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Druart L, Graham Longsworth SE, Terrisse H, Locher C, Blease C, Rolland C, Pinsault N. If only they knew! A non-inferiority randomized controlled trial comparing deceptive and open-label placebo in healthy individuals. Eur J Pain 2024; 28:491-501. [PMID: 37965922 DOI: 10.1002/ejp.2204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Placebo use is widespread in clinical practice. However, they are most often administered deceptively rather than openly. It is often suggested that open-label placebos (OLP) are less effective than deceptive placebos (DP). This study aimed to compare the use of DP and OLP treatments to reduce pain in healthy volunteers. METHODS We conducted a non-inferiority, parallel, randomized, controlled trial, which also included a nested cross-over no-treatment condition. This study was conducted at a university clinic in France. RESULTS We included 60 subjects and the main result shows that the OLP was not inferior to the DP by a margin of 10 mm. The mean difference between both groups regarding intensity of pain was 0.7 mm with a 95% compatibility interval (95% CI) of ]-∞; 5.4], and 97.5% CI of ]-∞; 6.3]. Secondary outcomes require cautious interpretation of the effect of placebo versus no treatment due to a time-treatment interaction. CONCLUSION The study indicates that OLP may perform just as well as DP and could provide support for the use of OLP as an ethical alternative to DP when they are to be used in a clinical setting. If only patients knew about the placebo nature of some treatments they are receiving, unnecessary lies could be avoided while maintaining similar placebo effects. SIGNIFICANCE This study is the first to show non-inferiority of placebos administered honestly, also called OLP, compared to DP in reducing pain. This suggests that OLP could be as effective as their deceptive counterparts while having the ethical advantage of not being required to lie. If deception is not a necessary condition for efficacy, OLP should be preferred over DP.
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Affiliation(s)
- L Druart
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble Alpes, Grenoble, France
| | - S E Graham Longsworth
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble Alpes, Grenoble, France
| | - H Terrisse
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
| | - C Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - C Blease
- Department of Psychiatry, Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - C Rolland
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
| | - N Pinsault
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble Alpes, Grenoble, France
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2
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Bluth K, Lathren C, Park J, Lynch C, Curry J, Harris-Britt A, Gaylord S. Feasibility, acceptability, and depression outcomes of a randomized controlled trial of Mindful Self-Compassion for Teens (MSC-T) for adolescents with subsyndromal depression. J Adolesc 2024; 96:322-336. [PMID: 38010232 PMCID: PMC10948004 DOI: 10.1002/jad.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/26/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Adolescents are experiencing high rates of depressive symptoms, with negative consequences to their long-term health. Group-based, mindful self-compassion programs show promise in mitigating the development of more significant depression in at-risk adolescents. However, the lack of well-designed, active control conditions has limited the ability to examine the efficacy of such interventions. METHODS Fifty-nine adolescents (Mage = 15.81, 70% female) with subsyndromal depressive symptoms from the Southeastern US were randomized to group-based Mindful Self-Compassion for Teens (N = 30) or a newly developed active control Healthy Lifestyles group (N = 29) during 2018 and 2019. Participants attended 8 weekly "main" sessions followed by 6 monthly continuation sessions. The feasibility and acceptability of participation in both groups were measured using attrition, attendance, credibility, and satisfaction data. Depression scores were collected weekly, and self-compassion scores were collected five times across 36 weeks. RESULTS Both groups were equally feasible and acceptable during the 8-week program period; however, monthly continuation sessions were poorly attended in both groups. The risk of developing clinically significant depression was 2.6 times higher in the control group compared with the self-compassion group (p = .037) across 36 weeks. Depression significantly decreased in the self-compassion group, while it significantly increased in the control group. Both groups increased significantly in reports of self-compassion. These findings are on par with results noting the efficacy of cognitive-based interventions for high-risk adolescents; follow-up studies with larger sample sizes should be conducted to confirm these findings. CONCLUSIONS Initial examination suggests Mindful Self-Compassion for Teens programming is feasible, acceptable, and efficacious in preventing the development of clinically significant depression in adolescents with subsyndromal depression. Future studies may benefit from refinements to the self-compassion measurement and/or the attention control condition; moreover, larger sample sizes are needed to confirm results.
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Affiliation(s)
- Karen Bluth
- Department of Psychiatry, University of North Carolina School of Medicine, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine Lathren
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jinyoung Park
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Chanee Lynch
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - John Curry
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - April Harris-Britt
- AHB Center for Behavioral Health and Wellness, Durham, North Carolina, USA
| | - Susan Gaylord
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Lachman DM, van Kooij YE, Slijper HP, Hovius SER, Selles RW, Wouters RM. Explaining Personalized Activity Limitations in Patients With Hand and Wrist Disorders: Insights from Sociodemographic, Clinical, and Mindset Characteristics. Arch Phys Med Rehabil 2024; 105:314-325. [PMID: 37604381 DOI: 10.1016/j.apmr.2023.08.003] [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: 04/22/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES To investigate the association of sociodemographic, clinical, and mindset characteristics on outcomes measured with a patient-specific patient-reported outcome measure (PROM); the Patient Specific Functional Scale (PSFS). Secondly, we examined whether these factors differ when a fixed-item PROM, the Michigan Hand Outcome Questionnaire (MHQ), is used as an outcome. DESIGN Cohort study, using the aforementioned groups of factors in a hierarchical linear regression. SETTING Twenty-six clinics for hand and wrist conditions in the Netherlands. PARTICIPANTS Two samples of patients with various hand and wrist conditions and treatments: n=7111 (PSFS) and n=5872 (MHQ). INTERVENTIONS NA. MAIN OUTCOME MEASURES The PSFS and MHQ at 3 months. RESULTS The PSFS exhibited greater between-subject variability in baseline, follow-up, and change scores than the MHQ. Better PSFS outcomes were associated with: no involvement in litigation (β[95% confidence interval=-0.40[-0.54;-0.25]), better treatment expectations (0.09[0.06;0.13]), light workload (0.08[0.03;0.14]), not smoking (-0.07[-0.13;-0.01]), men sex (0.07[0.02;0.12]), better quality of life (0.07[0.05;0.10]), moderate workload (0.06[0.00;0.13]), better hand satisfaction (0.05[0.02; 0.07]), less concern (-0.05[-0.08;-0.02]), less pain at rest (-0.04[-0.08;-0.00]), younger age (-0.04[-0.07;-0.01]), better comprehensibility (0.03[0.01;0.06]), better timeline perception (-0.03[-0.06;-0.01]), and better control (-0.02[-0.04;-0.00]). The MHQ model was highly similar but showed a higher R2 than the PSFS model (0.41 vs 0.15), largely due to the R2 of the baseline scores (0.23 for MHQ vs 0.01 for PSFS). CONCLUSIONS Health care professionals can improve personalized activity limitations by addressing treatment expectations and illness perceptions, which affect PSFS outcomes. Similar factors affect the MHQ, but the baseline MHQ score has a stronger association with the outcome score than the PSFS. While the PSFS is better for individual patient evaluation, we found that it is difficult to explain PSFS outcomes based on baseline characteristics compared with the MHQ. Using both patient-specific and fixed-item instruments helps health care professionals develop personalized treatment plans that meet individual needs and goals.
