was made up of 44 individuals reporting a level of physical activity > 3 hours a week. In order to obtain the necessary results, the respondents filled in their own personal data sheet; and 3 standardised questionnaires translated into Polish: Foot and Ankle Ability Measure (FAAM); Fear-Avoidance Beliefs Questionnaire (FABQ); Tampa Scale of Kinesiophobia (TSK-17).
Results: A high level of physical activity helps to avoid limitations in ankle and foot functioning. A relationship was found between functional limitations and the intensity of fear regarding movement according to the FABQ questionnaire. The limitations of the foot function translate into higher results for the FABQ questionnaire. No other statistically significant relationships were found.
Conclusions: Kinesiophobia is a protective factor in the acute disease/injury phase. Physiologically, its level should decrease as functional abilities are regained. If the functional limitations remain high, the fear of movement also increases. Regular, high-level physical activity significantly improves the functioning of the ankle and foot, and reduces the level of kinesiophobia.
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Affiliation(s)
- Joanna Balicka-Bom
- Institute for Clinical Physiotherapy, Faculty of Orthopaedics, Traumatology and Rehabilitation, Department of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków Poland
| | - Joanna Golec
- Institute for Trauma Rehabilitation, Faculty of Clinical Rehabilitation, Department of Movement Rehabilitation, University of Physical Education, Kraków, Poland
| | - Joanna Serafin
- Day Rehabilitation Centre, POLIMED - Outpatient Clinic, ul. Piastów, Kraków, Poland
| | - Elżbieta Szczygieł
- Institute for Orthopaedic Rehabilitation, Faculty of Clinical Rehabilitation, Department of Movement Rehabilitation, University of Physical Education, Kraków, Poland
| | - Justyna Golec
- Ophthalmology and Ophthalmic Oncology Clinical Department, University Hospital. Kraków, Poland
| | - Iwona Sihinkiewicz
- PhD Study, Department of Clinical Rehabilitation, University of Physical Education Krakow, Poland
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11
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Gevers-Montoro C, Deldar Z, Conesa-Buendía FM, Lazar EA, Mahillo-Fernandez I, Khatibi A, Ortega de Mues A. Pain catastrophizing mediates rapid benefits of accessing in-person chiropractic care during the COVID-19 lockdown. Eur J Pain 2021; 26:463-479. [PMID: 34618991 PMCID: PMC8653257 DOI: 10.1002/ejp.1872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/18/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022]
Abstract
Background In March 2020, the COVID‐19 pandemic forced the Spanish government to declare a state of emergency. A stringent lockdown was enforced, restricting access to healthcare services, including chiropractic. Reduced access to care provision in combination with psychological stress, social isolation and physical inactivity during the lockdown were shown to negatively influence pain conditions. However, data on strategies to mitigate the impact of the pandemic on these conditions are lacking. Methods Upon easing of restrictions in May 2020, 51 chiropractic clinics throughout Spain pseudo‐randomly invited patients, recruiting a total of 385 participants. During a 14‐day period, participants were exposed to in‐person chiropractic care in either one (n = 177) or multiple encounters (n = 109) or to no care (n = 99). The effects of access to chiropractic care on patients’ pain‐related and psychological outcomes were assessed online through validated self‐reported questionnaires before and after the period of care. Coprimary outcomes included pain intensity, pain interference and pain cognitions. Results When comparing to participants without access to care, pain intensity and interference were significantly decreased at follow‐up, irrespective of the number of encounters. Kinesiophobia was also significantly reduced at follow‐up, though only after multiple encounters. The relationship between fear of movement, changes in pain intensity and interference was mediated by catastrophizing. Conclusion Access to in‐person chiropractic care may provide pain relief, associated with reductions in interference and pain cognitions. Prioritizing in‐person care for patients with maladaptive pain cognitions may help dampen the detrimental consequences of the pandemic on physical and psychological well‐being.
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Affiliation(s)
- Carlos Gevers-Montoro
- Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Zoha Deldar
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | | | | | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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12
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Alghamdi NH, Pohlig RT, Lundberg M, Silbernagel KG. The Impact of the Degree of Kinesiophobia on Recovery in Patients With Achilles Tendinopathy. Phys Ther 2021; 101:6324957. [PMID: 34289066 PMCID: PMC8801001 DOI: 10.1093/ptj/pzab178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/28/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Kinesiophobia has been proposed to influence recovery in individuals with Achilles tendinopathy. However, whether there are differences in outcomes in individuals with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in individuals with Achilles tendinopathy and various levels of kinesiophobia. METHODS This study was a secondary analysis of a prospective observational cohort study of 59 individuals with Achilles tendinopathy. The participants were divided into 3 groups on the basis of scores on the Tampa Scale for Kinesiophobia (TSK) (those with low TSK scores [≤33; low TSK group], those with medium TSK scores [34-41; medium TSK group], and those with high TSK scores [≥42; high TSK group]). All participants were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period. RESULTS There were 16 participants (8 women) in the low TSK group (age = 51.9 [SD = 15.3] years, body mass index [BMI] = 24.3 [22.3-25.4]), 28 participants (13 women) in the medium TSK group (age = 52.7 [SD = 15.2] years, BMI = 26.4 [22.5-30.8]), and 15 participants (8 women) in the high TSK group (age = 61.1 [SD = 11.1] years, BMI = 28.1 [25.2-33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group. CONCLUSION Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months. IMPACT Evaluating the degree of kinesiophobia in individuals with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery.
