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Merlo JK, da Silva AV, Casonatto J, Ribeiro AS, de Oliveira Junior E, do Nascimento AP, de Oliveira RG, Buzzachera CF, da Silva RA, Aguiar AF. Effects of a Mat Pilates Exercise Program Associated with Photobiomodulation Therapy in Patients with Chronic Nonspecific Low Back Pain: A Randomized, Double-Blind, Sham-Controlled Trial. Healthcare (Basel) 2024; 12:1416. [PMID: 39057559 PMCID: PMC11276592 DOI: 10.3390/healthcare12141416] [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: 06/03/2024] [Revised: 06/26/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To investigate the effects of combining a Pilates program with photobiomodulation therapy (PBMT) in patients with chronic nonspecific low back pain (CNLBP). METHODS Thirty-eight adults with CNLBP were randomly assigned to two groups: Pilates exercise + active PBMT (PIL + PBMT) or Pilates exercise + sham PBMT (PIL + SHAM). Both groups performed an 8-week mat Pilates program and received PBMT on their lumbar muscles 10 min before and after each session. The following variables were assessed before and after intervention: peak pain intensity, postural balance (i.e., center of the pressure [A-COP], velocity anteroposterior [Vel AP], and velocity mediolateral [Vel ML]), perceived disability (i.e., Oswestry Disability Index [ODI] and Roland Morris Disability Questionnaire [RMDQ]), and pain-related fear of movement (i.e., Tampa Scale of Kinesiophobia [TSK], Fear Avoidance Beliefs Questionnaire [FABQ], and Pain Catastrophizing Scale [PCS]). RESULTS Postural balance variables showed no statistically significant differences (p > 0.05) across time or between groups. The groups showed similar (p < 0.05) reductions in peak pain intensity, ODI, RMDQ, and PCS scores, but no statistically significant difference (p > 0.05) in TSK and FABQ scores. CONCLUSION The mat Pilates program reduced peak pain intensity, perceived disability, and pain catastrophizing in adults with CNLBP, but PBMT had no additional effect on these variables. Mat Pilates alone or combined with PBMT was not able to improve postural balance.
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Affiliation(s)
- Jeanne Karlette Merlo
- Postgraduate Program in Rehabilitation Sciences, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil; (J.K.M.); (A.V.d.S.); (J.C.); (E.d.O.J.) (A.P.d.N.); (R.G.d.O.)
| | - Adriano Valmozino da Silva
- Postgraduate Program in Rehabilitation Sciences, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil; (J.K.M.); (A.V.d.S.); (J.C.); (E.d.O.J.) (A.P.d.N.); (R.G.d.O.)
| | - Juliano Casonatto
- Postgraduate Program in Rehabilitation Sciences, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil; (J.K.M.); (A.V.d.S.); (J.C.); (E.d.O.J.) (A.P.d.N.); (R.G.d.O.)
- Postgraduate Program in Physical Exercise in Health Promotion, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil;
| | - Alex Silva Ribeiro
- Postgraduate Program in Physical Exercise in Health Promotion, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil;
| | - Eros de Oliveira Junior
- Postgraduate Program in Rehabilitation Sciences, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil; (J.K.M.); (A.V.d.S.); (J.C.); (E.d.O.J.) (A.P.d.N.); (R.G.d.O.)
| | - Ana Paula do Nascimento
- Postgraduate Program in Rehabilitation Sciences, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil; (J.K.M.); (A.V.d.S.); (J.C.); (E.d.O.J.) (A.P.d.N.); (R.G.d.O.)
- Postgraduate Program in Human Movement Sciences, State University of Northern Paraná (UENP), Jacarezinho 86400-000, PR, Brazil
| | - Raphael Gonçalves de Oliveira
- Postgraduate Program in Rehabilitation Sciences, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil; (J.K.M.); (A.V.d.S.); (J.C.); (E.d.O.J.) (A.P.d.N.); (R.G.d.O.)
- Postgraduate Program in Human Movement Sciences, State University of Northern Paraná (UENP), Jacarezinho 86400-000, PR, Brazil
| | - Cosme Franklim Buzzachera
- Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy;
| | - Rubens Alexandre da Silva
- Program de Physiothérapie de L’université McGill Offert en Extension à L’UNIVERSITÉ du Québec à Chicoutimi (UQAC), Québec, QC G7H 5B8, Canada
| | - Andreo Fernando Aguiar
- Postgraduate Program in Rehabilitation Sciences, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil; (J.K.M.); (A.V.d.S.); (J.C.); (E.d.O.J.) (A.P.d.N.); (R.G.d.O.)
- Postgraduate Program in Physical Exercise in Health Promotion, Northern University of Paraná (UNOPAR), Londrina 86041-120, PR, Brazil;
- Postgraduate Program in Human Movement Sciences, State University of Northern Paraná (UENP), Jacarezinho 86400-000, PR, Brazil
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Kaplun A, Trosman S, Reitblat T, Friedman A, Kalichman L. The Effects of Brief Guided Imagery on Patients Suffering From Chronic Back Pain: An A-B Design Study. Pain Manag Nurs 2023; 24:492-497. [PMID: 37380585 DOI: 10.1016/j.pmn.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 05/09/2023] [Accepted: 06/04/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Guided imagery (GI) is a non-pharmacological method used to reduce pain, stress, and anxiety. AIMS This study aimed to evaluate the impact of brief GI on symptoms of chronic back pain in adults treated in the Rheumatology clinic. DESIGN A-B design study. SETTINGS & PARTICIPANTS A sample of 35 women with chronic back pain were recruited at the Rheumatology Outpatient Clinic of Barzilai Medical Center in Ashkelon, Israel. METHODS All subjects completed questionnaires at recruitment (T1), and after 8-10 weeks, they completed questionnaires again before the first intervention (T2). The intervention included five brief GI group meetings every 2-3 weeks, one hour each (3-5 subjects per group). Participants learned 6 GI exercises and were asked to practice brief guided imagery exercises at least once daily. Then, questionnaires were completed the third time (T3). OUTCOME MEASURES MOQ - Modified Oswestry Low Back Pain Disability Questionnaire, STAI - State-Trait Anxiety Inventory, FABQ - Fear-Avoidance Beliefs Questionnaire, NPRS - Numerical Pain Rating Scale (average pain over the last week). RESULTS Compared with the period without intervention, NPRS (Δ = 2.53, standard error [SE] = 0.43, p < .001), STAI (Δ = 8.41, SE = 1.95, p < .001), and MOQ (Δ = 0.06, SE = 0.02, p = .019) reported significantly lower levels after brief guided imagery training. However, no statistically significant change was found in FABQ. CONCLUSIONS The brief guided imagery intervention may help alleviate chronic back pain, help decrease anxiety, and improve daily activity in women who suffer from chronic low back pain.
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Affiliation(s)
- Anat Kaplun
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Svetlana Trosman
- Rheumatology Unit, Barzilai Medical Center, Ashkelon, Israel, affiliated with Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tatiana Reitblat
- Rheumatology Unit, Barzilai Medical Center, Ashkelon, Israel, affiliated with Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alan Friedman
- Rehabilitation Department, Soroka University Medical Center, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Abu-Leil S, Weisman A, Peled N, Kasem H, Dar G, Masharawi Y. Lumbosacral zone features in individuals with nonspecific chronic low back pain are unique compared to controls and correlate with pain and dysfunction. Eur Radiol 2023; 33:6392-6401. [PMID: 37060447 DOI: 10.1007/s00330-023-09626-9] [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: 11/14/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To compare the lumbosacral nerve distances (LNDs) and sacroiliac joint (SIJ) morphology in individuals with nonspecific chronic low back pain (NSCLBP) and control and examine their correlations with pain and dysfunction in the former. MATERIALS AND METHODS The sample includes 200 adult patients (ranging from 20 to 50 years old) referred for computerized abdominal tomography (CT): 100 individuals with NSCLBP (50 males and 50 females) and 100 individuals without NSCLBP (50 males and 50 females). CT scans were assessed for LNDs, degenerative sacroiliac changes, and joint bridging. Those factors were correlated to the outcomes of three self-reported questionnaires about pain and function (Oswestry, Fear-Avoidance, and Numerical Pain Rating Scale) in the NSCLBP group. RESULTS Individuals with NSCLBP tend to have reduced LNDs from the sacral part of the SIJ compared to controls (males: right Δ = 5.8 mm, left Δ = 6.03 mm; females: right Δ = 7.9 mm, left Δ = 7.73 mm, two-way ANOVA, p < 0.01), with moderate significant negative correlations with all three questionnaires (-0.38 < Pearson's r < - 0.57, p < 0.02, i.e., reduced LNDs with greater disability and pain). The NSCLBP group had more significant SIJ degeneration severity that moderately correlated with two questionnaires (0.39 < Pearson's r < 0.66, p < 0.04, i.e., greater SIJ degeneration with greater disability and pain). In males, the existence of SIJ bridging strongly correlated with all three questionnaires (0.38 < Pearson's r < 0.78, p < 0.03), and in females, only the Fear-Avoidance Questionnaire and Numerical Pain Scale (0.29 < Pearson's r < 0.41, p < 0.04). CONCLUSION Compared to controls, individuals with NSCLBP have reduced LNDs and worse SIJ degenerative changes that correlate with function and pain. KEY POINTS • Individuals with nonspecific low back pain tend to have reduced lumbosacral nerve distances than healthy controls. This may be due to entrapments or inflammation of the nerves or surrounding tissues. • Individuals with nonspecific low back pain tend to have more severe degeneration of their sacroiliac joint than healthy controls. • The above findings significantly correlated with the scores of three self-reported questionnaires about pain and function, implicating that they may be of clinical significance.
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Affiliation(s)
- Saher Abu-Leil
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel-Aviv, Israel
- Department of Physical Therapy, Zefat Academic College, Zefat, Israel
| | - Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel-Aviv, Israel
| | - Natan Peled
- Department of Radiology, Carmel Medical Center, Haifa, Israel
| | - Haytam Kasem
- Department of Mechanical Engineering, Azrieli College of Engineering, Jerusalem, Israel
| | - Gali Dar
- Department of Physical Therapy, The University of Haifa, Haifa, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel-Aviv, Israel.
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Hoch MC, Hertel J, Gribble PA, Heebner NR, Hoch JM, Kosik KB, Long D, Sessoms PH, Silder A, Torp DM, Thompson KL, Fraser JJ. Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol. BMC Sports Sci Med Rehabil 2023; 15:54. [PMID: 37032355 PMCID: PMC10084629 DOI: 10.1186/s13102-023-00667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Lateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI. METHODS This study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation. DISCUSSION The overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition. Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).
