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Hacquebord S, Kiers H, van der Wees P, Hoogeboom TJ. Towards a better understanding of our patients. A qualitative study about how patients and their physiotherapists perceive the recovery of shoulder problems. Musculoskelet Sci Pract 2024; 71:102931. [PMID: 38520875 DOI: 10.1016/j.msksp.2024.102931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To investigate how people with shoulder problems and their physiotherapists perceive the recovery of shoulder problems. METHOD We performed a qualitative study using semi-structured interviews with patients and their physiotherapists. Nine pairs of patients and physiotherapists (n = 18) were recruited. The transcribed interviews were analyzed in a consecutive multistep iterative process using a conventional content analysis. RESULTS Analysis of the interviews resulted in three major themes: 'What do I expect from my recovery?', 'Am I recovering?' and 'When do I consider myself recovered?' The patients and physiotherapists talked similarly about the importance of and interdependency between these themes. Central to these three themes are the analysis of the cause of shoulder problems and the experience of uncertainty. Our analyses suggest that there are conceptual differences in how patients and physiotherapists formulate their expectations about recovery, observe the recovering process, and conceptualize when someone may be considered recovered. Different interpretations by the patients of the information provided by the physical therapists appeared to fuel these differences. CONCLUSION Our results show that the concept of recovery is defined by patients and physiotherapists in three distinct themes. Within these themes the patients and physiotherapists differ substantially in their conceptualization of the recovery. IMPACT STATEMENT This insight in the concept of recovery can help patients and physiotherapists better understand each other, enhance the alignment of ideas about the care process, and support making decisions together. Physiotherapists should be aware that patients might interpret their words, explanations, and expectations substantially different.
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Affiliation(s)
- Sijmen Hacquebord
- University of Applied Sciences Utrecht, Institute for Human Movement Studies, Utrecht, Netherlands; Radboud University Medical Center, IQ Healthcare, Nijmegen, Netherlands.
| | - Henri Kiers
- University of Applied Sciences Utrecht, Institute for Human Movement Studies, Utrecht, Netherlands
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Juhlin S, Mannerkorpi K, Bergenheim A. Factors promoting improvements in symptoms and health in women with fibromyalgia and chronic widespread pain: a qualitative interview study. Disabil Rehabil 2024; 46:2234-2239. [PMID: 37264559 DOI: 10.1080/09638288.2023.2218655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To describe experiences of improvement among women with chronic widespread pain (CWP). MATERIALS AND METHODS Recruitment was made from a cohort of women with CWP who participated in a 10- to 12-year follow-up study in 2016. The inclusion criterion was an improvement of at least 30% on a visual analog scale of pain intensity between baseline and follow-up. Seventeen women participated in semi-structured interviews. Data were analysed using qualitative content analysis. RESULTS The analysis resulted in three categories with eight subcategories: Experience of improvement included feeling better despite persisting symptoms and to be capable of more activity. Developing strategies for better health included choosing to act to improve health, developing a constructive mental approach to the illness, and changing one's view of oneself and one's life. Contextual factors supporting improvement included support from healthcare, social support from one's environment, and reduced load in daily life. CONCLUSIONS Experiences of health improvement involved active changes as well as contextual factors. Clinical implications of this study are that increased knowledge regarding pain management, increased physical activity, and reduced stress could contribute to symptom improvement in persons with CWP.
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Affiliation(s)
- Sofia Juhlin
- Närhälsan Rehabilitation Centres, Region Västra Götaland, Sweden
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Anna Bergenheim
- Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
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La Touche R, Pardo-Montero J, Grande-Alonso M, Paris-Alemany A, Miñambres-Martín D, Nouvilas-Pallejà E. Psychological, Pain, and Disability Factors Influencing the Perception of Improvement/Recovery from Physiotherapy in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study. Healthcare (Basel) 2023; 12:12. [PMID: 38200918 PMCID: PMC10778840 DOI: 10.3390/healthcare12010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES The aim of this study was to identify the possible relationships between psychological, pain, and disability variables with respect to the perception of change/recovery from physiotherapy in patients with chronic musculoskeletal pain (CMP). METHODS A cross-sectional observational study was performed with 150 patients. All patients completed a series of self-administered questionnaires and a series of self-reports to quantify the perception of change with respect to the physiotherapy they underwent, the level of disability and pain intensity, the level of fear of movement, the level of catastrophism, the degree of self-efficacy, the level of therapeutic alliance and their adherence to the physiotherapy. RESULTS The strongest correlations were between the subjective perception of change and the number of sessions, treatment beliefs, self-efficacy, pain intensity, collaboration, and bonding. The linear regression model showed that the number of sessions, treatment beliefs, self-efficacy, compliance, pain intensity, and bonding were predictors of subjective perception of improvement, with 50% of the variance. CONCLUSIONS Treatment beliefs, therapeutic alliance, degree of self-efficacy, and pain intensity have been shown to be predictors of a subjective perception of improvement in patients with CMP. In turn, multimodal treatments had the greatest positive impact on the subjective perception of improvement.
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Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain; (R.L.T.)
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain; (R.L.T.)
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
| | - Mónica Grande-Alonso
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina, Universidad de Alcalá, 28871 Alcalá de Henares, Spain;
- Grupo de Investigación Clínico-Docente Sobre Ciencias de la Rehabilitación (INDOCLIN), Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Diego Miñambres-Martín
- Premium Madrid Global Health Care, 28016 Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Encarnación Nouvilas-Pallejà
- Department of Social and Organizational Psychology, National University of Distance Education, 28040 Madrid, Spain
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Frydendal T, Thomsen KS, Mechlenburg I, Mikkelsen LR, Overgaard S, Ingwersen KG, Myburgh C. Patient and public involvement to inform the protocol of a clinical trial comparing total hip arthroplasty with exercise: an exploratory qualitative case study. BMJ Open 2023; 13:e070866. [PMID: 37094895 PMCID: PMC10151957 DOI: 10.1136/bmjopen-2022-070866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE To explore patient, clinician and decision-maker perceptions on a clinical trial evaluating the effectiveness of total hip arthroplasty (THA) compared with exercise to inform the trial protocol. DESIGN This is an exploratory qualitative case study using a constructivist paradigm. SETTING AND PARTICIPANTS Participants were enrolled into three key stakeholder groups: patients eligible for THA, clinicians, and decision makers. Focus group interviews were conducted in undisturbed conference rooms at two hospitals in Denmark, according to group status using semi-structured interview guides. ANALYSIS Interviews were recorded, transcribed verbatim and thematic analysed using an inductive approach. RESULTS We conducted 4 focus group interviews with 14 patients, 1 focus group interview with 4 clinicians (2 orthopaedic surgeons and 2 physiotherapists) and 1 focus group interview with 4 decision-makers. Two main themes were generated. 'Treatment expectations and beliefs impact management choices' covered three supporting codes: Treatment without surgery is unlikely to lead to recovery; Clinician authority impacts the management narrative; The 'surgery vs exercise' debate. 'Factors influencing clinical trial integrity and feasibility' highlighted three supporting codes: Who is considered eligible for surgery?; Facilitators and barriers for surgery and exercise in a clinical trial context; Improvements in hip pain and hip function are the most important outcomes. CONCLUSIONS Based on key stakeholder treatment expectations and beliefs, we implemented three main strategies to improve the methodological rigorousness of our trial protocol. First, we added an observational study investigating the generalisability to address a potential low enrolment rate. Second, we developed an enrolment procedure using generic guidance and balanced narrative conveyed by an independent clinician to facilitate communication of clinical equipoise. Third, we adopted change in hip pain and function as the primary outcome. These findings highlight the value of patient and public involvement in the development of trial protocols to reduce bias in comparative clinical trials evaluating surgical and non-surgical management. TRIAL REGISTRATION NUMBER NCT04070027 (pre-results).
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Affiliation(s)
- Thomas Frydendal
- Department of Physiotherapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kristine Sloth Thomsen
- Department of Physiotherapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Ramer Mikkelsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Kim Gordon Ingwersen
- Department of Physiotherapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Cornelius Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Chiropractic Knowledge Hub, Odense, Denmark
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Lehmann H, Kraus T, Esser A, Krabbe J. Evaluation of a Workplace Active Rest Program in Office Workers With Comparison of a Prospective and Retrospective Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231220605. [PMID: 38146165 PMCID: PMC10752044 DOI: 10.1177/00469580231220605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023]
Abstract
Physical activity-related workplace interventions can be counterstrategies for physical inactivity due to office work. Newly introduced programs should be evaluated for success. This study aimed to evaluate the intervention of a workplace active rest program and to compare a prospective and retrospective design of evaluation. A Germany-wide multicenter evaluation of a 3-month workplace active rest program (30 min, once a week) was carried out at 14 locations with a longitudinal pre/post design by means of an anonymous questionnaire (npre = 405, npost = 369). The participants' program-related changes in targeted characteristics regarding posture, function, complaints and physical awareness were collected with a questionnaire in a prospective design and afterward retrospectively. The prospective evaluation showed a significant improvement in the target characteristic "postural muscles in the neck area". In the retrospective survey, all target characteristics improved significantly. There were no differences between locations. The workplace active rest program in this study had positive effects on the perception of postural neck muscle status regardless of prospective or retrospective approach. Selection of survey mode should depend on desired outcome and consecutive influencing factors. In this specific case, retrospective survey could give more indirect information about overall satisfaction with the program and job although being influenced by response bias. Recall bias should be relatively small for shorter time periods assessed. Future studies should account for corresponding bias and specifics of target characteristics regardless of the chosen approach to survey.
