scholarly journals Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Fabíola Costa ◽  
Dora Janela ◽  
Maria Molinos ◽  
Jorge Lains ◽  
Gerard E. Francisco ◽  
...  
Keyword(s):  
Rating Scale ◽  
Retention Rate ◽  
Control Group ◽  
Large Sample Size ◽  
Fear Avoidance ◽  
Patient Satisfaction Score ◽  
Fear Avoidance Beliefs ◽  
Wide Range ◽  
Secondary Outcomes ◽  
Very High

Abstract Background Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Objective Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Methods Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Results Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Strengths and limitations This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. Conclusions We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. Trial registration NCT, NCT04092946. Registered 17/09/2019;

Gluteal Central Activation in Females With Patellofemoral Pain: A Preliminary Study

2021 ◽  
pp. 1-8
Author(s):  
Neal R. Glaviano ◽  
Grant E. Norte
Keyword(s):  
Physical Activity ◽  
Gluteus Maximus ◽  
Patellofemoral Pain ◽  
Fear Avoidance ◽  
Cross Sectional ◽  
Central Activation ◽  
Fear Avoidance Beliefs ◽  
Hip Muscle ◽  
Wide Range ◽  
Muscle Inhibition

Context: Lesser hip muscle strength is commonly observed in females with patellofemoral pain (PFP) compared with females without PFP and is associated with poor subjective function and single-leg squat (SLS) biomechanics. Hip muscle weakness is theorized to be related to PFP, suggesting centrally mediated muscle inhibition may influence the observed weakness. The central activation ratio (CAR) is a common metric used to quantify muscle inhibition via burst superimposition. However, gluteal inhibition has yet to be evaluated using this approach in females with PFP. The study objectives are to (1) describe gluteal activation in the context of subjective function, hip strength, and squatting biomechanics and (2) examine the relationship of gluteal activation with subjective function and squatting biomechanics in females with PFP. Design: Cross-sectional. Methods: Seven females with PFP (age = 22.8 [3.6] y; mass = 69.4 [18.0] kg; height = 1.67 [0.05] m, duration of pain = 6–96 mo) completed this study. Subjective function was assessed with the Anterior Knee Pain Scale, while fear-avoidance beliefs were assessed with the Fear-Avoidance Belief Questionnaire physical activity and work subscales. Biomechanical function was assessed with peak hip and knee angles and moments in the sagittal and frontal planes during SLS. Gluteus medius (GMed) and gluteus maximus (GMax) activation were assessed with the CAR. Descriptive statistics were calculated, and relationships between variables were assessed with Spearman rho correlations. Results: The CAR of GMed and GMax was 90.5% (8.1%) and 84.0% (6.3%), respectively. Lesser GMed CAR was strongly associated with greater hip adduction during SLS (ρ = −.775, P = .02) and greater fear-avoidance beliefs—physical activity subscale (ρ = −.764, P = .018). Conclusion: We found a wide range in GMed and GMax activation across females with PFP. Lesser GMed activation was associated with greater hip adduction during SLS and fear of physical activity, suggesting that gluteal inhibition should be assessed in patients with PFP.

scholarly journals Do patients with chronic unilateral orofacial pain due to a temporomandibular disorder show increased attending to somatosensory input at the painful side of the jaw?

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4310 ◽  
Author(s):  
Stefaan Van Damme ◽  
Charlotte Vanden Bulcke ◽  
Linda Van Den Berghe ◽  
Louise Poppe ◽  
Geert Crombez
Keyword(s):  
Orofacial Pain ◽  
Temporomandibular Disorder ◽  
Control Group ◽  
Somatosensory Processing ◽  
Spatial Bias ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Tactile Stimuli ◽  
Significant Difference ◽  
Somatosensory Input

