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18. Assessing the psychometric properties of an activity pacing questionnaire for chronic pain and fatigue

Author

Antcliff, Deborah, Campbell, Malcolm, Woby, Steve, and Keeley, Philip

Subjects
Care and treatment, Evaluation, Research, Precision medicine -- Research, Chronic pain -- Care and treatment, Practice guidelines (Medicine) -- Evaluation, Medical research
Abstract

Activity pacing involves the modification of behavior to improve function, manage symptoms, and reduce relapses and disability. (1-3) Pacing is advised as a coping strategy to manage long-term conditions, such [...], Background. Therapists frequently advise the use of activity pacing as a coping strategy to manage long-term conditions (eg, chronic low back pain, chronic widespread pain, chronic fatigue syndrome/myalgic encephalomyelitis). However, activity pacing has not been clearly operationalized, and there is a paucity of empirical evidence regarding pacing. This paucity of evidence may be partly due to the absence of a widely used pacing scale. To address the limitations of existing pacing scales, the 38-item Activity Pacing Questionnaire (APQ-38) was previously developed using the Delphi technique. Objective. The aims of this study were: (1) to explore the psychometric properties of the APQ-38, (2) to identify underlying pacing themes, and (3) to assess the reliability and validity of the scale. Design. This was a cross-sectional questionnaire study. Methods. Three hundred eleven adult patients with chronic pain or fatigue participated, of whom 69 completed the test-retest analysis. Data obtained for the APQ-38 were analyzed using exploratory factor analysis, internal and test-retest reliability, and validity against 2 existing pacing subscales and validated measures of pain, fatigue, anxiety, depression, avoidance, and mental and physical function. Results. Following factor analysis, 12 items were removed from the APQ-38, and 5 themes of pacing were identified in the resulting 26-item Activity Pacing Questionnaire (APQ-26): activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance. These themes demonstrated satisfactory internal consistency (Cronbach [alpha]=.72-.92), test-retest reliability (intraclass correlation coefficient=.50-.78, P Limitations. Data were collected from self-report questionnaires only. Conclusions. Developed to be widely used across a heterogeneous group of patients with chronic pain or fatigue, the APQ-26 is multifaceted and demonstrates reliability and validity. Further study will explore the effects of pacing on patients' symptoms to guide therapists toward advising pacing themes with empirical benefits.

Published
2015
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20. Runs of homozygosity and testicular cancer risk

Author

Loveday, C, Sud, A, Litchfield, K, Levy, M, Holroyd, A, Broderick, P, Kote-Jarai, Z, Dunning, AM, Muir, K, Peto, J, Eeles, R, Easton, DF, Dudakia, D, Orr, N, Pashayan, N, Rustin, Gordon, Srihari, Narayanan N, Cole, David, Askill, Colin, Bertelli, Gianfilippo, Barber, James, Gilby, Ed, White, Jeff, Baybrooke, Jeremy, Leahy, Michael, Welch, Richard, Chakraborti, Prabir, Joffe, Johnathan, Brown, Richard, Faust, Guy, Simmonds, Peter, Mazhar, Danish, Stockdale, Andrew, Hrounda, David, Humber, Caroline, Appel, Wiebke, Hong, Anne, Howard, Grahame, Douglas, Fiona, Bloomfield, David, Butt, Mohammad, Kelly, Kay, Mehra, Rakesh, Rogers, Paul, Hatton, Matthew, Hennig, Ivo, McAteer, John, Savage, Philip, Seckl, Michael, Gale, Joanna, Clark, Peter, Woby, Steve, Rathmell, Adrian, Lamont, Alan, Sarwar, Naveed, Stuart, Nick, Chowdhury, Simon, Beesley, Sharon, Winkler, Mathius, Hamid, Abdel, Pathak, Sanjeev, Madhavan, Krishnaswamy, Highley, Martin, Money-Kryle, Julian, Brock, Cathryn, Sreenivasan, Thiagarajan, Henderson, Brian E, Haiman, Christopher A, Schumacher, Fredrick R, Al Olama, Ali Amin, Benlloch, Sara, Berndt, Sonja I, Conti, David V, Wiklund, Fredrik, Chanock, Stephen, Gapster, Susan, Stevens, Victoria L, Tangen, Catherine M, Batra, Jyotsna, Clements, Judith, Gronberg, Henrik, Schleutker, Johanna, Albanes, Demetrius, Wolk, Alicja, West, Catharine, Mucci, Lorelei, Cancel-Tassin, Geraldine, Koutros, Stella, Sorensen, Karina Dalsgaard, Maehle, Lovise, Neal, David E, Hamdy, Freddie C, Donovan, Jenny L, Travis, Ruth C, Hamilton, Robert J, Ingles, Sue Ann, Rosenstein, Barry S, Lu, Yong-Jie, Giles, Graham G, Kibel, Adam S, Vega, Ana, Kogevinas, Manolis, Penney, Kathryn L, Park, Jong Y, Stanford, Janet L, Cybulski, Cezary, Nordestgaard, Borge G, Brenner, Hermann, Maier, Christiane, Kim, Jeri, John, Esther M, Teixeira, Manuel R, Neuhausen, Susan L, De Ruyck, Kim, Razack, Azad, Newcomb, Lisa F, Lessel, Davor, Kaneva, Radka, Usmani, Nawaid, Claessens, Frank, Townsend, Paul A, Dominguez, Manuela Gago, Roobol, Monique J, Menegaux, Florence, Khaw, Kay-Tee, Cannon-Albrigh, Lisa, Pandha, Hardev, Thibodeau, Stephen N, Reid, A, Huddart, RA, Houlston, RS, Turnbull, C, and Urology