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Affiliation(s)
- Heidi Lehmann
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Social Accident Insurance Institution for the Energy, Textile, Electrical and Media Products Sectors (BG ETEM), Köln, Germany
| | - Thomas Kraus
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - André Esser
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Julia Krabbe
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Deleu PA, Piron M, Leemrijse G, Besse JL, Chèze L, Devos Bevernage B, Lalevée M, Leemrijse T. Patients' point of view on the long-term results of total ankle arthroplasty, tibiotalar and tibiotalocalcaneal arthrodeses. Orthop Traumatol Surg Res 2022; 108:103369. [PMID: 35850423 DOI: 10.1016/j.otsr.2022.103369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/16/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total ankle arthroplasty (TAA), tibiotalar (TT) arthrodesis and tibiotalocalcaneal (TTC) arthrodesis are common surgical procedures that are sometimes concurrent. The functional results of TTC are deemed to be inferior because of the double joint sacrifice. Patient-Reported Outcome Measures (PROMs), as well as satisfaction scores, are commonly used to assess the outcome of these surgeries, but lack at capturing patients' ability to cope with potential functional limitations. The objective of our study was to compare the results of TAA, TT and TTC arthrodeses according to patients' point of view. We proposed two hypotheses: 1) TAA confer better results than TT arthrodeses, 2) and TT arthrodeses confer better results than TTC arthrodeses, on this specific criterion. MATERIAL AND METHODS We carried out a retrospective study integrating all TAA, TT and TTC arthrodeses performed in our center from 2010 to 2017. These surgeries were compared using PROMs (Foot Function Index (FFI), Foot and Ankle Outcome Scale (FAOS) and 12-Item Short Form Survey (SF-12)), a satisfaction rating and self-reported perceived recovery state. RESULTS Fifty-one patients were included in the TAA group, 50 in the TT group and 51 in the TTC group. The mean duration of follow-up was 46±20.8 months. The TAA group had better results than the TT group regarding the FFI score and satisfaction, thus confirming our primary hypothesis. On the other hand, no significant difference was found between the TT group and the TTC group, which invalidated our secondary hypothesis. No significant difference between the groups was found regarding the distribution of patients' perceived recovery state. CONCLUSION Our hypothesis was not confirmed. In fact, TAAs, TT and TTC arthrodeses presented substantially similar results. Although it is difficult to compare surgeries with different indications, it is surprising to find that the patients' perceived recovery state, deviating from the usual clinical and radiological results, are relatively similar. LEVEL OF EVIDENCE IV; Retrospective study.
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Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France; Foot & Ankle Institute, Bruxelles, Belgium.
| | - Maud Piron
- Centre Hospitalier Régional La Citadelle, Liège, Belgium
| | | | - Jean-Luc Besse
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, 69495 Pierre-Bénite, France
| | - Laurence Chèze
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France
| | | | - Matthieu Lalevée
- Centre Hospitalo-Universitaire de Rouen, Service de chirurgie Orthopédique et Traumatologique, 76000 Rouen, France
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Smith H, Grindey C, Hague I, Newbould L, Brown L, Clegg A, Thompson C, Lawton R. Reducing delayed transfer of care in older people: A qualitative study of barriers and facilitators to shorter hospital stays. Health Expect 2022; 25:2628-2644. [PMID: 36193616 DOI: 10.1111/hex.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Growing numbers of older patients occupy hospital beds despite being 'medically fit' for discharge. These Delayed Transfers of Care amplify inefficiencies in care and can cause harm. Delayed transfer because of family or patient choice is common; yet, research on patient and family perspectives is scarce. To identify barriers to, and facilitators of, shorter hospital stays, we sought to understand older people's and caregivers' thoughts and feelings about the benefits and harms of being in hospital and the decisions made at discharge. METHODS A multimethod qualitative study was carried out. Content analysis was carried out of older people's experiences of health or care services submitted to the Care Opinion online website, followed by telephone and video interviews with older people and family members of older people experiencing a hospital stay in the previous 12 months. RESULTS Online accounts provide insight into how care was organized for older people in the hospital, including deficiencies in care organization, the discharge process and communication, as well as how care was experienced by older people and family members. Interview-generated themes included shared meanings of hospitalization and discharge experiences and the context of discharge decisions including failure in communication systems, unwarranted variation and lack of confidence in care and lack of preparation for ongoing care. CONCLUSION Poor quality and availability of information, and poor communication, inhibit effective transfer of care. Communication is fundamental to patient-centred care and even more important in discharge models characterized by limited assessments and quicker discharge. Interventions at the service level and targeted patient information about what to expect in discharge assessments and after discharge could help to address poor communication and support for improving discharge of older people from hospital. PATIENT OR PUBLIC CONTRIBUTION The Frailty Oversight Group, a small group of older people providing oversight of the Community Aging Research 75+ study, provided feedback on the research topic and level of interest, the draft data collection tools and the feasibility of collecting data with older people during the COVID-19 pandemic. The group also reviewed preliminary findings and provided feedback on our interpretation.
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Affiliation(s)
- Helen Smith
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and Humber, Bradford Institute for Health Research, Bradford, UK
| | - Chloe Grindey
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and Humber, Bradford Institute for Health Research, Bradford, UK
| | - Isabel Hague
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and Humber, Bradford Institute for Health Research, Bradford, UK
| | - Louise Newbould
- Social Policy Research Unit (SPRU), University of York, York, UK
| | - Lesley Brown
- Academic Unit for Aging and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Aging and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Carl Thompson
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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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] [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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O'Halloran B, Cook CE, Oakley E. Criterion validation and interpretability of the Single Assessment Numerical Evaluation (SANE) of self-reported recovery in patients with neck pain. Musculoskelet Sci Pract 2021; 56:102467. [PMID: 34673312 DOI: 10.1016/j.msksp.2021.102467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The SANE is a PROM of recovery, which may assist clinicians in clinical decision-making and discharge planning. The psychometric measurement properties of the SANE have yet to be determined for neck pain. OBJECTIVES Threefold objectives included: 1)determine the numerical threshold for the SANE at which patients with neck pain determine their symptoms are acceptable; 2)determine the association between scores for the NDI and VAS, with the SANE; 3)determine the average number of visits, costs and value associated with the management of neck pain. DESIGN Longitudinal repeated measures cohort design. METHODS Threshold measures for self-reported recovery with the SANE anchored to the PASS were examined using ROC. PCC determined the relationship between the VAS/pain and NDI raw/percentage change scores and the SANE at discharge. Descriptive statistics were used for number of visits and cost. Value was calculated as the proportion of change on the NDI and VAS/$100 US dollars spent. RESULTS 57 subjects completed full observation. ROC analysis indicates a threshold value of 82.5%(Sn = 56.0, Sp = 85.7,+LR = 1.68,-LR = 0.29) on the SANE with an AUC of 0.820(95%CI = 0.638, 1.00). A weak correlation was found between raw NDI(r = 0.39 p < 0.05)/Pain(r = 0.45 p < 0.05) scores and the SANE with a moderate correlation between percent change scores of NDI(r = 0.52 p < 0.05)/PAIN(r = 0.54 p < 0.05) and the SANE. The value proposition indicated cost of care amounted to a 10.5% and 12.9%; improvement in the NDI and pain scores/$100 spent. CONCLUSIONS Patients reporting greater than 82.5% on the SANE are likely to find their present status acceptable and potentially stop seeking care.
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Affiliation(s)
- Bryan O'Halloran
- School of Physical Therapy, Samson College of Health Sciences, University of the Sciences, 600 S 43rd St Philadelphia, PA, 19104, USA.
| | - Chad E Cook
- Doctor of Physical Therapy Division, DUMC 104002311 Trent Drive, Duke University, Durham, NC, 27710, USA.
| | - Elizabeth Oakley
- Physical Therapy Building 135, Andrews University, 8975 Old 31, Berrien Springs, MI, 49104, USA.
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Salsbury SA, Maiers M. Qualitative Analysis of Illness Representations and Coping Perceptions Among Older Adults With Chronic Spinal Disability: “A Thought in the Back of My Mind”. J Manipulative Physiol Ther 2021; 44:652-662. [DOI: 10.1016/j.jmpt.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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Schwartz CE, Stark RB, Michael W, Rapkin BD, Finkelstein JA. "Looking Under the Hood" of Anchor-Based Assessment of Clinically Important Change: A Machine Learning Approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1009-1015. [PMID: 34243824 DOI: 10.1016/j.jval.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The Global Assessment of Change (GAC) item has facilitated the interpretation of change in patient-reported outcomes, providing an anchor for computing minimally important differences. Construct validity has been documented via disease-specific patient-reported outcomes change. We examined what domains, sociodemographic characteristics, attributions of change, and cognitive-appraisal processes are reflected in GAC ratings. METHODS This secondary analysis examined data from 1,481 chronically ill patients and caregivers surveyed at baseline and 17 months. Items queried change since baseline in overall disease symptoms (GAC) and in physical, emotional, and social functioning. Candidate predictors included sociodemographic factors, health-related quality-of-life domains, change attributions, and quality-of-life appraisal processes. Least absolute shrinkage and selection operator and bootstrapping tested 77 predictors' effectiveness and stability. RESULTS GAC worsening was notably associated with being disabled (β = -0.24) and having difficulty paying bills (β = -0.13). GAC was better explained by the physical domain than the emotional or social (β = 0.67, 0.10, and 0.03, respectively; R2adj = 0.63) after sociodemographic-covariate adjustment. In a separate model (R2adj = 0.18), GAC variance was explained by attributions about changing health and changing response of one's health team, goals related to solving healthcare problems and maintaining activities, and appraisal about things getting better (β = -0.14, 0.08, -0.07, 0.05, 0.21, respectively; prange ~0.0005-0.05) after adjustment. CONCLUSIONS The GAC primarily reflects the physical domain, and the GAC reflects attributions, goals, and patterns of emphasis related to change in health and healthcare. Commonly unmeasured factors have some bearing on GAC scores and can facilitate the interpretation of change.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc, Concord, MA, USA; Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA.
| | | | | | - Bruce D Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joel A Finkelstein
- Divisions of Orthopedic Surgery and Spine Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Rushing CJ, Rathnayake VR, Oxios AJ, Spinner SM, Hardigan P. Patient-Perceived Recovery and Outcomes after Bipolar Radiofrequency Controlled Ablation with Platelet-Rich Plasma Injection for Refractory Plantar Fasciosis. J Foot Ankle Surg 2021; 59:673-678. [PMID: 32600560 DOI: 10.1053/j.jfas.2019.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 02/03/2023]
Abstract
Previous studies have documented persistent postoperative symptoms and limitations following plantar fasciotomy using patient-reported outcome measures (PROMs). The incomplete recovery (resolution) has been theorized to occur from altered foot biomechanics, and alternative treatment methods have continued to gained popularity for addressing refractory plantar fasciosis (RPF). The purpose of the present study was to assess patient-perceived recovery (PPR) and outcomes after bipolar radiofrequency controlled ablation (BRC) with platelet-rich plasma (PRP) injection for RPF. From July 2006 to July 2016, 43 patients (52 procedures) were enrolled. PROMS were prospectively obtained and compared between patients who perceived themselves as recovered without/residual deficits (recovered-resolved, recovered-not resolved) and those not recovered. Holistic satisfaction, procedure-specific satisfaction, complications, reoperations, and failure were recorded. Overall, 67.4% perceived themselves as recovered-resolved, 23.3% as recovered-not resolved, and 9.3% as not recovered. Holistic and procedure specific satisfaction were high (90.7% and 88.4%), with a mean modified Foot Function Index of 11.65, visual analog scale for pain 1.5, and failure rate of 9.3% at a median of 53 months (interquartile range 33 to 83). In the present study, outcomes with BRC with PRP injection compared favorably to the long-term outcomes reported for partial and complete plantar fasciotomy. Although 14 patients (32.6%) continued to have some postoperative symptoms, 71% indicated that they were satisfied with their symptoms, and 64% would undergo a similar procedure again. Therefore, despite the study's shortcomings, a patient's ability to cope appears to have a role in recovery from RPF.
