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Saby A, Alvarez A, Smolins D, Petros J, Nguyen L, Trujillo M, Aygün O. Effects of Embodiment in Virtual Reality for Treatment of Chronic Pain: Pilot Open-Label Study. JMIR Form Res 2024; 8:e34162. [PMID: 38363591 PMCID: PMC10907942 DOI: 10.2196/34162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/13/2022] [Accepted: 09/21/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and nonpharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Further, because of its noninvasive nature, virtual reality (VR) provides an attractive platform for potentially developing novel therapeutic modalities. OBJECTIVE The purpose of this study was to determine the feasibility of a novel VR-based digital therapy for the treatment of chronic pain. METHODS An open-label study assessed the feasibility of using virtual embodiment in VR to treat chronic pain. In total, 24 patients with chronic pain were recruited from local pain clinics and completed 8 sessions of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of 4 weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as the primary outcome measure. Additionally, a battery of patient-reported pain questionnaires (Fear-Avoidance Beliefs Questionnaire, Oswestry Low Back Pain Disability Questionnaire, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after 8 sessions of virtual embodiment training as exploratory outcome measures to assess if the measures are appropriate and warrant a larger randomized controlled trial. RESULTS A 2-way ANOVA on session × pre- versus postvirtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by the visual analog scale (P<.001). Perceived disability due to lower back pain as measured by the Oswestry Low Back Pain Disability Questionnaire significantly improved (P=.003) over the 4-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale (P=.02). CONCLUSIONS This study provides evidence that functional rehabilitation exercises delivered in VR are safe and may have positive effects on alleviating the symptoms of chronic pain. Additionally, the virtual embodiment intervention may improve perceived disability and helplessness of patients with chronic pain after 8 sessions. The results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04060875; https://clinicaltrials.gov/ct2/show/NCT04060875.
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Affiliation(s)
- Adam Saby
- Department of Emergency Medicine, Occupational Health Division, University of California Los Angeles, Los Angeles, CA, United States
| | | | | | - James Petros
- Allied Pain and Spine, San Jose, CA, United States
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Ríos-León M, Cuñado-González Á, Domínguez-Fernández S, Martín-Casas P. Effectiveness of motor imagery in complex regional pain syndrome: A systematic review with meta-analysis. Pain Pract 2024. [PMID: 38265184 DOI: 10.1111/papr.13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of motor imagery (MI) on pain intensity and disability in individuals with complex regional pain syndrome (CRPS). METHODS A systematic search was conducted in various electronic databases to identify all relevant studies: PubMed, CINAHL, WOS, PEDro, CENTRAL, and Scopus. Randomized controlled trials assessing the effects of MI in individuals with CRPS were included. The risk of bias was assessed with the Cochrane Risk of Bias tool, the methodological quality was evaluated using PEDro scale, and the level of evidence was reported according to the GRADE. Between-groups standardized mean differences (SMD) were calculated. RESULTS Six studies were included. The meta-analysis found moderate-quality evidence that MI improves pain intensity and related disability as immediate (pain: SMD -1.07, 95% CI: -1.53 to -0.60; disability: SMD 1.05, 95% CI: 0.59 to 1.51), short-term (pain: SMD -1.28, 95% CI: -2.14 to -0.42; disability: SMD 1.37; 95% CI: 0.16 to 2.58), and long-term effects (pain: SMD -1.18; 95% CI: -1.89 to -0.46; disability: SMD 1.18; 95% CI: 0.46 to 1.89), as compared with a comparison group. The risk of bias of the trials was relatively low, but the imprecision of the results downgraded the level of evidence. CONCLUSIONS Moderate-quality evidence suggests a positive effect of MI for improving pain intensity and disability immediately after and at short-term in individuals with CRPS.
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Affiliation(s)
- Marta Ríos-León
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos (SESCAM), Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, Spain
| | | | | | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
- InPhysio Research Group, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Capel-Alcaraz AM, Castro-Sánchez AM, Matarán-Peñarrocha GA, Antequera-Soler E, Lara-Palomo IC. Effects of Motor Control Exercises in Patients With Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis. Clin J Sport Med 2023; 33:579-597. [PMID: 37432388 DOI: 10.1097/jsm.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The primary objective of this systematic review is to assess whether motor control exercises consisting of the methodology described by Richardson and Hodges improve the pain and disability of patients with nonspecific low back pain. DESIGN Systematic review and a meta-analysis. SETTING A literature review was conducted using PubMed, PEDro, Scielo, CINAHL, Web of Science, Dialnet, Scopus, and MEDLINE from inception to November 2021. PATIENTS Patients with chronic nonspecific low back pain. INTERVENTIONS Randomized controlled trials assessing motor control exercises versus inactive control, placebo or minimal intervention, and other exercises. MAIN OUTCOME MEASURES Pain intensity, disability, and physical activity were considered as primary outcomes. RESULTS Eighteen studies with 1356 patients were finally included in the systematic review, of which only 13 randomized clinical trials could be meta-analyzed. Statistically significant results were found in favor of the motor control group for the comparison with other exercises in disability at postintervention term (Mean Difference, 95% Confidence Interval [CI], -3.13 [-5.87 to -0.38], P = 0.03); for the comparison with inactive control, placebo, or minimal intervention in pain at postintervention term (MD, 95% CI, -18.10 [-30.79 to -5.41], P = 0.008); and for comparison with general exercises (MD, 95% CI, -12.70 [-20.80 to -4.60], P = 0.002). CONCLUSIONS Moderate-quality evidence regarding the effectiveness of motor control exercises to reduce pain intensity and disability exists, but the reduction should be interpreted with caution.
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Affiliation(s)
- Ana M Capel-Alcaraz
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain; and
| | | | | | - Eduardo Antequera-Soler
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain; and
| | - Inmaculada C Lara-Palomo
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain; and
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Dee JM, Littenberg B. Regional vs global physical therapy interventions to treat chronic pain in survivors of trauma: a randomized controlled trial. J Man Manip Ther 2023; 31:328-339. [PMID: 36567611 PMCID: PMC10566413 DOI: 10.1080/10669817.2022.2159615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A history of traumatic life events is associated with chronic pain in later life. Physical therapists utilize a variety of methods to treat pain, however, they have struggled to find effective interventions to improve patient outcomes. OBJECTIVE To compare impairment-based, regional (REGION-PT) physical therapy (PT) to a global (GLOBAL-PT) model consisting of pain neuroscience education, graded motor imagery, and exercise for adults with chronic pain and history of trauma. DESIGN Randomized Controlled Trial. METHODS Adults ≥ 18 years of age with chronic pain and a history of ≥1 trauma identified through the Life Events Checklist received the allocated intervention once a week for six weeks. Treatment effects were assessed using linear mixed models. RESULTS Ninety-eight participants completed the trial. There were no difference in outcomes between groups. There were significant interactions between race and intervention. Both interventions were associated with improvements in pain interference for white participants, but non-white participants experienced improvement only with GLOBAL-PT. Regardless of allocation, participants improved in physical function, six of the PROMIS-29 domains, and in pain interference measures. CONCLUSION Both interventions are reasonable strategies for individuals with chronic pain and a history of trauma.
