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Nijs J, Kosek E, Chiarotto A, Cook C, Danneels LA, Fernández-de-Las-Peñas C, Hodges PW, Koes B, Louw A, Ostelo R, Scholten-Peeters GGM, Sterling M, Alkassabi O, Alsobayel H, Beales D, Bilika P, Clark JR, De Baets L, Demoulin C, de Zoete RMJ, Elma Ö, Gutke A, Hanafi R, Hotz Boendermaker S, Huysmans E, Kapreli E, Lundberg M, Malfliet A, Meziat Filho N, Reis FJJ, Voogt L, Zimney K, Smeets R, Morlion B, de Vlam K, George SZ. Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations. Lancet Rheumatol 2024; 6:e178-e188. [PMID: 38310923 DOI: 10.1016/s2665-9913(23)00324-7] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 02/06/2024]
Abstract
The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alessandro Chiarotto
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Lieven A Danneels
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Bart Koes
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Research Unit of General Practice, Department of Public Health and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Adriaan Louw
- Department of Pain Science, Evidence in Motion, Story City, IA, USA
| | - Raymond Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Michele Sterling
- RECOVER Injury Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Othman Alkassabi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physiotrio, Riyadh, Saudi Arabia; Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hana Alsobayel
- Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Darren Beales
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Jacqui R Clark
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Pains and Brains specialist pain physiotherapy clinic, Tauranga, New Zealand
| | - Liesbet De Baets
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Belgium
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia
| | - Ömer Elma
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rikard Hanafi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Sabina Hotz Boendermaker
- University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
| | - Eva Huysmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Mari Lundberg
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Ney Meziat Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta-UNISUAM, Rio de Janeiro, Brazil
| | - Felipe J J Reis
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physical Therapy Department of Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lennard Voogt
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; University of Applied Sciences, Rotterdam, Netherlands
| | - Kory Zimney
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Rob Smeets
- Maastricht University, Maastricht, Netherlands; Clinics in Rehabilitation, Eindhoven, Netherlands
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, Unit Anaesthesiology and Algology, KU Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Belgium; Skeletal Biology and Engineering Research Center, Dept of Development and Regeneration, KU Leuven, Belgium
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
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Dickson C, de Zoete RMJ, Berryman C, Weinstein P, Chen KK, Rothmore P. Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review. Pain Med 2024; 25:104-115. [PMID: 37769242 PMCID: PMC10833081 DOI: 10.1093/pm/pnad134] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. METHODS We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. RESULTS Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. CONCLUSION Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. STUDY REGISTRATION Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
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Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance Unit, IIMPACT in Health, The University of South Australia, Adelaide, 5001, Australia
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
- Brain Stimulation, Imaging and Cognition Group, The University of Adelaide, Adelaide, 5000, Australia
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Museum, Adelaide, 5000, Australia
| | - Kexun Kenneth Chen
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Paul Rothmore
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
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Chiddarwar V, de Zoete RMJ, Dickson C, Lathlean T. Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Br J Sports Med 2023; 57:1498-1508. [PMID: 37451706 DOI: 10.1136/bjsports-2022-106422] [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] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD). DESIGN Systematic review and meta-analysis. DATA SOURCES Systematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar). ELIGIBILITY Studies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges' g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS Sixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43). CONCLUSIONS Surgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.
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Affiliation(s)
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Timothy Lathlean
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
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de Zoete RMJ. Exercise Therapy for Chronic Neck Pain: Tailoring Person-Centred Approaches within Contemporary Management. J Clin Med 2023; 12:7108. [PMID: 38002720 PMCID: PMC10671970 DOI: 10.3390/jcm12227108] [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] [Received: 10/16/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Exercise therapy is considered the best evidence-based approach for managing chronic neck pain. However, the implementation of exercise therapy presents several challenges. Systematic reviews indicate that it has modest effectiveness, while clinical practice guidelines offer limited guidance on the exercise parameters required to optimise clinical outcomes. Moreover, recommendations often fail to differentiate between different types of neck pain. This article addresses the challenges associated with the prescription of exercise for chronic neck pain and provides recommendations for exercise therapy specific to chronic nociceptive, neuropathic, and nociplastic neck pain. The goal of this article is to facilitate the implementation of high-value evidence-based exercise therapy for these distinct types of chronic neck pain with the aim to improve its outcomes and to reduce the related individual and societal burdens.
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Affiliation(s)
- Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA 5005, Australia
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5
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de Zoete RMJ, Nikles J, Coombes JS, Onghena P, Sterling M. The effectiveness of aerobic versus strengthening exercise therapy in individuals with chronic whiplash-associated disorder: a randomised single case experimental design study. Disabil Rehabil 2023; 45:3519-3528. [PMID: 36173391 DOI: 10.1080/09638288.2022.2127937] [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] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Recent RCTs and meta-analyses compare the effectiveness of different types of exercise for chronic whiplash associated disorder (WAD). This study aimed to verify whether the results of these studies translate to statistically significant and clinically meaningful effects in individual participants. MATERIALS AND METHODS A series of replicated randomised single case experimental design studies (SCEDs) with A-B design (A: baseline, B: intervention). Eight participants with chronic WAD (8 female, mean [SD] age 47 [10] years) were randomised into one of four baseline durations (5, 8, 11, and 14 days) and to one of two eight-week exercise interventions (aerobic or strengthening). Daily measures of pain intensity, bothersomeness, and interference were collected during the baseline phase and the intervention phase. RESULTS Visual analyses indicated that three participants in the aerobic exercise group meaningfully improved. No improvements were found in the strengthening group. Effect sizes favoured the aerobic exercise group, yet randomisation tests of pooled effects did not show a difference in between-intervention effectiveness. CONCLUSION Contrary to our expectations, three out of four participants were nearly pain-free at the end of the aerobic exercise intervention, whereas none of the participants in the strengthening group improved meaningfully. This suggests that aerobic exercise may be favourable for WAD.Implications for RehabilitationOur results suggest that aerobic exercises are favourable over strengthening exercises and may be the preferred option for patients with chronic WAD.We found substantial variability in self-reported outcomes within participants, clinicians should be aware of this in the judgement of treatment effectiveness.
