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Alaca N, Arslan DÇ, Sırlan S, Yarar HA, Başcı O. Tactile acuity, left/right judgment performance, motor imagery ability, and pressure-pain threshold in patients with chronic rotator cuff-related shoulder pain: a cross-sectional case-control study. Musculoskelet Sci Pract 2025; 76:103278. [PMID: 39929090 DOI: 10.1016/j.msksp.2025.103278] [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: 08/14/2024] [Revised: 12/17/2024] [Accepted: 02/04/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND Chronic pain can alter cortical pain representation, and tests like Two-Point Discrimination Test (TPDT), Left/Right Judgment Task (LRJT), motor imagery, and Pressure-Pain Threshold (PPT) can assess these changes. However, their applicability to all pain mechanisms is uncertain. OBJECTIVE To compare the TPDT, LRJT, motor imagery ability, and PPT of chronic rotator cuff-related shoulder pain (C-RCRSP) patients with asymptomatic and pain-free controls. METHODS Forty-eight C-RCRSP patients and 45 pain-free controls were assessed using a caliper for TPDT and the Recognize® application for LRJT. Motor ability, PPT, physical function, fear avoidance, pain catastrophizing, and Central Sensitization Inventory (CSI) were also evaluated. As part of the subgroup analysis, C-RCRSP patients were divided into two groups based on their CSI (≥40, n = 19; <40, n = 29). RESULTS C-RCRSP patients demonstrated higher TPDT thresholds [acromion (F = 5.41, p = 0.001) and deltoid (F = 26.67, p < 0.001)] but no significant differences in LRJT performance [recognition accuracy (F = 2.47, p = 0.063) and response time (F = 0.98, p = 0.414)] than pain-free controls in both shoulder joints. C-RCRSP patients had poorer motor imagery abilities (p < 0.001). The deltoid region PPT differed significantly between the groups (F = 17.45, p < 0.001), but it was not significant for the tibialis anterior region (F = 1.16, p = 0.33). C-RCRSP patients with a CSI≥40 reported higher night pain, reduced shoulder range of motion, slower response times, poorer motor imagery ability, and higher scores on pain-related questionnaires compared to those with a CSI<40 (p = 0.043-<0.001). CONCLUSION C-RCRSP patients demonstrated poorer tactile acuity, mechanical sensitivity, and motor imagery ability especially in those with central sensitization, which should be considered in treatment planning.
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Affiliation(s)
- Nuray Alaca
- Acıbadem Mehmet Ali Aydınlar University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey; Acıbadem Mehmet Ali Aydınlar University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Dilek Çağrı Arslan
- Acıbadem Mehmet Ali Aydınlar University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey; Bezmialem Vakif University, Institute of Health Sciences, Department of Cardiopulmonary Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Seda Sırlan
- Acıbadem Mehmet Ali Aydınlar University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Hacı Ahmet Yarar
- Dokuz Eylül University, Faculty of Physical Therapy and Rehabilitation, Department of Orthopedic Physiotherapy, Izmir, Turkey.
| | - Onur Başcı
- Dokuz Eylül University Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey.
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Moreira LF, Coelho VK, Mendonça LF, Reis FJJ, Telles GF, Calazans Nogueira LA. Pain intensity and lower limb dynamic balance were related to the laterality judgment test of patients with patellofemoral pain. Musculoskelet Sci Pract 2025; 76:103259. [PMID: 39832428 DOI: 10.1016/j.msksp.2025.103259] [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: 09/24/2024] [Revised: 12/06/2024] [Accepted: 01/08/2025] [Indexed: 01/22/2025]
Abstract
INTRODUCTION Laterality judgement evaluates the capacity to differentiate between the left and right sides of bodily parts. Cortical body representations are impaired in various musculoskeletal conditions, yet this remains unexplored in individuals with patellofemoral pain (PFP). OBJECTIVE This study compared laterality judgement performance between individuals with PFP and asymptomatic controls. Additionally, we investigated the relationship between laterality judgement and self-reported disability, physical performance, and dynamic stability within the PFP group. METHODS A secondary analysis encompassed 48 patients and 48 controls. Participants were examined for laterality judgement, pain intensity, knee disability, physical performance and lower limb dynamic balance. Statistical analyses included Student's t-test for group differences and linear regression to examine relationships between laterality judgement and other measurements. RESULTS The sample comprised 60 males (62.5%) with a mean age of 31.3 years. The PFP group reported a mean pain duration of 37.6 months and moderate pain intensity (4/10). Laterality judgement accuracy and time were identical between the PFP group (78.3% and 2.1 s, respectively) and controls (80.8% and 2.2 s, respectively) (accuracy p = 0.50 and time p = 0.66). Lower limb dynamic and pain intensity were related to laterality judgement accuracy (β = 0.4, p < 0.01) and time (β = 0.4, p = 0.03), respectively. CONCLUSION PFP and control groups demonstrated similar laterality judgement performance. In the PFP group, lower laterality judgement accuracy was related to dynamic balance and lower laterality judgement time was related to pain intensity. The physical performance and self-reported knee disability were not related to the knee laterality judgment of these patients.
