54 research outputs found
Unravelling the role of and the interrelation between somatosensory function and metabolic factors in chronic (postsurgical) OA pain
No full textAbstract: Chronic musculoskeletal pain (CMP) and knee osteoarthritis (OA) are highly prevalent and expected to increase in the future. Knee OA is the most common degenerative joint disease globally, causing significant pain, functional limitations, and disability. The pathological mechanisms underlying knee OA are complex, involving mechanical, inflammatory, and metabolic factors. Treatment mainly focuses on symptom reduction and when conservative treatments have been unsuccessful, total knee arthroplasty (TKA) is recommended. Despite good outcomes for many patients, 10-34% of patients still experience chronic pain after surgery. Possibly contributing to this chronic (postoperative) pain are metabolic conditions such as obesity and diabetes, along with altered somatosensory functioning. These conditions are associated with low-grade inflammation and may be interrelated due to this mutual link. Therefore, the overall aim of this doctoral thesis was to unravel the role and interrelation of somatosensory functioning and metabolic factors in chronic (postsurgical) OA pain. Chapter I provides a general introduction to the topic. Chapters II to V present the findings of four research studies, and Chapter VI concludes with a general discussion. Currently, there is a lack of comprehensive understanding of how metabolic disorders like obesity and diabetes affect CMP in general. Such insights are crucial for developing tailored management and treatment strategies for individuals with CMP. Therefore, Chapter II presents the results of a retrospective analysis of a longitudinal population-based research project. The aims of this study were: (a) to examine the association between metabolic factors and CMP, (b) to determine if baseline metabolic variables are predictive of CMP presence 10 years later, and (c) to investigate the association and progression of metabolic factors across various pain trajectory groups. Chapter III delves into CMP in patients with knee OA and explores the potential connections between obesity, diabetes, and altered somatosensory functioning through a cross-sectional analysis of patients awaiting their first TKA in a large multicentre prospective cohort study. If all recommended conservative treatments for knee OA have been unsuccessful, TKA is advised. Despite generally good outcomes, between 10-34% of patients still experience chronic pain post-TKA. Chapter IV describes the findings of a systematic review about metabolic factors and inflammatory markers that predict outcomes (pain, function, quality of life, and patient satisfaction) one year after TKA. Chapter V presents the results of the multicentre, longitudinal prospective study that aimed to identify preoperative predictors for pain one-year post-TKA and the change in pain from pre- to post-TKA in patients with knee OA
Do lumbar stabilising exercises reduce pain and disability in patients with recurrent low back pain?
No full textQuestionDoes a graded exercise program emphasising lumbar stabilising exercises reduce pain and disability at 12 months, compared with a walking program, for patients with recurrent low back pain?DesignRandomised controlled trial.SettingA single private physiotherapy clinic in Sweden.Participants71 patients with recurrent mechanical low back pain (> 8 weeks duration, with at least 1 pain-free period during the past year) and without leg pain were allocated to one of two groups, using a concealed allocation process. The groups were comparable at baseline with respect to age, sex, proportion of participants who had sought care for back pain, and pain duration (approximately 10 years).InterventionsThe graded exercise program and the walking program were both 8 weeks’ duration. The exercise program was individually supervised by a physiotherapist weekly for 45 minutes. In the walking program, patients met with a physiotherapist for 45 minutes in week 1 and again in week 8. The exercise program consisted primarily of stabilising exercises for the lumbar spine, commencing with re-learning activation of the transversus abdominis and multifidus muscles, with assistance of a pressure biofeedfack cuff. Exercises were progressed according to clinical judgement, pain levels, and movement control and quality. Progression entailed incorporation of muscle activation in upright positions and during functional activities. Continued implementation of the exercises in daily life was encouraged. The reference group were instructed to walk for 30 minutes daily at the fastest pace that did not aggravate pain. Walking compliance was monitored with a self-completed daily diary.OutcomesThe primary outcomes were perceived pain and disability at 12 months, measured by self-completed questionnaires returned by post. Disability was measured with the Oswestry Disability Questionnaire (scale 0–100, where 100 = maximum disability). Pain was measured with 100-mm visual analogue scale (where 100 = worst pain imaginable).ResultsAt 12 months 86% of patients were followed up. At this time there was no clinically-important difference between the groups with respect to median (IQR) change in pain: exercise group –12 (–34 to –3); walking group –12 (–22 to 0). For disability at 12 months, the between-group difference in median scores was 8 on the Oswestry score: exercise group –10 (–20 to –2); walking group –2 (–12 to 2).ConclusionLumbar stabilising exercises appear to have a similar effect on pain and disability for patients with recurrent low back pain as a daily walking program