Subjects
Oncology, Male, Endocrinology, Diabetes and Metabolism, LOCI, Genome-wide association study, Runs of Homozygosity, SUSCEPTIBILITY, VARIANTS, 0302 clinical medicine, Endocrinology, testicular germ cell tumour, Risk Factors, Genotype, genetics, Andrology, 030219 obstetrics & reproductive medicine, Genome, Homozygote, Neoplasms, Germ Cell and Embryonal, Disease gene identification, homozygosity mapping, Life Sciences & Biomedicine, RECENT POSITIVE SELECTION, medicine.medical_specialty, Urology, Biology, BREAST, Polymorphism, Single Nucleotide, 03 medical and health sciences, Endocrinology & Metabolism, Testicular Neoplasms, SDG 3 - Good Health and Well-being, Internal medicine, medicine, Genetic predisposition, cancer, Humans, Allele, GENOME-WIDE ASSOCIATION, SEX DETERMINATION, runs of homozygosity, Science & Technology, IDENTIFICATION, Cancer, recessive, medicine.disease, GERM-CELL TUMOR, CONSANGUINITY, Reproductive Medicine, Relative risk, genome-wide association studies, Genome-Wide Association Study
Abstract

BACKGROUND: Testicular germ cell tumour (TGCT) is highly heritable but > 50% of the genetic risk remains unexplained. Epidemiological observation of greater relative risk to brothers of men with TGCT compared to sons has long alluded to recessively acting TGCT genetic susceptibility factors, but to date none have been reported. Runs of homozygosity (RoH) are a signature indicating underlying recessively acting alleles and have been associated with increased risk of other cancer types. OBJECTIVE: To examine whether RoH are associated with TGCT risk. METHODS: We performed a genome-wide RoH analysis using GWAS data from 3206 TGCT cases and 7422 controls uniformly genotyped using the OncoArray platform. RESULTS: Global measures of homozygosity were not significantly different between cases and controls, and the frequency of individual consensus RoH was not significantly different between cases and controls, after correction for multiple testing. RoH at three regions, 11p13-11p14.3, 5q14.1-5q22.3 and 13q14.11-13q.14.13, were, however, nominally statistically significant at p

Published
2019
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24. Adjustment to chronic low back pain--the relative influence of fear-avoidance beliefs, catastrophizing, and appraisals of control

Author

Woby, Steve R., Watson, Paul J., Roach, Neil K., and Urmston, Martin

Subjects
Pain -- Care and treatment, Adjustment (Psychology), Backache, Psychology and mental health
Abstract

The present study investigated the relative extent to which patients' adjustment to chronic low back pain (CLBP) was influenced by their fear-avoidance beliefs, their tendency to catastrophize, and their appraisals of control. Eighty-three CLBP patients completed a series of self-report measures before participating in a physical therapist-led intervention. Hierarchical multiple regression analyses revealed that patients' perceptions of their ability to decrease pain explained a small, but statistically significant, proportion of the variance in pain intensity. In addition, patients' levels of catastrophizing, as well as their fear-avoidance beliefs about both work and physical activity, were independently associated with levels of disability. Interestingly, however, when exploring the relative predictive utility of these three psychological factors, it became evident that fear-avoidance beliefs about physical activity (FABs-PA) were the only significant predictor of patients' disability. Specifically, those patients who exhibited higher levels of FABs-PA tended to report greater levels of disability, even after adjusting for age, sex and pain intensity. Keywords: Chronic low back pain; Adjustment; Fear-avoidance beliefs; Catastrophizing; Appraisals of control

Published
2004

26. Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score

Author

Rowland, Andrew, primary, Cotterill, Sarah, additional, Heal, Calvin, additional, Garratt, Natalie, additional, Long, Tony, additional, Bonnett, Laura Jayne, additional, Brown, Stephen, additional, Woby, Steve, additional, and Roland, Damian, additional

Published
2020
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30. Opt-out Consent in Children's Emergency Medicine Research.

Author

Long, Tony, Rowland, Andrew, Cotterill, Sarah, Woby, Steve, Heal, Calvin, Garratt, Natalie, Brown, Steve, and Roland, Damian

Subjects
PARENT attitudes, HUMAN research subjects, PATIENT autonomy, PATIENT selection, ETHICAL decision making, PATIENT decision making, INFORMED consent (Medical law), EMERGENCY medicine, MEDICAL research
Abstract

There is global acceptance that individuals should be allowed to decide whether or not to take part in research studies, and to do so after being informed about the nature of the research and the risk that might attach to participation. The process of providing detailed information before seeking consent (formalized by signatures) in advance of undertaking research procedures may not be possible in some circumstances, and sometimes an amended approach may be adopted. The use of opt-out consent has been recognized as a valid and ethical means of recruiting participants to studies particularly with large samples and where the risk to participants is small. However, it is sometimes misunderstood and can be a problematic factor in being accepted by research ethics committees and governing authorities. This may be due partly to differing expectations of the amount of information and support offered, together with the nature of the process that is adopted to ensure that a decision has been made rather than consent simply being assumed. In accordance with ongoing discussions with young people, and following consultation with parents, an opt-out consent strategy including varied means of providing information was employed in a large study of 44,501 cases of children attending emergency or urgent care departments. The study was conducted over more than 12 months in dissimilar emergency departments and an urgent care unit, and was designed to support better decision-making in pediatric emergency departments about whether children need to be admitted to hospital or can be discharged home safely. Robust analysis of the factors that exerted the greatest impact on predicting the need to admit or the safety of discharging children led to a revised version of an existing tool. In this article, we review approaches to consent in research, the nature and impact of opt-out consent, the factors that made this an effective strategy for this study, but also more recent concerns which may make opt-out consent no longer acceptable. [ABSTRACT FROM AUTHOR]

Published
2022
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31. "Pacing does help you get your life back": The acceptability of a newly developed activity pacing framework for chronic pain/fatigue.

