Search

Chronic low back pain (CLBP) is a disabling condition worldwide. In CLBP, neuroimaging studies demonstrate abnormal activities in cortical areas responsible for pain modulation, emotional, and sensory components of pain experience [i.e., pregenual and dorsal anterior cingulate cortex (pgACC, dACC), and somatosensory cortex (SSC), respectively]. This pilot study, conducted in a university setting, evaluated the feasibility, safety, and acceptability of a novel electroencephalography-based infraslow-neurofeedback (EEG ISF-NF) technique for retraining activities in pgACC, dACC and SSC and explored its effects on pain and disability. Participants with CLBP (n = 60), recruited between July'20 to March'21, received 12 sessions of either: ISF-NF targeting pgACC, dACC + SSC, a ratio of pgACC*2/dACC + SSC, or Placebo-NF. Descriptive statistics demonstrated that ISF-NF training is feasible [recruitment rate (7 participants/month), dropouts (25%; 20–27%), and adherence (80%; 73–88%)], safe (no adverse events reported), and was moderate to highly acceptable [Mean ± SD: 7.8 ± 2.0 (pgACC), 7.5 ± 2.7 (dACC + SCC), 8.2 ± 1.9 (Ratio), and 7.7 ± 1.5 (Placebo)]. ISF-NF targeting pgACC demonstrated the most favourable clinical outcomes, with a higher proportion of participants exhibiting a clinically meaningful reduction in pain severity [53%; MD (95% CI): − 1.9 (− 2.7, − 1.0)], interference [80%; MD (95% CI): − 2.3 (− 3.5, − 1.2)], and disability [73%; MD (95% CI): − 4.5 (− 6.1, − 2.9)] at 1-month follow-up. ISF-NF training is a feasible, safe, and an acceptable treatment approach for CLBP. [ABSTRACT FROM AUTHOR]

• Movement-evoked pain is a reliable measure in people with shoulder pain. • Sensitivity to movement-evoked pain index derived from the studied MEP procedure is not a reliable measure in people with shoulder pain. • Other ways of assessing sensitivity to movement-evoked pain are warranted. The number of researchers and clinicians using movement-evoked pain and sensitivity to movement-evoked pain to assess shoulder pain has increased. However, the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in people with rotator cuff-related shoulder pain (RCRSP) is still unknown. We examined the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in participants with RCRSP. Seventy-four participants with RCRSP performed five trials of active shoulder abduction to elicit pain under two experimental conditions: active shoulder abduction to the onset of pain and maximum range of motion (ROM). The primary outcome measures were pain intensity and ROM. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain was examined using intraclass correlation coefficient (ICC 3,1) and minimal detectable change (MDC 90). The reliability of movement-evoked pain under both experimental conditions was good to excellent (ICC: 0.81 to 0.95), while the reliability of sensitivity to movement-evoked pain was poor in both conditions (ICC≤0.45). The MDC 90 for pain intensity was 1.6 and 1.8 during shoulder abduction to the onset of pain and maximum ROM, respectively. The MDC 90 for ROM was 17.5° and 11.2° during shoulder abduction to the onset of pain and maximum ROM condition, respectively. This study confirms movement-evoked pain testing during active shoulder abduction to the onset of pain or maximum ROM condition is reliable to assess pain associated with movement in patients with RCRSP. The minimal detectable change score of movement-evoked pain can guide clinicians and researchers on how to interpret changes in these outcomes. [ABSTRACT FROM AUTHOR]

