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<.01) and those with osteopathies, chondropathies, and acquired musculoskeletal deformities (Δ=5.52, P<.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.

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 The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising

2014 ◽  
Vol 22 (1) ◽  
Author(s):  
Bruce F Walker ◽  
Christine D Losco ◽  
Anthony Armson ◽  
Amanda Meyer ◽  
Norman J Stomski
Keyword(s):  
Pain Intensity ◽  
Psychosocial Factors ◽  
Scale Score ◽  
Short Form ◽  
Spinal Pain ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Pain Catastrophising ◽  
Increased Risk ◽  
Sf 36

Abstract Background The development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors. There is an extensive body of evidence that has associated various psychosocial factors with an increased risk of experiencing persistent pain. Clinicians require instruments that are brief, easy to administer and score, and capable of validly identifying psychosocial factors. The pain diagram is potentially such an instrument. The aim of our study was to examine the association between pain diagram area and psychosocial factors. Methods 183 adults, aged 20–85, with spinal pain were recruited. We administered a demographic checklist; pain diagram; 11-point Numerical Rating Scale assessing pain intensity; Pain Catastrophising Scale (PCS); MOS 36 Item Short Form Health Survey (SF-36); and the Fear Avoidance Beliefs Questionnaire (FABQ). Open source software, GIMP, was used to calculate the total pixilation area on each pain diagram. Linear regression was used to examine the relationship between pain diagram area and the following variables: age; gender; pain intensity; PCS total score; FABQ-Work scale score; FABQ-Activity scale score; and SF-36 Mental Health scale score. Results There were no significant associations between pain diagram area and any of the clinical variables. Conclusion Our findings showed that that pain diagram area was not a valid measure to identify psychosocial factors. Several limitations constrained our results and further studies are warranted to establish if pain diagram area can be used assess psychosocial factors.

scholarly journals Effectiveness of Neck Myofascial Release Techniques and Exercise Therapy on Pain Intensity and Disability in Patients with Chronic Tension-Type Headache

2016 ◽  
Vol 9 (6) ◽  
pp. 47
Author(s):  
Mohammad Hosseinifar ◽  
Razieh Bazghandi ◽  
Zahra Azimi ◽  
Bahareh Khodadadi Bohlouli
Keyword(s):  
Pain Intensity ◽  
Exercise Therapy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Tension Type Headache ◽  
Control Group ◽  
Myofascial Release ◽  
Headache Intensity ◽  
Headache Disability ◽  
Type Headache

PURPOSE: Tension type headache (TTH) is one of the most prevalent types of headache. TTH is classified as episodic if it occurs on less than 15 days a month and as chronic if it occurs more often. Tension, anxiety and depression are some etiological factors for TTH which leads to work efficiency reduction. Today the interest in non-pharmacological methods is increasing; massage is one of these approaches which has no side effects. Aim of this study was to investigate the effects of neck Myofascial Release (MFR) techniques and exercise therapy on pain intensity and disability in patients with chronic tension-type headache.METHODS: This randomized clinical trial study was investigated on 30 females suffering from TTH. Participants were randomly assigned into two equal groups (n=15). The MFR group received neck MFR massage and exercise therapy four times a week for 3 weeks, each session lasting 45 minutes. Control group had no intervention. Outcomes were headache intensity and disability measured by numerical rating scale (NRS) and headache disability index (HDI), respectively. Data was analysed through independent and pair t-test.RESULTS: Between group comparison showed significant improvement of headache intensity and disability rate in MFR group (p<0.05) than control group (p=0.000).DISCUSSION: This study provides evidences that MFR technique and exercise therapy have significant effect on patients with TTH.

scholarly journals The Effect of the Treatment at a Pain Clinic on the Patients’ Assessment of Their Pain Intensity and the Incidence of Mental Disorders in the form of Anxiety, Depression, and Aggression

2019 ◽  
Vol 16 (4) ◽  
pp. 586
Author(s):  
Dariusz Kosson ◽  
Marcin Kołacz ◽  
Robert Gałązkowski ◽  
Patryk Rzońca ◽  
Barbara Lisowska
Keyword(s):  
Mental Disorders ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Depression Scale ◽  
Emotional Disturbances ◽  
Pain Clinic ◽  
Pain Clinics ◽  
Pain Symptoms ◽  
Anxiety Depression

