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Dass R, Packham T. Brain fog in chronic pain: Protocol for a discourse analysis of social media postings. PLoS One 2024; 19:e0302443. [PMID: 38718019 PMCID: PMC11078377 DOI: 10.1371/journal.pone.0302443] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/29/2024] [Indexed: 05/12/2024] Open
Abstract
Brain fog is a phenomenon that is frequently reported by persons with chronic pain. Difficulties with cognition including memory impairments, attentional issues, and cloudiness are commonly described. The current medical literature demonstrates a similar cloudiness: there is no clear taxonomy or nomenclature, no well-validated evaluations and a dearth of effective interventions. To focus our understanding of this complex phenomenon, we will perform a discourse analysis to explore how brain fog is described in public posts on social media. Discursive methodology will generate insights regarding the societal understanding and meanings attributed to brain fog, by sampling perspectives of persons with lived experience, currently underrepresented in the medical literature. It is anticipated that the results of the proposed study will 1) help healthcare professionals better understand the experience of chronic pain-related brain fog and 2) generate hypotheses for future research. To conclude, by incorporating innovative and contemporary methods, this proposed discourse analysis of social media sources will generate nuanced insights, bridging the gap between researchers, health care providers, and persons with lived experience.
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Affiliation(s)
- Ronessa Dass
- Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Verweel L, Packham T, Goldstein R, Brooks D, MacKay C. Implementation of virtual pulmonary rehabilitation during the COVID-19 pandemic: Experiences and perceptions of patients and healthcare providers. Respir Med 2024; 225:107588. [PMID: 38460709 DOI: 10.1016/j.rmed.2024.107588] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Pulmonary rehabilitation (PR) plays an important role in the management of symptomatic patients with chronic respiratory diseases (CRD). While studies have investigated the feasibility and efficacy of virtual PR (VPR), it is important to understand the experiences of patients and healthcare providers (HCPs) during the rapid digital health transformation that occurred in the COVID-19 pandemic. OBJECTIVES To explore the experiences and perspectives of patients and HCPs who participated in VPR during the pandemic. METHODS Semi-structured interviews were conducted with CRD patients and HCPs. This study used a qualitative descriptive approach and a team-based inductive thematic analysis. RESULTS Participants included 11 HCPs (7 female; 29-55 years) and 19 CRD patients (11 male; 62-83 years; 15 COPD, 4 COPD/ILD). Three major themes and 10 subthemes were identified: i) the pandemic response: a 'trial by fire' (navigating uncertainty, emotional impact of change, shifting practice amid complexity); ii) beyond the emergency: navigating a 'new normal' (eligibility and assessment for VPR, virtual exercise, virtual education and resources, clinical supervision and patient safety); and iii) care beyond boundaries: the implications of using technology for PR (benefits and limitations of technology, psychosocial implications, VPR in the future). CONCLUSION The pivot to VPR was acknowledged as positive by both patients and HCPs although both groups were mindful of the implementation challenges. These findings provide insight into the experience of HCPs and patients in introducing VPR in response to the pandemic and will inform future implementation of VPR for individuals with CRD.
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Affiliation(s)
- L Verweel
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada.
| | - T Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - R Goldstein
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada; Departments of Medicine and Physical Therapy, University of Toronto, Toronto, Canada
| | - D Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada
| | - C MacKay
- West Park Healthcare Centre, Toronto, Canada; Departments of Medicine and Physical Therapy, University of Toronto, Toronto, Canada
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Madden K, Pallapothu S, Young Shing D, Adili A, Bhandari M, Carlesso L, Khan M, Kleinlugtenbelt YV, Krsmanovic A, Nowakowski M, Packham T, Romeril E, Tarride JE, Thabane L, Tushinski DM, Wallace C, Winemaker M, Shanthanna H. Opioid reduction and enhanced recovery in orthopaedic surgery (OREOS): a protocol for a feasibility randomised controlled trial in patients undergoing total knee arthroplasty. Pilot Feasibility Stud 2024; 10:30. [PMID: 38360686 PMCID: PMC10868001 DOI: 10.1186/s40814-024-01457-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Knee arthritis is a leading cause of limited function and long-term disability in older adults. Despite a technically successful total knee arthroplasty (TKA), around 20% of patients continue to have persisting pain with reduced function, and low quality of life. Many of them continue using opioids for pain control, which puts them at risk for potential long-term adverse effects such as dependence, overdose and risk of falls. Although persisting pain and opioid use after TKA have been recognised to be important issues, individual strategies to decrease their burden have limitations and multi-component interventions, despite their potential, have not been well studied. In this study, we propose a multi-component pathway including personalized pain management, facilitated by a pain management coordinator. The objectives of this pilot trial are to evaluate feasibility (recruitment, retention, and adherence), along with opioid-free pain control at 8 weeks after TKA. METHODS This is a protocol for a multicentre pilot randomised controlled trial using a 2-arm parallel group design. Adult participants undergoing unilateral total knee arthroplasty will be considered for inclusion and randomised to control and intervention groups. Participants in the intervention group will receive support from a pain management coordinator who will facilitate a multicomponent pain management pathway including (1) preoperative education on pain and opioid use, (2) preoperative risk identification and mitigation, (3) personalized post-discharge analgesic prescriptions and (4) continued support for pain control and recovery up to 8 weeks post-op. Participants in the control group will undergo usual care. The primary outcomes of this pilot trial are to assess the feasibility of participant recruitment, retention, and adherence to the interventions, and key secondary outcomes are persisting pain and opioid use. DISCUSSION The results of this trial will determine the feasibility of conducting a definitive trial for the implementation of a multicomponent pain pathway to improve pain control and reduce harms using a coordinated approach, while keeping an emphasis on patient centred care and shared decision making. TRIAL REGISTRATION Prospectively registered in Clinicaltrials.gov (NCT04968132).
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Affiliation(s)
- Kim Madden
- Department of Surgery, McMaster University, Hamilton, Canada.
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada.
- Department of Health Research Methods, McMaster University, Hamilton, Canada.
| | | | | | - Anthony Adili
- Department of Surgery, McMaster University, Hamilton, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Canada
| | - Lisa Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Moin Khan
- Department of Surgery, McMaster University, Hamilton, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | | | - Adrijana Krsmanovic
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Matilda Nowakowski
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Eric Romeril
- Hamilton Health Sciences-Juravinski Hospital, Hamilton, Canada
| | - Jean-Eric Tarride
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Canada
- Center for Health Economics and Policy Analyses, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Canada
| | - Daniel M Tushinski
- Department of Surgery, McMaster University, Hamilton, Canada
- Hamilton Health Sciences-Juravinski Hospital, Hamilton, Canada
| | - Christine Wallace
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | | | - Harsha Shanthanna
- Department of Surgery, McMaster University, Hamilton, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
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Kadakia Z, Lansang RP, Ball P, Kuspinar A, VanderKaay S, Packham T. Reliability, validity and responsiveness of composite finger flexion in patients with traumatic hand injuries: A clinical measurement study. J Hand Ther 2024:S0894-1130(23)00175-8. [PMID: 38278698 DOI: 10.1016/j.jht.2023.12.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/27/2023] [Accepted: 12/08/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Composite finger flexion (CFF) is proposed to be a convenient alternative to total active motion (TAM) and total passive motion (TPM). Passive CFF (PCFF) may be useful for early monitoring in post-operative rehabilitation of traumatic hand injuries. PURPOSE To determine whether active and passive CFF are reliable, valid, and responsive measures of hand motion and of higher utility to the tester. STUDY DESIGN Cross-sectional observational clinical measurement study. METHODS Fifty hand injury patients were recruited from a hospital-based out-patient clinic. TAM, TPM, repeated measures of active CFF (ACFF) and PCFF, self-reported stiffness, patient reported wrist/hand evaluation (PRWHE) scores, and grip strength were recorded. Intraclass correlation coefficients (ICCs) and standard error of measurement were calculated for inter-rater and test-retest reliability. Criterion and construct validity were assessed using correlation coefficients. Responsiveness was explored by calculating correlation coefficients of change scores, effect sizes, and standardized response means. Time taken to measure CFF and TAM/TPM was recorded to consider utility. RESULTS The average age of participants was 47 years and 36% were female. Inter-rater and test-retest reliability estimates for ACFF and PCFF were excellent (ICCs = 0.95-98). Standard error of measurement values ranged from 0.21 to 0.33. The correlation coefficient for criterion validity between ACFF and TAM was -0.69; PCFF and TPM was -0.65; and ACFF and PCFF was 0.83. For construct validity, ACFF and TAM were similarly correlated with PRWHE. Correlations between changes in stiffness with ACFF and PCFF were 0.43 and 0.26, respectively. Effect sizes of ACFF and PCFF were small at 0.1 and 0.2. Time taken to measure CFF was much shorter than TAM/TPM. CONCLUSIONS The results of this study support the use of active and passive CFF as a reliable, valid, and efficient tool in the clinical setting. Further study is required to verify the responsiveness of CFF.
