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Soltanabadi S, Vatandoost S, Lukacs MJ, Rushton A, Walton DM. Association between clinical biomechanical metrics of cervical spine function and pain or disability in people with neuromusculoskeletal neck pain: Protocol for a systematic review and planned meta-analysis. PLoS One 2024; 19:e0303365. [PMID: 38728246 PMCID: PMC11086898 DOI: 10.1371/journal.pone.0303365] [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: 11/14/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION/BACKGROUND Neck pain is a burdensome condition associated with pain, disability, and economic cost. Neck pain has been associated with observable changes in neuromuscular function and biomechanics. Prior research shows impairments in kinematic control, including reduced mobility, velocity, and smoothness of cervical motion. However, the strength of association between these impairments and patient-reported pain and disability is unclear rendering development of novel and relevant rehabilitation strategies difficult. The aim of this systematic review is to synthesize existing evidence on the strength of association between clinical biomechanical metrics of neck function (ROM, strength, acceleration, accuracy, smoothness, etc.) and patient-reported neck pain and disability. METHODS/ANALYSIS This protocol follows Cochrane guidelines and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, SPORTDiscus, Web of Science and Scopus will be searched, along with the gray literature, up to 20 November 2023, using terms and keywords derived from initial scoping searches. Observational studies, including cohorts and cross-sectional studies, that explore associations between clinical biomechanics of the neck and patient-reported outcomes of neck pain or disability will be included. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment (National Institute of Health tool). Data will be synthesized using either a random effects meta-analytic approach or qualitatively using a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, dependent on the homogeneity of data available. DISCUSSION AND RELEVANCE This review addresses a gap in the literature by systematically synthesizing findings on the relationship between neck function impairments and patient-reported outcomes. It will identify priorities for neck pain rehabilitation and gaps in current knowledge. DISSEMINATION The results of this review will be disseminated through a peer-reviewed publication, conference presentation, and lay language summaries posted on an open-access website. TRIAL REGISTRATION PROSPERO Registration number: CRD42023417317. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023417317.
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Affiliation(s)
| | - Sima Vatandoost
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Michael J. Lukacs
- School of Physical Therapy, Western University, London, Ontario, Canada
- Physiotherapy Department, London Health Science Center (LHSC), London, Ontario, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - David M. Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
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Straatman LN, Lukacs MJ, Carlesso L, Grewal R, Lalone EA, Walton DM. A systematic review of the psychometric properties of pressure pain detection threshold in evaluating mechanical pain threshold in people with hand or wrist injuries. J Hand Ther 2023; 36:845-859. [PMID: 37778878 DOI: 10.1016/j.jht.2023.06.008] [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: 08/08/2022] [Revised: 11/16/2022] [Accepted: 06/09/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE The aim of this study was to conduct a systematic review of the psychometric properties of Pressure Pain Detection Threshold (PPDT) measures in people with hand or wrist injuries. STUDY DESIGN AND METHODS MEDLINE, Embase, and CINAHL databases were searched to identify eligible studies evaluating psychometric properties of PPDT in samples composed of at least 50% of people with hand or wrist injury. The Consensus-based Standards for the Measurement of Health Instruments' risk of bias checklist was used to critically appraise the included studies, and qualitative synthesis was performed by pooling the results of all studies that presented the same measurement property using Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS From 415 studies, 11 relevant studies were identified. Of the 11 studies, four hand or wrist injuries were represented; carpal tunnel syndrome, distal radius fractures, osteoarthritis, and complex regional pain syndrome. Intra-rater reliability was considered sufficient (intraclass correlation coefficient 0.64-0.94), with small reported standard error of the mean values (5.3-39.2 kPa). Results of validity and responsiveness could not be synthesized due to heterogeneity. Risk of bias for reliability and measurement error was assessed as very good or adequate, whereas validity and responsiveness were doubtful or inadequate. Overall quality of evidence was low or very low for all measurement properties. CONCLUSIONS Inconsistent results and low quality evidence provide little confidence in the overall measurement properties of PPDT in a hand or wrist injury population. No criterion standard for pain further highlights complexities around pain measurement such that the results obtained from PPDT measures in clinical practice cannot be compared to a gold standard measure.