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Affiliation(s)
- Calvin J Rushing
- Resident, Westside Regional Medical Center, Plantation, FL; Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL.
| | | | - Adam J Oxios
- Resident, Westside Regional Medical Center, Plantation, FL
| | - Steven M Spinner
- Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL; Residency Director, Westside Regional Medical Center, Plantation, FL
| | - Patrick Hardigan
- Director, Statistical Consulting Center, Nova Southeastern University, Ft. Lauderdale, FL
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Liu J, Wong MCM, Lo ECM. The use of Oral Health Impact on Daily Living (OHIDL) transition scale in measuring the change in oral health-related quality of life among older adults. BMC Oral Health 2021; 21:230. [PMID: 33941160 PMCID: PMC8094480 DOI: 10.1186/s12903-021-01593-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background This longitudinal study aimed to evaluate the longitudinal validity and reliability of the Oral Health Impact on Daily Living (OHIDL) transition scale and measure the perceived change in oral health-related quality of life (OHRQoL) after dental treatments among older adults.
Methods OHIDL was administered to older adults who sought dental treatments. Participants were asked to assess changes in impact for each OHIDL item retrospectively compared with that before the treatment. The responsiveness, minimal clinically important difference (MCID), internal consistency and test–retest reliability of the OHIDL transition scale were evaluated. Multiple linear regression was employed to predict the change in oral health impacts after dental treatment. Beta coefficients (β) and 95% confidence intervals (CI) were reported. Results One hundred and seventy-six participants were followed-up with upon completing their dental treatments. The follow-up rate was 70.4% (176/250). The OHIDL transition score strongly correlated with the global rating of change (rs = 0.76, P < 0.01). MCID was determined by participants who reported “a little improved” in the perceived oral health impacts, and their mean transition score was 3.3. Cronbach’s alpha of the transition scale was 0.87, and many items had a test–retest correlation of at least 0.60. Patients who perceived more oral health impacts at baseline as measured by the total intensity score (β = 0.32, 95% CI: 0.20, 0.44, P < 0.001) and those who had received endodontic treatment (β = 8.04, 95% CI: 4.36, 11.71, P < 0.001) would have more improvement in perceived oral health impacts. Conclusions The OHIDL transition scale has good psychometric properties and is sensitive to change over time. After receiving dental treatment, most of the study’s older adults perceived a lower intensity of OHIDL. Clinical relevance The OHIDL transition scale is a valid and reliable instrument to measure the change in OHRQoL after dental treatments.
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Affiliation(s)
- Jian Liu
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - May Chun Mei Wong
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Edward Chin Man Lo
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Identification of clinically-useful cut scores of the Traumatic Injuries Distress Scale (TIDS) for predicting rate of recovery following musculoskeletal trauma. PLoS One 2021; 16:e0248745. [PMID: 33755664 PMCID: PMC7987158 DOI: 10.1371/journal.pone.0248745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/04/2021] [Indexed: 01/08/2023] Open
Abstract
Objective The Traumatic Injuries Distress Scale (TIDS) is a 12-item self-report tool intended for prognostic risk phenotyping in people with acute musculoskeletal (MSK) trauma. The initial validation study showed good associations with outcomes 12 weeks later in a cohort of 72 acutely injured patients from one region in Canada. This study aims to provide further clinical utility through identification of meaningful cut scores in a larger, mixed geography sample, and expands the prediction window from 12 to 52 weeks. Methods Data were drawn from databanks in London, Canada and Chicago, United States. Participants were recruited within 3 weeks of non-catastrophic MSK trauma and followed for 12 months. Using outcomes trajectories, the TIDS underwent linear regression-based analysis to predict 52-week outcomes, and area under the receiver operating characteristic curves to identify discriminative accuracy and meaningful cut scores. Results N = 224 participants with acute trauma were followed and both %Interference and Pain Severity were captured at intake and 3 follow-ups to establish curvilinear recovery trajectories. The TIDS explained significant variance in both the interference and severity outcomes after controlling for sex, region of injury, and baseline scores. ROC analysis revealed significant discriminative accuracy for predicting both the trajectories and the distal outcomes over 52 weeks. The TIDS was more accurate for identifying the low-risk than high-risk patients. Conclusion The TIDS is a useful tool for ‘ruling out’ high risk of poor outcome in a mixed sample of participants from two different countries. Impact statement The TIDS will be a useful tool for clinicians to predict the rate of recovery by displaying meaningful cut-scores for their patients after an acute musculoskeletal injury. This could lead to reduced burden of care for low risk patients and more informed treatment options for higher risk patients.
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Modarresi S, Walton DM. Reliability, discriminative accuracy, and an exploration of response shift as measured using the satisfaction and Recovery Index over 12 months from musculoskeletal trauma. Musculoskelet Sci Pract 2021; 51:102300. [PMID: 33220633 DOI: 10.1016/j.msksp.2020.102300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The Satisfaction and Recovery Index (SRI) is an importance-weighted health-related satisfaction tool intended to be a patient-centric means to capture both the process and state of recovery following musculoskeletal trauma. The purpose of this study was to explore measurement invariance, responsiveness, discriminative accuracy, and potential response shift identifiable within the SRI. METHODS Participants were 111 adults with acute musculoskeletal trauma. Data were collected at baseline, and again at 1, 2, 3, 6, and 12 months post-injury. Other tools used were the Brief Pain Inventory (BPI) and a Global Rating of Change scale. 1-month test-retest reliability (ICC2,1), responsiveness (standardized response mean in stable vs. changed participants), discriminative accuracy (area under the curve for differentiating between recovered and non-recovered), and response shift (change in mean importance scores over the 12-month period) were explored. All but the final analysis were compared against the BPI. RESULTS Test-retest reliability was excellent across all metrics (ICC2,1 = 0.83 to 0.88). Responsiveness was greatest for the weighted SRI (SRM = 0.36) with MDC95 of 13.7%. All tools showed significant ability to discriminate between participants nominating recovery vs. non-recovery (AUC≥0.69) though the BPI subscales were significantly better than the SRI. Importance ratings showed small but significant change over time in 7 of the 9 SRI items. CONCLUSION This study provides support for the SRI as a useful tool for evaluating recovery, though it seems more valuable for capturing the process rather than state of recovery. While response shift was small, there is enough reason to endorse retention of the importance ratings.
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Affiliation(s)
- Shirin Modarresi
- 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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Pinsker EB, Sale JEM, Gignac MAM, Daniels TR, Beaton DE. “I Don’t Have to Think About Watching the Ground”: A Qualitative Study Exploring the Concept of Vigilance as an Important Outcome for Ankle Reconstruction. Arthritis Care Res (Hoboken) 2020; 72:1367-1373. [DOI: 10.1002/acr.24039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Ellie B. Pinsker
- St. Michael’s Hospital and University of Toronto Toronto Ontario Canada
| | - Joanna E. M. Sale
- St. Michael’s Hospital and University of Toronto Toronto Ontario Canada
| | | | | | - Dorcas E. Beaton
- Institute of Work & Health and University of Toronto Toronto Ontario Canada
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Abstract
OBJECTIVE This research aimed to explore the quality-of-life and experiences of people with Achilles tendinopathy. DESIGN This mixed-methods research used the 8-dimension Assessment of Quality-of-Life (AQoL-8D), focus groups and grounded theory analysis. AQoL-8D scores were compared with population normative scores. In focus groups, participants discussed their experiences with Achilles tendinopathy. SETTING An online survey was completed, followed by focus groups and interviews held at the University of Canberra. PARTICIPANTS Adults with Achilles tendon pain were eligible to participate in the online survey, which was distributed through email and social media. RESULTS Complete survey responses were obtained from 92 individuals, and 11 individuals participated in focus groups and interviews. AQoL-8D scores were significantly lower in those with Achilles tendinopathy (79 ± 11 vs 81 ± 13). AQoL-8Ds of mental health, pain, senses, and the physical "super dimension" were also significantly lower. The difference exceeded the AQoL-8D minimum clinically important difference of 6% only for the pain dimension. Themes identified included adapting lifestyles, living with the condition, changes in mental and social well-being, conflict with identity, frustration, and individual experiences. CONCLUSIONS Achilles tendinopathy is associated with a lower quality-of-life score, but on average, the difference does not exceed the minimum clinically important difference. In focus groups, some individuals described profound impacts on their life. This discrepancy likely reflects the variability of the impact across individuals. For some people, the effect is minimal, yet for those who tie their identity and social activities to fitness and physical activity, the effect can be profound.
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Pires D, Cruz EB, Gomes LA, Nunes C. How Do Physical Therapists Measure Treatment Outcomes in Adults With Chronic Low Back Pain? A Systematic Review. Phys Ther 2020; 100:1020-1034. [PMID: 32115634 DOI: 10.1093/ptj/pzaa030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/03/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is an increasing recognition of the importance of using a conceptual framework covering the full range of relevant health domains and outcome measures addressed by physical therapy modalities in patients with chronic low back pain (CLBP). However, little is known about what outcome domains have been measured and through what measures in physical therapy research. OBJECTIVE The purpose of this review was to synthesize outcome domains, instruments, and cutoff values reported in published randomized controlled trials and their compliance with the original Patient-Reported Outcomes Measurement Information System (PROMIS) framework. DATA SOURCES Embase, MEDLINE, Cochrane Library, and Physiotherapy Evidence Database electronic databases were systematically searched from January 2008 to April 2019. STUDY SELECTION Randomized controlled trials that compared physical therapy with any other intervention for adults with CLBP were included. DATA EXTRACTION Study characteristics, outcome domains, instruments, and cutoff values were extracted by 2 reviewers. The PROMIS framework was used for domain categorization. DATA SYNTHESIS One hundred ninety-five studies were included, with 52 outcome domains and 45 cutoff values identified from 182 instruments reported. Only 14 of 195 studies assessed all PROMIS health core areas, whereas the PROMIS physical health core area was assessed in all included studies. Pain intensity and disability were the most frequently used domains. LIMITATIONS Only studies for which full texts were available in English were included. CONCLUSIONS This review identified a poor overlap between the PROMIS framework and outcome domains used to define the effectiveness of physical therapy in adults with CLBP. This finding suggests that other potential benefits resulting from physical therapy modalities are not being measured. Furthermore, a large diversity in the outcome domains and instruments was found.