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Grants
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
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Affiliation(s)
- Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA.
| | - Jay Hertel
- Sports Medicine and Chair, Department of Kinesiology, University of Virginia, 550 Brandon Avenue, Charlottesville, VA, 22904-4407, USA
| | - Phillip A Gribble
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Johanna M Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Kyle B Kosik
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Doug Long
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 South Limestone, Lexington, KY, 40536-0200, USA
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Amy Silder
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Danielle M Torp
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Katherine L Thompson
- Dr. Bing Zhang Department of Statistics, University of Kentucky, 725 Rose Street, Lexington, KY, 40536, USA
| | - John J Fraser
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
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Nudelman Y, Pincus T, Nicholas MK, Ben Ami N. Cross-cultural adaptation, reliability, and validity of the pain self-efficacy questionnaire - Hebrew version. Musculoskelet Sci Pract 2023; 64:102749. [PMID: 36965246 DOI: 10.1016/j.msksp.2023.102749] [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: 11/23/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE This study aims to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew Pain Self-Efficacy Questionnaire (PSEQ). METHODS The study was designed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations for patient-reported outcome measurement instruments. The PSEQ was initially translated into Hebrew and cross-culturally adapted. The Hebrew version of the PSEQ (PSEQ-H) was administered to participants suffering from chronic musculoskeletal pain, along with other self-report measures of pain (NPRS, FABQ, HADS, PCS, and SF-12). Eight hypotheses on expected correlations of the PSEQ-H with other instruments were formulated a priori to assess construct validity. Structural validity was assessed using confirmatory factor analysis. Floor and ceiling effects, test-retest, and internal consistency reliability were also assessed. RESULTS The translation process retained the unidimensional model of the PSEQ. The PSEQ-H demonstrates excellent internal consistency (Cronbach's α = 0.97) and test-retest reliability (ICC = 0.88), and no significant floor and ceiling effects were observed. Construct validity was found satisfactory as 75% (six) of the analyses between the PSEQ-H and the other self-reported measures met the hypotheses. Factor analysis confirmed the single-factor structure of the questionnaire. CONCLUSIONS The PSEQ-H version was found to have excellent reliability, good construct, and structural validity, and can be used with heterogeneous chronic musculoskeletal pain populations. Future studies should test the PSEQ-H's responsiveness and psychometric properties with specific pain populations.
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Affiliation(s)
- Yaniv Nudelman
- Department of Physiotherapy, Ariel University, Ariel, Israel; Maccabi Healthcare Services, Tel-aviv, Israel.
| | - Tamar Pincus
- University of Southampton, Southampton, United Kingdom
| | - Michael K Nicholas
- Pain Management Research Institute, Sydney Medical School, The University of Sydney, Royal North Shore, Australia
| | - Noa Ben Ami
- Department of Physiotherapy, Ariel University, Ariel, Israel
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Ahmad I, Sharma A, Zaidi S, Alshahrani MS, Gautam AP, Raizah A, Reddy RS, Verma S, Tanwar T, Hussain ME, Malhotra D, Uddin S, Mukhtar EM. Establishing Responsiveness and Minimal Clinically Important Difference of Quebec Back Pain Disability Scale (Hindi Version) in Chronic Low Back Pain Patients Undergoing Multimodal Physical Therapy. Healthcare (Basel) 2023; 11:healthcare11040621. [PMID: 36833155 PMCID: PMC9957059 DOI: 10.3390/healthcare11040621] [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: 12/21/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Increasing emphasis is placed on physical functional measures to examine treatments for chronic low back pain (CLBP). The Quebec Back Pain Disability Scale (Hindi version) (QBPDS-H) has never been evaluated for responsiveness. The objectives of this study were to (1) examine the internal and external responsiveness of the Quebec Back Pain Disability Scale (Hindi version) (QBPDS-H) and (2) find out the minimal clinically important difference (MCID) and minimal detectable change (MDC) in the functional ability of patients with chronic low back pain (CLBP) undergoing multimodal physical therapy treatment. In this prospective cohort study, QBPDS-H responses were recorded at the baseline and after eight weeks from 156 CLBP patients undergoing multimodal physiotherapy treatment. To differentiate between the clinically unimproved (n = 65, age: 44.16 ± 11.8 years) and clinically improved (n = 91, age: 43.28 ± 10.7 years) scores of patients from the initial assessment to the last follow-up, the Hindi version of the Patient's Global Impression of Change (H-PGIC) scale was utilized. Internal responsiveness was large (E.S. (pooled S.D.) (n = 91): 0.98 (95% CI = 1.14-0.85) and Standardized Response Mean (S.R.M.) (n = 91): 2.57 (95% CI = 3.05-2.17)). In addition, the correlation coefficient and receiver operative characteristics (R.O.C.) curve were used to assess the QBPDS-H external responsiveness. MCID and MDC were detected by the R.O.C. curve and standard error of measurements (S.E.M.), respectively. The H-PGIC scale showed moderate responsiveness (ρ = 0.514 and area under the curve (A.U.C.) = 0.658; 95% CI, 0.596-0.874), while the MDC achieved 13.68 points, and the MCID was found have 6 points (A.U.C. = 0.82; 95% CI: 0.74-0.88, sensitivity = 90%, specificity = 61%). This study shows that QBPDS-H has moderate levels of responsiveness in CLBP patients receiving multimodal physical therapy treatment, so it can be used to measure the changes in disability scores. MCID and MDC changes were also reported with QBPDS-H.
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Affiliation(s)
- Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
| | - Akhil Sharma
- St. Stephens Hospital, Tis Hazari, New Delhi 110054, India
| | - Sahar Zaidi
- Department of Physiotherapy, Jamia Hamdard, New Delhi 110062, India
- Correspondence: ; Tel.: +91-97-3986-4312
| | - Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
| | - Ajay Prashad Gautam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
| | - Abdullah Raizah
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha 61413, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
| | - Shalini Verma
- Department of Physiotherapy, Jamia Hamdard, New Delhi 110062, India
| | - Tarushi Tanwar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mohammad Ejaz Hussain
- Faculty of Allied Health Sciences and Physiotherapy, SGT University, Gurugram 122505, India
| | - Deepak Malhotra
- Department of Physiotherapy, Jamia Hamdard, New Delhi 110062, India
| | - Shadab Uddin
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Jazan University, Jazan 82911, Saudi Arabia
| | - Emadeldin Mohammed Mukhtar
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
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7
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Mullins JF, Hoch MC, Gribble P, Heebner N, Kosik K, Westgate P, Nitz AJ. Examination of Dry Needling Dose and Effect Duration for Individuals With Chronic Ankle Instability. J Manipulative Physiol Ther 2023; 46:132-142. [PMID: 37422747 DOI: 10.1016/j.jmpt.2023.05.007] [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: 08/26/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of a single treatment vs serial dry needling (DN) treatments of the fibularis longus on individuals with chronic ankle instability and to determine the longevity of any effect found. METHODS Thirty-five adults with chronic ankle instability (24.17 ± 7.01 years, 167.67 ± 9.15 cm, 74.90 ± 13.23 kg) volunteered for a university laboratory repeated-measures study. All participants completed patient-reported outcomes and were objectively tested using the Star Excursion Balance Test (SEBT), threshold to detect passive motion (TTDPM) measurements, and single limb time-to-boundary measurements. Participants received DN treatment to the fibularis longus once weekly for 4 weeks on the affected lower extremity by a single physical therapist. Data were collected 5 times: baseline 1 week before initial treatment (T0), pre-treatment (T1A), immediately after the first treatment (T1B), after 4 weekly treatments (T2), and 4 weeks after the cessation of treatment (T3). RESULTS Significant improvements were found for clinician-oriented (SEBT-Composite P < .001; SEBT-Posteromedial P = .024; SEBT-Posterolateral P < .001; TTDPM-Inversion P = .042) and patient-oriented outcome measures (Foot and Ankle Ability Measure-Activities of Daily Living P < .001; Foot and Ankle Ability Measure-Sport P = .001; Fear Avoidance Belief Questionnaire P = .021) following a single DN treatment. Compounding effects from additional treatments exhibited improvement of TTDPM (T1B to T2). No significant losses were noted 4 weeks after cessation of treatment (T2 to T3). CONCLUSION For the participants in this study, outcomes improved immediately following the first DN treatment. This improvement was sustained but not further improved with subsequent treatments.
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Affiliation(s)
- Jennifer F Mullins
- Army-Baylor Physical Therapy Doctoral Program, Joint Base San Antonio, Texas.
| | - Matthew C Hoch
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Phillip Gribble
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Nicholas Heebner
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Kyle Kosik
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Philip Westgate
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Arthur J Nitz
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
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Walsh BM, Kosik KB, Bain KA, Houston MN, Hoch MC, Gribble P, Hoch JM. Exploratory factor analysis of the fear-avoidance beliefs questionnaire in patients with chronic ankle instability. Foot (Edinb) 2022; 51:101902. [PMID: 35255408 DOI: 10.1016/j.foot.2021.101902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/22/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To perform an exploratory factor analysis of the Fear-Avoidance Beliefs Questionnaire in patients with chronic ankle instability. METHODS A cross-sectional survey study was utilized. The Fear-Avoidance Beliefs Questionnaire was administered to patients with chronic ankle instability who met the inclusion criteria. Both an unrestricted and restricted factor analysis with varimax rotation were utilized to explore the factor structure of the instrument. Kaiser-Meyer-Olkin values were used to determine sampling adequacy. Bartlett's test of sphericity was used to justify that the correlations were suitable for the principal component analysis. RESULTS The restricted two-factor analysis resulted in two factors with acceptable internal consistency values. The Keiser-Meyer-Olkin value was acceptable (0.81), and Bartlett's test of sphericity was significant (χ2 (55) = 515.59, p < 0.001). CONCLUSION The ankle-specific Fear-Avoidance Beliefs Questionnaire consists of two stable factors and should be used to further examine fear-avoidance beliefs in people with chronic ankle instability.
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Affiliation(s)
- Bridget M Walsh
- College of Health Sciences, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY 40536, USA
| | - Kyle B Kosik
- College of Health Sciences, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY 40536, USA
| | - Katherine A Bain
- College of Health Sciences, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY 40536, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, NY 10996, USA
| | - Matthew C Hoch
- College of Health Sciences, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY 40536, USA
| | - Phillip Gribble
- College of Health Sciences, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY 40536, USA
| | - Johanna M Hoch
- College of Health Sciences, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY 40536, USA.
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9
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Ben Ami N, Hill J, Pincus T. STarT MSK tool: Translation, adaptation and validation in Hebrew. Musculoskeletal Care 2021; 20:541-546. [PMID: 34862708 DOI: 10.1002/msc.1607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Keele STarT MSK Tool divides musculoskeletal patients into three prognostic groups for risk-stratified care. It has shown good predictive and discriminative ability in development and validation samples. OBJECTIVES This study aimed to translate and validate the STarT MSK in a Hebrew version, among Israeli people living with musculoskeletal (MSK) pain. METHOD A cross-sectional study, with nested prospective sub-sample. The STarT MSK was translated into Hebrew using published guidelines. A total of 153 adults (18+) who reported living with MSK pain were administered the STarT MSK. Clinical measures included for validity testing included the 12-Item Short-Form Health Survey (SF-12), the Hospital Anxiety and Depression Scale (HADS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and a numerical pain rating scale (NPRS). RESULTS The STarT MSK was forward and backward translated, with minor changes to ensure cultural adaptation. The test-retest reliability of the STarT MSK total score was excellent (intraclass correlation coefficient 0.92). Internal consistency for the MSK scale was (α = 0.612). The Spearman's correlation coefficients between STarT MSK total score and the validation measures confirmed the hypotheses and were significant. CONCLUSION The Israeli translation and validation of the STarT MSK suggest that it is a valid and reliable instrument. The STarT MSK discriminated low-, medium- and high-risk groups.
