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Mun CJ, Speed TJ, Finan PH, Wideman TH, Quartana PJ, Smith MT. A Preliminary Examination of the Effects and Mechanisms of Cognitive Behavioral Therapy for Insomnia on Systemic Inflammation Among Patients with Knee Osteoarthritis. Int J Behav Med 2024; 31:305-314. [PMID: 37231221 DOI: 10.1007/s12529-023-10184-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Systemic inflammation, particularly the elevation of interleukin-6 (IL-6), plays an important role in the maintenance and progression of knee osteoarthritis. Insomnia, being highly prevalent in knee osteoarthritis, is understood to be a risk factor for systemic inflammation. The present study examined if cognitive behavioral therapy for insomnia (CBT-I) would reduce circulating IL-6 levels to a larger extent than the active control condition via greater improvement in sleep maintenance disturbance at mid-treatment, among individuals with knee osteoarthritis and insomnia disorder. METHODS This is an ancillary study (N = 64) from a larger double-blind, randomized, active controlled clinical trial. Serum IL-6 was measured at baseline, post-treatment, and 3- and 6-month follow-ups. Sleep was measured by daily sleep diaries. RESULTS Overall, there was no significant IL-6 trajectory differences between CBT-I and the active control (p = .64). Compared to the active control, CBT-I demonstrated greater improvement in sleep maintenance disturbance at mid-treatment (p = .01), which, in turn, was significantly associated with lower levels of IL-6 at 3-month follow-up (p < .05). Sleep maintenance disturbance at mid-treatment did not significantly predict changes in IL-6 levels at post-treatment (p = .43) and 6-month follow-up (p = .90). CONCLUSIONS Our study demonstrates that CBT-I can be efficacious in improving sleep maintenance disturbance among individuals with knee osteoarthritis and insomnia disorder. However, no convincing evidence was found that CBT-I can substantially reduce IL-6 levels via improvement in sleep. CBT-I alone may not be effective in reducing systematic inflammation in this clinical population. TRIAL REGISTRATION NCT00592449.
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Affiliation(s)
- Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Traci J Speed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Patrick H Finan
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Phillip J Quartana
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, USA
| | - Michael T Smith
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, USA
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Flegg D, Lima LV, Woznowski-Vu A, Aternali A, Gervais A, Stone L, Wideman TH. Are biomarkers associated with sensitivity to physical activity? Eur J Pain 2024; 28:120-132. [PMID: 37593830 DOI: 10.1002/ejp.2167] [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: 05/25/2022] [Revised: 04/12/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Activity-based treatments play an integral role in managing musculoskeletal conditions including low back pain. However, while therapeutic exercise has been shown to reduce pain in such conditions, certain individuals experience a paradoxical pain increase in response to exercise. The physiological processes underlying this sensitivity to physical activity (SPA) are not fully understood, however stress and inflammation have been shown to contribute to SPA. The present cross-sectional study investigated whether physiological indicators of stress (cortisol) and inflammation (IL-6) help explain SPA. METHODS Twenty-seven patients with chronic low back pain and 21 healthy controls completed a 1-h exercise session of standardized physical tasks. SPA was calculated from the difference between post- and pre-exercise pain levels. Participant's saliva was collected at several timepoints for cortisol and IL-6 levels quantification. Their waking cortisol response was calculated to reflect their cortisol regulation. Reactivity of IL-6 and cortisol was calculated to reflect changes in these measures during exercise. RESULTS IL-6 reactivity was significantly and positively correlated with SPA among participants with low back pain. In contrast, neither cortisol waking response nor cortisol reactivity was significantly correlated within the low back pain group. No significant differences in IL-6 reactivity, cortisol reactivity or cortisol waking response were observed. CONCLUSION These findings are the first to link SPA to an objective biomarker among people with low back pain. These findings help describe the physiological mechanisms of SPA and can support new clinical research that targets the inflammatory response of patients with chronic low-back pain and elevated SPA. SIGNIFICANCE This study reveals a correlation between SPA and an objective salivary biomarker of IL-6 in people with low back pain, improving our understanding of this clinically relevant subjective experience.
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Affiliation(s)
- D Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - L V Lima
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - A Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - A Aternali
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - A Gervais
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - L Stone
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Anesthesiology, Faculty of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - T H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
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Bussières A, Hancock MJ, Elklit A, Ferreira ML, Ferreira PH, Stone LS, Wideman TH, Boruff JT, Al Zoubi F, Chaudhry F, Tolentino R, Hartvigsen J. Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis. Eur J Psychotraumatol 2023; 14:2284025. [PMID: 38111090 PMCID: PMC10993817 DOI: 10.1080/20008066.2023.2284025] [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: 05/11/2023] [Accepted: 08/22/2023] [Indexed: 12/20/2023] Open
Abstract
Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.
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Affiliation(s)
- André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Mark J. Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Ask Elklit
- National Centre for Psychotraumatology, Department of Psychology, University of Southern DenmarkOdense, Denmark
| | - Manuela L. Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paulo H. Ferreira
- Musculoskeletal Health, Faculty of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Laura S. Stone
- Faculty of Dentistry, McGill University, Montreal, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
- Department of Anesthesiology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Jill T. Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - Fadi Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Fauzia Chaudhry
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Raymond Tolentino
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston ZJ, Wideman TH, Giangregorio LM. Development, Acceptability, and Usability of a Virtual Intervention for Vertebral Fractures. Phys Ther 2023; 103:pzad098. [PMID: 37555708 DOI: 10.1093/ptj/pzad098] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. METHODS VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. RESULTS VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5 weeks. Each session lasts 45 minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. CONCLUSION VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. IMPACT The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, Montreal, QC, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Judi Laprade
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa Ontario, Canada
- Faculty of Human and Social Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Hudon A, Augeard N, Tansey CM, Houston E, Bostick G, Wideman TH. Does feeling pain help prepare future clinicians to treat pain? A qualitative exploration of a novel experiential approach to teaching health professional students about pain. Physiother Theory Pract 2023:1-13. [PMID: 37682624 DOI: 10.1080/09593985.2023.2254367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND INTRODUCTION Pain is a subjective phenomenon, that is often misunderstood and invalidated. Despite recent advances in health professional training, it remains unclear how students should be taught about the subjectivity of pain. This study explored how a novel teaching activity that integrated physiotherapy students' first-hand experiences with laboratory-induced pain could address this gap. OBJECTIVE The study aimed to explore the experiences and perceptions of physiotherapy students in relation to a workshop where physiotherapy students experienced laboratory induced pain. METHODS We used a descriptive qualitative research design. Eighteen students participated in interviews. Transcripts were analyzed using an inductive conventional content analysis. RESULTS We identified four overarching themes: 1) First-hand pain experiences facilitated engagement in learning; 2) Reflecting on these personal and peer pain experiences helped students make sense of pain; 3) The learning activity helped students understand the inherent subjectivity and complexity of pain; and 4) Students saw benefits for clinical practice. CONCLUSION Integrating first-hand pain experiences within entry-level physiotherapy training appears to have novel value in helping students understand pain subjectivity. Future research should use robust and controlled designs to explore how this novel approach can be used to facilitate further understanding and empathy within clinical interactions with people living with pain.
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Affiliation(s)
- Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest de l'Ile-de-Montréal (CIUSSS COMTL) Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
| | - Nathan Augeard
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Catherine M Tansey
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Emilie Houston
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy H Wideman
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest de l'Ile-de-Montréal (CIUSSS COMTL) Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller HH, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences. Disabil Rehabil 2023:1-8. [PMID: 37493172 DOI: 10.1080/09638288.2023.2239146] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs). DESIGN AND SETTING We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. RESULTS Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. CONCLUSION HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation.Implications for RehabilitationNon-pharmacological strategies in combination with pain medication may be a more effective strategy to support recovery than pain medication alone but should be informed by fracture acuity and patient symptoms.To improve access to physiotherapy and other non-pharmacological treatment options during the acute or chronic management of vertebral fractures, it may be worthwhile to explore the effectiveness and feasibility of virtual-care.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, North York, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
| | - Judi Laprade
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Suzanne N Morin
- McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | | | - Zach Weston
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Waterloo, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
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de Oliveira FCL, Cossette C, Mailloux C, Wideman TH, Beaulieu LD, Massé-Alarie H. Within-Session Test-Retest Reliability of Pressure Pain Threshold and Mechanical Temporal Summation in Chronic Low Back Pain. Clin J Pain 2023; 39:217-225. [PMID: 36917769 DOI: 10.1097/ajp.0000000000001106] [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: 09/02/2022] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To determine the absolute and relative within-session test-retest reliability of pressure pain threshold (PPT) and temporal summation of pain (TSP) at the low back and the forearm in individuals with chronic low back pain (CLBP) and to test the impact of different sequences of measurements on reliability metrics. MATERIALS AND METHODS Twenty-eight adults with CLBP were recruited. Relative (intraclass correlation coefficient [ICC] and coefficient of variation) and absolute reliability (standard error of measurement and minimal detectable changes) were quantified at 4 sites (back: sacrum and lumbar erector spinae; wrist: hand dorsum and wrist flexors) for PPT and 2 sites (hand and low back) for TSP, for various sequences of measurements. RESULTS Systematic differences were found between within test and retest for most PPT sequences at the lumbar erector spinae site and 1 TSP sequence (1-2-3) at back and hand sites, precluding reliability analyses for these data. Within-session PPT relative reliability was excellent at low back (ICC = 0.83 to 0.94) and wrist (ICC = 0.88 to 0.97) sites, whereas TSP showed good to excellent reliability at hand (ICC = 0.80 to 0.90) and low back (ICC = 0.73 to 0.89). In general, 2 and 3 measurements optimized absolute and relative reliability for TSP and PPT, respectively. DISCUSSION Within-session reliability was generally excellent for PPT and TSP at the low back and hand sites among individuals with CLBP. We recommend using 3 measurements for PPT and 2 for TSP to optimize reliability. Caution is recommended when testing PPT of the painful lower back area since a systematic difference was present between the test and retest.