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Affiliation(s)
- Diogo Pires
- Public Health Research Center, National School of Public Health, Nova University of Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal; and Comprehensive Health Research Centre, Nova University of Lisbon, Lisbon, Portugal
| | - Eduardo Brazete Cruz
- Department of Physical Therapy, School of Health Care, Polytechnic Institute of Setúbal, Setúbal, Portugal; and Comprehensive Health Research Centre, Nova University of Lisbon
| | - Luís A Gomes
- Department of Physical Therapy, School of Health Care, Polytechnic Institute of Setúbal
| | - Carla Nunes
- Public Health Research Center, National School of Public Health, Nova University of Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal; and Comprehensive Health Research Centre, Nova University of Lisbon, Lisbon, Portugal
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Pires DADF, Brazete Cruz EJC, Canhão HCDM, Nunes CDRD. The role of pain and disability changes after physiotherapy treatment on global perception of improvement in patients with chronic low back pain. Musculoskelet Sci Pract 2020; 47:102139. [PMID: 32148329 DOI: 10.1016/j.msksp.2020.102139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effectiveness of physiotherapy in patients with chronic low back pain is usually measured through changes in pain and disability domains. However, recent research has suggested that these two domains are not sufficient to capture all the physiotherapy benefits when patients' perspective is considered. OBJECTIVE The aim of this study was to investigate the role of pain and disability changes in explaining the global perception of improvement in patients with chronic low back pain undergoing physiotherapy. DESIGN Prospective cohort study. METHODS The study was conducted on183 patients who were referred to physiotherapy treatment due to low back pain lasting more than 12 weeks. Sociodemographic and clinical characteristics were measured at baseline, together with pain intensity and disability. Eight (post-intervention) and twelve weeks later, global perception of improvement was measured together with pain and disability. The Pearson correlation coefficient and linear regression models were used for analyses. RESULTS Of the 183 participants included, 144 completed the 12-weeks follow-up. Significant and moderate correlation was found between pain and disability changes and the global perception of improvement after intervention and at the 12-weeks follow-up. Pain and disability changes explained 20.7%-36.3% of the variance in the global perception of improvement. CONCLUSIONS Pain and disability changes are related and contributed to explaining a partial proportion of variance in the global perception of improvement. The findings suggest that these domains are not sufficient to explain and measure all of the benefits of physiotherapy when patients' global perception of improvement is considered.
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Affiliation(s)
- Diogo André da Fonseca Pires
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal.
| | - Eduardo José Carvalho Brazete Cruz
- Comprehensive Health Research Center (CHRC), Portugal; Department of Physical Therapy, School of Health Care, Polytechnic Institute of Setúbal, Portugal
| | - Helena Cristina de Matos Canhão
- Comprehensive Health Research Center (CHRC), Portugal; Cedoc, EpiDoC Unit, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal; Department of Rheumatology, CHULC-Hospital Curry Cabral, Lisbon, Portugal
| | - Carla do Rosário Delgado Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
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Maxwell LJ, Beaton DE. Controversy and Debate Series on Core Outcome Sets. Paper 2: Debate on Paper 1 from the perspective of OMERACT [Outcome Measures in Rheumatology]. J Clin Epidemiol 2020; 125:213-215. [PMID: 32413388 DOI: 10.1016/j.jclinepi.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Dorcas E Beaton
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute for Work and Health and Institute Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Rydman E, Ottosson C, Ponzer S, Dahl A, Eneqvist T, Järnbert-Pettersson H, Kasina P. Intervention with an educational video after a whiplash trauma - a randomised controlled clinical trial. Scand J Pain 2020; 20:273-281. [PMID: 31747385 DOI: 10.1515/sjpain-2019-0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Previous systematic reviews have considered that providing patient information is ineffective for patients with whiplash-associated disorders (WAD), with the exception of interventional educational videos. The aim of this randomised controlled clinical trial was to determine if use of an educational video as an intervention in the acute stage after a whiplash injury might improve self-reported recovery at 6 months after the injury. Methods In total, 289 consecutive patients with a whiplash injury following a motor vehicle collision were randomised to an intervention group (educational video) or to a control group (written information sheet). The video focused on information about pain mechanisms, deep flexor physiotherapy and reassurance. Emailed questionnaires were used to collect baseline data within 2 weeks after the accident and then to collect outcome data at 6 months post-injury. Non-responders were followed up with a brief telephone interview regarding the outcome. The primary outcome measure was self-reported recovery (yes/no) at 6 months post-injury. The secondary outcomes measures were pain level according to a numeric rating scale (NRS) and the whiplash disability questionnaire (WDQ) score at the same time point. Results The response rate for the baseline questionnaire was 70% (203/289). The follow-up rate was 97% (196/203). The non-recovery rates were similar between the intervention group, at 37.9% (39/103), and the control group, at 33.3% (31/93) (p = 0.55). No differences between the groups were noted in pain levels, NRS scores (1.9 vs. 2.2, p = 0.35) or the mean WDQ scores (17.5 vs. 21.2, p = 0.42). Conclusions The intervention with the educational video used in this study had no effect on the non-recovery rate when compared to a basic written information sheet. Implications The results of this trial add knowledge to the area of patient education for patients with acute WAD. Further studies are needed before the current recommendations for patient information are modified.
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Affiliation(s)
- Eric Rydman
- Department of Orthopedics, Södersjukhuset, SE-118 83 Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Carin Ottosson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anna Dahl
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Ted Eneqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Piotr Kasina
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Skillgate E, Pico-Espinosa OJ, Côté P, Jensen I, Viklund P, Bottai M, Holm LW. Effectiveness of deep tissue massage therapy, and supervised strengthening and stretching exercises for subacute or persistent disabling neck pain. The Stockholm Neck (STONE) randomized controlled trial. Musculoskelet Sci Pract 2020; 45:102070. [PMID: 31655314 DOI: 10.1016/j.msksp.2019.102070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the effectiveness of deep tissue massage, supervised strengthening and stretching exercises, and a combined therapy (exercise followed by massage) (index groups), with advice to stay active (control group). METHODS Randomized controlled trial of 619 adults with subacute or persistent neck pain allocated to massage (n = 145), exercise (n = 160), combined therapy (n = 169) or advice (n = 147). Primary outcomes were minimal clinically important improvements in neck pain intensity and pain-related disability based on adapted questions from the Chronic Pain Questionnaire. Secondary outcomes were perceived recovery and sickness absence. Outcomes were measured at seven, 12, 26 and 52 weeks. RESULTS We found improvement in pain intensity favouring massage and combined therapy compared to advice; at seven weeks (RR = 1.36; 95%CI:1.04-1.77) and 26 weeks (RR = 1.23; 95%CI:0.97-1.56); and seven (RR = 1.39; 95%CI:1.08-1.81) and 12 weeks (RR = 1.28; 95%CI:1.02-1.60) respectively, but not at later follow-ups. Exercise showed higher improvement of pain intensity at 26 weeks (RR = 1.31; 95%CI:1.04-1.65). Perceived recovery was higher in the index groups than in the advice group at all follow-ups. We found no consistent differences in pain related disability or sickness absence. CONCLUSIONS In this study, at 12-months follow-up, none of the index therapies were more effective than advice in terms of pain intensity in the long term or in terms of pain-related disability in the short or long term. However, the index therapies led to higher incidence of improvement in pain intensity in the short term, and higher incidence of favorable perceived recovery in the short and in the long term than advice. TRIAL REGISTRATION ISRCTN01453590. Registered 3 July 2014.
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Affiliation(s)
- Eva Skillgate
- Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Oscar Javier Pico-Espinosa
- Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Pierre Côté
- Faculty of Health Sciences and UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Canada
| | - Irene Jensen
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Viklund
- Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena W Holm
- Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Rydman E, Kasina P, Ponzer S, Järnbert-Pettersson H. Association between cervical degeneration and self-perceived nonrecovery after whiplash injury. Spine J 2019; 19:1986-1994. [PMID: 31394280 DOI: 10.1016/j.spinee.2019.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pre-existing radiological degenerative changes have not previously been considered a risk factor for nonrecovery from neck pain due to motor vehicle accidents (MVA). Results from previous studies are however often based on assessment of plain radiography or MRI and little consideration has been given to facet joints. Furthermore, previous studies have often lacked a validated scoring system for degenerative changes. PURPOSE To investigate the association between cervical degeneration on computed tomography (CT) and nonrecovery after whiplash trauma. STUDY DESIGN Longitudinal cohort study. PATIENT SAMPLE One hundred twenty-one patients attending the Emergency Department because of neck pain after MVA, 2015-2017, with a valid CT-scan of the cervical spine and completion of follow up after 6 months. OUTCOME MEASURES The primary outcome measure was self-perceived nonrecovery (yes/no) after 6 months. A secondary outcome measure was self-reported pain level (Numeric Rating Scale). METHODS Baseline data regarding demographics and health factors were gathered through a web-based questionnaire. Degeneration of facet joints and intervertebral discs was assessed on CT-scans according to a validated scoring system. Binary logistic regression was used to study the association between cervical degeneration and nonrecovery. RESULTS Moderate facet joint degeneration was associated with nonrecovery. In the group with moderate degree of facet joint degeneration, 69.6% reported nonrecovery compared with 23.6% among patients without any signs of degeneration (adjusted odds ratio 6.7 [95% confidence interval: 1.9-24.3]). There was no association between disc degeneration and nonrecovery. Combined facet joint degeneration and disc degeneration were associated with nonrecovery (adjusted odds ratio 6.2 [2.0-19.0]). CONCLUSIONS These results suggest that cervical degeneration, especially facet joint degeneration, is a risk factor for nonrecovery after whiplash trauma. We hypothesize that whiplash trauma can be a trigger for painful manifestation of previously asymptomatic facet joint degeneration.