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Affiliation(s)
- Diego Marchano Lachman
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Physical Therapy Lansingerland, Lansingerland, the Netherlands.
| | - Yara Eline van Kooij
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Center for Hand Therapy, Xpert Handtherapie, Utrecht, the Netherlands
| | | | - Steven Eric Ruden Hovius
- Hand and Wrist Center, Xpert Clinic, Eindhoven, the Netherlands; Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruud Willem Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Robbert Maarten Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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4
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de Ridder WA, van der Oest MJW, Slijper HP, Vermeulen GM, Hovius SER, Selles RW, Wouters RM. Changes in illness perception, pain catastrophizing, and psychological distress following hand surgeon consultation: A prospective study. J Psychosom Res 2023; 174:111094. [PMID: 37729752 DOI: 10.1016/j.jpsychores.2022.111094] [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: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Baseline mindset factors are important factors that influence treatment decisions and outcomes. Theoretically, improving the mindset prior to treatment may improve treatment decisions and outcomes. This prospective cohort study evaluated changes in patients' mindset following hand surgeon consultation. Additionally, we assessed if the change in illness perception differed between surgical and nonsurgical patients. METHODS The primary outcome was illness perception, measured using the total score of the Brief Illness Perception Questionnaire (B-IPQ, range 0-80). Secondary outcomes were the B-IPQ subscales, pain catastrophizing (measured using the Pain Catastrophizing Scale (PCS)), and psychological distress (measured using the Patient Health Questionnaire-4). RESULTS A total of 276 patients with various hand and wrist conditions completed the mindset questionnaires before and after hand surgeon consultation (median time interval: 15 days). The B-IPQ total score improved from 39.7 (±10.6) before to 35.8 (±11.3) after consultation (p < 0.0001, Cohen's d = 0.36); scores also improved for the B-IPQ subscales Coherence, Concern, Emotional Response, Timeline, Treatment Control, and Identity and the PCS. There were no changes in the other outcomes. Surgical patients improved on the B-IPQ subscales Treatment Control and Timeline, while nonsurgical patients did not. CONCLUSIONS Illness perception and pain catastrophizing improved following hand surgeon consultation, suggesting that clinicians may actively influence the patients' mindset during consultations, and that they may try to enhance this effect to improve outcomes. Furthermore, surgical patients improved more in illness perceptions, indicating that nonsurgical patients may benefit from a more targeted strategy for changing mindset.
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Affiliation(s)
- Willemijn A de Ridder
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands; Center for Hand Therapy, Xpert Handtherapie, Eindhoven, the Netherlands.
| | - Mark J W van der Oest
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands
| | - Harm P Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands
| | - Guus M Vermeulen
- Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands
| | - Steven E R Hovius
- Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Radboudumc University Hospital, Nijmegen, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
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5
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Donker T, Fehribach J, van Klaveren C, Cornelisz I, Toffolo MBJ, van Straten A, van Gelder JL. Automated mobile virtual reality cognitive behavior therapy for aviophobia in a natural setting: a randomized controlled trial. Psychol Med 2023; 53:6232-6241. [PMID: 36426618 PMCID: PMC10520596 DOI: 10.1017/s0033291722003531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Access to evidence-based psychological treatment is a challenge worldwide. We assessed the effectiveness of a fully automated aviophobia smartphone app treatment delivered in combination with a $5 virtual reality (VR) viewer. METHODS In total, 153 participants from the Dutch general population with aviophobia symptoms and smartphone access were randomized in a single-blind randomized controlled trial to either an automated VR cognitive behavior therapy (VR-CBT) app treatment condition (n = 77) or a wait-list control condition (n = 76). The VR-CBT app was delivered over a 6-week period in the participants' natural environment. Online self-report assessments were completed at baseline, post-treatment, at 3-month and at 12-month follow-up. The primary outcome measure was the Flight Anxiety Situations Questionnaire (FAS). Analyses were based on intent-to-treat. RESULTS A significant reduction of aviophobia symptoms at post-test for the VR-CBT app compared with the control condition [p < 0.001; d = 0. 98 (95% CI 0.65-1.32)] was demonstrated. The dropout rate was 21%. Results were maintained at 3-month follow-up [within-group d = 1.14 (95% CI 0.46-1.81)] and at 12-month follow-up [within-group d = 1.12 (95% CI 0.46-1.79)]. Six participants reported adverse effects of cyber sickness symptoms. CONCLUSIONS This study is the first to show that fully automated mobile VR-CBT therapy delivered in a natural setting can maintain long-term effectiveness in reducing aviophobia symptoms. In doing so, it offers an accessible and scalable evidence-based treatment solution that can be applied globally at a fraction of the cost of current treatment alternatives.