Author

Antcliff, Deborah, Keenan, Anne‐Maree, Keeley, Philip, Woby, Steve, and McGowan, Linda

Subjects
CHRONIC pain treatment, CARDIAC pacing, CONCEPTUAL structures, THEMATIC analysis
Abstract

Objectives: We have developed and feasibility tested an activity pacing framework for clinicians to standardise their recommendations of activity pacing to patients with chronic pain/fatigue. This study aimed to explore the acceptability and fidelity to this framework in preparation for a future trial of activity pacing. Design: Acceptability and fidelity were explored using semi‐structured interviews. Data were analysed using framework analysis. Participants: Patients who attended a rehabilitation programme for chronic pain/fatigue underpinned by the framework, and clinicians (physiotherapists and psychological wellbeing practitioners) who led the programmes. Results: Seventeen interviews were conducted, involving 12 patients with chronic pain/fatigue and five clinicians. The framework analysis revealed four deductive themes: (1) Acceptability of the activity pacing framework, (2) Acceptability of the feasibility study methods, (3) Processes of change and (4) Barriers and facilitators to activity pacing; and one inductive theme: (5) Perspectives of patients and clinicians. Conclusions: The activity pacing framework appeared acceptable to patients and clinicians, and adherence to the framework was demonstrated. Processes of behaviour change included patients' regulation of activities through activity pacing. Barriers to pacing included work/social commitments and facilitators included identifying the benefits of pacing on symptoms. Different perspectives emerged between clinicians and patients regarding interpretations of symptom‐contingent and quota‐contingent strategies. The framework recognises fluctuations in symptoms of chronic pain/fatigue and encourages a quota‐contingent approach with flexibility. Future work will develop a patient friendly guide ahead of a clinical trial to explore the effects of pacing. [ABSTRACT FROM AUTHOR]

Published
2022
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35. Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Author

