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Ezzatvar Y, Poulter D, Lluch-Girbés E, Dueñas L, Balasch-Bernat M, Rossettini G. Comment on 'The importance of context (placebo effects) in conservative interventions for musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials' by Saueressig et al. Eur J Pain 2024; 28:855-856. [PMID: 38247029 DOI: 10.1002/ejp.2242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, University of Valencia, Valencia, Spain
| | - David Poulter
- MT3 Education and Consulting, Coon Rapids, Minnesota, USA
| | - Enrique Lluch-Girbés
- Department of Physiotherapy, Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Department of Physiotherapy, Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Mercè Balasch-Bernat
- Department of Physiotherapy, Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Verona, Italy
- Department of Human Neurosciences, University of Rome 'Sapienza Roma', Rome, Italy
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
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Ezzatvar Y, Dueñas L, Balasch-Bernat M, Lluch-Girbés E, Rossettini G. Which portion of physiotherapy treatments' effect is attributable to contextual effects in people with musculoskeletal pain?: A meta-analysis of randomised placebo-controlled trials. J Orthop Sports Phys Ther 2024:1-28. [PMID: 38602164 DOI: 10.2519/jospt.2024.12126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE: To quantify the proportion attributable to contextual effects of physical therapy interventions for musculoskeletal pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched Ovid, MEDLINE, EMBASE, CINAHL, Scopus, PEDro, Cochrane Controlled Trials Registry, and SPORTDiscus databases from inception to April 2023. STUDY SELECTION CRITERIA: Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain. DATA SYNTHESIS: Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (ROB 2.0). The proportion of physical therapy interventions effect that is explained by contextual effects was calculated, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method). RESULTS: Sixty-eight studies were included in the systematic review (participants: n=5,238), and 54 placebo-controlled trials informed our meta-analysis (participants: n=3,793). Physical therapy interventions included soft tissue techniques, mobilization, manipulation, taping, exercise therapy and dry needling. Placebo interventions included manual, non-manual interventions, or both. The proportion attributable to contextual effects of mobilization accounted for 88% of the immediate overall treatment effect for pain intensity (PCE=0.88, 95%CI 0.57-1.20). In exercise therapy, contextual effects accounted for 46% of the overall treatment effect for pain intensity (PCE=0.46, 95%CI 0.41-0.52). Contextual effects in manipulation excelled in short-term pain relief (PCE=0.81, 95%CI 0.62-1.01) and in mobilization in long-term effects (PCE=0.86, 95%CI 0.76-0.96). In taping, contextual effects accounted for 64% of disability improvement (PCE=0.64, 95%CI 0.48-0.80). CONCLUSION: The outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by contextual effects. Boosting contextual effects consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mercè Balasch-Bernat
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- These two authors contributed equally to this work
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Verona, Italy
- These two authors contributed equally to this work
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Caballero I, Dueñas L, Balasch-Bernat M, Fernández-Matías R, Bresó-Parra L, Gallego-Terres C, Aroca Navarro JE, Navarro-Bosch M, Lewis J, Lluch Girbés E. Effectiveness of non-surgical management in rotator cuff calcific tendinopathy (the effect trial): protocol for a randomised clinical trial. BMJ Open 2024; 14:e074949. [PMID: 38176875 PMCID: PMC10773347 DOI: 10.1136/bmjopen-2023-074949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Rotator cuff calcific tendinopathy (RCCT) involves calcific deposits in the rotator cuff. Non-surgical interventions such as extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) are recommended for its early management. Exercise therapy (ET) has shown to be an effective intervention for people with rotator cuff tendinopathy, but it has not been formally tested in RCCT. The main objective of this study is to compare the effectiveness of an ET programme with ESWT and US-PICT in people with RCCT. As a secondary aim, this study aims to describe the natural history of RCCT. METHODS AND ANALYSIS A randomised, single-blinded four-group clinical trial will be conducted. Adults from 30 to 75 years diagnosed with RCCT who accomplish eligibility criteria will be recruited. Participants (n=116) will be randomised into four groups: ET group will receive a 12-week rehabilitation programme; ESWT group will receive four sessions with 1 week rest between sessions during 1 month; US-PICT group will receive two sessions with 3 months of rest between sessions; and (actual) wait-and-see group will not receive any intervention during the 12-month follow-up. The primary outcome will be shoulder pain assessed with the Shoulder Pain and Disability Index at baseline, 2 weeks, 4 months, 6 months and 12 months from baseline. The primary analysis will be performed at 12 months from baseline. Secondary outcomes will include pain, range of motion, patient satisfaction and imaging-related variables. Moreover, the following psychosocial questionnaires with their corresponding outcome measure will be assessed: Central Sensitization Inventory (symptoms related to central sensitization); Pain Catastrophizing Scale (pain catastrophizing); Tampa Scale for Kinesiophobia 11 items (fear of movement); Fear Avoidance Belief Questionnaire (fear avoidance behaviour); Hospital Anxiety and Depression Scale (anxiety and depression); Pittsburgh Sleep Quality Index (sleep quality); and the EuroQol-5D (quality of life). An intention-to-treat analysis will be performed to reduce the risk of bias using a worst-case and best-case scenario analysis. ETHICS AND DISSEMINATION Ethics committee approval for this study has been obtained (reference number: 1718862). The results of the main trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05478902.