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Affiliation(s)
- Nabeel Hamdan Alghamdi
- Department of Physical Therapy, King Abdulaziz University, Jeddah, Saudi Arabia,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ryan T Pohlig
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Mari Lundberg
- Department of Health and Rehabilitation, University of Gothenburg, Göteborg, Sweden,Department of Health Promotion Sciences, Sophiahemmet University, Stockholm, Sweden
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13
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Giöstad A, Räntfors R, Nyman T, Nyman E. Enrollment in Treatment at a Specialized Pain Management Clinic at a Tertiary Referral Center after Surgery for Ulnar Nerve Compression: Patient Characteristics and Outcome. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:110-116. [PMID: 35415548 PMCID: PMC8991748 DOI: 10.1016/j.jhsg.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose To study patients who enroll in treatment at a specialized pain management clinic at a tertiary referral center following ulnar nerve decompression. Methods Data from medical charts and postoperative questionnaires were collected for all patients after surgery for ulnar nerve compression at the elbow from 2011 to 2014 (n = 173) at a tertiary referral center. Differences in characteristics between patients who enrolled in treatment at the pain management clinic (study group, n = 26) and the rest of the patients (reference group, n = 147) were analyzed. The study group was further evaluated using questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and regarding outcome of pain treatment. Results The study group was characterized by prior pain conditions, earlier contact with a pain management clinic, and high degrees of kinesiophobia, depression/anxiety, low quality of life, and low life satisfaction. These patients had significantly higher postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, were significantly younger, and had bilateral surgery significantly more often than the reference group. For patients with unilateral surgery, simple decompression was significantly more common in the reference group. The most common treatments at the clinic were antidepressants and anticonvulsants for neurogenic pain. In 5 of 26 patients, pain relief, or pain reduction was the documented reason for discharge. Conclusions Pain is a relevant outcome measure for ulnar nerve decompression among complicated cases at a referral center. Severe postoperative pain is connected to higher disability, reduced life satisfaction, and overall low health status. This study maps out characteristics of patients who postoperatively enroll in treatment at a specialized pain management clinic following ulnar nerve decompression. Further studies are needed to define predictive factors for such pain. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Alice Giöstad
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ronja Räntfors
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Torbjörn Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Pain and Rehabilitation Center, Linköping University Hospital, Linköping, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
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14
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Micke F, Weissenfels A, Wirtz N, von Stengel S, Dörmann U, Kohl M, Kleinöder H, Donath L, Kemmler W. Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial. Front Physiol 2021; 12:664991. [PMID: 33927646 PMCID: PMC8076746 DOI: 10.3389/fphys.2021.664991] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this multicenter trial was to compare the effects of whole-body electromyostimulation (WB-EMS) and whole-body vibration (WBV) with conventional back-strengthening training (CT) on changes in mean back pain intensity (MPI) and trunk strength in patients suffering from chronic non-specific low back pain (CNLBP). Two-hundred and forty CNLBP patients (40–70 years; 62% female) were randomly assigned to three intervention arms (WB-EMS: n = 80 vs. WBV: n = 80 vs. CT: n = 80). All training intervention programs were performed for 12 weeks in their usual commercial training setting. Before and during the last 4 weeks of the intervention, MPI was recorded using a 4-week pain diary. Additionally, maximal isometric trunk extension and -flexion strength was assessed on the BackCheck® machine. A moderate but significant decrease of MPI was observed in all groups (WB-EMS: 29.7 ± 39.1% (SMD 0.50) vs. WBV: 30.3 ± 39.3% (SMD 0.57) vs. CT: 30.5 ± 39.6% (SMD 0.59); p < 0.001). Similar findings were observed for maximal isometric strength parameters with a significant increase in all groups (extension: WB-EMS: 17.1 ± 25.5% vs. WBV: 16.2 ± 23.6% vs. CT: 21.6 ± 27.5%; p < 0.001; flexion: WB-EMS: 13.3 ± 25.6% vs. WBV: 13.9 ± 24.0% vs. CT: 13.9 ± 25.4%; p < 0.001). No significant interaction effects for MPI (p = 0.920) and strength parameters (extension: p = 0.436; flexion: p = 0.937) were observed. WB-EMS, WBV, and CT are comparably effective in improving MPI and trunk strength. However, training volume of WB-EMS was 43 or 62% lower, compared with CT and WBV.
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Affiliation(s)
- Florian Micke
- Department of Intervention Research in Exercise Training, Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Anja Weissenfels
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolas Wirtz
- Central Library for Sport Science, German Sport University Cologne, Cologne, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Dörmann
- Department of Intervention Research in Exercise Training, Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Villingen-Schwenningen, Germany
| | - Heinz Kleinöder
- Department of Intervention Research in Exercise Training, Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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15
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Alaca N, Kaba H, Atalay A. Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain. J Back Musculoskelet Rehabil 2021; 33:785-791. [PMID: 31868657 DOI: 10.3233/bmr-171039] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Low back pain (LBP) is one of the leading forms of chronic pain and is among the leading causes of pain and disability. In this study, we investigated the associations between the severity of disability and fear of movement and pain beliefs as well as the impact of the fear of movement and pain beliefs on the quality of life in patients with chronic LBP. METHODS A total of 89 patients (42.29 ± 16.05 years) with chronic low back pain were included in the study. The instruments used in the assessments include the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), the Tampa Kinesiophobia Scale (TKS), the Pain Belief Questionnaire (PBQ), and the SF 36-Short Form. Patients were assigned into three groups by disability severity based on ODI scores. Statistical analysis was performed using SPSS 15. RESULTS No statistically significant intergroup differences were found in TKS and PBQ scores (p> 0.05). A positive correlation was found between TKS scores, age (r: 0.227/p< 0.05), PBQ organic (r: -0.250/p< 0.05) scores. CONCLUSIONS Our study revealed high levels of kinesiophobia and similar pain beliefs, independent of the severity level of disability. We believe that cognitive-behavioral therapy that may reduce fear-avoidance behaviors and convert negative pain beliefs into positive ones should be added to rehabilitation procedures for LBP.
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16
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Hanel J, Owen PJ, Held S, Tagliaferri SD, Miller CT, Donath L, Belavy DL. Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations: Systematic Review and Meta-analysis. Sports Med 2020; 50:2193-2207. [PMID: 32946074 DOI: 10.1007/s40279-020-01345-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fear of pain and movement is an important factor in the development of hypervigilance and avoidance behaviours. OBJECTIVE We examined the effectiveness of exercise training on improving fear-avoidance beliefs. METHODS A systematic review (data sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL) and metaanalysis of randomised controlled/clinical trials of exercise training in adults versus relevant nonexercise comparators that quantified fear-avoidance was conducted. RESULTS After screening 4603 identified records, 17 (2014 participants) and 13 (1152 participants) studies were eligible for qualitative and quantitative synthesis, respectively. Pairwise meta-analysis showed exercise training was more effective than all non-exercise comparators (standardised mean difference (SMD) [95% CI] - 0.378 [- 0.623, - 0.133], P = 0.002, Grading of Recommendations Assessment, Development and Evaluation [GRADE]: very low) for reducing fear-avoidance. Exercise training was more effective than true control for reducing fear avoidance (- 0.407 [- 0.750, - 0.065], P = 0.020, GRADE: very low), however it was not more effective than other interventions (- 0.243 [- 0.614, 0.128], P = 0.199, GRADE: very low). In people with low back pain, exercise training was more effective than non-exercise comparator groups for reducing fear-avoidance (- 0.530 [- 0.755, - 0.304], P < 0.001, GRADE: very low). For individuals with neck pain, exercise training was not more effective than non-exercise comparator groups for reducing fear-avoidance (0.061 [- 0.360, 0.482], P = 0.777, GRADE: very low). CONCLUSION There is very low to low-quality evidence that exercise training is effective for reducing fear-avoidance, including in people with low back pain. Exercise training may be more effective than no intervention for reducing fear avoidance, but there is very low-quality evidence that non-exercise interventions are as effective as exercise for fear avoidance. Few studies with low risk of bias is a limitation. TRAIL REGISTRATION PROSPERO Registration Number: CRD42019139678.
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Affiliation(s)
- Joshua Hanel
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Steffen Held
- German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Scott D Tagliaferri
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Lars Donath
- German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia.
