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Loades ME, Chalder T, Smakowski A, Rimes KA. Anticipation of and response to exercise in adolescents with CFS: An experimental study. J Psychosom Res 2021; 146:110490. [PMID: 33892206 DOI: 10.1016/j.jpsychores.2021.110490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Using a laboratory-based exercise task, this study investigated objective exercise performance as well as expectations, anxiety and perceived task performance ratings in adolescents with CFS compared to healthy controls and illness controls. METHOD Trials of a sit-stand exercise task (SST) were undertaken (CFS: n = 61, asthma (AS): n = 31, healthy adolescents (HC): n = 78). Adolescents rated their expectations, pre- and post-task anxiety, and perceived task difficulty. Their parents independently rated their performance expectations of their child. RESULTS The CFS group took significantly longer to complete the SST than the AS group (MD 3.71, 95% CI [2.41, 5.01] p < .001) and HC (MD 3.61, 95% CI [2.41, 4.81], p < .001). Adolescents with CFS had lower expectations for their performance on the exercise task than AS participants (MD -11.79, 95% CI [-22.17, -1.42] p = .022) and HC (MD -15.08, 95% CI [-23.01, -7.14] p < .001). They rated their perceived exertion as significantly greater than AS (MD 3.04, 95% CI [1.86, 4.21] p < .001) and HC (MD 2.98, 95% CI [1.99, 3.98], p < .001). The CFS group reported greater anxiety pre-task than AS (MD 14.11, 95% CI [5.57, 22.65] p < .001) and HC (MD 11.19, 95% CI [2.64, 19.75], p. = 007). Parental group differences showed similar patterns to the adolescents''. CONCLUSIONS Lower expectations and greater anxiety regarding exercise may reflect learning from previous difficult experiences which could impact future exercise performance. Further examination of pre-exercise expectations and post-exercise appraisals could improve our understanding of the mechanisms by which fatigue is maintained.
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Affiliation(s)
| | - T Chalder
- King's College London, UK; South London & Maudsley Hospital NHS Foundation Trust, UK
| | - A Smakowski
- South London & Maudsley Hospital NHS Foundation Trust, UK
| | - K A Rimes
- King's College London, UK; South London & Maudsley Hospital NHS Foundation Trust, UK.
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Shulman J, Smith A, Keysor J, Kenney A, Damice B, DeFabio R, Jervis K, Zurakowski D, Sethna N. Putting fitness to the test: clinical application of the Fitkids Treadmill Test in youth with chronic pain. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1779343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Julie Shulman
- Department of Physical and Occupational Therapy, Boston Children’s Hospital, Boston, MA, USA
- Interprofessional PhD in Rehabilitation Science Program, MGH Institute of Health Professions, Boston, MA, USA
| | - Allison Smith
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Julie Keysor
- Interprofessional PhD in Rehabilitation Science Program, MGH Institute of Health Professions, Boston, MA, USA
| | - Anne Kenney
- Department of Physical and Occupational Therapy, Boston Children’s Hospital, Boston, MA, USA
| | - Brittany Damice
- Department of Physical and Occupational Therapy, Boston Children’s Hospital, Boston, MA, USA
| | - Roxanne DeFabio
- Department of Physical and Occupational Therapy, Boston Children’s Hospital, Boston, MA, USA
| | - Kelsey Jervis
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Navil Sethna
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
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Shulman J, Conroy C, Cybulski A, Smith KR, Jervis K, Johnson H, Zurakowski D, Sethna NF. Does intensive interdisciplinary pain treatment improve pediatric headache-related disability? Disabil Rehabil 2020; 44:194-201. [PMID: 32406759 DOI: 10.1080/09638288.2020.1762125] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To examine the effectiveness of intensive interdisciplinary pain treatment for improving disability in children with chronic headache using the International Classification of Functioning, Disability and Health model as a conceptual framework for disability assessment.Materials and methods: Children with chronic headache (n = 50; ages 10-19 years; 62% female) attended an intensive interdisciplinary pain treatment program 8 h/day, 5 times/week for 2-7 weeks. Disability measures were administered at admission, discharge, and 6-8 week follow-up. Disability outcomes were analyzed retrospectively. Wilcoxon signed rank tests and Friedman's analyses of variance were used to compare scores across two and three longitudinal time points, respectively.Results: After rehabilitation, disability reduced on the Headache Impact Test-6 from severe impact at admission to some impact at follow-up (p < 0.001). Median time on the modified Bruce protocol increased from 13.1 min (interquartile range = 12.6-14.1) to 14.4 min (interquartile range = 12.9-16.3), p < 0.001, with gains maintained at follow-up. Improvements in pain and disability were associated with improvements in school participation.Conclusions: Findings of this study support the effectiveness of intensive interdisciplinary pain treatment for improving disability in children with chronic headache.Implication for rehabilitationIntensive interdisciplinary pain treatment is effective for improving pain and disability in children with chronic headaches.Application of the ICF model to disability assessment suggests that children with chronic headaches may experience significant disability, even when standardized assessments of physical capacity are normal.The modified Bruce protocol, Pediatric Evaluation of Disability Inventory - Computerized Adaptive Tests, and Headache Impact Test-6 appear particularly valuable in understanding the nature of disability in children with chronic headaches.
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Affiliation(s)
- Julie Shulman
- Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA.,Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, USA
| | - Caitlin Conroy
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Anna Cybulski
- Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA.,Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, USA
| | - Kelly R Smith
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Kelsey Jervis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Hannah Johnson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, USA
| | - Navil F Sethna
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, USA
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Yoon IA, Sturgeon JA, Feinstein AB, Bhandari RP. The role of fatigue in functional outcomes for youth with chronic pain. Eur J Pain 2019; 23:1548-1562. [DOI: 10.1002/ejp.1431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 05/11/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Isabel Angela Yoon
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
| | - John Andrew Sturgeon
- Department of Anesthesiology and Pain Medicine University of Washington School of Medicine, Center for Pain Relief Seattle Washington
| | - Amanda Beth Feinstein
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
| | - Rashmi Parekh Bhandari
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
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