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Affiliation(s)
- Fábio Carlos Lucas de Oliveira
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Université Laval, Quebec
- Research Unit in Sport and Physical Activity (CIDAF), Universidade de Coimbra, Coimbra, Portugal
| | - Camille Cossette
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Université Laval, Quebec
| | - Catherine Mailloux
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Université Laval, Quebec
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal
| | | | - Hugo Massé-Alarie
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Université Laval, Quebec
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. Publisher Correction: International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1139. [PMID: 37036475 DOI: 10.1007/s00198-023-06717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Woznowski-Vu A, Martel MO, Ahmed S, Sullivan MJL, Wideman TH. Task-based measures of sensitivity to physical activity predict daily life pain and mood among people living with back pain. Eur J Pain 2023. [PMID: 36892468 DOI: 10.1002/ejp.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Clinical interventions aim to improve the daily life experiences of patients. However, past research has highlighted important discrepancies between commonly used assessments (e.g. retrospective questionnaires) and patients' daily life experiences of pain. These gaps may contribute to flawed clinical decision-making and ineffective care. Recent work suggests that real-time, task-based clinical assessments may help reduce these discrepancies by adding predictive value in explaining daily life pain experiences. This study aimed to investigate these relationships by evaluating whether task-based measures of sensitivity to physical activity (SPA) predict daily life pain and mood, beyond traditional pain-related questionnaires. METHODS Adults with back pain (<6-month onset) answered pain-related questionnaires and completed a standardized lifting task. SPA-Pain, SPA-Sensory and SPA-Mood were, respectively, assessed as task-evoked changes in pain intensity, pressure pain threshold (back, hands), situational catastrophizing. Over the next 9 days, daily life pain and mood were assessed using smartphone-based ecological momentary assessment (EMA-Pain and EMA-Mood, respectively) with stratified random sampling. Data analyses estimated fixed effects (b) using multilevel linear modelling with random intercepts. RESULTS Median EMA completion per participant was 66.67% (n = 67 participants). After controlling for covariates, SPA-Pain was associated with EMA-Pain (b = 0.235, p = 0.002) and SPA-Psych approached significance with EMA-Mood (b = -0.159, p = 0.052). CONCLUSIONS Task-based assessment of SPA helps explain daily life pain and mood among adults with back pain, beyond traditional questionnaires. Adding task-based assessment of SPA may achieve a more complete picture of pain and mood in daily life, offering clinicians better guidance when prescribing activity-based interventions that are designed to modify daily life behaviour, such as graded activity. SIGNIFICANCE This study found that, among people with back pain, task-based measures of sensitivity to physical activity contribute additional predictive value for daily life pain and mood beyond self-report questionnaires. Findings suggest that real-time, task-based measures may help mitigate some of the shortcomings that are commonly associated with retrospective questionnaires.
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Affiliation(s)
- A Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - M O Martel
- Faculties of Dentistry & Medicine, McGill University, Montreal, Quebec, Canada
| | - S Ahmed
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - M J L Sullivan
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - T H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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10
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Patricio P, Mailloux C, Wideman TH, Langevin P, Descarreaux M, Beaulieu LD, Massé-Alarie H. Assessment of exercise-induced hypoalgesia in chronic low back pain and potential associations with psychological factors and central sensitization symptoms: A case-control study. Pain Pract 2023; 23:264-276. [PMID: 36461643 DOI: 10.1111/papr.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/18/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Exercise is the most recommended treatment for chronic low back pain (CLBP) and is effective in reducing pain, but the mechanisms underlying its effects remain poorly understood. Exercise-induced hypoalgesia (EIH) may play a role and is thought to be driven by central pain modulation mechanisms. However, EIH appears to be disrupted in many chronic pain conditions and its presence in people with CLBP remains unclear. As people suffering from chronic pain often exhibit psychological factors and central sensitization symptoms influencing pain perception, EIH might be associated with these factors. OBJECTIVE The aim of this study is to compare the level of EIH between participants with and without CLBP following back and wrist exercises and to assess the associations between EIH, psychological factors, and symptoms of central sensitization (using the central sensitization inventory - CSI) in CLBP. METHOD Twenty-eight participants with CLBP and 23 without pain were recruited. Pressure pain thresholds (PPT) were measured at 4 sites (2 bony sites = capitate, S1|2 muscle sites = wrist flexors, lumbar erector spinae) before and after each of two exercises (wrist flexion and lumbar extension). Exercise-induced hypoalgesia was defined as percent change in PPT from pre- to post-exercise. Participants with CLBP also completed questionnaires to measure psychological factors (e.g., kinesiophobia, catastrophizing, anxiety, and self-efficacy) and symptoms of central sensitization (CSI), and correlations with EIH were calculated. RESULTS After wrist exercise, EIH measured at the muscle sites was lower in the CLBP group compared with the pain-free group (p = 0.047) but no differences were found at bony sites (p = 0.49). No significant differences for EIH were observed following back exercise at muscle sites (p = 0.14) or at bony sites (p = 0.65). Exercise-induced hypoalgesia was not correlated with any psychological factors or with the CSI score. CONCLUSION The lower EIH following wrist exercises may represent an alteration in pain modulation control in CLBP. However, psychological factors and central sensitization symptoms may not explain the differences observed.
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Affiliation(s)
- Philippe Patricio
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, Quebec City, Quebec, Canada
| | - Catherine Mailloux
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, Quebec City, Quebec, Canada.,PhysioInteractive/Cortex, Quebec City, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Pierre Langevin
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, Quebec City, Quebec, Canada.,PhysioInteractive/Cortex, Quebec City, Quebec, Canada.,Département de réadaptation, Université Laval, Quebec City, Quebec, Canada
| | - Martin Descarreaux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Louis-David Beaulieu
- BioNR Research Lab, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Hugo Massé-Alarie
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, Quebec City, Quebec, Canada.,Département de réadaptation, Université Laval, Quebec City, Quebec, Canada
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11
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Stilwell P, Hudon A, Meldrum K, Pagé MG, McIntyre V, Wideman TH. Moving Closer to An Inclusive Definition of Pain-related Suffering and Targeted Care. J Pain 2023; 24:552-553. [PMID: 36460168 DOI: 10.1016/j.jpain.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada; School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Ethics Research Center (CRÉ), Montreal, Quebec, Canada
| | | | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre hospitalier de l'Universite de Montréal (CRCHUM)
| | | | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.