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Affiliation(s)
- Justine McCuen Dee
- Department of Rehabilitation and Movement Science, University of Vermont
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Graham A, Ryan CG, MacSween A, Alexanders J, Livadas N, Oatway S, Atkinson G, Martin DJ. Sensory discrimination training for adults with chronic musculoskeletal pain: a systematic review. Physiother Theory Pract 2022; 38:1107-1125. [PMID: 33078667 DOI: 10.1080/09593985.2020.1830455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Sensory discrimination training (SDT) is a form of feedback guided sensory training used in the treatment of chronic musculoskeletal pain (CMP). OBJECTIVE This systematic review aimed to investigate the efficacy and safety of SDT for CMP. METHODS MEDLINE, CINAHL, EMBASE, AMED, CENTRAL, PsycINFO, Scopus, OT Seeker, PEDro, ETHOS, Web of Science, and Open Grey were searched for appropriate randomized controlled trials (RCTs). Included papers were assessed for risk of bias, and evidence was graded using the GRADE approach. The protocol was published on PROSPERO (anonymized). RESULTS Ten RCTs met the inclusion/exclusion criteria. There was conflicting evidence from seven RCTs for the efficacy of SDT for chronic low back pain (CLBP). There was very low-quality evidence from two studies supporting the efficacy of SDT for phantom limb pain (PLP). There was very low-quality evidence from one RCT for the efficacy of SDT for Fibromyalgia. No adverse effects of SDT were identified. CONCLUSIONS SDT has been delivered in multiple forms in the literature. SDT does not appear to be associated with any adverse effects and shows potential regarding its clinical efficacy. However, there is a lack of high-quality evidence upon which to make any firm clinical recommendations.
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Affiliation(s)
- Andrew Graham
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Cormac G Ryan
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Alasdair MacSween
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jenny Alexanders
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Nick Livadas
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Sarah Oatway
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Greg Atkinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Denis J Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Livett MF, Williams D, Potter H, Cairns M. Functional cortical changes associated with shoulder instability - a systematic review. Shoulder Elbow 2022; 14:452-464. [PMID: 35846404 PMCID: PMC9284298 DOI: 10.1177/17585732211019016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Glenohumeral joint instability is associated with structural deficits and/or alterations in sensory and motor processing; however, a proportion of patients with glenohumeral joint instability fail to respond to surgical and rehabilitative measures. This systematic review aimed to establish if functional cortical changes occur in patients with glenohumeral joint instability. METHODS AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, PEDro, Pubmed, PsychINFO and Scopus were searched from inception to 17 March 2021. Randomised controlled trials and non-randomised trials were included and quality was appraised using the Downs and Black tool. RESULTS One thousand two hundred seventy-nine records were identified of which five were included in the review. All studies showed altered cortical function when comparing instability patients with healthy controls and included areas associated with higher cortical functions. DISCUSSION The findings of this systematic review offer some insight as to why interventions addressing peripheral pathoanatomical factors in patients with glenohumeral joint instability may fail in some cases due to functional cortical changes. However, data are of moderate to high risk of bias. Further high-quality research is required to ascertain the degree of functional cortical changes associated with the type and duration of glenohumeral joint instability.
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Affiliation(s)
- Morissa F Livett
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK,Morissa F Livett, Cornwall Partnership NHS
Foundation Trust, Bodmin Community Hospital, Boundary Road, Bodmin, Cornwall
PL31 2QT, UK.
| | | | - Hayley Potter
- Cornwall Partnership NHS Foundation
Trust, Bodmin, UK
| | - Melinda Cairns
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
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Kelly KJ, Fisher BL, Rosen NO, Hamilton LD. Anxiety and Anticipated Pain Levels of Women With Self-Reported Penetration-Related Genito-Pelvic Pain are Elevated in Response to Pain-related Images. J Sex Med 2022; 19:1281-1289. [DOI: 10.1016/j.jsxm.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
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Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev 2022; 139:104735. [PMID: 35705110 DOI: 10.1016/j.neubiorev.2022.104735] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.
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Affiliation(s)
- Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom; Department of Psychology, Oslo New University College, Oslo, Norway.
| | - Monika Halicka
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Gavin Buckingham
- Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom
| | - Michael J Proulx
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Centre for Real and Virtual Environments Augmentation Labs, Department of Computer Science, University of Bath, Bath, Somerset, United Kingdom
| | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
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Hu F, Liu C, Cao S, Wang X, Liu W, Li T, Yang X, Zhang X. Cross-cultural adaptation and validation of the simplified chinese version of the fremantle back awareness questionnaire in patients with low back Pain. Eur Spine J 2022; 31:935-42. [PMID: 35039964 DOI: 10.1007/s00586-021-07085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/04/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The Fremantle back awareness questionnaire (FreBAQ) was recently developed as simple and quick tool to assess back-specific body perception in Low back pain (LBP) patients. The aim of the present study was to translate and cross-culturally adapt the Fremantle back awareness questionnaire (FreBAQ) into a Simplified Chinese version (FreBAQ-C), and evaluate the reliability and validity of the FreBAQ-C in patients with non-specific Chronic Low back pain (CLBP). METHODS The FreBAQ was translated into Chinese according to established methods. Internal consistency was assessed according to Cronbach's alpha. Test-retest reliability was estimated by Intraclass correlation coefficient (ICC). Construct validity was evaluated by correlations between the FreBAQ-C and Visual analogue scale (VAS), Roland-Morris disability questionnaire (RDQ), Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK) as well as Hospital anxiety and depression scale (HADS). RESULTS A total of 105 participants (38 males and 67 females) were included in this study with the mean age of 54.1 ± 15.6 years, mean duration of LBP of 6.8 ± 4.6 years. The FreBAQ-C total scores were well distributed, with no floor or ceiling effects. Internal consistency was excellent (Cronbach's alpha = 0.833). ICC of test-retest reliability was good (0.897, 95% confidence interval: 0.852-0.929). The limits of agreement (LOA) ranged from - 5.8 to 6.3. The Standard error of measurement (SEM) and Minimum detectable change (MDC) were 2.16 and 5.99. Construct validity was confirmed by significant correlation of The FreBAQ-C and VAS during motion (r = 0.274, p = 0.005) and rest (r = 0.243, p = 0.012), RDQ (r = 0.377, p < 0.001), PCS (r = 0.439, p < 0.001), and TSK(r = 0.311, p = 0.001). CONCLUSIONS The FreBAQ-C was demonstrated to have acceptable reliability and validity for patients with non-specific CLBP in Chinese mainland. It will allow evaluating body preception of the back in the Chinese population with CLBP.