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Affiliation(s)
- Rutger M J de Zoete
- Recover Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, Australia
| | - Jane Nikles
- Recover Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Patrick Onghena
- Research Unit on Methods, Individual and Cultural Differences, Affect and Social Behaviour, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
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de Zoete RMJ, McMahon KL, Coombes JS, Sterling M. The effects of physical exercise on structural, functional, and biochemical brain characteristics in individuals with chronic whiplash-associated disorder: A pilot randomized clinical trial. Pain Pract 2023; 23:759-775. [PMID: 37157897 DOI: 10.1111/papr.13240] [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] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/01/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exercise for people with whiplash associated disorder (WAD) induces hypoalgesic effects in some, but hyperalgesic effects in others. We investigated the exercise-induced neurobiological effects of aerobic and strengthening exercise in individuals with chronic WAD. METHODS Sixteen participants (8 WAD, 8 pain-free [CON]) were randomised to either aerobic or strengthening exercise. MRI for brain morphometry, functional MRI for brain connectivity, and magnetic resonance spectroscopy for brain biochemistry, were used at baseline and after the 8-week intervention. RESULTS There were no differences in brain changes between exercise groups in either the WAD or CON group, therefore aerobic and strengthening data were combined to optimise sample size. After the exercise intervention, the CON group demonstrated increased cortical thickness (left parahippocampus: mean difference = 0.04, 95% CI = 0.07-0.00, p = 0.032; and left lateral orbital frontal cortex: mean difference = 0.03, 95% CI = 0.00-0.06, p = 0.048). The WAD group demonstrated an increase in prefrontal cortex (right medial orbital frontal) volume (mean difference = 95.57, 95% CI = 2.30-192.84, p = 0.046). Functional changes from baseline to follow-up between the default mode network and the insula, cingulate cortex, temporal lobe, and somatosensory and motor cortices, were found in the CON group, but not in the WAD group. There were no changes post-exercise in brain biochemistry. CONCLUSION Aerobic and strengthening exercises did not exert differential effects on brain characteristics, however differences in structural and functional changes were found between WAD and CON groups. This suggests that an altered central pain modulatory response may be responsible for differential effects of exercise in individuals with chronic WAD.
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Affiliation(s)
- Rutger M J de Zoete
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Katie L McMahon
- Herston Imaging Research Facility, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
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de Zoete RMJ, Berryman CF, Nijs J, Walls A, Jenkinson M. Differential Structural Brain Changes Between Responders and Nonresponders After Physical Exercise Therapy for Chronic Nonspecific Neck Pain. Clin J Pain 2023; 39:270-277. [PMID: 37220328 DOI: 10.1097/ajp.0000000000001115] [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: 11/13/2022] [Accepted: 03/23/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Physical exercise therapy is effective for some people with chronic nonspecific neck pain but not for others. Differences in exercise-induced pain-modulatory responses are likely driven by brain changes. We investigated structural brain differences at baseline and changes after an exercise intervention. The primary aim was to investigate changes in structural brain characteristics after physical exercise therapy for people with chronic nonspecific neck pain. The secondary aims were to investigate (1) baseline differences in structural brain characteristics between responders and nonresponders to exercise therapy, and (2) differential brain changes after exercise therapy between responders and nonresponders. MATERIALS AND METHODS This was a prospective longitudinal cohort study. Twenty-four participants (18 females, mean age 39.7 y) with chronic nonspecific neck pain were included. Responders were selected as those with ≥20% improvement in Neck Disability Index. Structural magnetic resonance imaging was obtained before and after an 8-week physical exercise intervention delivered by a physiotherapist. Freesurfer cluster-wise analyses were performed and supplemented with an analysis of pain-specific brain regions of interest. RESULTS Various changes in grey matter volume and thickness were found after the intervention, for example, frontal cortex volume decreased (cluster-weighted P value = 0.0002, 95% CI: 0.0000-0.0004). We found numerous differences between responders and nonresponders, most notably, after the exercise intervention bilateral insular volume decreased in responders, but increased in nonresponders (cluster-weighted P value ≤ 0.0002). DISCUSSION The brain changes found in this study may underpin clinically observed differential effects between responders and nonresponders to exercise therapy for people with chronic neck pain. Identification of these changes is an important step toward personalized treatment approaches.