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Affiliation(s)
- T. Donker
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute Amsterdam, Amsterdam, Noord-Holland, The Netherlands
- Department of Biological Psychology, Clinical Psychology and Psychotherapy, Albert Ludwigs-University of Freiburg, Freiburg im Breisgau, Baden-Württenberg, Germany
| | - J.R. Fehribach
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - C. van Klaveren
- Department of Education Sciences, Section Methods and Statistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Center for Learning Analytics (ACLA), Amsterdam, Noord-Holland, The Netherlands
| | - I. Cornelisz
- Department of Education Sciences, Section Methods and Statistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Center for Learning Analytics (ACLA), Amsterdam, Noord-Holland, The Netherlands
| | - M. B. J. Toffolo
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - A. van Straten
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - J.-L. van Gelder
- Department of Criminology, Max Planck Institute for the Study of Crime, Security and Law, Freiburg im Breisgau, Baden-Württenberg, Germany
- Department of Clinical Neurodevelopmental Sciences, Institute of Education and Child Studies, Leiden University, Leiden, Zuid-Holland, The Netherlands
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Naresh-Babu J, Kwan KYH, Wu Y, Yilgor C, Alanay A, Cheung KMC, Polly DW, Park JB, Ito M, Lenke LG, van Hooff ML, de Kleuver M. AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care. Global Spine J 2023; 13:1490-1501. [PMID: 34402318 PMCID: PMC10448102 DOI: 10.1177/21925682211037935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Modified Delphi study. OBJECTIVE Adult spinal deformity (ASD) is an increasingly recognized condition, comprising a spectrum of pathologies considerably impacting patients' health and functional status. Patients present with a combination of pain, disability, comorbidities and radiological deformity. The study aims to propose a systematic approach of gathering information on the factors that drive decision-making by developing a patient profile. METHODS The present study comprises of 3 parts. Part 1: Development of prototype of patient profile: The data from the Core Outcome Study on SCOlisis (COSSCO) by Scoliosis Research Society (SRS) was categorized into a conceptual framework. Part 2: Modified Delphi study: Items reaching >70% agreement were included in a 4 round iterative process with 51 panellists across the globe. Part 3: Pilot testing-feasibility: Content validity and usability were evaluated quantitatively. RESULTS The profile consisted of 4 domains. 1. General health with demographics and comorbidities, 2.Spine-specific health with spine related health and neurological status, 3. Imaging with radiographic and MRI parameters and 4. Deformity type. Each domain consisted of 1 or 2 components with various factors and their measuring instruments. Profile was found to have an excellent content validity (I-CVIr 0.78-1.00; Ave-CVI 0.92) appropriateness, relevance and usefulness. CONCLUSIONS The present study, is first to provide a universally applicable multimodal ASD patient profile to methodically describe patients. Physicians are encouraged to assess ASD patients holistically using this profile and not just based on radiographic findings.
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Affiliation(s)
- J Naresh-Babu
- Department of Spine Surgery, Mallika Spine Centre, Guntur, Andhra Pradesh, India
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yabin Wu
- Research Department, AO Spine International, Davos, Switzerland
| | - Caglar Yilgor
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Kenneth M. C. Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - David W. Polly
- Department of Orthopaedic Surgery, University of Minnesota, MN, USA
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Manabu Ito
- Department of Orthopaedics, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Lawrence G. Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Miranda L. van Hooff
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Marinus de Kleuver
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Langford DJ, Lou R, Sheen S, Amtmann D, Colloca L, Edwards RR, Farrar JT, Katz NP, McDermott MP, Reeve BB, Wasan AD, Turk DC, Dworkin RH, Gewandter JS. Expectations for Improvement: A Neglected but Potentially Important Covariate or Moderator for Chronic Pain Clinical Trials. THE JOURNAL OF PAIN 2023; 24:575-581. [PMID: 36577461 PMCID: PMC10079631 DOI: 10.1016/j.jpain.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
Variability in pain-related outcomes can hamper assay sensitivity of chronic pain clinical trials. Expectations of outcome in such trials may account for some of this variability, and thereby impede development of novel pain treatments. Measurement of participants' expectations prior to initiating study treatment (active or placebo) is infrequent, variable, and often unvalidated. Efforts to optimize and standardize measurement, analysis, and management of expectations are needed. In this Focus Article, we provide an overview of research findings on the relationship between baseline expectations and pain-related outcomes in clinical trials of pharmacological and nonpharmacological pain treatments. We highlight the potential benefit of adjusting for participants' expectations in clinical trial analyses and draw on findings from patient interviews to discuss critical issues related to measurement of expectations. We conclude with suggestions regarding future studies focused on better understanding the utility of incorporating these measures into clinical trial analyses. PERSPECTIVE: This focus article provides an overview of the relationship between participants' baseline expectations and pain-related outcomes in the setting of clinical trials of chronic pain treatments. Systematic research focused on the measurement of expectations and the impact of adjusting for expectations in clinical trial analyses may improve assay sensitivity.
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Affiliation(s)
- Dale J Langford
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York; Department of Anesthesiology & Pain Medicine/Division of Pain Medicine, University of Washington, Seattle Washington.