Background: The incidence and severity of phantom limb pain (PLP) does not differ much between the extremities of amputation. However, its impact on functional ability and quality of life in lower limb amputation may be different, as prosthetic weight bearing is a key component in the movement and functional rehabilitation of individuals with a lower limb amputation. Objective: To evaluate the evidence for effectiveness or efficacy of non-pharmacological interventions in the management of PLP in adults with lower limb amputation. Methods: A comprehensive literature search conducted on 11 electronic databases, from their inception to 25 March 2016 identified 626 potentially relevant articles. Full-text randomised controlled trials in English which examined any form of non-pharmacologic intervention for managing PLP in lower limb amputees were included. The data with regard to characteristics of the studies, participants, intervention and outcome measures and overall statistical result were extracted. The Cochrane ‘Risk of bias assessment tool’ was used to assess the bias of all included articles. Results: Four studies met the final criteria to be included in the review. Four treatment techniques had been used in the treatment of 204 patients with lower limb amputation. Two trials showed a positive impact of intervention on PLP compared to control group. Risk of bias varied across studies, and only one included study was assessed as having a low risk of bias. Conclusion: The review identified lack of evidence to support non-pharmacological interventions in the management of PLP. Adequately powered high-quality trials are needed in this area to inform rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: To determine whether manual therapy or exercise therapy or both is beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life. Methods: Databases such as Medline, AMED, EMBASE, CINAHL, SPORTSDiscus, PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database, and SCOPUS were searched from their inception till September 2015. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures (pain, physical function and quality of life) were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for assessing the quality of the body of evidence for each outcome of interest. Results: Seven trials (886 participants) that met the inclusion criteria were included in the meta-analysis. There was high quality evidence that exercise therapy was beneficial at post-treatment (pain-SMD-0.27,95%CI-0.5to-0.04;physical function-SMD-0.29,95%CI-0.47to-0.11) and follow-up (pain-SMD-0.24,95%CI- 0.41to-0.06; physical function-SMD-0.33,95%CI-0.5to-0.15). There was low quality evidence that manual therapy was beneficial at post-treatment (pain-SMD-0.71,95%CI-1.08to-0.33; physical function-SMD-0.71,95%CI-1.08to-0.33) and follow-up (pain-SMD-0.43,95%CI-0.8to-0.06; physical function-SMD-0.47,95%CI-0.84to-0.1). Low quality evidence indicated that combined treatment was beneficial at post-treatment (pain-SMD-0.43,95%CI-0.78to-0.08; physical function-SMD-0.38,95%CI-0.73to-0.04) but not at follow-up (pain-SMD0.25,95%CI-0.35to0.84; physical function-SMD0.09,95%CI-0.5to0.68). There was no effect of any interventions on quality of life. Conclusion: An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis. The observed magnitude of the treatment effect would be considered small to moderate. [ABSTRACT FROM AUTHOR]

De novo mass spectrometric sequencing of two Conus peptides, Vi1359 and Vi1361, from the vermivorous cone snail Conus virgo, found off the southern Indian coast, is presented. The peptides, whose masses differ only by 2 Da, possess two disulfide bonds and an amidated C-terminus. Simple chemical modifications and enzymatic cleavage coupled with matrix assisted laser desorption ionization (MALDI) mass spectrometric analysis aided in establishing the sequences of Vi1359, ZCCITIPECCRI-NH2, and Vi1361, ZCCPTMPECCRI-NH2, which differ only at residues 4 and 6 (Z = pyroglutamic acid). The presence of the pyroglutamyl residue at the N-terminus was unambiguously identified by chemical hydrolysis of the cyclic amide, followed by esterification. The presence of Ile residues in both the peptides was confirmed from high-energy collision induced dissociation (CID) studies, using the observation of wn- and dn-ions as a diagnostic. Differential cysteine labeling, in conjunction with MALDI-MS/MS, permitted establishment of disulfide connectivity in both peptides as Cys2-Cys9 and Cys3-Cys10. The cysteine pattern clearly reveals that the peptides belong to the class of T-superfamily conotoxins, in particular the T-1 superfamily. [Copyright &y& Elsevier]

Stroke can cause lifelong disability and participatory limitations. Stroke survivors thus manage their recovery long term. Health professionals can support self-management, tailoring this support to be culturally appropriate. This study explored the unique culture and ethnicity specific experiences of Indian people living in New Zealand with stroke, focussing on self-management and facilitators and challenges to recovery. Eight individuals with stroke took part in semi-structured interviews. Data were analysed using the General Inductive Approach. Four themes were identified: (1) helping myself, in any way that I can, (2) family and support, (3) social connections, and (4) ethnicity was not a barrier. All participants felt well looked after within the New Zealand healthcare context but highlighted the need for long term support. Self-management strategies participants considered important included changes to their diet, acceptance by oneself and society, returning to work, the role of family, and the use of technology and social media. Health professionals should consider these factors when providing self-management support to individuals of Indian ethnicity. Advice and help around diet, lifestyle, and return to work were important priorities identified by our Indian stroke survivor participants. Our Indian stroke survivor participants requested more long-term specialist support and stroke information. Although the family willingly take increased responsibility for the wellbeing of the individual with stroke, it is not a substitute for professional input which needs to be tailored and offered proactively. [ABSTRACT FROM AUTHOR]

Background: Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence. Methods: Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972–73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains – suicidality, substance misuse, sleep problems, and pain – were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data. Results: We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [ β = 0.23, 95% CI (0.16–0.30), p < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [ β = 0.26, 95% CI (0.19–0.33), p < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders. Conclusions: Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair. [ABSTRACT FROM AUTHOR]