Background Patients with chronic orofacial pain due to temporomandibular disorders (TMD) display alterations in somatosensory processing at the jaw, such as amplified perception of tactile stimuli, but the underlying mechanisms remain unclear. This study investigated one possible explanation, namely hypervigilance, and tested if TMD patients with unilateral pain showed increased attending to somatosensory input at the painful side of the jaw. Methods TMD patients with chronic unilateral orofacial pain (n = 20) and matched healthy volunteers (n = 20) performed a temporal order judgment (TOJ) task indicated which one of two tactile stimuli, presented on each side of the jaw, they had perceived first. TOJ methodology allows examining spatial bias in somatosensory processing speed. Furthermore, after each block of trials, the participants rated the perceived intensity of tactile stimuli separately for both sides of the jaw. Finally, questionnaires assessing pain catastrophizing, fear-avoidance beliefs, and pain vigilance, were completed. Results TMD patients tended to perceive tactile stimuli at the painful jaw side as occurring earlier in time than stimuli at the non-painful side but this effect did not reach conventional levels of significance (p = .07). In the control group, tactile stimuli were perceived as occurring simultaneously. Secondary analyses indicated that the magnitude of spatial bias in the TMD group is positively associated with the extent of fear-avoidance beliefs. Overall, intensity ratings of tactile stimuli were significantly higher in the TMD group than in the control group, but there was no significant difference between the painful and non-painful jaw side in the TMD patients. Discussion The hypothesis that TMD patients with chronic unilateral orofacial pain preferentially attend to somatosensory information at the painful side of the jaw was not statistically supported, although lack of power could not be ruled out as a reason for this. The findings are discussed within recent theories of pain-related attention.

scholarly journals Does handwriting the name of a potential trial participant on an invitation letter improve recruitment rates? A randomised controlled study within a trial

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 659 ◽  
Author(s):  
Jennifer McCaffery ◽  
Alex Mitchell ◽  
Caroline Fairhurst ◽  
Sarah Cockayne ◽  
Sara Rodgers ◽  
...  
Keyword(s):  
Intervention Group ◽  
Small Sample ◽  
Controlled Study ◽  
Control Group ◽  
Trial Participant ◽  
Invitation Letter ◽  
Wide Range ◽  
Study Within A Trial ◽  
Secondary Outcomes ◽  
Randomised Controlled

Background: Randomised controlled trials (RCTs) often fail to recruit to target, resulting in a lack of generalisability of findings. A wide range of strategies for potentially increasing recruitment have been identified; however, their effectiveness has not been established. The aim of this study within a trial (SWAT) was to evaluate the effectiveness of handwritten personalisation of an invitation letter as part of a trial recruitment pack on recruitment to a host RCT. Methods: A pragmatic, two-armed RCT was conducted, embedded within an existing falls prevention trial (OTIS) in men and women aged 65 years and over living in the community. Participants were randomised 1:1 to receive an OTIS recruitment pack containing an invitation letter on which their name was handwritten (intervention group), or one on which it was printed (control group). The primary outcome was randomisation into the host trial.  Secondary outcomes related to trial eligibility and retention.  Analyses were via logistic regression and Cox Proportional Hazards regression. Results: Of the 317 SWAT participants, 12 (3.8%) were randomised into the OTIS trial: 3 (handwritten: 3/159 [1.9%]; printed: 9/158 [5.7%]; difference -3.8%, 95% CI -8.0% to 0.4%). There was weak evidence, against the intervention, of a difference in the likelihood of participants being randomised into the host trial between the two groups (OR 0.32, 95% CI 0.08 to 1.20, p=0.09). There were no statistically significant differences between the intervention and control groups on any of the secondary outcomes. Conclusions: There was no evidence that personalisation of invitation letters improved recruitment to the OTIS trial. However, due to the small sample size, the results should be interpreted with caution. These findings need to be replicated across larger studies and wider populations. Registration: ISRCTN22202133.

scholarly journals A Preliminary Study of the Objective Measurement of Compliance Rates for Semirigid Lumbar-Support Use in Patients with Chronic Nonspecific Low Back Pain: How Important Is the Compliance Rate?

2017 ◽  
Vol 11 (5) ◽  
pp. 748-755 ◽  
Author(s):  
Maryam Hekmatfard ◽  
Mohammad Ali Sanjari ◽  
Nader Maroufi ◽  
Hassan Saeedi ◽  
Esmail Ebrahimi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Compliance Rate ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Lumbar Support ◽  
Mean Compliance