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Affiliation(s)
- Eric Rydman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
| | - Piotr Kasina
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
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Ebert JR, Fearon AM, Smith A, Janes GC. Responsiveness of the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G), modified Harris hip and Oxford hip scores in patients undergoing hip abductor tendon repair. Musculoskelet Sci Pract 2019; 43:1-5. [PMID: 31129382 DOI: 10.1016/j.msksp.2019.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND A lack of consensus exists on which patient-reported outcome measures (PROMs) best evaluate change following hip abductor tendon (HAT) repair. OBJECTIVES To compare the responsiveness of the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G), Oxford Hip (OHS) and modified Harris Hip (mHHS) scores in patients undergoing HAT repair. STUDY DESIGN Prospective case series. METHODS 56 patients underwent HAT repair and were evaluated pre-surgery and 3, 6 and 12 months post-operatively using the VISA-G, OHS, mHHS and a Global Rating of Change (GRC) scale. Internal and external responsiveness, the minimal clinically important change (MIC) and the presence of ceiling effects were evaluated. The extent to which VISA-G change was associated with mHHS and OHS change was investigated, as was the extent to which PROM changes were discriminatory for GRC improvement. RESULTS All PROMs demonstrated large standardized effect sizes (>1), with the VISA-G demonstrating responsiveness similar to the mHHS and OHS. At 12 months, the GRC correlated similarly with VISA-G (0.42, 95% CI: 0.17-0.61), mHHS (0.44, 95% CI: 0.17-0.61) and OHS (0.53, 95% CI: 0.31-0.70) changes. Using a GRC anchor of ≥4, an MIC of 29/100, 29/91 (32/100) and 16/48 (33/100) was observed for the VISA-G, mHHS and OHS, respectively. At 12 months ceiling effects existed for the mHHS (18/56, 32.1%) and OHS (13/56, 23.2%), but not VISA-G (1/56, 1.8%). CONCLUSION The VISA-G demonstrated acceptable responsiveness and was more resistant to ceiling effects, though demonstrated similar change scores and correlations with perceived improvement to the mHHS and OHS. CLINICAL TRIAL REGISTRATION This research trial is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12616001655437).
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Perth, Western Australia, 6009, Australia; HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, Western Australia, 6009, Australia.
| | - Angela M Fearon
- UCRISE, Faculty of Health, University of Canberra, ACT, 2617, Australia
| | - Anne Smith
- The School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Bentley, Perth, Western Australia, 6102, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, Western Australia, 6005, Australia
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Chan ACM, Pang MYC, Ouyang H, Jehu DAM. Minimal Clinically Important Difference of Four Commonly Used Balance Assessment Tools in Individuals after Total Knee Arthroplasty: A Prospective Cohort Study. PM R 2019; 12:238-245. [DOI: 10.1002/pmrj.12226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/22/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Andy C. M. Chan
- Department of Rehabilitation SciencesHong Kong Polytechnic University Hong Kong China
- Physiotherapy DepartmentQueen Elizabeth Hospital Hong Kong China
| | - Marco Y. C. Pang
- Department of Rehabilitation SciencesHong Kong Polytechnic University Hong Kong China
| | - Huixi Ouyang
- Department of Rehabilitation SciencesHong Kong Polytechnic University Hong Kong China
- Physiotherapy DepartmentGuangdong Provincial Work Injury Rehabilitation Hospital Guangzhou China
| | - Deborah A. M. Jehu
- Department of Rehabilitation SciencesHong Kong Polytechnic University Hong Kong China
- Department of Physical Therapy, Faculty of MedicineUniversity of British Columbia Vancouver British Columbia Canada
- Center for Hip Health & MobilityVancouver Coastal Health Research Institute, University of British Columbia Vancouver British Columbia Canada
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Freitas P, Pires D, Nunes C, Cruz EB. Cross-cultural adaptation and psychometric properties of the European Portuguese version of the Global Perceived Effect Scale in patients with chronic low back pain. Disabil Rehabil 2019; 43:1008-1014. [PMID: 31382797 DOI: 10.1080/09638288.2019.1648568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To cross-culturally adapt the Global Perceived Effect Scale (GPES) into Portuguese and investigate its psychometric properties in patients with chronic low back pain. METHODS Cross-cultural adaptation was carried out according to published guidelines. Along with measures for pain and disability, GPES was administered at baseline, 48-h later and post-intervention. To estimate test-retest reliability, the intraclass correlation coefficient was used. The validity was examined through the correlation between the GPES and the Patient Global Improvement Change Scale and the contribution of baseline status to GPES scores. Responsiveness was assessed by analyzing hypotheses regarding areas under the curve and correlations with changes in other measures. RESULTS The test-retest reliability, the convergent validity and the contribution of the baseline status to GPES scores were demonstrated. The EPES correlated strongly with global perception of change (r = 0.677), and moderately with pain and disability changes (r = 0.457 and r = 0.452, respectively). Areas under the curve values of 0.71(95% CI = 0.607-0.825) and 0.83 (95% CI = 0.749-922) were found. CONCLUSION The GPES demonstrated adequate psychometric properties. This study's findings supported its use in clinical and research studies with patients with chronic low back pain.IMPLICATIONS FOR REHABILITATIONThe European Portuguese version of the Global Perceived Effect Scale demonstrated adequate reliability, validity and responsiveness. This instrument is suitable to evaluate meaningful changes in patients with chronic low back pain.The contribution of baseline status to GPES scores was confirmed by specific and recommended methods. The use of the GPES as external criterion of change in clinimetric studies was supported.The minimum important change was 2.5 points out of 11 of the GPES. Only improvements above this point should be considered as relevant to patients with chronic low back pain undergoing physiotherapy.
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Affiliation(s)
- Petra Freitas
- Departamento de Fisioterapia, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Diogo Pires
- Centro de Investigação em Saúde Pública - Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carla Nunes
- Centro de Investigação em Saúde Pública - Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Eduardo Brazete Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde - Instituto Politécnico de Setúbal, Setúbal, Portugal
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Hestbaek L, Myburgh C, Lauridsen HH, Boyle E, Kongsted A. Contrasting real time quantitative measures (weekly SMS) to patients' retrospective appraisal of their one-year's course of low back pain; a probing mixed-methods study. Chiropr Man Therap 2019; 27:12. [PMID: 30891183 PMCID: PMC6390359 DOI: 10.1186/s12998-018-0222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Due to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect. However, methods of frequent measuring still need development and validation. Therefore, this study aims to evaluate the agreement between continuous, quantitative self-assessment (weekly SMS) of the course of LBP over a one-year period and qualitatively derived retrospective patient self-appraisal of the same time-period. Methods Participants were 32 subjects with LBP from primary care. The quantitative measures consisted of weekly SMS questions for one-year about pain intensity, days with LBP, and activity limitations for that week. For each subject, the weekly responses were graphed and categorized into categories based on intensity, variation and overall change patterns. Qualitative measures were based on semi-structured telephone interviews one-year after a consultation for LBP, where two coders independently categorized the self-appraisal of LBP course into the same predefined categories as the SMS-based trajectories. Furthermore, patients' perceived overall recovery was related to variation patterns from SMS track. Results There was perfect agreement for 48% in the pain intensity domain, 53% in the variation domain and 63% in the change pattern domain. Most of the discordant cases were classified in neighboring categories with the majority relating to fluctuating patterns. The self-perceived overall recovery status seemed to be reflected quite well by the quantitative measures of pain intensity and days with pain in this study. Conclusion This study shows that a real time quantitative measure (weekly SMS) and the patient's retrospective appraisal do not fundamentally differ in their reflection of the one-year course of LBP.As a first investigation into this area, these results are promising, as longitudinal quantitatively derived trajectories of LBP seem to reflect the lived experience of the patient to a large degree. Furthermore, the patient's ability to retrospectively recall their one-year course of LBP appears to be quite good. Future studies should focus on refining the categories of trajectories.
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Affiliation(s)
- Lise Hestbaek
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,2Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Cornelius Myburgh
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,2Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
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Rushing CJ, Rathnayake VR, Oxios AJ, Galan GP, Ramil M, Spinner SM, Hardigan P. Patient-Perceived Recovery and Outcomes After Silastic Implant Arthroplasty. J Foot Ankle Surg 2019; 57:1080-1086. [PMID: 30172719 DOI: 10.1053/j.jfas.2018.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Indexed: 02/03/2023]
Abstract
In some chronic musculoskeletal conditions, patients with persistent pain and disability have still achieved recovery through behavioral adaptations (readjustment) or cognitive coping (redefinition). Although the pendulum shift from physician-reported clinical indicators to patient-reported outcomes measures (PROMs) has recently focused on quantifying residual pain and disability to determine recovery (resolution), whether patients are capable of coping with any ongoing deficits and achieving other forms of recovery has not been considered. We performed a retrospective case series to assess patient-perceived recovery and outcomes after silastic implant arthroplasty for hallux rigidus. From July 2006 to July 2016, 28 patients at a single institution were enrolled. PROMs were prospectively obtained and compared between patients considering themselves recovered without or with residual deficits (recovered-resolved, recovered-not resolved) and those not recovered. Holistic satisfaction, procedure-specific satisfaction, complications, reoperations, and failure rates were recorded. Overall, 50.0% perceived themselves as recovered-resolved, 43% as recovered-not resolved, and 7% as not recovered. The mean modified Foot Function Index was 17.26, the verbal analog scale for pain score was 2.03, and implant survivorship 100% at a median of 67 (interquartile range 28.4 to 103.5) months. Although only 50% of patients reported complete symptom resolution, satisfaction was high, and most perceived themselves as recovered, suggesting recovery in hallux rigidus might not always be predicated by the complete resolution of all symptomatology. Although PROMs relying on pain inference and functional disability will continue to be utilized with increasing frequency, foot and ankle surgeons should be cognizant of their inherent limitations in assessing other forms of recovery.
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Affiliation(s)
| | | | - Adam J Oxios
- Resident, Westside Regional Medical Center, Plantation, FL
| | | | - Madelin Ramil
- Research Director, Westside Regional Medical Center, Plantation, FL
| | - Steven M Spinner
- Residency Director, Westside Regional Medical Center, Plantation, FL
| | - Patrick Hardigan
- Director, Statistical Consulting Center, Nova Southeastern University, Fort Lauderdale, FL
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Côté P, Boyle E, Shearer HM, Stupar M, Jacobs C, Cassidy JD, Carette S, van der Velde G, Wong JJ, Hogg-Johnson S, Ammendolia C, Hayden JA, van Tulder M, Frank JW. Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial. BMJ Open 2019; 9:e021283. [PMID: 30679283 PMCID: PMC6347946 DOI: 10.1136/bmjopen-2017-021283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I-II. DESIGN Pragmatic randomised clinical trial with blinded outcome assessment. SETTING Multidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada. PARTICIPANTS 340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury. INTERVENTIONS Participants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury. RESULTS The median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ2=3.96; 2 df: p=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported. CONCLUSIONS Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life. TRIAL REGISTRATION NUMBER NCT00546806.