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Affiliation(s)
- Lauren N Straatman
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada.
| | - Michael J Lukacs
- School of Physical Therapy, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Lisa Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Emily A Lalone
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada
| | - David M Walton
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; School of Physical Therapy, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada
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Straatman LN, Lukacs MJ, Lee JY, Ghodrati M, Lalone EA, Walton DM. Are people good prognosticators of their own pain? An exploration of the relationship between sex-specific pain beliefs and clinical pain evaluation. Musculoskelet Sci Pract 2022; 62:102667. [PMID: 36198201 DOI: 10.1016/j.msksp.2022.102667] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Under-explored to date are the interacting influences of patient sex on multi-modal evaluation techniques that tap different domains of the pain experience. OBJECTIVES The primary aim of Study 1 was to explore the accuracy of sex-specific personal pain beliefs in relation to quantitative pain indicators within sexes, and the secondary objective was to compare the accuracy of sex-specific personal pain beliefs in relation to quantitative pain indicators between sexes. The primary objective of Study 2 was to explore the accuracy of sex-specific personal pain beliefs and self-rated pain severity within sexes, and the secondary objective was to compare sex-specific personal pain beliefs and pain severity ratings between sexes. METHODS A cross-sectional analysis on two datasets was performed (Study 1, n = 50; Study 2, n = 111). For both studies, independent samples t-tests were used to identify differences in clinical pain evaluations based on sex-specific pain beliefs. Receiver Operating Characteristic (ROC) curves were used to compare the predictive accuracy of males and females clinical pain evaluations based on their ability to handle pain. RESULTS There were no statistically significant differences in clinical pain evaluations based on self-rated pain beliefs in either study. In Study 2, males were descriptively more accurate predictors of their clinical pain evaluations than were females, though none of the between sex comparisons were statistically significant. CONCLUSION This work highlights the importance of considering all available clinical pain evaluations as one technique is unlikely to represent the patients pain experience.
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Affiliation(s)
- Lauren N Straatman
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada.
| | - Michael J Lukacs
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; School of Physical Therapy, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Joshua Y Lee
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; School of Physical Therapy, Western University, London, Ontario, Canada
| | - Maryam Ghodrati
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Emily A Lalone
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada
| | - David M Walton
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; School of Physical Therapy, Western University, London, Ontario, Canada; Bone and Joint Institute, Western University, London, Ontario, Canada
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Churchill L, Lukacs MJ, Lebedeva Y, MacDonald SJ, Giffin JR, Rudman DL, Bryant D. Primary care physicians' perceptions of the utility of novel education materials for patients with knee osteoarthritis. Disabil Rehabil 2022:1-7. [PMID: 35931102 DOI: 10.1080/09638288.2022.2107088] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management. MATERIALS AND METHOD We conducted a qualitative descriptive study using semi-structured interviews of newly practicing and resident PCPs after watching a series of patient education videos. A thematic analysis approach was used combining both inductive and research question driven coding, category formation, and theme identification. RESULTS Ten participants were included. Barriers to optimal management were identified including the challenge of patient adherence and access to non-operative treatments. PCPs indicated that the videos would support their management of patients with knee OA by (1) supporting credibility and building trust with their patient, (2) reinforcing patient understanding, and (3) enhancing their own management of patients. CONCLUSION Future implementation of these resources with attention to barriers that may limit uptake is necessary and may optimize management of knee OA in primary care.IMPLICATIONS FOR REHABILITATIONThe provision of patient educational materials may support patient buy-in regarding appropriate management, enhance patient understanding, and improve physicians' future practice.Viewing these videos could potentially improve physicians' future resource use, recommendation of non-operative treatments, and the quality of their total knee replacement referrals, which has benefits to both the patient and the healthcare system.Perceived barriers to implementing evidence-based recommendations may pose a challenge for patients and clinicians and should be considered to help facilitate the uptake of educational interventions.