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Affiliation(s)
- Zeal Kadakia
- School of Rehabilitation Sciences, McMaster University, Ontario, Canada.
| | | | - Pam Ball
- Regional Rehabilitation Centre, Hamilton Health Sciences, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Sciences, McMaster University, Ontario, Canada
| | - Sandra VanderKaay
- School of Rehabilitation Sciences, McMaster University, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Ontario, Canada
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Farzad M, MacDermid J, Packham T. Fear of Movement in People With CRPS: A Psychometric Evaluation of the Tampa Scale-11 for Kinesiophobia. Clin J Pain 2024; 40:26-34. [PMID: 37867330 DOI: 10.1097/ajp.0000000000001169] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND People with complex regional pain syndrome (CRPS) commonly report a fear of movement that can worsen symptoms and increase disability. The Tampa Scale of Kinesiophobia (TSK) is used to evaluate fear of movement and (re)injury, but findings have been inconsistent in different populations. OBJECTIVE To evaluate the psychometric properties of the Persian version of TSK-11 in individuals with upper limb CRPS. Specifically, to determine whether the factor structure aligns with the original 2-factor model, consisting of "activity avoidance" and "somatic focus." MATERIALS AND METHODS People with CRPS (n=142, mean age=42, 54% female) completed the TSK. The psychometric testing included internal consistency, test-retest reliability (intraclass correlation coefficient), and convergent construct validity. Confirmatory and exploratory factor analyses were performed to evaluate the structural validity. RESULTS The TSK-11 showed acceptable internal consistency (Cronbach alpha 0.93) and excellent test-retest reliability (intraclass correlation coefficient=0.93, 95% CI: 0.92-0.94). The Standard Error of Measurement and Minimal Detectable Change were 4.3 and 11.7, respectively. The results also demonstrated excellent criterion validity ( r =0.81). Confirmatory factor analysis demonstrated that the original 2-factor model did not fit. Exploratory factor analysis derived a 2-factor solution with different items. The factor structure accounted for 64.91% of the variance, and the internal consistency of the factors was acceptable (>0.90). Expert consensus suggested naming these 2 factors as fear avoidance and magnification and helplessness. DISCUSSION The TSK-11 demonstrates excellent retest reliability in people with CRPS. The original 2-factor structure was not confirmed, and a new 2-factor structure of the TSK-11 was proposed consisting of subscales for Fear Avoidance Beliefs and Magnification/Helplessness. Given the overlap between these constructs and the construct of pain catastrophizing, further study is needed to clarify both measures' content validity and relative uniqueness.
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Affiliation(s)
- Maryam Farzad
- Occupational Therapy, Department of Health and Rehabilitation Sciences, Hand and Upper Limb Center, St. Joseph's Health Center, School of Physical Therapy, University of Western Ontario, London, ON, Canada
| | - Joy MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Hand and Upper Limb Center, St. Joseph's Health Center, London, ON, Canada
- Rehabilitation Science McMaster University, Hamilton, ON, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Dabbagh A, MacDermid JC, Packham T, Grewal R, Fraser J. Provocative maneuvers demonstrate excellent accuracy in the "virtual" diagnosis of carpal tunnel syndrome among people with upper limb conditions-a short technical report. J Hand Ther 2024; 37:153-156. [PMID: 37586988 DOI: 10.1016/j.jht.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Armaghan Dabbagh
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada.
| | - Joy C MacDermid
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ruby Grewal
- Department of Surgery, Western University, London, Ontario, Canada
| | - James Fraser
- Department of Computer Science, University of Guelph, Guelph, Ontario, Canada
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Hebert A, MacDermid J, Harris J, Packham T. How should we treat painful sensitivity in the hand? An international e-Delphi study. J Hand Ther 2024; 37:12-21. [PMID: 37778879 DOI: 10.1016/j.jht.2023.08.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/25/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Evidence synthesis suggests allodynia resulting from neuropathic pain has few interventions with clear effectiveness. As research continues to build this needed evidence base, expert consensus recommendations can address the conflicting approaches within current hand therapy practice. PURPOSE This study aimed to develop consensus recommendations for the clinical management of allodynia from an international panel of hand therapists. STUDY DESIGN This was an international e-Delphi survey study. METHODS We recruited international hand rehabilitation experts to participate in an e-Delphi survey. Consensus was defined as 75% or more of participants agreeing with a recommendation, and at least 3 rounds of consensus building were anticipated. Experts were identified from 21 countries, and clinical vignettes describing a spectrum of patients with painful sensitivity in the hand were provided to elicit treatment recommendations. Initial recommendations were summarized, and consensus sought for clinical practice recommendations. RESULTS Sixty-eight participants were invited, with 44 more added through peer nominations. Fifty-four participants from 19 countries completed the initial survey and were invited to participate in all subsequent rounds. Over 900 treatment suggestions were provided from the initial vignettes across domains, including sensory, physical, and functional interventions, education, and cortical representation techniques: 46 ultimately reached consensus. However, important discrepancies in justification (eg, why allodynia should be covered) and implementation of techniques (eg, desensitization, sensory reeducation) were identified as the consensus exercise progressed. CONCLUSIONS Experts recommend individually tailored programs to treat allodynia using a variety of physical/movement, sensory-based, and "top-down" approaches; this is highly aligned with contemporary theories, such as the Neuromatrix Model of Pain. However, consensus was not reached on the justification and implementation of some of these approaches, reflecting the lack of a taxonomy and supporting evidence for tactile stimulation approaches in the current literature. Trials directly comparing the effectiveness of these approaches are needed.
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Affiliation(s)
- Andrea Hebert
- School of Rehabilitation Sciences, McMaster University, Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Rehabilitation Sciences, McMaster University, Institute for Applied Health Sciences, Hamilton, Ontario, Canada; School of Physiotherapy, Western University, Elborn College, London, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, McMaster University, Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Institute for Applied Health Sciences, Hamilton, Ontario, Canada.
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Farzad M, Packham T. Interpretation and content validity of the items of the Hamilton inventory to evaluate outcomes in Persian-speaking patients with complex regional pain syndrome: A cognitive interview approach. J Hand Ther 2023; 36:1007-1014. [PMID: 37783632 DOI: 10.1016/j.jht.2023.04.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/28/2022] [Accepted: 04/27/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The Hamilton Inventory for complex regional pain syndrome (CRPS) is a multidisciplinary assessment tool to evaluate signs and symptoms in patients with CRPS, developed in the English language. PURPOSE This study aims to translate and cross-culturally adapt this tool for Persian-speaking patients with CRPS. Furthermore, this study aimed to understand how 1) Persian-speaking experts and patients interpret and calibrate responses to items on the Hamilton Inventory and 2) compensatory strategies that might affect responses. STUDY DESIGN A cross sectional study with cognitive interview method. METHODS Ten health care providers and 10 patients with CRPS were interviewed using cognitive interviewing techniques (talk-aloud, semi-structured interview probes). All interviews were recorded and transcribed verbatim. A directed content analysis was done to analyze the interviews using a previously established framework. RESULTS Overall, the items on the Hamilton Inventory were well received by participants. Areas, where questions were unclear to some participants were recorded and categorized into five themes: Clarity and Comprehension (100%) in item 1 from the health professional tool and (65%) from the eleven items of the patient-reported tool. Perspective modifiers of culture influenced the calibrations of items "I feel my condition has negatively affected my relationships." (12%) and "My symptoms affect my comfort level with intimacy." (20%) from the patient-reported tool. CONCLUSION The findings of this study demonstrate that there is no need for substantive changes to the items of the Hamilton Inventory, as they tend to be understood by Persian-speaking experts and patients with CRPS.