Background: Chronic musculoskeletal pain (CMP), an invisible disease, is due to complex biological and psychological processing. A CMP epidemic occurs concurrently during historically high global population movement. Nationalistic geopolitical rhetoric arises, in part, in response to perceptions of increased immigration rates and healthcare policies. Limited evidence exists about the impact of the current geopolitical climate on the CMP experience amongst migrant populations. Strategies to improve inequitable CMP management in marginalized populations may include improving the clinical conversation. Effective communication is a critical part of pain management and successful interactions between patients and their healthcare providers. Aims: The primary aims are to 1) develop subgroups of self-reported pain experiences in people who have CMP and experience marginalization and 2) interpret the pain experience of marginalized populations with CMP in the context of geopolitical, historical, and societal influences. Methods: A mixed methods sequential explanatory design study will be used. The first quantitative phase will be a survey, to be completed in three languages, with questions related to pain status, patient beliefs, and perspectives on healthcare. Latent class analysis will be used to generate experience-based subgroups. Focus groups will provide nuanced descriptions of the patient experience. Discussion: Results from this study will inform the understanding of the influence of geopolitical, historical, and societal influences on CMP in people who experience marginalization. This understanding will be used to develop a framework to educate clinicians on the broader factors in the CMP experience and to consider steps that can mitigate inequitable CMP outcomes in marginalized populations. Marginalized patient populations may have different experiences in CMP. Societal and historical policies may influence clinical conversations and outcomes. CMP management may be impacted by the contemporary geopolitical environment. A mixed-method protocol is established to interpret patients' CMP experiences in people who may experience marginalization. [ABSTRACT FROM AUTHOR]

Background: The chronic musculoskeletal pain (CMP) epidemic occurs concurrently during historical mass population movements and significant income inequities. Epidemiological studies indicate CMP may occur disproportionately in marginalized populations. Nationalistic rhetoric has arisen, in part, due to perceived concerns over access to healthcare. Political policies directly and indirectly impact healthcare. Objectives: To explore 1) how potential historical, societal, and political factors may contribute to the clinical conversation of pain; 2) the impact ineffective clinical conversations may have on the CMP experience. Methods: Literature Review. Major Findings: CMP is an invisible disease decoupled from normal tissue healing. The clinical conversation is increasingly recognized to impact treatment outcomes. The clinician and the patient bring differing histories, values, and interpretations to clinic visits. Systemic healthcare racism, implicit biases, incongruent provider/patient assessment of pain, and provider stigmatization contribute to olgioanalgesia. As healthcare professional groups become more politically active, providers bring that political experience into the clinic. Marginalized populations, at risk for greater stress, discrimination, and fear bring their own intensified political perceptions into the clinic. We suggest that poor management and discordant clinical conversation may be adversely influenced by the current political climate. Conclusion: Identifying contributing factors to ineffective clinical conversations is important to improve CMP outcomes and to minimize inequities in CMP management. We hope to identify populations that may be more vulnerable to political biases, understand factors in the clinical conversation that are important to patients, and to build opportunities to educate providers and patients on these forces impacting the clinical conversation. [ABSTRACT FROM AUTHOR]

Background: Diabetic peripheral neuropathy (DPN) not only produces severe pain, tingling, and numbness sensation in the involved limbs, but also limits physical function due to loss of sensation. There are no recommended methods for clinical situations to measure these signs and symptoms. Studies with high methodological quality use the modified Brief Pain Inventory for Diabetic Peripheral Neuropathic pain (mBPI-DPN) scale and the short form Screening of Activity Limitations and Safety Awareness (sSALSA) scale for measuring these symptoms in DPN population. In order to capture a real change in the variables of interest, the psychometric properties of that measure should be within acceptable limits. As these two measures were not assessed for all of the psychometric properties, there was a need for further evaluation. Methods: Data were collected (n = 38 patients) in a longitudinal cohort study. Test-retest reliability (0-4 weeks) and Responsiveness- Minimal Clinically Important Difference (MCID) (0-12 weeks) were calculated between two sessions. Convergent validity was assessed (between mBPI-DPN pain interference and sSALSA scale). Results: Both measures demonstrated acceptable test-retest reliability (mBPI-DPN scale: ICC = 0.61, SEM = 12.92; the sSALSA scale: ICC = 0.81, SEM = 4.88) and convergent validity (Spearman's correlation coefficient r = 0.62). The computational methods used in different methodologies to calculate MCID for the mBPI-DPN and the sSALSA scale were varied, hence the magnitude of derived MCID scores also varied. Conclusions: Our study have provided evidence to add to the scientific basis surrounding the use of mBPI-DPN and sSALSA scales in DPN population, but standardization of these measures in a larger population is required [ABSTRACT FROM AUTHOR]