<sec><title>Study Design</title><p>Clinical pilot study.</p></sec><sec><title>Purpose</title><p>To objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs.</p></sec><sec><title>Overview of Literature</title><p>Wearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects.</p></sec><sec><title>Methods</title><p>Twelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire.</p></sec><sec><title>Results</title><p>The mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (<italic>p</italic>=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (<italic>p</italic>&lt;0.001, <italic>p</italic>=0.02, respectively).</p></sec><sec><title>Conclusions</title><p>The compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.</p></sec>

scholarly journals Predictors of a suicidal behavior in patients with dementia

2017 ◽  
Vol 41 (S1) ◽  
pp. S399-S399
Author(s):  
N. Maruta ◽  
I. Mudrenko
Keyword(s):  
Suicidal Behavior ◽  
Suicide Risk ◽  
Rating Scale ◽  
Cognitive Disorders ◽  
Severe Depression ◽  
Control Group ◽  
Self Awareness ◽  
Wide Range ◽  
Significant Difference ◽  
High Level

IntroductionCognitive disorders are associated with a wide range of psychopathological syndromes and behavioral disorders, and suicidal manifestations in dementia are understudied nowadays.ObjectivesTo investigate clinical-psychopathological predictors of a suicidal behavior in patients with dementia.MethodologyForty-four patients with dementia were examined: 23 patients with suicidal manifestations and 21 patients without them (control group). Clinical and psychometrical methods were used: Mini Mental State Examination (MMSE) scale; Assessment of Suicide Risk scale; Hamilton Rating Scale for Depression (HDRS), and statistical ones.ResultsIt was determined that male patients with dementia had suicidal behavioral manifestations more often than female patients (69.6%; P < 0.05). An average age of the patients was 69.88 ± 1.85 years with no significant difference between the main and control groups.The majority of the patients with dementia (52.3%) had suicidal manifestations. Real suicidal intentions were the most frequent (25%; P < 0.05); 20.5% of patients expressed passive thoughts (anti-vital sentences, fantasies, ideas concerning death); 2 patients (6.82%; P < 0.05) had suicidal attempts. Patients with suicidal tendencies in their clinical picture more often had hallucinatory syndrome (39.1%; P < 0.05); features of severe depression (35.04 ± 1.54 points; P < 0.01); a high level of suicidal risk (26.34 ± 1.68 points; P < 0.01); a severe cognitive deficit (ММSE score 0–10); and a significantly lower level of self-awareness of death (18.53 ± 0.72 points; P < 0.05) in comparison with the control group.ConclusionsA high suicide risk in dementia correlated with a level of depressive symptoms (r = 0.6), moderate and/or severe grades of dementia (r = 0.45), and a low level of self-awareness of death (r = 0.35).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Influence of Fear-Avoidance Beliefs on Functional Status Outcomes for People With Musculoskeletal Conditions of the Shoulder

2012 ◽  
Vol 92 (8) ◽  
pp. 992-1005 ◽  
Author(s):  
Bhagwant S. Sindhu ◽  
Leigh A. Lehman ◽  
Sergey Tarima ◽  
Mark D. Bishop ◽  
Dennis L. Hart ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Functional Status ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Functional Change ◽  
Minimal Detectable Change ◽  
Fear Avoidance ◽  
Computerized Adaptive Test ◽  
Fear Avoidance Beliefs ◽  
Musculoskeletal Conditions

Background The influence of elevated fear-avoidance beliefs on change in functional status is unclear. Objective The purpose of this study was to determine the influence of fear-avoidance on recovery of functional status during rehabilitation for people with shoulder impairments. Design A retrospective longitudinal cohort study was conducted. Methods Data were collected from 3,362 people with musculoskeletal conditions of the shoulder receiving rehabilitation. At intake and discharge, upper-extremity function was measured using the shoulder Computerized Adaptive Test. Pain intensity was measured using an 11-point numerical rating scale. Completion rate at discharge was 57% for function and 47% for pain intensity. A single-item screen was used to classify patients into groups with low versus elevated fear-avoidance beliefs at intake. A general linear model (GLM) was used to describe how change in function is affected by fear avoidance in 8 disease categories. This study also accounted for within-clinic correlation and controlled for other important predictors of functional change in functional status, including various demographic and health-related variables. The parameters of the GLM and their standard errors were estimated with the weighted generalized estimating equations method. Results Functional change was predicted by the interaction between fear and disease categories. On further examination of 8 disease categories using GLM adjusted for other confounders, improvement in function was greater for the low fear group than for the elevated fear group among people with muscle, tendon, and soft tissue disorders (Δ=1.37, P&lt;.01) and those with osteopathies, chondropathies, and acquired musculoskeletal deformities (Δ=5.52, P&lt;.02). These differences were below the minimal detectable change. Limitations Information was not available on whether therapists used information on level of fear to implement treatment plans. Conclusions The influence of fear-avoidance beliefs on change in functional status varies among specific shoulder impairments.