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Affiliation(s)
- Maryam Farzad
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, St Joseph's Health Care, London, ON, Canada.
| | - Tara Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Hebert A, MacDermid J, Harris J, Packham T. How should we define and assess painful sensitivity in the hand? An international e-Delphi study. J Hand Ther 2023:S0894-1130(23)00116-3. [PMID: 37777441 DOI: 10.1016/j.jht.2023.08.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/24/2023] [Accepted: 08/15/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Painful sensitivity in the hand is commonly seen with neuropathic pain, interfering with daily activities including rehabilitation. However, there are currently several terms used to describe the problem and a lack of guidance on what assessments should be used. PURPOSE To gather expert opinion a) identifying current and common terminology used in hand therapy, b) developing a consensus definition of hypersensitivity, and c) developing consensus guidance on how to best assess allodynia. STUDY DESIGN International e-Delphi survey study. METHODS We conducted an e-Delphi consensus study drawing on international experts in hand rehabilitation. We planned up to four rounds of consensus-seeking, defining consensus as 75% or more of participants agreeing with a definition or recommendation. Experts were identified from 21 countries, with the nomination of other experts encouraged for 'snowball sampling'. The first round included clinical vignettes describing 'painful sensitivity of the hand' and asked participants to describe how they would assess each case. Definitions for hypersensitivity, tactile hyperesthesia, and allodynia were also requested. RESULTS We invited 68 participants: 44 more were added through nominations. Sixty-three agreed to participate and were sent the round one survey; 54 participants from 19 countries completed this survey and were invited to participate in all subsequent rounds. No two definitions of hypersensitivity were the same, while 87% of the definitions for allodynia and 78% for tactile hyperesthesia were concordant with a published taxonomy. Over 700 assessment items were proposed in round one: ultimately 38 items representing eight distinct constructs reached a consensus for assessing allodynia. CONCLUSIONS Therapists definitions were consistent with an existing taxonomy for allodynia. Although hypersensitivity conceptualizations varied regarding the qualities of stimulus and response, a working definition was reached. Recommended assessments were relatively consistent internationally, holistic, and reflected a potential link between allodynia and central sensitization.
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Affiliation(s)
- Andrea Hebert
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada; School of Physiotherapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada.
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Shafiee E, MacDermid J, Packham T, Grewal R, Farzad M, Bobos P, Walton D. Rehabilitation Interventions for Complex Regional Pain Syndrome: An Overview of Systematic Reviews. Clin J Pain 2023; 39:473-483. [PMID: 37224001 DOI: 10.1097/ajp.0000000000001133] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES An increasing number of systematic reviews have been conducted on various conservative management of complex regional pain syndrome (CRPS) targeting different rehabilitation interventions and objectives. The intent of this article was to summarize and critically appraise the body of evidence on conservative management of the CRPS and to provide an overall picture of the current state of the literature. METHODS This study was an overview of systematic reviews on conservative treatments for CRPS. We conducted a literature search from inception to January 2023 in the following databases: Embase, Medline, CINAHL, Google Scholar, Cochrane Library, and Physiotherapy Evidence Database (PEDro). Two independent reviewers conducted study screening, data extraction, and methodological quality assessment (using AMSTAR-2). Qualitative synthesis was the preferred method for reporting the findings of our review. We calculated the corrected covered area index to account for the proportion of overlapping primary studies that were included in multiple reviews. RESULT We identified 214 articles, and a total of 9 systematic reviews of randomized controlled trials were eligible for inclusion. Pain and disability were the most common outcomes evaluated in the reviews. There were 6 (6/9; 66%) high-quality, 2 (2/9; 22%) moderate-quality, and 1 critically low-quality systematic review (1/9;11%), with the quality of the included trials ranging from very low to high. There was a large overlap across primary studies that were included in the systematic reviews (corrected covered area=23%). The findings of high-quality reviews support the effectiveness of mirror therapy (MT) and graded motor imagery (GMI) programs on pain and disability improvement in CRPS patients. The large effect size was reported for the effectiveness of MT on pain and disability (SMD:1.88 (95% CI: 0.73-3.02) and 1.30 (95% CI: 0.11-2.49), respectively) and the effectiveness of GMI program (GMIP) on pain and disability improvement (SMD: 1.36 (95% CI: 0.75-1.96) and 1.64 (95% CI: 0.53-2.74), respectively). DISCUSSION The evidence is in favor of adopting movement representation techniques, such as MT and GMI programs, for the treatment of pain and disability in patients with CRPS. However, this is based on a small body of primary evidence, and more research is required to generate conclusions. Overall, the evidence is not comprehensive or of sufficient quality to make definitive recommendations about the effectiveness of other rehabilitation interventions in improving pain and disability.
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Affiliation(s)
- Erfan Shafiee
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
| | - Joy MacDermid
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
- Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Ruby Grewal
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Maryam Farzad
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
| | - Pavlos Bobos
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
| | - David Walton
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
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Verweel L, Newman A, Michaelchuk W, Packham T, Goldstein R, Brooks D. The effect of digital interventions on related health literacy and skills for individuals living with chronic diseases: A systematic review and meta-analysis. Int J Med Inform 2023; 177:105114. [PMID: 37329765 DOI: 10.1016/j.ijmedinf.2023.105114] [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: 04/17/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Chronic diseases are a leading cause of death and disease burden globally. Digital interventions could be an approach to improve patients' ability to find, evaluate, and use health information. OBJECTIVES The main objective was to conduct a systematic review to determine the effect of digital interventions on digital health literacy for patients living with chronic disease. Secondary objectives were to provide an overviewof the design and delivery characteristics of interventions that impact digital health literacy in people with chronic disease. METHODS Randomized controlled trials examining digital health literacy (and related components) for individuals with cardiovascular disease, chronic lung disease, osteoarthritis, diabetes, chronic kidney disease, and HIV were identified. This review was conducted following the PRIMSA guidelines. Certainty was assessed using GRADE and the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42022375967). RESULTS 9386 articles were identified and 17 articles representing 16 unique trials were included. Studies evaluated 5138 individuals with one or more chronic conditions (50% women, ages 42 ± 7-71 ± 12 years). The most targeted conditions were cancer, diabetes, cardiovascular disease, and HIV. Interventions included: skills training, websites, electronic personal health records, remote patient monitoring, and education. The effects of the interventions were related to: (i) digital health literacy, (ii) health literacy, (iii) health information skills, (iv) technology skills and access, and (v) self-management and participation in care. A meta-analysis of three studies identified the effect of digital interventions was better than usual care for eHealth literacy (1.22 [CI 0.55, 1.89], p < 0.001). CONCLUSIONS The evidence of the effects of digital interventions on related health literacy is limited. Existing studies reflect the heterogeneity in study design, population, and outcome measures. There is a need for further studies on the effects of digital interventions on related health literacy for individuals with chronic conditions.