Heathfield, Sarah, Parker, Ben, Zeef, Leo, Bruce, Ian, Alexander, Yvonne, Collins, Fraser, Stone, Michael, Wang, Edward, Williams, Anwen S., Wright, Helen L., Thomas, Huw B., Moots, Robert J., Edwards, Steven W., Bullock, Craig, Chapman, Victoria, Walsh, David A., Mobasheri, Ali, Kendall, David, Kelly, Sara, Bayley, Rachel, Buckley, Chris D., Young, Stephen P., Rump-Goodrich, Lisa, Middleton, Jim, Chen, Liye, Fisher, Roman, Kollnberger, Simon, Shastri, Nilabh, Kessler, Benedikt M., Bowness, Paul, Nazeer Moideen, Abdul, Evans, Laura, Osgood, Louise, Jones, Simon A., Nowell, Mari A., Mahadik, Younis, Young, Stephen, Morgan, Matthew, Gordon, Caroline, Harper, Lorraine, Giles, Joanna L., Paul Morgan, B., Harris, Claire L., Rysnik, Oliwia J., McHugh, Kirsty, Payeli, Sravan, Marroquin, Osiris, Shaw, Jacqueline, Renner, Christoph, Nayar, Saba, Cloake, Tom, Bombardieri, Michele, Pitzalis, Costantino, Buckley, Chris, Barone, Francesca, Lane, Peter, Coles, Mark, Williams, Emma L., Edwards, Christopher J., Cooper, Cyrus, Oreffo, Richard O., Dunn, Sara, Crawford, Aileen, Wilkinson, Mark, Le Maitre, Christine, Bunning, Rowena, Daniels, Jodie, Phillips, Kate L. E., Chiverton, Neil, Le Maitre, Christine L., Shaw, Jackie, Ridley, Anna, Wong-Baeza, Isabel, Keidel, Sarah, Chan, Antoni, Gullick, Nicola J., Abozaid, Hanan S., Jayaraj, David M., Evans, Hayley G., Scott, David L., Choy, Ernest H., Taams, Leonie S., Hickling, M., Golor, G., Jullion, A., Shaw, S., Kretsos, K., Bari, Syed F., Rhys-Dillon, Brian, Amos, Nicholson, Siebert, Stefan, Bunning, Rowena D., Haddock, Gail, Cross, Alison K., Kate, I., Phillips, E., Cross, Alison, Bunning, Rowena A. D., Ceeraz, Sabrina, Spencer, Jo, Choy, Ernest, Corrigall, Valerie, Crilly, Anne, Palmer, Helen, Lockhart, John, Plevin, Robin, Ferrell, William R., McInnes, Iain, Hutchinson, David, Perry, Liz, DiCicco, Maria, Humby, Frances, Kelly, Stephen, Hands, Rebecca, McInnes, Ian, Taylor, Peter, Mehta, Puja, Mitchell, Adam, Tysoe, Carolyn, Caswell, Richard, Owens, Martina, Vincent, Tonia, Hashmi, Tahir M., Price-Forbes, Alec, Sharp, Charlotte A., Murphy, Helen, Wood, Elizabeth F., Doherty, Teresa, Sheldon, Jo, Sofat, Nidhi, Goff, Iain, Platt, Philip N., Abdulkader, Rita, Clunie, Gavin, Ismajli, Mediola, Nikiphorou, Elena, Young, Adam, Tugnet, Nicola, Dixey, Josh, Banik, Snehashish, Alcorn, Desmond, Hunter, John, Win Maw, Win, Patil, Pravin, Hayes, Fiona, Main Wong, Way, Borg, Frances A., Dasgupta, Bhaskar, Malaviya, Anshuman P., Ostor, Andrew J., Chana, Jasroop K., Ahmed, Azeem A., Edmonds, Sally, Coward, Lucy, Borg, Frances, Heaney, Jonathan, Amft, Nicole, Simpson, John, Dhillon, Veena, Ayalew, Yezenash, Khattak, Fazlihakim, Gayed, Mary, Amarasena, Roshan I., McKenna, Frank, Mc Laughlin, Maeve, Baburaj, Krishnan, Fattah, Zozik, Ng, Nora, Wilson, Jo, Colaco, Bernard, Williams, Mark R., Adizie, Tochukwu, Casey, Matthew, Lip, Stefanie, Tan, Shaun, Anderson, David, Robertson, Calum, Devanny, Ian, Field, Max, Walker, David, Robinson, Sandra, Ryan, Sarah, Hassell, Andrew, Bateman, James, Allen, Maggie, Davies, David, Crouch, Carina, Walker-Bone, Karen, Gainsborough, Nicola, Lutalo, Pamela M., Davies, Ursula M., Mckew, Jennifer R., Millar, Auleen M., Wright, Stephen A., Bell, Aubrey L., Thapper, Muryum, Roussou, Thalia, Cumming, Jo, Hull, Richard G., McKeogh, John, O'Connor, Mortimer B., Hassan, Ahmed I., Bond, Ursula, Swan, Joan, Phelan, Mark J., Coady, David, Kumar, Namita, Farrow, Luke, Bukhari, Marwan, Oldroyd, Alexander G., Greenbank, Cathi, McBeth, John, Duncan, Rosie, Brown, Deborah, Horan, Michael, Pendleton, Neil, Littlewood, Alison, Cordingley, Lis, Mulvey, Matthew, Curtis, Elizabeth M., Cole, Zoe A., Crozier, Sarah R., Georgia, Ntani, Robinson, Siân M., Godfrey, Keith M., Sayer, Avan A., Inskip, Hazel M., Harvey, Nicholas C., Davies, Rebecca, Mercer, Louise, Galloway, James, Low, Audrey, Watson, Kath, Lunt, Mark, Symmons, Deborah, Hyrich, Kimme, Chitale, Sarang, Estrach, Cristina, Goodson, Nicola J., Rankin, Elizabeth, Jiang, C. Q., Cheng, K. K., Lam, T. H., Adab, Peymané, Ling, Stephanie, Humphreys, Jennifer, Ellis, Corrinne, Bunn, Diane, Verstappen, Suzanne M., Fluess, Elisa, Macfarlane, Gary J., Bond, Christine, Jones, Gareth T., Scott, Ian C., Steer, Sophia, Lewis, Cathryn M., Cope, Andrew, Mulvey, Matthew R., Lovell, Karina, Keeley, Philip, Woby, Steve, Beasley, Marcus, Viatte, Sebastien, Plant, Darren, Fu, Bo, Solymossy, Csilla, Worthington, Jane, Barton, Anne, Williams, Frances M., Osei-Bordom, Daniel-Clement, Popham, Maria, MacGregor, Alex, Spector, Tim, Little, Jayne, Herrick, Ariane, Pushpakom, S., Ennis, H., McBurney, H., Worthington, J., Newman, W., Ibrahim, Ibrahim, Morgan, Anne, Wilson, Anthony, Isaacs, John, Sanderson, Tessa, Hewlett, Sarah, Calnan, Michael, Morris, Marianne, Raza, Karim, Kumar, Kanta, Cardy, Caroline M., Pauling, John D., Jenkins, Jessica, Brown, Sue J., McHugh, Neil, Mugford, Miranda, Davies, Charlotte, Cooper, Nicola, Brooksby, Alan, Dures, Emma, Ambler, Nick, Fletcher, Debbie, Pope, Denise, Robinson, Frances, Rooke, Royston, Gorman, Claire L., Reynolds, Piero, Hakim, Alan J., Bosworth, Ailsa, Weaver, Dan, Kiely, Patrick D., Skeoch, Sarah, Jani, Meghna, Amarasena, Roshan, Rao, Chandini, Macphie, Elizabeth, McLoughlin, Yokemei, Shah, Preeti, Else, Sara, Semenova, Olga, Thompson, Helen, Ogunbambi, Olabambo, Kallankara, Sathish, Patel, Yusuf, Baguley, Elaine, Halsey, John, Severn, Andrew, Selvan, Shilpa, Price, Elizabeth, Husain, Muhammad J., Brophy, Sinead, Phillips, Ceri J., Cooksey, Roxanne, Irvine, Elizabeth, Lendrem, Dennis, Mitchell, Sheryl, Bowman, Simon, Pease, Colin T., Emery, Paul, Andrews, Jacqueline, Sutcliffe, Nurhan, Lanyon, Peter, Gupta, Monica, McLaren, John, Regan, Marian, Cooper, Annie, Giles, Ian, Isenberg, David, Griffiths, Bridget, Foggo, Heather, Edgar, Suzanne, Vadivelu, Saravanan, Ng, Wan-Fai, Iqbal, Itrat, Heron, Louise, Pilling, Claire, Marks, Jonathan, Hull, Richard, Ledingham, Jo, Han, Chenglong, Gathany, Tim, Tandon, Neeta, Hsia, Elizabeth, Taylor, P., Strand, V., Sensky, T., Harta, N., Fleming, S., Kay, Lesley, Rutherford, Michelle, Nicholl, Karl, Eyre, Tracey, Wilson, Gillian, Johnson, Phil, Russell, M., Timoshanko, J., Duncan, G., Spandley, A., Roskell, S., West, Louise, Adshead, Rebecca, Donnelly, Simon P., Ashton, Simon, Tahir, Hasan, Patel, Dipti, Darroch, James, Boulton, John, Ellis, Benjamin, Finlay, Ron, Murray-Brown, William, Priori, R., Tappuni, T., Vartoukian, S., Seoudi, N., Picarelli, G., Fortune, F., Valesini, G., Pitzalis, C., Bombardieri, M., Ball, Elisabeth, Rooney, Madeleine, Bell, Aubrey, Mérida, Angeles Acosta, Tarelli, Edward, Axford, John, Pericleous, Charis, Pierangeli, Silvia S., Ioannou, John, Rahman, Anisur, Alavi, Azita, Hughes, Michael, Evans, Bronwen, Zaki, Awal, Hui, Michelle, Garner, Rozeena, Rees, Frances, Bavakunji, Riaz, Daniel, Priya, Varughese, Sneha, Srikanth, Asha, Andres, Mariano, Pearce, Fiona, Leung, Jansen, Lim, Ken, Oomatia, Amin, Petri, Michelle, Fang, Hong, Birnbaum, Julius, Amissah-Arthur, Maame, Stewart, Kirsty, Jennens, Hannah, Braude, Simon, Sutton, Emily J., Watson, Kath D., Yee, Chee-Seng, Jayne, David, Akil, Mohammed, Ahmad, Yasmeen, D'Cruz, David, Khamashta, Munther, Teh, Lee-Suan, Zoma, Asad, Dey, Ida D., Kenu, Ernest, Garza-Garcia, Acely, Murfitt, Lucy, Driscoll, Paul C., Pierangeli, Silvia, Ioannou, Yiannis, Reynolds, John A., Ray, David W., O'Neill, Terence, Segeda, Iuliia, Shevchuk, Sergii, Kuvikova, Inna, Brown, Nina, Venning, Michael, Dhanjal, Mandish, Mason, Justin, Nelson-Piercy, Catherine, Basu, Neil, Paudyal, Priya, Stockton, Marie, Lawton, Sally, Dent, Caroline, Kindness, Kathy, Meldrum, Gillian, John, Elizabeth, Arthur, Catherine, West, Lucy, Macfarlane, Matthew V., Reid, David M., Yates, Max, Loke, Yoon, Watts, Richard, Christidis, Dimitrios, Williams, Mark, Sivakumar, Rajappa, Misra, Ramnath, Danda, Debashish, Mahendranath, K. M., Bacon, Paul A., and Mackie, Sarah L.