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Affiliation(s)
- Noa Ben Ami
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Jonathan Hill
- Department of Physiotherapy, Keele University, Keele, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
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Gulle H, Prior T, Miller S, Birn-Jeffery AV, Morrissey D. Online questionnaire, clinical and biomechanical measurements for outcome prediction of plantar heel pain: feasibility for a cohort study. J Foot Ankle Res 2021; 14:34. [PMID: 33902655 PMCID: PMC8077700 DOI: 10.1186/s13047-021-00472-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Plantar heel pain (PHP) accounts for 11-15% of foot symptoms requiring professional care in adults. Recovery is variable, with no robust prognostic guides for sufferers, clinicians or researchers. Therefore, we aimed to determine the validity, reliability and feasibility of questionnaire, clinical and biomechanical measures selected to generate a prognostic model in a subsequent cohort study. METHODS Thirty-six people (19 females & 17 males; 20-63 years) were recruited with equal numbers in each of three groups: people with PHP (PwPHP), other foot pain (PwOP) and healthy (H) controls. Eighteen people performed a questionnaire battery twice in a randomised order to determine online and face-to-face agreement. The remaining 18 completed the online questionnaire once, plus clinical measurements including strength and range of motion, mid-foot mobility, palpation and ultrasound assessment of plantar fascia. Nine of the same people underwent biomechanical assessment in the form of a graded loaded challenge augmenting walking with added external weight and amended step length on two occasions. Outcome measures were (1) feasibility of the data collection procedure, measurement time and other feedback; (2) establishing equivalence to usual procedures for the questionnaire battery; known-group validity for clinical and imaging measures; and initial validation and reliability of biomechanical measures. RESULTS There were no systematic differences between online and face-to-face administration of questionnaires (p-values all > .05) nor an administration order effect (d = - 0.31-0.25). Questionnaire reliability was good or excellent (ICC2,1_absolute)(ICC 0.86-0.99), except for two subscales. Full completion of the survey took 29 ± 14 min. Clinically, PwPHP had significantly less ankle-dorsiflexion and hip internal-rotation compared to healthy controls [mean (±SD) for PwPHP-PwOP-H = 14°(±6)-18°(±8)-28°(±10); 43°(±4)- 45°(±9)-57°(±12) respectively; p < .02 for both]. Plantar fascia thickness was significantly higher in PwPHP (3.6(0.4) mm vs 2.9(0.4) mm, p = .01) than the other groups. The graded loading challenge demonstrated progressively increasing ground reaction forces. CONCLUSION Online questionnaire administration was valid therefore facilitating large cohort recruitment and being relevant to remote service evaluation and research. The physical and ultrasound examination revealed the expected differences between groups, while the graded loaded challenge progressively increases load and warrants future research. Clinician and researchers can be confident about these methodological approaches and the cohort study, from which useful clinical tools should result, is feasible. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Halime Gulle
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
| | - Trevor Prior
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
- Consultant Podiatric Surgeon, Homerton University Hospital, Homerton Row, London, E9 6SR UK
| | - Stuart Miller
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
| | - Aleksandra V. Birn-Jeffery
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary University London, Mile End, Bancroft road, London, E1 4DG, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London, E1 4DG UK
- Physiotherapy Department, Barts Health NHS Trust, London, UK
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Alamam DM, Leaver A, Alsobayel HI, Moloney N, Lin J, Mackey MG. Low Back Pain-Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non-English-Speaking Populations: Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 22:2974-2989. [PMID: 33624814 DOI: 10.1093/pm/pnaa430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis examined relationships between low back pain (LBP)-related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non-English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined. STUDY DESIGN Systematic review and meta-analysis. METHODS Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods. RESULTS Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = -0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = -0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire-Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion. DISCUSSION LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non-English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.
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Affiliation(s)
- Dalyah M Alamam
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew Leaver
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Hana I Alsobayel
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Niamh Moloney
- Department of Health Professions, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia.,THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Jianhua Lin
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Martin G Mackey
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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12
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Reliability and Validity of the Turkish Short-Form McGill Pain Questionnaire-2 (TR-SF-MPQ-2) in patients with chronic low back pain. Turk J Phys Med Rehabil 2020; 66:343-350. [PMID: 33089091 PMCID: PMC7557621 DOI: 10.5606/tftrd.2020.3689] [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: 09/24/2018] [Accepted: 04/03/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives
The aim of this study was to assess validity and reliability of the Turkish version of the expanded and revised version of the Short-Form McGill Pain Questionnaire (TR-SF-MPQ-2) in patients with chronic low back pain (CLBP) and to investigate the relationship between TR-SF-MPQ-2 and etiology, pain scales, and disability index. Patients and methods
Between October 2014 and December 2014, a total of 194 patients with CLBP (66 males, 128 females; mean age 50±14.3 years; range, 35 to 65 years) attending to our outpatient clinic were included. To assess reliability, Cronbach alpha (α) and intraclass correlation coefficient (ICC) were estimated for participants who completed the questionnaire in the morning and afternoon. The validity of the questionnaire was evaluated by analyzing the confirmatory factor analysis. The Visual Analog Scale and Oswestry Disability Index were also used to test concurrent validity of the questionnaire. Results
For total score, Cronbach α was 0.912 and ICC was 0.973, ranging from 0.72 to 0.84 for Cronbach α and from 0.960 to 0.989 for ICC in subgroups. The confirmatory factor analysis showed a good model fit for each subgroup (χ2/Df <3, GFI >0.95, CFI >0.90, NFI >0.90, and RMSEA <0.10). The correlation coefficient between the mean VAS and the mean total score was 0.648. Conclusion Our study results indicate that the Turkish version of the SF-MPQ-2 is a reliable and valid tool to assess pain in the Turkish patients with CLBP.
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13
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Huijnen IPJ, Schasfoort FC, Smeets RJEM, Sneekes E, Verbunt JA, Bussmann JBJ. Subgrouping patients with chronic low back pain: What are the differences in actual daily life behavior between patients classified as avoider or persister? J Back Musculoskelet Rehabil 2020; 33:303-311. [PMID: 31450487 DOI: 10.3233/bmr-171048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study is to determine whether patients, classified by their treating consultant in rehabilitation medicine as avoider or persister, show differences in a large set of detailed outcomes of actual, objectively measured daily physical behaviour. METHODS In this explorative cross-sectional study, 16 patients were included; 9 patients were categorized as avoider and 7 patients as persister. Subjects wore the VitaMove activity monitor, a high-end accelerometry-based device that allowed automatic detection of a large set of body postures and motions. Physical behaviour was assessed in detail by total duration of body postures and motions as percentages of 24 hours, as well as by the number of sit-to-stand transfers, overall activity level, walking speed, and the distribution of bouts of physical activity and sedentary behaviour. Differences between groups were tested with the Mann Whitney U test. RESULTS There were no significant differences between groups in any of the physical behaviour outcomes. CONCLUSIONS Our study showed that activity-related behavioural style categorization by consultants in rehabilitation medicine is not expressed in objectively measured detailed outcomes of daily physical behaviour.
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Affiliation(s)
- Ivan P J Huijnen
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Fabienne C Schasfoort
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,CIR Revalidatie Location Eindhoven, Eindhoven, The Netherlands
| | - Emiel Sneekes
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Jeanine A Verbunt
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Fear-Avoidance Beliefs and Health-Related Quality of Life in Post-ACL Reconstruction and Healthy Athletes: A Case–Control Study. J Sport Rehabil 2020; 29:772-776. [DOI: 10.1123/jsr.2018-0491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 11/18/2022]
Abstract
Context: Many athletes return to sport after anterior cruciate ligament reconstruction (ACLR) with lingering physical or mental health impairments. Examining health-related quality of life (HRQL) and fear-avoidance beliefs across the spectrum of noninjured athletes and athletes with a history of ACLR may provide further insight into targeted therapies warranted for this population. Objective: The purpose of this study was to examine differences in fear-avoidance beliefs and HRQL in college athletes with a history of ACLR not participating in sport (ACLR-NPS), participating in sport (ACLR-PS), and healthy controls (Control) with no history of injury participating in sport. Design: Cross-sectional. Setting: Laboratory. Patients (or Other Participants): A total of 10 college athletes per group (ACLR-NPS, ACLR-PS, and Control) were included. Participants were included if on a roster of a Division I or III athletic team during data collection. Interventions: Participants completed a demographic survey, the modified Disablement in the Physically Active Scale (mDPA) to assess HRQL, and Fear-Avoidance Beliefs Questionnaire (FABQ) to assess fear-avoidance beliefs. Main Outcome Measures: Scores on the mDPA (Physical and Mental) and FABQ subscales (Sport and Physical Activity) were calculated, a 1-way Kruskal–Wallis test and separate Mann–Whitney U post hoc tests were performed (P < .05). Results: ACLR-NPS (30.00 [26.00]) had higher FABQ-Sport scores than ACLR-PS (18.00 [26.00]; P < .001) and Controls (0.00 [2.50]; P < .001). ACLR-NPS (21.50 [6.25]) had higher FABQ-Physical Activity scores than ACLR-PS (12.50 [13.00]; P = .001) and Controls (0.00 [1.00]; P < .001). Interestingly, ACLR-PS scores for FABQ-Sport (P = .01) and FABQ-Physical Activity (P = .04) were elevated compared with Controls. ACLR-NPS had higher scores on the mDPA-Physical compared with the ACLR-PS (P < .001) and Controls (P < .001), and mDPA-Mental compared with ACLR-PS (P = .01), indicating decreased HRQL. Conclusions: The ACLR-NPS had greater fear-avoidance beliefs and lower HRQL compared with ACLR-PS and Controls. However, the ACLR-PS had higher scores for both FABQ subscales compared with Controls. These findings support the need for additional psychosocial therapies to address fear-avoidance beliefs in the returned to sport population.
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15
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The Effects of Thrust Joint Manipulation on the Resting and Contraction Thickness of Transversus Abdominis in Patients With Low Back Pain: A Randomized Control Trial. J Manipulative Physiol Ther 2020; 43:339-355. [PMID: 32709514 DOI: 10.1016/j.jmpt.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the immediate changes in resting and contracted thickness of the transversus abdominis (TrA) muscle after application of thrust joint manipulation (TJM) vs sham manipulation in participants with low back pain. METHODS A pretest-posttest randomized controlled trial design was performed. Consecutive subjects satisfying eligibility criteria completed patient-report outcome baseline measures, pretreatment rehabilitative ultrasound imaging (RUSI) measurements, followed by the randomly assigned intervention then, post-treatment RUSI measurements, and post-treatment & final patient-reported outcome measures. To compare the outcomes of TJM and sham manipulation on the TrA muscle thickness, a 2-by-2 analysis of variance (treatment [TJM and sham manipulation]) by time (pretreatment and post-treatment) was completed for both the TrA muscle thickness at rest and muscle thickness during contraction. Descriptive statistics including independent-sample t tests for continuous variables and χ2 tests for categorical variables were used to analyze differences in patient-reported outcome measures between groups. RESULTS Sixty-seven eligible participants agreed to participate. No significant interactions were identified for either muscle thickness at rest or contraction. CONCLUSION This study did not support the hypothesis that manipulation would result in greater changes in TrA thickness at rest or during contraction in participants with low back pain. Based on prior research that identified subgroups of participants likely to respond to manipulation, future research should include participants more likely to respond favorably to TJM. This study was a priori registered with clinicaltrails.gov (NCT02558855).
