Play the Pain: A Digital Strategy for Play-Oriented Research and Action

Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol

BACKGROUND

Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients' outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP.

METHODS

This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.

DISCUSSION

This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients' pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP.

TRIAL REGISTRATION

NCT05823857, registered prospectively on April 27th, 2023.

Toward a digital citizen lab for capturing data about alternative ways of self-managing chronic pain: An attitudinal user study

Background

Myriad psychosocial and cultural factors influence personal ways of coping with chronic pain (CP). Mobile health (mHealth) apps facilitate creation of citizen laboratories outside clinical frameworks. However, issues of safety, privacy and technostress must be addressed. This attitudinal user study aimed to assess whether persons with persistent pain (PwPP) would be open to sharing qualitative and quantitative data about their self-management of CP via mHealth platforms.

Methods

In March 2020, we invited PwPPs, their personal or medical caregivers, or those interested in the development of an app for researching alternative ways of self-managing CP to complete an anonymous survey. We formulated an attitudinal survey within the theoretical framework of stress to estimate whether the novelty, unpredictability, and risks of data-sharing via mHealth apps concerned users. Descriptive statistics (% Part/Group) were used to interpret the survey, and open comments were reflectively analyzed to identify emerging themes.

Results

Of 202 responses (June 2021), 127 identified as PwPPs (average age 43.86 ± 14.97; 100/127 female), and listed several primary and secondary CP diagnoses. In almost 90% of PwPPs, physical and emotional wellbeing were affected by CP. More than 90% of PwPPs used alternative therapies (acupuncture, homeopathy, massage therapy, etc.). Attitude toward mHealth apps were positive even though nearly half of PwPPs were unfamiliar with them. More than 72% of respondents were open to using a health-related app as a research tool for data collection in real life situations. Comprehensive data collection (especially about psychosocial factors) was the most important requirement. More respondents (especially medical professionals) were concerned about health hazards of misinformation communicated via health-related information and communication systems (maximum 80%) than about privacy (maximum 40%). Qualitative analyses revealed several promises and impediments to creation of data-sharing platforms for CP.

Conclusions

This study shows a general willingness among PwPPs to become partners in studying alternative pain management. Despite a generally positive attitude toward the concept of sharing complex personal data to advance research, heterogeneity of attitudes shaped by personal experiences must be considered. Our study underlines the need for any digital strategy for CP research to be person-centered and flexible.

Lives Penciled in, the Reality of Chronic Health Conditions and Trauma: Reflexivity, Health, and Shadowed Identities

When living with chronic health conditions or experiences of trauma our lives can become perpetually penciled in. The use of the penciled-in metaphor means to arrange our time tentatively: a date, an appointment, a meeting, seeing a movie, or attending a class. In our technologically-driven world of electronic calendars where everything is entered electronically, the utility of the pencil and hand-written agendas have all but vanished. However, for the purpose of this article, the pencil provides a metaphoric common ground to learn about the totality of the disruption experienced by living with chronic health conditions and their residual trauma. The pencil is touchable, tangible and as a researcher and a person who lives with challenging health concerns, metaphors help me to create an understanding of the chaos of living a life in pain with cancer. This article is a person-centered account of the process of reflexive coping and self-processing of pain by a pain researcher and educator. This article focuses on the metaphor of penciled-in lives to provide a qualitative account of experiences of pain from chronic health issues and the trauma both physical and emotional it causes. This act of reflexivity becomes a personal examination of life. It reveals to me my beliefs, decisions, and practices before and during my hermeneutic journey and how these may have prejudiced my thinking and behaviors.