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Affiliation(s)
- L Verweel
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada.
| | - A Newman
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada
| | - W Michaelchuk
- West Park Healthcare Centre, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - T Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - R Goldstein
- West Park Healthcare Centre, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - D Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada
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12
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Dabbagh A, Ziebart C, MacDermid JC, Packham T, Grewal R. The effectiveness of biophysical agents in the treatment of carpal tunnel syndrome- an umbrella review. BMC Musculoskelet Disord 2023; 24:645. [PMID: 37563725 PMCID: PMC10416372 DOI: 10.1186/s12891-023-06778-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Our objective was to summarize, synthesize, and integrate the evidence evaluating the effectiveness of biophysical agents compared to other conservative treatments, for the management of carpal tunnel syndrome (CTS). METHODS This was an overview of systematic reviews (SRs). We searched several online databases and obtained SRs relating to managing CTS using biophysical agents. Two independent researchers screened and appraised the quality of the SRs using the A MeaSurement Tool to Assess systematic Reviews-2 appraisal tool. We extracted information related to study characteristics as well as the effectiveness of biophysical agents for CTS, the effect sizes, and between-group significances. We categorized the information based on the type of biophysical agent. We also performed a citation mapping and calculated the corrected covered area index. RESULTS We found 17 SRs addressing 12 different biophysical agents. The quality of the SRs was mainly critically low (n = 16) or low (n = 1). The evidence was inconclusive for the effectiveness of Low-level Laser therapy and favorable for the short-term efficacy of non-thermal ultrasound in improving symptom severity, function, pain, global rating of improvement, satisfaction with treatment, and other electrophysiological measures compared to manual therapy or placebo. Evidence was inconclusive for Extracorporeal Shockwave therapy, and favorable for the short-term effectiveness of Shortwave and Microwave Diathermy on pain and hand function. The corrected covered area index was lower than 35% indicating a low overlap of the SRs. CONCLUSIONS The findings were based on low-quality primary studies, with an unclear or high risk of bias, small sample sizes, and short follow-ups. Therefore, no recommendations can be made for the long-term effectiveness of any biophysical agents. High-quality evidence is needed to support evidence-based recommendations on the use of biophysical agents in the management of CTS. PROSPERO REGISTRATION NUMBER CRD42022319002, registered on 17/04/2022.
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Affiliation(s)
- Armaghan Dabbagh
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada.
| | - Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada
- KITE-UHN, University of Toronto, Toronto, ON, Canada
| | - Joy C MacDermid
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ruby Grewal
- Department of Surgery, Western University, London, ON, Canada
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13
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Dass R, Kalia M, Harris J, Packham T. Understanding the Experience and Impacts of Brain Fog in Chronic Pain: A Scoping Review. Can J Pain 2023; 7:2217865. [PMID: 37441085 PMCID: PMC10334862 DOI: 10.1080/24740527.2023.2217865] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
Introduction Approximately 15% to 40% of persons with chronic pain as a primary disorder experience brain fog. Prior research has investigated the etiology of "brain fog" in conditions in which pain presents as a key feature (e.g., fibromyalgia). However, it remains understudied in the context of chronic 10 musculoskeletal pain. Following current scoping review guidelines, we obtained stakeholder input from patient and health care professionals (HCPs) to define this phenomenon. Specific aims of this review were to (1) identify factors contributing to brain fog, (2) identify the functional correlates of brain fog and assessments used to measure them, and (3) establish a definition of brain fog that can be employed by researchers and HCPs to advance research and care. Methods A scoping review was conducted using recommendations of the Joanna Briggs Institute methodology of scoping reviews and the Levac et al methodology. Embase, Cinahl, PsycINFO, and Medline was searched to identify relevant sources. Findings were verified with patient and healthcare professionals. Results We identified four 15 key features of brain fog: perceived variability, subjective cognitive dysfunction, participation limitations, and changes in functional activities. We developed a model of brain fog illustrating the overlapping categories of contributors to brain fog in chronic musculoskeletal pain: (1) neuroanatomical and neurophysiological, (2) mental health/emotional, and (3) environmental/lifestyle. Conclusion The results of this scoping review conclude that the inconsistency in research regarding brain fog in 20 chronic musculoskeletal pain is obstructing a clear understanding of the phenomenon and therefore may be impeding persons with chronic pain and brain fog from receiving optimal care.
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Affiliation(s)
- Ronessa Dass
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mohini Kalia
- Faculty of Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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14
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Roby NU, Packham T, MacDermid JC, Carlesso LC. Assessing validity of the original and Rasch versions of the central sensitization inventory with psychophysical tests in people with knee osteoarthritis. Pain Medicine 2022:6874127. [DOI: 10.1093/pm/pnac189] [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] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/19/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Abstract
Objective
To determine the extent of agreement between the original CSI and the Rasch analyzed version (RC-CSI) and to explore the association of both versions with psychophysical tests and their respective sensitivity and specificity.
Methods
Patients with knee OA enrolled in a multicenter cohort study in Montreal, Canada completed the original CSI and RC-CSI and psychophysical tests i.e., Pressure pain thresholds (PPTs), Temporal Summation, Conditioned pain modulation using standardized protocols. Bland-Altman analyses assessed the agreement between the original CSI and the RC-CSI; Spearman correlations and chi-square analysis evaluated the association between the two CSI scores and psychophysical tests. A CSI cut point of 40 and the RC-CSI cut-point of 31.37 was used. Receiver Operating Characteristic curves and the resulting sensitivity and specificity with psychophysical tests was also analyzed.
Results
293 participants were included (58.7% female, mean age of 63.6 and BMI 31.9 kg/m2). The original CSI & RC-CSI mean difference 3.3/8.2, t (292)= 8.84(p < 0.001) was significantly different indicating a small bias. Small but significant inverse correlations were found for the original CSI and RC CSI scores with PPTs at the forearm and patella with variance explained ranging from 0.01 to 0.12. The largest area under the curve suggested cut-points of 23 (CSI) and 25 (RC-CSI) with 80.9% sensitivity and 38.5% specificity.
Conclusions
Due to poor variance explained with QST and high false positive rates, our results indicate there is little clinical value of using either version of the CSI in people with knee OA.
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Affiliation(s)
- Naym Uddin Roby
- McMaster University School of Rehabilitation Science, , Hamilton, ON, Canada
| | - Tara Packham
- McMaster University School of Rehabilitation Science, , Hamilton, ON, Canada
| | - Joy C MacDermid
- Western University Physical Therapy and Surgery, , London, ON, Canada
| | - Lisa C Carlesso
- McMaster University School of Rehabilitation Science, , Hamilton, ON, Canada
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15
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Farzad M, MacDermid JC, Packham T, Khodabandeh B, Vahedi M, Shafiee E. Factors associated with disability and pain intensity in patients with complex regional pain syndrome. Disabil Rehabil 2022; 44:8243-8251. [PMID: 34870547 DOI: 10.1080/09638288.2021.2009045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/19/2023]
Abstract
PURPOSE To examine the associations between psychological factors (pain catastrophizing, pain-related anxiety, and fear of pain) and level of pain and disability in patients with complex regional pain syndrome (CRPS). METHODS One hundred and two patients with CRPS were recruited from tertiary care centers with the different upper limb injuries were evaluated for pain, disability, and psychological factors. Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Patient Rated Wrist Evaluation (PRWE), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK-11), and Depression, Anxiety, and Stress Scale (DASS). The associations of pain and disability with presence of these behavioral and mental health factors were examined using bivariate and multivariable analyses. These models were adjusted for age, sex, injured dominant hand, and previous surgery. RESULTS A higher pain catastrophizing score (β = 0.55, p = 0.00) was associated with greater disability. A higher pain catastrophizing score (β = 0.35, p = 0.001) and female gender (β = 0.24, p = 0.01) were associated with greater pain at rest (PAR). A higher pain catastrophizing score and having a surgical history were associated with greater pain with movement (β = 0.25, p = 0.02). Scores of ≥18.5 in PCS, ≥57.5 on TSK, and ≥15.5 on DASS were associated with higher risk of experiencing pain and disability. CONCLUSIONS Pain catastrophizing, female sex, and surgical intervention are associated with poor outcomes. Physiologic, psychological factors, and treatment factors interact to influence outcomes. The results of this study further validate the associations of chronic pain and disability with pain catastrophizing in patients with CRPS. The novel finding of this study is introducing cut-off scores for TSK, PCS, and DASS as a screening tool to predict pain, functional limitations.Implication for rehabilitationPain catastrophizing has a vital role in the magnitude of disability and pain in patients with CRPS.The novel finding of this paper was the cut-off scores on the psychological evaluations that can enable using them as screening tool for bad outcomes in patients with CRPS.Cut off scores from different psychological evaluations can be used as a yellow flag for clinician's for detecting patients with increased risk of pain and disability.The identification of a cut-off can also have implications for implementing change in clinical practice by identifying the need for early and intensive interventions.