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Heussler M, Winter J, Hotz-Boendermaker S, Bauer CM. Watch Your Back: Development and Usability of a Visual Feedback System for People with Low Back Pain – A Single Subject Usability Study. physioscience 2022. [DOI: 10.1055/a-1460-2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background To find effective treatments for low back pain remains a major challenge in physical therapy. Numerous treatment methods currently exist, but the use of real-time visual feedback is a promising new therapeutic approach. The opportunities for its implementation and use require further research.
Objective To develop a video-supported system for visual feedback and to test its usability.
Method The prototype of a video-based system for visual feedback was developed and tested on a person with persistent unspecific lumbar back pain. The system was evaluated through an interview with the subject and the system usability scale (SUS).
Results The subject was optimistic about the system’s functionality. He was astonished to see his own back while moving, which triggered positive emotions. He also found the apparatus comfortable to wear. The system achieved a value of 77.5 out of 100 on the SUS, which represents good usability.
Conclusion By means of technical adjustments to avoid a delay in transmission and an exact positioning of the monitor, further improvements in the usability can be achieved. More research will be required to evaluate the efficacy of the developed system in the treatment of lumbar back pain.
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Affiliation(s)
- Moana Heussler
- Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | - Jasmin Winter
- Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | - Sabina Hotz-Boendermaker
- Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | - Christoph Michael Bauer
- Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland
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García-Dopico N, de la Torre-Luque A, Sitges C, Velasco-Roldán O. Proprioceptive acuity is core for back awareness in chronic low back pain: Further analysis of the content validity of the Spanish version of the Fremantle Back Awareness Questionnaire. Front Hum Neurosci 2022; 16:1070402. [PMID: 36875741 PMCID: PMC9983349 DOI: 10.3389/fnhum.2022.1070402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/28/2022] [Indexed: 02/19/2023] Open
Abstract
Treatments aimed at increasing self-perception may improve chronic low back pain (CLBP) symptomatology and present novel management approaches. Consequently, it is important to have valid, complete, and reliable tools for its assessment, and to understand which variables influence altered back awareness. We aimed to evaluate the face/content validity of the Spanish version of the Fremantle Back Awareness Questionnaire (FreBAQ-S) among people with and without CLBP, and to explore additional variables suggested to be involved in back awareness. A total of 264 individuals with CLBP and 128 healthy controls (HC) answered an online survey, including the FreBAQ-S, and questions regarding the completeness, comprehensibility, time-to-complete adequacy, and time spent completing it. If participants declared a lack of completeness, they had to report which aspects would be incorporated into the questionnaire to explore additional back-awareness-related variables. A statistically significant difference in completeness emerged between groups (p < 0.01). The questionnaire was comprehensible for more than 85% of participants, regardless of the group (p = 0.45). CLBP participants spent significantly more time in completing the questionnaire than controls (p < 0.01), but no differences were found between groups regarding the time-to-complete adequacy (p = 0.49). Regarding the back-awareness-related variables, 77 suggestions from CLBP group and seven from the HC were received. Most of them were related to proprioceptive acuity such as posture, weight, or movement patterns, among others. The FreBAQ-S demonstrated adequate face/content validity, completeness, comprehensibility, and adequate time of response. The feedback provided will help improve currently available assessment tools.
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Affiliation(s)
- Nuria García-Dopico
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, CIBERSAM ISCIII, Complutense University of Madrid (UCM), Madrid, Spain
| | - Carolina Sitges
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Barbosa AM, José-Jandre Dos Reis F, Caseiro M, Barbero M, Falla D, Siriani de Oliveira A. Clinical evaluation of somatosensory integrity in people with chronic shoulder pain. Musculoskelet Sci Pract 2021; 53:102364. [PMID: 33773178 DOI: 10.1016/j.msksp.2021.102364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Indirect evaluation tests of somatosensory integrity, such as the left/right judgment task and two-point discrimination thresholds, are used to complement a clinical evaluation facilitating tailored rehabilitation programs for patients with chronic pain. This study aimed to compare performance on the left/right judgment task and two-point shoulder discrimination thresholds between people with chronic shoulder pain and asymptomatic controls. The study's secondary objective was to investigate whether there is a relationship between pain intensity and the painful area with TPDT and LRJT. MATERIALS AND METHODS It is a cross-sectional study with a control group. Volunteers participated in the left/right judgment task using the Recognise ShoulderTM app, and two-point discrimination thresholds were performed using a Mitutoyo® digital caliper. The extent of the painful area, affectivity, and functionality were also determined to characterize the sample. RESULTS We assessed 52 symptomatic and 50 asymptomatic individuals. A between-group difference was observed in time response for the left/right judgment task (p = 0.025) and the two-point discrimination thresholds when tested over the shoulder's lateral region (p = 0.012). There was a significant positive weak correlation between pain intensity and TPDT test performance over the anterior shoulder (rs = 0.35; p = 0.01) and a positive weak correlation between pain area and LRJT response time (rs = 0.26; p = 0.04). CONCLUSIONS This study demonstrates a difference of small magnitude in the response time of the LRJT for the shoulder segment and TPDT in the lateral shoulder region between individuals with chronic shoulder pain and asymptomatic controls.