Heterogeneity in individuals with knee osteoarthritis awaiting total knee arthroplasty and its impact on outcome from a biopsychosocial perspective
No full textAbstract: Knee osteoarthritis (KOA) is considered one of the most important chronic musculoskeletal pain conditions in the world, due to its common prevalence and its expected increase in numbers attributed to the global trends in ageing and obesity rates. In previous decades, KOA has transitioned from a \u2018cartilage focused\u2019 to a \u2018whole-joint focused\u2019 condition, but recent evidence confirms that even a broader \u2018whole person focused\u2019 approach is needed to understand the complexity of KOA. Indeed, the development and cause of KOA are multifactorial and heterogenous, resulting in very divergent clinical presentations and treatment responses of individuals with KOA. Therefore, this \u2018whole person\u2019 approach is currently recommended for the assessment and treatment of individuals with KOA, integrating all aspects of the entire biopsychosocial model. In addition, it is particularly crucial to focus on the individual's pain experience, as this is the primary symptom of KOA and must also be addressed from a biopsychosocial perspective. Consequently, the main aim of this dissertation was to gain better insight in the heterogeneity in individuals with KOA, especially those awaiting total knee arthroplasty (TKA), and to investigate its impact on treatment outcome from a biopsychosocial perspective. To contribute to this knowledge, the dissertation was divided into three parts. Part 1 comprises Chapters 2, 3, and 5 on data of 223 individuals with KOA undergoing TKA from a large multicentre prospective cohort study in four hospitals in Belgium and the Netherlands, and Chapter 4, a systematic review on the evolution of somatosensory functioning after nociceptive targeted surgery in individuals with musculoskeletal disorders. Part 2 includes Chapter 6 on data of the same large multicentre prospective cohort study in four hospitals in Belgium and the Netherlands, and Chapter 7 on data of 599 individuals with osteoarthritis (not restricted to KOA) undergoing interdisciplinary multimodal pain treatment (IMPT) from another large multicentre prospective longitudinal cohort study in six clinics in rehabilitation centres in the Netherlands. Finally, Part 3 comprises Chapters 8, a systematic review on stratified versus non-stratified prehabilitation and their long-term treatment effects in individuals with KOA undergoing TKA
Psychometric Evaluation of 2 New Upper Extremity Functional Strength Tests in Children With Cerebral Palsy
Get PDFBackground For children with unilateral spastic cerebral palsy (USCP), reduced muscle strength can lead to activity limitations. However, none of the existing measures of upper extremity strength measure strength in the context of functional activities in which strength must be maintained for several seconds. Objective The objective of this study was to evaluate the psychometric properties of 2 newly developed functional hand and upper extremity muscle-strength tests (Cup-Task and Box-Task) in children aged 7 to 12 years with USCP. Design A longitudinal study design was used. Methods A standardized protocol with detailed descriptions of all procedures and measurements was used to determine test-retest reliability, interrater reliability, and criterion validity. Results A total of 86 children (53 males, 33 females, mean age=9.3 years) with USCP participated in this study, with a subset performing each measurement. Only the results of children who were able to perform the measurement were included for analysis. Excellent test-retest reliability (intraclass correlation coefficients = 0.887-0.944; 95% confidence intervals = 0.713-0.969) and interrater reliability (intraclass correlation coefficients = 0.896-0.960; 95% confidence intervals = 0.813-0.980) were observed. The Cup-Task Affected-Hand and Box-Task were moderately correlated with maximum isometric grip strength. The Cup-Task Nonaffected-Hand had a low correlation with maximum isometric grip strength. Limitations Age, sex, and manual ability were not normally distributed, which could have influenced the results. Conclusions For children with USCP who can perform the tasks, the Cup-Task and Box-Task are reliable and valid instruments for measuring functional upper extremity muscle strength