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Affiliation(s)
- Luiza Ferreira Moreira
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, CEP, 21041-020, Rio de Janeiro, RJ, Brazil.
| | - Vanessa Knust Coelho
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, CEP, 21041-020, Rio de Janeiro, RJ, Brazil.
| | - Lucas Ferreira Mendonça
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rua Carlos Wenceslau, 343, Realengo. CEP 21715-000. Rio de Janeiro, Brazil.
| | - Felipe J J Reis
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rua Carlos Wenceslau, 343, Realengo. CEP 21715-000. Rio de Janeiro, Brazil; School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Gustavo Felicio Telles
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, CEP, 21041-020, Rio de Janeiro, RJ, Brazil.
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, CEP, 21041-020, Rio de Janeiro, RJ, Brazil; Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rua Carlos Wenceslau, 343, Realengo. CEP 21715-000. Rio de Janeiro, Brazil.
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Araya-Quintanilla F, Gutiérrez-Espinoza H, Méndez-Rebolledo G, Cavero-Redondo I, Álvarez-Bueno C, Stasinopoulos D. Affective and Clinical Outcomes Related to Pain After Graded Motor Imagery in Patients With Chronic Shoulder Pain: A Pre-Post-Single-Group Study. Rehabil Res Pract 2024; 2024:7355866. [PMID: 39735290 PMCID: PMC11679276 DOI: 10.1155/rerp/7355866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/19/2024] [Accepted: 12/02/2024] [Indexed: 12/31/2024] Open
Abstract
Objective: The aim of this study was to assess at 6-month and 1-year follow-up the effect of graded motor imagery (GMI) in addition to usual care on the affective and clinical outcomes in patients with chronic shoulder pain. Methods: A pre-post-intervention single-group study was conducted. One hundred forty-eight patients with chronic shoulder pain were included. All participants received a 6-week GMI program in addition to usual care. The primary outcome assessed was pain intensity using visual analog scale (VAS), the secondary outcomes were fear of movement with the Tampa Scale of Kinesiophobia (TSK), catastrophization with the pain catastrophization scale (PCS), shoulder flexion active range of motion (AROM) with a goniometer, and central sensitization with the central sensitization inventory (CSI). All outcomes were assessed at baseline and 6-month and 1-year follow-up. Results: At 6 months, GMI showed to be statistically significant for all outcomes assessed (p < 0.001). At 1-year follow-up, the VAS showed a decrease of 3.3 cm (p < 0.001), TSK showed a decrease of 16.1 points (p < 0.001), PCS showed a decrease of 17.4 points (p < 0.001), AROM showed an increase of 29.9° (p < 0.001), and CSI showed a decrease of 17.9 (p < 0.001). Conclusions: At medium- and long-term follow-up, the individuals who received the GMI program in addition to usual care showed a clinically and statistically significant change for all outcomes assessed. Further studies, including clinical trials, are needed to confirm our findings.
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Affiliation(s)
- Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | | | | | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Facultad de Enfermeria, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Facultad de Enfermeria, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
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Díaz-Mohedo E, González-Roldán G, Muñoz-Gámez I, Padilla-Romero V, Castro-Martín E, Cabrera-Martos I, Sánchez-García C. Implicit Motor Imagery for Chronic Pelvic Pain: A Cross-Sectional Case-Control Study. J Clin Med 2023; 12:4738. [PMID: 37510853 PMCID: PMC10380828 DOI: 10.3390/jcm12144738] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Implicit motor imagery (IMI), with an image laterality discrimination (LD) task, has been proposed as a useful therapeutic tool to restore body schema in patients with chronic pelvic pain (CPP). The aim of this study was to analyse the existence of differences between patients with CPP and healthy individuals in order to justify the use of IMI. An observational, cross-sectional study with non-probabilistic sampling was designed as a one-to-one matched case-control study. Through a web link designed for this purpose, a total of 40 abdominoperineal images were shown to 130 participants during the laterality task. Outcome measures were pain intensity (visual analogue scale, VAS), accuracy, response time (RT), and CPPQ-Mohedo score (Chronic Pelvic Pain Questionnaire-Mohedo). This was an observational, cross-sectional study with a total of 64 CPP patients and 66 healthy individuals. The comparative analysis between groups revealed significant differences in accuracy, CPPQ-Mohedo and VAS (p < 0.001), but not in RT; in patients with CPP, accuracy was correlated with a lower CPPQ-Mohedo score and RT and, the greater the pain intensity, the higher the CPPQ-Mohedo score and RT, and the lower the accuracy. In the LD task, the patients with CPP made more mistakes than the healthy individuals. IMI could be a useful and complementary tool in the therapeutic approach for patients with CPP.