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Kozinc Ž, Baltrusch S, Houdijk H, Šarabon N. Reliability of a battery of tests for functional evaluation of trunk exoskeletons. APPLIED ERGONOMICS 2020; 86:103117. [PMID: 32342882 DOI: 10.1016/j.apergo.2020.103117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
Recently, several spinal exoskeletons were developed with the aim to assist occupational tasks such as load-handling and work in prolonged static postures. While the biomechanical effects of such devices has been well investigated, only limited feedback to the developers is usually provided regarding the subjective perceptions of the end-users. The aim of this study was to present a novel battery of tests, designed to assess functional performance and subjective outcomes during the use of assistive trunk exoskeletons, and to assess its test-retest reliability. The battery of tests consists of 12 different simple functional tasks. Twenty participants were included in an intra-session reliability test and repeated the tests within 7-10 days to assess inter-session reliability. They were wearing a novel passive spinal exoskeleton during all trials. The outcomes included quantitative and subjective measures, such as performance time and rating of discomfort and perceived task difficulty. The majority of the outcome measures were reliable within session and between sessions (ICC or α > 0.80). Systematic effects were observed in a few tasks, suggesting that familiarization trials will be needed to minimize the learning effects. The novel battery of tests could become an important easy-to-use tool for functional testing of the spinal exoskeletons in addition to more specific biomechanical and physiological testing. Further studies should address the reliability of the present battery of tests for assessing specific populations, such as low back pain patients and explore how to minimize systematic effects that were observed in this study.
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Affiliation(s)
- Žiga Kozinc
- University of Primorska, Andrej Marusic Institute, Department of Health Study, Koper, Slovenia; University of Primorska, Faculty of Health Sciences, Department of Kinesiology and Physiotherapy, Koper, Slovenia
| | - Saskia Baltrusch
- Research and Development, Rehabilitation Centre Heliomare, Wijk aan Zee, the Netherlands; Amsterdam Movement Sciences, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Han Houdijk
- Research and Development, Rehabilitation Centre Heliomare, Wijk aan Zee, the Netherlands; Amsterdam Movement Sciences, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Department of Kinesiology and Physiotherapy, Koper, Slovenia; S2P, Science to Practice, Ltd, Laboratory for Motor Control and Motor Behaviour, Ljubljana, Slovenia.
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Alperovitch-Najenson D, Weiner C, Ribak J, Kalichman L. Sliding Sheet Use in Nursing Practice: An Intervention Study. Workplace Health Saf 2019; 68:171-181. [DOI: 10.1177/2165079919880566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Previous studies have discovered that the utilization of sliding sheets in patient care is a valuable technique for repositioning bedridden patients compared with traditional cotton sheets or carriers. Our aim was to examine the effects of sliding sheet usage on work-related musculoskeletal disorders and disability, perceived workload, burnout, and job satisfaction, among nurses and nursing assistants. Method: This repeated measurement study included 41 female nurses and nursing assistants from three internal medicine departments who provided direct patient care. Participants completed an eight-part questionnaire (demographics, Neck Disability Index, Quick Disability of the Arms, Shoulder and Hand Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, BackAche Disability Index workload, burnout, and job satisfaction) 4 times during the study period: 3 months prior to the intervention, on the first day of the intervention, and 3 and 6 months after commencement of the intervention. Findings: After 3 and 6 months of sliding sheet usage, pain and disability decreased in the neck ( p < .001); arms, shoulders, hands ( p = .041); and lower back ( p < .001), with an increase in job satisfaction ( p < .001). Discussion/Application to Practice: The findings of our study indicate a clear influence of reducing work-related musculoskeletal pain and disability while increasing job satisfaction when sliding sheets are introduced into nursing practice. Occupational health nurses in health care should consider this type of low-cost intervention as a method for reducing musculoskeletal injury among direct patient care providers.
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18
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Generic and psychological patient-reported deficits in those with chronic ankle instability: A cross sectional study. Phys Ther Sport 2019; 40:137-142. [DOI: 10.1016/j.ptsp.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/26/2022]
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Treatment monitoring as a component of psychologically informed physical therapy: A case series of patients at high risk for persistent low back pain related disability. Musculoskelet Sci Pract 2019; 41:36-42. [PMID: 30909109 PMCID: PMC6528824 DOI: 10.1016/j.msksp.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/29/2019] [Accepted: 03/14/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychologically Informed Physical Therapy (PIPT) aims to identify individuals at high risk for transitioning to chronicity and merge impairment-focused physical therapy with cognitive behavioral therapy principles. Treatment monitoring is an important part of PIPT and involves identifying changes in clinical measures to inform clinical decision making. OBJECTIVES The purpose of this case series is to describe treatment monitoring using psychological and physical impairment measures for patients identified as 'high-risk' for persistent low back pain (LBP) related disability. DESIGN Secondary analysis of patients (n = 23) identified as 'high-risk' using the STarT Back Tool and enrolled in two-phased, sequential study that evaluated feasibility and generated preliminary PIPT treatment effects for 4-week clinical outcomes. METHOD Physical therapists (n = 5) used psychological [Fear-Avoidance Beliefs Questionnaire (FABQ-PA, FABQ-W), Tampa Scale for Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS) and Fear of Daily Activities Questionnaire (FDAQ)] and the Physical Impairment Index (PII) measures for PIPT treatment monitoring. Clinical outcome measures [Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI)] were administered at intake and 4-weeks later. Linear regression models evaluated independent contribution of intake and 4-week changes in psychological measures and PII scores as predictors of 4-week NPRS and ODI scores. RESULTS FABQ-PA and PCS changes provided largest contributions to prediction of 4-week ODI scores. Treatment monitoring measures did not explain additional variability in 4-week NPRS scores after baseline scores were considered. CONCLUSIONS For patients at high risk for persistent LBP psychological measures consistently performed better as treatment monitoring variables compared to physical impairment measures. Treatment monitoring for PIPT with psychological measures provides opportunities to refine prediction of disability outcomes. Findings from this exploratory case series should be interpreted with caution based on its small sample size and lack of statistical power which prohibits definitive conclusions to be made on any of the treatment monitoring measures.
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Rabin A, Shmushkevich Y, Kalichman L. Initial pain and disability characteristics can assist the prediction of the centralization phenomenon on initial assessment of patients with low back pain. J Man Manip Ther 2019; 27:66-72. [PMID: 30935340 DOI: 10.1080/10669817.2018.1542560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Determine whether the achievement of the centralization phenomenon on initial assessment of patients with low back pain (LBP) can be predicted by history and physical examination variables. METHODS Ninety patients referred to physical therapy due to LBP completed pain, disability, and fear-avoidance questionnaires, followed by a complete history and a physical examination based on mechanical diagnosis and therapy principles. Patients were subsequently classified as centralizers or noncentralizers. Univariate, followed by multivariate analysis was performed to identify history and physical examination variables that predicted the occurrence of the CP. Factors retained in the multivariate analysis were used to develop a clinical prediction rule (CPR). RESULTS Twenty-eight patients (31%) were classified as centralizers immediately following assessment. Three predictors were retained in the multivariate analysis: (1) modified Oswestry Disability Index score lower than 33%; (2) intensity of the most distal symptom lower than 6/10; and (3) back pain equal to or greater than leg pain. The resultant CPR indicated the presence of all three variables increased the post-test likelihood of the CP to 57%. DISCUSSION The findings of this study suggest the CP may be considerably more likely in less severe cases of LBP characterized by lower disability, lower intensity of distal symptoms, and a greater back-versus-leg pain intensity. Pending future validation, the CPR developed in this study may aide decision making regarding the initial management strategy of patients with LBP.
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Affiliation(s)
- Alon Rabin
- a Department of Physiotherapy , Ariel University , Ariel , Israel
| | - Yaniv Shmushkevich
- b Outpatient Physical therapy , Meuhedet Health Services , Hadera , Israel
| | - Leonid Kalichman
- c Department of Physiotherapy , Ben Gurion University , Beer Sheva , Israel
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Effectiveness and Downstream Healthcare Utilization for Patients That Received Early Physical Therapy Versus Usual Care for Low Back Pain: A Randomized Clinical Trial. Spine (Phila Pa 1976) 2018; 43:1313-1321. [PMID: 29489568 DOI: 10.1097/brs.0000000000002619] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE The aim of this study was to compare early physical therapy versus usual care in patients with low back pain. SUMMARY OF BACKGROUND DATA Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system. METHODS Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. Analysis of covariance was used to compare differences between groups, significance set at 0.05. TRIAL REGISTRATION clinicaltrials.gov: NCT01556581 RESULTS.: A total of 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference = 4.4; 95% CI: 0.41-10.1; P = 0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5037; 95 CI $4171-$6082 and PT $5299; 95 CI $4367-$6431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1096; 95% CI $855-$1405) compared to PT ($2016, 95% CI $1570-$2590). CONCLUSION There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC. LEVEL OF EVIDENCE 2.
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Ganesh GS, Sahu PK, Das SP, Mishra C, Dhiman S. A subgroup analysis to compare patients with acute low back pain classified as per treatment-based classification. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1747. [PMID: 30226651 DOI: 10.1002/pri.1747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/17/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The evidence for the effectiveness of interventions targeting acute low back pain (LBP) is suboptimal. It is difficult to identify those patients who are more likely to develop chronic pain and disability after an acute episode of LBP. These shortcomings may be attributed to considering LBP as one homogenous condition. METHODS In this quasi-experimental study, we examined and analysed a prospective cohort of 267 patients with first-onset LBP and classified them into one of the groups based on treatment-based classification: direction-specified exercises (Group 2), manipulation (Group 3), stabilization exercises (Group 4), traction (Group 5), and a physician care group (Group 1). Disability and pain were assessed at baseline, after treatment, and at 6 months using the Oswestry Disability Index and the Numerical Rating Scale, respectively. Comparisons were made between the groups, and we predicted measures of disability and pain intensity at 6 months with age, gender, fear avoidance behaviour, centralization phenomenon (CP), expectations about recovery, CP, group classification, baseline pain, and disability. RESULTS Analysis showed that all the heterogeneous groups of LBP improved their outcomes with the respective treatment provided. However, when the entire sample was considered as one homogenous group of LBP, the results showed improvement with time (p < 0.05) only and no difference was found between groups (p > 0.05). None of the studied factors, except baseline pain (R = 0.227, R2 = 0.051, p < 0.05), were able to accurately predict the development of chronic pain in our study sample. CONCLUSION Though our results showed no differences between the subgroups in the reduction of pain and disability, we conclude that classifying and treating patients with LBP into subgroups based on signs and symptoms produce better outcomes. Baseline pain alone may predict a small percentage of people who may develop chronic pain.
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Affiliation(s)
- G Shankar Ganesh
- Department of Physiotherapy, Composite Regional Centre for Persons with Disabilities, Lucknow, India
| | - Pradeep Kumar Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sakti Prasad Das
- Department of Physical Medicine and Rehabilitation, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Chittaranjan Mishra
- Department of Physiotherapy, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Sapna Dhiman
- Department of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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Hall EA, Chomistek AK, Kingma JJ, Docherty CL. Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part II: Assessing Patient-Reported Outcome Measures. J Athl Train 2018; 53:578-583. [PMID: 29995462 DOI: 10.4085/1062-6050-387-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Assessing global, regional, and fear-of-reinjury outcomes in individuals with chronic ankle instability (CAI) is critical to understanding the effectiveness of clinical interventions. OBJECTIVE To determine the improvement of patient-reported outcomes after balance- and strength-training and control protocols among participants with CAI. DESIGN Randomized controlled clinical trial. SETTING Athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-nine volunteers with CAI who scored 11 or greater on the Identification of Functional Ankle Instability questionnaire were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). INTERVENTION(S) Each group met for 20 minutes, 3 times each week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. MAIN OUTCOME MEASURE(S) Global patient-reported outcomes, regional ankle function, and perceived instability were measured using the Disablement in the Physically Active Scale, the Fear-Avoidance Beliefs Questionnaire, the Foot and Ankle Ability Measure, and a visual analog scale for perceived instability. Participants completed the questionnaires at pretest and 6 weeks posttest. A multivariate repeated-measures analysis of variance with follow-up univariate analysis was conducted. The α level was set a priori at .05. RESULTS No time-by-group interaction was found ( P = .78, η2 = 0.09). However, we observed a main effect for time ( P = .001, η2 = 0.49). Follow-up univariate analyses revealed differences between the pretest and posttest for the Disablement in the Physically Active Scale ( P = .02, η2 = 0.15), Fear-Avoidance Beliefs Questionnaire ( P = .001, η2 = 0.27), Foot and Ankle Ability Measure-Activities of Daily Living subscale ( P = .003, η2 = 0.22), Foot and Ankle Ability Measure-Sport subscale ( P = .001, η2 = 0.36), and visual analog scale ( P = .008, η2 = 0.18). CONCLUSIONS Statistically, after the 6-week intervention, all groups improved in global and regional health-related quality of life. Clinicians should compare patient-reported outcomes with clinical measures to have a better understanding of progression during rehabilitation.