Abstract

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q < 0.00005). This was supported by qPCR analysis at 6 hrs (E-selectin and VCAM-1; 208.5 fold and 40.5, respectively above control) and also at 1, 3 and 24 hrs (E-selectin; 25.6, 93.5, 12.7 fold, respectively) (VCAM-1; 4.7, 47.2, 17.6 fold) (n = 3; p < 0.05). In contrast, HAoECs treated with TNF in combination with CZP exhibited control levels of E-selectin and VCAM-1 transcript (p > 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interest

Published
2017

36. Inter-rater reliability of paediatric emergency assessment: physiological and clinical features.

Author

Heal, Calvin, Cotterill, Sarah, Rowland, Andrew Graeme, Garratt, Natalie, Long, Tony, Brown, Stephen, O'Connor, Grainne, Rishton, Chloe, Woby, Steve, and Roland, Damian

Subjects
PEDIATRIC emergency services, OUTPATIENT medical care, EMERGENCY nursing, BLAND-Altman plot, MEDICAL records, HEART beat, HOSPITAL emergency services, RESEARCH, RESEARCH evaluation, RESEARCH methodology, EVALUATION research, MEDICAL cooperation, MEDICAL emergencies, SEVERITY of illness index, NATIONAL health services, COMPARATIVE studies, EMERGENCY medical services, RESEARCH funding, RESEARCH bias
Abstract

Objective: The Paediatric Admission Guidance in the Emergency Department (PAGE) score is an assessment tool currently in development that helps predict hospital admission using components including patient characteristics, vital signs (heart rate, temperature, respiratory rate and oxygen saturation) and clinical features (eg, breathing, behaviour and nurse judgement). It aims to assist in safe admission and discharge decision making in environments such as emergency departments and urgent care centres. Determining the inter-rater reliability of scoring tools such as PAGE can be difficult. The aim of this study was to determine the inter-rater reliability of seven clinical components of the PAGE Score.Design: Inter-rater reliability was measured by each patient having their clinical components recorded by two separate raters in succession. The first rater was the assessing nurse, and the second rater was a research nurse.Setting: Two emergency departments and one urgent care centre in the North West of England. Measurements were recorded over 1 week; data were collected for half a day at each of the three sites.Patients: A convenience sample of 90 paediatric attendees (aged 0-16 years), 30 from each of the three sites.Main Outcome Measures: Two independent measures for each child were compared using kappa or prevalence-adjusted bias-adjusted kappa (PABAK). Bland-Altman plots were also constructed for continuous measurements.Results: Inter-rater reliability ranged from moderate (0.62 (95% CI 0.48 to 0.74) weighted kappa) to very good (0.98 (95% CI 95 to 0.99) weighted kappa) for all measurements except 'nurse judgement' for which agreement was fair (0.30, 95% CI 0.09 to 0.50 PABAK). Complete information from both raters on all the clinical components of the PAGE score were available for 73 children (81%). These total scores showed good' inter-rater reliability (0.64 (95% CI 0.53 to 0.74) weighted kappa).Conclusions: Our findings suggest different nurses would demonstrate good inter-rater reliability when collecting acute assessments needed for the PAGE score, reinforcing the applicability of the tool. The importance of determining reliability in scoring systems is highlighted and a suitable methodology was presented. [ABSTRACT FROM AUTHOR]

Published
2021
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37. Exploring patients’ opinions of activity pacing and a new activity pacing questionnaire for chronic pain and/or fatigue:a qualitative study

Author

Ancliff, Deborah, Keeley, Philip, Campbell, Malcolm, Woby, Steve, and McGowan, Linda

Subjects
RA
Abstract

Objective: Despite the frequent recommendation of activity pacing as a coping strategy for patients with chronic pain and/or fatigue, pacing is interpreted in different ways and there is an absence of a widely accepted pacing scale. We have developed a new Activity Pacing Questionnaire(APQ). The aims of this study were to explore patients’ views and beliefs about the concept of pacing, together with the acceptability of the APQ.\ud Design: Qualitative pragmatic study using semi-structured telephone interviews. Data were analysed using Framework analysis. Participants 16 adult patients attending secondary care physiotherapy out-patient departments were recruited via purposive sampling. Diagnoses included chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. \ud Findings: Pacing emerged as a multifaceted concept from participants’ descriptions. The implementation of pacing was influenced by participants’ age, the presence of co-morbidities and participants’ emotions. The APQ was found to be generally acceptable in comparison to two existing pacing subscales. Participants undertook activities using quota/symptom-contingent approaches. Four behavioural typologies emerged: Task avoidance, Task persistence, Task fluctuation (boom-bust) and Task modification (activity pacing). \ud Conclusions: The APQ appears to be easy to complete, and acceptable to patients who are attending physiotherapy for the management of long-term conditions. It emerged that individual patients implemented different pacing facets to varying degrees, and that different behavioural typologies were apparent. The relationships between behavioural typologies and facets of pacing warrant further investigation to facilitate the development of effective tailored pacing interventions.