Objective: To investigate whether sensitivity to movement‐evoked pain (SMEP), central sensitivity symptom burden, and quantitative sensory testing (QST) outcomes differ between healthy controls and people with chronic shoulder pain. Methods: People with chronic shoulder pain (n = 39) and healthy controls (n = 26) completed validated questionnaires measuring demographic, pain characteristics, psychological factors, social support, sleep quality, central sensitivity inventory (CSI), and physical activity levels. A blinded assessor administered QST measuring pressure pain threshold, temporal summation, conditioned pain modulation, and cold hyperalgesia. All participants performed repeated lifting of weighted canisters and reported severity of pain over successive lifts of the weighted canisters. Between‐group differences in the QST, SMEP and CSI scores were investigated. Demographic and psychosocial variables were adjusted in the analyses. Results: Dynamic mechanical allodynia, mechanical temporal summation, movement‐evoked pain scores, SMEP index, and CSI scores were significantly (p ≤ 0.05) higher in the chronic shoulder pain group than in healthy controls. A significant proportion of people with chronic shoulder pain presented with pro‐nociceptive profiles and experienced higher pain severity, interference, and disability. Conclusions: People with chronic shoulder pain displayed symptoms and signs of central sensitization. Future research should investigate the predictive role of central sensitization on clinical outcomes in shoulder pain. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes in New Zealand is estimated to be 7% of the total population. And higher incidence rates of peripheral neuropathic pain (NeP) in diabetic populations have been estimated (between 3 and 25%). A range of outcome measures (OMs) are used to evaluate a change following an intervention, in diabetic NeP clinical trials, but very few have adequate psychometric properties (PMPs) for key dimensions. This study aims to investigate the remaining PMPs (which have not been investigated so far) of established specific pain intensity and physical functional OMs in adults (⩾18 years) with chronic diabetic NeP. Methods and analysis: This prospective longitudinal cohort study aims to recruit a total of 80 adults with diabetic NeP in Dunedin, Otago region, New Zealand, from November 2013. Outcomes include two questionnaires: Pain OM – modified brief pain inventory (mBPI)-diabetic peripheral neuropathy item scale; and physical functional OM – screening of activity limitation and safety awareness (SALSA) scale. To capture the reliability and validity of these measures two follow-up assessments (4 and 12 weeks after the baseline assessment) will be scheduled. For test–retest reliability, 'Intraclass Correlation Coefficient' (ICC), and to find out the correlation between two measures, 'Pearson correlation coefficient' will be calculated. To investigate responsiveness, 'Minimally Clinically Important Change' (MCIC) scores will be calculated. Ethics and Dissemination: Full final ethical approval from the University of Otago Human Ethics Committee has been obtained: Ethical Committee reference number H13/041. Maori Research Consultation through the Ngāi Tahu Research Committee has also been undertaken. Trial registration: The Australian New Zealand Clinical Trials. [ABSTRACT FROM AUTHOR]

The article offers information on physiotherapy student research projects during the COVID19 lockdown. Topics include School of Physiotherapy is required to demonstrate that graduates can critically appraise evidence, interpret findings and apply these to practice, as well as to measure and analyse the outcome of practice, and the principles of evidence-informed teaching and learning are threaded throughout the programme.

Shoulder pain is a common musculoskeletal complaint associated with a significant impact on health and socioeconomic outcomes. Current evidence indicates a poor understanding of the mechanisms driving shoulder pain experience. The heightened nociceptive processing (pro-nociceptive pain modulation profile) within the central nervous system could explain variability in the shoulder pain experience. This topical review and hypothesis-generating paper discuss the current evidence and gaps regarding abnormal nociceptive processing in patients with shoulder pain. This paper also proposes hypotheses to test the presence of a pro-nociceptive pain modulation profile by measuring the pain responses to conditioned pain modulation, mechanical temporal summation and movement-evoked pain procedures. Moreover, this paper proposes whether a pro-nociceptive pain modulation profile can explain the variability in the pain experience in people with shoulder pain. Gaining insights into the abnormal nociceptive processing in people with acute and chronic shoulder pain will guide future research and clinical practice to improve shoulder pain outcomes. [ABSTRACT FROM AUTHOR]