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17
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Calatayud J, Pérez-Alenda S, Carrasco JJ, Cruz-Montecinos C, Andersen LL, Bonanad S, Querol F, Megías-Vericat JE, Casaña J. Safety and Effectiveness of Progressive Moderate-to-Vigorous Intensity Elastic Resistance Training on Physical Function and Pain in People With Hemophilia. Phys Ther 2020; 100:1632-1644. [PMID: 32525975 DOI: 10.1093/ptj/pzaa106] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/24/2019] [Accepted: 04/16/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Strength training is recommended for people with hemophilia; however, published data are anecdotal and have methodological limitations. The purpose of this study was to evaluate the safety and effectiveness of progressive moderate-to-vigorous intensity elastic resistance training on physical function and pain in this patient population. METHODS A randomized controlled trial was conducted in a university laboratory setting where 20 patients (17 with severe, 1 with moderate, and 2 with mild hemophilia) aged 21 to 53 years received evaluations at baseline and 8-week follow-up. Participants were allocated to intervention (progressive strength training) or control (usual daily activities) groups. The intervention group trained 2 days per week during 8 weeks with elastic resistance. Intensity during the first 2 weeks was a 20-repetition maximum and increased progressively toward 15, 12, and finally 10 repetition maximum. The primary outcome was muscle strength. Secondary outcomes were the Timed "Up and Go" Test score, sit-to-stand, range of motion, Haemophilia Joint Health Score, kinesiophobia score, global impression of pain change, general self-rated health status, and desire to exercise. RESULTS The intervention group showed greater strength improvements than the control group in almost all of the joints, with moderate to high effect sizes. The intervention group also showed better Timed "Up and Go" and sit-to-stand scores than the control group (moderate effect size), greater range of motion at the knee flexion with the right leg (trivial effect size), and better Haemophilia Joint Health Score at the left knee (small effect size). The intervention group showed greater overall pain reduction, self-rated overall status, and desire to exercise than the control group. CONCLUSIONS Progressive strength training with elastic resistance performed twice a week during 8 weeks is safe and effective in people with hemophilia to improve muscle strength and functional capacity, reduce general pain, and improve self-rated health status and desire to exercise. IMPACT This study provides evidence for the use of a specific strength training regimen for people with hemophilia. LAY SUMMARY People with hemophilia of differing levels of severity, with adequate coverage with clotting factor, can safely engage in progressive strength training and can improve their functioning.
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Affiliation(s)
- Joaquín Calatayud
- Department of Physiotherapy, Exercise Intervention for Health Research Group, University of Valencia, Valencia, Spain; and National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia, Gascó Oliag 5, Valencia CP 46100 Spain; and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Juan J Carrasco
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion and Intelligent Data Analysis Laboratory, University of Valencia
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia and Department of Physical Therapy, Faculty of Medicine, Laboratory of Clinical Biomechanics, University of Chile, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment and Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Felipe Querol
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Juan E Megías-Vericat
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe and Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe
| | - José Casaña
- Department of Physiotherapy, Exercise Intervention for Health Research Group, University of Valencia
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18
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Konrad KL, Baeyens JP, Birkenmaier C, Ranker AH, Widmann J, Leukert J, Wenisch L, Kraft E, Jansson V, Wegener B. The effects of whole-body electromyostimulation (WB-EMS) in comparison to a multimodal treatment concept in patients with non-specific chronic back pain-A prospective clinical intervention study. PLoS One 2020; 15:e0236780. [PMID: 32822361 PMCID: PMC7446884 DOI: 10.1371/journal.pone.0236780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background According to present guidelines, active exercise is one key component in the comprehensive treatment of nonspecific chronic back pain (NSCBP). Whole body electromyostimulation (WB-EMS) is a safe, and time-effective training method, that may be effective in NSCBP-patients. Methods In this prospective and controlled nonrandomized clinical study, two therapeutic approaches were compared. One group received 20 minutes WB-EMS per week. An active control group (ACG) received a multimodal therapy program. A third group included subjects without back pain. To all groups, the following measurement instruments were applied: Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), North American Spine Society Instrument (NASS); SF 36 survey and measurements for muscular function and postural stability. In the EMS-group: T0: baseline; T1: at 6 weeks; T2: at 12 weeks and T3: at 24 weeks. In the ACG: T0 baseline and T1 after 4 weeks. Results In the intervention group, 128 patients with low back pain were enrolled, 85 in the WB-EMS group and 43 in the ACG. 34 subjects were allocated to the passive control group. The average age was 58.6 years (18–86 years). In the EMS group, the NRS (1–10) improved statistically and clinically significantly by 2 points. The ODI was reduced by 19.7 points. The NASS and most of the SF 36 items improved significantly. In the multimodal treatment group, only the muscular function improved slightly. Conclusion Our data support the hypothesis that WB-EMS is at least as effective as a multimodal treatment, which is often referred to as being the golden standard. Therefore WB-EMS may be an effective and, with 20 min./week training time, very time-efficient alternative to established multimodal treatment models.
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Affiliation(s)
- Karl Lorenz Konrad
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Jean-Pierre Baeyens
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Christof Birkenmaier
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Anna Helena Ranker
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Jonas Widmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Johannes Leukert
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Lisa Wenisch
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Bernd Wegener
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel (VUB), Brussel, Belgium
- * E-mail:
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19
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Saracoglu I, Arik MI, Afsar E, Gokpinar HH. The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial. Physiother Theory Pract 2020; 38:868-878. [PMID: 32812478 DOI: 10.1080/09593985.2020.1809046] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the short- and mid-term effects of pain neuroscience education (PNE) combined with manual therapy (MT) and a home exercise program (HEP) on pain intensity, back performance, disability, and kinesiophobia in patients with chronic low back pain (CLBP). Methods: This study was designed as a prospective, randomized, controlled, single-blind study in which 69 participants were randomly assigned to three groups. Participants in Group 1 received PNE, MT, and the HEP, while Group 2 received MT and the HEP. Participants in the control group did the HEP only. All interventions lasted 4 weeks. The participants' pain intensity, disability, low back performance, and kinesiophobia were assessed. All assessments were executed before intervention, at 4 weeks, and at 12 weeks post-intervention by the same blinded physiotherapist. A mixed model for repeated measures was used for each outcome measure. Results: Analysis of pain level (p < .05), back performance (p < .05), disability (p < .05) and kinesiophobia (p < .05) revealed significant time, group, and time-by-group interaction effects. The participants in Group 1 exhibited greater improvement in terms of pain intensity and kinesiophobia compared to the participants in Group 2 and the control group. Level of disability was significantly decreased in both Group 1 and Group 2 compared to the control group. Conclusion: This study suggests that a multimodal treatment program combining PNE, MT, and HEP is an effective method for improving back performance and reducing pain, disability, and kinesiophobia in the short (4 weeks) and midterm (12 weeks).