Published
2016

38. Engaging stakeholders to refine an activity pacing framework for chronic pain/fatigue: A nominal group technique.

Author

Antcliff, Deborah, Keenan, Anne‐Maree, Keeley, Philip, Woby, Steve, and McGowan, Linda

Subjects
CHRONIC pain, FATIGUE (Physiology), WELL-being, STAKEHOLDER analysis
Abstract

Objectives: Due to the current absence of a standardized guide for activity pacing, the concept of pacing is interpreted in various ways by healthcare professionals, patients and researchers. Consequently, the effects of pacing across different conditions are unclear. The present study aimed to undertake the second stage in the development of an activity pacing framework for chronic pain/fatigue. Methods: The newly developed activity pacing framework was refined using a consensus method. A nominal group technique (NGT) was selected to engage stakeholders to reach agreement on the top 10 priorities for inclusion in the framework and accompanying appendices. Participants included patients with diagnoses of chronic pain/fatigue and healthcare professionals working in fields of chronic pain/fatigue. Results: Ten participants were recruited via purposive sampling: four patients, two physiotherapists, two occupational therapists and two psychological wellbeing practitioners. The top priorities for the pacing framework included a clear definition of pacing, and stating the aims and context of pacing. The appendices were refined as a teaching guide, including priorities of detailing the stages of pacing, the overactivity–underactivity cycle/pain cycle and goal setting. Conclusions: Incorporating a diverse panel of stakeholders was an effective and inclusive method to refine the activity pacing framework. The framework has been purposefully designed for wider use across patients with chronic pain/fatigue and by various healthcare professionals. The framework provides a comprehensive definition, background and manual for healthcare professionals to instruct activity pacing. Further study will test the clinical usability of the framework, to enable the standardization of activity pacing in future investigations. [ABSTRACT FROM AUTHOR]

Published
2019
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39. Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial

Author

Beasley, Marcus, Prescott, Gordon J, Scotland, Graham, Mcbeth, John, Lovell, Karina, Keeley, Phil, Hannaford, Philip C, Symmons, Deborah, MacDonald, Ross I R, Woby, Steve, and Macfarlane, Gary J

Subjects
Pain, Psychology, Fibromyalgis/Pain Syndromes, Economic Evaluations, RA
Abstract

OBJECTIVES: The MUSICIAN study has previously shown short-term benefit but only marginal cost-effectiveness for two non-pharmacological interventions for chronic widespread pain (CWP). We wished to determine their long-term effectiveness and cost-effectiveness. METHODS: A 2×2 factorial randomised controlled trial based in primary care in the UK. People were eligible if they were aged ≥25 years with CWP for which they had consulted their general practitioner. The interventions were a 6-month telephone cognitive behaviour therapy (tCBT) and/or a tailored exercise programme, in comparison to usual care. The primary outcome was patient-reported change in health. RESULTS: 884 persons were eligible, 442 were randomised and 81.7% were followed up 24 months post-treatment. In comparison to usual care (positive outcome 12.8%), tCBT (35.4%; OR 3.7 95% CI (1.8 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those who exhibited passive coping at baseline were more likely to have a positive outcome with tCBT than persons without these characteristics. tCBT was associated with the greatest increase in quality of life and lowest costs. Cost per quality adjusted life year was £3957-£5917 depending on method of analysis. CONCLUSIONS: A short course of tCBT for people with CWP was effective long-term and was highly cost-effective. Exercise was also effective but delivered positive outcome for fewer patients at greater cost, and there was no advantage for patients receiving both interventions. TRIAL REGISTRATION NUMBER: ISRCTN67013851.

Published
2015
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41. Receiving Preferred Treatment not Associated with Positive Outcome in a Randomized Trial

Author

Beasley, Marcus, Jones, Elizabeth, McBeth, John, Jones, Gareth T., Hannaford, Philip, Lovell, Karina, Symmons, Deborah, Keeley, Philip, Woby, Steve, Prescott, Gordon, Macfarlane, Gary J., Beasley, Marcus, Jones, Elizabeth, McBeth, John, Jones, Gareth T., Hannaford, Philip, Lovell, Karina, Symmons, Deborah, Keeley, Philip, Woby, Steve, Prescott, Gordon, and Macfarlane, Gary J.

Abstract

Background: In a randomized trial of treatments for chronic widespread pain (CWP), participants were asked their treatment preference just prior to randomisation (baseline). This analysis examined whether treatment preference was associated with baseline factors and whether receiving a preferred treatment affected outcomes. Methods: The MUSICIAN trial was a 2 × 2 randomized trial of cognitive behavioural therapy (CBT) or exercise for people with CWP. Participants were randomly allocated to one of three active treatments [CBT (n = 112), exercise (n = 109), both exercise and CBT (n = 112)] or usual care (n = 109). Before allocation participants were asked, if they had a choice, which active treatment they would choose. A positive outcome was self-reported improvement in health of much or very much better 6, 9 and 30 months after entering the study. Associations between preference and baseline characteristics were examined, including age, gender, chronic pain grade (CPG), passive and active coping, fatigue, psychological distress, sleep problems and kinesiophobia. Differences in gender and CPG between preferences were tested by chi-square tests. For continuous variables, comparison was by analysis of variance and, where a difference was observed, Tukey’s honest significant difference was used to identify which preferences differed and then the standardized mean difference (d) with 95% CIs were calculated. Among those allocated to active treatments, logistic regression was used to calculate odds ratios, adjusted for factors associated with preference, with 95% CIs of positive outcome in those receiving their preferred treatment and not receiving preferred treatment as the referent group. Results: Of 442 participants, 144 (33%) expressed preference for exercise, 20 (5%) for CBT, 199 (45%) for combined exercise and CBT and 79 (18%) expressed no preference. Compared with females, males were more likely to prefer exercise only (44 vs 28%) and less likely to prefer combined

Published
2016

43. The processes underpinning reductions in disability among people with chronic neck pain. A preliminary comparison between two distinct types of physiotherapy intervention.