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12
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1065-1074. [PMID: 36799981 DOI: 10.1007/s00198-023-06688-9] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
UNLABELLED We identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. MAIN RESULTS This international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral fractures. SIGNIFICANCE These recommendations will guide clinical practice and inform interventions for future research. PURPOSE To establish international consensus on recommendations for the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. METHODS We adopted a five-step modified Delphi consensus process: (1) literature search and content analysis, (2) creation of the survey, (3) selection of the expert panel, (4) first round of the rating process, and (5) second round of the rating process. The first round included 49 statements and eight open-ended questions; the second round included 30 statements. Panelists were asked to rate their agreement with each of the statements using a 9-point scale, with the option to provide further comments. Consensus for each statement was determined by counting the number of panelists whose rating was outside the 3-point region containing the median. RESULTS We invited 76 people with degree in medicine, physiotherapy, kinesiology, and experience in the management of osteoporotic vertebral; 31 (41%) and 27 (36%) experts agreed to participate to the first and the second round, respectively. The mean percentage agreement after the first and second rounds was 76.6% ± 16.0% and 90.7% ± 6.5%, respectively. We established consensus on recommendations on pain, early satiety, weight loss, bracing, safe movement, and exercise for individuals with acute and chronic vertebral fractures. CONCLUSION Our international consensus provides multidisciplinary biopsychosocial recommendations to guide the management of osteoporotic vertebral fractures and inform interventions for future research.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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13
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Gervais-Hupé J, Filleul A, Perreault K, Gaboury I, Wideman TH, Charbonneau C, Loukili F, Gagnon M, Hudon A. What are the perceived needs of people living with chronic pain regarding physiotherapy services? A scoping review protocol. PLoS One 2023; 18:e0274730. [PMID: 36730241 PMCID: PMC9894470 DOI: 10.1371/journal.pone.0274730] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/02/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Chronic pain represents a major health issue, affecting the physical and mental health of approximately one in five people worldwide. It is now widely recognized that health professionals should use interventions that meet the needs of people living with chronic pain. Therefore, physiotherapists should attend to patients' perceived needs regarding physiotherapy services, i.e. the needs that are perceived by patients themselves based on their beliefs, values, preferences and expectations. However, previous reviews have mainly focused on health professionals' and experts' evaluations of patients' needs, which may result in inadequate answers to these needs. Therefore, a better understanding of patients' perceived needs could lead to more ethical and higher quality physiotherapy services. OBJECTIVE The aim of this scoping review is thus to explore what is known from the existing literature about the perceived needs of people living with chronic pain regarding physiotherapy services. METHODS This scoping review will follow Arksey and O'Malley's six-step framework. Medline, Embase, CINHAL, and APA PsycINFO will be used to search the scientific literature. The grey literature will also be searched using Google Scholar, OpenGrey and ProQuest Dissertation & Theses Global (PQDTGlobal). Studies published in English and French will only be considered. Two independent reviewers will perform the selection and extraction processes. Descriptive statistics will be performed to characterize the included studies. Quantitative, qualitative and mixed methods studies will be analyzed and synthetized using convergent qualitative meta-integration. Thereby, we will use the seven steps for convergent qualitative meta-integration proposed by Frantzen and Fetters to transform, analyze and integrate the quantitative and qualitative data. INCLUSION CRITERIA Included studies will describe the perceived needs of adults living with chronic pain regarding physiotherapy services. Studies focusing on the perspectives of health professionals and rehabilitation services other than physiotherapy will be excluded.
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Affiliation(s)
- Jonathan Gervais-Hupé
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) de l’Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l’Ile-de-Montréal (CCSMTL), Montréal, Quebec, Canada
- Centre de Recherche en Ethique (CRÉ), Montréal, Quebec, Canada
- * E-mail:
| | - Arthur Filleul
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) de l’Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l’Ile-de-Montréal (CCSMTL), Montréal, Quebec, Canada
- Université Grenoble Alpes, Saint-Martin-d’Hères, France
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) de l’Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
| | - Céline Charbonneau
- Association Québécoise de la Douleur Chronique, Montreal, Quebec, Canada
| | - Fatiha Loukili
- Association des Personnes Vivant Avec de la Douleur Chronique, Gatineau, Quebec, Canada
| | - Martine Gagnon
- Bibliothèque de l’Université Laval, Quebec City, Quebec, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) de l’Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l’Ile-de-Montréal (CCSMTL), Montréal, Quebec, Canada
- Centre de Recherche en Ethique (CRÉ), Montréal, Quebec, Canada
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14
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Wideman TH, Bostick G, Miller J, Thomas A, Bussières A, Walton D, Tousignant-Laflamme Y, Carlesso L, Hunter J, Perreault K, Shay B. The development of a stakeholder-endorsed national strategic plan for advancing pain education across Canadian physiotherapy programs. Can J Pain 2022; 6:21-32. [PMID: 35694143 PMCID: PMC9176229 DOI: 10.1080/24740527.2022.2056006] [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 Canadian Pain Task Force recently advanced an action plan calling for improved entry-level health professional pain education. However, there is little research to inform the collaboration and coordination across stakeholders that is needed for its implementation. Aims This article reports on the development of a stakeholder-generated strategic plan to improve pain education across all Canadian physiotherapy (PT) programs. Methods Participants included representatives from the following stakeholder groups: people living with pain (n = 1), PT students and recent graduates (n = 2), educators and directors from every Canadian PT program (n = 24), and leaders of Canada's national PT professional association (n = 2). Strategic priorities were developed through three steps: (1) stakeholder-generated data were collected and analyzed, (2) a draft strategic plan was developed and refined, and (3) stakeholder endorsement of the final plan was assessed. The project was primarily implemented online between 2016 and 2018. Results The plan was developed through five iterative versions. Stakeholders unanimously endorsed a plan that included five priorities focusing on uptake of best evidence across (1) national PT governance groups and (2) within individual PT programs; (3) partnering with people living with pain in pain education; (4) advocacy for the PT role in pain management; and (5) advancing pain education research. Conclusion This plan is expected to help Canadian stakeholders work toward national improvements in PT pain education and to serve as a useful template for informing collaboration on entry-level pain education within other professions and across different geographic regions.
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Affiliation(s)
- Timothy H. Wideman
- School of Physical and Occupational Therapy McGill University, Montreal, Quebec, Canada,CONTACT Timothy H. Wideman School of Physical and Occupational Therapy Faculty of Medicine, McGill University, Hosmer House, Room 303B, 3630 Promenade Sir-William-Osler, Montreal, QCH3G 1Y5, Canada
| | - Geoffrey Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy McGill University, Montreal, Quebec, Canada,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal
| | - André Bussières
- School of Physical and Occupational Therapy McGill University, Montreal, Quebec, Canada
| | - David Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Lisa Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster UniversityHamilton, Ontario, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kadija Perreault
- Department of Rehabilitation Science, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Barbara Shay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Stilwell P, Hudon A, Meldrum K, Pagé MG, Wideman TH. What is Pain-Related Suffering? Conceptual Critiques, Key Attributes, and Outstanding Questions. J Pain 2022; 23:729-738. [PMID: 34852304 DOI: 10.1016/j.jpain.2021.11.005] [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: 06/18/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that specifically addresses this construct. Yet, important critiques of Cassell's work have not been integrated within the pain literature. This Focus Article aims to take a preliminary step towards an updated operationalization of pain-related suffering by 1) presenting key attributes of pain-related suffering derived from a synthesis of the literature and 2) highlighting key challenges associated with Cassell's conceptualization of suffering. We present 4 key attributes: 1) pain and suffering are inter-related, but distinct experiences, 2) suffering is a subjective experience, 3) the experience of suffering is characterized by a negative affective valence, and 4) disruption to one's sense of self is an integral part of suffering. A key outstanding challenge is that suffering is commonly viewed as a self-reflective and future-oriented process, which fails to validate many forms of suffering and marginalizes certain populations. Future research addressing different modes of suffering - with and without self-reflection - are discussed. PERSPECTIVE: This article offers a preliminary step toward operationalizing the construct of pain-related suffering and proposes priorities for future research. A robust operationalization of this construct is essential to developing clinical strategies that aim to better recognize and alleviate suffering among people living with pain.
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Affiliation(s)
- Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada; School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Ethics Research Center (CRÉ), Montreal, Quebec, Canada
| | | | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre hospitalier de l'Universite de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.
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16
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Sullivan MJL, Wideman TH, Gauthier N, Thibault P, Ellis T, Adams H. Risk-targeted behavioral activation for the management of work disability associated with comorbid pain and depression: a feasibility study. Pilot Feasibility Stud 2022; 8:90. [PMID: 35461255 PMCID: PMC9034524 DOI: 10.1186/s40814-022-01040-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose The purpose of the present study was to conduct a preliminary evaluation of the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with comorbid pain and depression. Methods The design of the study was a single-arm non-randomized trial. The sample consisted of 66 work-disabled individuals with comorbid pain and depression. The treatment program consisted of a 10-week standardized behavioral activation intervention supplemented by techniques to target two psychosocial risk factors for delayed recovery, namely, catastrophic thinking and perceptions of injustice. Measures of pain severity, depression, catastrophic thinking, perceived injustice, and self-reported disability were completed pre-, mid-, and post-treatment. Satisfaction with treatment was assessed at post-treatment. Return to work was assessed at 6-month follow-up. Results The drop-out rate was 18%. At treatment termination, 91% of participants indicated that they were “very” or “completely” satisfied with their involvement in the treatment program. Significant reductions in pain (Cohen’s d = 0.71), depression (d = 0.86), catastrophic thinking (d = 1.1), and perceived injustice (d = 1.0) were observed through the course of treatment. In multivariate analyses, treatment-related reductions in depression, catastrophic thinking, and perceived injustice, but not pain, contributed significant unique variance to the prediction of return-to-work outcomes. Conclusions Risk-targeted behavioral activation was found to be an acceptable and effective intervention for work-disabled individuals with comorbid pain and depression. The findings suggest that interventions targeting psychosocial risk factors for pain and depression might contribute to more positive recovery outcomes in work-disabled individuals with comorbid pain and depression. Trial registration ClinicalTrials.gov: NCT0517442. Retrospectively registered.