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Affiliation(s)
- Amanda Matias Barbosa
- Master in Science Student, Rehabilitation and Functional Performance Post-Graduation Program, -Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Felipe José-Jandre Dos Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil; Postgraduation Progam - Clinical Medicine Department of Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium; Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marília Caseiro
- Master in Science Student, Rehabilitation and Functional Performance Post-Graduation Program, -Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences -Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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de Villiers E, Stone T, Wang NW, Sarangi V, Pelah A, Shenker N. Virtual Environment Rehabilitation for Patients with Motor Neglect Trial (VERMONT): A Single-Center Randomized Controlled Feasibility Trial. Brain Sci 2021; 11:464. [PMID: 33917497 PMCID: PMC8067499 DOI: 10.3390/brainsci11040464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Motor neglect occurs in patients with chronic pain conditions. Virtual environments (VE) help rehabilitation through biofeedback and improving motivation. AIM To assess the feasibility of a VE for patients with motor neglect with chronic pain. METHODS 10 subjects with chronic pain (Fibromyalgia, Sciatica, and Complex Regional Pain Syndrome) underwent a treadmill task three times per week for two weeks. Groups were randomized to receive real-time biofeedback from the VE (intervention) or shown still images (control). Primary outcomes were: (i) distance walked at baseline compared to the final 5 min cycle of week 2; (ii) the Lower Extremity Functional Index (LEFI) questionnaire. A satisfaction questionnaire was used. Follow up was to 24 weeks. RESULTS Total distance walked was significantly higher in the intervention group (p < 0.05), and 33% (2/6) of the intervention group had a clinically important LEFI improvement compared to 0/4 in the control group at week 2. No secondary outcome measures demonstrated any significant differences. The intervention received high satisfaction scores, significantly greater than the control group at week 24. No harms were recorded. DISCUSSION This feasibility study showed that VE and treadmill-walking improved walking distances and function for subjects with motor neglect. This is a promising novel approach and requires further validation through larger study.
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Affiliation(s)
- Elsje de Villiers
- Department of Physiotherapy, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Thomas Stone
- Department of Medical Physics, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Nai-Wei Wang
- Hull York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK;
| | - Viswadeep Sarangi
- Department of Electronic Engineering, University of York, York YO10 5DD, UK; (V.S.); (A.P.)
| | - Adar Pelah
- Department of Electronic Engineering, University of York, York YO10 5DD, UK; (V.S.); (A.P.)
- York Biomedical Research Institute, University of York, York YO10 5DD, UK
| | - Nicholas Shenker
- Rheumatology Research Unit, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
- Department of Medicine, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
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Öztürk Ö, Bombacı H, Keçeci T, Algun ZC. Effects of additional action observation to an exercise program in patients with chronic pain due to knee osteoarthritis: A randomized-controlled trial. Musculoskelet Sci Pract 2021; 52:102334. [PMID: 33582621 DOI: 10.1016/j.msksp.2021.102334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/30/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) leads to pain, stiffness, and functional impairment and eventually decreased level of the quality of life. Although several treatment methods have been used to achieve pain relief, patients still complain of pain. OBJECTIVE The aim of this study was to investigate the effects of the addition of action observation therapy to an exercise program on pain severity, pressure pain threshold, kinesiphobia functionality, and pain catastrophization in knee OA patients with chronic pain. METHODS This prospective, randomized-controlled, superiority trial included a total of 36 patients with knee OA. The patients were randomly divided into two groups as the treatment group (n = 18) receiving action observation therapy in addition to exercise and control group (n = 18) receiving exercise alone. The interventions were performed three times weekly for six weeks. The primary outcomes were pain and pressure pain threshold. Secondary outcomes were kinesiphobia, functionality, and pain catastrophization. All participants were assessed at baseline (pre-intervention) and after the six-week treatment (post-intervention). RESULTS There was no significant difference in the primary and secondary outcome measures before and after the intervention between the groups (p > 0.05). Both groups showed a significant improvement in all outcome measures after the intervention (p < 0.01). CONCLUSION Our study results suggest that action observation therapy in addition to an exercise program does not contribute any additional benefits to pain, pressure pain threshold, kinesiophobia, pain catastrophization, and functionality in knee OA patients with chronic pain. Nonetheless, further large-scale, long-term, prospective studies are needed to gain a better understanding on this subject.
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Affiliation(s)
- Özgül Öztürk
- Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Hasan Bombacı
- University of Health Sciences, Haydarpaşa Numune Research and Training Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Tolga Keçeci
- Ordu University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ordu, Turkey
| | - Zeliha Candan Algun
- Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
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15
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Ribas J, Gomes MA, Montes AM, Ribas C, Duarte JA. Resolution of chronic lower back pain symptoms through high-intensity therapeutic exercise and motor imagery program: a case-report. Physiother Theory Pract 2020; 38:1545-1552. [PMID: 33225789 DOI: 10.1080/09593985.2020.1839985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Nonspecific chronic lower back pain (CLBP) is a difficult to manage clinical condition that is more prevalent in adulthood but also affects adolescents, compromising their well-being and activities of daily living. This case report aimed to describe the clinical evolution of a female adolescent with nonspecific and severe CLBP treated successfully through a combination of high-intensity exercise and motor imagery training. Case Description: A 13-year-old girl with CLBP with radicular pain to the lower limbs, spasms, and movement limitations, for whom pharmacological treatment (i.e. analgesic and muscle relaxant agents) and hydrotherapy, hot wet therapy, and muscle relaxation were unsuccessful. After a careful physiotherapy evaluation, the patient underwent a 36-session intervention, performed 3 times/week for 12 weeks, which was composed of high-intensity therapeutic exercise, adjusted for the patient condition, along with motor imagery training. The patient was reevaluated after the intervention and again 3 years later by the same physiotherapist. Outcomes: The intervention led to a favorable clinical outcome, with pain relief, improved posture, and decreased disability. The patient's clinical condition remained stable at the time of the last follow-up evaluation. Conclusion: These results show that the adjusted combined program led to favorable clinical improvement in the condition, with sustained long-term effects after the intervention.
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Affiliation(s)
- Jorge Ribas
- Department of Morphological Sciences, School of Health, Polytechnic Institute of Porto, Porto, Portugal.,Porto Physio Center, Private Practice, Porto, Portugal
| | - Maria Armanda Gomes
- Department of Anesthesiology, Centro Hospitalar De S. João, Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - António Mesquita Montes
- Department of Physiotherapy, Santa Maria Health School, Porto, Portugal.,Department of Physiotherapy and Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino De Almeida, Porto, Portugal
| | - Cláudia Ribas
- Porto Physio Center, Private Practice, Porto, Portugal
| | - José Alberto Duarte
- Sport Biology Department and Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
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Summers SJ, Chalmers KJ, Wallwork SB, Leake HB, Moseley GL. Interrogating cortical representations in elite athletes with persistent posterior thigh pain - New targets for intervention? J Sci Med Sport 2020; 24:135-140. [PMID: 32798128 DOI: 10.1016/j.jsams.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 05/14/2020] [Accepted: 07/13/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Hamstring injuries in athletes can lead to significant time away from competition as a result of persistent posterior thigh pain. These cases are often difficult to treat as the state of the tissues alone cannot explain symptoms. In non-athletic populations with persistent pain, disruptions to tactile, proprioceptive, and spatial cortical representations exist, which has led to promising brain-based treatments. Here, we explored whether athletes with persistent posterior thigh pain also display impairments in these cortical representations. DESIGN Cross-sectional study. METHODS Fourteen male professional athletes with persistent posterior thigh pain ('Patients') and 14 pain-free age, sport, body mass index and level-matched controls ('Controls') participated. The tactile cortical representation was assessed using two-point discrimination (TPD) threshold and accuracy of tactile localisation; the proprioceptive cortical representation was assessed using a left/right judgement task; spatial processing was assessed using an auditory detection task. RESULTS TPD thresholds were similar for Patients and Controls (p=0.70). Patients were less accurate at localising tactile stimuli delivered to their affected leg, slower to make left/right judgements when the lower limb image corresponded to the side of their affected leg, and less accurate at detecting auditory stimuli delivered near their affected leg, when compared to their healthy leg or to the leg of Controls (p<0.01 for all). CONCLUSIONS Leg-specific tactile, proprioceptive, and spatial processing deficits exist in athletes with persistent posterior thigh pain. That these processing deficits exist despite rehabilitation and normal tissue healing time suggests they may play a role in the persistence of posterior thigh pain.