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Affiliation(s)
- Ismail Saracoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Meltem Isintas Arik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Emrah Afsar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Hasan Huseyin Gokpinar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
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Salvador EMES, Franco KFM, Miyamoto GC, Franco YRDS, Cabral CMN. Analysis of the measurement properties of the Brazilian-Portuguese version of the Tampa Scale for Kinesiophobia-11 in patients with fibromyalgia. Braz J Phys Ther 2020; 25:168-174. [PMID: 32487449 DOI: 10.1016/j.bjpt.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/18/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze the measurement properties of the Brazilian-Portuguese version of the Tampa Scale for Kinesiophobia-11 in patients with fibromyalgia. METHODS Assessment was made at three time points: baseline (n=130) and 15 days (n=54) and eight weeks after baseline (n=51). Data collected at baseline were used to assess internal consistency, criterion and construct validity, and ceiling and floor effects. Data collected at baseline and 15 days after baseline were used to assess reliability and measurement error, and data collected before and after an eight-week exercise-based physical therapy intervention were used to assess interpretability of change scores. RESULTS The Tampa Scale for Kinesiophobia-11 showed adequate internal consistency (Cronbach's alpha=0.77; alpha if item deleted: 0.74-0.77), substantial reliability (intraclass correlation coefficient2,1=0.85; 95% confidence interval: 0.75, 0.90), good measurement error (standard error of measurement: 2.65 points), and a minimal detectable change (90% confidence) of 6.16 points. For validity, the Tampa Scale for Kinesiophobia-11 showed a positive and good correlation with the original Tampa Scale for Kinesiophobia (r=0.84, p<0.01), positive and moderate correlation with the Pain Catastrophizing Scale (r=0.55, p<0.01), positive and weak correlation with the Numerical Pain Rating Scale (r=0.25, p<0.01), positive and moderate correlation with the Beck Depression Inventory (r=0.39, p<0.01), and no correlation with the Patient-Specific Functional Scale (r=0.11, p=0.23). Kinesiophobia, pain, function, catastrophizing, and depression statistically improved after the eight-week intervention (p<0.01). CONCLUSION The Tampa Scale for Kinesiophobia-11 is consistent, reliable, and appropriate to assess fear of movement in patients with fibromyalgia in the clinical context. Responsiveness of the Tampa Scale for Kinesiophobia-11 should be tested in future studies.
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Affiliation(s)
| | | | - Gisela Cristiane Miyamoto
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
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Kemani MK, Hägg O, Jakobsson M, Lundberg M. Fear of Movement Is Related to Low Back Disability During a Two-Year Period in Patients Who Have Undergone Elective Lumbar Spine Surgery. World Neurosurg 2020; 137:e416-e424. [DOI: 10.1016/j.wneu.2020.01.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
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The Relationship Between Fear-avoidance Beliefs in Employees with Chronic Musculoskeletal Pain and Work Productivity: A Longitudinal Study. J UOEH 2020; 42:13-26. [PMID: 32213739 DOI: 10.7888/juoeh.42.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study aimed to identify risk factors for chronic musculoskeletal pain (CMSP) and sought to examine the effect of fear-avoidance beliefs (FABs) on work productivity in workers with CMSP. We performed a longitudinal study using self-administered questionnaires given to employees in three different industries between April 2016 and March 2017. The questionnaire concerned background characteristics, work-related factors and musculoskeletal pain, the Work Functioning Impairment Scale (WFun), and the Japanese version of the Tampa Scale for Kinesiophobia (TSK-J). We performed logistic regression analysis to evaluate factors affecting CMSP and a multi-way analysis of variance to analyze the relationship between FABs and CMSP and the effect of FABs on the ability to function at work. Age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.00-1.03), mean working hours (OR = 1.18, 95% CI: 1.04-1.33), and changes in working hours (OR = 1.18, 95% CI: 1.02-1.37) were significantly associated with CMSP. Regarding FABs, we found that the stronger the FAB, the greater the WFun score, and that an increase in FABs resulted in a significant increase in WFun scores. This study demonstrated that long or increased working hours may be risk factors for CMSP, and that stronger FABs in those with CMSP are associated with decreased ability to function at work. In addition, measures to reduce FABs in workers with CMSP may be effective.
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Timing of anterior cruciate ligament reconstruction and preoperative pain are important predictors for postoperative kinesiophobia. Knee Surg Sports Traumatol Arthrosc 2020; 28:2502-2510. [PMID: 31879792 PMCID: PMC7429522 DOI: 10.1007/s00167-019-05838-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE Fear of movement (kinesiophobia) is a major limiting factor in the return to pre-injury sport level after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to gain insight into the prevalence of kinesiophobia pre-ACLR, 3 months post-ACLR and 12 months post-ACLR. Furthermore, the preoperative predictability of kinesiophobia at 3 months post-ACLR was addressed. METHODS A retrospective study with data, which were prospectively collected as part of standard care, was conducted to evaluate patients who underwent ACLR between January 2017 and December 2018 in an orthopaedic outpatient clinic. Patient characteristics (age, sex, body mass index), injury-to-surgery time, preoperative pain level (KOOS pain subscale) and preoperative knee function (IKDC-2000) were used as potential predictor variables for kinesiophobia (TSK-17) at 3 months post-ACLR in linear regression analysis. RESULTS The number of patients with a high level of kinesiophobia (TSK > 37) reduced from 92 patients (69.2%) preoperatively to 44 patients (43.1%) 3 months postoperatively and 36 patients (30.8%) 12 months postoperatively. The prediction model, based on a multivariable regression analysis, showed a positive correlation between four predictor variables (prolonged injury-to-surgery time, high preoperative pain level, male sex and low body mass index) and a high level of kinesiophobia at 3 months postoperatively (R2 = 0.384, p = 0.02). CONCLUSION The prevalence of kinesiophobia decreases during postoperative rehabilitation, but high kinesiophobia is still present in a large portion of the patients after ACLR. Timing of reconstruction seems to be the strongest predictor for high kinesiophobia 3 months post-ACLR. This study is the first step in the development of a screening tool to detect patients with kinesiophobia after ACLR. Identifying patients preoperatively opens the possibility to treat patients and thereby potentially increase the return to pre-injury sport level rate after ACLR. LEVEL OF EVIDENCE III.
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Tagliaferri SD, Miller CT, Owen PJ, Mitchell UH, Brisby H, Fitzgibbon B, Masse-Alarie H, Van Oosterwijck J, Belavy DL. Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective. Pain Pract 2019; 20:211-225. [PMID: 31610090 DOI: 10.1111/papr.12846] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
Abstract
Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an individual patient. This information can guide treatment selection when working with an individual with CLBP.