| | - Raissa Lou
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Soun Sheen
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Dagmar Amtmann
- Department of Anesthesiology & Pain Medicine/Division of Pain Medicine, University of Washington, Seattle Washington
| | - Luana Colloca
- Department of Pain & Translational Symptom Science, University of Maryland, Baltimore, Maryland
| | - Robert R Edwards
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - John T Farrar
- Departments of Epidemiology, Neurology, and Anesthesia, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nathaniel P Katz
- Department of Anesthesiology & Perioperative Medicine, Tufts University and Ein Sof Innovation, Boston, Massachusetts
| | - Michael P McDermott
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Bryce B Reeve
- Department of Population Health Sciences, Center for Health Measurement, Duke University School of Medicine, Durham, North Carolina
| | - Ajay D Wasan
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine/Division of Pain Medicine, University of Washington, Seattle Washington
| | - Robert H Dworkin
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
| | - Jennifer S Gewandter
- Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, New York
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8
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Greminger M, Koopman JE, van Kooij YE, Hoogendam L, Smit J, Slijper HP, Selles RW, Calcagni M. Factors associated with self-reported pain and hand function following dorsal wrist ganglion excision. J Hand Surg Eur Vol 2023; 48:551-560. [PMID: 36794465 DOI: 10.1177/17531934231153029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This study aimed to analyse which factors contribute to pain and limited hand function after dorsal wrist ganglion excision. We included 308 patients who underwent surgery between September 2017 and August 2021. Patients completed baseline questionnaires and the patient-rated wrist/hand evaluation questionnaire at baseline and 3 months postoperatively. We observed an improvement in postoperative pain and hand function, but individual outcomes were highly variable. We performed stepwise linear regression analyses to examine which patient characteristics, disease characteristics and psychological factors were associated with postoperative pain and hand function. Higher postoperative pain intensity was associated with recurrence following previous surgery, treatment of the dominant hand, higher baseline pain intensity, lower credibility the patient attributes to the treatment and longer symptom duration. Worse hand function was associated with recurrence following prior surgery, worse baseline hand function and lower treatment credibility. Clinicians should take these findings into account during patient counselling and expectation management.Level of evidence: II.
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Affiliation(s)
- Martina Greminger
- Department of Plastic- and Hand Surgery, University Hospital Zurich, Switzerland
| | - Jaimy Emerentiana Koopman
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yara Eline van Kooij
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Xpert Clinics Hand Therapy, The Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Xpert Clinics Hand and Wrist Center, The Netherlands
| | - Jeroen Smit
- Xpert Clinics Hand and Wrist Center, The Netherlands
| | | | - Ruud Willem Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maurizio Calcagni
- Department of Plastic- and Hand Surgery, University Hospital Zurich, Switzerland
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9
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Yinghao Z, Dan Z, Ao F, Lin Z. Chinese version of the stressor scale for emergency nurse: A methodological study design. Nurs Open 2022; 10:2999-3010. [PMID: 36484242 PMCID: PMC10077376 DOI: 10.1002/nop2.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study was to modify and test the psychometric properties of the Chinese version of the stressor scale for emergency nurses. DESIGN The methodological design was carried out in two phases: (a) form the Chinese version by Delphi method and (b) test the psychometric properties by cross-sectional survey. METHODS The translated scale was administered to 420 nurses in Qingdao. Validity was assessed in terms of content validity, calibration correlation validity and construct validity using exploratory factor analysis and confirmatory factor analysis. Internal consistency was estimated using Cronbach α coefficients. RESULTS The Chinese version of the SSEN retains 27 items, four common factors were extracted by exploratory factor analysis, and the factor cumulative variance contribution rate was 78.463%. The fitting indexes of the four-factor model of CFA were all in the acceptable range[χ2 = 711.30, df = 312, p < 0.001, χ2 /df = 2.280, CFI = 0.933, TLI = 0.924, IFI = 0.933, RMSEA = 0.079 (90% confidence interval = 0.071-0.086)].The item-level content validity index of the Chinese SSEN is 0.89 ~ 1.00; the scale-level content validity index is 0.98; the Cronbach α coefficient of the total table is 0.971 and the split-half reliability is 0.877. PATIENT OR PUBLIC CONTRIBUTION The C-SSEN can be used to help nursing managers accurately formulate management measures to improve the stress coping ability of nurses in the ED, stabilize the nursing team and ensure nursing safety.
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Affiliation(s)
- Zhou Yinghao
- Affiliated Hospital of Qingdao University Qingdao China
- School of Nursing Qingdao University Qingdao China
| | - Zhou Dan
- Affiliated Hospital of Qingdao University Qingdao China
| | - Feng Ao
- School of Nursing Qingdao University Qingdao China
| | - Zhao Lin
- Affiliated Hospital of Qingdao University Qingdao China
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10
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Egerton T, Bennell KL, McManus F, Lamb KE, Hinman RS. Comparative effect of two educational videos on self-efficacy and kinesiophobia in people with knee osteoarthritis: an online randomised controlled trial. Osteoarthritis Cartilage 2022; 30:1398-1410. [PMID: 35750241 DOI: 10.1016/j.joca.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare change in self-efficacy for managing knee osteoarthritis (OA) pain and kinesiophobia after watching an educational video based on an empowerment and participatory discourse with a video based on a disease and impairment discourse. DESIGN Two-arm randomised controlled trial with participants aged ≥45 years with knee pain (n = 589). Participants completed both baseline and follow-up outcomes and watched one randomly-allocated video (12-minute duration) during one 30-45-minute session within a single online survey. The experimental video presented evidence-based knee OA information using design and language that aimed to empower people and focus on activity participation to manage OA, while the control video presented similar information but with a disease and impairment focus. Primary outcome measures were Arthritis Self-Efficacy Scale pain subscale (range 0-10) and Brief Fear of Movement Scale for OA (range 6-24). Secondary outcomes were expectations about prognosis and physical activity benefits, perceived importance and motivation to be physically active, knee OA knowledge, hopefulness for the future, level of concern and perceived need for surgery. RESULTS Compared to control (n = 293), the experimental group (n = 296) showed improved self-efficacy for managing OA pain (mean difference 0.4 [95%CI 0.2, 0.6] units) and reduced kinesiophobia (1.6 [1.1, 2.0] units). The experimental group also demonstrated greater improvements in all secondary outcomes apart from hopefulness, which was high in both groups. CONCLUSION An educational video based on an empowerment and participatory discourse improved pain self-efficacy and reduced kinesiophobia in people with knee OA more than a video based on a disease and impairment discourse. CLINICALTRIALS gov registration NCT05156216, Universal trial number U1111-1269-6143.