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Affiliation(s)
- Iván Caballero
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mercè Balasch-Bernat
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Luis Bresó-Parra
- Department of Radiology, Lluis Alcanyis Hospital of Xativa, Xativa, Spain
| | | | | | - Marta Navarro-Bosch
- Shoulder and Elbow Unit, University and Polytechnic Hospital, Valencia, Spain
| | - Jeremy Lewis
- Consultant Physiotherapist, Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London N12 0JE, UK
- Professor of Musculoskeletal Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Enrique Lluch Girbés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
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Mertens MG, Struyf F, Verborgt O, Dueñas L, Balasch-Bernat M, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Lluch Girbes E, Meeus M. Exploration of the clinical course and longitudinal correlations in frozen shoulder: The role of autonomic function, central pain processing, and psychological variables. A longitudinal multicenter prospective observational study. Musculoskelet Sci Pract 2023; 67:102857. [PMID: 37725869 DOI: 10.1016/j.msksp.2023.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Altered central pain processing (CPP) and dysautonomia might play a role in the clinical course of frozen shoulder and psychological factors, like pain catastrophizing and hypervigilance, might influence clinical variables in frozen shoulder. OBJECTIVES To explore the clinical course of frozen shoulder regarding CPP, dysautonomia, pain catastrophizing, and hypervigilance and to explore whether longitudinal correlations between these outcomes and pain intensity were present. DESIGN prospective longitudinal observational study. METHOD Participants with frozen shoulder were recruited at hospitals and general practitioner practices and followed for 9 months. They completed six questionnaires (about demographics, shoulder pain and disability, pain intensity, pain catastrophizing, pain hypervigilance, and autonomic symptoms) and underwent tactile sensitivity (allodynia), pressure pain thresholds (hyperalgesia), temporal summation, and conditioned pain modulation during four timeframes (3-month intervals). RESULTS Initially, 149 participants with frozen shoulder were recruited and 88 completed all the measurements. An improvement from baseline to at least one follow-up measurement was found for shoulder pain and disability, pain intensity, pain catastrophizing, hypervigilance, and dysautonomia. A fair longitudinal correlation was found between pain intensity and catastrophizing and hypervigilance (r = 0.301-0.397). Poor longitudinal correlations were found between pain intensity and allodynia and hyperalgesia (r = -0.180-0.193), between pain catastrophizing and dysautonomia (r = 0.209) and between hypervigilance and hyperalgesia (r = -0.159). CONCLUSION Patients with frozen shoulder showed an early improvement that flattened with time in several pain and psychological variables over the course of 9 months. However, autonomic symptoms rather showed a late improvement over 9 months.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital (UZA), Edegem, Belgium.
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, 46010, Valencia, Spain.
| | - Mercè Balasch-Bernat
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, 46010, Valencia, Spain.
| | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street 5, 52004, Melilla, Spain.
| | | | | | - Enrique Lluch Girbes
- Pain in Motion International Research Group(1), Belgium; Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, 46010, Valencia, Spain; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group(1), Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
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Mertens MG, Meeus M, Verborgt O, Girbes EL, Horno SMD, Aguilar-Rodriguez M, Dueñas L, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F. Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments. Braz J Phys Ther 2023; 27:100539. [PMID: 37639942 PMCID: PMC10474583 DOI: 10.1016/j.bjpt.2023.100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Contradictory evidence exists regarding the clinical course of frozen shoulder (FS). OBJECTIVES To explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables. METHODS Patients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR. RESULTS Initially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15). CONCLUSION Almost all factors improved in the early phase (3-6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery, University Hospital (UZA), Edegem, Belgium
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Marta Aguilar-Rodriguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | | | | | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Mena-Del Horno S, Balasch-Bernat M, Louw A, Luque-Suarez A, Rodríguez-Brazzarola P, Navarro-Ledesma S, Murillo C, Dueñas L, Lluch E. Is there any benefit of adding a central nervous system-focused intervention to a manual therapy and home stretching program for people with frozen shoulder? A randomized controlled trial. J Shoulder Elbow Surg 2023; 32:1401-1411. [PMID: 37001795 DOI: 10.1016/j.jse.2023.02.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion. The aim of this study was to evaluate the effect of adding a central nervous system (CNS)-focused approach to a manual therapy and home stretching program in people with FS. METHODS A total of 34 patients with a diagnosis of primary FS were randomly allocated to receive a 12-week manual therapy and home stretching program or manual therapy and home stretching program plus a CNS-focused approach including graded motor imagery and sensory discrimination training. The Shoulder Pain and Disability Index score, self-perceived shoulder pain (visual analog scale score), shoulder range of motion, and the Patient-Specific Functional Scale score were measured at baseline, after a 2-week washout period just before starting treatment, after treatment, and at 3 months' follow-up. RESULTS No significant between-group differences in any outcome were found either after treatment or at 3 months' follow-up. CONCLUSION A CNS-focused approach provided no additional benefit to a manual therapy and home stretching program in terms of shoulder pain and function in people with FS.
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Affiliation(s)
- Silvia Mena-Del Horno
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Universidad Internacional de Valencia, Valencia, Spain
| | - Mercè Balasch-Bernat
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Physiotherapy in Motion, Multi-speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Adriaan Louw
- Evidence in Motion, San Antonio, TX, USA; Physical Therapy Department, St. Ambrose University, Davenport, IA, USA
| | - Alejandro Luque-Suarez
- Facultad de Ciencias de la Salud, Universidad de Malaga, Malaga, Spain; Instituto de la Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | | | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | - Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Lirios Dueñas
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Physiotherapy in Motion, Multi-speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Enrique Lluch
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Physiotherapy in Motion, Multi-speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Departments of Human Physiology and Rehabilitation Sciences, "Pain in Motion" International Research Group, Brussels, Belgium
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Ferrando-Terradez I, Dueñas L, Parčina I, Ćopić N, Petronijević S, Beltrami G, Pezzoni F, San Martín-Valenzuela C, Gijssel M, Moliterni S, Papageorgiou P, Rodríguez-Carrasco Y. Women's Involvement in Steady Exercise (WISE): Study Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2023; 11:1279. [PMID: 37174821 PMCID: PMC10177760 DOI: 10.3390/healthcare11091279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Physical inactivity is a serious public health problem for people of all ages and is currently the fourth highest global risk factor for mortality. The transition period from adolescence to adulthood coincides with a marked reduction in participation in physical activity, with more than 50% (and up to 80%) of young adults stopping physical activity. This decrease in physical activity is more evident in women than in men. Despite efforts, existing programs face challenges in effectively initiating and maintaining physical activity among individuals, particularly women, for extended durations. To address these limitations, the Women's Involvement in Steady Exercise (WISE) randomized controlled trial (RCT) seeks to assess the efficacy of a digital high-intensity training intervention complemented by nutritional plans and other health-related advice. METHODS The study will be a three-center, randomized (1:1), controlled, parallel-group trial with a six-month intervention period. A total of 300 participants will be recruited at three study sites in Spain, Serbia and Italy. The participants will be randomized to one of the two groups and will follow a six-month program. The primary outcome of the study is the daily step count. Self-reported physical activity, the adherence to the exercise program, body composition, physical activity enjoyment, quality of sleep and physical capacities will also be evaluated.