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Affiliation(s)
- Scott D Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, U.S.A
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bernadette Fitzgibbon
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Hugo Masse-Alarie
- Centre Interdisciplinaire de Recherche en Réadaptation et Integration Sociale (CIRRIS), Université Laval, Québec City, Québec, Canada
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Pain in Motion International Research Group
| | - Daniel L Belavy
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Kedroff L, Li Ko Lun A, Shimoni D, Bearne LM. Cognitive behavioural therapy-informed physiotherapy for patellofemoral pain: A feasibility study. Musculoskeletal Care 2019; 17:382-389. [PMID: 31691524 DOI: 10.1002/msc.1429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Louise Kedroff
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Alain Li Ko Lun
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Doron Shimoni
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Lindsay M Bearne
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
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Comparison of Whole-Body Electromyostimulation versus Recognized Back-Strengthening Exercise Training on Chronic Nonspecific Low Back Pain: A Randomized Controlled Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5745409. [PMID: 31687394 PMCID: PMC6794965 DOI: 10.1155/2019/5745409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/16/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022]
Abstract
Background Low back pain (LBP) affects almost everyone at least once in their lifetime. Various meta-analyses show promising effects on pain reduction for conventional exercise. However, the lack of time and, especially for pain patients, a fear of movement (“kinesiophobia”) as well as functional limitations often oppose participation in such activities. In contrast, the advantage of novel training technologies like whole-body electromyostimulation (WB-EMS) lies particularly in a joint-friendly, time-effective, and highly customized training protocol and might be an alternative option for LBP patients. A meta-analysis of individual patient data and a comparison of WB-EMS against a passive control group confirmed the proof principle. Thus, the aim of this randomized controlled trial is to compare WB-EMS with a recognized back-strengthening exercise protocol to determine the corresponding effects on chronic, nonspecific LBP in people suffering from this. Methods and Findings This randomized, controlled multicenter study is focused on novel and time-effective training technologies and LBP. In this contribution, the focus is primarily on the comparison of WB-EMS against a comparable conventional exercise training (CT). One hundred ten nonspecific chronic LBP patients, 40–70 years old, were randomly allocated to the intervention arms (WB-EMS: 55 vs. CT: 55). Both groups completed a 12-week program (WB-EMS: 1 × 20 min/week vs. CT: 1 × 45 min/week) specifically dedicated to LBP. The selection of the content of the active control group was based on the principles of WB-EMS training, which uses electrical stimulation to train mainly strength and stabilization in a very short time. Exercises were similar in all groups, with the focus on strengthening and stabilizing the trunk. Outcome measures were assessed by a four-week pain diary (before and during the last four weeks of intervention) as well as an isometric maximum strength measurement of the trunk muscles at baseline and after 12 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. Secondary study endpoints were maximum isometric strength of the back and the abdominals. The mean pain intensity of LBP decreased significantly in both groups (WB-EMS: −22.3 ± 20.9% vs. CT: −30.2 ± 43.9%; p < 0.001), however, without significant intergroup difference (p=0.160). A similar result was observed for “maximum isometric strength of trunk muscles.” The increase in back strength (WB-EMS: 15.6 ± 24.9% vs. CT: 23.0 ± 30.9%) was highly significant in both groups (p=0.001), and similar changes were observed for the trunk flexors (WB-EMS: 17.6 ± 24.8% vs. CT: 18.1 ± 24.8%). Also, at the secondary endpoint, no significant difference in pairwise comparison was observed in both cases (extension: p=0.297; flexion: p=0.707). Conclusion In summary, both, WB-EMS and conventional back-strengthening protocol are comparably effective in reducing nonspecific chronic LBP in this dedicated cohort. The result is particularly positive in terms of time effectiveness and offers an adequate alternative for people with limited time resources or other barriers to conventional training methods.
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Tseli E, Boersma K, Stålnacke BM, Enthoven P, Gerdle B, Äng BO, Grooten WJ. Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Clin J Pain 2019; 35:148-173. [PMID: 30371517 PMCID: PMC6343958 DOI: 10.1097/ajp.0000000000000669] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR). MATERIALS AND METHODS Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE). DISCUSSION While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
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Affiliation(s)
- Elena Tseli
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet
| | - Katja Boersma
- School of Law, Psychology and Social Work, Örebro University, Örebro
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå
| | | | - Björn Gerdle
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping
| | - Björn O. Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet
- School of Education, Health and Social Studies, Dalarna University
- Center for Clinical Research Dalarna,Uppsala University, Falun, Sweden
| | - Wilhelmus J.A. Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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Günay Uçurum S, Kalkan AC. Bel ağrılı hastalarda ağrı, kinezyofobi ve yaşam kalitesi arasındaki ilişki. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.418139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sugano R, Ikegami K, Michii S, Ando H, Nozawa H, Imoto H, Shima A, Kawatsu Y, Fujino Y, Ogami A. Musculoskeletal pain in Japanese workers and the relationship between labor productivity by presenteeism and chronic musculoskeletal pain: a cross-sectional study. ENVIRONMENTAL AND OCCUPATIONAL HEALTH PRACTICE 2019. [DOI: 10.1539/eohp.2019-0003-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryosuke Sugano
- Department Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | - Kazunori Ikegami
- Department Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | - Satoshi Michii
- Department Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | - Hajime Ando
- Department Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | - Hiroki Nozawa
- Department Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | | | | | | | - Yoshihisa Fujino
- Department of Environmental Epidemiology Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | - Akira Ogami
- Department Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
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Nordström K, Ekhammar A, Larsson MEH. Physiotherapist-guided Free Movement Dance for patients with persistent pain is empowering in everyday living. A qualitative study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1536893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Annika Ekhammar
- Rehabilitation Clinic, Primary Health Care, Närhälsan Eriksberg Rehabilitation Clinic, Gothenburg, Sweden
| | - Maria EH Larsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
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Weissenfels A, Teschler M, Willert S, Hettchen M, Fröhlich M, Kleinöder H, Kohl M, von Stengel S, Kemmler W. Effects of whole-body electromyostimulation on chronic nonspecific low back pain in adults: a randomized controlled study. J Pain Res 2018; 11:1949-1957. [PMID: 30288089 PMCID: PMC6160275 DOI: 10.2147/jpr.s164904] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Low back pain (LBP) is one of the most frequent chronic conditions worldwide. Data from a recent meta-analysis indicated that whole-body electromyostimulation (WB-EMS), a time-effective, joint-friendly, and highly individualized training technology, demonstrated promising effects on LBP; however, methodologic limitations prevent definitive evidence for this result. Thus, the aim of this study was to conduct a randomized controlled WB-EMS trial to determine the corresponding effect on chronic, nonspecific LBP in people with chronic LBP. Patients and methods Thirty LBP patients, 40-70 years old, were randomly assigned into two groups (WB-EMS: 15; control [CG]: 15). While the nonactive CG maintained their lifestyle, the WB-EMS group completed a 12-week WB-EMS protocol (1×20 min/week) with slight movements, specifically dedicated to LBP. Pain intensity and frequency were determined by a 4-week pain diary before and during the last 4 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. Results At baseline, no group differences apart from nonregular exercise were observed. Mean intensity of LBP decreased significantly in the WB-EMS group (P=0.002) and remained unchanged in the CG (P=0.730), with a significant difference between both groups (P=0.027). Maximum isometric trunk extensors improved significantly in the WB-EMS group (P=0.005), while no significant difference was seen in the CG (P=0.683). In contrast to the significant difference between WB-EMS group and CG for the latter parameter (P=0.038), no intergroup difference was determined for maximum isometric trunk flexors (P=0.091). The WB-EMS group showed a significant increase of this parameter (P=0.003), while no significant change was determined in the CG (P=0.563). Conclusion WB-EMS is a time-effective training method for reducing chronic nonspecific LBP and increasing maximum trunk strength in people with such complaints. After this promising comparison with a nonactive CG, research needs to be extended to include comparisons with active groups (WB-Vibration, conventional back strengthening).