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Affiliation(s)
- T Egerton
- Centre for Health Exercise & Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - K L Bennell
- Centre for Health Exercise & Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - F McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - K E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Methods and Implementation Support for Clinical Health Research Platform, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - R S Hinman
- Centre for Health Exercise & Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
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11
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Toffolo MBJ, Fehribach JR, van Klaveren CPBJ, Cornelisz I, van Straten A, van Gelder JL, Donker T. Automated app-based augmented reality cognitive behavioral therapy for spider phobia: Study protocol for a randomized controlled trial. PLoS One 2022; 17:e0271175. [PMID: 35830423 PMCID: PMC9278761 DOI: 10.1371/journal.pone.0271175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Fear of spiders, or Arachnophobia, is one of the most common specific phobias. The gold standard treatment, in vivo exposure therapy, is effective, but comes with significant limitations, including restricted availability, high costs, and high refusal rates. Novel technologies, such as augmented reality, may help to overcome these limitations and make Exposure Therapy more accessible by using mobile devices. Objective This study will use a Randomized Controlled Trial design to investigate whether ZeroPhobia: Arachnophobia, a 6-week Augmented Reality Exposure Therapy smartphone self-help application, can effectively reduce spider phobia symptoms. Additionally, we will examine user-friendliness of the application and the effect of usage intensity and presence on treatment outcome. Methods This study is registered in the Netherlands Trial Registry under NL70238.029.19 (Trial NL9221). Ethical approval was received on October 11, 2019. One-hundred-twelve participants (age 18–64, score ≥ 59) on the Fear of Spiders Questionnaire [FSQ] will be recruited from the general Dutch population and randomly assigned to a treatment or waitlist control group. The ZeroPhobia application can be accessed on users’ smartphone. Baseline, post-test (i.e., at six weeks), 3- and 12-month follow-up assessments will be done, each including the Fear of Spiders Questionnaire as the main outcome measure as well as additional measures of anxiety, depression, user-friendliness, and presence as secondary measures and covariates. Results The study was funded on September 25, 2018. Data collection started in September 2021 and the study is expected to run until September 2022. Conclusions Our study will improve our understanding of the efficacy and feasibility of providing Exposure Therapy for spider phobia using an Augmented Reality self-help application, with the intention of making mental health care more accessible.
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Affiliation(s)
- Marieke B. J. Toffolo
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Jamie R. Fehribach
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Chris P. B. J. van Klaveren
- Department of Education Sciences, Section Methods and Statistics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Center for Learning Analytics (ACLA), Amsterdam, The Netherlands
| | - Ilja Cornelisz
- Department of Education Sciences, Section Methods and Statistics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Center for Learning Analytics (ACLA), Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Jean-Louis van Gelder
- Max Planck Institute for the Study of Crime, Security and Law, Freiburg im Breisgau, Germany
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Tara Donker
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute Amsterdam, Amsterdam, The Netherlands
- Department of Psychology, Laboratory of Biological and Personality Psychology, Albert Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
- * E-mail:
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12
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Teunissen JS, van der Oest MJW, van Groeninghen DE, Feitz R, Hovius SER, Van der Heijden EPA. The impact of psychosocial variables on initial presentation and surgical outcome for ulnar-sided wrist pathology: a cohort study with 1-year follow-up. BMC Musculoskelet Disord 2022; 23:109. [PMID: 35105316 PMCID: PMC8808973 DOI: 10.1186/s12891-022-05045-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Ulnar-sided wrist pain has historically been equated to lower-back pain of wrist surgery. Little is known about the relationship between psychosocial profile and the manifestation of ulnar-sided wrist pathology and their treatment outcomes. This study aimed to determine the impact of pain catastrophising, psychological distress, illness perception, and patients' outcome expectations on patient-reported pain and hand function before and one year after surgery for ulnar-sided wrist pathology. PATIENTS AND METHODS We included patients who underwent surgical treatment for ulnar-sided wrist pathology. Before surgery, patients completed the Pain Catastrophising Scale (PCS), Patient Health Questionnaire (PHQ), Brief-Illness Perception Questionnaire (B-IPQ), and Credibility/Expectancy Questionnaire (CEQ). Pain and dysfunction were assessed before (n = 423) and one year after surgery (n = 253) using the Patient Rated Wrist/Hand Evaluation (PRWHE). Hierarchical linear regression was used to assess the relationship between psychosocial factors and the preoperative PRWHE score, postoperative PRWHE score, and change in PRWHE. RESULTS Psychosocial variables explained an additional 35% of the variance in preoperative PRWHE scores and 18% on postoperative scores. A more negative psychosocial profile was associated with higher (worse) preoperative PRWHE scores (PCS: B = 0.19, CI = [0.02-0.36]; B-IPQ Consequences: B = 3.26, CI = 2.36-4.15; and B-IPQ Identity, B = 1.88 [1.09-2.67]) and postoperative PRWHE scores (PCS: B = 0.44, CI = [0.08-0.81]) but not with the change in PRWHE after surgery. Higher treatment expectations were associated with a lower (better) postoperative PRWHE score (CEQ expectancy: B = -1.63, CI = [-2.43;-0.83]) and a larger change in PRWHE scores (B =|1.62|, CI = [|0.77; 2.47|]). CONCLUSION A more negative psychosocial profile was associated with higher pain levels and dysfunction preoperatively and postoperatively. However, these patients showed similar improvement as patients with a more feasible psychosocial profile. Therefore, patients should not be withheld from surgical treatment based on their preoperative psychosocial profile alone. Boosting treatment expectations might further improve treatment outcomes. LEVEL OF EVIDENCE III (Cohort study).