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Affiliation(s)
- Laura Churchill
- Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Canada
| | | | | | - Steven J MacDonald
- Western University, London, Canada.,London Health Sciences Center-University Hospital, London, Canada
| | - J Robert Giffin
- Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Canada.,London Health Sciences Center-University Hospital, London, Canada
| | | | - Dianne Bryant
- Western University, London, Canada.,McMaster University, Hamilton, Canada
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Lukacs MJ, Salim S, Katchabaw MJ, Yeung E, Walton DM. Virtual reality in physical rehabilitation: a narrative review and critical reflection. Physical Therapy Reviews 2022. [DOI: 10.1080/10833196.2022.2105077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Michael J. Lukacs
- Health and Rehabilitation Sciences, Western University, Canada
- Bone and Joint Institute, Western University, Canada
| | - Shahan Salim
- Public Health and Health Systems, University of Waterloo, Canada
| | | | - Euson Yeung
- Physical Therapy, University of Toronto, Canada
| | - David M. Walton
- Bone and Joint Institute, Western University, Canada
- School of Physical Therapy, Western University, Canada
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Kowalski KL, Lukacs MJ, Mistry J, Goodman M, Rushton AB. Physical functioning outcome measures in the lumbar spinal surgery population and measurement properties of the physical outcome measures: protocol for a systematic review. BMJ Open 2022; 12:e060950. [PMID: 35667717 PMCID: PMC9171219 DOI: 10.1136/bmjopen-2022-060950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Low back pain can lead to substantial decline in physical functioning. For disabling pain not responsive to conservative management, surgical intervention can enhance physical functioning. Measurements of physical functioning include patient-reported outcome measures and physical outcome measures using evaluations of impairments, performance on a standardised task or activity in a natural environment. Selecting outcome measures with adequate measurement properties is fundamental to evaluating effectiveness of interventions. The purpose of this systematic review is to identify outcome measures (patient reported and physical) used to evaluate physical functioning (stage 1) and assess the measurement properties of physical outcome measures of physical functioning (stage 2) in the lumbar spinal surgery population. METHODS AND ANALYSIS This protocol aligns with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Using a two-staged approach, searches will be performed in MEDLINE, EMBASE, Health and Psychosocial Instruments, CINAHL, Web of Science, Scopus, PEDro and the grey literature from inception until 15 December 2021. Stage 1 will identify studies evaluating physical functioning with patient-reported or physical outcome measures in the lumbar spinal surgery population. Stage 2 will search for studies evaluating measurement properties (validity, reliability, responsiveness) of the physical outcome measures identified in stage 1 in the lumbar spinal surgery population. Two independent reviewers will evaluate studies for inclusion, extract data, assess risk of bias (COSMIN risk of bias tool and checklist) and quality of evidence (modified Grading of Recommendations Assessment, Development and Evaluation approach). Results for each measurement property per physical outcome measure will be quantitatively pooled if there is adequate clinical and methodological homogeneity or qualitatively synthesised if there is high heterogeneity in studies. ETHICS AND DISSEMINATION Ethics approval is not required. Results will be disseminated through peer-reviewed journal publication and conference presentation. PROSPERO REGISTRATION NUMBER CRD42021293880.
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Affiliation(s)
- Katie L Kowalski
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Michael J Lukacs
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jai Mistry
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Physiotherapy, St George's Hospital, London, UK
| | - Maren Goodman
- Western Libraries, Western University, London, Ontario, Canada
| | - Alison B Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Lukacs MJ, Kowalski KL, Peters N, Stanley M, Rushton AB. How is recovery defined and measured in patients with low back pain? Protocol for a mixed study systematic review. BMJ Open 2022; 12:e061475. [PMID: 35537787 PMCID: PMC9092166 DOI: 10.1136/bmjopen-2022-061475] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This protocol describes the methods for a mixed study systematic review aiming to explore the definitions and measurements of recovery in patients with low back pain, and how perspectives of recovery differ between patients and providers. This review will be the first to review the concept of recovery in patients with low back pain across both quantitative and qualitative literature. METHODS AND ANALYSIS This protocol has been designed and reported in line with Preferred Reporting Items of Systematic Reviews and Meta-Analyses Protocols. The following databases will be electronically searched from database inception until 30 November 2021: Medline, EMBASE, CINAHL, Cochrane, PEDro. Grey literature will be searched for through targeted searching of ProQuest Dissertations and Theses and handsearching of the references of all included studies. Studies will be included if they include a patient population of >50% with low back pain (with or without leg pain), and mention the concept of recovery within the abstract, methods or results. The Mixed Methods Appraisal Tool will be used for quality assessment of both quantitative and qualitative included studies. Two independent reviewers will conduct the search, screen titles/abstracts and extract relevant data from full texts. Discrepancies between reviewers will be settled by a third reviewer with spinal pain expertise. For syntheses, thematic analysis will be used to analyse both qualitative and quantitative investigations to explore meanings, measurement and perspectives of recovery from a diverse evidence base. There is no clinical trial associated with this protocol. ETHICS AND DISSEMINATION There are no ethical issues associated with this systematic review, and ethics approval was not required. Once completed, the results of this review will be published in a peer-reviewed journal within the realm of spinal pain to help guide future research inquiries. PROSPERO REGISTRATION NUMBER CRD42022295804.