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Affiliation(s)
- Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Heather M Shearer
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Maja Stupar
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Craig Jacobs
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - John David Cassidy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Simon Carette
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, University Health Network, Toronto, Ontario, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jessica J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jill Alison Hayden
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - John W Frank
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Corbett DB, Rejeski WJ, Tudor-Locke C, Glynn NW, Kritchevsky SB, McDermott MM, Church TS, Fielding RA, Gill TM, King AC, Miller ME, Chen H, Pahor M, Manini TM. Social Participation Modifies the Effect of a Structured Physical Activity Program on Major Mobility Disability Among Older Adults: Results From the LIFE Study. J Gerontol B Psychol Sci Soc Sci 2018; 73:1501-1513. [PMID: 28482106 PMCID: PMC6178963 DOI: 10.1093/geronb/gbx051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/21/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate whether baseline social participation modifies the effect of a long-term structured physical activity (PA) program on major mobility disability (MMD). Methods 1,635 sedentary adults (70-89 years) with physical limitations were randomized to either a structured PA or health education (HE) intervention. Social participation was defined categorically at baseline. High social participation was defined as attending organized group functions at least once per week and visiting with noncohabitating friends and family ≥7 hr per week. Anything less was considered limited social participation. Participants performed a standardized walking test at baseline and every 6 months for up to 42 months. MMD was defined as the loss in the ability to walk 400 m. Results There was a significant intervention by social participation interaction (p = .003). Among individuals with high levels of social participation, those randomized to PA had significantly lower incidence of MMD (hazard ratio [HR], 0.43 [95% confidence interval (CI), 0.27-0.68]; p < .01) than those randomized to HE. Individuals with limited social participation showed no mobility benefit of the PA intervention when compared with their HE counterparts (HR, 0.92 [95% CI, 0.77-1.11]; p = .40). Discussion Our findings suggest that baseline social participation is an important factor for the success of a PA intervention aimed at delaying mobility disability.
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Affiliation(s)
- Duane B Corbett
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | | | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Mary M McDermott
- Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Tufts University, Boston, Massachusetts
| | - Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Abby C King
- Department of Health Research & Policy and Medicine, School of Medicine, Stanford University, California
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Haiying Chen
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Marco Pahor
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville
| | - Todd M Manini
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville
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Söderlund A, Nordgren L, Sterling M, Stålnacke BM. Exploring patients' experiences of the whiplash injury-recovery process - a meta-synthesis. J Pain Res 2018; 11:1263-1271. [PMID: 29988716 PMCID: PMC6029586 DOI: 10.2147/jpr.s158807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The aim of this study was to conduct a meta-synthesis to analyze qualitative research findings and thereby understand patients’ experiences of whiplash-associated disorders (WAD) and the injury-recovery process. Materials and methods A qualitative meta-synthesis, which is an interpretive integration of existing qualitative findings, was performed. The databases PubMed, PsychINFO, Scopus, and Web of Science were searched. The Critical Assessment Skills Programme was used to assess the quality of the included studies. Results Four studies were included. The synthesis resulted in several codes, 6 categories, and 3 themes (distancing from normalcy, self-efficacy in controlling the life situation after the injury, and readjustment and acceptance) that described the participants’ pain beliefs, their WAD-related life situation and their future expectations and acceptance. Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity. Focusing on increasing knowledge and understanding the pain and its consequences were believed to lead to better strategies for handling the situation. Furthermore, recapturing life roles, including returning to work, was challenging, but an optimistic outlook reinforced symptom improvements and contributed to feelings of happiness. Conclusion The results of the present study provide a comprehensive understanding of patients’ complex, multifaceted experiences of WAD, and the injury-recovery process. The findings can guide us in the development of new ways to evaluate and manage WAD. The results also indicate that a more patient-centered approach is needed to determine the depth and breadth of each patient’s problems.
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Affiliation(s)
- Anne Söderlund
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden,
| | - Lena Nordgren
- Center for Clinical Research Sörmland (CKFD), Uppsala University, Eskilstuna, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland, Herston, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Sweden.,Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
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Wu FL, Shih YF, Lee SH, Luo HJ, Wang WTJ. Development of a clinical prediction rule to identify patients with plantar heel pain likely to benefit from biomechanical anti-pronation taping: A prospective cohort study. Phys Ther Sport 2018; 31:58-67. [PMID: 29655069 DOI: 10.1016/j.ptsp.2018.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To develop a clinical prediction rule (CPR) to identify patients with plantar heel pain (PHP) likely to benefit from biomechanical anti-pronation taping (BAPT). DESIGN A prospective cohort study. SETTING An outpatient rehabilitation department in a general hospital. PARTICIPANTS Seventy-five patients with PHP. MAIN OUTCOME MEASURES After completing a series of physical examinations, all patients received BAPT and were evaluated with a numeric rating scale for pain intensity, the patient-specific functional scale and foot function index (FFI) for function, and the global rating of change for perceived improvement. RESULTS Twenty-eight patients achieved a successful outcome. A CPR with 6 significant variables was identified by a multivariate logistic regression: FFI score less than 33.3, hip adduction angle of the most affected side was greater than the contralateral side, ankle plantarflexors and hip abductors on the most affected side were not weaker than those on the contralateral side, ankle invertors on the most affected side were weaker than the contralateral side, and having more than 2 painful sites in the low back and lower extremity regions. If 5 or more of the 6 predictors were presented, the probability of success increased from 37% to 80%. CONCLUSIONS A CPR has been developed to identify patients with PHP likely to benefit from BAPT.
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Affiliation(s)
- Fu-Lien Wu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Si-Huei Lee
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hong-Ji Luo
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Wendy Tzyy-Jiuan Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
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Llewellyn A, McCabe C, Hibberd Y, White P, Davies L, Marinus J, Perez R, Thomassen I, Brunner F, Sontheim C, Birklein F, Schlereth T, Goebel A, Haigh R, Connett R, Maihöfner C, Knudsen L, Harden R, Zyluk A, Shulman D, Small H, Gobeil F, Moskovitz P. Are you better? A multi-centre study of patient-defined recovery from Complex Regional Pain Syndrome. Eur J Pain 2017; 22:551-564. [PMID: 29194871 DOI: 10.1002/ejp.1138] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- A. Llewellyn
- Royal United Hospitals; Bath UK
- University of the West of England; Bristol UK
| | - C.S. McCabe
- Royal United Hospitals; Bath UK
- University of the West of England; Bristol UK
| | | | - P. White
- University of the West of England; Bristol UK
| | | | - J. Marinus
- Leiden University Medical Centre; Leiden The Netherlands
| | | | - I. Thomassen
- Dutch National CRPS Patient Organization; Nijmegen The Netherlands
| | - F. Brunner
- Balgrist University Hospital; Zurich Switzerland
| | - C. Sontheim
- Balgrist University Hospital; Zurich Switzerland
| | - F. Birklein
- University Medical Centre Mainz; Mainz Germany
| | - T. Schlereth
- University Medical Centre Mainz; Mainz Germany
- DKD HELIOS Klinik; Wiesbaden Germany
| | - A. Goebel
- Walton Centre NHS Foundation Trust and Pain Research Institute; University of Liverpool; Liverpool UK
| | - R. Haigh
- Royal Devon & Exeter Hospital; Exeter UK
| | - R. Connett
- Royal Devon & Exeter Hospital; Exeter UK
| | - C. Maihöfner
- Department of Neurology; General Hospital Fürth; Fürth Germany
| | - L. Knudsen
- The Spinal Cord Injury Centre of Western Denmark; Viborg Regional Hospital; Viborg Denmark
- Danish Pain Research Centre; Aarhus University Hospital; Aarhus Denmark
| | - R.N. Harden
- Rehabilitation Institute of Chicago; Chicago IL USA
| | - A. Zyluk
- Pomeranian Medical University; Szczecin Poland
| | - D. Shulman
- Markham-Stouffville Hospital; Markham ON Canada
| | - H. Small
- PARC (Promoting Awareness of RSD and CRPS in Canada); St. Catharines Canada
| | - F. Gobeil
- CSSS Pierre Boucher; Longueuil QC Canada
| | - P. Moskovitz
- The George Washington University Hospital; Washington DC USA
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Brown B, Huszar K, Chapman R. 'Betwixt and between'; liminality in recovery stories from people with myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS). SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:696-710. [PMID: 28239872 DOI: 10.1111/1467-9566.12546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper explores experiences of 16 people claiming to have recovered from Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) using the concept of liminality. Liminality describes the status of those falling between socially recognised and medically sanctioned categories, and illuminates both the experience of illness and the process of recovery from ME/CFS. The liminality experienced during illness was akin to that described by Turner with a degree of communitas among sufferers. As recovery progressed, participants stressed the percentage to which they had improved, and compared themselves with peers and themselves prior to the illness. Recovery did not mean transition into a post-liminal phase, but involved a new liminality, characterised by straddling boundaries between illness and wellness. Participants continued strategies such as rest, pacing and meditation. This second liminal state included difficulty in communicating the experience convincingly, and estrangement from the ME/CFS community. Thus, recoverees moved from the liminality of illness to a second, and less legible state of sustained liminality in recovery, described as having one foot in the ill world, one foot in the well world. This suggests that more needs to be understood about the recovery experience to assist those making the transition toward wellness.
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Affiliation(s)
- Brian Brown
- School of Applied Social Sciences, De Montfort University, UK
| | - Kate Huszar
- School of Applied Social Sciences, De Montfort University, UK
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The impact of psychological factors on recovery from injury: a multicentre cohort study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:855-866. [PMID: 27803978 PMCID: PMC5504249 DOI: 10.1007/s00127-016-1299-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/16/2016] [Indexed: 12/03/2022]
Abstract
PURPOSE Unintentional injuries have a significant long-term health impact in working age adults. Depression, anxiety and post-traumatic stress disorder are common post-injury, but their impact on self-reported recovery has not been investigated in general injury populations. This study investigated the role of psychological predictors 1 month post-injury in subsequent self-reported recovery from injury in working-aged adults. METHODS A multicentre cohort study was conducted of 668 unintentionally injured adults admitted to five UK hospitals followed up at 1, 2, 4 and 12 months post-injury. Logistic regression explored relationships between psychological morbidity 1 month post-injury and self-reported recovery 12 months post-injury, adjusting for health, demographic, injury and socio-legal factors. Multiple imputations were used to impute missing values. RESULTS A total of 668 adults participated at baseline, 77% followed up at 1 month and 63% at 12 months, of whom 383 (57%) were included in the main analysis. Multiple imputation analysis included all 668 participants. Increasing levels of depression scores and increasing levels of pain at 1 month and an increasing number of nights in hospital were associated with significantly reduced odds of recovery at 12 months, adjusting for age, sex, centre, employment and deprivation. The findings were similar in the multiple imputation analysis, except that pain had borderline statistical significance. CONCLUSIONS Depression 1 month post-injury is an important predictor of recovery, but other factors, especially pain and nights spent in hospital, also predict recovery. Identifying and managing depression and providing adequate pain control are essential in clinical care post-injury.