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Affiliation(s)
- J S Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands.
| | - M J W van der Oest
- Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - D E van Groeninghen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - R Feitz
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands
| | - S E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands
| | - E P A Van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
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13
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Birling Y, Zhu X, Avard N, Tannous C, Fahey PP, Sarris J, Bensoussan A. Zao Ren An Shen capsule for insomnia: A double-blind, randomized, placebo-controlled trial. Sleep 2021; 45:6425938. [PMID: 34788454 DOI: 10.1093/sleep/zsab266] [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: 09/14/2021] [Revised: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to test the efficacy and safety of Zao Ren An Shen (ZRAS) capsule, a Chinese herbal medicine product, for the treatment of insomnia. METHODS We conducted a double-blind randomized placebo-controlled trial. After a one-week placebo run-in, a total of 85 people with insomnia were randomly allocated to receive ZRAS or placebo for four weeks. The primary outcomes were insomnia severity assessed with the Insomnia Severity Index (ISI) and the number of participants with adverse events. Secondary outcomes included objective and subjective sleep parameters, psychological status, fatigue level, quality of life, acceptability, and tolerability. RESULTS A non-significant (p > 0.05) difference of 0.7 points in ISI in favor of ZRAS capsule was found at the end of the treatment. The number of participants with adverse events was not significantly different (p > 0.05) between the two groups. Except for subjective sleep onset latency, which had a non-significant (p > 0.05) medium effect (Cohen's d = 0.5), the effects in secondary efficacy outcomes were all small (Cohen's d < 0.4) and non-significant (p > 0.05). The acceptability and tolerability were high in the active group. CONCLUSIONS ZRAS capsule is safe, acceptable, and tolerable, yet not more effective than placebo in the treatment of insomnia. As previous evidence showed that Chinese herbal medicine was effective for insomnia, these results may be explained by the dose of the product, which was lower than the dose generally used in the clinic.
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Affiliation(s)
- Yoann Birling
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Xiaoshu Zhu
- School of Health Sciences, NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Nicole Avard
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Caterina Tannous
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Paul P Fahey
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia; The Florey Institute of Neuroscience and Mental Health & Professional Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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14
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van der Oest MJW, Hoogendam L, Wouters RM, Vermeulen GM, Slijper HP, Selles RW, Vranceanu AM, Porsius JT. Associations between positive treatment outcome expectations, illness understanding, and outcomes: a cohort study on non-operative treatment of first carpometacarpal osteoarthritis. Disabil Rehabil 2021; 44:5487-5494. [PMID: 34232069 DOI: 10.1080/09638288.2021.1936661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE More positive outcome expectations and illness perceptions are associated with better outcomes for patients with several osteoarthritic orthopedic conditions. However, it is unknown whether these factors also influence outcomes of non-operative treatment for first carpometacarpal osteoarthritis (CMC-1 OA). Therefore, we assess the role of pre-treatment outcome expectations and illness perceptions in reports of pain and hand function 3 months after non-operative treatment for CMC-1 OA. MATERIALS AND METHODS We conducted a cohort study with 219 patients treated non-operatively for CMC-1 OA between September 2017 and October 2018. Patients were included in the study if they completed measures of pain and hand function, illness perceptions (scale: 0-10), and expectations (scale: 3-27) as part of routine outcome measurements. Pain and hand function were measured before treatment and 3 months after starting treatment using the Dutch version of the Michigan Hand Outcomes Questionnaire. Multivariable linear regression analysis was used to assess the influence of outcome expectations and illness perceptions on pain and hand function. RESULTS Both positive outcome expectations (B = 0.64; 95% CI [0.1-1.2]) and a better illness understanding (an illness perception subdomain; B = 1.53; 95% CI [0.2-2.9]) at baseline were associated with less pain at 3 months. For hand function, similar estimates were found. CONCLUSIONS We found that positive outcome expectations and a better illness understanding, were associated with a better outcome of non-operative treatment for CMC-1 OA.IMPLICATIONS FOR REHABILITATIONNon-operative treatment can often be successful for patients with arthritis of the thumb.Outcome expectations and illness perceptions are associated with pain and hand function 3 months after non-operative treatment for thumb base osteoarthritis.Improving the outcome expectations and illness perceptions of patients through better education could improve the outcome of non-operative treatment.
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Affiliation(s)
- Mark J W van der Oest
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands
| | - Guus M Vermeulen
- Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Harm P Slijper
- Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Jarry T Porsius
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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15
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Silva S, Barbosa E, Salgado J, Cunha C. Portuguese validation of the credibility/expectancy questionnaire in routine practice. ACTA ACUST UNITED AC 2021; 24:495. [PMID: 33937109 PMCID: PMC8082527 DOI: 10.4081/ripppo.2021.495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022]
Abstract
This study aimed to validate and explore the psychometric properties of the credibility/expectancy questionnaire (CEQ) for the Portuguese population in the context of routine practice. The sample includes 87 clients from a university psychotherapy clinic. All clients completed self-report measures to assess credibility and expectation (CEQ), as well as measures of general mental health, depressive symptoms and therapeutic alliance in session 1 and session 2. The exploratory analysis revealed the existence of two factors in CEQ for the Portuguese population, factor 1 credibility and factor 2 expectation. The measure demonstrated good internal consistency, test-retest reliability and good adjustment in the confirmatory analysis. In terms of convergent validity, no significant correlation was found between credibility and expectation and the therapeutic alliance. The results corroborate the CEQ psychometric qualities for the Portuguese population, also showing its applicability in a context of routine practice.