Are contextual factors associated with activities and participation after total hip arthroplasty? A systematic review
Get PDFAbstract: Objectives After total hip arthroplasty (THA), over 30% of individuals report activity limitations and participation restrictions. This systematic review aimed to determine the association between contextual factors and outcomes in the activity and participation domain after THA for hip osteoarthritis (OA). Methods This systematic review was developed according to the PRISMA guidelines for systematic reviews. PubMed, Web of Science, Embase and Scopus were searched until August 2022. Risk of bias was assessed with the Quality in Prognosis Studies tool (QUIPS). Results Twenty-nine articles were included. Eighteen had a high risk of bias, 3 had a low risk of bias, and 8 had a moderate risk of bias. Anxiety was only investigated in studies with high risk of bias but showed a consistent negative association with activities and participation after THA across multiple studies. Evidence was inconsistent regarding the associations between depression, trait anxiety, sense of coherence, big 5 personality traits, educational level, marital status, employment status, job position, expectations and social support, and the activity and participation domain. Optimism, general self-efficacy, cognitive appraisal processes, illness perception, ethnicity, and positive life events were associated with activities and participation but were only investigated in 1 study. No associations were identified across multiple studies for living or smoking status. Control beliefs, kinesiophobia, race, discharge location, level of poverty in neighbourhood, negative life events and occupational factors, were not associated with the activity and participation domain but were only investigated in 1 study. Conclusion Methodological quality of the included studies was low. Anxiety was the only factor consistently associated with worse outcomes in the activity and participation domain after THA but was only investigated in studies with high risk of bias. Further research is needed to confirm relationships between other contextual factors and activities and participation after THA
Physical activity, participation and health-related quality of life in chronic fatigue syndrome and multiple osteochondromas
No full textAbstract: Chronic fatigue and pain are prevalent symptoms in the adult general population (approximately >20%), debilitating in nature and often co-occurring in various chronic conditions. Both symptoms have been found to negatively affect health-related quality of life (HRQOL), one of the primary outcomes of healthcare and rehabilitation. HRQOL is seen as a comprehensive concept that can be influenced by biological factors, such as fatigue and pain, psychological as well as social factors. Despite the established high prevalence and negative effects of fatigue, it is not always taken into account in clinical research on chronic pain, and its importance is frequently overlooked in clinical practice. This thesis is therefore interested in the impact of chronic fatigue in patients who also experience chronic pain. Fatigue is proposed as a transdiagnostic rather than a disease-specific symptom. To explore this hypothesis, two distinct patient populations experiencing chronic fatigue and pain were included in this doctoral thesis, patients with chronic fatigue syndrome (CFS) and patients with multiple osteochondromas (MO). Because HRQOL is an important health care outcome, this doctoral thesis is centered around the exploration of disease-specific and transdiagnostic bio-, psycho-, social determinants of HRQOL in patients with chronic fatigue and pain, and specifically taking the physical activity level into account due to its established positive relationship with health in the general population. The first part (chapter 2-4) focuses on measurement instruments to evaluate activity limitations and participation restrictions, which are considered more objectively measured subitems of HRQOL, and the physical activity level and pattern in patients with CFS. The second part of this thesis (chapter 5-6) focuses on the physical activity level and HRQOL in patients with MO, and transdiagnostic and disease-specific determinants of HRQOL. The results of this thesis show that fatigue and pain are co-occurring symptoms that may not be overlooked. Patients may report significant reductions in their physical activity level, mental and physical HRQOL and several determinants negatively related herewith were identified. The thesis concludes with directions for future impact: measuring the physical activity level and HRQOL in clinical practice and related future research needs; opportunities for a preventive approach to prevent psychological symptoms, activity limitations and participation restrictions; and needs regarding the expansion of occupational therapy in primary care to provide appropriate treatment to patients with chronic fatigue and pain
A comparison of the relationship between depression, perceived disability, and physical performance in persons with chronic pain: a comment on Alschuler et al. (2008)