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Affiliation(s)
- Emily A Hall
- Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa; Departments of
| | | | - Jackie J Kingma
- Kinesiology, School of Public Health, Indiana University, Bloomington
| | - Carrie L Docherty
- Kinesiology, School of Public Health, Indiana University, Bloomington
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Canaway A, Pincus T, Underwood M, Shapiro Y, Chodick G, Ben-Ami N. Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel. BMJ Open 2018; 8:e019928. [PMID: 29643158 PMCID: PMC5898302 DOI: 10.1136/bmjopen-2017-019928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of an enhanced transtheoretical model of behaviour change in conjunction with physiotherapy compared with standard care (physiotherapy) in patients with chronic lower back pain (CLBP). DESIGN Cost-utility and cost-effectiveness analyses alongside a multicentre controlled trial from a healthcare perspective with a 1-year time horizon. SETTING The trial was conducted in eight centres within the Sharon district in Israel. PARTICIPANTS 220 participants aged between 25 and 55 years who suffered from CLBP for a minimum of 3 months were recruited. INTERVENTIONS The intervention used a model of behaviour change that sought to increase the adherence and implementation of physical activity in conjunction with physiotherapy. The control arm received standard care in the form of physiotherapy. PRIMARY AND SECONDARY MEASURES The primary outcome was the incremental cost per quality-adjusted life year (QALY) of the intervention arm compared with standard care. The secondary outcome was the incremental cost per Roland-Morris Disability Questionnaire point. RESULTS The cost per QALY point estimate was 10 645 New Israeli shekels (NIS) (£1737.11). There was an 88% chance the intervention was cost-effective at NIS50 000 per QALY threshold. Excluding training costs, the intervention dominated the control arm, resulting in fewer physiotherapy and physician visits while improving outcomes. CONCLUSIONS The enhanced transtheoretical model intervention appears to be a very cost-effective intervention leading to improved outcomes for low cost. Given limitations within this study, there is justification for examining the intervention within a larger, long-term randomised controlled trial. TRIAL REGISTRATION NUMBER NCT01631344; Pre-results.
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Affiliation(s)
- Alastair Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Yair Shapiro
- Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Gabriel Chodick
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Noa Ben-Ami
- Faculty of Health Sciences, Ariel University, Ariel, Israel
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Bishop MD, Mintken P, Bialosky JE, Cleland JA. Factors shaping expectations for complete relief from symptoms during rehabilitation for patients with spine pain. Physiother Theory Pract 2018; 35:70-79. [PMID: 29452024 DOI: 10.1080/09593985.2018.1440676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Patient expectations are related to treatment outcome across a broad variety of patient conditions. Here we sought to examine factors associated with the expectation of complete relief from treatment for spinal pain. DESIGN Secondary analysis of data pooled from two randomized controlled trials of conservative rehabilitation interventions. PATIENTS 252 patients (103 men, 149 women) with neck (n = 140) or back (n = 112) pain. METHODS We used logistic regression model with backward elimination to test which patient clinical or demographic factors were most related to the expectation of complete relief. MAIN OUTCOME MEASURES The expectation of complete recovery, which was collected at the baseline examination visit in the primary trials. RESULTS The final model examining the contributions of patient and clinical characteristics to the expectation of complete relief included two significant interactions. First, increasing disability was associated with increased odds of expecting complete recovery in women while there was very little change for men across levels of disability (OR 0.9 [95%CI 0.8, 0.9]). Second, patients with low fear and a sudden onset of pain had higher odds of expecting recovery than patients with a gradual onset of pain (OR 0.7 [95%CI 0.5, 0.97]). A main effect for education level of the patient was also significant with better odds for expecting complete recovery for college educated patients compared to those with graduate school education (OR 5.0 [95%CI 1.9, 13.4]). CONCLUSION The results should assist physical therapists to recognize patients who may have lower expectations of recovery and plan pre-treatment education interventions.
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Affiliation(s)
- Mark D Bishop
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Center for Pain Research and Behavioral Health , University of Florida , Gainesville , FL , USA
| | - Paul Mintken
- c Department of Physical Therapy , University of Colorado , Aurora , CO , USA.,d Wardenburg Health Center , University of Colorado Boulder , Boulder , CO , USA
| | - Joel E Bialosky
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Center for Pain Research and Behavioral Health , University of Florida , Gainesville , FL , USA
| | - Joshua A Cleland
- e Department of Physical Therapy , Franklin Pierce University , Concord , NH , USA.,f Rehabilitation Services , Concord Hospital , Concord , NH , USA
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Seo BK, Han K, Kwon O, Jo DJ, Lee JH. Efficacy of Bee Venom Acupuncture for Chronic Low Back Pain: A Randomized, Double-Blinded, Sham-Controlled Trial. Toxins (Basel) 2017; 9:toxins9110361. [PMID: 29112155 PMCID: PMC5705976 DOI: 10.3390/toxins9110361] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 11/23/2022] Open
Abstract
Bee venom acupuncture (BVA) is an effective treatment for chronic low back pain (CLBP) through the pharmacological effects of bee venom and the simultaneous stimulation of acupoints. However, evidence of its efficacy and safety in humans remains unclear. Using a double-blind, randomized study, 54 patients with non-specific CLBP were assigned to the BVA and sham groups. All participants underwent six sessions of real or sham BVA for 3 weeks, in addition to administration of 180 mg of loxonin per day. The primary outcome, that is, “bothersomeness” derived from back pain, was assessed using the visual analog scale. Secondary outcomes included pain intensity, dysfunction related to back pain (Oswestry Disability Index), quality of life (EuroQol 5-Dimension), and depressive mood (Beck’s depression inventory). Outcomes were evaluated every week during the treatment period and followed up at weeks 4, 8, and 12. After 3 weeks of the treatment, significant improvements were observed in the bothersomeness, pain intensity, and functional status in the BVA group compared with the sham group. Although minimal adverse events were observed in both groups, subsequent recovery was achieved without treatment. Consequently, our results suggest that it can be used along with conventional pharmacological therapies for the treatment of CLBP.
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Affiliation(s)
- Byung-Kwan Seo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul 05278, Korea.
| | - Kyungsun Han
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea.
| | - Ojin Kwon
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea.
| | - Dae-Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul 05278, Korea.
| | - Jun-Hwan Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea.
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon 34113, Korea.
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Leysen M, Nijs J, Van Wilgen CP, Struyf F, Meeus M, Fransen E, Demoulin C, Smeets RJ, Roussel NA. Illness Perceptions Explain the Variance in Functional Disability, but Not Habitual Physical Activity, in Patients With Chronic Low Back Pain: A Cross-Sectional Study. Pain Pract 2017; 18:523-531. [DOI: 10.1111/papr.12642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/18/2017] [Accepted: 09/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Marijke Leysen
- Rehabilitation Sciences and Physiotherapy (REVAKI); Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Pain in Motion International Research Group
- Department of Physiotherapy, Physiology and Anatomy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Jo Nijs
- Pain in Motion International Research Group
- Department of Physiotherapy, Physiology and Anatomy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Department of Physical Medicine and Physiotherapy; University Hospital Brussels; Brussels Belgium
| | - C. Paul Van Wilgen
- Pain in Motion International Research Group
- Department of Physiotherapy, Physiology and Anatomy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Transdisciplinary Pain Management Centre; Transcare; Groningen The Netherlands
| | - Filip Struyf
- Rehabilitation Sciences and Physiotherapy (REVAKI); Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Pain in Motion International Research Group
- Department of Physiotherapy, Physiology and Anatomy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Mira Meeus
- Rehabilitation Sciences and Physiotherapy (REVAKI); Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Pain in Motion International Research Group
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Erik Fransen
- StatUA Centre for Statistics; University of Antwerp; Antwerp Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences; University of Liege; Liege Belgium
- Department of Physical Medicine and Rehabilitation; Liege University Hospital; Liege Belgium
| | - Rob J.E.M. Smeets
- Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- School of Caphri; Maastricht University; Maastricht, Limburg The Netherlands
| | - Nathalie A. Roussel
- Rehabilitation Sciences and Physiotherapy (REVAKI); Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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Unique Contributions of Body Diagram Scores and Psychosocial Factors to Pain Intensity and Disability in Patients With Musculoskeletal Pain. J Orthop Sports Phys Ther 2017; 47:88-96. [PMID: 27819193 DOI: 10.2519/jospt.2017.6778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Retrospective cross-sectional cohort of military patients with musculoskeletal pain. Background Body diagrams are used to document symptoms and can also serve as a proxy to assess psychological influence. However, literature to support this is conflicting. Objectives To (1) examine the unique contribution of pain and nonpain symptom distribution to magnitude of self-reported pain intensity and disability, and (2) assess the moderating influence of psychological factors and body diagram score on concurrent pain intensity and disability. Methods Pain, numbness, and tingling were denoted on a body diagram at initial evaluation. Fear-avoidance beliefs, pain catastrophizing, and region-specific self-reported disability measures were collected. The contributions of pain and nonpain symptom distribution to pain intensity and disability were assessed to determine which body diagram symptom scoring method (pain only, nonpain, or composite) was appropriate for subsequent analyses. Hierarchical linear regression analyses were then used to determine the moderating effects of the Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire and the body diagram score on concurrent pain and disability. Results The Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire explained between 16% and 17% of the variance in pain intensity, and 8% of variance in disability (all, P<.001). The composite symptom score explained an additional 4% to 5% variance in concurrent disability and pain intensity (all, P<.001). The Pain Catastrophizing Scale moderated the relationship between body diagram score and pain intensity. The positive relationship between composite symptom score and concurrent pain intensity is stronger for patients with low catastrophizing. Conclusion The clinical utility of body diagrams with low symptom distribution may be improved by concomitant assessment of pain catastrophizing and warrants further longitudinal investigation. Level of Evidence Symptom prevalence, level 2b. J Orthop Sports Phys Ther 2017;47(2):88-96. Epub 5 Nov 2016. doi:10.2519/jospt.2017.6778.