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Affiliation(s)
- Simon J Summers
- Brain Stimulation and Rehabilitation Lab, School of Health Sciences, Western Sydney University, Australia; University of Canberra's Research Institute for Sport and Exercise, University of Canberra, Australia
| | - K Jane Chalmers
- Brain Stimulation and Rehabilitation Lab, School of Health Sciences, Western Sydney University, Australia
| | - Sarah B Wallwork
- University of Canberra's Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Australia
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Suso‐Martí L, La Touche R, Angulo‐Díaz‐Parreño S, Cuenca‐Martínez F. Effectiveness of motor imagery and action observation training on musculoskeletal pain intensity: A systematic review and meta‐analysis. Eur J Pain 2020; 24:886-901. [DOI: 10.1002/ejp.1540] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/26/2020] [Accepted: 02/05/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Luis Suso‐Martí
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Departament of Physiotherapy Universidad CEU Cardenal Herrera CEU Universities Valencia Spain
| | - Roy La Touche
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN) Madrid Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ) Madrid Spain
| | - Santiago Angulo‐Díaz‐Parreño
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Facultad de Medicina Universidad CEU San Pablo Madrid Spain
| | - Ferran Cuenca‐Martínez
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
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Christakou A, Vasileiadis G, Kapreli E. Motor imagery as a method of maintaining performance in pianists during forced non-practice: a single case study. Physiother Theory Pract 2019; 37:540-548. [PMID: 31267825 DOI: 10.1080/09593985.2019.1636917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Musicians suffer from upper limb playing-related musculoskeletal disorders that often oblige them to periodic inactivity. Objectives: To assess the effectiveness of motor imagery as a means of practice when the physical piano practice is restricted. Methods: A 17-year-old healthy pianist participated in a single subject case study with a multiple baseline design (ABC design). Performance ability was assessed during a period of the no practice, then a period of performing motor imagery and again during a period of another no practice. Assessments were performed subjectively by a professional piano teacher and objectively by the Synthesia software. Three visual analog scales were used to record stress, fatigue, and general psychological state. The participant's motor imagery ability was recorded by the use of the Movement Imagery Questionnaire. Results: There was a statistically significant reduction in performance after no practice. There was no change in performance during motor imagery intervention. The pianist's scores moderately correlated with the general psychological state. The Synthesia scoring presented high correlations with professional piano teacher scoring. Conclusions: Motor imagery seemed to have a positive effect in maintaining the musician's performance level. Synthesia shows promise as an outcome measure for assessing music performance, although further research is needed.
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Affiliation(s)
- Anna Christakou
- Physiotherapy Department, University of Western Attica, Athens, Greece, General Hospital of Athens "Euagelismos", Greece
| | | | - Eleni Kapreli
- Physiotherapy Department, TEI of Sterea Ellada, Lamia, Greece
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Şimşek Ş, Duray M, Altuğ F. Kronik boyun ağrısında bakış yönü tanıma egzersizlerinin ağrı şiddeti, eklem hareket açıklığı ve izometrik kas enduransına etkisi. Cukurova Medical Journal 2019. [DOI: 10.17826/cumj.451482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Anderson B, Meyster V. Treatment of a Patient With Central Pain Sensitization Using Graded Motor Imagery Principles: A Case Report. J Chiropr Med 2019; 17:264-267. [PMID: 30846919 DOI: 10.1016/j.jcm.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/03/2018] [Accepted: 05/01/2018] [Indexed: 10/27/2022] Open
Abstract
Objective This case report describes the application of graded motor imagery principles to a patient experiencing central sensitization and chronic pain. Clinical Features A 46-year-old woman presented with pain in all 4 limbs along with global spinal pain and loss of range of motion. These symptoms initiated after a motor vehicle accident 5 years before and were exacerbated by 2 subsequent motor vehicle accidents. Examination indicated global loss of spinal range of motion, severe apprehension toward any movement, decreased grip strength bilaterally, and loss of 2-point discrimination. A variety of outcome assessments indicated severe disability. Intervention and Outcome The patient was seen at the chiropractic clinic 5× over 6 weeks and showed marked improvement with each visit. Treatment included pain neuroscience education, laterality training using the Recognize app, and explicit motor imagery. The patient demonstrated improvement in all baseline measures just described, including outcome assessment scores. Conclusions Over time, the patient reported decreased chronic pain and disability, along with improvement in grip strength and range of motion, after application of graded motor imagery strategies.
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Affiliation(s)
- Brian Anderson
- Department of Clinical Practice, National University of Health Sciences, Lombard, IL
| | - Vitaliy Meyster
- Department of Clinical Practice, National University of Health Sciences, Lombard, IL
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21
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Goossens N, Rummens S, Janssens L, Caeyenberghs K, Brumagne S. Association Between Sensorimotor Impairments and Functional Brain Changes in Patients With Low Back Pain: A Critical Review. Am J Phys Med Rehabil 2018; 97:200-11. [PMID: 29112509 DOI: 10.1097/PHM.0000000000000859] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Low back pain (LBP) coincides with sensorimotor impairments, for example, reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available functional magnetic resonance imaging studies on brain activation related to nonnociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area, and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. In addition, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Overactivation in these regions could indicate an overresponsiveness to sensory inputs that signal potential harm to the spine, thereby inducing overgeneralized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative.