Increased symptoms related to central sensitization have previously been reported in inflammatory bowel disease (IBD) patients, identified by the original central sensitization inventory (CSI-25). However, the recently developed CSI short form (CSI-9) may be more clinically useful. The aim of the present study was to evaluate the performance of CSI-9 compared to the original CSI-25 in individuals with IBD. Study objectives were to investigate the criterion validity of the CSI-9 to the CSI-25, assess individual association of the CSI measures with clinical features of IBD and pain presentations, and to establish disease-specific CSI-9 and CSI-25 cut-off scores for discriminating the presence of self-reported pain in individuals with IBD. Cross-sectional online survey was performed on adults with IBD exploring self-reported demographics, comorbidity, and clinical IBD and pain features. Criterion validity of the CSI-9 was investigated using intraclass correlation coefficient (ICC)3,1. Area under the receiver operating characteristic curve (AUC-ROC) analysis was conducted to investigate the discriminative ability of both versions of CSI. Of the 320 participants, 260 reported the presence of abdominal and/or musculoskeletal pain. CSI-9 and CSI-25 demonstrated substantial agreement (ICC3,1=0.64, 95% CI [0.58, 0.69]). AUC (95% CI) indicated that CSI-9 (0.788 (0.725, 0.851), p<0.001) and CSI-25 (0.808 (0.750, 0.867), p<0.001) were able to adequately discriminate the presence of pain using cut-offs scores of ≥17 (CSI-9) and ≥40 (CSI-25). Abdominal pain severity was the only feature to differ in significant association to CSI-25 (p=0.002) compared to CSI-9 (p=0.236). All other features demonstrated significant associations to both CSI versions, except age (p=0.291 and 0.643) and IBD subtype (p=0.115 and 0.675). This is the first study to explore and validate the use of CSI-9 in IBD patients. Results demonstrated concurrent validity of the CSI-9 to CSI-25, with similar significant association to multiple patient features, and a suggested cut-off value of 17 on CSI-9 to screen for individuals with pain experiences. Study findings suggest that CSI-9 is suitable to use as a brief tool in IBD patients. [ABSTRACT FROM AUTHOR]

Musculoskeletal (MSK) pain is a common complaint in patients with inflammatory bowel diseases (IBD). MSK pain in IBD has previously demonstrated association with symptoms of central sensitization; however it is uncertain whether these symptoms are influenced simply by the presence of MSK pain and/or IBD. Primary aim of this study was to investigate whether symptoms of central sensitization differed across three groups: IBD patients with and without MSK pain and healthy controls. Secondary aim was to investigate between-group differences for measures of somatosensory functioning. Cross-sectional study was performed on adults with IBD. Assessments included: central sensitization inventory (CSI), pressure pain threshold, temporal summation, conditioned pain modulation, perceived stress, affect style, anxiety, depression, and pain catastrophizing. One-way analyses of variance and covariance were used to investigate between-group differences for measures of central sensitization and potential confounding by psychological factors. Study participants (n=66) were age/gender matched across three study groups. Between-group differences were solely demonstrated for CSI scores [F(2,63)=19.835, p<0.001, r=0.62], with IBD patients with MSK pain demonstrating the highest CSI scores and healthy controls the lowest. After controlling for individual psychological features, post hoc comparisons indicated that CSI scores were significantly different between-groups (p≤0.025) after controlling for most psychological variables, with the exception of perceived stress (p=0.063) and pain catastrophizing (p=0.593). IBD patients as a whole demonstrated significantly greater symptoms of central sensitization compared to healthy controls. However, IBD patients with persistent MSK pain demonstrated the greatest symptoms of central sensitization compared to patients without MSK pain and healthy controls. Between-group differences for CSI in IBD patients with MSK were not confounded by psychological features. Study results indicate that persistent MSK pain in IBD represents patients with greater central sensitization symptomology. This increased symptomology is suggestive of underlying mechanisms related to central sensitization, highlighting patient potentially at risk for worse pain experiences. [ABSTRACT FROM AUTHOR]