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Affiliation(s)
| | - Carolyn F Berryman
- Brain Stimulation, Imaging and Cognition Group, School of Medicine
- IIMPACT in Health, The University of South Australia
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel
- Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Angela Walls
- Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute
| | - Mark Jenkinson
- Australian Institute for Machine Learning (AIML), School of Computer Science, University of Adelaide
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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8
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Farrell SF, Kho PF, Lundberg M, Campos AI, Rentería ME, de Zoete RMJ, Sterling M, Ngo TT, Cuéllar-Partida G. A Shared Genetic Signature for Common Chronic Pain Conditions and its Impact on Biopsychosocial Traits. J Pain 2023; 24:369-386. [PMID: 36252619 DOI: 10.1016/j.jpain.2022.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
The multiple comorbidities & dimensions of chronic pain present a formidable challenge in disentangling its aetiology. Here, we performed genome-wide association studies of 8 chronic pain types using UK Biobank data (N =4,037-79,089 cases; N = 239,125 controls), followed by bivariate linkage disequilibrium-score regression and latent causal variable analyses to determine (respectively) their genetic correlations and genetic causal proportion (GCP) parameters with 1,492 other complex traits. We report evidence of a shared genetic signature across chronic pain types as their genetic correlations and GCP directions were broadly consistent across an array of biopsychosocial traits. Across 5,942 significant genetic correlations, 570 trait pairs could be explained by a causal association (|GCP| >0.6; 5% false discovery rate), including 82 traits affected by pain while 410 contributed to an increased risk of chronic pain (cf. 78 with a decreased risk) such as certain somatic pathologies (eg, musculoskeletal), psychiatric traits (eg, depression), socioeconomic factors (eg, occupation) and medical comorbidities (eg, cardiovascular disease). This data-driven phenome-wide association analysis has demonstrated a novel and efficient strategy for identifying genetically supported risk & protective traits to enhance the design of interventional trials targeting underlying causal factors and accelerate the development of more effective treatments with broader clinical utility. PERSPECTIVE: Through large-scale phenome-wide association analyses of >1,400 biopsychosocial traits, this article provides evidence for a shared genetic signature across 8 common chronic pain types. It lays the foundation for further translational studies focused on identifying causal genetic variants and pathophysiological pathways to develop novel diagnostic & therapeutic technologies and strategies.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia; NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia; Tess Cramond Pain & Research Centre, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
| | - Pik-Fang Kho
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Molecular Cancer Epidemiology Laboratory, Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mischa Lundberg
- UQ Diamantina Institute, The University of Queensland & Translational Research Institute, Woolloongabba, Queensland, Australia; Transformational Bioinformatics, CSIRO Health & Biosecurity, North Ryde, New South Wales, Australia
| | - Adrián I Campos
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia; Genetic Epidemiology Laboratory, Mental Health & Neuroscience Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Miguel E Rentería
- Genetic Epidemiology Laboratory, Mental Health & Neuroscience Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia; NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia
| | - Trung Thanh Ngo
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Gabriel Cuéllar-Partida
- UQ Diamantina Institute, The University of Queensland & Translational Research Institute, Woolloongabba, Queensland, Australia
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Senarath ID, Chen KK, Weerasekara I, de Zoete RMJ. Exercise-induced hypoalgesic effects of different types of physical exercise in individuals with neck pain: A systematic review and meta-analysis. Pain Pract 2023; 23:110-122. [PMID: 35869789 DOI: 10.1111/papr.13150] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/11/2023]
Abstract
OBJECTIVE To evaluate the exercise-induced hypoalgesic (EIH) effects of different types of physical exercise in individuals with neck pain. DESIGN Systematic review with meta-analysis. LITERATURE SEARCH An electronic search of six databases was completed to include studies assessing EIH effects on neck pain. STUDY SELECTION CRITERIA Randomized controlled trials, controlled trials, and observational studies that assessed before and immediate after-effects of a single session of physical exercise in people with neck pain were included. Two reviewers independently screened records, extracted outcomes, assessed the risk of bias, and rated the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. DATA SYNTHESIS EIH is characterized by increased pain threshold, pain tolerance, and/or decreased sensitivity to painful stimuli or unpleasantness, which may last up to 30 min after a single bout of exercise. EIH is usually measured with quantitative sensory testing (QST) and is mostly taken as the difference between pre- and postexercise pressure pain threshold (PPT). Data were pooled and analyzed using a fixed-effect meta-analysis. RESULTS Eleven articles were included in this review; nine with low risk of bias and two with some concerns about the risk of bias. Three studies with chronic whiplash-associated disorders (WAD) were included in the meta-analysis; isometric exercise had a larger EIH effect at the local testing site compared with submaximal aerobic exercises (MD = -0.21, [95% CI = -0.43, 0.00], p = 0.05, I2 = 92%), submaximal aerobic and isometric exercises had equal EIH effects at the remote testing site (MD = 0.01, [95% CI = -0.33, 0.35], p = 0.95, I2 = 0%), and submaximal aerobic exercises exerted comparably larger EIH effect at the remote testing site than local testing site (MD = -0.01, [95% CI = -0.20, 0.18], p = 0.93, I2 = 56%). The certainty of evidence (GRADE) for these analyses was low to very low. According to the descriptive analysis of the studies of chronic nonspecific neck pain, isometric and range of motion (ROM) exercises have shown EIH effects. Active stretching exercises have illustrated contradictory effects. CONCLUSION Isometric and ROM exercises exerted hypoalgesia at local and remote sites. A larger EIH effect following submaximal aerobic exercises was exerted at the remote testing site compared with the local site.