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22
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Yap BWD, Lim ECW. The Effects of Motor Imagery on Pain and Range of Motion in Musculoskeletal Disorders: A Systematic Review Using Meta-Analysis. Clin J Pain 2019; 35:87-99. [DOI: 10.1097/ajp.0000000000000648] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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23
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Adamczyk WM, Sługocka A, Mehlich K, Saulicz E, Luedtke K. Preliminary Validation of a Two-Point Estimation Task for the Measurement of Sensory Dissociation in Patients with Chronic Low Back Pain. Pain Medicine 2018; 20:2472-2478. [DOI: 10.1093/pm/pny220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AbstractObjectivesSensory dissociation (SEDI), the discrepancy between perception and actual size or shape of a painful body part, is a frequently observed finding in patients with chronic low back pain. However, the current methods of evaluating SEDI have several limitations, such as a qualitative nature and weak evidence supporting their reliability. In the current study, the reliability of two versions (manual and verbal) of a novel test, a two-point estimation task (TPE), was investigated.MethodsTo perform the manual version of the task, patients estimated the distance between two tactile stimuli delivered to their back using callipers, whereas in the verbal version they verbally reported the estimated distance.ResultsThe manual version of TPE showed greater interexaminer reliability than the verbal version, and the mean of the two repeated measurements was sufficient for reaching excellent reliability for the pain-free (intraclass correlation coefficient [ICC] = 0.91, 95% confidence interval [CI] = 0.77–0.97) and painful (ICC = 0.86, 95% CI = 0.65–0.94) sides. Intra-examiner reliability was moderate to excellent (ICC = 0.66–0.96) for the manual version performed at the pain-free and painful sides. Distribution, duration, and intensity of pain significantly predicted SEDI and accounted for 42% of the total variance (corrected R2 = 0.42, P < 0.01).ConclusionsTPE showed higher reliability coefficients compared with tools previously suggested in the literature and can therefore be used clinically and experimentally by one or more examiners. Further research is required to investigate the validity of this new test.
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Affiliation(s)
- Wacław M Adamczyk
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
- Department of Orthopedics and Trauma Surgery, Physiotherapy, University of Luebeck, Luebeck, Germany
| | - Anna Sługocka
- Department of Experimental Medicine, School of Medicine in Katowice, Katowice, Poland
- Department of Physiology, School of Medicine in Katowice, Katowice, Poland
| | - Krzysztof Mehlich
- Department of Physiotherapy in Orthopaedics and Traumatology, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- Upper Silesian Rehabilitation Centre Repty, Tarnowskie Góry, Poland
| | - Edward Saulicz
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Kerstin Luedtke
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- Department of Orthopedics and Trauma Surgery, Physiotherapy, University of Luebeck, Luebeck, Germany
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Ribeiro D, Silva AG. A single session of visual feedback improves range of motion in patients with chronic idiopathic neck pain: A randomized and controlled study. Musculoskeletal Care 2018; 17:72-78. [PMID: 30378756 DOI: 10.1002/msc.1369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Chronic pain is associated with cortical reorganization, and interventions targeting cortical remapping, such as visual feedback of the painful body segment, seem promising. The primary aim of the present study was to evaluate the impact of visual feedback of the neck, using mirrors on pain intensity. Secondary aims were to evaluate the impact of visual feedback on neck range of motion and unadjusted cognitive processes. METHODS Pain intensity, range of motion, fear of movement, catastrophizing and anxiety were assessed before and after 10 repetitions of each of the neck movements, with (experimental group; n = 21) and without (control group; n = 21) visual feedback of the neck. RESULTS A significant increase in the range of motion of all neck movements (p < 0.05) was found in the experimental group when compared with the control group. Increases in range of motion varied between 2.5° and 3.4°. No significant effects were found for the remaining variables (p > 0.05). CONCLUSIONS The study findings suggest that performing a series of 10 active movements of the neck while observing the reflection of the neck in a mirror might help to improve neck range of motion. Furthermore, our results support further studies investigating the effect of longer interventions using visual feedback of the neck, either alone or combined with other interventions.
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Affiliation(s)
- Daniela Ribeiro
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | - Anabela G Silva
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,CINTESIS.UA, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
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Ehrenbrusthoff K, Ryan CG, Grüneberg C, Wand BM, Martin DJ. The translation, validity and reliability of the German version of the Fremantle Back Awareness Questionnaire. PLoS One 2018; 13:e0205244. [PMID: 30286171 PMCID: PMC6171905 DOI: 10.1371/journal.pone.0205244] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/23/2018] [Indexed: 12/19/2022] Open
Abstract
Background The Fremantle Back Awareness Questionnaire (FreBAQ) claims to assess disrupted self-perception of the back. The aim of this study was to develop a German version of the FreBAQ (FreBAQ-G) and assess its test-retest reliability, its known-groups validity and its convergent validity with another purported measure of back perception. Methods The FreBaQ-G was translated following international guidelines for the transcultural adaptation of questionnaires. Thirty-five patients with non-specific CLBP and 48 healthy participants were recruited. Assessor one administered the FreBAQ-G to each patient with CLBP on two separate days to quantify intra-observer reliability. Assessor two administered the FreBaQ-G to each patient on day 1. The scores were compared to those obtained by assessor one on day 1 to assess inter-observer reliability. Known-groups validity was quantified by comparing the FreBAQ-G score between patients and healthy controls. To assess convergent validity, patient’s FreBAQ-G scores were correlated to their two-point discrimination (TPD) scores. Results Intra- and Inter-observer reliability were both moderate with ICC3.1 = 0.88 (95%CI: 0.77 to 0.94) and 0.89 (95%CI: 0.79 to 0.94), respectively. Intra- and inter-observer limits of agreement (LoA) were 6.2 (95%CI: 5.0–8.1) and 6.0 (4.8–7.8), respectively. The adjusted mean difference between patients and controls was 5.4 (95%CI: 3.0 to 7.8, p<0.01). Patient’s FreBAQ-G scores were not associated with TPD thresholds (Pearson’s r = -0.05, p = 0.79). Conclusions The FreBAQ-G demonstrated a degree of reliability and known-groups validity. Interpretation of patient level data should be performed with caution because the LoA were substantial. It did not demonstrate convergent validity against TPD. Floor effects of some items of the FreBAQ-G may have influenced the validity and reliability results. The clinimetric properties of the FreBAQ-G require further investigation as a simple measure of disrupted self-perception of the back before firm recommendations on its use can be made.