Depressive symptoms in patients with schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. S141-S142 ◽  
Author(s):  
T. Aladashvili
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Control Group ◽  
Schizophrenic Disorder ◽  
Inclusion Criteria ◽  
Wide Range ◽  
Icd 10 ◽  
Schizophrenic Patients ◽  
Hamilton Rating Scale

IntroductionDepression is common among patients with schizophrenia and is associated with a wide range of poor outcomes, including psychotic relapse and suicide. The aim of the study is to evaluate the presence of depressive symptoms in patients with schizophrenia and to compare depression intensity in schizophrenic patients and patients with depressive disorder.MethodsIn this cross sectional study were included 40 patients from both genders. Patients were divided in 2 groups: (1) examined group: 20 schizophrenic patients who presented depressive symptomatology. Depressive symptoms-evaluated with the 17-item Hamilton Rating Scale for Depression. Inclusion criteria: schizophrenic disorder by ICD-10 (F20.0-F20.9), total score higher than 7 on the HRSD-17 and age between 25 and 65; (2) control group: 20 patients with depressive disorder. Inclusion criteria: recurrent depressive disorder by ICD-10 (F33.0-F33.9), total score higher than 7 on the HRSD-17 and age between 25 and 65. Psychiatric rating scales for clinical evaluation of prominence of symptomatology: 17-item Hamilton Rating Scale for Depression (HRSD-17) and PANSS (Positive And Negative Syndrome Scale).ResultsThe prevalence of patients with depressive symptoms among the schizophrenic patients was 45% i.e. out of 20 evaluated patients with schizophrenia, 9 showed depressive symptoms. The total score in the remaining 11 patients on the HRSD-17 was lower than 7 and they were excluded. Difference between the two groups for gender difference was not statistically significant.ConclusionsThe percentage of patients with depressive symptoms among the patients with schizophrenic disorder was 45%. Schizophrenic patients more frequently presented mild and moderate depression in comparison to the control group. In the majority of subjects with schizophrenia and depressive symptoms positive schizophrenic symptomatology was predominant.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Kenneth Jay ◽  
Sannie Vester Thorsen ◽  
Emil Sundstrup ◽  
Ramon Aiguadé ◽  
Jose Casaña ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sickness Absence ◽  
Musculoskeletal Pain ◽  
Occupational Physical Activity ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
High Level ◽  
Very High

Background and Objective. Musculoskeletal pain is common in the population. Negative beliefs about musculoskeletal pain and physical activity may lead to avoidance behavior resulting in absence from work. The present study investigates the influence of fear avoidance beliefs on long-term sickness absence. Methods. Workers of the general working population with musculoskeletal pain (low back, neck/shoulder, and/or arm/hand pain; n = 8319) from the Danish Work Environment Cohort Study were included. Long-term sickness absence data were obtained from the Danish Register for Evaluation and Marginalization (DREAM). Time-to-event analyses (cox regression) controlled for various confounders estimated the association between fear avoidance beliefs (very low, low, moderate [reference category], high, and very high) at baseline and long-term sickness absence (LTSA; ≥6 consecutive weeks) during a 2-year follow-up. Results. During the 2-year follow-up, 10.2% of the workers experienced long-term sickness absence. In the fully adjusted model, very high-level fear avoidance increased the risk of LTSA with hazard ratio (HR) of 1.48 (95% CI 1.15-1.90). Similar results were seen analyses stratified for occupational physical activity, i.e., sedentary workers (HR 1.72 (95% CI 1.04-2.83)) and physically active workers (HR 1.48 (95% CI 1.10-2.01)). Conclusion. A very high level of fear avoidance is a risk factor for long-term sickness absence among workers with musculoskeletal pain regardless of the level of occupational physical activity. Future interventions should target fear avoidance beliefs through information and campaigns about the benefits of staying active when having musculoskeletal pain.

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