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Affiliation(s)
- Michael J Lukacs
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Katie L Kowalski
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Nicole Peters
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Meagan Stanley
- Western University Allyn and Betty Taylor Library, London, Ontario, Canada
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
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Lukacs MJ, Melling CWJ, Walton DM. Exploring the relationship between meaningful conditioned pain modulation and stress system reactivity in healthy adults following exposure to the cold pressor task. Musculoskelet Sci Pract 2022; 57:102489. [PMID: 34861579 DOI: 10.1016/j.msksp.2021.102489] [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: 09/24/2021] [Revised: 10/23/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis have been implicated in conditioned pain modulation (CPM). As there has recently been a push to identify meaningful CPM responses based on ± 2 SEM of the test stimulus, we sought to evaluate if meaningful CPM had relationships with both SNS and HPA axis reactivity. METHODS 50 university-aged healthy participants (25 males, 25 females) underwent evaluation of pressure pain detection threshold (PPDT), conditioned pain modulation (CPM), galvanic skin response (GSR) and salivary cortisol before and after a cold pressor test (CPT). Meaningful CPM was evaluated based on change ±2 SEM of baseline PPDT to classify participants as experiencing inhibition of pain, facilitation, or non-response. RESULTS As a group, there were no significant changes in PPDT or salivary cortisol after exposure to noxious cold. GSR was significantly elevated from baseline values during the CPT, and 10 min after (p < 0.001). When meaningful CPM was assessed, only 30% of participants experienced inhibitory CPM. Within this group, there was a large positive correlation ranging from r = 0.63 to 0.69 (p < 0.01) between CPM and the absolute change in GSR from baseline to immersion, and the immediate 5 min after immersion. CONCLUSIONS This work continues to support the growing body of literature suggesting that CPM is not universally experienced. Inhibitory CPM may be associated with an increase in SNS activity for healthy participants in reaction to noxious cold. Future work is required to ascertain individual characteristics (e.g., age, sex) that relate to CPM responses.
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Affiliation(s)
- Michael J Lukacs
- Health and Rehabilitation Sciences, Western University, Canada; Bone and Joint Institute, Western University, Canada.