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Affiliation(s)
- I Dilhari Senarath
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kexun K Chen
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Ishanka Weerasekara
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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10
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de Zoete RMJ, Coppieters I, Farrell SF. Editorial: Whiplash-associated disorder—advances in pathophysiology, patient assessment and clinical management. Front Pain Res 2022; 3:1071810. [DOI: 10.3389/fpain.2022.1071810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
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11
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Souza MB, Mascarenhas RO, Maia LB, Fonseca LS, Silva HJ, de Zoete RMJ, McAuley JH, Henschke N, Oliveira VC. Comparative efficacy and acceptability of non-pharmacological interventions in fibromyalgia: Protocol for a network meta-analysis. PLoS One 2022; 17:e0274406. [PMID: 36191010 PMCID: PMC9529083 DOI: 10.1371/journal.pone.0274406] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Although several non-pharmacological interventions have been tested in the management of Fibromyalgia (FM), there is little consensus regarding the best options for the treatment of this health condition. The purpose of this network meta-analysis (NMA) is to investigate the comparative efficacy and acceptability of non-pharmacological interventions for FM, in order to assist clinical decision making through a ranking of interventions in relation to the most important clinical outcomes in these patients. METHODS AND ANALYSIS We will perform a systematic search to identify randomised controlled trials of non-pharmacological interventions endorsed in guidelines and systematic reviews. Information sources searched will include major bibliographic databases without language or date restrictions (MEDLINE, Cochrane Library, EMBASE, AMED, PsycINFO and PEDro). Our primary outcomes will be pain intensity, patient-reported quality of life (QoL), and acceptability of treatment will be our secondary outcome. Risk of bias of the included trials will be assessed using the Cochrane risk of bias tool (RoB2). For each pairwise comparison between the different interventions, we will present mean differences (MDs) for pain intensity and QoL outcomes and Relative Risks (RRs) for acceptability, both with respective 95% confidence intervals (CIs). Initially, standard pairwise meta-analyses will be performed using a DerSimonian-Laird random effects model for all comparisons with at least two trials and then we will perform a frequentist NMA using the methodology of multivariate meta-analysis assuming a common heterogeneity parameter, using the mvmeta command and network suite in STATA. In the NMA, two different types of control group, such as placebo/sham and no intervention/waiting list will be combined as one node called "Control". The competing interventions will be ranked using the P-score, which is the frequentist analogue of surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at immediate- (intervention duration of up to 2 weeks), short- (over 2 weeks up to 12 weeks) and long-terms (over 12 weeks). The confidence in the results from NMA will be assessed using the Confidence in Network Meta-analysis (CINeMA) framework. ETHICS AND DISSEMINATION This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal. REGISTRATION OSF (DOI: 10.17605/OSF.IO/7MS25) and registered in the PROSPERO database (CRD42020216374).
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Affiliation(s)
- Mateus B. Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- * E-mail:
| | - Rodrigo O. Mascarenhas
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Laisa B. Maia
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Letícia S. Fonseca
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Hytalo J. Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Rutger M. J. de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - James H. McAuley
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Vinicius C. Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
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12
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de Zoete RMJ, Stanwell P, Weber KA, Snodgrass SJ. Differences in Structural Brain Characteristics Between Individuals with Chronic Nonspecific Neck Pain and Asymptomatic Controls: A Case–Control Study. J Pain Res 2022; 15:521-531. [PMID: 35210851 PMCID: PMC8863323 DOI: 10.2147/jpr.s345365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Neck pain is a prevalent and costly problem, but its underlying mechanisms are poorly understood. Neuroimaging studies show alterations in brain morphometry in chronic musculoskeletal pain, but reports on neck pain are scarce. Objective This study investigates (1) differences in brain morphometry between individuals with chronic nonspecific neck pain and asymptomatic individuals and (2) associations between brain morphometry and patient-reported outcomes. Methods Sixty-three participants (33 pain, 11 female, mean [SD] age 35 [10] years; 30 control, 12 female, age 35 [11] years) underwent magnetic resonance imaging. Brain regions of interest (ROIs) were determined a priori, outcomes included cortical thickness and volume. Between-group differences were determined using cluster-wise correction for multiple comparisons and analyses of pain-related ROIs. Results Between-group differences in volume were identified in the precentral, frontal, occipital, parietal, temporal, and paracentral cortices. ROI analyses showed that parahippocampal cortical thickness was larger in the neck pain group (p=0.015, 95% CI: −0.27 to −0.03). Moderate to strong associations between volume and thickness of the cingulate cortex, prefrontal cortex, and temporal lobe and neck pain duration, pain intensity, and neck disability were identified (p-values 0.006 to 0.048). Conclusion Alterations in brain morphology that are associated with clinical characteristics inform the mechanisms underlying chronic nonspecific neck pain and may guide the development of more effective treatment approaches.