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Affiliation(s)
- Maryam Farzad
- Department of Health and Rehabilitation Sciences, School of Physical Therapy, University of Western Ontario, London, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, Canada.,Clinical Research Lab, Hand and Upper Limb Center, St. Joseph's Health Center, London, Canada.,Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Behzad Khodabandeh
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Erfan Shafiee
- Department of Health and Rehabilitation Sciences, School of Physical Therapy, University of Western Ontario, London, Canada
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16
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Sivagurunathan M, Walton DM, Packham T, Booth RG, MacDermid JC. Discourses Around Male IPV Related Systemic Biases on Reddit. J Interpers Violence 2022; 37:NP17834-NP17859. [PMID: 34251276 DOI: 10.1177/08862605211030015] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To date research on intimate partner violence (IPV) has focused on the experience of females. The limited studies on male IPV survivors have shown that they are less likely to disclose their IPV experiences. Systemic biases may marginalize and silence male IPV survivors.The current study sought to explore the discourse around perceived systemic biases that may be present for male IPV survivors.A widely used social networking site (http://www.reddit.com/) was scraped for submissions relating to male IPV. Search was carried out using three keywords resulting in 917 submissions, out of which 82 met inclusion criteria. Submissions were included in final analysis if they consisted of more than half a page of data pertaining to male IPV. Thematic content analysis was utilized to analyze the data.Responses reflect common experiences with participants identifying multiple sources of perceived systemic biases: (1) social norms, (2) legal system, (3) social services, (4) media, and (5) government.The sources of potential support for male IPV survivors exhibit substantial pervasive biases against males as victims of IPV. Findings from current study can inform policies across multiple systems.
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Affiliation(s)
| | | | | | | | - Joy C MacDermid
- Western University, London, ON, Canada
- McMaster University, Hamilton, ON, Canada
- St Joseph's Health Centre, London, ON, Canada
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17
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Pallapothu S, Madden K, Adili A, Krsmanovic A, Nowakowski M, Packham T, Shoaib S, Thabane L, Tarride JE, Tushinski D, Shanthanna H. Opioid Reduction and Enhanced Recovery in Orthopaedic Surgery (OREOS): A Feasibility Randomized Controlled Trial in Knee Replacement Patients. Can J Pain 2022; 6:1-2. [PMID: 36213524 PMCID: PMC9542329 DOI: 10.1080/24740527.2022.2102465] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Total knee arthroplasties are the second most common surgery in Canada. Most patients recover well, but 20% or more still suffer from persistent pain and opioid use. Though opioids are an important part of perioperative pain management, their potential for long-term adverse effects is well recognized. Limiting opioids may be insufficient to overcome the issue of opioid overuse. Pain and opioid use are highly linked, so an effective alternative needs to address both issues. Objectives The principal objective of this pilot trial is to assess the feasibility. The clinical objectives are to determine the effects of a multicomponent care pathway on opioid-free pain control, persisting pain and opioid use, functional knee outcomes, quality of life, and return to function. Methods We will include adult patients scheduled for primary elective total knee arthroplasty. Patients in the intervention group will undergo a multicomponent intervention pathway that will be facilitated by an intervention coordinator linking each patient and their surgical/ perioperative team. The interventional pathway will include (1) preoperative education on pain and opioid use, (2) preoperative risk identification and mitigation using cognitive behavioral skills, (3) personalized postdischarge analgesic prescriptions, and (4) continued support for pain control and recovery up to 8 weeks. Patients in the control group will receive the usual care at their institution. Discussion The overarching goal is to implement and evaluate a coordinated approach to clinical care to improve pain control and reduce harms, with an emphasis on patient-centered care and shared decision making. Trial Registration Number: NCT04968132 (informed consent/ research ethics board statement).
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Affiliation(s)
| | - Kim Madden
- Department of Surgery, McMaster University
- Research Institute of St. Joseph’s Healthcare Hamilton
| | - Anthony Adili
- Department of Surgery, McMaster University
- Research Institute of St. Joseph’s Healthcare Hamilton
| | | | - Matilda Nowakowski
- Research Institute of St. Joseph’s Healthcare Hamilton
- Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | - Tara Packham
- School of Rehabilitation Science, McMaster University
| | - Sidra Shoaib
- Research Institute of St. Joseph’s Healthcare Hamilton
| | - Lehana Thabane
- Department of Health Research Methods, McMaster University
- Research Institute of St. Joseph’s Healthcare Hamilton
| | - Jean-Eric Tarride
- Department of Health Research Methods, McMaster University
- Research Institute of St. Joseph’s Healthcare Hamilton
| | - Daniel Tushinski
- Department of Surgery, McMaster University
- Hamilton Health Sciences – Juravinski Hospital
| | - Harsha Shanthanna
- Research Institute of St. Joseph’s Healthcare Hamilton
- Department of Anesthesia, McMaster University
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18
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Yong J, MacDermid JC, Packham T, Bobos P, Richardson J, Moll S. Performance-based outcome measures of dexterity and hand function in person with hands and wrist injuries: A scoping review of measured constructs. J Hand Ther 2022; 35:200-214. [PMID: 34253403 DOI: 10.1016/j.jht.2021.04.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/21/2021] [Accepted: 04/07/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity. PURPOSE This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions. STUDY DESIGN Scoping review, with qualitative content analysis. METHODS MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function. RESULTS Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks. CONCLUSIONS Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD.
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Affiliation(s)
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Science, Elborn College, Western University, London, ON, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Pavlos Bobos
- Western's Bone and Joint Institute, Western University, London, Ontario, Canada; Institute for Health Policy, Management & Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, Canada; Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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19
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Loy E, Scheidler A, Packham T, Dow H, Winston P. Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS. Can J Pain 2022; 6:77-84. [PMID: 35694140 PMCID: PMC9176228 DOI: 10.1080/24740527.2022.2063113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS). Aims The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective. Methods An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS: PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment). Results CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment. Conclusions This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS.
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Affiliation(s)
- Emma Loy
- Faculty of Medicine, University of British Columbia, Vancouver, BritishColumbia, Canada
| | - Anna Scheidler
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Heather Dow
- Canadian Association of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada
| | - Paul Winston
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BritishColumbia, Canada,CONTACT Dr. Paul Winston Division of Physical Medicine and Rehabilitation, University of British Columbia, 1 Hospital Way, Victoria General Hospital, Victoria, BCV8Z 6R5, Canada
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20
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Packham T, MacDermid JC, Selles RW, Slijper HP, Wouters R. Rasch Analysis of the Michigan Hand Questionnaire. Value Health 2022; 25:638-646. [PMID: 35365308 DOI: 10.1016/j.jval.2021.09.015] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/05/2021] [Accepted: 09/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The Michigan Hand Questionnaire (MHQ) is a commonly used evaluation for hand problems, but previous work reports conflicting evidence regarding the subscale structures. Rasch analysis uses probabilistic modeling of items and responses: if scale items can be fit to the Rasch model, it provides evidence of construct validity and interval-level measurement for precise statistical estimates. We conducted Rasch analysis on the MHQ to evaluate model fit, unidimensionality of the subscales, bias across person factors, and conversion to interval metrics. METHODS We conducted a secondary Rasch analysis of MHQ data from 924 persons with thumb basal joint osteoarthritis using the RUMM2030 software. Modeling was based on responses for the most affected hand and person factors including age, sex, type of work, whether the dominant side was the most affected, and surgical status. The analysis plan followed the published recommendations for examinations of person and item fit, with iterative adjustments as required. RESULTS A total of 11 of the 37 items required rescoring to create orderly progression of scoring thresholds. Only the overall hand function and pain subscales could be fit to the Rasch model, demonstrating unidimensionality and good reliability of fit estimates. Dividing the activities of daily living subscale into unilateral and bilateral activities also allowed unilateral activities to fit the model. Persistent misfitting in other subscales suggested local dependency and response bias across multiple person factors. CONCLUSIONS This Rasch analysis of the MHQ raises concerns regarding the validity and fundamental measurement properties of this widely used outcome evaluation when used as a summary score.