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Affiliation(s)
- Sara Silva
- ISMAI - University Institute of Maia & Center for Psychology at University of Porto, Portugal
| | - Eunice Barbosa
- ISMAI - University Institute of Maia & Center for Psychology at University of Porto, Portugal
| | - João Salgado
- ISMAI - University Institute of Maia & Center for Psychology at University of Porto, Portugal
| | - Carla Cunha
- ISMAI - University Institute of Maia & Center for Psychology at University of Porto, Portugal
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16
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Fehribach JR, Toffolo MBJ, Cornelisz I, van Klaveren C, van Straten A, van Gelder JL, Donker T. Virtual Reality Self-help Treatment for Aviophobia: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e22008. [PMID: 33843605 PMCID: PMC8076993 DOI: 10.2196/22008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/10/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aviophobia (the fear of flying) can greatly impact the daily life functioning of people with the condition. Traditional exposure-based treatment is hampered by the limited availability of airplane practice situations, which is a result of economical and practical concerns. Easily accessible and low-cost virtual reality exposure therapy may address these challenges. OBJECTIVE The purpose of our study is to investigate the effectiveness of ZeroPhobia: Aviophobia (a self-help mobile app-based treatment) in reducing flight anxiety symptoms and depressive and anxiety symptoms. We will also investigate the effects of usage intensity, the sense of immersion, inherent absorption ability, and perceived user-friendliness on the treatment effect. METHODS Participants (N=114) who are aged 18-64 years and experience at least mild symptoms of aviophobia will be recruited from the general Dutch population and randomized into a treatment group or waitlist control group. By using their own phones and rudimentary mobile virtual reality headsets, participants will receive six modules of psychoeducation and cognitive behavioral therapy, which will include six levels of virtual reality exposure therapy over a period of 6 weeks. Assessments will be conducted at baseline, posttest (ie, after 6 weeks), and 3- and 12-month follow-ups. The primary outcome measure of our study is the Flight Anxiety Situations Questionnaire. The secondary outcome measures include anxiety and depression measures and additional covariates (including usage intensity, the degree of immersion, etc). We will test treatment effectiveness by conducting an intention-to-treat analysis and estimating average treatment effects on the treated. The mechanisms of treatment effect will also be explored. RESULTS The study was funded on September 25, 2018. Ethical approval was received on October 11, 2019. Recruitment closed on May 7, 2020. CONCLUSIONS Our study will further the scientific understanding and clinical implications of technology's current ability to aid in providing effective, accessible treatment for the fear of flying. TRIAL REGISTRATION Netherlands Trial Registry NL70238.029.19; https://www.trialregister.nl/trial/8257. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/22008.
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Affiliation(s)
- Jamie Rhiannon Fehribach
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marieke Bianca Jolien Toffolo
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ilja Cornelisz
- Methods and Statistics, Department of Education Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Center for Learning Analytics, Amsterdam, Netherlands
| | - Chris van Klaveren
- Methods and Statistics, Department of Education Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Center for Learning Analytics, Amsterdam, Netherlands
| | - Annemieke van Straten
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jean-Louis van Gelder
- Department of Criminology, Max Planck Institute for the Study of Crime, Security and Law, Freiburg, Germany
- Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Tara Donker
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Laboratory of Biological and Personality Psychology, Department of Psychology, Albert Ludwigs-University of Freiburg, Freiburg, Germany
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17
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Patients With Higher Treatment Outcome Expectations Are More Satisfied With the Results of Nonoperative Treatment for Thumb Base Osteoarthritis: A Cohort Study. Arch Phys Med Rehabil 2021; 102:1533-1540. [PMID: 33581136 DOI: 10.1016/j.apmr.2021.01.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate how satisfaction with treatment outcome is associated with patient mindset and Michigan Hand Outcome Questionnaire (MHQ) scores at baseline and 3 months in patients receiving nonoperative treatment for first carpometacarpal joint (CMC-1) osteoarthritis (OA). DESIGN Cohort study SETTING: A total of 20 outpatient locations of a clinic for hand surgery and hand therapy in the Netherlands. PARTICIPANTS Patients (N=308) receiving nonoperative treatment for CMC-1 OA, including exercise therapy, an orthosis, or both, between September 2017 and February 2019. INTERVENTIONS Nonoperative treatment (ie, exercise therapy, an orthosis, or both) MAIN OUTCOME MEASURES: Satisfaction with treatment outcomes was measured after 3 months of treatment. We measured total MHQ score at baseline and at 3 months. As baseline mindset factors, patients completed questionnaires on treatment outcome expectations, illness perceptions, pain catastrophizing, and psychological distress. We used multivariable logistic regression analysis and mediation analysis to identify factors associated with satisfaction with treatment outcomes. RESULTS More positive pretreatment outcome expectations were associated with a higher probability of being satisfied with treatment outcomes at 3 months (odds ratio, 1.15; 95% confidence interval, 1.07-1.25). Only a relatively small part (33%) of this association was because of a higher total MHQ score at 3 months. None of the other mindset and hand function variables at baseline were associated with satisfaction with treatment outcomes. CONCLUSIONS This study demonstrates that patients with higher pretreatment outcome expectations are more likely to be satisfied with treatment outcomes after 3 months of nonoperative treatment for CMC-1 OA. This association could only partially be explained by a better functional outcome at 3 months for patients who were satisfied. Health care providers treating patients nonoperatively for CMC-1 OA should be aware of the importance of expectations and may take this into account in pretreatment counseling.