Objective: Alteration in somatosensory function has been linked to pain experience in individuals with joint pain. In this systematic review we aimed to establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function that were assessed via quantitative sensory testing (QST) among individuals with joint pain. Methods: A comprehensive literature search was conducted in 6 electronic databases from their inception to July 2019. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. Results: Seventeen studies related to joint pain were included. Pain catastrophizing, depression, anxiety, and physical activity level have been shown to have a significant (small to fair) association with several QST measures. Pressure pain threshold (PPT) is the only measure that was found to be consistently correlated with all the domains. The overall quality of evidence for all factors ranged from very low to moderate. Subgroup analysis revealed a stronger association for depression and pain catastrophizing and PPT and temporal pain summation in individuals with shoulder pain. Conclusion: Psychological factors and physical activity levels are associated with somatosensory function in people with joint pain. These factors need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with joint pain. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal conditions are well documented in inflammatory bowel disease (IBD). However, whether IBD activity influences musculoskeletal pain experiences is uncertain. Central sensitization has been proposed in patients with IBD who are suffering from persistent pain. Identification of central sensitization symptomology using the Central Sensitization Inventory (CSI) has been reported in many pain‐related disorders. Aims of this study were to explore predictive relationships between IBD activity and musculoskeletal pain experiences (severity/interference), and the mediating effects of the CSI. Methods: A cross‐sectional online survey was performed exploring self‐reported musculoskeletal pain in adults with IBD. Survey questionnaires included IBD activity indices, numeric rating scales, PROMIS Pain Interference, and the CSI. Linear regression was used to examine the relationship between active IBD and pain experiences. Simple and serial mediation analyses were used to explore mediation models: independent variable (IBD activity), dependent variables (severity/interference), and mediators (CSI/severity). Results: 208 adults with IBD, 18 to 88 years of age, reported musculoskeletal pain. Regression analysis identified IBD activity as a significant predictor of worse pain severity (R2 = 0.039, P < 0.005) and interference (R2 = 0.067, P < 0.001). Simple mediation showed a significant indirect effect from CSI scores between IBD activity and pain severity. Serial mediation analysis showed a significant indirect effect from CSI scores and pain severity, between IBD activity and pain interference. Conclusion: Active IBD demonstrated a positive association with worse musculoskeletal pain experiences. The CSI demonstrated significant mediation between active IBD and pain severity. Additionally, the CSI and pain severity demonstrated significant mediation between active IBD and pain interference. This suggests that symptoms of central sensitization significantly influence musculoskeletal pain experiences in IBD. [ABSTRACT FROM AUTHOR]

Background: Alteration in somatosensory function, assessed via responses to quantitative sensory testing (QST), has been associated with heightened pain severity and interference in individuals with musculoskeletal (MSK) pain. However, a range of factors may confound the relationship between QST and clinical outcomes of pain. Therefore, there is a need for a comprehensive systematic review establishing the relationships between a range of factors (psychological, social, sleep, and physical activity) and QST responses among individuals with MSK pain. Objective: To establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and QST responses among patients with MSK pain. Method and analysis: A comprehensive literature search will be conducted in the following electronic database (CINAHL, Ovid-MEDLINE, Scopus, PsycINFO, PubMed, and Web of Science) from their inception to June 2018. Two reviewers will assess the methodological quality using a modified QUIPS tool, which is tailored for the need of this review and supplemented by recommendations from CHARMS checklist and QUADAS-2 tool. The level of evidence will be assessed using GRADE criteria. Data pertinent to statistical measures of relationships from the included studies will be pooled to evaluate the strength of the relationship for each factor with a somatosensory abnormality, through meta-analysis. Appropriate subgroup and sensitivity analyses will be conducted. Where statistical pooling of data not feasible, a narrative review of the findings will be conducted. Significance: This systematic review will provide evidence of modifiable factors associated with altered sensory processing in individuals with MSK pain. Such evidence may also direct to test interventions targeting those factors to influence somatosensory function, thereby improve pain outcomes. [ABSTRACT FROM AUTHOR]

Background: Chronic musculoskeletal pain in the elderly is highly prevalent, with osteoarthritis, low back pain, neck pain and other musculoskeletal disorders as the leading contributors to pain chronicity and disability. Previous reviews identifying effective components of non-pharmacological interventions for treating chronic pain have either few studies or the included studies examine outcome over a limited time span. This systematic review will investigate the effectiveness and components of interventions associated with management of chronic musculoskeletal pain in older adults (≥65 years). Methods/Design: This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Randomised controlled trials of non-pharmacological interventions aimed at reducing pain in older adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, Web of Science and PEDro. Two review authors will independently screen articles retrieved from the search for eligibility, and extract relevant data on methodological issues. A narrative synthesis will be completed if there are insufficient data for a meta-analysis. The narrative synthesis will summarise the current state of knowledge, interventions, study designs and robustness of evidence. Discussion: Findings of the study will inform support programs and interventions to assist people aging with pain, carers and other supporters and practitioners. Systematic review registration: PROSPERO 2017:CRD42017074173. [ABSTRACT FROM AUTHOR]

