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Objective: This explorative study investigates the moderating effect of sex and baseline pain characteristics on the effectiveness of preoperative pain neuroscience education (PNE) plus knee joint mobilization versus biomedical education plus knee joint mobilization in patients who have knee osteoarthritis and are scheduled to undergo total knee arthroplasty (TKA). Methods: After baseline assessment of self-reported questionnaires (pain intensity, disability, symptoms of central sensitization and pain cognitions) and quantitative sensory testing, 44 participants with knee osteoarthritis were randomized into the PNE plus knee joint mobilization or biomedical education plus knee joint mobilization group. The questionnaires were retaken directly after and 1 month after 4 sessions of treatment and at 3 months after surgery. Based on baseline quantitative sensory testing results, the sample was subdivided into a high (showing high experimental pain levels and low pressure pain thresholds) and low pain cluster using principal components analysis and cluster analysis. Therapy effects over time were evaluated using 3-way analysis of variance, with time as the within factor and treatment, sex, and baseline pain cluster as between factors. Results: Women benefited significantly more from the PNE intervention compared with the control intervention in terms of self-reported symptoms of central sensitization. For both pain clusters, differences in therapeutic effects concerning pain intensity and pain cognitions were found, with higher superiority of the PNE intervention in the high-pain cluster subgroup compared with the low-pain cluster. Conclusion: Based on these explorative analyses, it can be concluded that sex and preoperative pain measures may influence the effectiveness of preoperative PNE for some specific outcome measures in people scheduled to undergo TKA. Impact: Although further research on this topic is needed, the potential influence of sex and preoperative pain measures on the effectiveness of preoperative PNE should be considered when implementing this intervention in people undergoing TKA. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of suboccipital inhibitory techniques in people with migraine compared with a control treatment based on myofascial trigger point (MTrP) therapy and stretching. Design: A randomized, double-blind controlled pilot trial was conducted. Settings/Location: University research laboratory. Subjects: Forty-six adults diagnosed with migraine with over 6 months duration. Interventions: Participants were randomized to receive either combined MTrP therapy and stretching (control group) or the control treatment plus suboccipital soft tissue inhibition (experimental group). Treatment was applied on four occasions over 8 weeks (one every 15 days), with a duration of 30 minutes per session in the experimental group and 20 min in the control group. Outcome measures: The impact of headache was assessed with the Headache Impact Test (HIT-6), disability by the migraine disability assessment (MIDAS), and quality of life by the Short Form Health Survey (SF-36). Both groups were assessed at baseline and 1 week immediately after the end of treatment. Results: The amount of change of the HIT-6 score and MIDAS scores were significantly different between groups (p < 0.05), although the SF-36 scores were not. The change in the HIT-6 score and MIDAS scores was greater in the experimental group. Both groups showed a reduction on the HIT-6 score (p < 0.001), MIDAS scores (p < 0.05), and SF-36 physical subscale, whereas the SF-36 mental subscale improved only in the experimental group (p < 0.001). Conclusion: Soft tissue techniques based on MTrP therapy and stretching were helpful for improving certain aspects of migraine, such as the impact and disability caused by the headache, and the frequency and intensity of headache; however, when combined with suboccipital soft tissue inhibition, the treatment effect was larger. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Longitudinal clinimetric study. BACKGROUND: Pain self-efficacy predicts poor recovery and mediates the relationship between pain and disability in patients with neck pain disorders (NPDs). The Pain Self-Efficacy Questionnaire (PSEQ) is a frequently used instrument to measure pain self-efficacy; however, its measurement properties have never been evaluated in a group of patients with NPDs. OBJECTIVES: This study aimed to assess validity and responsiveness of the PSEQ in patients with NPDs. METHODS: Patients with NPDs (n = 161) were included. Confirmatory and exploratory factor analysis was used to assess structural validity. Twelve hypotheses on expected correlations with other instruments were formulated a priori to assess construct validity. Responsiveness was evaluated in 146 patients with NPDs who underwent multimodal rehabilitation by testing 12 hypotheses on expected effect sizes, area