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Affiliation(s)
- Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Correspondence: Rutger MJ de Zoete, School of Allied Health Science and Practice, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia, Email
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Suzanne J Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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13
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Dickson C, de Zoete RMJ, Stanton TR. From Where We've Come to Where We Need to Go: Physiotherapy Management of Chronic Whiplash-Associated Disorder. Front Pain Res 2022; 2:795369. [PMID: 35295440 PMCID: PMC8915571 DOI: 10.3389/fpain.2021.795369] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Cameron Dickson
| | - Rutger M. J. de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
| | - Tasha R. Stanton
- Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
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14
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Farrell SF, Campos AI, Kho PF, de Zoete RMJ, Sterling M, Rentería ME, Ngo TT, Cuéllar-Partida G. Genetic basis to structural grey matter associations with chronic pain. Brain 2021; 144:3611-3622. [PMID: 34907416 DOI: 10.1093/brain/awab334] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 01/26/2023] Open
Abstract
Structural neuroimaging studies of individuals with chronic pain conditions have often observed decreased regional grey matter at a phenotypic level. However, it is not known if this association can be attributed to genetic factors. Here we employed a novel integrative data-driven and hypothesis-testing approach to determine whether there is a genetic basis to grey matter morphology differences in chronic pain. Using publicly available genome-wide association study summary statistics for regional chronic pain conditions (n = 196 963) and structural neuroimaging measures (n = 19 629-34 000), we applied bivariate linkage disequilibrium-score regression and latent causal variable analyses to determine the genetic correlations (rG) and genetic causal proportion (GCP) between these complex traits, respectively. Five a priori brain regions (i.e. prefrontal cortex, cingulate cortex, insula, thalamus and superior temporal gyrus) were selected based on systematic reviews of grey matter morphology studies in chronic pain. Across this evidence-based selection of five brain regions, 10 significant negative genetic correlations (out of 369) were found (false discovery rate < 5%), suggesting a shared genetic basis to both reduced regional grey matter morphology and the presence of chronic pain. Specifically, negative genetic correlations were observed between reduced insula grey matter morphology and chronic pain in the abdomen (mean insula cortical thickness), hips (left insula volume) and neck/shoulders (left and right insula volume). Similarly, a shared genetic basis was found for reduced posterior cingulate cortex volume in chronic pain of the hip (left and right posterior cingulate), neck/shoulder (left posterior cingulate) and chronic pain at any site (left posterior cingulate); and for reduced pars triangularis volume in chronic neck/shoulder (left pars triangularis) and widespread pain (right pars triangularis). Across these negative genetic correlations, a significant genetic causal proportion was only found between mean insula thickness and chronic abdominal pain [rG (standard error, SE) = -0.25 (0.08), P = 1.06 × 10-3; GCP (SE) = -0.69 (0.20), P = 4.96 × 10-4]. This finding suggests that the genes underlying reduced cortical thickness of the insula causally contribute to an increased risk of chronic abdominal pain. Altogether, these results provide independent corroborating evidence for observational reports of decreased grey matter of particular brain regions in chronic pain. Further, we show for the first time that this association is mediated (in part) by genetic factors. These novel findings warrant further investigation into the neurogenetic pathways that underlie the development and prolongation of chronic pain conditions.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, The University of Queensland, Herston, QLD, Australia.,NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Herston, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Adrián I Campos
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia.,Genetic Epidemiology Laboratory, Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Pik-Fang Kho
- Molecular Cancer Epidemiology Laboratory, Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, QLD, Australia.,NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Herston, QLD, Australia
| | - Miguel E Rentería
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia.,Genetic Epidemiology Laboratory, Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Trung Thanh Ngo
- Diamantina Institute, The University of Queensland and Translational Research Institute, Woolloongabba, QLD, Australia
| | - Gabriel Cuéllar-Partida
- Diamantina Institute, The University of Queensland and Translational Research Institute, Woolloongabba, QLD, Australia
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15
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Farrell SF, Cowin GJ, Pedler A, Durbridge G, de Zoete RMJ, Sterling M. Magnetic Resonance Spectroscopy Assessment of Brain Metabolite Concentrations in Individuals With Chronic Whiplash-associated Disorder: A Cross-sectional Study. Clin J Pain 2021; 37:28-37. [PMID: 33093341 DOI: 10.1097/ajp.0000000000000890] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pathophysiologic mechanisms underpinning ongoing pain in whiplash-associated disorder (WAD) are not well understood, however, alterations in brain morphology and function have been observed in this population and in other chronic pain conditions. This study investigated metabolite profiles of brain regions in people with chronic WAD compared with controls. MATERIALS AND METHODS Thirty-eight individuals with chronic WAD (mean [SD] age, 39.5 [11.3] years, 23 female individuals) and 16 pain-free controls (38.9 [12.7] years, 11 female individuals) underwent multivoxel brain magnetic resonance spectroscopy. At the anterior cingulate cortex (ACC), primary motor cortex (1MC), and somatosensory cortex (SSC), ratios of metabolite concentrations were calculated for N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myo-inositol (Ins), and glutamate/glutamine (Glx). Chronic WAD group participants completed clinical questionnaires and cold and pressure pain threshold assessment. Data were analyzed with hypothesis testing and Spearman correlations (P≥0.05), with Benjamini-Hochberg corrections (5% false discovery rate). RESULTS No group differences were observed for NAA:Cr, NAA:Cho, Cr:Cho, Glx:NAA, Glx:Cr, Glx:Cho, Ins:NAA, Ins:Cr, Ins:Cho or Ins:Glx for left or right ACC, 1MC, or SSC following correction for multiple comparisons. No significant correlations were observed between metabolite ratios and any clinical variable. DISCUSSION These results suggest that ongoing pain and disability in this population may not be underpinned by metabolite aberrations in the brain regions examined. Further research is required to progress our understanding of cortical contributions to neurophysiologic mechanisms in chronic WAD.