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Affiliation(s)
| | - Lirios Dueñas
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Ivana Parčina
- Faculty of Sport, University “Union—Nikola Tesla”, 11000 Belgrade, Serbia
| | - Nemanja Ćopić
- Faculty of Sport, University “Union—Nikola Tesla”, 11000 Belgrade, Serbia
| | | | | | | | - Constanza San Martín-Valenzuela
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maarten Gijssel
- Kinetic Analysis, Jheronimus Academy of Data Science, 5211 DA ‘s-Hertogenbosh, The Netherlands
| | | | | | - Yelko Rodríguez-Carrasco
- Department of Food Science and Toxicology, Faculty of Pharmacy, University of Valencia, Av. Vicent Andrés Estellés s/n, 46100 Burjassot, Spain
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Gutierrez-Coronado J, López-Bueno L, Cardero-Durán MDLA, Albornoz-Cabello M, Toledo-Marhuenda JV, Hernández-Sánchez S, Dueñas L, Marques-Sule E, Morral A, Espejo-Antúnez L. The Clinical Benefits of a Dynamic vs. Static Component as Part of a Comprehensive Warm-Up for Recreational Sports Players with Clinical Histories of Hamstring Injuries: A Randomized Clinical Trial. Int J Environ Res Public Health 2022; 20:744. [PMID: 36613065 PMCID: PMC9819227 DOI: 10.3390/ijerph20010744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Background: Few previous studies have analyzed the effects of certain specific static and dynamic warm-up components on recreational sports players with a previous hamstring injury. Therefore, the aim of this study was to analyze changes in some modifiable and external risk factors after (immediately and in a follow-up assessment after 10 min) a static or dynamic warm-up program on recreational sports players with a previous hamstring injury. Methods: A total of 62 participants were randomized into 2 groups: static warm-up (SW) (n = 31) or dynamic warm-up (DW) (n = 31). Range of movement (RoM), perceived pain, the pressure−pain threshold, and joint position sense were assessed at baseline, immediately after the intervention and 10 min afterwards. The intervention for the SW (hot pack procedures in both hamstring muscles) lasted 20 min. The DW intervention consisted of a running exercise performed on a treadmill for 10 min. Results: Both groups showed statistically significant changes (p ≤ 0.05) in the primary outcomes (perceived pain and the pressure−pain threshold) at the three measurement times (this was also true for RoM for the SW group, with statistically significant differences only between times from the baseline to the 10-min follow-up; p ≤ 0.05, d = 0.23). The intra-group secondary outcome showed no statistically significant changes (p > 0.05) in both groups (except for the period from the baseline−immediately after in the DW group; p ≤ 0.05, d = 0.53). The comparison between groups showed no statistically significant differences for any of the variables analyzed. (p ≥ 0.05). Conclusion: The present findings suggest that both specific warm-up modalities seem to positively influence perceived pain on stretching and the pressure threshold; however, the significant reduction in the joint repositioning error and the larger effect sizes observed in the DW group suggest that this method has a greater beneficial impact in recreational sports players with clinical histories of hamstring injuries.
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Affiliation(s)
- Javier Gutierrez-Coronado
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, Av. Elvas, s/n, 06006 Badajoz, Spain
| | - Laura López-Bueno
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010 Valencia, Spain
| | - María de los Angeles Cardero-Durán
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, Av. Elvas, s/n, 06006 Badajoz, Spain
| | - Manuel Albornoz-Cabello
- Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, University of Seville, C/Avicena, 6, 41009 Seville, Spain
| | - Jose Vicente Toledo-Marhuenda
- Department of Pathology and Surgery (Area of Physiotherapy), Medicine Faculty, Miguel Hernández University, Ctra Alicante-Valencia Km 8,7—N 332, 03550 Alicante, Spain
| | - Sergio Hernández-Sánchez
- Department of Pathology and Surgery (Area of Physiotherapy), Medicine Faculty, Miguel Hernández University, Ctra Alicante-Valencia Km 8,7—N 332, 03550 Alicante, Spain
| | - Lirios Dueñas
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010 Valencia, Spain
- Physiotherapy in Motion, Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Elena Marques-Sule
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010 Valencia, Spain
| | - Antoni Morral
- Blanquerna School of Health Sciences, Ramon Llull University, Carrer de Claravall, 1, 3, 08022 Barcelona, Spain
| | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, Av. Elvas, s/n, 06006 Badajoz, Spain
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Mertens MG, Meeus M, Noten S, Verborgt O, Fransen E, Lluch Girbés E, Aguilar Rodríguez M, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F, Dueñas L. Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study. BMJ Open 2022; 12:e056563. [PMID: 36410809 PMCID: PMC9680192 DOI: 10.1136/bmjopen-2021-056563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. The aim of the current study was to examine to what extent range of motion (ROM) limitation, metabolic factors (diabetes mellitus and thyroid disorders), autonomic symptoms and pain sensitivity may contribute to the prognosis in terms of shoulder pain and disability and quality of life in patients with FS. METHODS Patients with stage 1 or 2 FS were longitudinally followed-up during 9 months after baseline assessment. They completed six questionnaires and underwent quantitative sensory testing (pressure pain thresholds, temporal summation and conditioned pain modulation) and ROM assessment. RESULTS One hundred and forty-nine patients with FS were initially recruited and 121 completed at least one follow-up measurement. Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. Several domains of quality of life also improved over time and external rotation ROM, diabetes mellitus, thyroid disorder and autonomic symptoms were found to be prognostic factors for final outcome. These prognostic factors explained 2.5%-6.3% of the final outcome of shoulder pain and disability and quality of life. DISCUSSION AND CONCLUSION In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. Other variables not explored in this study might contribute to the prognosis of patients with FS, which should be investigated in future research. In clinical practice, baseline assessment of prognostic factors and focusing on a more holistic approach might be useful to inform healthcare practitioners about progression of patients with FS during a 9-month period.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Suzie Noten
- Department of Rehabilitation Medicine, Erasmus MC University medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerpen, Belgium
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium
| | - Enrique Lluch Girbés
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Marta Aguilar Rodríguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | | | | | | | - Filip Struyf
- Rehabilitation Sciences, Universiteit Antwerpen Campus Drie Eiken, Wilrijk, Belgium
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
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Mertens MG, Struyf F, Lluch Girbes E, Dueñas L, Verborgt O, Meeus M. Autonomic Nervous System Function and Central Pain Processing in People With Frozen Shoulder: A Case-control Study. Clin J Pain 2022; 38:659-669. [PMID: 36111678 DOI: 10.1097/ajp.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The pathophysiology of a frozen shoulder (FS) is thought to be related to chronic inflammation. Chronic inflammation may disturb the immune system and consequently the nervous system as part of an overarching system. The aim of this study was to determine the presence of disturbed autonomic nervous system function and altered central pain processing (CPP) in patients with FS. Secondarily, the presence of psychological variables (catastrophizing and hypervigilance) and self-reported associated symptoms of altered CPP in patients with FS were investigated. METHODS Patients with FS and healthy controls completed the Composite Autonomic Symptom Score (autonomic function) and underwent quantitative sensory testing to assess tactile sensitivity (ie, allodynia), pressure pain thresholds (PPTs, ie, hyperalgesia), temporal summation of pain, and Conditioned Pain Modulation (CPM). Psychological issues were explored with the Pain Catastrophizing Scale and the Pain Vigilance and Awareness Questionnaire, and self-reported symptoms associated with altered CPP were determined with the Central Sensitization Inventory. RESULTS Thirty-two patients with FS and 35 healthy controls were analyzed in the study. Patients with FS showed more self-reported autonomic symptoms and symptoms of altered CPP, higher levels of pain catastrophizing and hypervigilance, and are more sensitive to tactile touches and mechanical pressure compared with controls. DISCUSSION On the basis of the effect sizes, between-group differences in allodynia, hyperalgesia, catastrophizing, and hypervigilance were clinically relevant, but only local allodynia, hyperalgesia, catastrophizing, and hypervigilance were statistically different. Therefore, obvious altered CPP was not present at the group level in patients with FS compared with controls.