Author

Thompson, Dave P. and Woby, Steve R.

Subjects
*ANALYSIS of variance, *BEHAVIOR modification, *CHRONIC pain, *STATISTICAL correlation, *FUNCTIONAL assessment, *NATIONAL health services, *NECK pain, *PHYSICAL therapy, *QUESTIONNAIRES, *RESEARCH funding, *MULTIPLE regression analysis, *DATA analysis software, *DESCRIPTIVE statistics
Abstract

Purpose:To establish whether different processes underpin changes in disability in people with neck pain who underwent two types of active physiotherapy intervention. Materials and methods:This study was a sub-analysis of a randomized controlled trial assessing whether the addition of Interactive Behavioral Modification Therapy (a cognitively informed physiotherapy treatment) to a Progressive Neck Exercise Program improved outcome in patients with chronic neck pain. Regression analyses were performed to determine the extent to which demographics, changes in pain, and changes in certain cognitive factors were related to changes in disability. Results:In the progressive neck exercise group, changes in levels of pain intensity were the only factor significantly related to change in disability, explaining 33% of the variance. In the interactive behavioral modification therapy group, changes in pain intensity, and catastrophizing together explained 54% of the variance in change in disability. Only changes in catastrophizing displayed a significant β value in the final model. Conclusions:Different processes appear to underpin changes in disability in patients undergoing cognitively informed physiotherapy to those undergoing a primarily exercise-based approach.Implications for rehabilitationCertain cognitive factors are known to be related to levels of disability in patients with chronic neck painSpecifically targeting these factors results in more patients making a clinically meaningful reduction in disabilityDifferent processes appear to underpin reductions in disability when people with neck pain are treated with cognitively informed physiotherapy to when treated with exercise alone, which may account for why more patients improve when treated in this manner.Reductions in catastrophizing appear to be particularly important and efforts should be made to assess and treat catastrophic thoughts in people with chronic neck pain. [ABSTRACT FROM PUBLISHER]

Published
2018
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45. Long-term effects of cognitive behaviour therapy and exercise for chronic widespread pain

Author

Beasley, Marcus, Prescott, Gordon, McBeth, John, Lovell, Karina, Keeley, Philip, McNamee, Paul, Woby, Steve, Gkazinou, Chrysa, Jones, Elizabeth A., Macfarlane, Gary J., Beasley, Marcus, Prescott, Gordon, McBeth, John, Lovell, Karina, Keeley, Philip, McNamee, Paul, Woby, Steve, Gkazinou, Chrysa, Jones, Elizabeth A., and Macfarlane, Gary J.

Abstract

Background Cognitive behaviour therapy (CBT) and exercise have been shown to improve short-term outcomes for chronic widespread pain (CWP) patients. There is little data on whether improvement maintains long-term. Methods or theme The MUSICIAN Trial was a 2 x 2 factorial randomised controlled trial. A survey of general practitioner (GP)-registers identified CWP patients consulting their GP in the last year. Random assignation was to four study arms: the Cognitive Behavior Therapist (tCBT), exercise, combined treatment, or treatment as usual (TAU). tCBT participants had eight weekly telephone sessions and three and six month follow-up calls. Exercise group participants followed an individual fitness-instructor designed program over six months with monthly review. Combined treatment participants received both interventions. TAU participants received usual care. Follow-up by postal questionnaire or telephone was 24 months post-treatment. Positive outcome was patient-reported change in health of ‘much’ or ‘very much’ better. Analysis was by logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) are reported. Results Totally 442 persons participated (median age 57 years, 69% female) – 361 had 24-month follow-up. Of 94 respondents, 12 (12.8%) in TAU reported positive outcomes, 29 of 82 in tCBT (35.4%), 27 of 92 in exercise (29.3%) and 29 of 93 in combined treatment (31.2%). ORs compared to TAU were: tCBT, OR 4.0 (95% CI, 1.8–8.7); exercise, 2.9 (1.4–6.3); combined, 3.5 (1.6–7.5). Improvement odds did not differ across active treatments – there was no advantage in receiving both interventions. Conclusions tCBT and/or exercise for CWP are associated with long-term patient-reported health improvements. These are amongst the largest, longest-term benefits reported for CWP and offer potential management strategies.

Published
2015

46. Alcohol Consumption in Relation to Risk and Severity of Chronic Widespread Pain: Results From a UK Population‐Based Study

Author

Macfarlane, Gary J., primary, Beasley, Marcus, additional, Prescott, Gordon J., additional, McNamee, Paul, additional, Hannaford, Philip C., additional, McBeth, John, additional, Lovell, Karina, additional, Keeley, Phil, additional, Symmons, Deborah P. M., additional, Woby, Steve, additional, and Norrie, John, additional

Published
2015
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47. Psychometric properties of the TSK-11: a shortened version of the Tampa scale for kinesiophobia

Author

Roach, Neil K., Woby, Steve R., Urmston, Martin, and Watson, Paul J.

Abstract

The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed measures for assessing pain-related fear in back pain patients. Despite its widespread use, there is relatively little data to support the psychometric properties of the English version of this scale. This study investigated the psychometric properties of the English version of the TSK in a sample of chronic low back pain patients. Item analysis revealed that four items possessed low item total correlations (4, 8, 12, 16) and four items had response trends that deviated from a pattern of normal distribution (4, 9, 12, 14). Consequently, we tested the psychometric properties of a shorter version of the TSK (TSK-11), having excluded the six psychometrically poor items. The psychometric properties of this measure were compared to those of the original TSK. Both measures demonstrated good internal consistency (TSK: α=0.76; TSK-11: α=0.79), test–retest reliability (TSK: ICC=0.82, SEM=3.16; TSK-11: ICC=0.81, SEM=2.54), responsiveness (TSK: SRM=−1.19; TSK-11: SRM=−1.11), concurrent validity and predictive validity. In respect of specific cut-off scores, a reduction of at least four points on both measures maximised the likelihood of correctly identifying an important reduction in fear of movement. Overall, the TSK-11 possessed similar psychometric properties to the original TSK and offered the advantage of brevity. Further research is warranted to investigate the utility of the new instrument and the cut-off scores in a wider group of chronic pain patients in different clinical settings.