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries
- Menzies Health Institute Queensland, Griffith University, Gold Coast
| | - Gary J Cowin
- Centre for Advanced Imaging, The University of Queensland, Brisbane
| | - Ashley Pedler
- Menzies Health Institute Queensland, Griffith University, Gold Coast
| | - Gail Durbridge
- Centre for Advanced Imaging, The University of Queensland, Brisbane
| | - Rutger M J de Zoete
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries
- Menzies Health Institute Queensland, Griffith University, Gold Coast
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16
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Blyton SJ, Edwards S, Moghaddas D, de Zoete RMJ, Palazzi K, Oldmeadow C, Bolton P, Rivett DA, Snodgrass SJ. A Pilot Longitudinal Study of 3-Dimensional Head and Neck Kinematics During Functional Tasks in Individuals With Chronic Idiopathic Neck Pain Either Wait-Listed for or Receiving Chiropractic Spinal Manipulative Therapy With Exercise. J Manipulative Physiol Ther 2020; 43:490-505. [PMID: 32859398 DOI: 10.1016/j.jmpt.2019.01.003] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/14/2018] [Accepted: 01/25/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine if there is a relationship between pain and movement kinematics during functional tasks, evaluated over time, in individuals with chronic idiopathic neck pain. METHODS Ten participants with chronic idiopathic neck pain performed 2 functional tasks (overhead reach to the right and putting on a seatbelt) while evaluated using 8 Oqus 300+ cameras. Kinematic variables included joint angles and range of motion (ROM) (°), head segment relative to neck segment (head-neck [HN]); and head/neck segment relative to upper thoracic segment (head/neck-trunk), velocity (m/s), and time (% of movement phase). Pain was quantified using a 100-mm visual analog scale. Linear mixed effects regression models were used to analyze associations between pain and kinematic variables adjusting for treatment group. RESULTS For overhead reach, higher pain was associated with less HN peak rotation at baseline (β = -0.33; 95% CI -0.52 to -0.14, P = .003) and less HN total rotation ROM at 6 months (β = -0.19; 95% CI -0.38 to -0.003, P = .048). For the seatbelt task, higher pain was associated with less HN peak rotation (β = -0.52; 95% CI -0.74 to -0.30 to -0.74, P < .001) and less HN total rotation ROM at baseline (β = -0.32; 95% CI -0.53 to -0.10, P = .006). No other movement variables demonstrated meaningful relationships with pain for the reach or seatbelt tasks. CONCLUSION Higher pain is associated with less HN peak and total rotation during functional reaching tasks requiring head rotation. Recognizing altered functional kinematics in individuals with chronic neck pain may assist patient management.
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Affiliation(s)
- Sarah J Blyton
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Suzi Edwards
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - Diana Moghaddas
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - Rutger M J de Zoete
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerrin Palazzi
- Clinical Research Design, IT and Statistical Support (CReDITSS), Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Chris Oldmeadow
- Clinical Research Design, IT and Statistical Support (CReDITSS), Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Philip Bolton
- School of Biomedical Science and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Darren A Rivett
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia.
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Abstract
OBJECTIVE Primary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical outcomes and (2) to investigate whether different types and dosages of physical exercise exert different central changes. DESIGN Systematic review searching four electronic databases up to September 2018: AMED, CINAHL, Embase and MEDLINE. Two reviewers independently assessed the methodological quality of included studies using the Cochrane Collaboration's Risk of Bias in Non-Randomised Studies-I tool. A standardised extraction table was used for data extraction, which was performed by two reviewers. INTERVENTIONS Studies reporting any physical exercise intervention in any chronic musculoskeletal pain condition were included. Eligibility of 4011 records was screened independently by two reviewers, and four studies were included in the review. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: any brain outcome assessed with any MR technique. SECONDARY OUTCOMES any self-reported clinical outcomes, and type and dosage of the exercise intervention. RESULTS All four studies had high risk of bias. There was heterogeneity between the brain areas studied and the types of exercise interventions delivered. All studies reported functional MRI changes in various brain areas following an exercise intervention. Insufficient data were available to conduct a meta-analysis or to answer the secondary aims. CONCLUSIONS Only a limited number of studies were available and all were at high risk of bias. None of the studies was randomised or included blinded assessment. Exercise may exert effects on brain neurobiology in people with chronic pain. Due to the high risk of bias, future studies should use a randomised study design. Investigation of morphological brain changes could be included. PROSPERO REGISTRATION NUMBER CRD42018108179.