under the curve, and correlations with change in other instruments. RESULTS: Factor analyses showed that the PSEQ is a unidimensional instrument with moderate construct validity and responsiveness (50% to 75% of hypotheses met). Validity was consistent when analyzed separately for patients with whiplash-associated disorders and idiopathic neck pain, and responsiveness was better in patients with idiopathic neck pain. CONCLUSION: The PSEQ is a unidimensional measure of pain self-efficacy in patients with NPDs, as found by previous studies in other populations. Nevertheless, in contrast with previous studies, its construct validity and responsiveness were found to be suboptimal in NPDs, suggesting that the content validity of the PSEQ and of the comparator instruments used in this study should be better assessed. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Controlled laboratory study, case-control design. OBJECTIVE: To evaluate spine kinematics and gait characteristics in people with nonspecific chronic neck pain. BACKGROUND: People with chronic neck pain present with a number of sensorimotor and biomechanical alterations, yet little is known about the influence of neck pain on gait and motions of the spine during gait. METHODS: People with chronic nonspecific neck pain and age- and sex-matched asymptomatic controls walked on a treadmill at 3 different speeds (self-selected, 3 km/h, and 5 km/h), either with their head in a neutral position or rotated 30°. Tridimensional motion capture was employed to quantify body kinematics. Neck and trunk rotations were derived from the difference between the transverse plane component of the head and thorax and thorax and pelvis angles to provide an indication of neck and trunk rotation during gait. RESULTS: Overall, the patient group showed shorter stride length compared to the control group (P<.001). Moreover, the patients with neck pain showed smaller trunk rotations (P<.001), regardless of the condition or speed. The difference in the amount of trunk rotation between groups became larger for the conditions of walking with the head rotated. CONCLUSION: People with chronic neck pain walk with reduced trunk rotation, especially when challenged by walking with their head positioned in rotation. Reduced rotation of the trunk during gait may have long-term consequences on spinal health. [ABSTRACT FROM AUTHOR]

Background. Expanded distribution of pain is considered a sign of central sensitization (CS). The relationship between recording of symptoms and CS in people with knee osteoarthritis (OA) has been poorly investigated. Objective. The aim of this study was to examine whether the area of pain assessed using pain drawings relates to CS and clinical symptoms in people with knee OA. Design. This was a cross-sectional study. Methods. Fifty-three people with knee OA scheduled to undergo primary total knee arthroplasty were studied. All participants completed pain drawings using a novel digital device, completed self-administration questionnaires, and were assessed by quantitative sensory testing. Pain frequency maps were generated separately for women and men. Spearman correlation coefficients were computed to reveal possible correlations between the area of pain and quantitative sensory testing and clinical symptoms. Results. Pain frequency maps revealed enlarged areas of pain, especially in women. Enlarged areas of pain were associated with higher knee pain severity (rs=.325, P<.05) and stiffness (rs=.341, P<.05), lower pressure pain thresholds at the knee (rs= -.306, P<.05) and epicondyle (rs=-.308, P<05), and higher scores with the Central Sensitization Inventory (rs=.456, P<.01). No significant associations were observed between the area of pain and the remaining clinical symptoms and measures of CS. Limitations. Firm conclusions about the predictive role of pain drawings cannot be drawn. Further evaluation of the reliability and validity of pain area extracted from pain drawings in people with knee OA is needed. Conclusion. Expanded distribution of pain was correlated with some measures of CS in individuals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is needed. [ABSTRACT FROM AUTHOR]

Background. Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. Objective. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. Design. A multicenter randomized controlled trial was conducted. Setting. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. Patients. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. Intervention. A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used. Outcome Measures. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. Results. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval = -0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. Limitations. The nature of the exercise intervention did not allow blinding of patients and care providers. Conclusion. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care. [ABSTRACT FROM AUTHOR]