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Affiliation(s)
- Katja Ehrenbrusthoff
- Health and Social Care Institute, Teesside University, Middlesbrough, Tees Valley, United Kingdom
- Hochschule für Gesundheit, Department of Applied Health Sciences, Bochum, Germany
- * E-mail:
| | - Cormac G. Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough, Tees Valley, United Kingdom
| | - Christian Grüneberg
- Hochschule für Gesundheit, Department of Applied Health Sciences, Bochum, Germany
| | - Benedict M. Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Denis J. Martin
- Health and Social Care Institute, Teesside University, Middlesbrough, Tees Valley, United Kingdom
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Griffin K, O'Hearn M, Franck CC, Courtney CA. Passive accessory joint mobilization in the multimodal management of chronic dysesthesia following thalamic stroke. Disabil Rehabil 2018; 41:1981-1986. [PMID: 29557687 DOI: 10.1080/09638288.2018.1450453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Study design: Case Report. Purpose: Stroke is the most common cause of long-term disability. Dysesthesia, an unpleasant sensory disturbance, is common following thalamic stroke and evidence-based interventions for this impairment are limited. The purpose of this case report was to describe a decrease in dysesthesia following manual therapy intervention in a patient with history of right lacunar thalamic stroke. Case description: A 66-year-old female presented with tingling and dysesthesia in left hemisensory distribution including left trunk and upper/lower extremities, limiting function. Decreased left shoulder active range of motion, positive sensory symptoms but no sensory loss in light touch was found. She denied pain and moderate shoulder muscular weakness was demonstrated. Laterality testing revealed right/left limb discrimination deficits and neglect-like symptoms were reported. Passive accessory joint motion assessment of glenohumeral and thoracic spine revealed hypomobility and provoked dysesthesia. Interventions included passive oscillatory joint mobilization of glenohumeral joint, thoracic spine, ribs and shoulder strengthening. Results: After six sessions, shoulder function, active range of motion, strength improved and dysesthesia decreased. Global Rating of Change Scale was +5 and QuickDASH score decreased from 45% to 22% disability. Laterality testing was unchanged. Conclusion: Manual therapy may be a beneficial intervention in management of thalamic stroke-related dysesthesia. Implications for Rehabilitation While pain is common following thalamic stroke, patients may present with chronic paresthesia or dysesthesia, often in a hemisensory distribution. Passive movement may promote inhibition of hyperexcitable cortical pathways, which may diminish aberrant sensations. Passive oscillatory manual therapy may be an effective way to treat sensory disturbances such as paresthesias or dysesthesia.
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Affiliation(s)
- Kristina Griffin
- a Outpatient Orthopedics , Shirley Ryan Ability Lab , Chicago , IL , USA.,b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Michael O'Hearn
- b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA.,c Outpatient Orthopedics , Lakeland Health , St. Joseph , MI , USA
| | - Carla C Franck
- b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Carol A Courtney
- b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA
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Adamczyk W, Luedtke K, Saulicz E. Lumbar Tactile Acuity in Patients With Low Back Pain and Healthy Controls: Systematic Review and Meta-Analysis. Clin J Pain 2018; 34:82-94. [DOI: 10.1097/ajp.0000000000000499] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zangrando F, Piccinini G, Tagliolini C, Marsilli G, Iosa M, Vulpiani MC, Paolucci T. The efficacy of a preparatory phase of a touch-based approach in treating chronic low back pain: a randomized controlled trial. J Pain Res 2017; 10:941-949. [PMID: 28461765 PMCID: PMC5404807 DOI: 10.2147/jpr.s129313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Massage therapy is an important element of rehabilitation in the treatment of chronic low back pain (CLBP). The objective of this study was to determine the relative efficacy of massage therapy between traditional massage and a new massage approach for CLBP. We also examined whether any reduction in pain was linked to interoceptive awareness and parasympathetic activation. Methods A single-blind, randomized, controlled trial of 51 patients who were allocated into a traditional massage therapy group (TMG; N=24, mean age: 50.54±9.13 years) or experimental massage therapy group (SMG; N=27, mean age: 50.77±6.80 years). The primary outcome was the reduction in pain per the visual analog scale (VAS); the secondary outcome measures were multidimensional pain intensity on the McGill Pain Questionnaire, pain-related disability per the Waddel Disability Index, interoceptive awareness per the Multidimensional Assessment of Interoceptive Awareness Questionnaire, quality of life per the Short Form - 12 Health Survey, and heart rate variability, expressed as the coherence ratio (CR) by photoplethysmography. The following outcome measures were assessed at baseline, at the end of the treatment program, and at the 3-month follow-up. The mean and standard deviation were calculated for continuous data. Mann–Whitney U test was used to perform between-group comparisons, Friedman’s analysis was used for data on the 3 assessment times in each group, and Spearman’s R coefficient was used to analyze correlations. Results Both approaches had a positive result on pain, an effect that was more acute in the SMG versus TMG for all pain scales, with better maintenance at the 3-month follow-up (VAS p=0.005 and p=0.098; Waddell Index p=0.034 and 0.044; McGill total p=0.000 and 0.003). In the SMG, CR scores were significant at baseline and at the end of the treatment program (p=0.000 and 0.002). Conclusion The new massage approach with a preparatory phase that is pleasant to the touch was more effective than the traditional approach for CLBP.
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Affiliation(s)
- Federico Zangrando
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Piccinini
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Clara Tagliolini
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Gabriella Marsilli
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation, Rome, Italy
| | - Maria Chiara Vulpiani
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Teresa Paolucci
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
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Wittkopf PG, Lloyd DM, Johnson MI. Changing the size of a mirror-reflected hand moderates the experience of embodiment but not proprioceptive drift: a repeated measures study on healthy human participants. Exp Brain Res 2017; 235:1933-1944. [PMID: 28315946 PMCID: PMC5435794 DOI: 10.1007/s00221-017-4930-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/21/2017] [Indexed: 01/24/2023]
Abstract
Mirror visual feedback is used for reducing pain and visually distorting the size of the reflection may improve efficacy. The findings of studies investigating size distortion are inconsistent. The influence of the size of the reflected hand on embodiment of the mirror reflection is not known. The aim of this study was to compare the effect of magnifying and minifying mirror reflections of the hand on embodiment measured using an eight-item questionnaire and on proprioceptive drift. During the experiment, participants (n = 45) placed their right hand behind a mirror and their left hand in front of a mirror. Participants watched a normal-sized, a magnified and a minified reflection of the left hand while performing synchronised finger movements for 3 min (adaptive phase). Measurements of embodiment were taken before (pre) and after (post) synchronous movements of the fingers of both hands (embodiment adaptive phase). Results revealed larger proprioceptive drift post-adaptive phase (p = 0.001). Participants agreed more strongly with questionnaire items associated with location, ownership and agency of the reflection of the hand post-adaptive phase (p < 0.001) and when looking at the normal-sized reflection (p < 0.001). In conclusion, irrespective of size, watching a reflection of the hand while performing synchronised movements enhances the embodiment of the reflection of the hand. Magnifying and minifying the reflection of the hand has little effect on proprioceptive drift, but it weakens the subjective embodiment experience. Such factors need to be taken into account in future studies using this technique, particularly when assessing mirror visual feedback for pain management.