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Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial. J Orthop Sports Phys Ther 2017; 47:57-66. [PMID: 28142364 DOI: 10.2519/jospt.2017.7057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Prospective, pragmatic, nonrandomized controlled clinical trial. Background Clinical guidelines recommend physical activity for the treatment of chronic low back pain. But engaging patients in physical activity has proven difficult. Known obstacles to physical activity include low self-efficacy and fear avoidance. Objectives This study tested the effectiveness of an enhanced transtheoretical model intervention (ETMI) aimed at increasing recreational physical activity in patients with chronic low back pain, in comparison to usual physical therapy. Methods Patients (n = 220) referred to physical therapy for chronic low back pain were allocated to ETMI or to a control group. The ETMI was delivered by physical therapists and based on behavior-change principles, combined with increased reassurance, therapeutic alliance, and exposure to reduce fear avoidance. The primary outcome was back pain-related disability (Roland-Morris Disability Questionnaire). Secondary outcomes included pain intensity, mental and physical health, and levels of physical activity. Results Intention-to-treat analysis in 189 patients at 12 months indicated that patients in the ETMI group had significantly lower disability compared to usual physical therapy. The difference in mean change from baseline between the interventions was 2.7 points (95% confidence interval: 0.9, 4.5) on the Roland-Morris Disability Questionnaire. At 12 months, worst pain, physical activity, and physical health were all significantly better in patients receiving ETMI. The average number of sessions was 3.5 for the ETMI group and 5.1 for controls. Conclusion Targeting obstacles to physical activity with an intervention that includes components to address self-efficacy and fear avoidance appears to be more effective than usual physical therapy care in reducing long-term disability. Further research is needed to explore the mechanisms that impact outcomes in this intervention package. Level of Evidence Therapy, level 2b. Registered June 7, 2012 at ClinicalTrials.gov (NCT01631344). J Orthop Sports Phys Ther 2017;47(2):57-66. doi:10.2519/jospt.2017.7057.
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Prevalence of back pain in adolescent pupils according to their activity. SPORT SCIENCES FOR HEALTH 2016. [DOI: 10.1007/s11332-016-0302-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rhon DI, Teyhen DS, Shaffer SW, Goffar SL, Kiesel K, Plisky PP. Developing predictive models for return to work using the Military Power, Performance and Prevention (MP3) musculoskeletal injury risk algorithm: a study protocol for an injury risk assessment programme. Inj Prev 2016; 24:81-88. [PMID: 27884941 PMCID: PMC5800339 DOI: 10.1136/injuryprev-2016-042234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Musculoskeletal injuries are a primary source of disability in the US Military, and low back pain and lower extremity injuries account for over 44% of limited work days annually. History of prior musculoskeletal injury increases the risk for future injury. This study aims to determine the risk of injury after returning to work from a previous injury. The objective is to identify criteria that can help predict likelihood for future injury or re-injury. METHODS There will be 480 active duty soldiers recruited from across four medical centres. These will be patients who have sustained a musculoskeletal injury in the lower extremity or lumbar/thoracic spine, and have now been cleared to return back to work without any limitations. Subjects will undergo a battery of physical performance tests and fill out sociodemographic surveys. They will be followed for a year to identify any musculoskeletal injuries that occur. Prediction algorithms will be derived using regression analysis from performance and sociodemographic variables found to be significantly different between injured and non-injured subjects. DISCUSSION Due to the high rates of injuries, injury prevention and prediction initiatives are growing. This is the first study looking at predicting re-injury rates after an initial musculoskeletal injury. In addition, multivariate prediction models appear to have move value than models based on only one variable. This approach aims to validate a multivariate model used in healthy non-injured individuals to help improve variables that best predict the ability to return to work with lower risk of injury, after a recent musculoskeletal injury. TRIAL REGISTRATION NUMBER NCT02776930.
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Affiliation(s)
- Daniel I Rhon
- Center for the Intrepid, Brooke Army Medical Center, JBSA, Fort Sam Houston, Texas, USA.,Doctoral Program in Physical Therapy, Baylor University, JBSA, Fort Sam Houston, Texas, USA
| | | | - Scott W Shaffer
- Doctoral Program in Physical Therapy, Baylor University, JBSA, Fort Sam Houston, Texas, USA.,Army Medical Department Center and School, Graduate School, JBSA, Fort Sam Houston, Texas, USA
| | - Stephen L Goffar
- University of the Incarnate Word, School of Physical Therapy, San Antonio, Texas, USA
| | - Kyle Kiesel
- University of Evansville, School of Physical Therapy, Evansville, Indiana, USA
| | - Phil P Plisky
- University of Evansville, School of Physical Therapy, Evansville, Indiana, USA
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Dynamic balance as measured by the Y-Balance Test is reduced in individuals with low back pain: A cross-sectional comparative study. Phys Ther Sport 2016; 22:29-34. [DOI: 10.1016/j.ptsp.2016.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/26/2022]
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Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm. Arch Phys Med Rehabil 2016; 98:80-87. [PMID: 27693421 DOI: 10.1016/j.apmr.2016.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM). DESIGN Single-group, repeated-measures design. SETTING The laboratory and participants' home and work environments. PARTICIPANTS Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men). INTERVENTION Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks. MAIN OUTCOME MEASURES The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention. RESULTS The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements. CONCLUSIONS The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states.
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Segal-Snir Y, Lubetzky VA, Masharawi Y. Rotation exercise classes did not improve function in women with non-specific chronic low back pain: A randomized single blind controlled study. J Back Musculoskelet Rehabil 2016; 29:467-75. [PMID: 26519116 DOI: 10.3233/bmr-150642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise is considered the first line of treatment for people with non-specific chronic low back pain (NSCLBP) but the ideal exercise type is currently unclear. Given the unique anatomical structure of the lower lumbar spine and the lumbosacral junction transverse-plane rotation exercises may be helpful for people suffering from pain in this region. OBJECTIVE We aimed to examine the effect of spinal rotation exercises delivered in a group format on range of motion, pain level and function parameters in women with NSCLBP. METHODS This was a randomized controlled single-blinded study. Thirty-five women with NSCLBP, participated in either a bi-weekly rotation exercise classes (n= 20) or a `wait-list' control group (n = 15). The exercises aimed at improving lumbar mobility in the transverse plane. Pain rated on a Visual Analog Scale, back specific disability (Rolland Morris questionnaire), and lumbar range of motion (flexion, extension and left and right rotation) were taken prior to intervention, immediately following 4 weeks of intervention and 8 weeks later. RESULTS There were no significant differences for either group (p> 0.05) on all dependent variables at all times of measurements. CONCLUSIONS A specific group program of rotation exercises had no effect on the functional status, pain level and lumbar range of motion in women with NSCLBP.
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Affiliation(s)
- Yael Segal-Snir
- Haclalit Medical Center, and Department of Physiotherapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Jaffa, Israel
| | - V Anat Lubetzky
- Department of Physical Therapy, New York University, New York, NY, USA
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physiotherapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Jaffa, Israel
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van Weering M, Vollenbroek-Hutten M, Kotte E, Hermens H. Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls. A systematic review. Clin Rehabil 2016; 21:1007-23. [DOI: 10.1177/0269215507078331] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To gain an insight into the daily physical activity levels of patients with chronic pain or fatigue compared with asymptomatic controls. Data sources: MEDLINE, EMBASE, PsycINFO, Picarta, Cochrane Database of Systematic Reviews, reference tracking and a manual search of relevant journals. Review methods: A systematic, computerized database search of the medical databases up to September 2006 was performed. In addition, a hand search of relevant journals was carried out. Appropriate studies reported on the daily physical activities of adult patients with chronic pain or fatigue and included an asymptomatic control group. Two reviewers independently carried out methodological quality assessment and data extraction. A qualitative analysis was performed. Results: Twelve studies were included, involving five different syndromes. Results show large heterogeneity in methods used and syndromes investigated, which limited evidence. Eleven different methods were used to assess daily physical activities resulting in 16 different outcome parameters. There seem to be differences between the different syndromes, but results are not conclusive. Eight studies reported a lower physical activity level in patients compared with controls. There seems to be a difference in results between studies using objective versus those using subjective methods. Conclusions: Results reported in the literature with respect to the activity level of patients with chronic pain or fatigue compared with controls were too heterogeneous to give sufficient evidence and were not conclusive.
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Affiliation(s)
| | | | | | - H.J. Hermens
- Roessingh Research and Development, Enschede and Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
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Van Dillen LR, Norton BJ, Sahrmann SA, Evanoff BA, Harris-Hayes M, Holtzman GW, Earley J, Chou I, Strube MJ. Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. ACTA ACUST UNITED AC 2016; 24:52-64. [PMID: 27317505 DOI: 10.1016/j.math.2016.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 03/31/2016] [Accepted: 04/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown. OBJECTIVES Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes. DESIGN 2 center, 2 parallel group, prospective, randomized, clinical trial. METHOD Participants with chronic LBP were classified and randomized. Self-report data was obtained at baseline, post-treatment, and 6 and 12 months post-treatment. The primary outcome was the modified Oswestry Disability Index (mODI; 0-100%). Treatment effect modifiers were exercise adherence and performance training adherence. An intention to treat approach and hierarchical linear modeling were used. RESULTS 47 people received CS treatment, 54 people received NCs treatment. Treatment groups did not differ in mODI scores (p > 0.05). For both groups, scores improved with treatment (p < 0.05), plateaued at 6 months (p > 0.05), and minimally regressed at 12 months (p < 0.05). Performance training adherence had a unique, independent effect on mODI scores above and beyond the effect of exercise adherence (p < 0.05). There were no treatment group effects on the relationship between mODI scores and the two types of adherence (p < 0.05). CONCLUSIONS There were no differences in function between the two treatment groups (CS and NCs). In both treatment groups, people with chronic LBP displayed clinically important long-term improvements in function. When both forms of adherence were considered, the improvements were uniquely related to adherence to performance training.
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Affiliation(s)
- Linda R Van Dillen
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Barbara J Norton
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Shirley A Sahrmann
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave, St. Louis, MO, 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, Campus Box 8228, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Bradley A Evanoff
- Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Gregory W Holtzman
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Jeanne Earley
- Physical Therapy Department, The Rehabilitation Institute of Saint Louis, 4455 Duncan Avenue, St. Louis, MO, 63110, USA
| | - Irene Chou
- Physical Therapy Department, The Rehabilitation Institute of Saint Louis, 4455 Duncan Avenue, St. Louis, MO, 63110, USA
| | - Michael J Strube
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Psychology, Washington University, Campus Box 1125, One Brookings Drive, St. Louis, MO, 63130, USA
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Rhon D, Fritz J. COMParative Early Treatment Effectiveness between physical therapy and usual care for low back pain (COMPETE): study protocol for a randomized controlled trial. Trials 2015; 16:423. [PMID: 26399603 PMCID: PMC4581511 DOI: 10.1186/s13063-015-0959-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/14/2015] [Indexed: 12/02/2022] Open
Abstract
Background Low back pain is among the leading causes of medical visits and lost duty days among members of the United States Armed Forces and represents the highest 5-year risk of permanent disability in the US Army. For certain elements of care, the timing may be just as important as the type of care. The purpose of this study is to assess the impact of the timing of access to a physical therapist by patients with low back pain, by looking at outcomes and low back pain-related healthcare utilization over a 1-year period. Methods/Design This trial will be a two-arm pragmatic randomized clinical trial occurring at two different clinical sites in the Military Health System. We will assess outcomes and related downstream costs for patients who access physical therapy at the primary care level compared to those that receive usual care only. There will be 220 consecutive patients randomized to receive care in either group (early physical therapy or usual care only) for the first 4 weeks, and these patients will then be allowed to receive any additional care dictated by their primary care provider for the following year. The primary outcome measure is the Oswestry Disability Index. Secondary outcome measures are the Global Rating of Change, Patient Satisfaction and 1-year healthcare utilization. Follow-ups will occur at 4 weeks, 3 months and 1 year. Discussion This trial takes a pragmatic approach to delivering care by enabling a usual care environment for managing low back pain, while also allowing immediate access to physical therapy. After the initial intervention, the patient’s primary provider can continue to manage the patient as he/she normally would in practice. The Military Health System Data Repository will capture all low back pain-related healthcare utilization that occurs in order to allow for a comparison between groups. Analysis from retrospective cohorts has shown improved outcomes and decreased costs for patients that received early versus late physical therapy, but this has yet to be shown in prospective trials. Trial registration ClinicalTrials.Gov NCT01556581 initially on 14 March 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0959-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Rhon
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA.
| | - Julie Fritz
- Department of Physical Therapy, College of Health, University of Utah, 520 Wakara Way, Salt Lake City, Utah, 84108, USA.