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van Erp RMA, Huijnen IPJ, Köke AJA, Verbunt JA, Smeets RJEM. Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1840627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Reni M. A. van Erp
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ivan P. J. Huijnen
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Albère J. A. Köke
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Faculty of Health, Department of Physiotherapy, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jeanine A. Verbunt
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rob J. E. M. Smeets
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- CIR Revalidatie location Eindhoven, Eindhoven, The Netherlands
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19
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Haas JW, Rief W, Doering BK. Open-Label Placebo Treatment: Outcome Expectations and General Acceptance in the Lay Population. Int J Behav Med 2020; 28:444-454. [PMID: 33094438 PMCID: PMC8263407 DOI: 10.1007/s12529-020-09933-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
Background Most physicians sometimes apply therapies without specific active ingredients. Although patients seem to judge such placebo treatments as acceptable under certain circumstances, deception is still an ethical problem. Open-label placebos (OLPs) might be a promising approach to solve this dilemma. This study compared general acceptance and outcome expectations of OLPs and deceptive placebos (DPs). Methods In an experimental online study, 814 participants read a case vignette of a person with insomnia receiving a pill. The participants were then randomly allocated into two groups, where the second part of the vignette described the pill as either a deceptive placebo (DP group) or as an open-label placebo (OLP group). The Credibility/Expectancy Questionnaire (CEQ) assessed outcome expectations after the first (pre-assessment) and the second (post-assessment) parts of the vignette. Treatment acceptance was measured at post-assessment. Data from 798 participants were analyzed by a mixed multivariate analysis of variance (MANOVA), t-tests, and post-hoc mediation analyses. Results The MANOVA revealed a significant group main effect and a significant time × group interaction effect. At post-assessment, outcome expectations were higher in the DP group than in the OLP group. Acceptance of the placebo treatment was also higher in the DP group than in the OLP group. Mediation analyses confirmed that higher acceptance in the DP group was mediated by higher expectations. Conclusions When laypersons read about placebo treatment, their outcome expectations toward DPs were higher than toward OLPs. Surprisingly, the application of DPs was rated as more acceptable than OLPs. This result might be explained by indirect effects of treatment expectations. Electronic supplementary material The online version of this article (10.1007/s12529-020-09933-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia W Haas
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Bettina K Doering
- Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
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20
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Zhao Q, Zheng S, Delaney GP, Moylan E, Agar MR, Koh ES, Lai H, Birling Y, Zhang GS, Wang K, Ma Y, Zhu X. Acupuncture for Cancer Related Pain: Protocol for a Pragmatic Randomised Wait-List Controlled Trial. Integr Cancer Ther 2020; 19:1534735420976579. [PMID: 33300382 PMCID: PMC7734530 DOI: 10.1177/1534735420976579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acupuncture has been proved effective for cancer related pain (CRP) in China, America and some other countries. However, there is relative lack of evidence to support the use of acupuncture for CRP in Australia. OBJECTIVES To assess the effectiveness and safety of acupuncture for management of CRP in a real-world setting and to understand cancer patients' experience of undergoing acupuncture for CRP. METHODS A pragmatic randomised controlled trial will be conducted in South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Adults with cancer related pain (n = 106) will be randomised in a 1:1 ratio to receive the acupuncture intervention up front versus after a wait list period of 4 weeks. Pain level (by Numerical Rating Scale), analgesic use, auricular acupressure frequency and adverse events will be assessed at baseline, mid-treatment and post-treatment. Expectancy on trial outcome (by Credibility and Expectancy questionnaire) will be assessed at baseline. The perspective of the participants (by an interview) will be recorded after the last intervention. EXPECTED OUTCOMES We hypothesise that acupuncture will relieve cancer related pain at mid-treatment and post-treatment. We also hypothesise that few adverse events will be provoked by acupuncture. TRIAL REGISTRATION Australia New-Zealand Clinical Trial Registry (ACTRN12620000325909).
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Affiliation(s)
- Qi Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | - Suyang Zheng
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- Nanjing University of Chinese Medicine, Nanjing, China
| | | | - Eugene Moylan
- South Western Sydney Local Health District, NSW, Australia
| | - Meera R. Agar
- South Western Sydney Local Health District, NSW, Australia
- University of Technology Sydney, NSW, Australia
- University of NSW, NSW, Australia
| | - Eng-Siew Koh
- South Western Sydney Local Health District, NSW, Australia
| | - Hezheng Lai
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | - Yoann Birling
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | | | - Kang Wang
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yong Ma
- Nanjing University of Chinese Medicine, Nanjing, China
- Affiliated Hospital of Nanjing University of Chinese Medicine
| | - Xiaoshu Zhu
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
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21
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van Erp RMA, Huijnen IPJ, Ambergen AW, Verbunt JA, Smeets RJEM. Biopsychosocial primary care versus physiotherapy as usual in chronic low back pain: results of a pilot-randomised controlled trial. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1630855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Reni M. A. van Erp
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ivan P. J. Huijnen
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Antonius W. Ambergen
- Department of Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Jeanine A. Verbunt
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Rob J. E. M. Smeets
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
- CIR Revalidatie, Eindhoven, the Netherlands
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22
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Birling Y, Bensoussan A, Sarris J, Avard N, Zhu X. Zao Ren An Shen capsule for chronic insomnia: Study protocol for a randomized, placebo-controlled trial. Medicine (Baltimore) 2019; 98:e14853. [PMID: 30946312 PMCID: PMC6456021 DOI: 10.1097/md.0000000000014853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Zao Ren An Shen (ZRAS), a Chinese Herbal Medicine product, has been proposed as an alternative to recommended treatments for chronic insomnia. There is a lack of strong evidence supporting this proposition. AIMS To assess the efficacy and safety of ZRAS capsule for chronic insomnia compared to placebo. METHODS A parallel-group, double-blind, randomized-controlled trial will be performed in Western Sydney University, Australia. After a 1-week placebo run-in, adults with chronic insomnia (n = 90) will be randomized in a 1:1 ratio to receive either ZRAS capsule or placebo for 4 weeks. Insomnia severity (Insomnia Severity Scale score), sleep parameters (measured with the Consensus Sleep Diary and actigraphy), fatigue levels (Fatigue Severity Scale score), psychological status (Depression Anxiety Stress Scale score), quality of life (Assessment of Quality of Life score), and adverse events will be assessed at baseline, mid-treatment, post-treatment and at a 1-month follow-up. EXPECTED OUTCOMES We hypothesize that ZRAS capsule will improve insomnia severity, sleep parameters, fatigue levels, psychological status, and quality of life better than placebo at mid-treatment, post-treatment, and follow-up. We also hypothesize that the number of adverse events provoked by ZRAS capsule will be similar to placebo at these time-points. TRIAL REGISTRATION Australia New-Zealand Clinical Trial Registry (Registration number ACTRN12619000140156).
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Affiliation(s)
- Yoann Birling
- NICM Health Research Institute, Western Sydney University, Westmead, NSW
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Westmead, NSW
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW
- Professional Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC
| | - Nicole Avard
- NICM Health Research Institute, Western Sydney University, Westmead, NSW
| | - Xiaoshu Zhu
- School of Science and Health, NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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