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Pinsker E, Inrig T, Daniels TR, Warmington K, Beaton DE. Symptom Resolution and Patient-Perceived Recovery Following Ankle Arthroplasty and Arthrodesis. Foot Ankle Int 2016; 37:1269-1276. [PMID: 27521356 DOI: 10.1177/1071100716660820] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients' perception of outcomes is not always defined by the absence of limitations/symptoms (resolution), but can also be characterized by behavioral adaptation and cognitive coping arising in cases with residual deficits. Patient-reported outcome measures (PROs) are designed to measure levels of function or symptoms, largely missing whether patients are coping with ongoing limitations. This study aimed to broaden the conventional definition of a "satisfactory" outcome following ankle reconstruction by comparing patient-reported outcomes of patients with and without residual symptoms and limitations. METHODS The study consisted of a cross-sectional survey of ankle arthroplasty (n = 85) and arthrodesis (n = 15) patients. Outcome measures included the Ankle Osteoarthritis Scale, Short Musculoskeletal Function Assessment, Short Form-12, and EuroQol-5 Dimension. Patients also completed measures of pain (0-10), stiffness (0-10), satisfaction (0-3), and ability to complete activities of daily living (ADL) (0-6). Based on a self-reported question regarding recovery and coping, patients were categorized as "Recovered-Resolved" (better with no symptoms or residual effects), "Recovered, not Resolved" (RNR, better with residual effects), or "Not Recovered" (not better). Recovery groups were compared across measures. RESULTS Only 15% of patients were categorized Recovered-Resolved. Most were RNR (69%), leaving 14% Not Resolved. Recovered-Resolved experienced lower rates of pain (1.4 ± 2.3), stiffness (1.1 ± 2.6), and difficulty performing ADLs (0.9 ± 1.2). Overall, outcome measure scores were high (ie, better health) for Recovered-Resolved patients, midrange for RNR patients, and low for Not Recovered patients, thus confirming predefined hypotheses. Recovered-Resolved and RNR patients had similarly high satisfaction summary scores (3.0 ± 0.0 vs 2.6 ± 0.6). CONCLUSION Most patients reported positive outcomes, but few (15%) experienced resolution of all symptoms and limitations. Current PROs focus on achieving low levels of symptoms and limitations, but miss an important achievement when patients are brought to a level of residual deficits with which they can cope. Patients' perceptions of satisfactory outcomes were not predicated on the resolution of all limitations; thus, the conventional definition of "satisfactory" outcomes should be expanded accordingly. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Ellie Pinsker
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada .,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Taucha Inrig
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kelly Warmington
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Dorcas E Beaton
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.,Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada.,Institute for Work & Health, Toronto, Ontario, Canada
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Laporte S, Wang D, Lecompte J, Blancho S, Sandoz B, Feydy A, Lindberg P, Adrian J, Chiarovano E, de Waele C, Vidal PP. An Attempt of Early Detection of Poor Outcome after Whiplash. Front Neurol 2016; 7:177. [PMID: 27812348 PMCID: PMC5072109 DOI: 10.3389/fneur.2016.00177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/03/2016] [Indexed: 12/17/2022] Open
Abstract
The main concern with whiplash is that a large proportion of whiplash patients experience disabling symptoms or whiplash-associated disorders (WAD) for months if not years following the accident. Therefore, identifying early prognostic factors of WAD development is important as WAD have widespread clinical and economic consequences. In order to tackle that question, our study was specifically aimed at combining several methods of investigation in the same WAD patients at the acute stage and 6 months later. Our longitudinal, open, prospective, multi-center study included 38 whiplash patients, and 13 healthy volunteers matched for age, gender, and socio-economic status with the whiplash group. Whiplash patients were evaluated 15-21 days after road accident, and 6 months later. At each appointment, patients underwent a neuropsychological evaluation, a full clinical neurological examination, neurophysiological and postural tests, oto-neurological tests, cervical spine cord magnetic resonance imaging (MRI) with tractography (DTI). At 6 months, whiplash patients were categorized into two subgroups based on the results of the Diagnostic and Statistical Manual of Mental Disorders as having either favorable or unfavorable progression [an unfavorable classification corresponding to the presence of post-concussion symptom (PCS)] and we searched retrospectively for early prognostic factors of WAD predicting the passage to chronicity. We found that patients displaying high level of catastrophizing at the acute stage and/or post-traumatic stress disorder associated with either abnormalities in head or trunk kinematics, abnormal test of the otolithic function and at the Equitest or a combination of these syndromes, turned to chronicity. This study suggests that low-grade whiplash patients should be submitted as early as possible after the trauma to neuropsychological and motor control tests in a specialized consultation. In addition, they should be evaluated by a neuro-otologist for a detailed examination of vestibular functions, which should include cervical vestibular evoked myogenic potential. Then, if diagnosed at risk of WAD, these patients should be subjected to an intensive preventive rehabilitation program, including vestibular rehabilitation if required.
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Affiliation(s)
- Sebastien Laporte
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech , Paris , France
| | - Danping Wang
- Plateforme d'étude de la Sensorimotricité, Université Paris Descartes , Paris , France
| | - Jennyfer Lecompte
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech , Paris , France
| | - Sophie Blancho
- Institut pour la Recherche sur la Moelle épinière et l'Encéphale (IRME) , Paris , France
| | - Baptiste Sandoz
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech , Paris , France
| | - Antoine Feydy
- FR 3636, Université Paris Descartes, INSERM U894, Paris, France; Service de Radiologie B, APHP, CHU Cochin, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Pavel Lindberg
- FR 3636, Université Paris Descartes, INSERM U894 , Paris , France
| | | | - Elodie Chiarovano
- COGNition and ACtion Group (COGNAC-G), Université Paris Descartes - CNRS UMR-MD - SSA , Paris , France
| | - Catherine de Waele
- COGNition and ACtion Group (COGNAC-G), Université Paris Descartes - CNRS UMR-MD - SSA , Paris , France
| | - Pierre-Paul Vidal
- COGNition and ACtion Group (COGNAC-G), Université Paris Descartes - CNRS UMR-MD - SSA , Paris , France
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Prognostic Markers for Poor Recovery After Mild Traumatic Brain Injury in Older Adults: A Pilot Cohort Study. J Head Trauma Rehabil 2016; 31:E33-E43. [DOI: 10.1097/htr.0000000000000226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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How Well Do You Expect to Recover, and What Does Recovery Mean, Anyway? Qualitative Study of Expectations After a Musculoskeletal Injury. Phys Ther 2016; 96:797-807. [PMID: 26586855 DOI: 10.2522/ptj.20150229] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Expecting to recover from a musculoskeletal injury is associated with actual recovery. Expectations are potentially modifiable, although it is not well understood how injured people formulate expectations. A better understanding of how expectations are formulated may lead to better knowledge about how interventions might be implemented, what to intervene on, and when to intervene. OBJECTIVES The objective of this study was to explore what "recovery" meant to participants, whether they expected to "recover," and how they formed these expectations. METHODS This qualitative study used interpretive phenomenological analysis. Eighteen semistructured interviews were conducted with people seeking treatment for recent musculoskeletal injuries. RESULTS Recovery was conceptualized as either (1) complete cessation of symptoms or pain-free return to function or (2) return to function despite residual symptoms. Expectations were driven by desire for a clear diagnosis, belief (or disbelief) in the clinician's prognosis, prior experiences, other people's experiences and attitudes, information from other sources such as the Internet, and a sense of self as resilient. CONCLUSIONS Expectations appear to be embedded in both hopes and fears, suggesting that clinicians should address both when negotiating realistic goals and educating patients. This approach is particularly relevant for cases of nonspecific musculoskeletal pain, where diagnoses are unclear and treatment may not completely alleviate pain.
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Boyle E, Cassidy JD, Côté P, Carroll LJ. The relationship between insurance claim closure and recovery after traffic injuries for individuals with whiplash associated disorders. Disabil Rehabil 2016; 39:889-896. [DOI: 10.3109/09638288.2016.1170211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J. David Cassidy
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Pierre Côté
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Canada
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Canada
| | - Linda J. Carroll
- School of Public Health and Injury Prevention Centre, University of Alberta, Edmonton, Canada
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The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases. Spine (Phila Pa 1976) 2016; 41:224-33. [PMID: 26571174 PMCID: PMC4718181 DOI: 10.1097/brs.0000000000001202] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of a prospective, multicenter database. OBJECTIVE The aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values. SUMMARY OF BACKGROUND DATA Recent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD. METHODS Consecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID). RESULTS Between 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD = 40.9; US = 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05). CONCLUSIONS SASD is a heterogeneous condition that, depending upon the type and severity of the deformity, can have a debilitating impact on health often exceeding the disability of more recognized chronic diseases. Health care providers must be aware of the types of SASD that correlate with disability to facilitate appropriate diagnosis, treatment, and research efforts. LEVEL OF EVIDENCE 3.