| | | | - David M Walton
- Bone and Joint Institute, Western University, Canada; School of Physical Therapy, Western University, Canada
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Docter S, Lukacs MJ, Fathalla Z, Khan MCM, Jennings M, Liu SH, Dong S, Getgood A, Bryant DM. Inconsistencies in the Methodological Framework Throughout Published Studies in High-Impact Orthopaedic Journals: A Systematic Review. J Bone Joint Surg Am 2022; 104:181-188. [PMID: 34648473 DOI: 10.2106/jbjs.21.00116] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT) guidelines recommend that clinical trials follow a study framework that aligns with their objective to test the relative efficacy or safety (equality) or effectiveness (superiority, noninferiority, or equivalence) between interventions. We conducted a systematic review to assess the proportion of studies that demonstrated inconsistency between the framing of their research question, sample size calculation, and conclusion and those that should have framed their research question differently based on the compared interventions. METHODS We included studies from 5 high-impact-factor orthopaedic journals published in 2017 and 2019 that compared at least 2 interventions using patient-reported outcome measures. RESULTS We included 228 studies. The sample size calculation was reported in 60.5% (n = 138) of studies. Of these, 52.2% (n = 72) were inconsistent between the framing of their research question, sample size calculation, and conclusion. The majority (n = 137) of sample size calculations were for equality, but 43.8% of these studies concluded superiority, noninferiority, or equivalence. Studies that framed their research question as equality (n = 186) should have been framed as superiority (n = 129), equivalence (n = 52), or noninferiority (n = 3). Only 2 studies correctly framed their research question as equality. CONCLUSIONS Studies published in high-impact journals were inconsistent between the framing of their research question, sample size calculation, and conclusion. Authors may be misinterpreting research findings and making clinical recommendations solely based on p values. Researchers are encouraged to state and justify their methodological framework and choice of margin(s) in a publicly published protocol as they have implications for sample size and the applicability of conclusions. CLINICAL RELEVANCE The results of clinical research must be interpreted using confidence intervals, with careful consideration as to how the confidence intervals relate to clinically meaningful differences in outcomes between treatments. The more typical practice of relying on p values leaves the clinician at high risk of erroneous interpretation, recommendation, and/or action.
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Affiliation(s)
- Shgufta Docter
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Michael J Lukacs
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Zina Fathalla
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michaela C M Khan
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Morgan Jennings
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Shu-Hsuan Liu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan Dong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alan Getgood
- Bone and Joint Institute, Western University, London, Ontario, Canada.,Division of Orthopaedics, Department of Surgery, Fowler Kennedy Sport Medicine, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Division of Orthopaedics, Department of Surgery, Fowler Kennedy Sport Medicine, Western University, London, Ontario, Canada
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Modarresi S, Lukacs MJ, Ghodrati M, Salim S, MacDermid JC, Walton DM. A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain. Clin J Pain 2021; 38:132-148. [PMID: 34699406 DOI: 10.1097/ajp.0000000000000999] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 05/02/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To conduct a systematic search and synthesis of evidence about the measurement properties of the Numeric Pain Rating Scale (NPRS) and the Visual Analog Scale (VAS) as patient-reported outcome measures in neck pain research. METHODS AND MATERIALS CINAHL, Embase, PsychInfo, and MedLine databases were searched to identify studies evaluating the psychometric properties of the NPRS and the VAS used in samples of which >50% of participants were people with neck pain. Quality and consistency of findings were synthesized to arrive at recommendations. RESULTS A total of 46 manuscripts were included. Syntheses indicated high-to-moderate-quality evidence of good-to-excellent (intraclass correlation coefficient 0.58 to 0.93) test-retest reliability over an interval of 7 hours to 4 weeks. Moderate evidence of a clinically important difference of 1.5 to 2.5 points was found, while minimum detectable change ranged from 2.6 to 4.1 points. Moderate evidence of a moderate association (r=0.48 to 0.54) between the NPRS or VAS and the Neck Disability Index. Findings from other patient-reported outcomes indicated stronger associations with ratings of physical function than emotional status. There is limited research addressing the extent that these measures reflect outcomes that are important to patients. DISCUSSION It is clear NPRS and the VAS ratings are feasible to implement, provide reliable scores and relate to multi-item patient-reported outcome measures. Responsiveness (meaningful change) of the scales and interpretation of change scores requires further refinement. The NPRS can be a useful single-item assessment complimenting more comprehensive multi-item patient-reported outcome measures in neck pain research and practice.