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Houston MN, Van Lunen BL, Hoch MC. Health-related quality of life in individuals with chronic ankle instability. J Athl Train 2015; 49:758-63. [PMID: 25299444 DOI: 10.4085/1062-6050-49.3.54] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Individuals with chronic ankle instability (CAI) have reported decreased global and regional function. Despite the identification of functional deficits in those with CAI, more research is required to determine the extent to which CAI influences the multidimensional profile of health-related quality of life. OBJECTIVE To determine whether global, regional, and psychological health-related outcomes differ between individuals with and without CAI. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-five participants with CAI (age = 21.9 ± 2.5 years, height = 170.8 ± 8.6 cm, mass = 69.8.0 ± 11.7 kg) were sex- and limb-matched to 25 healthy participants (age = 22.0 ± 2.1 years, height = 167.4 ± 9.1 cm, mass = 64.8 ± 11.2 kg). MAIN OUTCOME MEASURE(S) Both groups completed the Disablement in the Physically Active Scale, the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport, the Tampa Scale of Kinesiophobia-11, and the Fear-Avoidance Beliefs Questionnaire. Dependent variables were scores on these instruments, and the independent variable was group. RESULTS Compared with healthy individuals, those with CAI reported decreased function on the Disablement in the Physically Active Scale, FAAM, and FAAM-Sport (P < .001) and increased fear of reinjury on the Tampa Scale of Kinesiophobia-11 and Fear-Avoidance Beliefs Questionnaire (P < .001). In the CAI group, the FAAM and FAAM-Sport demonstrated a significant relationship (r = 0.774, P < .01). CONCLUSIONS Individuals with CAI reported decreased function and increased fear of reinjury compared with healthy control participants. Also, within the CAI group, there was a strong relationship between FAAM and FAAM-Sport scores but not between any other instruments. These findings suggest that health-related quality of life should be examined during the rehabilitation process of individuals with CAI.
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Kumar K, Verma AK, Wilson J, LaFontaine A. Vertebroplasty in Osteoporotic Spine Fractures: A Quality of Life Assessment. Can J Neurol Sci 2014; 32:487-95. [PMID: 16408580 DOI: 10.1017/s0317167100004492] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT:Objective:Our goal was to perform a quantitative evaluation of the improvement in functional capacity, quality of life, mental function, reduction in drug intake and impact on hospital admissions after vertebroplasty in the treatment of osteoporotic compression fractures. The efficacy of vertebroplasty in relief of pain has been addressed in previous publications but the quantitative evaluation of improvement in quality of life has not been addressed before.Methods:This is a prospective study of 42 patients with 83 symptomatic vertebral fractures treated by vertebroplasty with a mean follow-up of 9.1 months. The outcome was measured by pre and postoperatively utilizing the Visual Analogue Scale, the Oswestry Disability Index, the Rolland Morris Scale for Back Pain and EuroQol-5D questionnaire (EQ-5D). The postoperative evaluations were performed at one week, one month, three month, and six month intervals thereafter.Results:In 34 out of 39 active patients, marked pain relief was noted (87%). The Visual Analogue Scale score improved from a mean preoperative score of 8.2 to a mean postoperative score of 2.9 (p=0.0000003) at one week follow up and 3.9 at the last follow-up. The Rolland Morris Scale for Back Pain showed a drop from a mean preoperative rating of 13 to a mean postoperative rating of 10, showing a 25% improvement (p= 0.0207). The Oswestry Disability Index preoperatively was 64.4 which improved to 43.8 postoperatively, showing a 32% improvement (p= 0.0207). The EQ-5D showed a mean preoperative index value of 0.097 and mean postoperative index value of 0.592 (p = 0.0000003). All p-values were determined by the Willcoxin sign-ranked test.Conclusion:Vertebroplasty is a safe and efficacious procedure with a resulting improvement in pain and quality of life.
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Affiliation(s)
- Krishna Kumar
- Department of Surgery, Section of Neurosurgery, Regina General Hospital, University of Saskatchewan, Regina, SK, Canada
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Leonhardt M, Liebers F, Dionne CE, Latza U. Cross-cultural adaptation of the delphi definitions of low back pain prevalence (German DOLBaPP). BMC Musculoskelet Disord 2014; 15:397. [PMID: 25425047 PMCID: PMC4258005 DOI: 10.1186/1471-2474-15-397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessed dimensions of low back pain (LBP) vary in prevalence studies. This may explain the heterogeneity in frequency estimates. To standardize definitions of LBP, an English consensus with 28 experts from 12 countries developed the "Delphi Definitions of Low Back Pain Prevalence" (DOLBaPP). The optimal definition and the shorter minimal definition with the related questionnaires for online, paper, and face-to-face use and telephone surveys are suitable for population-based studies. The definitions have to be adapted to different languages and cultures to provide comparable frequency estimates. The objective was to culturally adapt and pre-test the English definitions and corresponding Delphi DOLBaPP questionnaire forms into German. METHODS The German DOLBaPP adaptation was conducted using the systematic approach suggested by Beaton et al. A pre-test of the Delphi DOLBaPP optimal paper questionnaire including an additional evaluation form was conducted in a sample of 121 employees (mainly office workers). In order to evaluate the comprehensibility, usability, applicability, and completeness of the adapted questionnaire, response to the questionnaire and 6 closed evaluation questions were analyzed descriptively. Qualitative methods were used for the 3 open questions of the evaluation form. RESULTS The cultural adaptation of the DOLBaPP for a German-speaking audience required little linguistic adaptation. Conceptual equivalence was difficult for the expression "low back pain". The expert committee considered the face validity of the pre-final version of the related Delphi DOLBaPP questionnaires as good. In the pre-test, most participants (95%) needed less than 5 minutes to fill in the optimal Delphi DOLBaPP questionnaire. They were generally positive regarding length, wording, diagram, and composition. All subjects with LBP (n=61 out of 121 - 50.4%) answered the questions on functional limitation, sciatic pain, frequency and duration of symptoms as well as pain severity. CONCLUSION The results indicate that the cross-cultural German adaptation of the DOLBaPP Definitions and the corresponding questionnaires was successful. The definitions can be used in epidemiological studies to measure the prevalence of LBP. Some critical issues were raised regarding the general features of the Delphi DOLBaPP questionnaires. Future research is needed to evaluate these instruments.
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Affiliation(s)
- Marja Leonhardt
- />Berlin School of Public Health at the Charité, Seestr. 73, D-13347 Berlin, Germany
| | - Falk Liebers
- />Federal Institute for Occupational Safety and Health (BAuA), Noeldnerstr. 40/42, D-10317 Berlin, Germany
| | - Clermont E Dionne
- />Axe Santé des populations et pratiques optimales en santé du Centre de recherche FRQ-S du CHU de Québec, 1050, chemin Ste-Foy, Québec City, QC G1S 4L8 Canada
| | - Ute Latza
- />Federal Institute for Occupational Safety and Health (BAuA), Noeldnerstr. 40/42, D-10317 Berlin, Germany
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Beneciuk JM, Robinson ME, George SZ. Subgrouping for patients with low back pain: a multidimensional approach incorporating cluster analysis and the STarT Back Screening Tool. THE JOURNAL OF PAIN 2014; 16:19-30. [PMID: 25451622 DOI: 10.1016/j.jpain.2014.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 10/02/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Early screening for psychological distress has been suggested to improve patient management for individuals experiencing low back pain. This study compared 2 approaches to psychological screening (ie, multidimensional and unidimensional) so that preliminary recommendations on which approach may be appropriate for use in clinical settings other than primary care could be provided. Specifically, this study investigated aspects of the STarT Back Screening Tool (SBT): 1) discriminant validity by evaluating its relationship with unidimensional psychological measures and 2) construct validity by evaluating how SBT risk categories compared to empirically derived subgroups using unidimensional psychological and disability measures. Patients (N = 146) receiving physical therapy for LBP were administered the SBT and a battery of unidimensional psychological measures at initial evaluation. Clinical measures consisted of pain intensity and self-reported disability. Several SBT risk-dependent relationships (ie, SBT low < medium < high risk) were identified for unidimensional psychological measure scores, with depressive symptom scores associated with the strongest influence on SBT risk categorization. Empirically derived subgroups indicated that there was no evidence of distinctive patterns among psychological or disability measures other than high or low profiles; therefore, 2 groups may provide a clearer representation of the level of pain-associated psychological distress, maladaptive coping, and disability in this setting compared with 3 groups as suggested when using the SBT in primary care settings. PERSPECTIVE This study suggests that the SBT can replace administering several unidimensional psychological measures as a first-line screening measure for psychological distress. However, clinicians need to be aware of the potential for misclassification with SBT results when compared to unidimensional measures. This study also suggests that a modified SBT risk stratification scheme based on empirically derived subgroups could potentially assist in identifying elevated levels of pain-associated psychological distress, maladaptive coping, and disability in practice settings outside of primary care. Patients identified with elevated levels of pain-associated distress and maladaptive coping may be indicated for additional assessment using construct-specific questionnaires.
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida; Brooks Rehabilitation-University of Florida College of Public Health and Health Professions Research Collaboration, Jacksonville, Florida.
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, Florida; Brooks Rehabilitation-University of Florida College of Public Health and Health Professions Research Collaboration, Jacksonville, Florida; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida
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Huijnen IPJ, Verbunt JA, Meeus M, Smeets RJEM. Energy Expenditure during Functional Daily Life Performances in Patients with Fibromyalgia. Pain Pract 2014; 15:748-56. [DOI: 10.1111/papr.12245] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/01/2014] [Accepted: 08/18/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Ivan P. J. Huijnen
- Research School CAPHRI; Department of Rehabilitation Medicine; Maastricht University; Maastricht The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Academic Hospital Maastricht; Department of Rehabilitation Medicine; Maastricht The Netherlands
| | - Jeanine A. Verbunt
- Research School CAPHRI; Department of Rehabilitation Medicine; Maastricht University; Maastricht The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Academic Hospital Maastricht; Department of Rehabilitation Medicine; Maastricht The Netherlands
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy; Ghent University; Ghent Belgium
- Pain in Motion research group; Faculty of Medicine and Health Sciences; Department of Rehabilitation Sciences and Physiotherapy; University of Antwerp; Antwerp Belgium
| | - Rob J. E. M. Smeets
- Research School CAPHRI; Department of Rehabilitation Medicine; Maastricht University; Maastricht The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Academic Hospital Maastricht; Department of Rehabilitation Medicine; Maastricht The Netherlands
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Letzen JE, Sevel LS, Gay CW, O'Shea AM, Craggs JG, Price DD, Robinson ME. Test-retest reliability of pain-related brain activity in healthy controls undergoing experimental thermal pain. THE JOURNAL OF PAIN 2014; 15:1008-14. [PMID: 24998897 DOI: 10.1016/j.jpain.2014.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/19/2014] [Accepted: 06/24/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED Although functional magnetic resonance imaging (fMRI) has been proposed as a method to elucidate pain-related biomarkers, little information exists related to psychometric properties of fMRI findings. This knowledge is essential for potential translation of this technology to clinical settings. The purpose of this study was to assess the test-retest reliability of pain-related brain activity and how it compares to the reliability of self-report. Twenty-two healthy controls (mean age = 22.6 years, standard deviation = 2.9) underwent 3 runs of an fMRI paradigm that used thermal stimuli to elicit experimental pain. Functional MRI summary statistics related to brain activity during thermal stimulation periods were extracted from bilateral anterior cingulate cortices and anterior insula. Intraclass correlations (ICCs) were conducted on these summary statistics and generally showed "good" test-retest reliability in all regions of interest (ICC range = .32-.88; mean = .71); however, these results did not surpass ICC values from pain ratings, which fell within the "excellent" range (ICC range = .93-.96; mean = .94). Findings suggest that fMRI is a valuable tool for measuring pain mechanisms but did not show an adequate level of test-retest reliability for fMRI to potentially act as a surrogate for individuals' self-report of pain. PERSPECTIVE This study is one of the first reports to demonstrate the test-retest reliability of fMRI findings related to pain processing and provides a comparison to the reliability of subjective reports of pain. This information is essential for determining whether fMRI technology should be potentially translated for clinical use.