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Affiliation(s)
- Rutger M J de Zoete
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kenneth Chen
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
- Geriatric Education and Research Institute, Singapore
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
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18
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de Zoete RMJ, Osmotherly PG, Rivett DA, Snodgrass SJ. Cervical Sensorimotor Control Does Not Change Over Time and Is Not Related to Chronic Idiopathic Neck Pain Characteristics: A 6-Month Longitudinal Observational Study. Phys Ther 2020; 100:268-282. [PMID: 32031655 DOI: 10.1093/ptj/pzz167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 11/14/2019] [Revised: 05/06/2019] [Accepted: 07/28/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cervical sensorimotor control (CSMC) outcomes have been suggested to be important in the assessment of individuals with neck pain, despite the lack of consistent supporting evidence that CSMC skills are related to neck pain. OBJECTIVE The aim of this study was to investigate whether CSMC changes over time in individuals with chronic idiopathic neck pain and whether neck pain characteristics are associated with CSMC. DESIGN A longitudinal observational study was performed. METHODS A total 50 participants with chronic idiopathic neck pain and 50 matched participants who were healthy (controls) completed 7 CSMC tests (including 14 test conditions): joint position error, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Neck pain characteristics included pain intensity (visual analog scale), pain duration, and neck disability (Neck Disability Index). Linear mixed models were used to investigate whether any factors were associated with changes in CSMC. RESULTS Neck pain intensity was associated with 1 of 14 CSMC test conditions (balance with torsion and eyes open), and neck disability was associated with balance with eyes open and high-load head steadiness. Other factors, including sex, age, body mass index, physical activity levels, and neck pain duration, showed no association with CSMC. LIMITATIONS Although all other tests involved computerized data collection, the joint position error test was administered manually, introducing the risk of researcher bias. CONCLUSIONS The few associations between test conditions and neck pain characteristics were at best weak; hence, these are likely to be chance findings. These results suggest that CSMC may not be associated with improvement/worsening of chronic idiopathic neck pain, spawning debate on the clinical usefulness of CSMC tests.
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Affiliation(s)
- Rutger M J de Zoete
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia; Center for Brain and Mental Health Research, The University of Newcastle; Hunter Medical Research Institute, Newcastle, New South Wales, Australia; and Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle; Center for Brain and Mental Health Research, The University of Newcastle; and Hunter Medical Research Institute
| | - Darren A Rivett
- School of Health Sciences, The University of Newcastle; Center for Brain and Mental Health Research, The University of Newcastle; and Hunter Medical Research Institute
| | - Suzanne J Snodgrass
- School of Health Sciences, The University of Newcastle; Center for Brain and Mental Health Research, The University of Newcastle; and Hunter Medical Research Institute
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Snodgrass SJ, de Zoete RMJ, Croker C, Yerrapothu M, Elliott JM. Reliability of cervical muscle volume quantification using magnetic resonance imaging. Musculoskelet Sci Pract 2019; 44:102056. [PMID: 31563630 DOI: 10.1016/j.msksp.2019.102056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 03/17/2019] [Revised: 06/06/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is used to quantify the size and structure of the architecturally complex cervical spine musculature of individuals with traumatic and idiopathic neck pain. However, to our knowledge, no scan-rescan reliability data is available on neck muscle volumes. OBJECTIVES This study investigates the intra- and inter-rater reliability and scan-rescan reliability in cervical muscle volume investigations. DESIGN Clinical Measurement, Reliability study. METHODS MRI scans were performed and repeated (within 1 h) for five asymptomatic individuals. Two raters manually traced levator scapulae, multifidus including semispinalis cervicis, semispinalis capitis, splenius capitis including splenius cervicis, and sternocleidomastoid using Analyze software (v12.0). Reliability was determined using intra-class correlation coefficients, Lin's concordance coefficient and Bland-Altman plots, with interpretation of reliability coefficients using the criteria from Fleiss. RESULTS Intra-rater reliability of muscle quantification was excellent (ICCs ranging from 0.78 to 0.96). Inter-rater reliability was excellent for sternocleidomastoid(ICC 0.92, 95% CI 0.80, 0.97) and splenius capitis (ICC 0.77, 0.51, 0.90), and ranged from fair to good for levator scapulae (0.63, 0.18, 0.85), multifidus (0.73, 0.44, 0.88), and semispinalis capitis (0.50, 0.08, 0.77). The scan-rescan reliability was excellent for all muscles (ICCs ranging from 0.94 to 0.98). CONCLUSION Threats to reliability appear to be more related to manual quantification of muscles on images rather than protocols related to re-positioning a participant in the scanner and repeating the same protocol. The current findings suggest that the proposed methods can be used in establishing normative data for cervical muscle volume and comparing individuals with and without neck pain.
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Affiliation(s)
- Suzanne J Snodgrass
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia.
| | - Rutger M J de Zoete
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia; Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia.
| | - Christopher Croker
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia.
| | - Meghana Yerrapothu
- Neuromuscular Imaging Research Laboratory, Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, USA.
| | - James M Elliott
- Neuromuscular Imaging Research Laboratory, Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, USA; Northern Sydney Local Health District, The Kolling Institute, and Faculty of Health Sciences, The University of Sydney, Australia.
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de Zoete RMJ, Osmotherly PG, Rivett DA, Snodgrass SJ. No Differences Between Individuals With Chronic Idiopathic Neck Pain and Asymptomatic Individuals on Seven Cervical Sensorimotor Control Tests: A Cross-Sectional Study. J Orthop Sports Phys Ther 2019:1-37. [PMID: 31443626 DOI: 10.2519/jospt.2019.8846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/07/2023]
Abstract
STUDY DESIGN Case-control study. BACKGROUND Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. OBJECTIVES To compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability. METHODS Fifty participants with chronic idiopathic neck pain and 50 age and sex-matched asymptomatic controls completed seven cervical sensorimotor control tests: joint position error, joint position error torsion, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with Mann-Whitney U tests. Correlations between tests and levels of neck pain and disability were investigated using Spearman's rho. RESULTS There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (p-values ranged from p=0.203 to p=0.981). For each test, 'poor performers' consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r values ranged from 0.010 to 0.294) and neck disability (0.007 to 0.316). DISCUSSION These findings suggest sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2019.8846.