The aim of the study was to analyze the effect of the treatment given to patients in a pain clinic on their assessment of pain intensity and the incidence of emotional disturbances in the form of anxiety, depression, and aggression. The study was conducted from January 2014 to April 2018 among patients under the care of two Warsaw pain clinics. The study tools were the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NRS). The project enrolled 325 patients, with women comprising 60.62% of patients, and the age bracked of 65–79 years comprising 39.38% of patient. The major reasons for attending the pain clinic were osteoarticular pain (44.92%) and neuropathic pain (42.77%). The therapy applied lowered the patients’ pain intensity (4.98 vs. 3.83), anxiety (8.71 vs. 8.12), aggression (3.30 vs. 3.08), and the overall HADS-M score (18.93 vs. 17.90), which shows that the treatment of both the pain symptoms and the associated emotional disturbances in the form of anxiety and aggression was effective. Sex is a factor affecting pain intensity. The level of mental disorders was influenced by the sex and age of the patients and how long they had been treated in the pain clinics.

scholarly journals Effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients

2017 ◽  
Vol 5 (2) ◽  
pp. 631
Author(s):  
Zahra Abbas Ali Madadi ◽  
Jalil Azimian ◽  
Farzaneh Falahatpishe ◽  
Mahmoud Alipour Heidari
Keyword(s):  
Pain Intensity ◽  
Arteriovenous Fistula ◽  
Rating Scale ◽  
Control Method ◽  
Numerical Rating Scale ◽  
Simple Random Sampling ◽  
Hemodialysis Patients ◽  
Numerical Rating ◽  
Rating Scale Data ◽  
Frequent Hemodialysis

Background: Pain and stress of hemodialysis are experienced by more than 50% of patients who are suffering from renal disease; hence decreasing a part of these adverse effects can be effective on individual’s long term coping with hemodialysis. The current study was done to determine the effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients.Methods: This clinical trial was conducted on 31 hemodialysis patients in 2014. The patients were selected by simple random sampling method and placed in one group. First, the pain intensity of all patients was measured in the six frequent hemodialysis sessions without any intervention (control method). After two weeks, the intervention of warm footbath with vibration was done on all patients and the pain intensity was measured for six frequent hemodialysis sessions (intervention method). The patients were received 40±2 °C footbath with vibration by foot massage spa machine for ten minutes; then, fistula needles were placed and the pain intensity was assessed by using a numerical rating scale. Data were analyzed by ANOVA and T test.Results: The study group had contained 20 males (64.5%), 11 females (35.5%), with an average age of 44.16±14.85 and a range of 18 to 65 years old, which shows that the pain intensity of the warm footbath with vibration method was lower than the control method (P< 0.05).Conclusions: Warm footbath with vibration can be used as an effective palliative method to reduce pain of hemodialysis patients.

scholarly journals The antistress effect of Xenon in subnarcotic concentrations in children with severe injuries

2020 ◽  
Vol 24 (4) ◽  
pp. 249-255
Author(s):  
Vladimir G. Bagaev ◽  
V. A. Mitish ◽  
T. C. Sabinina ◽  
O. C. Melnichuk ◽  
P. V. Medinsky ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Rating Scale ◽  
Acute Stress ◽  
Numerical Rating Scale ◽  
Terrorist Attack ◽  
Stress Hormones ◽  
Pain Syndrome ◽  
Stress Effect ◽  
Drug Induced ◽  
Severe Injuries