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Affiliation(s)
- Michel G Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk
- Pain in Motion International Research group
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk
| | - Enrique Lluch Girbes
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels
- Pain in Motion International Research group
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp
- Department of Orthopedic Surgery, University Hospital (UZA), Edegem, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent
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11
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Mertens MGCAM, Meeus M, Pieters L, Balasch-Bernat M, Dueñas L, Verborgt O, Struyf F. An Instrument-Assisted Coracoid Pain Test: An Exploratory Diagnostic Accuracy Study. Int J Environ Res Public Health 2022; 19:12735. [PMID: 36232033 PMCID: PMC9566369 DOI: 10.3390/ijerph191912735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
The coracoid pain test (CPT) could contribute to the diagnosis of frozen shoulder (FS) with palpation. However, due to assessor performance these values might be unreliable. Therefore, the aim was to explore the diagnostic accuracy of an instrument-assisted CPT and two alternative approaches (pain severity and side comparison) for assistance in the diagnosis of FS. Patients with FS and healthy age-matched controls were recruited. All participants underwent the instrument-assisted CPT on both shoulders with a pressure algometer. Sensitivity, specificity, and likelihood ratios were determined for the three approaches. In total, 35 patients with FS and 35 healthy participants were included. The original approach was positive in eight participants (11.4%), with only sufficient specificity to draw a conclusion. The pain severity approach was positive in 31 participants (44.3%) with sufficient sensitivity, specificity and likelihood ratios. The side comparison approach was positive in 10 participants (14.3%) with excellent specificity and positive likelihood ratio. The specificity of the instrument-assisted CPT can be used to increase the probability of FS with both the original and alternative approaches. Only the pain severity approach can draw a conclusion with a negative test result. This study should be repeated with a cross-sectional design to strengthen and confirm the conclusions.
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Affiliation(s)
- Michel GCAM Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Louise Pieters
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Mercè Balasch-Bernat
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, C/Gasco Oliag 5, 46010 Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, C/Gasco Oliag 5, 46010 Valencia, Spain
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Harmoniestraat 68, 2018 Antwerp, Belgium
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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12
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Navarro-Ledesma S, Pruimboom L, Lluch E, Dueñas L, Mena-Del Horno S, Gonzalez-Muñoz A. The Relationship between Daily Physical Activity, Psychological Factors, and Vegetative Symptoms in Women with Fibromyalgia: A Cross-Sectional Observational Study. Int J Environ Res Public Health 2022; 19:ijerph191811610. [PMID: 36141882 PMCID: PMC9517117 DOI: 10.3390/ijerph191811610] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 05/27/2023]
Abstract
Nowadays, there is evidence that relates the amount of physical activity, as well as the impact of psychological factors, to the intensity of symptoms present in patients with fibromyalgia (FM). However, there are no studies which correlate the level of association of physical activity, psychological factors and vegetative symptoms in the FM population. The study has a cross-sectional observational design with 41 participants being recruited from a private clinic and rehabilitation service. The Autonomic Symptom Profile (Compass-31) to assess vegetative symptoms, the GODIN questionnaire to evaluate the level of leisure activity, and the pain catastrophizing scale, Tampa Kinesiophobia Scale and Self-Efficacy Scale to assess psychological factors, were used. A low and significant level of association was found between pain catastrophizing (PCS) and Kinesiophobia (r = 0.398; p < 0.01), as well as with catastrophizing and vegetative symptoms (r = 0.428; p < 0.05). Furthermore, a low and significant level of association was also found between self-efficacy and vegetative symptoms (r = 0.397; p < 0.05). No association was found between the level of daily physical activity (measured by the Godin Leisure questionnaire) and vegetative symptoms, nor with any psychological factor studied. There is an association between vegetative symptoms and psychological factors. Nevertheless, more research which takes other factors into account, such as lifestyle and nutritional, is needed.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street 5, 52004 Melilla, Spain
- University Chair in Clinical Psychoneuroimmunology (University of Granada and PNI Europe), Querol Street 5, 52004 Melilla, Spain
- PNI Europe, 2518 JP The Hague, The Netherlands
| | - Leo Pruimboom
- University Chair in Clinical Psychoneuroimmunology (University of Granada and PNI Europe), Querol Street 5, 52004 Melilla, Spain
- PNI Europe, 2518 JP The Hague, The Netherlands
| | - Enrique Lluch
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Street de Gascó Oliag, 5, 46010 Valencia, Spain
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Pain in Motion International Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Lirios Dueñas
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Street de Gascó Oliag, 5, 46010 Valencia, Spain
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Silvia Mena-Del Horno
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Street de Gascó Oliag, 5, 46010 Valencia, Spain
| | - Ana Gonzalez-Muñoz
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
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13
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Ezzatvar Y, López-Bueno L, Fuentes-Aparicio L, Dueñas L. Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10245753. [PMID: 34945049 PMCID: PMC8708542 DOI: 10.3390/jcm10245753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 01/21/2023] Open
Abstract
Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Laura López-Bueno
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Laura Fuentes-Aparicio
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
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14
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Huysmans E, Baeyens JP, Dueñas L, Falla D, Meeus M, Roose E, Nijs J, Lluch Girbés E. Do Sex and Pain Characteristics Influence the Effectiveness of Pain Neuroscience Education in People Scheduled for Total Knee Arthroplasty? Secondary Analysis of a Randomized Controlled Trial. Phys Ther 2021; 101:6352443. [PMID: 34459493 DOI: 10.1093/ptj/pzab197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/23/2021] [Accepted: 06/27/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This explorative study investigates the moderating effect of sex and baseline pain characteristics on the effectiveness of preoperative pain neuroscience education (PNE) plus knee joint mobilization versus biomedical education plus knee joint mobilization in patients who have knee osteoarthritis and are scheduled to undergo total knee arthroplasty (TKA). METHODS After baseline assessment of self-reported questionnaires (pain intensity, disability, symptoms of central sensitization and pain cognitions) and quantitative sensory testing, 44 participants with knee osteoarthritis were randomized into the PNE plus knee joint mobilization or biomedical education plus knee joint mobilization group. The questionnaires were retaken directly after and 1 month after 4 sessions of treatment and at 3 months after surgery. Based on baseline quantitative sensory testing results, the sample was subdivided into a high (showing high experimental pain levels and low pressure pain thresholds) and low pain cluster using principal components analysis and cluster analysis. Therapy effects over time were evaluated using 3-way analysis of variance, with time as the within factor and treatment, sex, and baseline pain cluster as between factors. RESULTS Women benefited significantly more from the PNE intervention compared with the control intervention in terms of self-reported symptoms of central sensitization. For both pain clusters, differences in therapeutic effects concerning pain intensity and pain cognitions were found, with higher superiority of the PNE intervention in the high-pain cluster subgroup compared with the low-pain cluster. CONCLUSION Based on these explorative analyses, it can be concluded that sex and preoperative pain measures may influence the effectiveness of preoperative PNE for some specific outcome measures in people scheduled to undergo TKA. IMPACT Although further research on this topic is needed, the potential influence of sex and preoperative pain measures on the effectiveness of preoperative PNE should be considered when implementing this intervention in people undergoing TKA.