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Affiliation(s)
- Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; School of Physiotherapy, Western University, London, Ontario, Canada
| | - Ruud W Selles
- Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Harm P Slijper
- Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic and Handtherapie Nederland, Rotterdam, The Netherlands
| | - Robbert Wouters
- Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic and Handtherapie Nederland, Rotterdam, The Netherlands
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21
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Wiens M, Jarrett D, Settimi A, White C, Hollingham Z, Packham T. Role of Rehabilitation in Opioid Tapering: A Scoping Review. Physiother Can 2022; 74:75-85. [PMID: 35185251 PMCID: PMC8816366 DOI: 10.3138/ptc-2020-0011] [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: 02/03/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023]
Abstract
Purpose: Among industrialized countries, Canada has the second-highest opioid prescribing rate for pain management. Physiotherapy and occupational therapy interventions are potential non-pharmacological alternatives. We undertook a scoping review to explore and summarize the current evidence describing the interventions included or used in physiotherapy and occupational therapy in opioid tapering for individuals with chronic pain. Method: A systematic search of the peer-reviewed health databases was conducted, with data synthesis guided by Arksey and O'Malley's scoping review methodology. Articles were included in the narrative synthesis if (1) interventions within the scope of practice for physiotherapists or occupational therapists were described or these professionals were part of interdisciplinary care and (2) opioid tapering or reduction was addressed. Results: The 39 articles identified included 2 systematic reviews, 9 narrative reviews or commentaries, 2 case reports, 11 uncontrolled cohort studies, 1 cross-sectional study, 5 randomized controlled trials, 4 programme evaluations, and 4 qualitative studies. Of the 28 studies reporting specific outcomes, 25 reported positive outcomes of rehabilitation interventions for opioid tapering. There was greater representation of interventions from physiotherapy than from occupational therapy: few articles contained substantive descriptions (e.g., dosage and duration). Conclusions: The evidence to guide therapists in supporting opioid tapering for people with chronic pain seems to be limited. Further research is needed to establish effectiveness for stand-alone interventions and as part of a comprehensive rehabilitation approach.
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Affiliation(s)
- Miranda Wiens
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Devon Jarrett
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alissa Settimi
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Courtney White
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Zachary Hollingham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Nazari G, Lu S, Packham T, MacDermid JC. Rasch analysis of the firefighters' critical incident inventory questionnaire. Work 2021; 71:281-291. [PMID: 34924432 DOI: 10.3233/wor-213627] [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: 11/15/2022] Open
Abstract
BACKGROUND The Critical Incident Inventory (CII) was developed to assess stressful exposures in firefighters and emergency service workers. The CII includes six subscales: trauma to self, victims known to fire-emergency worker, multiple casualties, incidents involving children, unusual or problematic tactical operations, and exposure to severe medical trauma. OBJECTIVES To examine the construct validity of all subscales of the Critical Incident Inventory (CII) by assessing the unidimensionality of the scales, and the interval properties of CII subscales by examining fit to the Rasch model and ordering of item thresholds. METHODS This was a secondary data analysis based on survey data collected from a sample of 390 firefighters. RESULTS Item 4 and Item 20 were removed with the confirmation of unacceptable fit residual. This revised version of the CII showed satisfactory fit to the Rasch model by non-significant Chi-square test and acceptable level of item fit. We rescored the CII original version and considered all items as only dichotomous response options where 0 represented the original no experience, and 1 presents the combination of experiencing 1, 2, 3 cases. CONCLUSION The re-appraisal of the revised version CII indicated a satisfactory level of Rasch model fit.
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Affiliation(s)
- Goris Nazari
- School of Physical Therapy, Health and Rehabilitation, Western University, London, Ontario, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Steve Lu
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, ON, Canada
| | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Health and Rehabilitation, Western University, London, Ontario, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, ON, Canada
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23
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Affiliation(s)
- Joshua Yong
- Department of Occupational Therapy, Sengkang General Hospital, Singapore.
| | - Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; School of Physical Therapy, Western University, London, Ontario, Canada; Hand & Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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24
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Sivagurunathan M, Walton DM, Packham T, Booth R, MacDermid J. "Punched in the Balls": Male Intimate Partner Violence Disclosures and Replies on Reddit. Am J Mens Health 2021; 15:15579883211039666. [PMID: 34414824 PMCID: PMC8396797 DOI: 10.1177/15579883211039666] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Research on male intimate partner violence (IPV) survivors is limited. The sparse
research on male IPV disclosure suggest males receive more negative and less
helpful responses from potential sources of formal or informal support. Males
may seek support on social networking sites (SNSs), hence, it is important to
understand their emerging experiences of virtual disclosures. This study
examined the nature and content of responses to IPV disclosures by male IPV
survivors on a popular SNS (reddit.com). Search of Reddit submissions related to
male IPV were carried out using three IPV related keywords for the calendar
month of February 2019, resulting in 917 submissions. Twelve submissions that
focused on male IPV disclosure were examined in detail. The 12 submissions were
analyzed using quantitative content analysis while associated comments
(n = 569) were analyzed using qualitative approach.
Two-thirds of the disclosures (8/12) were of personal IPV experiences. All
disclosure narratives identified the sex of perpetrator, most stated the types
of abuse (7/12), and some revealed the outcomes of past disclosures (4/12). Six
major themes were developed through qualitative analysis of the associated
comments: (1) Informational Support, (2) Nurturant Support, (3) Tangible Aid,
(4) Negative Response (5) Self-Defence, and (6) Reciprocal Disclosure. Overall,
males experienced a majority of supportive responses to IPV disclosures and some
negative responses including criticism and minimizing the abuse. Males take
risks in disclosure of IPV in person and online.
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Affiliation(s)
- Marudan Sivagurunathan
- Department of Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - David M Walton
- Department of Health and Rehabilitation Sciences, Western University, London, ON, Canada.,Department of Physical Therapy, Western University, London, ON, Canada
| | - Tara Packham
- The School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Richard Booth
- Health Information Sciences, Western University, London, ON, Canada
| | - Joy MacDermid
- Department of Physical Therapy, Western University, London, ON, Canada.,The School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.,Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, London, ON, Canada
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25
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Snyder N, Wilson R, Finch L, Gallant B, Landa C, Frankel D, Brooks D, Packham T, Oliveira A. The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e30244. [PMID: 34309572 PMCID: PMC8367120 DOI: 10.2196/30244] [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] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Chronic respiratory diseases are highly prevalent and compromise an individual's ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual's exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful "occupations," improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines. OBJECTIVE The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs. METHODS The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic. RESULTS The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022. CONCLUSIONS The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes. TRIAL REGISTRATION OSF Registries ZH63W; https://osf.io/zh63w. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30244.