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Affiliation(s)
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Nathalie Gauthier
- Clinique de Consultation Conjugale et Familiale Poitras-Wright, Coté, Longueuil, QC, Canada
| | - Pascal Thibault
- Department of Psychology, McGill University, Montreal, QC, H3A 1G1, Canada
| | - Tamra Ellis
- Centre for Rehabilitation and Health, Toronto, ON, Canada
| | - Heather Adams
- University Centre for Research and Disability, Halifax, Nova Scotia, Canada
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17
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Mailloux C, Wideman TH, Massé-Alarie H. Wrist, but Not Back, Isometric Contraction Induced Widespread Hypoalgesia in Healthy Participants. Front Pain Res (Lausanne) 2022; 2:701830. [PMID: 35295510 PMCID: PMC8915648 DOI: 10.3389/fpain.2021.701830] [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] [Received: 04/28/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Exercise may reduce pain sensitivity. This phenomenon called exercise-induced hypoalgesia is observed in different types of exercises and involves the activation of endogenous pain modulation systems. Although the effect of limb exercise on pain sensitivity has often been tested, few studies explored the impact of back exercises that are often used to treat low back pain. The main objective is to measure the effect of back-muscle exercise on pain sensitivity and compare it to the effect of a limb-muscle exercise. Methods: Twenty-three participants who were pain-free performed a 4-min wrist flexion isometric contraction followed by a 4-min low back extension, separated by a 20-min break. Pressure pain thresholds were tested at two low back (S1 spinous process, lumbar erector spinae muscle) and two wrist (capitate bone, wrist flexor muscles) sites before and after each exercise. For each exercise, sites were considered as remote or local in relation to the muscles contracted during the exercise. An independent sample of 11 participants was recruited to confirm the influence of low back extension on pain sensitivity. Results: Wrist exercise induced a larger increase in pain sensitivity than back exercise at the remote site. Only wrist exercise induced a hypoalgesia effect at both the local and the remote sites. Back exercise induced a similar effect in the independent sample. Conclusions: This study showed that back and wrist exercises induced a distinct effect on pain sensitivity in participants who were pain-free. The wrist exercise induced a systemic reduction in pain sensitivity (locally and remotely), whereas the back exercise did not. This differential effect may be present because wrist exercise induced most fatigue compared with the back exercise.
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Affiliation(s)
- Catherine Mailloux
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Quebec City, QC, Canada
| | - Timothy H Wideman
- Lethbridge-Layton-Mackay Rehabilitation Centre, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Hugo Massé-Alarie
- Département de réadaptation, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Quebec City, QC, Canada
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18
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Ippersiel P, Teoli A, Wideman TH, Preuss RA, Robbins SM. The Relationship Between Pain-Related Threat and Motor Behavior in Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:6478879. [PMID: 34939120 DOI: 10.1093/ptj/pzab274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/12/2020] [Revised: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although pain-related fear and catastrophizing are predictors of disability in low back pain (LBP), their relationship with guarded motor behavior is unclear. The aim of this meta-analysis was to determine the relationship between pain-related threat (via pain-related fear and catastrophizing) and motor behavior during functional tasks in adults with LBP. METHODS This review followed PRISMA guidelines. MEDLINE, Embase, PsychINFO, and CINAHL databases were searched to April 2021. Included studies measured the association between pain-related fear or pain catastrophizing and motor behavior (spinal range of motion, trunk coordination and variability, muscle activity) during movement in adults with nonspecific LBP. Studies were excluded if participants were postsurgery or diagnosed with specific LBP. Two independent reviewers extracted all data. The Newcastle-Ottawa Scale was used to assess for risk of bias. Correlation coefficients were pooled using the random-effects model. RESULTS Reduced spinal range of motion during flexion tasks was weakly related to pain-related fear (15 studies, r = -0.21, 95% CI = -0.31 to -0.11) and pain catastrophizing (7 studies, r = -0.24, 95% CI = -0.38 to -0.087). Pain-related fear was unrelated to spinal extension (3 studies, r = -0.16, 95% CI = -0.33 to 0.026). Greater trunk extensor muscle activity during bending was moderately related to pain-related fear (2 studies, r = -0.40, 95% CI = -0.55 to -0.23). Pain catastrophizing, but not fear, was related to higher trunk activity during gait (2 studies, r = 0.25, 95% CI = 0.063 to 0.42). Methodological differences and missing data limited robust syntheses of studies examining muscle activity, so these findings should be interpreted carefully. CONCLUSION This study found a weak to moderate relationship between pain-related threat and guarded motor behavior during flexion-based tasks, but not consistently during other movements. IMPACT These findings provide a jumping-off point for future clinical research to explore the advantages of integrated treatment strategies that target both psychological and motor behavior processes compared with traditional approaches.
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Affiliation(s)
- Patrick Ippersiel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Anthony Teoli
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Richard A Preuss
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Shawn M Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
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19
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Wideman TH, Stilwell P. How to think about pain with the whole person in mind. IJWPC 2022. [DOI: 10.26443/ijwpc.v9i1.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Too often, pain is reduced to a simple symptom of illness or injury – a puzzle piece to fit into the differential diagnostic jigsaw. Pain reports that fit the emerging pathoanatomical picture are validated and treated accordingly. But many reports don’t fit this picture, and the widespread stigma associated with persistent pain is most commonly directed toward these individuals, whose symptoms aren’t well explained by known pain mechanisms. A root problem is not seeing the person in pain or the suffering they experience.
This presentation aims to help participants develop a more comprehensive perspective on pain that better integrates its complexities within clinical practice. Participants will be introduced to the Multi-modal Assessment model of Pain (MAP; Wideman et al, Clinical Journal of Pain 2019; 35(3): 212). MAP offers a novel framework to understand the fundamentally subjective natures of pain and suffering and how they can be best addressed within clinical practice. MAP aims to help clinicians view pain, first and foremost, as an experience (like sadness), which may or may not correspond to specific pathology or diagnostic criteria (like clinical depression). MAP aims to facilitate a more compassionate approach to pain management by providing a rationale for why all reported pain should be validated, even when poorly understood. Viewing pain in this manner helps highlight the central importance of listening to patients’ narrative reports, trying to understand the meaning and context for their experiences of pain and using this understanding to help alleviate suffering.
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20
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Augeard N, Bostick G, Miller J, Walton D, Tousignant-Laflamme Y, Hudon A, Bussières A, Cooper L, McNiven N, Thomas A, Singer L, Fishman SM, Bement MH, Hush JM, Sluka KA, Watt-Watson J, Carlesso LC, Dufour S, Fletcher R, Harman K, Hunter J, Ngomo S, Pearson N, Perreault K, Shay B, Stilwell P, Tupper S, Wideman TH. Development of a national pain management competency profile to guide entry-level physiotherapy education in Canada. Can J Pain 2022; 6:1-11. [PMID: 35036823 PMCID: PMC8757473 DOI: 10.1080/24740527.2021.2004103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across Canada. AIMS This study aimed to create a consensus-based competency profile for pain management, specific to the Canadian PT context. METHODS A modified Delphi design was used to achieve consensus across Canadian university-based and clinical pain educators. RESULTS Representatives from 14 entry-level PT programs (93% of Canadian programs) and six clinical educators were recruited. After two rounds, a total of 15 competencies reached the predetermined endorsement threshold (75%). Most participants (85%) reported being "very satisfied" with the process. CONCLUSIONS This process achieved consensus on a novel pain management competency profile specific to the Canadian PT context. The resulting profile delineates the necessary abilities required by physiotherapists to manage pain upon entry to practice. Participants were very satisfied with the process. This study also contributes to the emerging literature on integrated research in pain management by profiling research methodology that can be used to inform related work in other health professions and regions.
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Affiliation(s)
- Nathan Augeard
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - David Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Anne Hudon
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Lynn Cooper
- Canadian Injured Workers Alliance, Thunder Bay, Ontario, Canada
| | - Nicol McNiven
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Lesley Singer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Scott M. Fishman
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Marie H. Bement
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Julia M. Hush
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sinead Dufour
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Roland Fletcher
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Harman
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Suzy Ngomo
- Department of Health Science, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Neil Pearson
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kadija Perreault
- Department of Rehabilitation Science, Faculty of Medicine, Université Laval, Québec City, Quebec, Canada
| | - Barbara Shay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Susan Tupper
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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21
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Leemans L, Nijs J, Antonis L, Wideman TH, Bandt HD, Franklin Z, Mullie P, Moens M, Joos E, Beckwée D. Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis. Braz J Phys Ther 2022; 26:100453. [PMID: 36279767 PMCID: PMC9597124 DOI: 10.1016/j.bjpt.2022.100453] [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: 07/15/2021] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined. OBJECTIVES The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain. METHODS For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain. CONCLUSIONS Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.