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Affiliation(s)
- Eva Huysmans
- Research Foundation Flanders (FWO), Brussels, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Pain in Motion International Research Group (PiM), www.paininmotion.be
| | - Jean-Pierre Baeyens
- EXAN Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,THIM - Internationale Hochschule für Physiotherapie, Landquart, Switzerland
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Mira Meeus
- Pain in Motion International Research Group (PiM), www.paininmotion.be.,MovAnt, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Pain in Motion International Research Group (PiM), www.paininmotion.be.,Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Pain in Motion International Research Group (PiM), www.paininmotion.be
| | - Enrique Lluch Girbés
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Pain in Motion International Research Group (PiM), www.paininmotion.be.,Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
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15
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Aguilar-Rodríguez M, Dueñas L, Balasch i Bernat M, Meeus M, Struyf F, Lluch E. Conditioned Pain Modulation Is Not Impaired in Individuals with Frozen Shoulder: A Case-Control Study. Int J Environ Res Public Health 2021; 18:ijerph182312330. [PMID: 34886056 PMCID: PMC8656545 DOI: 10.3390/ijerph182312330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
Frozen shoulder (FS) is a poorly understood condition resulting in substantial shoulder pain and mobility deficits. The mechanisms behind FS are not yet fully understood, but, similar to other persistent pain states, central pain mechanisms may contribute to ongoing symptoms in this population. The objective of this research was to investigate conditioned pain modulation (CPM) in people with FS compared with pain-free individuals. A total of 64 individuals with FS and 64 healthy volunteers participated in this cross-sectional study. CPM was assessed by using the pressure pain threshold (PPT) and an occlusion cuff (tourniquet test) as the test and conditioning stimulus, respectively. The absolute and percentage of change in PPT (CPM effect) as well as pain profiles (pro-nociceptive vs. anti-nociceptive) of individuals with FS and healthy controls were calculated. No significant differences in the absolute change in the PPT or CPM effect were found in people with FS compared to pain-free controls. Moreover, no between-group differences in the percentage of subjects with pro-nociceptive and anti-nociceptive pain profiles were observed. These results suggest that endogenous pain inhibition is normally functioning in people with FS. Altered central pain-processing mechanisms may thus not be a characteristic of this population.
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Affiliation(s)
- Marta Aguilar-Rodríguez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (M.A.-R.); (M.B.i.B.); (E.L.)
| | - Lirios Dueñas
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (M.A.-R.); (M.B.i.B.); (E.L.)
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-963-983-853 (ext. 51264)
| | - Mercè Balasch i Bernat
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (M.A.-R.); (M.B.i.B.); (E.L.)
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Mira Meeus
- Pain in Motion International Research Group, 2000 Antwerp, Belgium;
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium;
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium;
| | - Enrique Lluch
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (M.A.-R.); (M.B.i.B.); (E.L.)
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Pain in Motion International Research Group, 2000 Antwerp, Belgium;
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium
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16
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Rodriguez Rodriguez AM, Blanco-Díaz M, Lopez Diaz P, de la Fuente Costa M, Dueñas L, Escobio Prieto I, Calatayud J, Casaña J. Quality Analysis of YouTube Videos Presenting Shoulder Exercises after Breast Cancer Surgery. Breast Care (Basel) 2021; 17:188-198. [PMID: 35747900 PMCID: PMC9162479 DOI: 10.1159/000518265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/02/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> The prolonged immobilization suggested after breast cancer (BC) surgery causes morbidity. Patients search the Internet, especially social networks, for recommended exercises. <b><i>Objective:</i></b> The aim of this observational study was to assess the quality of YouTube videos, accessible for any patient, about exercises after BC surgery. <b><i>Methods:</i></b> A systematic search was performed on YouTube. One hundred and fifty videos were selected and analyzed. Two statistical analyses were conducted based on machine-learning techniques. Videos were classified as “Relevant” and “Non-Relevant” using principal component analysis models. Popularity was evaluated by Video Power Index (VPI), informational quality and accuracy were measured using the DISCERN Scale and Global Quality Scale (GQS). Scoring criteria for exercises were established according to the exercises recommended by the Oncology Section of the American Physical Therapy Association (APTA). Interobserver agreement and individual correlations were statistically examined. <b><i>Results:</i></b> DISCERN scored a mean of 50.97 (standard deviation [SD] 19.19). HONcode scored 78.30 (11.02) and GQS scored 3.49 (0.74). Average number of views was 53,963 (SD 67,376), mean duration was 9:42 min (9:15), mean days online was 2,158 (922), mean view ratio was 27.14 (30.24), mean likes was 245 (320.5), mean dislikes was 13.4 (14.2), and mean VPI was 93.48 (5.42). <b><i>Conclusion:</i></b> The quality of YouTube videos of recommended exercises post-BC surgery is high and can be a translational activity to improve patients’ behavior. Health institutions and NGOs, with higher popularity levels than academic institutions, should consider this information when implementing new policies focused on video quality which can contribute to adaptive behavior in patients.