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Affiliation(s)
- Esther Díaz-Mohedo
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Avda. Arquitecto Francisco Peñalosa, s/n, 29071 Málaga, Spain
| | | | | | | | - Eduardo Castro-Martín
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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Guerra-Armas J, Flores-Cortes M, Pineda-Galan C, Luque-Suarez A, La Touche R. Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients. Brain Sci 2023; 13:617. [PMID: 37190582 PMCID: PMC10136729 DOI: 10.3390/brainsci13040617] [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: 03/17/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Primary chronic pain is a major contributor to disability worldwide, with an estimated prevalence of 20-33% of the world's population. The high socio-economic impact of musculoskeletal pain justifies seeking an appropriate therapeutic strategy. Immersive virtual reality (VR) has been proposed as a first-line intervention for chronic musculoskeletal pain. However, the growing literature has not been accompanied by substantial progress in understanding how VR exerts its impact on the pain experience and what neurophysiological mechanisms might be involved in the clinical effectiveness of virtual reality interventions in chronic pain patients. The aim of this review is: (i) to establish the state of the art on the effects of VR on patients with chronic pain; (ii) to identify neuroplastic changes associated with chronic pain that may be targeted by VR intervention; and (iii) to propose a hypothesis on how immersive virtual reality could modify motor behavioral decision-making through an interactive experience in patients with chronic pain.
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Affiliation(s)
- Javier Guerra-Armas
- Faculty of Health Sciences, Universidad Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas, Spain
| | - Mar Flores-Cortes
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
| | | | - Alejandro Luque-Suarez
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
- Instituto de la Investigacion Biomedica de Malaga (IBIMA), 29071 Malaga, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
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Kim A, Yang EJ, Ji M, Beom J, Yi C. Distorted body schema after mastectomy with immediate breast reconstruction: a 4-month follow up study. PeerJ 2022; 10:e14157. [PMID: 36213497 PMCID: PMC9536299 DOI: 10.7717/peerj.14157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/08/2022] [Indexed: 01/21/2023] Open
Abstract
Background After breast cancer, some patients report residual pain-related upper limb disability without physical impairment. Although pain and altered proprioception are known to affect the working body schema (WBS), there is little available evidence investigating the WBS of breast cancer survivors (BrCS). WBS-body representations in the brain-affect the "neuromatrix" that modulates pain sensitivity and the threshold for threatening stimuli. The aim of this study was to investigate whether WBS was disrupted after mastectomy with immediate breast reconstruction (IBR) for breast cancer and whether pain and proprioceptive changes affected WBS. Methods Thirty-five BrCS participated in the 4-month follow-up study. They were observed at 1 and 4 months postoperatively. The main outcome measures were the left right judgement test (LRJT) results, absolute angle error, pectoralis minor length index (PMI), pain, and Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score. They were measured at each observation, and parametric tests were performed to identify the nature of WBS. Results Both the reaction time and accuracy of the hand LRJT were poorer than those of the foot and back LRJT (p < 0.001). The hand LRJT reaction time and accuracy were unchanged over the total follow-up period (p = 0.77 and p = 0.47, respectively). There was a weak correlation between the LRJT reaction time and PMI (r = -0.26, p = 0.07), pain severity (r = 0.37, p = 0.02), and Q-DASH score (r = 0.37, p = 0.02). There was also a weak correlation between LRJT accuracy and Q-DASH score (r = -0.31, p = 0.04). The LRJT accuracy of BrCS who underwent surgery on their dominant side was higher than that of BrCS who underwent surgery on their non-dominant side (p = 0.002). Regression analysis found a weak but significant relationship between the early hand LRJT results and late pain severity (adjusted R2 = 0.179, p = 0.007). A similar relationship was found between early hand LRJT results and Q-DASH score (adjusted R2 = 0.099, p = 0.039). Conclusion To the best of our knowledge, this is the first study providing the nature of WBS after mastectomy with IBR. In this population, it is necessary to postoperatively preserve WBS integrity for pain and upper limb disability.
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Affiliation(s)
- Asall Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea,Department of Physical Therapy, The Graduate school, Yonsei University, Wonju, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Daelim Catholic Hospital, Seoul, South Korea
| | - Myungki Ji
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chunghwi Yi
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
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Effect of different postures of the scapular girdle and arm on the pressure pain threshold in the infraspinatus muscle. J Bodyw Mov Ther 2021; 28:276-282. [PMID: 34776153 DOI: 10.1016/j.jbmt.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. METHODS This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. RESULTS No differences were observed between groups. The within-group analysis showed differences for both factors: "Positions" (F = 69.91; p = 0.001) and the interaction "Positions^Group" (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. CONCLUSION Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.
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