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Affiliation(s)
- Priscilla G Wittkopf
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University City Campus, Leeds, LS1 3HE, UK.
| | - Donna M Lloyd
- School of Psychology, University of Leeds, Lifton Place, Leeds, LS2 9JT, UK
| | - Mark I Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University City Campus, Leeds, LS1 3HE, UK
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Abstract
Specialist bibliographic databases offer essential online tools for researchers and authors who work on specific subjects and perform comprehensive and systematic syntheses of evidence. This article presents examples of the established specialist databases, which may be of interest to those engaged in multidisciplinary science communication. Access to most specialist databases is through subscription schemes and membership in professional associations. Several aggregators of information and database vendors, such as EBSCOhost and ProQuest, facilitate advanced searches supported by specialist keyword thesauri. Searches of items through specialist databases are complementary to those through multidisciplinary research platforms, such as PubMed, Web of Science, and Google Scholar. Familiarizing with the functional characteristics of biomedical and nonbiomedical bibliographic search tools is mandatory for researchers, authors, editors, and publishers. The database users are offered updates of the indexed journal lists, abstracts, author profiles, and links to other metadata. Editors and publishers may find particularly useful source selection criteria and apply for coverage of their peer-reviewed journals and grey literature sources. These criteria are aimed at accepting relevant sources with established editorial policies and quality controls.
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Affiliation(s)
- Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK
| | - Marlen Yessirkepov
- Department of Biochemistry, Biology and Microbiology, South Kazakhstan State Pharmaceutical Academy, Shymkent, Kazakhstan
| | - Alexander A. Voronov
- Department of Marketing and Trade Deals, Kuban State University, Krasnodar, Russian Federation
| | - Vladimir I. Trukhachev
- Department of Technological Management, Stavropol State Agrarian University, Stavropol, Russian Federation
| | - Elena I. Kostyukova
- Faculty of Accounting and Finance, Department of Accounting Management, Stavropol State Agrarian University, Stavropol, Russian Federation
| | - Alexey N. Gerasimov
- Department of Statistics and Econometrics, Stavropol State Agrarian University, Stavropol, Russian Federation
| | - George D. Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
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Wittkopf PG, Johnson MI. Managing pain by visually distorting the size of painful body parts: is there any therapeutic value? Pain Manag 2016; 6:201-4. [DOI: 10.2217/pmt.16.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Priscilla G Wittkopf
- Centre for Pain Research, Faculty of Health & Social Sciences, Leeds Beckett University, Leeds, UK
- Leeds Pallium Research Group, Leeds, UK
| | - Mark I Johnson
- Centre for Pain Research, Faculty of Health & Social Sciences, Leeds Beckett University, Leeds, UK
- Leeds Pallium Research Group, Leeds, UK
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Testa M, Rossettini G. Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. ACTA ACUST UNITED AC 2016; 24:65-74. [PMID: 27133031 DOI: 10.1016/j.math.2016.04.006] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Placebo and nocebo represent complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological modifications occur together with the application of a treatment. Despite a better understanding of this topic in the medical field, little is known about their role in physiotherapy. PURPOSE The aim of this review is: a) to elucidate the neurobiology behind placebo and nocebo effects, b) to describe the role of the contextual factors as modulators of the clinical outcomes in rehabilitation and c) to provide clinical and research guidelines on their uses. IMPLICATIONS The physiotherapist's features, the patient's features, the patient-physiotherapist relationship, the characteristics of the treatment and the overall healthcare setting are all contextual factors influencing clinical outcomes. Since every physiotherapy treatment determines a specific and a contextual effect, physiotherapists should manage the contextual factors as a boosting element of any manual therapy to improve placebo effects and avoid detrimental nocebo effects.
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Affiliation(s)
- Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy.
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
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Kälin S, Rausch-Osthoff AK, Bauer CM. What is the effect of sensory discrimination training on chronic low back pain? A systematic review. BMC Musculoskelet Disord 2016; 17:143. [PMID: 27038609 PMCID: PMC4818915 DOI: 10.1186/s12891-016-0997-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/24/2016] [Indexed: 01/17/2023] Open
Abstract
Background Sensory discrimination training (SDT) for people with chronic low back pain (CLBP) is a novel approach based on theories of the cortical reorganization of the neural system. SDT aims to reverse cortical reorganization, which is observed in chronic pain patients. SDT is still a developing therapeutic approach and its effects have not been systematically reviewed. The aim of this systematic review was to evaluate if SDT decreases pain and improves function in people with CLBP. Methods A systematic review was performed on the available literature to evaluate the effects of SDT. Randomised controlled trials compared the effectiveness of SDT on pain and function in people with CLBP with the effectiveness of other physiotherapy interventions, no treatment, or sham therapy. The methodological quality of the included studies and the clinical relevance of reported treatment effects were investigated. Results The original search revealed 42 records of which 6 fulfilled the inclusion criteria. The majority of studies showed that SDT caused statistically significant improvements in pain and function, but only two studies reported clinically relevant improvements. The applied SDT varied considerably with regard to dosage and content. The methodological quality of the included studies also varied, which hampered the comparability of results. Conclusions Although SDT seems to improve pain and function in people with CLBP, study limitations render firm conclusions unsafe. Future studies should pay closer attention to power and sample selection as well as to the content and dosage of the SDT intervention. We recommend a large, well-powered, prospective randomized control study that uses a standardized SDT approach to address the hypothesis that SDT causes clinically relevant improvements in pain and function. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0997-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel Kälin
- Institute of Physiotherapy, Department of Health, Zurich University of Applied Sciences, Technikumstrasse 71, 8400, Winterthur, Switzerland
| | - Anne-Kathrin Rausch-Osthoff
- Institute of Physiotherapy, Department of Health, Zurich University of Applied Sciences, Technikumstrasse 71, 8400, Winterthur, Switzerland
| | - Christoph Michael Bauer
- Institute of Physiotherapy, Department of Health, Zurich University of Applied Sciences, Technikumstrasse 71, 8400, Winterthur, Switzerland. .,University of Tampere, School of Medicine, Kalevantie 4, FI-33014, Tampere, Finland.
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