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Affiliation(s)
- Natalie Snyder
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ria Wilson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lian Finch
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Brooklyn Gallant
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Landa
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Daniel Frankel
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dina Brooks
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tara Packham
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ana Oliveira
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
- Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
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26
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Peters N, Dal Bello-Haas V, Packham T, Chum M, O'Connell C, Johnston WS, MacDermid JC, Turnbull J, Van Damme J, Kuspinar A. Do Generic Preference-Based Measures Accurately Capture Areas of Health-Related Quality of Life Important to Individuals with Amyotrophic Lateral Sclerosis: A Content Validation Study. Patient Relat Outcome Meas 2021; 12:191-203. [PMID: 34211304 PMCID: PMC8242131 DOI: 10.2147/prom.s313512] [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] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022]
Abstract
Objective The objectives of this study were to 1) assess the content validity of generic preference-based measures (GPBMs), and (2) examine the convergent validity of the EuroQol 5 Dimension 5 Level (EQ-5D-5L), against the Patient Generated Index (PGI) in Amyotrophic Lateral Sclerosis (ALS). Methods Participants were recruited from 3 clinical sites across Canada. The PGI, EQ-5D-5L and Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) were administered through an online or hardcopy survey and scores compared for convergent validation. Domains nominated by participants as important to their health-related quality of life were generated using the PGI, classified using the International Classification of Functioning, Disability and Health (ICF) and mapped onto GPBMs to determine content coverage. Results Fifty-two participants (N=28 female; 61.3 ± 11.6 mean age ± standard deviation (SD); 3.5 ± 2.9 mean ± SD years since diagnosis) completed this study. The top three ICF domains identified by participants were recreation and leisure, lower limb mobility, and interpersonal relationships. The Quality of Well-Being Self-Administered (QWB-SA) scale had the highest content coverage (87%) and the Health Utilities Index 3 (HUI3) had the lowest (33%). Two domains were covered by all GPBMs and no GPBM included all domains identified as important by participants. A moderate correlation coefficient of 0.52 between the PGI and EQ-5D-5L was found. Conclusion The majority of GPBMs covered only approximately half of the domains important to individuals with ALS suggesting the need for an ALS specific preference-based measure to better reflect the health-related quality of life of this population.
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Affiliation(s)
- Nicole Peters
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Marvin Chum
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Wendy S Johnston
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, ON, Canada
| | - John Turnbull
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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27
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Sivagurunathan M, Packham T, Dimopoulos L, Murray R, Madden K, MacDermid JC. Hand therapists' attitudes, environmental supports, and self-efficacy regarding intimate partner violence in their practice. J Hand Ther 2020; 32:353-360. [PMID: 29290505 DOI: 10.1016/j.jht.2017.11.042] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/16/2017] [Accepted: 11/30/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Descriptive, cross-sectional. INTRODUCTION Intimate partner violence (IPV) may involve physical, psychological, or sexual abuse. Although hand injuries are reported as common sequelae of IPV, there is limited attention to this issue in hand therapy research reports or practice recommendations. PURPOSE OF THE STUDY The primary aim is to describe the attitudes and beliefs of hand therapists (HTs) about IPV issues. METHODS A sample of 189 HT completed a standardized survey investigating perceptions regarding issues pertaining to IPV. Areas addressed included self-efficacy (in dealing with IPV), perceived systemic support, victim blaming, professional role responsibility, and safety. Data were analyzed using descriptive statistics while between-group comparisons evaluating the impact of prior IPV experience and demographic variables of gender, country, certified hand therapy, and occupation on questionnaire scores used Mann-Whitney U analysis. RESULTS The majority of therapists (66%) had some prior experience with IPV. HTs reported neutral perceptions about self-efficacy (M = 2.9/5), client or personal safety (M = 3/5), and support systems available when addressing IPV in practice (M = 3/5). However, therapists considered intervening as part of their professional role (M = 3.8/5) and reported low levels of victim-blaming attitudes (M = 4.4/5). Those with firsthand IPV experience reported lower victim blaming (mdn = 4.9/5 vs 4.6/5, P = .02). Additionally, females were less likely to blame victims of IPV than males (mdn = 4.7/5 vs 4.3/5, P = .003). DISCUSSION Although Hand Therapists believe their professional role includes addressing IPV, confidence to deal with IPV, access/awareness of resources and perceived safety were substantive barriers. CONCLUSION Continuing research should identify effective tools to educate and assist therapists to identify and support victims of IPV in hand therapy.
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Affiliation(s)
- Marudan Sivagurunathan
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.
| | - Tara Packham
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay Dimopoulos
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Robyn Murray
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Joy C MacDermid
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Physical Therapy, Western University, London, Ontario, Canada; Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, London, Ontario, Canada; Division of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
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28
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Packham T, Holly J. Mechanism-specific rehabilitation management of complex regional pain syndrome: Proposed recommendations from evidence synthesis. J Hand Ther 2019; 31:238-249. [PMID: 29452930 DOI: 10.1016/j.jht.2018.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/30/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Narrative review. INTRODUCTION There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients. PURPOSE OF THE STUDY To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS. METHODS A systematic search of the literature was conducted to identify all randomized controlled trials, systematic reviews, and clinical practice guidelines addressing rehabilitation of CRPS. Results were reviewed independently by 2 reviewers and final selection of articles was reached by consensus, Data was extracted using standardized forms, and a single rater gave quality ratings. Both reviewers then used the extracted data to present a synthesis of the evidence categorized by the proposed mechanisms of effect. RESULTS A total of 111 articles were retrieved and reviewed for inclusion; 49 were selected for data extraction. A synthesis of the key recommendations was compiled into a rehabilitation-specific version of the mechanism-based management algorithm proposed by Gierthmühlen et al (2014). CONCLUSIONS Consideration of mechanism-appropriate rehabilitation interventions may assist therapists to select the most appropriate and effective treatments from the body of evidence supporting rehabilitation of CRPS.
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Affiliation(s)
- Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
| | - Janet Holly
- The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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29
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Tang K, Diaz J, Lui O, Proulx L, Galle E, Packham T. Do active assist transfer devices improve transfer safety for patients and caregivers in hospital and community settings? A scoping review. Disabil Rehabil Assist Technol 2019; 15:614-624. [PMID: 31248300 DOI: 10.1080/17483107.2019.1604822] [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: Safe patient handling practices reduce injury risk for healthcare workers (HCW) and patients, but may conflict with goals of rehabilitation and person-centred care by minimizing (a) active participation in transfers and (b) autonomy and dignity while using mechanical lifts. Active assist transfer devices (AATDs) have potential to address both safety and support needs for appropriate clients.Purpose: What is the scope and nature of the evidence to support the use of AATD for improving transfer safety for patients and caregivers in both hospital and community settings?Methods: Scoping review of peer-reviewed and Gray literature, using systematic search strategies and multiple reviewers for identifying papers and extracting data.Findings: Twenty-nine peer-reviewed publications, and 12 other documents (policy, technical) were included in the review. Half focused on HCW safety in the hospital setting, with only seven addressing patient safety in the community. Generally, literature was of low quality, with no controlled trials to support the benefit of this equipment, and often represented a nursing care perspective. However, positive outcomes reported included safety, satisfaction, and equipment utilization.Implications: There is a need for rigorous research on use of AATDs in the community comparing rehabilitation outcomes across other forms of transfer equipment. Other important targets include injury risk for family caregivers, and potential to support early discharge. At present, utilization of AATDs within the rehabilitation field will continue to rely on best judgement of the care team. Implementation of AATDs should be considered a compelling target for practice-based research and quality improvements.Implications for rehabilitationThe use of active assist transfer devices is associated with their availability in the in-patient hospital setting.The use of active assist transfer devices is associated with positive patient experience, such as increased patient satisfaction and dignity. Improved patient adherence and cooperation with healthcare workers during mobilization and rehabilitation may follow.Most current evidence is focused on caregiver safety outcomes and is in support of decreased injury rates with increased active assist transfer device use. There is a limited amount of evidence focusing on the rehabilitation outcomes with active assist transfer device use.With current evidence, the use of AATDs should be used at the discretion of the care team.