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Affiliation(s)
- Alvaro Manuel Rodriguez Rodriguez
- Faculty of Medicine and Health Sciences, University of Oviedo, Physiotherapy and Traslational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
| | - María Blanco-Díaz
- Faculty of Medicine and Health Sciences, University of Oviedo, Physiotherapy and Traslational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
- *María Blanco-Díaz,
| | - Pedro Lopez Diaz
- Faculty of Medicine and Health Sciences, University of Oviedo, Physiotherapy and Traslational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
| | - Marta de la Fuente Costa
- Faculty of Medicine and Health Sciences, University of Oviedo, Physiotherapy and Traslational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
| | - Lirios Dueñas
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Joaquin Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Jose Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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17
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Balasch-Bernat M, Lluch E, Vaegter HB, Dueñas L. Should Exercises be Painful or not? Effects on Clinical and Experimental Pain in Individuals with Shoulder Pain. J Pain 2021; 22:1246-1255. [PMID: 33887445 DOI: 10.1016/j.jpain.2021.03.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
Exercise can reduce pain, however the effect of painful versus non-painful exercises is uncertain. The primary aim of this randomized crossover study was to compare the effect of painful versus nonpainful isometric shoulder exercises on pain intensity after exercise in individuals with rotator cuff-related shoulder pain. Secondary exploratory aims were to describe the effects on pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and muscle strength. On separate days, 35 individuals performed painful isometric shoulder exercises (external rotation; 20% above pain threshold), nonpainful isometric shoulder exercises (external rotation; 20% below pain threshold), and a rest condition, in randomised order. Shoulder pain intensity, PPTs, CPM, and external rotation strength were assessed before, immediately after and 45 minutes after conditions. No significant differences were observed between painful and nonpainful exercises. Visual analogue scale scores increased immediately after both painful and non-painful exercises compared with rest (P = .047, partial ƞ2 = .07), but were similar to preexercise levels after 45 minutes. No changes in PPTs, CPM, or muscle strength after exercises compared with rest were observed. Painful and non-painful isometric exercises caused a moderate but short-lasting increase in shoulder pain in individuals with RCRSP. Isometric exercises had no effect on pain sensitivity and shoulder muscle strength or CPM. Perspective: This study evaluated for the first time in individuals with rotator cuff-related shoulder pain the effects of painful versus non-painful isometric exercises on different pain-related outcome measures. Both painful and non-painful isometric exercises caused a moderate but relatively short-lasting increase in shoulder pain in individuals with rotator cuff-related shoulder pain. Trial registration number: (ClinicalTrials.gov) NCT03675399.
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Affiliation(s)
- M Balasch-Bernat
- Department of Physiotherapy, University of Valencia, Spain; Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain
| | - E Lluch
- Department of Physiotherapy, University of Valencia, Spain; Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain; Departments of Human Physiology and Rehabilitation Sciences, "Pain in Motion" International Research Group, Brussels, Belgium.
| | - H B Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - L Dueñas
- Department of Physiotherapy, University of Valencia, Spain; Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain
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18
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Dueñas L, Arnal-Gómez A, Aparicio I, Balasch-Bernat M, López-Bueno L, González JC, Solves-Camallonga C, Alcántara E. Influence of age, gender and obesity on pressure discomfort threshold of the foot: A cross-sectional study. Clin Biomech (Bristol, Avon) 2021; 82:105252. [PMID: 33497989 DOI: 10.1016/j.clinbiomech.2020.105252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot pain is a highly prevalent health problem for which measures such as a pattern of Pressure Discomfort Threshold of the foot plantar surface can provide valuable information for orthosis design. This study aimed to describe such pattern as a tool for the assessment of painful conditions of the feet and to analyse how it modifies according to age, gender and obesity. METHODS A cross-sectional study was performed with participants allocated in: Group 1 people aged 20 to 35 years, Group 2 aged 50 to 65 years and Group 3 aged over 65. Pressure Discomfort Threshold on twelve points of the foot plantar surface was measured with an adapted manual dynamometer. Inferential analyses of the data were performed using one-way analysis of variance (ANOVA) considering foot areas, age group, gender and obesity. FINDINGS 36 participants were analysed. The pattern of Pressure Discomfort Threshold for all individuals showed a significantly higher threshold on the heel and external foot (P < 0.001, η2 = 0.124) and was statistical significantly influenced by age (P < 0.001, η2 = 0.17), especially in participants aged over 65; by gender, with women having higher values (P < 0.001, η2 = 0.13), and by obesity (P < 0.001, η2 = 0.19). INTERPRETATION A Pressure Discomfort Threshold pattern exists in the foot plantar surface. The characteristics of the discomfort pattern of the foot and its association with aging, gender and obesity may have considerable implications for orthosis and footwear design.
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Affiliation(s)
- L Dueñas
- Department of Physiotherapy, University of Valencia, Valencia, Spain; "Physiotherapy in Motion, Multi-specialty Research Group" (PTinMOTION), University of Valencia, Valencia, Spain.
| | - A Arnal-Gómez
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Research Unit in Clinical Biomechanics (UBIC Research Group), University of Valencia, Valencia, Spain.
| | - I Aparicio
- Department of Physical Education, Research Group of Sports Biomechanic (GIBD) University of Valencia, Spain.
| | - M Balasch-Bernat
- Department of Physiotherapy, University of Valencia, Valencia, Spain; "Physiotherapy in Motion, Multi-specialty Research Group" (PTinMOTION), University of Valencia, Valencia, Spain.
| | - L López-Bueno
- Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | - J C González
- Instituto de Biomécanica de Valencia, Valencia, Spain.
| | | | - E Alcántara
- Instituto de Biomécanica de Valencia, Valencia, Spain.
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19
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Dueñas L, Zamora T, Lluch E, Artacho-Ramírez MA, Mayoral O, Balasch S, Balasch-Bernat M. The effect of vibration therapy on neck myofascial trigger points: A randomized controlled pilot study. Clin Biomech (Bristol, Avon) 2020; 78:105071. [PMID: 32521284 DOI: 10.1016/j.clinbiomech.2020.105071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of low-frequency self-administered vibration therapy into myofascial trigger points in the upper trapezius and levator scapulae on patients with chronic non-specific neck pain. METHODS Twenty-eight patients with chronic non-specific neck pain were randomly assigned into a vibration group, receiving 10 self-applied sessions of vibration therapy in the upper trapezius and levator scapulae trigger points; or a control group, receiving no intervention. Self-reported neck pain and disability (Neck Disability Index) and pressure pain threshold were assessed at baseline and after the first, fifth and 10th treatment sessions. FINDINGS Significant differences were found in the vibration group when compared to the control group after the treatment period: the vibration group reached lower Neck Disability Index scores (F = 4.74, P = .033, η2 = 0.07) and greater pressure pain threshold values (F = 7.56, P = .01, η2 = 0.10) than the control group. The vibration group reported a significant reduction in Neck Disability Index scores (χ2 = 19,35, P = .00, Kendall's W = 0.28) and an increase in pressure pain threshold (χ2 = 87,10, P = .00, Kendall's W = 0.73) between the assessment times over the course of the treatment. The mean increase in pressure pain threshold in the vibration group after the 10 sessions was 8.54 N/cm2, while the mean reduction in Neck Disability Index scores was 4.53 points. INTERPRETATION Vibration therapy may be an effective intervention for reducing self-reported neck pain and disability and pressure pain sensitivity in patients with chronic non-specific neck pain. This tool could be recommended for people with non-specific neck pain.