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Affiliation(s)
- Lynn Leemans
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Corresponding author at: Rehabilitation Research Department and Pain in Motion International Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Belgium,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Luna Antonis
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Hester den Bandt
- Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Physical Therapy, University of Applied Sciences Rotterdam, Rotterdam, the Netherlands
| | - Zoe Franklin
- Department of Sport and Exercise Sciences, Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Patrick Mullie
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Belgian Defense, COS Well-Being, Queen Elisabeth Barracks, Evere, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Erika Joos
- Physical Medicine & Rehabilitation Department, UZ Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Department Rehabilitation Sciences and Physical Therapy
- Research Group MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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22
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Woznowski-Vu A, Aternali A, Gervais A, Pavilanis ADS, Nijs J, Sullivan MJL, Wideman TH. The Prospective Prognostic Value of Biopsychosocial Indices of Sensitivity to Physical Activity Among People With Back Pain. Clin J Pain 2021; 37:719-729. [PMID: 34419972 DOI: 10.1097/ajp.0000000000000965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/05/2020] [Accepted: 03/22/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Many people living with musculoskeletal pain conditions experience a range of negative biopsychosocial responses to physical activity, referred to as increased sensitivity to physical activity (SPA), that may undermine successful rehabilitation. This exploratory study aims to provide the first prospective analysis of the potential prognostic value of 3 biopsychosocial indices of SPA in relation to rehabilitation outcomes. This study also aimed to shed light on the cross-sectional interrelationships between these 3 biopsychosocial indices of SPA. MATERIALS AND METHODS Adults with back pain were evaluated upon starting physical therapy and then again 3 months later. The initial testing session consisted of self-reported pain-related questionnaires and assessment of activity-related changes in pressure pain thresholds (SPA-Sensory), pain intensity ratings (SPA-Pain), and situational catastrophizing (SPA-Psych). The 3-month follow-up consisted of self-reported disability and pain questionnaires. Correlational and hierarchical linear regression analyses were conducted. RESULTS A total of 97 participants completed both the initial visit and 3-month follow-up. The SPA-Pain index and the SPA-Psych index were significantly intercorrelated, but neither were correlated with the SPA-Sensory index. The SPA-Sensory index was not correlated with outcomes. The SPA-Pain index was correlated only with cross-sectional disability and pain outcomes. The SPA-Psych index was the only SPA index significantly correlated with outcomes both cross-sectionally and at 3-month follow-up. After controlling for baseline pain/disability and pain catastrophizing, SPA-Psych was no longer a significant prognostic factor for pain, but remained a significant prognostic factor for disability at 3-month follow-up (β=0.272, t=2.674, P=0.008, R2 Δ=5.60%). DISCUSSION This study highlights the importance of conceptualizing and measuring SPA as a biopsychosocial (rather than unidimensional) construct and points toward the added prognostic value of this construct. Implications for future research and practice are discussed.
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Affiliation(s)
| | - Andrea Aternali
- Department of Psychology, York University, Toronto, ON, Canada
| | | | | | - Jo Nijs
- Pain in Motion International Research Group
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
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23
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wideman TH. A Cumulative Impact of Psychological and Sensitization Risk Factors on Pain-Related Outcomes. Pain Pract 2021; 21:523-535. [PMID: 33316140 DOI: 10.1111/papr.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/11/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Risk constructs based on psychological risk factors (eg, pain catastrophizing, PC) and sensitization risk factors (eg, pressure pain threshold, PPT) are important in research and clinical practice. Most research looks at individual constructs but does not consider how different constructs might interact within the same individual. An evaluation of the cumulative impact of psychological and sensitization risk factors on pain-related outcomes may help guide us in the risk assessment of patients with pain conditions. The aim of this study is to evaluate the cumulative impact of these psychological (PC) and sensitization (PPT) risk factors on pain-related outcomes (activity avoidance, pain severity, and disability) considering covariates. METHODS We included 109 participants (70.60% women; mean ± SD age 53.6 ± 12.3 years) with chronic musculoskeletal pain for data analysis, who completed all measures of this study. Participants completed a single testing session that included measures of risk factors (PC and PPT) and pain-related outcomes (self-reported avoidance, functional avoidance, disability, and pain severity). Subgroups were constructed by dichotomizing of PC and PPT scores, resulting in four groups: (1) low catastrophizing and low sensitivity (N = 26), (2) high catastrophizing and low sensitivity (N = 27), (3) low catastrophizing and high sensitivity (N = 25), and (4) high catastrophizing and high sensitivity (N = 31). RESULTS One-way analysis of variance (ANOVA) revealed significant group differences (P < 0.05, η2 = 0.08 to 0.14) in all outcomes of this study (except functional avoidance), and post hoc analysis indicated the significant differences are between group 1 and 4. A cumulative impact is reflected by large effect sizes between group 1 and 4 (d = 0.8 to 1). The group 2 and 3 (one risk dimension groups: either high-PC or high-PPT) represent 47% of the total participants. CONCLUSIONS The study suggests both higher level of PC and pressure sensitivity have a cumulative impact on risk screening for pain-related outcomes, considering gender in functional avoidance (task-related outcome). A clinical presentation with high-PC (one dimension of risk) is not associated with high-PPT (another dimension of risk). This finding has important clinical and theoretical implications.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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24
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Mailloux C, Beaulieu LD, Wideman TH, Massé-Alarie H. Within-session test-retest reliability of pressure pain threshold and mechanical temporal summation in healthy subjects. PLoS One 2021; 16:e0245278. [PMID: 33434233 PMCID: PMC7802960 DOI: 10.1371/journal.pone.0245278] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/27/2020] [Indexed: 12/19/2022] Open
Abstract
Objective To determine the absolute and relative intra-rater within-session test-retest reliability of pressure pain threshold (PPT) and mechanical temporal summation of pain (TSP) at the low back and the forearm in healthy participants and to test the influence of the number and sequence of measurements on reliability metrics. Methods In 24 participants, three PPT and TSP measures were assessed at four sites (2 at the low back, 2 at the forearm) in two blocks of measurements separated by 20 minutes. The standard error of measurement, the minimal detectable change (MDC) and the intraclass correlation coefficient (ICC) were investigated for five different sequences of measurements (e.g. measurement 1, 1–2, 1-2-3). Results The MDC for the group (MDCgr) for PPT ranged from 28.71 to 50.56 kPa across the sites tested, whereas MDCgr for TSP varied from 0.33 to 0.57 out of 10 (numeric scale). Almost all ICC showed an excellent relative reliability (between 0.80 and 0.97), except when only the first measurement was considered (moderate). Although minimal differences in absolute PPT reliability were present between the different sequences, in general, using only the first measurement increase measurement error. Three TSP measures reduced the measurement error. Discussion We established that two measurements of PPT and three of TSP reduced the measurement error and demonstrated an excellent relative reliability. Our results could be used in future pain research to confirm the presence of true hypo/hyperalgesia for paradigms such as conditioned pain modulation or exercise-induced hypoalgesia, indicated by a change exceeding the measurement variability.
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Affiliation(s)
- Catherine Mailloux
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Université Laval, Quebec, Canada
| | | | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Hugo Massé-Alarie
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Université Laval, Quebec, Canada
- * E-mail:
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25
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Vader K, Bostick GP, Carlesso LC, Hunter J, Mesaroli G, Perreault K, Tousignant-Laflamme Y, Tupper S, Walton DM, Wideman TH, Miller J. The Revised IASP Definition of Pain and Accompanying Notes: Considerations for the Physiotherapy Profession. Physiother Can 2021; 73:103-106. [PMID: 34456418 PMCID: PMC8370731 DOI: 10.3138/ptc-2020-0124-gee] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen’s University
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston
| | - Geoff P. Bostick
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta
| | | | - Judith Hunter
- Department of Physical Therapy, University of Toronto
| | - Giulia Mesaroli
- Department of Physical Therapy, University of Toronto
- Department of Rehabilitation Services, Hospital for Sick Children, Toronto
| | - Kadija Perreault
- Department of Rehabilitation
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Université Laval, Quebec City
| | | | - Susan Tupper
- Saskatchewan Health Authority
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Sask
| | | | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University
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26
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Leemans L, Elma Ö, Nijs J, Wideman TH, Siffain C, den Bandt H, Van Laere S, Beckwée D. Transcutaneous electrical nerve stimulation and heat to reduce pain in a chronic low back pain population: a randomized controlled clinical trial. Braz J Phys Ther 2021; 25:86-96. [PMID: 32434666 PMCID: PMC7817858 DOI: 10.1016/j.bjpt.2020.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/13/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Low back pain is the leading cause of disability worldwide. The therapeutic management of patients with chronic LBP is challenging. OBJECTIVES The aim of this study is to evaluate the effects of heat and transcutaneous electrical nerve stimulation combined on pain relief in participants with chronic low back pain. METHODS Fifty participants with chronic (≥3 months) low back pain were randomly assigned to two groups: HeatTens (n=25) and control group (n=25). Primary outcome was pain. Secondary outcomes were pressure pain thresholds, temporal summation, conditioned pain modulation, fear-avoidance and beliefs questionnaire, central sensitization inventory, quality of life, and medication use. The control group received no treatment and continued usual care. After four weeks of treatment, all measurements were repeated. RESULTS Fifty individuals participated in this study. Significant higher pressure pain threshold measures after both 30min and 4 weeks for the lower back region and the second plantar toe were found only in the experimental group. CONCLUSION The combination of heat and transcutaneous electrical nerve stimulation does not reduce pain scores in patients with chronic low back pain. Pressure pain threshold values significantly improved, showing beneficial effects of the experimental treatment. ClinicalTrials.gov: NCT03643731 (https://clinicaltrials.gov/ct2/show/NCT03643731).