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Affiliation(s)
- Rutger M J de Zoete
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, QLD, Australia
| | - Peter G Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Darren A Rivett
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Suzanne J Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
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de Zoete RMJ, Brown L, Oliveira K, Penglaze L, Rex R, Sawtell B, Sullivan T. The effectiveness of general physical exercise for individuals with chronic neck pain: a systematic review of randomised controlled trials. European Journal of Physiotherapy 2019. [DOI: 10.1080/21679169.2018.1561942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rutger M. J. de Zoete
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia
| | - Lauren Brown
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Katie Oliveira
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Liam Penglaze
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Rachelle Rex
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Bronte Sawtell
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Tegan Sullivan
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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de Zoete RMJ, Osmotherly PG, Rivett DA, Snodgrass SJ. Seven cervical sensorimotor control tests measure different skills in individuals with chronic idiopathic neck pain. Braz J Phys Ther 2018; 24:69-78. [PMID: 30446237 DOI: 10.1016/j.bjpt.2018.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/23/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sensorimotor control is commonly reported in neck pain research and rapidly gaining interest in clinical practice. Joint position error (conventional and torsion), postural balance, subjective visual vertical, head tilt response, The Fly®, smooth pursuit neck torsion and head steadiness are tests that have been reported to assess cervical sensorimotor control. However, it is unknown whether clinicians could use one test, or a test battery, to appropriately assess cervical sensorimotor control and improve efficiency. Our main research question is: Do seven cervical sensorimotor control tests measure unique or similar characteristics of sensorimotor control in individuals with chronic idiopathic neck pain? METHODS Principle components factor analysis. Data from seven cervical sensorimotor control tests of 50 participants with chronic idiopathic neck pain were included. Individual factors, potentially related to sensorimotor control, were determined by Eigen values >1.00 and inspection of a loading plot. Items with loadings ≥0.40 were considered satisfactory for inclusion in a factor. RESULTS All cervical sensorimotor control tests were found to measure unique skills. Four factors were isolated with two, postural balance and head steadiness, accounting for most of the variance across tests. The remaining two factors, continuous movement accuracy and perceived verticality, contributed less to the observed variance. CONCLUSION Postural balance and head steadiness were the major underlying factors explaining cervical sensorimotor control in the current sample. However, our results imply that all seven tests are independent and measure different skills. It is not possible to recommend a test battery for clinical practice, as all tests measure unique skills which appear to be independent of each other.
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Affiliation(s)
- Rutger M J de Zoete
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia; Center for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia.
| | - Peter G Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia; Center for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Darren A Rivett
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia; Center for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Suzanne J Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia; Center for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
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Young JL, Rhon DI, de Zoete RMJ, Cleland JA, Snodgrass SJ. The influence of dosing on effect size of exercise therapy for musculoskeletal foot and ankle disorders: a systematic review. Braz J Phys Ther 2018; 22:20-32. [PMID: 29157736 PMCID: PMC5816081 DOI: 10.1016/j.bjpt.2017.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Received: 10/06/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The purpose of this review was to identify doses of exercise therapy associated with greater treatment effect sizes in individuals with common musculoskeletal disorders of the foot and ankle, namely, achilles tendinopathy, ankle sprains and plantar heel pain. METHODS AMED, EMBASE and MEDLINE were searched from 2005 to August 2017 for randomized controlled trials related to exercise for these three diagnoses. The Physiotherapy Evidence Database scale was used for methodological quality assessment. Exercise dosing variables and outcome measures related to pain and function were extracted from the studies, and standardized mean differences were calculated for the exercise groups. RESULTS Fourteen studies met the final inclusion. A majority of the studies showed large effects and two small trends were identified. Patients with plantar heel pain may benefit more from a daily home exercise program than two supervised visits per week (SMD=3.82), but this recommendation is based on weak evidence. In achilles tendinopathy, a relationship was also seen when sets and repetitions of eccentric exercise were performed as tolerated (SMD=1.08 for function, -1.29 for pain). CONCLUSIONS Session duration, frequency, total number of visits, and overall length of care may all be dosing variables with limited value for determining effective exercise prescription. However, the limited number of studies prevents any definitive conclusions. Further investigation is warranted to improve our understanding of the influence exercise dosing has on treatment effect sizes. Future randomized controlled trials comparing specific exercise dose variables should be conducted to clarify the impact of these variables.
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Affiliation(s)
- Jodi L Young
- Arizona School of Health Sciences, Department of Physical Therapy, AT Still University, Mesa, AZ, USA; The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia.
| | - Daniel I Rhon
- The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia; Center for the Intrepid, San Antonio, TX, USA; Physical Therapy, Baylor University, Joint Base San Antonio - Fort Sam Houston, TX, USA
| | - Rutger M J de Zoete
- The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia
| | - Joshua A Cleland
- Franklin Pierce University, Manchester, Department of Physical Therapy, NH, USA
| | - Suzanne J Snodgrass
- The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia
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