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Affiliation(s)
- K Tang
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - J Diaz
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - O Lui
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - L Proulx
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - E Galle
- West Lincoln Memorial Hospital Hamilton Health Sciences, Grimsby, Canada
| | - T Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
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Sivagurunathan M, Packham T, Dimopoulos L, Murray R, Madden K, Bhandari M, MacDermid JC. Perceptions of preparedness and intimate partner violence screening practices amongst hand therapists. Hand Therapy 2018. [DOI: 10.1177/1758998318798668] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction While hand injuries are reported as common sequelae of intimate partner violence, there is limited attention to hand therapist’s screening practices and perceived preparedness to deal with intimate partner violence in hand therapy setting. The primary aim of the current study is to describe the intimate partner violence training, knowledge of referrals, perceived preparedness, and screening practices of hand therapists. Methods An online survey investigating the perceptions regarding issues pertaining to intimate partner violence was completed by a sample of 189 hand therapists. Areas addressed included intimate partner violence training, perceived preparedness to deal with intimate partner violence-related responsibilities, screening practices and knowledge of resources for referrals. Data were analyzed using descriptive statistics while comparisons of groups used non-parametric analyses to evaluate the impact of training, intimate partner violence experience and knowledge of referrals on preparedness and screening practices. Results Hand therapists reported low perceived preparedness scores (median = 2.1/7) and screening practices. The majority (73%) of hand therapists indicated having received no intimate partner violence training. Additionally, intimate partner violence training, intimate partner violence experience, and knowledge of referrals had significant impact on hand therapists’ perceived preparedness and screening practices. Conclusion Training is significantly related to perceived preparedness and screening practices. Intimate partner violence screening may result in clients receiving appropriate referrals leading to improved quality of life. Future research should seek out ideal methods for offering intimate partner violence training for hand therapists so that they can meet the needs of clients with intimate partner violence experience.
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Affiliation(s)
- Marudan Sivagurunathan
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Tara Packham
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay Dimopoulos
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Robyn Murray
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Joy C MacDermid
- The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Physical Therapy, Western University, London, Ontario, Canada
- Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph’s Health Centre, London, Ontario, Canada
- Division of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
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Packham T, MacDermid J, Bain J, Buckley N. Identification of complex regional pain syndrome in the upper limb: Skin temperature asymmetry after cold pressor test. Can J Pain 2018; 2:248-257. [PMID: 35005383 PMCID: PMC8730613 DOI: 10.1080/24740527.2018.1504283] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Skin temperature asymmetry (SkTA) may assist in early identification of complex regional pain syndrome (CRPS), but previous work has been limited by methodological shortcomings including failure to account for the cutaneous nerve distribution where temperature is measured and reliance on laboratory equipment not clinically available. Pilot work suggested that a cold pressor test (CPT) provided a consistent thermoregulatory stress and might increase sensitivity/specificity of SkTA measurements generated reliably by handheld infrared (IR) thermometers. Aims This study investigated the sensitivity, specificity, and validity of SkTA in the upper limb to identify CRPS. Methods This study was part of a larger clinical trial (the SARA study: www.clinicaltrials.gov NCT02070367). Using IR thermometers, we evaluated SkTA over major peripheral nerve distributions in the hands before and after immersing a single foot in 5°C water for 30 s. Participant groups included healthy volunteers, CRPS, known nerve injury, and hand fracture. Results SkTA was measured in 65 persons, including 17 persons with CRPS (meeting Budapest criteria). Analysis of variance for n = 378 SkTA observations supported diagnosis, CPT, and nerve distribution as significant predictors (P < 0.001) explaining 94% of the variance. Post CPT, sensitivity for a >1.5°C SkTA improved to 82.4% from 58.8%, whereas specificity dropped from 56.3% to 43.8%. Conclusion This study adds further support for the accuracy of SkTA as a diagnostic indicator of CRPS. Further precision in estimates will be gained from larger studies, which should also seek to replicate our findings for SkTA in the lower limbs.
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Affiliation(s)
- Tara Packham
- Hamilton Health Sciences, Regional Rehabilitation Program , Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Elborn College, Western University , London, Ontario, Canada
| | - James Bain
- Department of Surgery, Hamilton Health Sciences , Hamilton, Ontario, Canada
| | - Norm Buckley
- Michael G. DeGroote Institute for Pain Research and Care , Hamilton, Ontario, Canada
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Grieve S, Perez RSGM, Birklein F, Brunner F, Bruehl S, Harden R N, Packham T, Gobeil F, Haigh R, Holly J, Terkelsen A, Davies L, Lewis J, Thomassen I, Connett R, Worth T, Vatine JJ, McCabe CS. Recommendations for a first Core Outcome Measurement set for complex regional PAin syndrome Clinical sTudies (COMPACT). Pain 2017; 158:1083-1090. [PMID: 28178071 PMCID: PMC5438049 DOI: 10.1097/j.pain.0000000000000866] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Complex regional pain syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS. In 2013, an international consortium of patients, clinicians, researchers, and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populations. The development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. "What is the clinical presentation and course of CRPS, and what factors influence it?" was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as follows: pain, disease severity, participation and physical function, emotional and psychological function, self-efficacy, catastrophizing, and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and 1 clinician-reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally.
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Affiliation(s)
- Sharon Grieve
- Royal United Hospitals NHS Foundation Trust, Bath, UK
- University of the West of England, Bristol, UK
| | | | | | | | - Stephen Bruehl
- Vanderbilt University School of Medicine, Nashville, USA
| | | | | | | | | | - Janet Holly
- The Ottawa Hospital Rehabilitation Centre, Ottawa, Canada
| | | | | | - Jennifer Lewis
- Royal United Hospitals NHS Foundation Trust, Bath, UK
- University of the West of England, Bristol, UK
| | | | | | | | - Jean-Jacques Vatine
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Candida S McCabe
- Royal United Hospitals NHS Foundation Trust, Bath, UK
- University of the West of England, Bristol, UK
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Packham T, MacDermid JC. Measurement properties of the Patient-Rated Wrist and Hand Evaluation: Rasch analysis of responses from a traumatic hand injury population. J Hand Ther 2014; 26:216-23; quiz 224. [PMID: 23561017 DOI: 10.1016/j.jht.2012.12.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 08/26/2012] [Revised: 12/17/2012] [Accepted: 12/26/2012] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Patient-Rated Wrist and Hand Evaluation (PRWHE) is a self-reported assessment of pain and disability to evaluate outcome after hand injuries. Rasch analysis is an alternative strategy for examining the psychometric properties of a measurement scale based in item response theory, rather than classical test theory. PURPOSE OF THE STUDY This study used Rasch analysis to examine the content, scoring and measurement properties of the PRWHE. METHODS PRWHE scores (n = 264) from persons with a traumatic injury or reconstructive surgery to one hand were collected from an outpatient hand rehabilitation facility. Rasch analysis was conducted to assess how the PRWHE fit the Rasch model, confirms the scaling structure of the pain and disability subscales, and identifies any areas of bias from differential item functioning. RESULTS Rasch analysis of the PRWHE supports internal consistency of the scale (α = 0.96) and reliability (as measured by the person separation index) of 0.95. While gender, age, diagnosis, and duration since injury all systematically influenced how people scored the PRWHE, hand dominance and affected side did not. Rasch analysis supported a 3 subscale structure (pain, specific activities and usual activities) rather than the current divisions of pain and disability. CONCLUSIONS Initial examination of the PRWHE indicates the psychometric properties of consistency, reliability and responsiveness previously tested by classical methods are further supported by Rasch analysis. It also suggests the scale structure may be best considered as 3 subscales rather than simply pain and disability.
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Affiliation(s)
- Tara Packham
- McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada.
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Affiliation(s)
- Zakir Uddin
- PhD Candidate at School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Joy MacDermid
- Professor at School of Rehabilitation Science and Assistant Dean of Rehabilitation Science Graduate Programs at McMaster University, Hamilton, ON, Canada
- Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, ON, Canada
| | - Tara Packham
- PhD Candidate at School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Affiliation(s)
- Zakir Uddin
- School of Rehabilitation Science, McMaster University, Canada
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Affiliation(s)
- Zakir Uddin
- School of Rehabilitation Science, McMaster University, Canada
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Dewan N, MacDermid JC, Packham T. Role of a Self-Efficacy-based Model of Intervention: The LEARN Approach in Rehabilitation of Distal Radius Fracture. ACTA ACUST UNITED AC 2013. [DOI: 10.1615/critrevphysrehabilmed.2013010110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Packham T, MacDermid JC, Henry J, Bain J. A systematic review of psychometric evaluations of outcome assessments for complex regional pain syndrome. Disabil Rehabil 2011; 34:1059-69. [DOI: 10.3109/09638288.2011.626835] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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