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Affiliation(s)
- Anja Weissenfels
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen, Erlangen, Germany,
| | - Marc Teschler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen, Erlangen, Germany,
| | - Sebastian Willert
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen, Erlangen, Germany,
| | - Michael Hettchen
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen, Erlangen, Germany,
| | - Michael Fröhlich
- Department of Sports Science, University of Kaiserslautern, Kaiserslautern, Germany
| | - Heinz Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences University of Furtwangen, Villingen-Schwenningen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen, Erlangen, Germany,
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen, Erlangen, Germany,
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Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med 2018; 53:554-559. [DOI: 10.1136/bjsports-2017-098673] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/04/2022]
Abstract
Objective(1) To explore the level of association between kinesiophobia and pain, disability and quality of life in people with chronic musculoskeletal pain (CMP) detected via cross-sectional analysis and (2) to analyse the prognostic value of kinesiophobia on pain, disability and quality of life in this population detected via longitudinal analyses.DesignA systematic review of the literature including an appraisal of the risk of bias using the adapted Newcastle Ottawa Scale. A synthesis of the evidence was carried out.Data sourcesAn electronic search of PubMed, AMED, CINAHL, PsycINFO, PubPsych and grey literature was undertaken from inception to July 2017.Eligibility criteria for selecting studiesObservational studies exploring the role of kinesiophobia (measured with the Tampa Scale for Kinesiophobia) on pain, disability and quality of life in people with CMP.ResultsSixty-three articles (mostly cross-sectional) (total sample=10 726) were included. We found strong evidence for an association between a greater degree of kinesiophobia and greater levels of pain intensity and disability and moderate evidence between a greater degree of kinesiophobia and higher levels of pain severity and low quality of life. A greater degree of kinesiophobia predicts the progression of disability overtime, with moderate evidence. A greater degree of kinesiophobia also predicts greater levels of pain severity and low levels of quality of life at 6 months, but with limited evidence. Kinesiophobia does not predict changes in pain intensity.Summary/conclusionsThe results of this review encourage clinicians to consider kinesiophobia in their preliminary assessment. More longitudinal studies are needed, as most of the included studies were cross-sectional in nature.Trial registration numberCRD42016042641.
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Effects of Whole-Body Electromyostimulation on Low Back Pain in People with Chronic Unspecific Dorsal Pain: A Meta-Analysis of Individual Patient Data from Randomized Controlled WB-EMS Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:8480429. [PMID: 29234437 PMCID: PMC5664316 DOI: 10.1155/2017/8480429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
In order to evaluate the favorable effect of whole-body electromyostimulation (WB-EMS) on low back pain (LBP), an aspect which is frequently claimed by commercial providers, we performed a meta-analysis of individual patient data. The analysis is based on five of our recently conducted randomized controlled WB-EMS trials with adults 60 years+, all of which applied similar WB-EMS protocols (1.5 sessions/week, bipolar current, 16–25 min/session, 85 Hz, 350 μs, and 4–6 s impulse/4 s impulse-break) and used the same pain questionnaire. From these underlying trials, we included only subjects with frequent-chronic LBP in the present meta-analysis. Study endpoints were pain intensity and frequency at the lumbar spine. In summary, 23 participants of the underlying WB-EMS and 22 subjects of the control groups (CG) were pooled in a joint WB-EMS and CG. At baseline, no group differences with respect to LBP intensity and frequency were observed. Pain intensity improved significantly in the WB-EMS (p < .001) and was maintained (p = .997) in the CG. LBP frequency decreased significantly in the WB-EMS (p < .001) and improved nonsignificantly in the CG (p = .057). Group differences for both LBP parameters were significant (p ≤ .035). We concluded that WB-EMS appears to be an effective training tool for reducing LBP; however, RCTs should further address this issue with more specified study protocols.
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Process of Change in Pain-Related Fear: Clinical Insights From a Single Case Report of Persistent Back Pain Managed With Cognitive Functional Therapy. J Orthop Sports Phys Ther 2017; 47:637-651. [PMID: 28704623 DOI: 10.2519/jospt.2017.7371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Single case report with repeated measures over 18 months. Background Management of persistent low back pain (PLBP) associated with high pain-related fear is complex. This case report aims to provide clinicians with insight into the process of change in a person with PLBP and high bending-related fear, who was managed with an individualized behavioral approach of cognitive functional therapy. Case Description A retired manual worker with PLBP believed that his spine was degenerating, that bending would hurt him, and that avoidance was the only form of pain control. At baseline, he presented high levels of pain-related fear on the Tampa Scale of Kinesiophobia (score, 47/68) and a high-risk profile on the Örebro Musculoskeletal Pain Questionnaire (score, 61/100). Unhelpful beliefs and behaviors led to a vicious cycle of fear and disengagement from valued life activities. Guided behavioral experiments were used to challenge his thoughts and protective responses, indicating that his behavior was modifiable and the pain controllable. Using a multidimensional clinical-reasoning framework, cognitive functional therapy management was tailored to target key drivers of PLBP and delivered over 6 sessions in a 3-month period. Outcomes Over an 18-month clinical journey, he demonstrated improvements in bending-related fear, pain expectancy, and pain experience, and substantial changes in pain-related fear (Tampa Scale of Kinesiophobia: 33/68; change, -14 points) and risk profile (Örebro Musculoskeletal Pain Questionnaire: 36/100; change, -25 points). Clinical interviews at 6 and 18 months revealed positive changes in mindset, understanding of pain, perceived pain control, and behavioral responses to pain. Discussion This case report provides clinicians with an insight to using a multidimensional clinical-reasoning framework to identify and target the key drivers of the disorder, and to using cognitive functional therapy to address unhelpful psychological and behavioral responses to pain in a person with PLBP and high pain-related fear. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(9):637-651. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7371.
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Åkerström ML, Grimby-Ekman A, Lundberg M. Work ability is influenced by kinesiophobia among patients with persistent pain. Physiother Theory Pract 2017; 33:634-643. [PMID: 28590818 DOI: 10.1080/09593985.2017.1328722] [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] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate how kinesiophobia fluctuates in patients over a four weeks multimodal rehabilitation program and to study the relationship between work ability and kinesiophobia. The study included 112 patients (94 women, 18 men). Measurements were made before, directly after, 2 months after, and 12 months after the program. The level of work ability was rated by the patients on a scale from 0% to 100%, and kinesiophobia was measured by the Swedish version of the Tampa Scale for Kinesiophobia (TSK-SV). Kinesiophobia decreased between the start of the multimodal rehabilitation program and the follow-up periods. Work ability increased over time, but not between baseline and the 2-month follow-up. Decreases in the TSK-SV score between baseline and the 2-month follow-up were related to the increased probability of improved work ability at the 12-month follow-up. In conclusion, a decrease in kinesiophobia seems to be related to increased work ability of patients participating in a 4-week multimodal rehabilitation program.