Background: Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the level of evidence for PMPs of those test procedures, administered to identify somatosensory abnormalities in individuals with neck pain. Methods: A comprehensive electronic literature search was conducted in seven databases from inception to July 2018. The Quality Appraisal for Reliability Studies (QAREL) checklist and the COSMIN tool were used to assess risk of bias of the included studies. Level of evidence was determined based on two components: the methodological quality of included studies and the quality of statistical measures of measurement properties for each testing procedure. Results: Eighteen studies related to neck pain were included. The majority of included articles were considered to be of insufficient methodological quality to ascertain the PMPs of each testing procedure investigated. However, adequate methodological studies indicated that there is moderate level of evidence for the reliability and discriminative validity of the electrical current perception threshold using the neurometer CPT/C. In addition, the hand-held digital pressure algometer (Wagner FDX-25 Greenwich, CT) has moderate evidence for the reliability and responsiveness. Conclusions: This systematic review identified that the hand-held digital pressure algometer and the neurometer has acceptable PMPs. Future research should include adequate sample size, description of the assessors, and inclusion of blinding processes. Further research with standardized protocols is recommended to investigate the predictive ability and responsiveness of reported test procedures to ensure their extended clinical utility. [ABSTRACT FROM AUTHOR]

Abstract: Background: Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain (PJP). Methods: A comprehensive electronic literature search was conducted in 7 databases from inception to March 2016. The Quality Appraisal for Reliability Studies (QAREL) checklist and the Consensus‐based Standards for the Selection of Health Status Measurement Instruments (COSMIN) tool were used to assess risk for bias of the included studies. Level of evidence was evaluated based on the methodological quality and the quality of the measurement properties. Results: Forty‐one studies related to PJP were included. The majority of included studies were considered to be of insufficient methodological quality, and the level of evidence for PMPs varied across different test procedures. The level of evidence for PMPs varied across different test procedures in different types of PJP. Hand‐held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability, agreement, and responsiveness, simultaneously, when it was investigated in patients with chronic knee osteoarthritis. Conclusions: This systematic review identified that the level of evidence for PMPs varied across different testing procedures to assess somatosensory abnormalities for different PJP populations. Further research with standardized protocols is recommended to further investigate the predictive ability and responsiveness of reported test procedures in order to warrant their extended utility in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Pain is known to affect over 70% of individuals with inflammatory bowel disease (IBD), with abdominal and musculoskeletal (MSK) pain representing the most common complaints in this population. Although possible mediating and overlapping pathways have been proposed in the development of MSK pain in IBD, the multifactorial nature of painful conditions is not well understood nor fully captured. Aims: Primary aims are to characterize MSK pain in individuals with IBD through a national survey, in order to identify patient subgroups based on self-reported features of pain and assess how these subgroups differ with regards to demographics, comorbidity, and IBD characteristics. Methods: The present study is a cross-sectional online survey of adults with IBD and self-reported pain, living in New Zealand. The survey includes a range of measures examining demographics and comorbidity, IBD status (type, activity, and severity of IBD course), and pain status (intensity, location, interference, and quality). Latent class analysis will be used to generate mechanism-based subgroups of pain in this population Discussion: The present study will gather data on the multidimensional experience of self-reported MSK pain in IBD, and describe subgroups of pain in this population. Subgrouping has been shown to generate distinct profiles of patients with similar attributes, while permitting comparison of features between subgroups. Use of mechanism-based classification provides the opportunity to understand differing and potentially overlapping contributions of pathophysiological pain mechanisms. Results from the present study will be used to develop a clinical framework for assessing and describing MSK pain in IBD. [ABSTRACT FROM AUTHOR]

Objective: To conduct an overview of systematic reviews on risk factors for the development of non-specific LBP and critically appraise the level of evidence for those risk factors. Methods: Systematic reviews on risk factors for LBP were searched in the following electronic databases: EMBASE (via Ovid), Medline (via Ovid), CINAHL (EBSCO), AMED, PsycINFO (via Ovid), Scopus, Web of Science (via Web of Knowledge), ProQuest Central, PEDro and The Cochrane Library. Two reviewers independently screened the reviews that investigated primary longitudinal studies on risk factors associated with non-specific LBP including only LBP free subjects at baseline assessment period. Database search resulted in 438 studies, of which 5 SRs met our criteria. Inter-rater reliability between the reviewers were observed as substantial (k = 0.76). First reviewer extracted the risk factors along with risk estimates and study characteristics and the data was cross checked by the second reviewer. The methodological quality of the SRs was evaluated using AMSTAR tool. A two-staged procedure was performed to determine the level of evidence. Results: Eleven risk factors found to have moderate evidence: lifting ≥25 lb (females); standing for >2 h (females); history of LBP ≥1 month duration and ≤1 year since LBP onset; previous history of frequent LBP; poor general health; childhood status including psychosocial difficulties, abdominal pain >7 days/month, carrying out part-time job, spine asymmetry (females), >18 versus <5 h of sports activities/week, lumbar extension mobility: lumbar extensor muscle endurance ratio. Conclusion: This overview of systematic reviews concluded that there is no potential risk factor with strong evidence for the development of LBP. Posture, history of LBP, other pain conditions and sports and leisure activities are the risk factors found to have moderate evidence for the development of LBP. [ABSTRACT FROM AUTHOR]