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Affiliation(s)
- Lynn Leemans
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group, Belgium.
| | - Ömer Elma
- Pain in Motion International Research Group, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Canada
| | - Carolie Siffain
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group, Belgium
| | - Hester den Bandt
- Pain in Motion International Research Group, Belgium; Department of Physiotherapy, University of Applied Sciences Rotterdam, Rotterdam, The Netherlands
| | - Sven Van Laere
- Interfaculty Center Data Processing and Statistics, Vrije Universiteit Brussel, Belgium
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium; Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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27
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Vader K, Bostick GP, Carlesso LC, Hunter J, Mesaroli G, Perreault K, Tousignant-Laflamme Y, Tupper S, Walton DM, Wideman TH, Miller J. La définition révisée de la douleur de l’IASP et les notes complémentaires : les considérations pour la profession de la physiothérapie. Physiother Can 2021; 73:106-109. [PMID: 34456419 PMCID: PMC8370722 DOI: 10.3138/ptc-2020-0124-gef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyle Vader
- École de thérapie de réadaptation, Queen’s University
- Clinique de douleur chronique, Kingston Health Sciences Centre, Kingston
| | - Geoff P. Bostick
- Faculté de médecine de réadaptation, University of Alberta, Edmonton (Alberta)
| | - Lisa C. Carlesso
- École des sciences de la réadaptation, McMaster University, Hamilton
| | - Judith Hunter
- Département de physiothérapie, University of Toronto
| | - Giulia Mesaroli
- Département de physiothérapie, University of Toronto
- Département des services de réadaptation, The Hospital for Sick Children, Toronto
| | - Kadija Perreault
- Département de réadaptation
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec
| | | | - Susan Tupper
- Autorité sanitaire de la Saskatchewan
- École des sciences de la réadaptation, University of Saskatchewan, Saskatoon (Saskatchewan)
| | - David M. Walton
- École de physiothérapie, Western University, London (Ontario)
| | | | - Jordan Miller
- École de thérapie de réadaptation, Queen’s University
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Bussières A, Hartvigsen J, Ferreira ML, Ferreira PH, Hancock MJ, Stone LS, Wideman TH, Boruff J, Elklit A. Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis. Syst Rev 2020; 9:215. [PMID: 32943108 PMCID: PMC7495859 DOI: 10.1186/s13643-020-01474-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/02/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direction of associations. The purpose of this review is to appraise and summarize evidence on the relationship between ACEs and persistent pain and disability outcomes in adulthood. The specific aims are (1) to determine whether there is a relationship between exposure to ACE and persistent pain and disability in adults and (2) to determine whether unique and cumulative ACEs exposures (number and type) increase the risk of developing persistent pain and disability in adulthood. METHOD A systematic review and meta-analysis of observational studies will be conducted. Our eligibility criteria are defined following a PECOS approach: population, adults with persistent (≥ 3 months) musculoskeletal and somatoform painful disorders exposed to single or cumulative direct ACEs alone (i.e., physical, sexual, emotional abuse or neglect) or in combination to indirect types of ACE (e.g., parental death, exposure to domestic violence) in the first 18 years of life; comparators, unexposed individuals; outcomes, measurements for persistent pain (≥ 3 months) and disability using discrete and/or continuous measures; and settings, general population, primary care. A comprehensive search of MEDLINE (Ovid) and nine other pertinent databases was conducted from inception to 29 August 2019 using a combination of key words and MeSh terms (the search will be updated prior to conducting the analyses). Pairs of reviewers will independently screen records and full text articles, and a third reviewer will be consulted in cases of disagreement. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Review Manager (RevMan) Version 5.3. The Scottish Intercollegiate Guidelines Network (SIGN) and the Joanna Briggs Institute (JBI) checklists will be used to assess the quality of the included studies. If heterogeneity is high, the findings will be presented in narrative form. DISCUSSION The present review will help consolidate knowledge on persistent pain and disability by evaluating whether frequency and type of adverse childhood experiences produces the most harm. Findings may help inform practitioners and policy-makers who endeavor to prevent and/or mitigate the consequences of ACEs and promote healthy development and well-being of children, youth, and families. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020150230.
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Affiliation(s)
- André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada. .,Département Chiropratique, Université du Québec à Trois-Rivières, 3351, boul. Des Forges, C. P. 500, Trois-Rivières, Québec, G9A 5H7, Canada.
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230, Odense M, Denmark
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Level 10, Kolling Building, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - Paulo H Ferreira
- Musculoskeletal Health, Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Room 155, O Block, Cumberland Campus C42, Sydney, NSW, 1825, Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
| | - Laura S Stone
- Faculty of Dentistry, McGill University, 2001 Av McGill College #500, Montreal, Quebec, H3A1G1, Canada.,Alan Edwards Centre for Research on Pain, McGill University, 845 Sherbrooke Ouest, Montreal, Quebec, H3A 0G4, Canada.,Faculty of Medicine, Department of Anesthesiology, 420 Delaware Street SE MMC 294, Minneapolis, MN, 55455, USA
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Macdonald-Stewart Library Building, 809 Sherbrooke Street West, Montreal, Quebec, H3A 0C1, Canada
| | - Ask Elklit
- National Centre for Psychotraumatology, Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
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Caseiro M, Woznowski-Vu A, De Oliveira AS, Reis FJJ, Wideman TH. From Paper to Digitalized Body Map: A Reliability Study of the Pain Area. Pain Pract 2019; 19:602-608. [PMID: 30884135 DOI: 10.1111/papr.12780] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/18/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Computerized methods to analyze pain drawings (PDs) have been developed and may aid to measure the pain area more precisely. OBJECTIVE The aim of this study was to verify whether examiners can reproduce the patient's PDs with acceptable reliability. METHODS This was an intra-rater and inter-rater reliability study. The protocol consisted of 4 steps: (1) scanning of paper PDs; (2) sharing the digitalized PD images between examiners; (3) reproducing the PD images in the sketching application; and (4) calculating the pain area in pixels and percentages. We calculated intraclass correlation coefficients (ICCs; 2,1), the standard error of the measurement (SEM), and the smallest detectable difference (SDD). RESULTS Reliability was tested using 31 PDs from 17 patients in our database (11 female [64.7%], mean age: 53.23 ± 11.57 years). Intra-rater reliability varied from ICC (2,1) = 0.991 (95% confidence interval [CI] = 0.982 to 0.996; SEM = 3,432.45; SDD = 162.39 pixels; P < 0.001) to ICC (2,1) = 0.992 (95% CI = 0.978 to 0.997; SEM = 3,412.96; SDD = 161.93 pixels; P < 0.001). Inter-rater reliability for the measurement between all examiners was considered excellent (ICC [2,1] = 0.976; 95% CI = 0.956 to 0.987; SEM =8,580.75; SDD = 256.76 pixels; P < 0.001), being higher between Examiners A and C (ICC [2,1] = 0.970; 95% CI = 0.936 to 0.986; SEM = 6,453.34; SDD = 222.67 pixels; P < 0.001). CONCLUSION Our results show that intra- and inter-rater reliabilities were excellent when an examiner reproduced the paper PDs into digitalized PDs. This process gives clinicians and researchers the opportunity to analyze pain extent more precisely using a computerized method.