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Affiliation(s)
- L Dueñas
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain.
| | - T Zamora
- European Sleep Care Institute, San Vicente 16, 46023, Valencia, Spain.
| | - E Lluch
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain; "Pain in Motion" international research group, Belgium.
| | - M A Artacho-Ramírez
- Department of Engineering Projects, Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain.
| | - O Mayoral
- Physical Therapy Unit, Hospital Provincial de Toledo, Toledo, Spain.
| | - S Balasch
- Departamento de Estadística e Investigación Operativa Aplicadas y Calidad, Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain.
| | - M Balasch-Bernat
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain.
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20
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Mena-Del Horno S, Balasch-Bernat M, Dueñas L, Reis F, Louw A, Lluch E. Laterality judgement and tactile acuity in patients with frozen shoulder: A cross-sectional study. Musculoskelet Sci Pract 2020; 47:102136. [PMID: 32148332 DOI: 10.1016/j.msksp.2020.102136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Disrupted tactile acuity and poor laterality judgement have been shown in several chronic musculoskeletal pain conditions. Whether they are impaired in people with frozen shoulder (FS) remains unknown. OBJECTIVES To determine whether there is impairment in tactile acuity and laterality judgement in subjects with FS. METHODS Thirty-eight subjects with idiopathic FS and 38 sex and age-matched healthy controls were enrolled. The two-point discrimination threshold (TPDT) over the affected and unaffected shoulder of patients with FS and shoulder of healthy controls was evaluated. In addition, all participants performed a left/right judgment task (LRJT). Independent and dependent t-tests were used to compare group means. Pearson-product moment coefficient correlations between pain intensity and duration and LRJT and TPDT were calculated for the FS group. RESULTS The TPDT over the affected shoulder was significantly increased compared to the unaffected shoulder (mean difference, 3.82 mm; 95% confidence interval [CI]:0.53, 7.10; p = .02) and controls (mean difference, 5.80 mm; 95% CI: 1.09, 10.52; p = .02). Patients with FS were less accurate (mean difference, 5.90%; 95% CI: 0.36, 11.43; p = .03) and slower (mean difference, -0.26 s; 95% CI: 0.06, 0.45; p = .01) responding to images of their affected shoulder compared to their unaffected shoulder. No associations were found between pain intensity and duration and either TPDT or laterality judgement. CONCLUSIONS Participants with FS demonstrated reduced tactile acuity and impaired laterality judgement over their affected shoulder compared to their unaffected shoulder. When compared to controls, subjects with FS showed reduced tactile acuity. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT03320200.
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Affiliation(s)
| | - M Balasch-Bernat
- Department of Physiotherapy, University of Valencia, Spain; Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Spain.
| | - L Dueñas
- Department of Physiotherapy, University of Valencia, Spain; Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Spain
| | - F Reis
- Physiotherapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil; Postgraduation Program in Clinical Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - A Louw
- International Spine and Pain Institute, Story City, IA, USA
| | - E Lluch
- Department of Physiotherapy, University of Valencia, Spain; Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Spain; Departments of Human Physiology and Rehabilitation Sciences(1), Vrije Univesiteit Brussels, Brussels "Pain in Motion" International Research Group, Belgium. http://www.paininmotion.be
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21
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Lluch-Girbés E, Dueñas L, Mena-Del Horno S, Luque-Suarez A, Navarro-Ledesma S, Louw A. A central nervous system-focused treatment approach for people with frozen shoulder: protocol for a randomized clinical trial. Trials 2019; 20:498. [PMID: 31409380 PMCID: PMC6693238 DOI: 10.1186/s13063-019-3585-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 07/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background Frozen shoulder (FS) is a musculoskeletal condition of poorly understood etiology that results in shoulder pain and large mobility deficits. Despite some physical therapy interventions, such as joint mobilization and exercise, having shown therapeutic benefit, a definitive treatment does not currently exist. The aim of this study will be to compare the effectiveness of a central nervous system (CNS)-directed treatment program versus a standard medical and physical therapy care program on outcomes in participants with FS. Methods/design The study is a two-group, randomized clinical trial with blinding of participants and assessors. Participants will be recruited via referrals from orthopedic surgeons and physical therapists, community-based advertisements, private care practices and hospitals. Participants will be randomized to receive either a CNS-focused treatment program or standard medical and physical therapy care. The Shoulder Pain And Disability Index (SPADI) will be the primary outcome, while the Numeric Pain Rating Scale (NPRS), shoulder range of movement (ROM), The Patient Specific Functional Scale, two-point discrimination threshold and laterality judgement accuracy will be the secondary outcomes. Assessment will occur at baseline, at the end of the treatment program (week 10), and at 3 and 6 months’ follow-up. Discussion Preliminary data suggest that treatments that target CNS function are a promising approach to the treatment of people with shoulder pain including patients with FS. In the context of modest effects from most available physical therapy treatments for FS, this CNS-focused approach may lead to improved clinical outcomes. The trial should determine if the CNS-directed program is more effective than traditional interventions at reducing pain intensity and improving function in a FS cohort and will follow up participants for 6 months, providing important information on the persistence of any treatment effects. Trial registration NCT03320200. Registered on October 25, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3585-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Enrique Lluch-Girbés
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group.,Physiotherapy in Motion, Multi speciality Research Group (PTinMOTION), Malaga, Spain
| | - Lirios Dueñas
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Physiotherapy in Motion, Multi speciality Research Group (PTinMOTION), Malaga, Spain
| | | | - Alejandro Luque-Suarez
- Department of Physiotherapy, Universidad de Malaga, Andalucia TECH, Malaga, Spain. .,Instituto de la Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain.
| | | | - Adriaan Louw
- International Spine and Pain Institute, Story City, Iowa, USA
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22
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Lluch E, Dueñas L, Falla D, Baert I, Meeus M, Sánchez-Frutos J, Nijs J. Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial. Clin J Pain 2018; 34:44-52. [PMID: 28514231 DOI: 10.1097/ajp.0000000000000511] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables. MATERIALS AND METHODS Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery. RESULTS Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery. DISCUSSION Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.