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Affiliation(s)
- Janelle E Letzen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Landrew S Sevel
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Charles W Gay
- Department of Rehabilitation Sciences, University of Florida, Gainesville, Florida
| | - Andrew M O'Shea
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Jason G Craggs
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Donald D Price
- Department of Oral and Maxillofacial Surgery, University of Florida, Gainesville, Florida
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida.
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Meroni R, Piscitelli D, Bonetti F, Zambaldi M, Guccione AA, Pillastrini P. Rasch analysis of the Italian version of fear avoidance beliefs questionnaire (FABQ-I). Disabil Rehabil 2014; 37:151-7. [PMID: 24766100 DOI: 10.3109/09638288.2014.909890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To perform a Rasch analysis (RA) of the Fear Avoidance Beliefs questionnaire (FABQ-I) in a sample of chronic non-specific low back pain (CLBP) patients. The RA is expected to provide information about the internal construct validity and all the single items consistency of the FABQ-I and then contributing to the knowledge about the questionnaire's clinimetric properties. METHODS One hundred and fifty subjects with CLBP were enrolled into the study. The FABQ-I have been studied by means of RA. The sample size needed to obtain stable person, item and rating-scale calibrations for use with the Rasch model was based on the level of error expected in the measure. RESULTS RA did not support the total scale as an unidimensional measure of Fear Avodiance Beliefs. Also the analysis of the Physical Activity (PA) and Word (WO) subscales as well as the attempts of manipulation failed in achieving an acceptable fit to the Rasch model. CONCLUSION FABQ-I may be considered to reflect a multiple psychological constructs describing scale. The raw score of the FABQ-I and changes in scores must be interpreted with caution because as a general measure of fear avoid beliefs was not supported.
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Affiliation(s)
- Roberto Meroni
- Department of Translational Medicine and Surgery, Program in Physical Therapy, University of Milan Bicocca , Monza , Italy
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Davenport TE, Cleland JA, Yamada KA, Kulig K. Measurement Properties of the Low Back Activity Confidence Scale (LoBACS). Eval Health Prof 2014; 39:204-14. [DOI: 10.1177/0163278714527757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to determine the measurement properties of the Low Back Activity Confidence Scale (LoBACS) in individuals with post-acute low back pain (LBP) receiving nonsurgical intervention, including construct validity, factorial validity, and internal consistency reliability. Data were analyzed from an existing randomized clinical trial involving 112 patients with LBP. Evidence for convergent validity was observed through significant correlations between LoBACS subscale scores and other function, pain, and psychobehavioral measures. LoBACS subscales accounted for 36% of the unique variance in dependent variable measurements, suggesting a satisfactory level of statistical divergence between the LoBACS and other psychobehavioral measurements in this study. Cronbach’s α ranged from .88 to .92 for LoBACS subscales, and item-total correlations exceeded .6, indicating high internal consistency reliability. Principal axis factoring confirmed the hypothesized three-subscale structure by correctly classifying 14 of the 15 items. These findings indicate the LoBACS is valid and internally consistent to measure domain-specific self-efficacy beliefs.
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Affiliation(s)
- Todd E. Davenport
- Department of Physical Therapy, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, USA
| | - Joshua A. Cleland
- Department of Physical Therapy, Franklin Pierce University, Concord, NH, USA
| | - Kimiko A. Yamada
- Division of Biokinesiology and Physical Therapy at the Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy at the Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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A clinical prediction rule to identify patients with low back pain who are likely to experience short-term success following lumbar stabilization exercises: a randomized controlled validation study. J Orthop Sports Phys Ther 2014; 44:6-B13. [PMID: 24261926 DOI: 10.2519/jospt.2014.4888] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE To determine the validity of a previously suggested clinical prediction rule (CPR) for identifying patients most likely to experience short-term success following lumbar stabilization exercise (LSE). Background Although LSE is commonly used by physical therapists in the management of low back pain, it does not seem to be more effective than other interventions. A 4-item CPR for identifying patients most likely to benefit from LSE has been previously suggested but has yet to be validated. METHODS One hundred five patients with low back pain underwent a baseline examination to determine their status on the CPR (positive or negative). Patients were stratified by CPR status and then randomized to receive an LSE program or an intervention consisting of manual therapy (MT) and range-of-motion/flexibility exercises. Both interventions included 11 treatment sessions delivered over 8 weeks. Low back pain-related disability was measured by the modified version of the Oswestry Disability Index at baseline and upon completion of treatment. RESULTS The statistical significance for the 2-way interaction between treatment group and CPR status for the level of disability at the end of the intervention was P = .17. However, among patients receiving LSE, those with a positive CPR status experienced less disability by the end of treatment compared with those with a negative CPR status (P = .02). Also, among patients with a positive CPR status, those receiving LSE experienced less disability by the end of treatment compared with those receiving MT (P = .03). In addition, there were main effects for treatment and CPR status. Patients receiving LSE experienced less disability by the end of treatment compared to patients receiving MT (P = .05), and patients with a positive CPR status experienced less disability by the end of treatment compared to patients with a negative CPR status, regardless of the treatment received (P = .04). When a modified version of the CPR (mCPR) containing only the presence of aberrant movement and a positive prone instability test was used, a significant interaction with treatment was found for final disability (P = .02). Of the patients who received LSE, those with a positive mCPR status experienced less disability by the end of treatment compared to those with a negative mCPR status (P = .02), and among patients with a positive mCPR status, those who received LSE experienced less disability by the end of treatment compared to those who received MT (P = .005). CONCLUSION The previously suggested CPR for identifying patients likely to benefit from LSE could not be validated in this study. However, due to its relatively low level of power, this study could not invalidate the CPR, either. A modified version of the CPR that contains only 2 items may possess a better predictive validity to identify those most likely to succeed with an LSE program. Because this modified version was established through post hoc testing, an additional study is recommended to prospectively test its predictive validity. LEVEL OF EVIDENCE Prognosis, level 1b-.
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Ratinaud M, Chamoux A, Glace B, Coudeyre E. Job satisfaction evaluation in low back pain: A literature review and tools appraisal. Ann Phys Rehabil Med 2013; 56:465-81. [DOI: 10.1016/j.rehab.2013.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 06/15/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
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Hall J, Cleland JA, Palmer JA. The Effects of Manual Physical Therapy and Therapeutic Exercise on Peripartum Posterior Pelvic Pain: Two Case Reports. J Man Manip Ther 2013. [DOI: 10.1179/106698105790825030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Hendrick P, Milosavljevic S, Hale L, Hurley DA, McDonough SM, Herbison P, Baxter GD. Does a patient's physical activity predict recovery from an episode of acute low back pain? A prospective cohort study. BMC Musculoskelet Disord 2013; 14:126. [PMID: 23560880 PMCID: PMC3626659 DOI: 10.1186/1471-2474-14-126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 04/02/2013] [Indexed: 11/14/2022] Open
Abstract
Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain. Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population. This prospective cohort study recruited 101 consenting patients with sub-acute LBP (< 6 weeks) who completed the Roland Morris Disability Questionnaire (RMDQ), the Visual Analogue Scale, and resumption of full ‘normal’ activity question (Y/N), at baseline and 3 months. Physical activity was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall questionnaire. Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ (p > 0.05) or RMDQ change (p > 0.05) over 3 months. A self-report of a return to full ‘normal’ activities was significantly associated with greater RMDQ change score at 3 months (p < 0.001). Paired t-tests found no significant change in activity levels measured with the RT3 (p = 0.57) or the recall questionnaire (p = 0.38) from baseline to 3 months. Conclusions These results question the predictive role of physical activity in LBP recovery, and the assumption that activity levels change as LBP symptoms resolve. The importance of a patient’s perception of activity limitation in recovery from acute LBP was also highlighted. Trial registration Clinical Trial Registration Number, ACTRN12609000282280
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Affiliation(s)
- Paul Hendrick
- Division of Physiotherapy Education, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK.
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The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings. Phys Ther 2013; 93:321-33. [PMID: 23125279 PMCID: PMC3588106 DOI: 10.2522/ptj.20120207] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychologically informed practice emphasizes routine identification of modifiable psychological risk factors being highlighted. OBJECTIVE The purpose of this study was to test the predictive validity of the STarT Back Screening Tool (SBT) in comparison with single-construct psychological measures for 6-month clinical outcomes. DESIGN This was an observational, prospective cohort study. METHODS Patients (n=146) receiving physical therapy for low back pain were administered the SBT and a battery of psychological measures (Fear-Avoidance Beliefs Questionnaire physical activity scale and work scale [FABQ-PA and FABQ-W, respectively], Pain Catastrophizing Scale [PCS], 11-item version of the Tampa Scale of Kinesiophobia [TSK-11], and 9-item Patient Health Questionnaire [PHQ-9]) at initial evaluation and 4 weeks later. Treatment was at the physical therapist's discretion. Clinical outcomes consisted of pain intensity and self-reported disability. Prediction of 6-month clinical outcomes was assessed for intake SBT and psychological measure scores using multiple regression models while controlling for other prognostic variables. In addition, the predictive capabilities of intake to 4-week changes in SBT and psychological measure scores for 6-month clinical outcomes were assessed. RESULTS Intake pain intensity scores (β=.39 to .45) and disability scores (β=.47 to .60) were the strongest predictors in all final regression models, explaining 22% and 24% and 43% and 48% of the variance for the respective clinical outcome at 6 months. Neither SBT nor psychological measure scores improved prediction of 6-month pain intensity. The SBT overall scores (β=.22) and SBT psychosocial scores (β=.25) added to the prediction of disability at 6 months. Four-week changes in TSK-11 scores (β=-.18) were predictive of pain intensity at 6 months. Four-week changes in FABQ-PA scores (β=-.21), TSK-11 scores (β=-.20) and SBT overall scores (β=-.18) were predictive of disability at 6 months. LIMITATIONS Physical therapy treatment was not standardized or accounted for in the analysis. CONCLUSIONS Prediction of clinical outcomes by psychology-based measures was dependent upon the clinical outcome domain of interest. Similar to studies from the primary care setting, initial screening with the SBT provided additional prognostic information for 6-month disability and changes in SBT overall scores may provide important clinical decision-making information for treatment monitoring.
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