Introduction. In the present trial, the authors studied anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe traumas. Purpose. To study anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe injuries. Material and methods. 10 children, aged 13 ± 3 years, with severe trauma were taken into the study: 6 girls with mine-explosive injuries ( a terrorist attack in Kerch in 2018), 3 boys with multiple dog bites and one patient after a traffic accident. To treat them, 20-30% Xe with O2 was used. A session lasted for 20 minutes; the course included from 5 to 12 sessions. Device KTK-01 (LLC “KseMed”, Russia) was used. Pain intensity was assessed with the numerical rating scale (NRS) , sedative effect - with BIS index and Ramsey sedation scale. Patients’ blood was also examined for the level of somatotropic hormone (STH), cortisol (Co) and insulin. Results. Indications for Xe therapy in children were: persistent pain syndrome (PS) and acute stress disorder (ASD). Patients fell asleep (drug-induced sleep) under 20-30% Xe concentration in the respiratory mixture. The average values of BIS index decreased from 95.5 ± 2.5 U to 86.5 ± 5.0 U (p <0.05), and of Ramsay scale - from 5.5 ± 0.5 to 2.7 ± 1.2 points (p <0.05). Pain intensity by NRS decreased from 4.1 ± 1.8 to 1.1 ± 0.4 points (p <0.05). The level of stress hormones during Xe session went down: STH- from 4.8 ± 0.9 ng / ml to 1.9 ± 0.5 ng / ml (p <0.001); Ko - from 375.5 ± 23.6 nmol / L to 303.2 ± 20.7 nmol / L (p <0.0001); insulin - from 19.9 ± 3.6 pmol / L to 11.7 ± 2.7 pmol / L (p <0.001). To restore sleep, 2 - 3 sessions were needed; to relief PS - 5 sessions, to refuse of painkillers in phantom pains - 12 sessions. Conclusion. 20-30% Xe with oxygen therapy has a pronounced analgesic, sedative and anti-stress effect in children with severe injuries.

scholarly journals Traditional Acupuncture and Laser Acupuncture in Chronic Nonspecific Neck Pain: Study Protocol for a Randomized Controlled Trial

2021 ◽  
Author(s):  
RAFAELA PERON ◽  
Érika Patrícia Rampazo ◽  
Richard Eloin Liebano
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Acupuncture Treatment ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Pressure Pain Threshold ◽  
Pain Modulation ◽  
Laser Acupuncture ◽  
Acupuncture Points

Abstract Background: Nonspecific neck pain is a multifactorial and very common condition in adult individuals. No reports were found in the literature comparing the effectiveness of Traditional Acupuncture (TA) and Laser Acupuncture (LA) in cases of chronic nonspecific neck pain. Therefore, the aim of the present study is to investigate the effectiveness of TA and LA therapies in individuals with chronic nonspecific neck pain.Methods/design: This study will be a controlled and randomized clinical trial. A total of 60 individuals will be randomized into two groups (30 each). The TA group will receive the acupuncture treatment using needles, while the LA group will receive the laser acupuncture treatment. The acupuncture points (Tianzhu, Fengchi, Jianjing, and Jianzhongshu) will be stimulated bilaterally with needles or laser. The primary outcome will be pain intensity, determined using the numerical rating scale. The secondary outcomes will be pressure pain threshold, temporal summation of pain, conditioned pain modulation, use of analgesic drugs after treatment, and the global perceived effect scale. The assessments will be performed immediately before and after treatment. At the follow-up, 1 months after the end of the treatments, evaluation will be made of the pain intensity and the global perceived effect. Statistical analysis of the data obtained will consider a significance level of p < 0.05.Discussion: This study will provide evidence concerning the effects of LA treatment, in comparison to TA, leading to benefits for individuals suffering from chronic nonspecific neck pain.Trial registration: RBR-7vbw5gd (Brazilian Registry of Clinical Trials - ​ReBEC)

What is the clinical relevance of the Numerical rating scale for pain?

2018 ◽  
Author(s):  
Felicia Cox
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Clinical Importance ◽  
Patient Global Impression ◽  
Numerical Rating ◽  
Group A ◽  
Clinically Significant ◽  
Global Impression Of Change

The landmark paper discussed in this chapter is ‘Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale’, published by Farrar et al. in 2001. The numerical rating scale is now the standard instrument used in chronic pain studies to measure pain intensity. Farrar et al. determined the changes in pain intensity that were clinically significant for studies of chronic pain while measuring the patient’s global impression of change. The paper used pooled data from ten recent studies of pregabalin in 2,724 subjects. The authors reported a consistent relationship between pain intensity and patient global impression of change, regardless of study, disease type, age, sex, study result, or treatment group. A reduction of approximately two points on the numerical rating scale, or of 30% in the global impression of change of pain intensity, represented a clinically important difference.

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