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Affiliation(s)
- Shirin Modarresi
- School of Physical Therapy
- Department of Health and Rehabilitation Sciences, Western University, London
| | - Michael J Lukacs
- Department of Health and Rehabilitation Sciences, Western University, London
| | - Maryam Ghodrati
- Department of Health and Rehabilitation Sciences, Western University, London
| | - Shahan Salim
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy
- Department of Health and Rehabilitation Sciences, Western University, London
| | - David M Walton
- School of Physical Therapy
- Department of Health and Rehabilitation Sciences, Western University, London
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Docter S, Fathalla Z, Lukacs MJ, Khan MCM, Jennings M, Liu SH, Dong S, Getgood A, Bryant DM. Interpreting Patient-Reported Outcome Measures in Orthopaedic Surgery: A Systematic Review. J Bone Joint Surg Am 2021; 103:185-190. [PMID: 32941309 DOI: 10.2106/jbjs.20.00474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Consolidated Standards of Reporting Trials (CONSORT) Statement recommends that studies report results beyond p values and include treatment effect(s) and measures of precision (e.g., confidence intervals [CIs]) to facilitate the interpretation of results. The objective of this systematic review was to assess the reporting and interpretation of patient-reported outcome measure (PROM) results in clinical studies from high-impact orthopaedic journals, to determine the proportion of studies that (1) only reported a p value; (2) reported a treatment effect, CI, or minimal clinically important difference (MCID); and (3) offered an interpretation of the results beyond interpreting a p value. METHODS We included studies from 5 high-impact-factor orthopaedic journals published in 2017 and 2019 that compared at least 2 intervention groups using PROMs. RESULTS A total of 228 studies were analyzed, including 126 randomized controlled trials, 35 prospective cohort studies, 61 retrospective cohort studies, 1 mixed cohort study, and 5 case-control studies. Seventy-six percent of studies (174) reported p values exclusively to express and interpret between-group differences, and only 22.4% (51) reported a treatment effect (mean difference, mean change, or odds ratio) with 95% CI. Of the 54 studies reporting a treatment effect, 31 interpreted the results using an important threshold (MCID, margin, or Cohen d), but only 3 interpreted the CIs. We found an absolute improvement of 35.5% (95% CI, 20.8% to 48.4%) in the reporting of the MCID between 2017 and 2019. CONCLUSIONS The majority of interventional studies reporting PROMs do not report CIs around between-group differences in outcome and do not define a clinically meaningful difference. A p value cannot effectively communicate the readiness for implementation in a clinical setting and may be misleading. Thus, reporting requirements should be expanded to require authors to define and provide a rationale for between-group clinically important difference thresholds, and study findings should be communicated by comparing CIs with these thresholds.
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Affiliation(s)
- Shgufta Docter
- Faculty of Health Sciences (S.D., M.J.L., M.C.M.K., M.J., and D.M.B.), Fowler Kennedy Sports Medicine Clinic, Division of Orthopaedics, Department of Surgery (A.G. and D.M.B.), and Bone and Joint Institute (S.D., M.J.L, M.C.M.K., M.J., A.G., and D.M.B.), Western University, London, Ontario, Canada
| | - Zina Fathalla
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael J Lukacs
- Faculty of Health Sciences (S.D., M.J.L., M.C.M.K., M.J., and D.M.B.), Fowler Kennedy Sports Medicine Clinic, Division of Orthopaedics, Department of Surgery (A.G. and D.M.B.), and Bone and Joint Institute (S.D., M.J.L, M.C.M.K., M.J., A.G., and D.M.B.), Western University, London, Ontario, Canada
| | - Michaela C M Khan
- Faculty of Health Sciences (S.D., M.J.L., M.C.M.K., M.J., and D.M.B.), Fowler Kennedy Sports Medicine Clinic, Division of Orthopaedics, Department of Surgery (A.G. and D.M.B.), and Bone and Joint Institute (S.D., M.J.L, M.C.M.K., M.J., A.G., and D.M.B.), Western University, London, Ontario, Canada
| | - Morgan Jennings
- Faculty of Health Sciences (S.D., M.J.L., M.C.M.K., M.J., and D.M.B.), Fowler Kennedy Sports Medicine Clinic, Division of Orthopaedics, Department of Surgery (A.G. and D.M.B.), and Bone and Joint Institute (S.D., M.J.L, M.C.M.K., M.J., A.G., and D.M.B.), Western University, London, Ontario, Canada
| | - Shu-Hsuan Liu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan Dong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alan Getgood
- Faculty of Health Sciences (S.D., M.J.L., M.C.M.K., M.J., and D.M.B.), Fowler Kennedy Sports Medicine Clinic, Division of Orthopaedics, Department of Surgery (A.G. and D.M.B.), and Bone and Joint Institute (S.D., M.J.L, M.C.M.K., M.J., A.G., and D.M.B.), Western University, London, Ontario, Canada