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Affiliation(s)
- Mona-Lisa Åkerström
- a Rehabilitation Medicine in Sandviken/Physiotherapy , Uppsala University , Sandviken , Sweden
| | - Anna Grimby-Ekman
- b Occupational and Environmental Medicine , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Mari Lundberg
- c Department of Neurobiology, Care Sciences and Sociology, Division of Physiotherapy , Karolinska Institutet , Huddinge , Sweden
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Kinesiophobia, Pain, Muscle Functions, and Functional Performances among Older Persons with Low Back Pain. PAIN RESEARCH AND TREATMENT 2017. [PMID: 28634547 PMCID: PMC5467352 DOI: 10.1155/2017/3489617] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives This study aims (1) to determine the association between kinesiophobia and pain, muscle functions, and functional performances and (2) to determine whether kinesiophobia predicts pain, muscle functions, and functional performance among older persons with low back pain (LBP). Methods This is a correlational study, involving 63 institutionalized older persons (age = 70.98 ± 7.90 years) diagnosed with LBP. Anthropometric characteristics (BMI) and functional performances (lower limb function, balance and mobility, and hand grip strength) were measured. Muscle strength (abdominal and back muscle strength) was assessed using the Baseline® Mechanical Push/Pull Dynamometer, while muscle control (transverse abdominus and multifidus) was measured by using the Pressure Biofeedback Unit. The pain intensity and the level of kinesiophobia were measured using Numerical Rating Scale and Tampa Scale of Kinesiophobia, respectively. Data were analyzed using Pearson's correlation coefficients and multivariate linear regressions. Results No significant correlations were found between kinesiophobia and pain and muscle functions (all p > 0.05). Kinesiophobia was significantly correlated with mobility and balance (p = 0.038, r = 0.263). Regressions analysis showed that kinesiophobia was a significant predictor of mobility and balance (p = 0.038). Conclusion We can conclude that kinesiophobia predicted mobility and balance in older persons with LBP. Kinesiophobia should be continuously assessed in clinical settings to recognize the obstacles that may affect patient's compliance towards a rehabilitation program in older persons with LBP.
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Hållstam A, Löfgren M, Benson L, Svensén C, Stålnacke BM. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain. Scand J Pain 2016; 17:233-242. [PMID: 29229208 DOI: 10.1016/j.sjpain.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Pain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that the condition will persist. These patients have the option of being referred to specialised pain clinics. However, the complexity surrounding chronic pain patients is not well studied in these settings. This study aimed to describe patients with chronic pain referred to a pain clinic by using the information submitted during their first visit and one year later and also to identify associations between baseline characteristics and improvements in health-related quality of life in the follow-up. METHODS This was a longitudinal observational study of a sample consisting of 318 patients referred to a pain clinic. One group of patients containing 271 individuals (median age 48, 64% females) was assessed and received conventional pain treatment (CPT group) and a second group of 47 patients (median age 53, 64% females) was assessed by a pain specialist and referred back to their physician with a treatment recommendation (assessment only, AO group). Patient-reported outcome measures in health-related quality of life (EQ-5D), pain intensity (VAS), mental health (HADS), insomnia (ISI), pain-related disability (PDI), kinesiophobia (TSK) and sense of coherence (SOC) were collected at the first visit and one year later. RESULTS At baseline, the CPT group reported a low EQ-5D Index (median (md) 0.157) and EQ VAS (md 40) as well as considerable high, current pain intensity VAS (md 58), HADS anxiety (md 8), ISI (md 17), PDI (md 36) and TSK (md 39). The AO group showed similar problems (no significant differences compared to the CPT group), except for ISI, where the AO group reported less severe problems. At the one-year follow-up, the CPT group had a statistically significant improvement in EQ-5D, VAS, ISI, PDI and TSK. In the AO group no significant changes were observed. In the CPT group there was an association between a high ISI level at baseline and an improved EQ-5D Index in the follow-up. CONCLUSIONS The study describes rarely explored groups of patients with chronic pain at a pain clinic. Severe pain problems were present in both groups at their first visit. A statistically significant improvement could be seen in the group that was conventionally treated while this was not the case among those subjects who were assessed and referred. The results imply, that relatively limited treatment strategies were helpful for the patients' health-related quality of life. Despite these improvements, the patients were not fully recovered, pointing to the chronicity of pain conditions and the need of support for many patients. IMPLICATIONS Increased knowledge about assessment, selection and treatment at pain clinics is important to improve the quality of the work performed at these clinics. Despite limited resources, further efforts should be made to collect comparable, valid data on a regular base from pain clinics in order to develop recommendation models.
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Affiliation(s)
- Andrea Hållstam
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Anaesthesiology and Intensive Care, Södersjukhuset, SE-11883 Stockholm, Sweden.
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-18288 Stockholm, Sweden.
| | - Lina Benson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-11883 Stockholm, Sweden
| | - Christer Svensén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Anaesthesiology and Intensive Care, Södersjukhuset, SE-11883 Stockholm, Sweden; University of Texas Medical Branch at Galveston, UTMB Health, Department of Anaesthesiology, Galveston, TX, USA.
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-18288 Stockholm, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90185 Umeå, Sweden.
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Hållstam A, Löfgren M, Svensén C, Stålnacke BM. Patients with chronic pain: One-year follow-up of a multimodal rehabilitation programme at a pain clinic. Scand J Pain 2016; 10:36-42. [PMID: 28361769 DOI: 10.1016/j.sjpain.2015.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Multimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment, there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year. METHODS A prospective, observational study with a one-year follow-up was performed. SUBJECTS A total of 42 individuals (38 females, age 44.0±12.3 years and 4 men age 40±8.5 years) with different pain diagnoses were included. After a team assessment, the patients began a programme that lasted about three months. The MMR programme contained coordinated, individually adapted treatments administered individually or in groups, and was based on cognitive behavioural principles. Questionnaires regarding health-related quality of life (HRQoL) (EQ-5D), insomnia (ISI), mental health (HADS), pain-related disability (PDI), kinesiophobia (TSK), current pain intensity (VAS) and sense of coherence (SOC) were used at the start of the MMR and at follow-up. Demographic data were collected from the patient records. RESULTS The PROM at baseline showed substantial pain problems with low HRQoL (EQ-5D index of 0.1±0.282, and EQ VAS of 32.67±20.1), moderate insomnia (ISI 18.95±6.7), doubtful cases of depression and anxiety (HADS-depression 9.35±4.1 and HADS-anxiety 9.78±3.95), presence of pain-related disability (PDI 39.48 ±12.64), kinesiophobia (TSK 40.8±9.8), as well as moderate current pain (VAS 61.31±20.4). The sense of coherence was weak (SOC of 51.37±14). At one-year follow-up, significant (p≤0.05) improvement occurred on the EQ-5D index, EQ VAS, ISI, PDI and TSK. In the logistic regression analysis, no significant associations could be identified. CONCLUSIONS MMR for patients with complex pain problems can be a successful treatment alternative at conventional pain clinics. IMPLICATIONS Since access to rehabilitation clinics in Sweden may be limited, the availability of MMR can increase by providing this type of intervention in pain clinics. Increased knowledge of MMR in different settings can also contribute to increased understanding and collaboration between pain clinics and rehabilitation units.