Published
2005

48. Long-Term Results from a Randomised Controlled Trial (RCT) Of Telephone Delivered Cognitive Behaviour Therapy (TCBT) And Exercise In The Management Of Chronic Widespread Pain (CWP), And Predictors Of Treatment-Effectiveness

Author

Beasley, Marcus, Prescott, Gordon, Scotland, Graham Stewart, McBeth, John, Keeley, Philip, Lovell, Karina, Hannaford, Philip Christopher, McNamee, Paul, Symmons, Deborah, Woby, Steve, Macfarlane, Gary, Beasley, Marcus, Prescott, Gordon, Scotland, Graham Stewart, McBeth, John, Keeley, Philip, Lovell, Karina, Hannaford, Philip Christopher, McNamee, Paul, Symmons, Deborah, Woby, Steve, and Macfarlane, Gary

Abstract

BackgroundChronic Widespread Pain (CWP), the primary symptom associated with fibromyalgia, has been shown to persist over time. It is challenging to manage and can have impacts on functioning and quality of life. Recent reviews have, however, suggested that non-pharmacological treatments such as behaviour therapy and exercise may be effective, at least for short-term management. The MUSICIAN study was a trial of 6-month courses of treatment by telephone-delivered cognitive behavioural therapy (tCBT), exercise, or a combination of both for the management of CWP that have previously shown short-term improvements in patient-reported health compared to treatment as usual (TAU). The aim of the current study is to determine whether these improvements are maintained long-term (2 years after the end of treatment), to determine if any of the active treatments were cost-effective in relation to TAU, and to determine if pre-treatment characteristics identify patients who are more likely to benefit from these treatments.MethodsPopulation survey was used to identify patients who: met the American College of Rheumatology (ACR) definition of CWP, consulted a GP for pain in the last year, and had no contraindications for exercise. Random assignation was to: a) 8 weekly sessions of tCBT, with refreshers at 3 and 6 months; b) an individually tailored exercise programme with monthly review over 6 months; c) both active treatments, or d) TAU. Follow-ups were at end of treatment, and 3 and 24 months later. Primary outcome was self-reported change in health since before the trial. Positive outcomes were Much better or Very much better, on a 7-point scale from Very much worse to Very much better. Analysis was by longitudinal logistic regression. Results are presented as odds ratios (OR) with 95% Confidence Intervals (CI). Additional models were run to assess cost-effectiveness, and the influence of baseline characteristics on the effectiveness of each treatment.Results442 persons (median

Published
2014

49. A Randomised Controlled Trial (RCT) of Telephone Delivered Cognitive Behaviour Therapy (tCBT) and Exercise In The Management Of Chronic Widespread Pain (CWP): Identifying Long-Term Outcome and Who Benefits From Which Treatment

Author

Macfarlane, Gary J., Beasley, Marcus, Keeley, Philip, Lovell, Karina, Hannaford, Philip, Symmons, Deborah P. M., Woby, Steve, Prescott, Gordon, Prescott, Gordon James, Macfarlane, Gary J., Beasley, Marcus, Keeley, Philip, Lovell, Karina, Hannaford, Philip, Symmons, Deborah P. M., Woby, Steve, Prescott, Gordon, and Prescott, Gordon James

Abstract

Background/Purpose: CWP is challenging for rheumatologists to manage and results from long-term epidemiological studies demonstrate that improvement in symptoms is uncommon. Recent reviews have, however, suggested that non-pharmacological therapies such as behaviour therapy and exercise may be effective, at least in the short-term. The aim of the current study is to determine whether tCBT, exercise, or both treatments combined deliver long-term health benefits to patients with CWP in comparison to treatment as usual (TAU) and to characterise patients who benefit from each specific treatment. Methods: A 2 x 2 factorial RCT. Patients with CWP were identified from a population screening survey of 45, 994 adults in the UK. Eligible individuals met the ACR definition of CWP and reported disability. They had consulted their family physician in the last year with pain, and with no cause identified which required specific treatment. Participants were randomly assigned to a) 8 sessions of tCBT over 6 weeks, and refresher sessions at 3 and 6 months, b) an individually tailored exercise programme with monthly review over 6 months at a local fitness centre c) a combination of these treatments, or d) TAU. Participants were followed up at the end of treatment and 3 and 24 months later. The primary outcome was self reported “change in health since entering the study” and a positive outcome was at least 6 (“I felt much better”) on a scale from 0 (“I feel very much worse”) to 7 (“I feel very much better”). Analysis was intention-to-treat with longitudinal logistic regression using generalised estimating equations (GEE). Results are presented as Odds ratios (OR) with 95% Confidence Intervals (CI). Additional models were run to assess the effect of baseline characteristics in predicting the response to the specific treatments received. Results: A total of 442 persons (median age 57 years, 69% female) entered the study and 361 persons (82%) provided information at final follow-up. At 2

Published
2013

50. Can results from randomised controlled trials be generalised to all patients seeking care?

Author

Jones, Elizabeth A., Jones, Gareth T., Hannaford, Philip C., Keeley, Philip, Lovell, Karina, McBeth, John, McNamee, Paul, Prescott, Gordon, Woby, Steve, Macfarlane, Gary J., Jones, Elizabeth A., Jones, Gareth T., Hannaford, Philip C., Keeley, Philip, Lovell, Karina, McBeth, John, McNamee, Paul, Prescott, Gordon, Woby, Steve, and Macfarlane, Gary J.

Published
2010

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