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Stupar M, Côté P, Beaton DE, Boyle E, Cassidy JD. A Test-Retest Reliability Study of the Whiplash Disability Questionnaire in Patients With Acute Whiplash-Associated Disorders. J Manipulative Physiol Ther 2015; 38:629-636. [DOI: 10.1016/j.jmpt.2015.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/23/2015] [Accepted: 08/27/2015] [Indexed: 12/26/2022]
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Robinson J, Gott M, Gardiner C, Ingleton C. A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs. Palliat Med 2015; 29:703-10. [PMID: 25769983 DOI: 10.1177/0269216315575841] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The acute hospital plays a significant role in caring for people with a life-limiting illness. Most research to date has focused exclusively upon the negative aspects of hospitalisation. Currently, there is little known about the benefits of hospital admissions for patients with palliative care needs. AIM The aim of this study was to explore the benefits of hospital admissions, from the perspectives of patients with palliative care needs. DESIGN A qualitative study design was adopted. Longitudinal, semi-structured, face-to-face interviews were used to elicit the views of patients admitted to hospital in one large urban acute hospital in New Zealand. SETTING/PARTICIPANTS The study sample comprised 14 patients admitted to Auckland City Hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need. RESULTS Through a process of thematic analysis, four themes were identified from the data: being cared for and feeling safe, receiving care to manage at home, relief for family and 'feeling better and/or getting better'. The benefits of being in hospital were reported to extend beyond treatments received. Most participants reported their preference was to come to hospital even if they had been able to access the care they received in hospital at home. CONCLUSION This research contributes to a greater understanding of the benefits associated with hospitalisation for patients with palliative care needs. The findings suggest that such benefits extend beyond the treatment patients receive and challenge current assumptions regarding the role of the acute hospital in palliative care.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand Auckland City Hospital, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Clare Gardiner
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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See KS, Treleaven J. Identifying upper limb disability in patients with persistent whiplash. ACTA ACUST UNITED AC 2014; 20:487-93. [PMID: 25554214 DOI: 10.1016/j.math.2014.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/26/2014] [Accepted: 12/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with persistent whiplash associated disorders (WAD) report upper limb (UL) symptoms and functional difficulties but there is limited information regarding the nature of these complaints. Impairments in motor performance may relate to functional deficits. OBJECTIVE To identify symptoms and the degree and nature of UL functional difficulties. DESIGN Cross sectional study. METHODS Twenty-four age matched subjects with persistent WAD and healthy controls were surveyed using the Disabilities of the Arm, Shoulder and Hand (DASH), Neck Disability Index (NDI) and Patient Specific Functional Scale (PSFS). A series of case studies on six subjects with persistent WAD and thirteen age and gender matched controls also had their motor performance assessed using a specialised UL testing battery, including reaction time, movement speed, accuracy, co-ordination and tapping speed. RESULTS The results suggest that UL symptoms and functional deficits are prevalent in persistent WAD. All individual item scores on the DASH, except one, were significantly higher in the WAD group and the DASH moderately correlated to pain, NDI and PSFS. Four-choice reaction time was the only motor performance measure that was significantly impaired in the WAD compared to control group and this correlated to pain levels. CONCLUSIONS The findings suggest the DASH is a suitable measure for subjects with persistent WAD and could be administered when high NDI scores are present or the patient specifically reports difficulty with UL activities. Further investigation regarding UL motor performance in subjects with persistent WAD is warranted to determine relationships between symptoms and reported functional deficits.
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Affiliation(s)
- Kirsten Sue See
- CCRE Spine, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia
| | - Julia Treleaven
- CCRE Spine, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia.
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Jacobson GP, Piker EG, Watford KE, Gruenwald J, Wanna GB, Rivas A. Concordance and discordance in patient and provider perceptions of dizziness. Am J Otolaryngol 2014; 35:779-83. [PMID: 25123779 DOI: 10.1016/j.amjoto.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the present investigation was to determine whether there are significant differences in patient/healthcare provider perceptions of patient's dizziness severity, dizziness disability/handicap, anxiety, and signs of autonomic system activation. MATERIALS AND METHODS This was a prospective investigation of 30 patient-provider dyads drawn as a sample of convenience from an otology clinic in a large, tertiary care, medical center. Patients completed both the Dizziness Handicap Inventory (DHI) and the Vestibular Symptom Scale (VSS) prior to vestibular function testing. Providers were instructed to complete the same measures following the patient's clinic visit from what they estimated was the patient's point of view. The two measures were analyzed for concordance and discordance. RESULTS Patient/provider differences in DHI and VSS vertigo subscale scores were not significantly different. However, difference scores on the VSS anxiety/autonomic subscale indicated that providers significantly under-estimated patient anxiety and symptoms of autonomic system activation. CONCLUSIONS The results suggest that providers may be missing information pertinent to the role anxiety and autonomic system activation may play in patient visits for complaints of dizziness. We suggest that this problem can be mitigated by administrating to patients prior to their clinic visit a standardized measure that quantifies patient self-report dizziness, vertigo, anxiety and autonomic system arousal. Patterns of response by patients on these measures can enable providers to diagnose correctly dizziness disorders that are rooted in clinically significant anxiety either related to, or unrelated to, a history of vestibular system impairment.
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Abstract
BACKGROUND The Functional Gait Assessment (FGA) is commonly used to measure walking balance. The minimal clinically important difference (MCID) has yet to be determined for the FGA. OBJECTIVE The purposes of this study were to determine: (1) the MCID in the FGA for older community-dwelling adults relative to patients' and physical therapists' estimates of change and (2) the extent of agreement between patients' and physical therapists' estimates of change. DESIGN This study was a prospective case series. METHODS Patients and physical therapists rated the amount of change in balance while walking after an episode of physical therapy for balance retraining on a 15-point global rating of change (GROC) scale. Weighted kappa statistics were calculated to express agreement between patients' and physical therapists' GROC ratings. Functional Gait Assessment change scores were plotted on receiver operating characteristic curves. A cutoff of +3 on the GROC was the criterion used for important change. The optimal FGA change cutoff score for MCID was determined, and sensitivity (SN), specificity (SP), and likelihood ratios (LRs) were calculated. RESULTS One hundred thirty-five community-dwelling older adults (average age=78.8 years) and 14 physical therapists participated. There was poor agreement between the patients' and therapists' ratings of change (weighted kappa=.163). The estimated MCID value for the FGA using physical therapists' ratings of change as an anchor was 4 points (SN=0.66, SP=0.84, LR+=4.07, LR-=0.40). No accurate value for the FGA MCID could be determined based on the patients' ratings of change. LIMITATIONS The small sample size was a limitation. CONCLUSION Poor agreement between therapists' and patients' ratings indicate the need for further communication relative to patient goals. The 4-point MCID value for the FGA can be used for goal setting, tracking patient progress, and program evaluation.
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Hoffmann TC, Thomas ST, Shin PNH, Glasziou PP. Cross-sectional analysis of the reporting of continuous outcome measures and clinical significance of results in randomized trials of non-pharmacological interventions. Trials 2014; 15:362. [PMID: 25230673 PMCID: PMC4177425 DOI: 10.1186/1745-6215-15-362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/02/2014] [Indexed: 01/27/2023] Open
Abstract
Background Reporting the scoring details of continuous outcome measures in randomized trials allows readers to interpret the size of any effect of the intervention. This study aimed to determine, in a sample of randomized trials: 1) the completeness of reporting of scoring details for continuous outcome measures, and 2) whether trial authors comment on the clinical significance of statistically significant trial results. Methods A descriptive analysis of randomized trials of non-pharmacological interventions published during 2009 in the six leading general medical journals (n = 138), and which used at least one continuous outcome measure (n = 85). From each trial report, two authors independently extracted the following information about each continuous outcome measure: the reporting of its scoring details, presentation of its results, and the reporting and justification of the clinical significance of the results. Results Across the 84 trials, we identified 336 continuous outcome measures. A total of 146 (44%) were published measures, 12 (4%) were adapted from published measures, 5 (1%) were developed for the trial, and 173 (51%) were ‘conventional measures’ for which scoring details are not necessary (such as weight). For 57 (35%) of the 163 non-conventional outcome measures no scoring details or reference to the outcome measure were provided in the trial report. Of the 159 outcome measures with a statistically significant result, clinical significance was not mentioned for 81 (51%) and was reported without any elaboration or justification for 39 (25%) of them. Conclusions Scoring details of continuous outcome measures used in this sample of randomized trials of non-pharmacological interventions were incompletely reported, which hampers interpretation of a trial’s results. Complete reporting of scoring details is important when considering the clinical significance of the results. When deciding about an intervention, having this information may help clinicians in their conversations with patients about the possible benefits and harms, and their size, of the intervention. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-362) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, University Drive, Robina, Gold Coast, Australia.
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Trask C, Bath B, McCrosky J, Lawson J. A profile of farmers and other employed Canadians with chronic back pain: a population-based analysis of the 2009-2010 Canadian community health surveys. J Rural Health 2014; 30:300-10. [PMID: 24483214 DOI: 10.1111/jrh.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Chronic back disorders (CBDs) are a serious public health issue, both in the general population and among farmers. However, it is not clear whether all individuals with CBD should be treated the same, or if some subpopulations have special needs. This study's purpose was to determine the demographic, socioeconomic, co-morbidity, and other health characteristics of Canadian farmers and nonfarmers with self-reported CBD. METHODS We performed a secondary analysis of the 2009-2010 Canadian Community Health Survey to develop a profile of adults with CBD comparing farmers (N = 350) to nonfarmer employed persons (N = 11,251). In addition to descriptive analysis, multiple logistic regression was used to control for possible confounding. FINDINGS Our results indicate that farmers with CBD are significantly more likely to be older, less educated, and more often male and living rurally than nonfarmers with CBD. We found no difference between rates and type of co-morbidities between farmers and nonfarmers. However, the sociodemographic differences between farmers and nonfarmers with CBD may impact the design of effective interventions and have implications for health services planning and health care delivery. The information presented is anticipated to help address the identified need for musculoskeletal disorder prevention in agriculture.
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Affiliation(s)
- Catherine Trask
- Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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"I know it's changed": a mixed-methods study of the meaning of Global Perceived Effect in chronic neck pain patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:888-97. [PMID: 24408636 DOI: 10.1007/s00586-013-3149-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 12/15/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Global Perceived Effect (GPE) is a commonly used outcome measure for musculoskeletal conditions like neck pain; however, little is known regarding the factors patients take into account when determining their GPE. The overall objective of this work was to describe the thematic variables, which comprise the GPE from the patient's perspective. METHODS This was a mixed-methods study in which qualitative data were collected within a randomized clinical trial assessing exercise and manual therapy for chronic neck pain. A consecutive sample of 106 patients who completed the trial intervention took part in semi-structured interviews querying the meaning of GPE. Quantitative measures were collected through self-report questionnaires. Interview transcripts were analyzed using content analysis to identify themes, which were then quantified to assess potential relationships. RESULTS A model of GPE for chronic neck pain emerged comprised of five main themes: neck symptoms (cited by 85%), biomechanical performance (38%), activities of daily living (31%), self-efficacy (10%), and need for other treatment (6%). Influencing factors included those contributing to GPE: treatment process (64%), biomechanical performance (51%), self-efficacy (16%), and the nature of the condition (8%). Factors, which detracted from GPE or prevented recovery included perceived nature of condition (58%), required daily activities (10%), lack of diagnosis (5%), and history of failed treatment (5%). CONCLUSIONS GPE appears to capture chronic neck pain patient perceptions of change in different domains important to their individual pain experiences that may not be captured by other outcome instruments. Thus, GPE is a suitable patient-oriented outcome that can complement other measures in research and clinical practice. Importantly, many chronic neck pain patients believe it impossible to reach complete recovery because of a perceived intractable aspect of their neck condition; this has important implications regarding long-term disability and health-seeking behaviors.
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