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Affiliation(s)
- Andrea Hållstam
- Karolinska Institutet, Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Sjukhusbacken 10, Södersjukhuset, Stockholm 118 83,StockholmSweden
| | - Monika Löfgren
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm 182 88, StockholmSweden
| | - Christer Svensén
- Karolinska Institutet, Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Sjukhusbacken 10, Södersjukhuset, Stockholm 118 83,StockholmSweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå 901 85, UmeåSweden
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The relationship between the Tampa Scale of Kinesiophobia and low back pain rehabilitation outcomes. Spine J 2015; 15:2466-71. [PMID: 26282104 DOI: 10.1016/j.spinee.2015.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 06/25/2015] [Accepted: 08/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUNDCONTEXT The Tampa Scale for Kinesiophobia (TSK) is commonly used in clinical practice to quantify levels of pain-related fear of activity or re-injury in patients presenting with back pain. Patients with high levels of kinesiophobia are often considered at greater risk of developing long-term activity limitation and chronicity. There is, however, little evidence to support this assumption. PURPOSE The purpose of this study was to assess the role of the TSK in determining eventual outcome in a cohort of low back pain patients completing a multidisciplinary rehabilitation program. STUDY DESIGN/SETTING A prospective cohort study was used. PATIENT SAMPLE The sample consisted of 313 low back pain patients treated at one of six rehabilitation clinics in New Zealand over a 4-year period. OUTCOME MEASURES The outcome measures for this study are the TSK, Numeric Pain Scale (NPS), Modified Low Back Outcome Score (m-LBOS), and vocational status (working or not working). METHODS TSK questionnaire scores and three additional quality of life (QoL) measures (NPS, m-LBOS, and vocational status) were recorded at the initial assessment and after a 6- to 12-week period of rehabilitation. Statistical analysis was performed to determine the relationships between TSK scores and the QoL values recorded at initial assessment and postrehabilitation checkpoints. RESULTS The correlations between initial TSK, NPS, and m-LBOS values recorded at assessment were statistically significant, but the relationships were weak. More importantly, there was no correlation between baseline TSK scores and changes in the numeric pain rating, perceived function, or vocational status after a period of rehabilitation. Correlations between changes in TSK scores and changes in NPS and m-LBOS values after rehabilitation were statistically significant, but the relationships were weak. CONCLUSIONS The TSK provides no benefit as a screening tool to predict pain, functional and work outcomes following rehabilitation. Measured changes in TSK scores following rehabilitation do not correlate strongly with similar, concordant changes in pain scores, functional levels, or return-to-work outcomes.
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Abstract
STUDY DESIGN Qualitative interview study. OBJECTIVE Explore attitudes, beliefs, and perceptions related to low back pain (LBP) and analyze how these might influence the perceived threat associated with back pain. SUMMARY OF BACKGROUND DATA Psychological factors that contribute to the perceived threat associated with LBP play an important role in back pain development and the progression to persistent pain and disability. Improved understanding of underlying beliefs may assist clinicians to investigate and assess these factors. METHODS Semistructured qualitative interviews were conducted with 12 participants with acute LBP (<6-wk duration) and 11 participants with chronic LBP (>3 mo duration). Data were analyzed thematically using the framework of Interpretive Description. RESULTS The back was viewed as being vulnerable to injury due to its design, the way in which it is used, and personal physical traits or previous injury. Consequently, participants considered that they needed to protect their back by resting, being careful with or avoiding dangerous activities, and strengthening muscles or controlling posture. Participants considered LBP to be special in its nature and impact, and they thought it difficult to understand without personal experience. The prognosis of LBP was considered uncertain by those with acute pain and poor by those with chronic pain. These beliefs combined to create a negative (mis)representation of the back. CONCLUSION Negative assumptions about the back made by those with LBP may affect information processing during an episode of pain. This may result in attentional bias toward information indicating that the spine is vulnerable, an injury is serious, or the outcome will be poor. Approaching consultations with this understanding may assist clinicians to have a positive influence on beliefs. LEVEL OF EVIDENCE 3.
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Assessment of Kinesiophobia and Use of Music Therapy in the Acute Care Setting. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2014. [DOI: 10.1097/01.jat.0000453143.07069.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Larsson C, Hansson EE, Sundquist K, Jakobsson U. Psychometric properties of the Tampa Scale of Kinesiophobia (TSK-11) among older people with chronic pain. Physiother Theory Pract 2014; 30:421-8. [DOI: 10.3109/09593985.2013.877546] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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O’Connor SR, Bleakley CM, Tully MA, McDonough SM. Predicting functional recovery after acute ankle sprain. PLoS One 2013; 8:e72124. [PMID: 23940806 PMCID: PMC3734311 DOI: 10.1371/journal.pone.0072124] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/10/2013] [Indexed: 12/26/2022] Open
Abstract
Introduction Ankle sprains are among the most common acute musculoskeletal conditions presenting to primary care. Their clinical course is variable but there are limited recommendations on prognostic factors. Our primary aim was to identify clinical predictors of short and medium term functional recovery after ankle sprain. Methods A secondary analysis of data from adult participants (N = 85) with an acute ankle sprain, enrolled in a randomized controlled trial was undertaken. The predictive value of variables (age, BMI, gender, injury mechanism, previous injury, weight-bearing status, medial joint line pain, pain during weight-bearing dorsiflexion and lateral hop test) recorded at baseline and at 4 weeks post injury were investigated for their prognostic ability. Recovery was determined from measures of subjective ankle function at short (4 weeks) and medium term (4 months) follow ups. Multivariate stepwise linear regression analyses were undertaken to evaluate the association between the aforementioned variables and functional recovery. Results Greater age, greater injury grade and weight-bearing status at baseline were associated with lower function at 4 weeks post injury (p<0.01; adjusted R square=0.34). Greater age, weight-bearing status at baseline and non-inversion injury mechanisms were associated with lower function at 4 months (p<0.01; adjusted R square=0.20). Pain on medial palpation and pain on dorsiflexion at 4 weeks were the most valuable prognostic indicators of function at 4 months (p< 0.01; adjusted R square=0.49). Conclusion The results of the present study provide further evidence that ankle sprains have a variable clinical course. Age, injury grade, mechanism and weight-bearing status at baseline provide some prognostic information for short and medium term recovery. Clinical assessment variables at 4 weeks were the strongest predictors of recovery, explaining 50% of the variance in ankle function at 4 months. Further prospective research is required to highlight the factors that best inform the expected convalescent period, and risk of recurrence.
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Affiliation(s)
- Sean R. O’Connor
- Faculty of Science and Engineering, University of Brighton, Brighton, United Kingdom
| | - Chris M. Bleakley
- Faculty of Life and Health Science, University of Ulster, Belfast, Northern Ireland, United Kingdom
- * E-mail:
| | - Mark A. Tully
- UKCRC Centre of Excellence for Public Health (NI), Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Suzanne M. McDonough
- Faculty of Life and Health Science, University of Ulster, Belfast, Northern Ireland, United Kingdom
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