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Rationale: Cervical radiculopathy is initially typically managed conservatively. Surgery is indicated when conservative management fails or with severe/progressive neurological signs. Personalised multimodal physiotherapy could be a promising conservative strategy. However, aggregated evidence on the (cost‐)effectiveness of personalised multimodal physiotherapy compared to surgery with/without post‐operative physiotherapy is lacking. Aim/Objectives: To systematically summarise the literature on the (cost‐)effectiveness of personalised multimodal physiotherapy compared to surgery with or without post‐operative physiotherapy in patients with cervical radiculopathy. Methods: PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched from inception to 1st of March 2023. Primary outcomes were effectiveness regarding costs, arm pain intensity and disability. Neck pain intensity, perceived recovery, quality of life, neurological symptoms, range‐of‐motion, return‐to‐work, medication use, (re)surgeries and adverse events were considered secondary outcomes. Randomised clinical trials comparing personalised multimodal physiotherapy versus surgical approaches with/without post‐operative physiotherapy were included. Two independent reviewers performed study selection, data‐extraction, and risk of bias assessment using the Cochrane RoB 2 and Consolidated Health Economic Evaluation Reporting Standards statement. Certainty of the evidence was determined using Grading of Recommendations, Assessment, Development and Evaluations. Results: From 2109 records, eight papers from two original trials, with 117 participants in total were included. Low certainty evidence showed there were no significant differences on arm pain intensity and disability, except for the subscale 'heavy work' related disability (12 months) and disability at 5–8 years. Cost‐effectiveness was not assessed. There was low certainty evidence that physiotherapy improved significantly less on neck pain intensity, sensory loss and perceived recovery compared to surgery with/without physiotherapy. Low certainty evidence showed there were no significant differences on numbness, range of motion, medication use, and quality of life. No adverse events were reported. Conclusion: Considering the clinical importance of accurate management recommendations and the current low level of certainty, high‐quality cost‐effectiveness studies are needed. [ABSTRACT FROM AUTHOR]

Aim: To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia. Design: This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021. Methods: Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model. Results: A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified. Conclusion: Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real‐time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision‐making in clinical practice. Impact: Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence‐based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations. Reporting Method: The study adheres to the CONSORT reporting guidelines. Patient or Public Contribution: One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance. Trial Registration: Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820). [ABSTRACT FROM AUTHOR]

In virtual reality, avatar embodiment can spur perceptions and behaviours related the avatars' characteristics. We tested whether embodying superhero-like avatars can change self-perceptions in people with chronic low back pain (CLBP). A non-blinded pilot randomized controlled trial. Participants were randomly allocated to embody a superhero (VR-SH, n = 20) or a neutral, non-superhero (VR-Play, n = 10) avatar. Primary outcomes related to body image (e.g., self-perceived vulnerability) and pain intensity were assessed at baseline, during exposure, immediately after and at one-week follow-up. Fear of movement, strength and patient impression of change were also recorded. The VR-SH group reported gains in body image during (p <.001, η p 2 =0.71) and immediately after (p <.001, η p 2 =0.66) VR, whereas the VR-Play group reported small gains during VR (p =.021, η p 2 =0.46) but not immediately after (p =.076, η p 2 =0.31). Pain, strength and fear of movement did not change and there were no sustained effects at follow-up (all ps >.05). A greater proportion of people in the VR-SH group reported at least minimal improvement at follow-up (7/20 vs. 1/10). A VR-SH session produced temporary positive effects on body image. Future research may consider whether larger and sustained effects can be obtained with multisession exposures or explore combined interventions. Physical confidence and bodily trust can be significantly enhanced in people with chronic back pain using virtual reality. These positive body image effects may have implications for rehabilitation, such as in enhancing confidence with movement Whether a multisession intervention might produce more robust effects and changes in pain is yet to be determined [ABSTRACT FROM AUTHOR]

BackgroundMobile eHealth apps are important tools in personal health care management. The Patient Journey app was developed to inform patients with musculoskeletal disorders during their perioperative period. The app contains timely information, video exercises, and functional tasks. Although the Patient Journey app and other health apps are widely used, little research is available on how patients appreciate these apps. ObjectiveThe primary aim of this study was to evaluate the user-friendliness of the Patient Journey app in terms of its usability and the attitudes of users toward the app. The secondary aim was to evaluate positive and negative user experiences. MethodsA web-based questionnaire was sent to 2114 patients scheduled for surgery for a musculoskeletal disorder. Primary outcomes were usability (measured with the System Usability Scale) and user attitudes regarding the Patient Journey app (assessed with the second part of the eHealth Impact Questionnaire). The secondary outcomes were evaluated with multiple choice questions and open-ended questions, which were analyzed via inductive thematic content analyses. ResultsOf the 940 patients who responded, 526 used the Patient Journey app. The usability of the app was high (System Usability Scale: median 85.0, IQR 72.5-92.5), and users had a positive attitude toward the Information and Presentation provided via the app (eHealth Impact Questionnaire: median 78.0, IQR 68.8-84.4). The app did not adequately improve the users’ confidence in discussing health with others (eHealth Impact Questionnaire: median 63.9, IQR 50.0-75.0) or motivation to manage health (eHealth Impact Questionnaire: median 61.1, IQR 55.6-72.2). Three core themes emerged regarding positive and negative user experiences: (1) content and information, (2) expectations and experiences, and (3) technical performance. Users experienced timely information and instructions positively and found that the app prepared and guided them optimally through the perioperative period. Negative user experiences were overly optimistic information, scarcely presented information about pain (medication), lack of reference data, insufficient information regarding clinical course deviations and complications, and lack of interaction with clinicians. ConclusionsThe Patient Journey app is a usable, informative, and presentable tool to inform patients with musculoskeletal disorders during their perioperative period. The qualitative analyses identified aspects that can further improve the user experiences of the app.