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Affiliation(s)
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Anamaria S De Oliveira
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, São Paulo University, São Paulo, Brazil
| | - Felipe J J Reis
- Federal Institute of Rio de Janeiro, Postgraduation Progam - Clinical Medicine Department of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wickens R, Wideman TH. Evaluating the Novel Added Value of Neurophysiological Pain Sensitivity within the Fear-Avoidance Model of Pain. Can J Pain 2019. [DOI: 10.1080/24740527.2019.1591838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | | | - Rebekah Wickens
- School of Physical and Occupational Therapy, Constance Lethbridge Rehabilitation Centre/McGill University, Montreal, Quebec, Canada
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wickens R, Wideman TH. Evaluating the novel added value of neurophysiological pain sensitivity within the fear-avoidance model of pain. Eur J Pain 2019; 23:957-972. [PMID: 30648781 DOI: 10.1002/ejp.1364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/09/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The fear-avoidance model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain-related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysiological processes related to pain sensitivity also play an important role in chronicity. To date, there has been limited research that has specifically explored the role of pain sensitivity within the FAM. This study addresses this gap by evaluating whether clinical measures of pain sensitivity help explain FAM-related outcomes, beyond model-relevant psychological predictors. METHODS The study sample consisted of 80 adults with chronic and widespread musculoskeletal pain. Participants completed a single testing session that included measures of all of the major constructs of the FAM, including pain catastrophizing, pain-related fear, activity avoidance (self-report and functional measures), pain-related disability, depression and pain severity, as well as a battery of quantitative sensory testing that included measures of pressure pain threshold and temporal summation of mechanical pain across eight body sites. RESULTS A series of hierarchical regression analyses revealed that after controlling for the psychological predictors of the FAM, indices of pain sensitivity significantly predicted 4 of the 5 FAM-related outcomes (p < 0.05). Depression was the only outcome not significantly predicted by pain sensitivity. Interestingly, measures of pain sensitivity, but not FAM psychological factors, predicted the functional measure of activity avoidance. CONCLUSIONS These findings provide further evidence for the importance of neurophysiological factors within the FAM and have important clinical and theoretical implications. SIGNIFICANCE This study provides evidence for the unique and added value of neurophysiological factors within the Fear Avoidance Model of pain and for the importance of integrating both sensory and psychological factors within both theoretical paradigms and clinical management strategies.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Rebekah Wickens
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Wideman TH, Miller J, Bostick G, Thomas A, Bussières A, Wickens RH. The current state of pain education within Canadian physiotherapy programs: a national survey of pain educators. Disabil Rehabil 2019; 42:1332-1338. [PMID: 30620223 DOI: 10.1080/09638288.2018.1519044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/27/2022]
Abstract
Purpose: To determine the current state of pain education across physiotherapy programs in Canada.Materials and methods: Educators that were responsible for teaching pain-related content at each of the 14 Canadian physiotherapy programs were invited to complete a cross-sectional survey. The online survey evaluated total time spent on pain education and the integration of content from international guidelines on pain education curricula.Results and conclusions: Complete data were obtained from all Canadian physiotherapy programs. The total median time spent on pain education was 18 h, ranging from 8 to 65 h. Across all programs, only 38.6% of the recommended pain curriculum themes were fully integrated within physiotherapy programs. Most of the curriculum themes were partially addressed (median: 52.6%) and a small minority were not addressed (median: 10.5%). There was an overall trend in which greater time spent on pain education corresponded to a higher proportion of pain curriculum themes that were fully integrated. This is the first national survey of pain education that has included all physiotherapy programs across Canada. These data provide a foundation for understanding the current resources and content dedicated to pain education and are an essential step in benchmarking and potentially improving pain education for physiotherapists.Implications for rehabilitationIntegrating pain education within entry-level physiotherapy programs is a foundational step in translating pain research into effective physiotherapy pain management.This survey of all entry-level physiotherapy programs across Canada shows considerable variability in the time and scope of pain education and that, on average, less than 40% of recommended pain education curriculum content is adequately addressed.This work highlights the need for national reference standards in pain education to help improve consistency across training programs.
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Affiliation(s)
- Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research of Greater Montreal, Montreal, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Geoff Bostick
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Aliki Thomas
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research of Greater Montreal, Montreal, Canada.,Centre for Medical Education, McGill University, Montreal, Canada
| | - André Bussières
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research of Greater Montreal, Montreal, Canada
| | - Rebekah H Wickens
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
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Wideman TH, Hudon A, Bostick G. The Added Value of Qualitative Methodologies for Studying Emotional Disclosure About Pain. J Pain 2018; 19:1366. [PMID: 30025707 DOI: 10.1016/j.jpain.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/12/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec.
| | - Anne Hudon
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Geoff Bostick
- Rehabilitation Medicine, University of Alberta, Canada
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Wideman TH, Miller J, Bostick G, Thomas A, Bussières A. Advancing Pain Education in Canadian Physiotherapy Programmes: Results of a Consensus-Generating Workshop. Physiother Can 2018; 70:24-33. [PMID: 29434415 DOI: 10.3138/ptc.2016-57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This article reports on a national stakeholder workshop that focused on advancing pain education in physiotherapy programmes across Canada. Methods: Workshop participants included national leaders from the following stakeholder groups: people living with pain; physiotherapy students and recent graduates; pain educators; physiotherapy programme administrators; and representatives from the Canadian Alliance of Physiotherapy Regulators, Physiotherapy Education Accreditation Canada, Canadian Physiotherapy Association, and Physiotherapy Practice Profile project. During the workshop, barriers to, facilitators of, and strategies for advancing pain education were discussed, and a stakeholder-endorsed consensus statement was generated. The workshop was recorded, and data were thematically analyzed. Results: Participants identified important barriers and facilitators associated with the field of pain, standards and regulatory processes, physiotherapy programmes, and physiotherapy students and people living with pain. Strategies for advancing pain education included integrating pain competencies into standards and regulatory policy, encouraging the development of best teaching practices, partnering with people living with pain, building awareness, and setting goals and assessing clear outcomes. The consensus statement highlighted the central importance of pain education for physiotherapists and the need for a reference standard to guide its implementation in the Canadian context. Conclusion: This was the first initiative to specifically explore national stakeholders' perceptions of pain education. The workshop outcomes provide a strong mandate and direction for advancing pain education across Canadian physiotherapy programmes.
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Affiliation(s)
- Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Ont
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal
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35
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Mankovsky-Arnold T, Wideman TH, Thibault P, Larivière C, Rainville P, Sullivan MJL. Sensitivity to Movement-Evoked Pain and Multi-Site Pain are Associated with Work-Disability Following Whiplash Injury: A Cross-Sectional Study. J Occup Rehabil 2017; 27:413-421. [PMID: 27744640 DOI: 10.1007/s10926-016-9672-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 06/06/2023]
Abstract
Objectives Previous research has shown that sensitivity to movement-evoked pain is associated with higher scores on self-report measures of disability in individuals who have sustained whiplash injuries. However, it remains unclear whether sensitivity to movement-evoked pain is associated with work-disability. The aim of the present study was to examine the relation between sensitivity to movement-evoked pain and occupational status in individuals receiving treatment for whiplash injury. Methods A sample of 105 individuals with whiplash injuries participated in a testing session where different measures of pain (i.e. spontaneous pain, multi-site pain, sensitivity to movement-evoked pain) were collected during the performance of a simulated occupational lifting task. Results Hierarchical logistic regression analysis revealed that the measures of multisite pain and sensitivity to movement-evoked pain made significant independent contributions to the prediction of work-disability. Discussion The findings suggest that including measures of multisite pain and sensitivity to movement evoked pain in assessment protocols has the potential to increase the value of pain assessments for the prediction of occupational disability associated with whiplash injury. Clinical and theoretical implications of the findings are addressed.
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Affiliation(s)
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Pascal Thibault
- Department of Psychology, McGill University, Montreal, Canada
| | - Christian Larivière
- Occupational Health and Safety, Research Institute Robert-Sauvé, Montreal, Canada
| | - Pierre Rainville
- Département de stomatology, Université de Montréal, Montreal, Canada
| | - Michael J L Sullivan
- Recover Injury Research Centre, University of Queensland, 288 Herston Road, Level 7, Herston, QLD, 4029, Australia.