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Affiliation(s)
- Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain.,Departments of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel.,Pain in Motion International Research Group
| | - Lirios Dueñas
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Isabel Baert
- Pain in Motion International Research Group.,MovAnt, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp
| | - Mira Meeus
- Pain in Motion International Research Group.,MovAnt, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Jo Nijs
- Departments of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel.,Pain in Motion International Research Group
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23
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Segarra V, Dueñas L, Torres R, Falla D, Jull G, Lluch E. Inter-and intra-tester reliability of a battery of cervical movement control dysfunction tests. ACTA ACUST UNITED AC 2015; 20:570-9. [PMID: 25677675 DOI: 10.1016/j.math.2015.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/09/2015] [Accepted: 01/15/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Apart from the cranio-cervical flexion test and the deep neck flexor endurance test, evidence related to reliability of cervical movement control dysfunction tests is lacking. OBJECTIVES This study investigated the inter- and intra-tester reliability of a battery of cervical movement control dysfunction tests and the effect of clinician experience on reliability in 15 patients with chronic neck pain and 17 non-neck pain controls. In addition, it explored whether impaired performance on this battery of tests was more frequently observed in the neck pain group. DESIGN Inter and intra-tester reliability study. METHOD Participants were videotaped while performing a battery of nine active cervical movement control dysfunction tests. Two physiotherapists, with different levels of experience, independently rated all tests on two occasions two weeks apart. They were masked to participants' neck pain or non-neck pain status. RESULTS Inter-tester reliability for the complete battery of tests was substantial (κ = 0.69; 95% CI: 0.62, 0.76). Intra-rater reliability values for the expert (κ = 0.86; 95% CI: 0.79, 0.92) and novice (κ = 0.76; 95% confidence intervals (CI): 0.68, 0.84) were overall comparable suggesting that novices can achieve good accuracy with the battery of tests if trained. The frequency of impaired performances in cervical movement control dysfunction tests was low and comparable between groups. Only two tests achieved a greater number of impaired ratings in the patient group. CONCLUSIONS Although reliable, further research in larger neck pain populations is required to explore this battery of tests, in order to establish their diagnostic accuracy for identifying clinically relevant cervical movement control dysfunction.
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Affiliation(s)
- V Segarra
- CEREDE Sports Medicine, Barcelona, Spain; International Institute of Exercise Science and Health, Spain
| | - L Dueñas
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - R Torres
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - D Falla
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany; Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - G Jull
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - E Lluch
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group, Department of Human Physiology, Faculty of Physical Education & Rehabilitation, Vrije Universiteit Brussel, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Faculty of Physical Education & Rehabilitation, Vrije Universiteit Brussel, Belgium.
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24
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Rosenthal VD, Lynch P, Jarvis WR, Khader IA, Richtmann R, Jaballah NB, Aygun C, Villamil-Gómez W, Dueñas L, Atencio-Espinoza T, Navoa-Ng JA, Pawar M, Sobreyra-Oropeza M, Barkat A, Mejía N, Yuet-Meng C, Apisarnthanarak A. Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC. Infection 2011; 39:439-50. [PMID: 21732120 DOI: 10.1007/s15010-011-0136-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 06/09/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs). METHODS Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries. DA-HAIs were defined using criteria formulated by the Centers for Disease Control and Prevention. Country socioeconomic status was defined using World Bank criteria. RESULTS Central-line-associated bloodstream infection (CLA-BSI) rates in NICU patients were significantly lower in private than academic hospitals (10.8 vs. 14.3 CLA-BSI per 1,000 catheter-days; p < 0.03), but not different in public and academic hospitals (14.6 vs. 14.3 CLA-BSI per 1,000 catheter-days; p = 0.86). NICU patient CLA-BSI rates were significantly higher in low-income countries than in lower-middle-income countries or upper-middle-income countries [37.0 vs. 11.9 (p < 0.02) vs. 17.6 (p < 0.05) CLA-BSIs per 1,000 catheter-days, respectively]. Ventilator-associated-pneumonia (VAP) rates in NICU patients were significantly higher in academic hospitals than in private or public hospitals [13.2 vs. 2.4 (p < 0.001) vs. 4.9 (p < 0.001) VAPs per 1,000 ventilator days, respectively]. Lower-middle-income countries had significantly higher VAP rates than low-income countries (11.8 vs. 3.8 per 1,000 ventilator-days; p < 0.001), but VAP rates were not different in low-income countries and upper-middle-income countries (3.8 vs. 6.7 per 1,000 ventilator-days; p = 0.57). When examined by hospital type, overall crude mortality for NICU patients without DA-HAIs was significantly higher in academic and public hospitals than in private hospitals (5.8 vs. 12.5%; p < 0.001). In contrast, NICU patient mortality among those with DA-HAIs was not different regardless of hospital type or country socioeconomic level. CONCLUSIONS Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.
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MESH Headings
- Catheter-Related Infections/epidemiology
- Catheter-Related Infections/microbiology
- Catheter-Related Infections/mortality
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/instrumentation
- Catheterization, Central Venous/mortality
- Cross Infection/blood
- Cross Infection/epidemiology
- Cross Infection/microbiology
- Cross Infection/mortality
- Developing Countries
- Equipment Contamination
- Hospitals, Private/classification
- Hospitals, Public/classification
- Hospitals, Teaching/classification
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Pneumonia, Ventilator-Associated/epidemiology
- Pneumonia, Ventilator-Associated/mortality
- Prospective Studies
- Socioeconomic Factors
- Ventilators, Mechanical/adverse effects
- Ventilators, Mechanical/microbiology
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Affiliation(s)
- V D Rosenthal
- International Nosocomial Infection Control Consortium, Corrientes Ave #4580, Buenos Aires, Argentina.
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25
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Rosenthal V, Moreno CÁ, Mehta A, Leblebicioglu H, Medeiros E, Raka L, Hu B, Jamulitrat S, Khader I, Novales MM, Hussain Y, Hidalgo RF, Kanj S, Villacres Á, Navoa-Ng J, Mapp T, Garcell HG, Barkat A, Suljagic V, Mitrev Z, Dueñas L, Cuellar L, Hamdi A. Central line associated bloodstream infection rates in 166 intensive care units of 54 cities in 23 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.2056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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