No full textThe Fear Avoidance Model Disentangled: Improving the Clinical Utility of the Fear Avoidance Model
Get PDFBackground: The model of fear avoidance proposes that fear of movement in back pain patients is an obstacle to recovery and leads over time to increased disability. Therefore, fear of movement should be targeted explicitly by interventions. Aims: To review the evidence (1) for the causal components proposed by the model, and (2) about interventions that attempt to reduce fear of movement. In addition, we aim to propose alternatives and extensions to the current model in order to increase the clinical utility of the model. Methods: A collaborative narrative review. Results: The fear avoidance model needs to be conceptually expanded and further tested to provide adequate and appropriate clinical utility. Currently, although there is experimental support for the model, observational studies in patients show contradictory results. Interventions based on the model have not delivered convincing results, only partly due to methodological shortcomings. Some assumptions inherent in the current model need adjusting, and other factors should be incorporated to indicate subgroupings within patients high in avoidance behavior. In addition, both theoretical and methodological limitations were identified in measurements of fear and avoidance. Conclusions: Future research should elucidate whether the proposed subgrouping of patients with avoidance behavior is helpful. Further research should focus on developing more accurate and psychometrically sound assessment tools as well as targeted interventions to improve activities and participation of patients with chronic disabling musculoskeletal pain disorders
Accelerometry measuring the outcome of robot-supported upper limb training in chronic stroke: a randomized controlled trial.
No full textThis study aims to assess the extent to which accelerometers can be used to determine the effect of robot-supported task-oriented arm-hand training, relative to task-oriented arm-hand training alone, on the actual amount of arm-hand use of chronic stroke patients in their home situation.This single-blind randomized controlled trial included 16 chronic stroke patients, randomly allocated using blocked randomization (n = 2) to receive task-oriented robot-supported arm-hand training or task-oriented (unsupported) arm-hand training. Training lasted 8 weeks, 4 times/week, 2 × 30 min/day using the (T-)TOAT ((Technology-supported)-Task-Oriented-Arm-Training) method. The actual amount of arm-hand use, was assessed at baseline, after 8 weeks training and 6 months after training cessation. Duration of use and intensity of use of the affected arm-hand during unimanual and bimanual activities were calculated.Duration and intensity of use of the affected arm-hand did not change significantly during and after training, with or without robot-support (i.e. duration of use of unimanual use of the affected arm-hand: median difference of -0.17% in the robot-group and -0.08% in the control group between baseline and after training cessation; intensity of the affected arm-hand: median difference of 3.95% in the robot-group and 3.32% in the control group between baseline and after training cessation). No significant between-group differences were found.Accelerometer data did not show significant changes in actual amount of arm-hand use after task-oriented training, with or without robot-support. Next to the amount of use, discrimination between activities performed and information about quality of use of the affected arm-hand are essential to determine actual arm-hand performance.Controlled-trials.com ISRCTN82787126
Personal influencing factors for pressure pain threshold in healthy people: A systematic review and meta-analysis
Get PDFAll studies that investigated personal factors influencing pressure pain threshold (PPT) in healthy people were synthesized. Data was summarized, and risk of bias (RoB) and level of evidence were determined. Results were pooled per influencing factor, grouped by body region and included in meta-analyses. Fifty-four studies were eligible. Five had low, nine moderate, and 40 high RoB. Following meta-analyses, a strong conclusion was found for the influence of scapular position, a moderate for the influence of gender, and a weak for the influence of age (shoulder/arm region) and blood pressure on PPT. In addition, body mass index, gender (leg region), alcohol consumption and pain vigilance may not influence PPT. Based on qualitative summary, depression and meno-pause may not influence PPT. For other variables there was only preliminary or conflicting evidence. However, caution is advised, since the majority of included studies showed a high RoB and several were not eligible to include in meta-analyses. Heterogeneity was high in the performed meta-analyses, and most conclusions were weak. More standardized research is necessary
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