| | - Dianne M Bryant
- Faculty of Health Sciences (S.D., M.J.L., M.C.M.K., M.J., and D.M.B.), Fowler Kennedy Sports Medicine Clinic, Division of Orthopaedics, Department of Surgery (A.G. and D.M.B.), and Bone and Joint Institute (S.D., M.J.L, M.C.M.K., M.J., A.G., and D.M.B.), Western University, London, Ontario, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Churchill L, Lukacs MJ, Pinto R, Macdonald SJ, Giffin JR, Laliberte Rudman D, Bryant D. A qualitative dominant mixed methods exploration of novel educational material for patients considering total knee arthroplasty. Disabil Rehabil 2020; 44:3054-3061. [PMID: 33284645 DOI: 10.1080/09638288.2020.1851782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To optimize non-operative management and decision making surrounding TKR we created educational whiteboard videos for patients with knee OA. The purpose of this study was to pilot our educational videos with end-users (patients) to determine patients' experiences and perspectives regarding the content and clarity of videos and to better understand their potential impact on patient's health behaviour. Materials and methods: This was a mixed methods evaluation, using a qualitative descriptive approach, of patients attending their first consultation with an arthroplasty surgeon for TKR. We conducted in-depth semi-structured interviews with patients. Three members of the research team coded data independently, implementing a thematic analysis. Results: Thirteen participants were included. Participants indicated that the videos enhanced their confidence and clarity surrounding their decision to undergo TKR. The videos also addressed several knowledge gaps in their understanding of OA management. Barriers to uptake of the education were identified including limited access to PTs and the challenge of weight loss. Conclusions: The current educational intervention was valued by patients with knee OA. Implementation of these videos may have important implications for patients, providers, and our health care system.IMPLICATIONS FOR REHABILITATIONPatients with knee OA referred by primary care physicians to arthroplasty surgeons have knowledge gaps that may influence their self-management and decision making surrounding their condition.Educational materials can address these gaps and support patients in their understanding and management of their condition, which may have important downstream implications.Barriers to accessing non-operative care including physiotherapy must be pre-emptively addressed to ensure that enhanced knowledge is met with improved access for patients.
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Affiliation(s)
- Laura Churchill
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada
| | - Michael J Lukacs
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Ryan Pinto
- Health and Rehabilitation Sciences, Western University, London, Canada
| | | | - J Robert Giffin
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada
| | | | - Dianne Bryant
- Health and Rehabilitation Sciences, Western University, London, Canada.,Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
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Schulz JM, Birmingham TB, Atkinson HF, Woehrle E, Primeau CA, Lukacs MJ, Al-Khazraji BK, Khan MCM, Zomar BO, Petrella RJ, Beier F, Appleton CT, Shoemaker JK, Bryant DM. Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2019; 54:771-775. [DOI: 10.1136/bjsports-2018-100231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesWe systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.Data sourcesPubMed, CINAHL, Scopus; inception to January 2019.Eligibility criteriaRandomised clinical trials (RCT), cohort studies, case series.DesignWe summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models.ResultsInterventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (−3.56 beats per minute; 95% CI −5.60 to −1.52) and DBP (−4.10 mm Hg; 95% CI −4.82 to −3.38) and no change in SBP (−0.36 mm Hg; 95% CI −3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI −0.11 to 0.85). Within-group differences were also small to moderate.ConclusionsIn studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.PROSPERO registration numberCRD42018087859.
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Smith PA, Lepage CRJ, Savage PB, Bowerbank CR, Lee ED, Lukacs MJ. Use of a hand-portable gas chromatograph–toroidal ion trap mass spectrometer for self-chemical ionization identification of degradation products related to O-ethyl S-(2-diisopropylaminoethyl) methyl phosphonothiolate (VX). Anal Chim Acta 2011; 690:215-20. [DOI: 10.1016/j.aca.2011.02.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 02/08/2011] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
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