Background: Identification of somatosensory abnormalities in patients with low back pain (LBP) is essential for targeted treatment strategies in an attempt to reduce or normalize altered sensory processing within the central nervous system. Several test procedures have been used to assess somatosensory abnormalities in patients with LBP, however, these test procedure should possess optimal psychometric properties (PMPs) to be used in clinical practice. Objectives: To systematically review the literature to evaluate the level of evidence for PMPs of test procedures administered to identify somatosensory abnormalities in individuals with LBP. Methods: A comprehensive electronic literature search was conducted in seven databases from inception to March 2016. The QAREL checklist and the COSMIN tool were used to assess methodological quality of the included studies. The level of evidence was determined based on the methodological quality of included studies and the quality of statistical measures of measurement properties. Results: Nineteen studies related to LBP were included. Studies demonstrated limited evidence for reliability and discriminative validity for cross-friction algometry in sub-acute LBP. Additionally, moderate evidence of reliability and strong evidence of discriminative validity exists for: electronic pressure algometer in chronic LBP, and a decline of conditioned pain modulation using the electronic pressure algometer (test stimulus) and a cold presser (conditioning stimulus) in acute and chronic LBP. Conclusions: This systematic review identified test procedures which demonstrated acceptable PMPs. Further research with adequate methodological quality and standardized protocols is recommended to investigate the predictive ability and responsiveness of test procedures to ensure their extended clinical utility. [ABSTRACT FROM AUTHOR]

Background:Physiotherapy plays an important role in management of acute nonspecific low back pain (NSLBP). However, there is a relative dearth of information about the current clinical practice for management of NSLBP and its relationships with clinical outcomes of pain and function. Objective:To investigate the current physiotherapy practice patterns in management of acute NSLBP in New Zealand (NZ), and determine its relationships with clinical outcomes of pain and function. Methods:A prospective observational cohort study, using data from private physiotherapy clinics, was conducted. Physiotherapists at each clinic completed a treatment summary form at time of discharge. Treatment techniques used and clinical outcome of pain [numeric pain rating scale (NPRS)] and function [Patient-specific Function scale (PSFS)] were extracted from recorded notes. Raw values of NPRS and PSFS were converted to percentage of available change scores and used for further analysis. Results and Conclusions:A total of 199 data-sets of acute NSLBP patients were included in the analysis. A wide variety of treatment techniques were used by NZ physiotherapists, with joint mobilization being the most popular form of treatment choice (88%), often combined with specific exercises and massage (21%). Linear regression analysis demonstrated a significant positive association between joint mobilization and massage and patient’s function, and pain and function, respectively; whereas, a significant negative association between specific exercises and patient’s function. The most popular form of treatments used by NZ physiotherapists’ lacks support from evidence-based clinical guidelines, but still seems to be effective in reducing pain and improving function. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine exposure to whole-body vibration (WBV) and mechanical shock in rural workers who use quad bikes and to explore how personal, physical, and workplace characteristics influence exposure.Methods: A seat pad mounted triaxial accelerometer and data logger recorded full workday vibration and shock data from 130 New Zealand rural workers. Personal, physical, and workplace characteristics were gathered using a modified version of the Whole Body Vibration Health Surveillance Questionnaire. WBVs and mechanical shocks were analysed in accordance with the International Standardization for Organization (ISO 2631-1 and ISO 2631-5) standards and are presented as vibration dose value (VDV) and mechanical shock (Sed) exposures.Results: VDVZ consistently exceeded European Union (Guide to good practice on whole body vibration. Directive 2002/44/EC on minimum health and safety, European Commission Directorate General Employment, Social Affairs and Equal Opportunities. 2006) guideline exposure action thresholds with some workers exceeding exposure limit thresholds. Exposure to mechanical shock was also evident. Increasing age had the strongest (negative) association with vibration and shock exposure with body mass index (BMI) having a similar but weaker effect. Age, daily driving duration, dairy farming, and use of two rear shock absorbers created the strongest multivariate model explaining 33% of variance in VDVZ. Only age and dairy farming combined to explain 17% of the variance for daily mechanical shock. Twelve-month prevalence for low back pain was highest at 57.7% and lowest for upper back pain (13.8%).Conclusions: Personal (age and BMI), physical (shock absorbers and velocity), and workplace characteristics (driving duration and dairy farming) suggest that a mix of engineered workplace and behavioural interventions is required to reduce this level of exposure to vibration and shock. [ABSTRACT FROM AUTHOR]