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36
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Lluch E, Nijs J, Courtney CA, Rebbeck T, Wylde V, Baert I, Wideman TH, Howells N, Skou ST. Clinical descriptors for the recognition of central sensitization pain in patients with knee osteoarthritis. Disabil Rehabil 2017; 40:2836-2845. [DOI: 10.1080/09638288.2017.1358770] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussel, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussel, Belgium
| | - Carol A. Courtney
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Trudy Rebbeck
- Faculty of Health Sciences, Discipline of Physiotherapy, John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Vikki Wylde
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Isabel Baert
- Pain in Motion International Research Group, Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Nick Howells
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Søren T. Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Lowry V, Ouellet P, Vendittoli PA, Carlesso LC, Wideman TH, Desmeules F. Determinants of pain, disability, health-related quality of life and physical performance in patients with knee osteoarthritis awaiting total joint arthroplasty. Disabil Rehabil 2017; 40:2734-2744. [PMID: 28728444 DOI: 10.1080/09638288.2017.1355412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance. MATERIAL AND METHODS Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteoarthritis Index, (2) Lower Extremity Functional Scale (LEFS) and (3) Short-Form 36 (SF-36). Physical performance was also assessed with four validated performance tests. Demographic, socioeconomic, psychosocial and clinical characteristics of the participants were also measured. Multivariate regression analyses were used to evaluate potential associations. RESULTS Higher fear-avoidance beliefs, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse pain, function or HRQOL (p < 0.05) and explained 12%-35% of the variances of the self-reported measure scores. Pretest pain and change in pain during posttest, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse performance on the physical tests (p < 0.05) and explained 41%-59% of the variances of the different physical tests results. CONCLUSIONS Several determinants were significantly associated with worse pain, disability, health-related quality of life or physical performance. Several of these associations may be considered clinically important, including psychosocial determinants in relation to self-reported measures, but to physical performance as well. Implications for rehabilitation Knee osteoarthritis is a highly prevalent and disabling condition incurring important socioeconomic costs. Several modifiable determinants have been shown to contribute to pain and disability in individuals suffering from knee OA awaiting TKA. Recent studies demonstrated the efficacy of education and rehabilitation (prehabilitation) in individuals awaiting TKA.
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Affiliation(s)
- Véronique Lowry
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada
| | - Philippe Ouellet
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Pascal-André Vendittoli
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,c Department of Surgery, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Lisa C Carlesso
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Timothy H Wideman
- d School of Physical and Occupational Therapy , McGill University , Montreal , Canada
| | - François Desmeules
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
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Walton DM, Elliott J, Lee J, Loh E, MacDermid J, Schabrun S, Siqueira WL, Corneil BD, Aal B, Birmingham T, Brown A, Cooper L, Dickey JP, Dixon SJ, Fraser D, Gati J, Gloor G, Good G, Holdsworth D, McLean SA, Millard W, Miller J, Sadi J, Seminowicz DA, Shoemaker JK, Siegmund G, Versteegh T, Wideman TH. Research priorities in the field of post-traumatic pain and disability: Results of a transdisciplinary consensus-generating workshop. Pain Res Manag 2015:17143. [PMID: 26583461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Mankovsky-Arnold T, Wideman TH, Larivière C, Sullivan MJL. Measures of spontaneous and movement-evoked pain are associated with disability in patients with whiplash injuries. J Pain 2014; 15:967-75. [PMID: 24998695 DOI: 10.1016/j.jpain.2014.06.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/28/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022]
Abstract
UNLABELLED This study examined the degree to which measures of spontaneous and movement-evoked pain accounted for shared or unique variance in functional disability associated with whiplash injury. The study also addressed the role of fear of movement as a mediator or moderator of the relation between different indices of pain and functional disability. Measures of spontaneous pain, single-point movement-evoked pain, repetition-induced summation of activity-related pain (RISP), and fear of movement and disability were obtained on a sample of 142 individuals who had sustained whiplash injuries. Participants' pain ratings, provided after lifting a weighted canister, were used as the index of single-point movement-evoked pain. RISP was computed as the increase in pain reported by participants over successive lifts of 18 weighted canisters. Measures of functional disability included physical lift tolerance and self-reported disability. Hierarchical regression analyses revealed that measures of single-point movement-evoked pain and RISP accounted for significant unique variance in self-reported disability, beyond the variance accounted for by the measure of spontaneous pain. Only RISP accounted for significant unique variance in lift tolerance. The results suggest that measures of movement-evoked pain represent a disability-relevant dimension of pain that is not captured by measures of spontaneous pain. The clinical and conceptual implications of the findings are discussed. PERSPECTIVE This study examined the degree to which measures of spontaneous and movement-evoked pain accounted for shared or unique variance in functional disability associated with whiplash injury. The findings suggest that approaches to the clinical evaluation of pain would benefit from the inclusion of measures of movement-evoked pain.
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Affiliation(s)
| | - Timothy H Wideman
- School of Occupational and Physical Therapy, McGill University, Montreal, Quebec, Canada
| | - Christian Larivière
- Robert-Sauvé Occupational Health and Safety Research Institute (IRSST), Montreal, Quebec, Canada
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Abstract
SUMMARY Over the past two decades increasingly compelling research has identified pain catastrophizing as an important psychological risk factor for a wide range of pain-related outcomes. In response to this literature, there have been calls for the clinical use of catastrophizing as a prognostic indicator of problematic recovery, and for the development of clinical interventions that target catastrophizing and its correlates. This article provides a review of the evidence-based assessment and management tools that are available for the clinical management of patients with elevated levels of catastrophic thinking. Recent research and clinical implementation strategies are discussed for the following interventions: cognitive behavioral techniques, emotional disclosure, reassurance and activity encouragement, neurophysiological education, and graded activity and exposure.
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Affiliation(s)
- Timothy H Wideman
- McGill University, Psychology Department, Montreal, Quebec, H3A 1B1, Canada
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Mankovsky-Arnold T, Wideman TH, Larivière C, Sullivan MJ. TENS Attenuates Repetition-Induced Summation of Activity-Related Pain Following Experimentally Induced Muscle Soreness. The Journal of Pain 2013; 14:1416-24. [DOI: 10.1016/j.jpain.2013.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 11/15/2022]
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Wideman TH, Asmundson GGJ, Smeets RJEM, Zautra AJ, Simmonds MJ, Sullivan MJL, Haythornthwaite JA, Edwards RR. Rethinking the fear avoidance model: toward a multidimensional framework of pain-related disability. Pain 2013; 154:2262-2265. [PMID: 23748115 DOI: 10.1016/j.pain.2013.06.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/03/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Timothy H Wideman
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA Department of Psychology, University of Regina, Regina, Saskatchewan, Canada Department of Rehabilitation, Maastricht University, Maastricht, The Netherlands Department of Psychology, Arizona State University, Phoenix, AZ, USA Department of Physical Therapy, University of Texas, Health Sciences Center, San Antonio, TX, USA Department of Psychology, McGill University, Montreal, Quebec, Canada Department of Anaesthesia, Harvard School of Medicine, Boston, MA, USA
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Martel MO, Wideman TH, Sullivan MJ. Patients who display protective pain behaviors are viewed as less likable, less dependable, and less likely to return to work. Pain 2012; 153:843-849. [DOI: 10.1016/j.pain.2012.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 12/10/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
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Wideman TH, Sullivan MJ. Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers’ compensation claimants. Pain 2011; 152:376-383. [DOI: 10.1016/j.pain.2010.10.044] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 10/16/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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Wideman TH, Sullivan MJ. Wideman and Sullivan Response to Letter to Editor by Vlaeyen et al. Pain 2009. [DOI: 10.1016/j.pain.2009.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wideman TH, Adams H, Sullivan MJL. A prospective sequential analysis of the fear-avoidance model of pain. Pain 2009; 145:45-51. [PMID: 19477072 DOI: 10.1016/j.pain.2009.04.022] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 04/20/2009] [Accepted: 04/22/2009] [Indexed: 11/25/2022]
Abstract
The primary purpose of this study was to analyze the sequential relationships proposed by the fear-avoidance model of pain [Vlaeyen JWS et al. The role of fear of movement/(re)injury in pain disability. J Occup Rehab 1995;5:235-52]. Specifically, this study evaluated whether early change in catastrophizing predicted late change in fear of movement, and whether these factors influenced post-treatment return-to-work. Secondary analyses tested relationships between (1) early change in catastrophizing, late change in depression, and disability; and (2) early change in catastrophizing, late change in pain severity, and disability. Analyses were conducted on a sample of 121 individuals (82 men and 32 women) with a work-related musculoskeletal injury, and high baseline catastrophizing and fear of movement scores. Participants were enrolled in a 10-week community-based disability management intervention, and they completed measures of catastrophizing, fear of movement, depression and pain severity at pre-, mid- and post-treatment. Return-to-work was assessed 4 weeks following termination of the intervention. Contrary to predictions, results from correlational analyses revealed non-significant relationships among indices of early change in catastrophizing and late changes in fear of movement, depression and pain severity. Multiple logistic regression analyses revealed that early change in catastrophizing, late changes in fear of movement and late change in pain severity were significant predictors of return-to-work, while late changes in depression were not. These findings highlight the importance of reductions in psychosocial risk factors in augmenting return-to-work outcomes. Implications for the fear-avoidance model and future research are discussed.
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Affiliation(s)
- Timothy H Wideman
- Department of Psychology, McGill University, 1205 Docteur Penfield, Montreal, Quebec, Canada H3A 1B1
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