Relationships between pain thresholds,catastrophizing and gender in acute whiplash injury

The mechanisms underlying sensory hypersensitivity (SH) in acute whiplash associated disorders (WAD) are not well understood. We examined the extent of the relationships between the sensory measures of pressure pain threshold (PPT) and cold pain threshold (CPT), catastrophizing, pain and disability levels and gender in acute WAD. Thirty-seven subjects reporting neck pain following a motor vehicle accident were examined within five weeks post-injury. Measures of neck pain and disability (Neck Disability Index, NDI) and catastrophizing (Pain Catastrophizing Scale, PCS) were taken. CPT was assessed in the cervical spine and PPTs were assessed in the cervical spine (PPTcx) and at a remote site (PPTdistal). CPT and PCS were moderately correlated (r = 0.46; p < 0.01); however there were no significant relationships between PPT (cervical and distal) and PCS. Both CPT (r = 0.55, p < 0.01) and PPTcx (r = ?0.42, p < 0.01) were significantly correlated with NDI but PPTdistal was not (r = ?0.08, p = 0.65). Finally, gender modulated the relationships between sensory measures, catastrophizing, and pain and disability levels. In conclusion, subjects with higher levels of catastrophizing presented with sensory hypersensitivity to cold stimuli in the acute phase of whiplash. Differences between genders are in accordance with the growing body of evidence suggesting that the relationships between some psychological factors and injury-related symptoms are modulated by gender.     

Chronic neck pain and vertigo: Is a true balance disorder present?

ObjectiveWe sought to establish whether chronic neck pain patients suffering from vertigo and instability have true balance disorders.Patients and methodsNinety-two patients having suffered from chronic neck pain for at least 3 months were enrolled in the present study. Patients with a history of neck trauma or ear, nose and throat, ophthalmological or neurological abnormalities were excluded. The patients were evaluated in a clinical examination (neck mobility) and a test of dynamic and static balance on the Satel^® platform in which mediolateral (Long X) and anterior-posterior deviations (Long Y) were monitored. Our patients were divided into three groups: a group of 32 patients with neck pain and vertigo (G1), a group of 30 patients with chronic neck pain but no vertigo (G2) and a group of 30 healthy controls.ResultsAll groups were comparable in terms of age, gender, weight and shoe size. Osteoarthritis was found in 75% and 70% of the subjects in G1 and G2, respectively. Neck-related headache was more frequent in G1 than in G2 (65.5% versus 40%, respectively; p = 0.043). Restricted neck movement was more frequent in G1 and concerned flexion (p < 0.001), extension (p < 0.001), rotation (p < 0.001), right inclination (p < 0.001) and left inclination (p < 0.001). Balance abnormalities were found more frequently in G1 than in G2 or G3. Static and dynamic posturographic assessments (under “eyes open” and “eyes shut” conditions) revealed abnormalities in statokinetic parameters (Long X and Long Y) in G1.ConclusionOur study evidenced abnormal static and dynamic balance parameters in chronic neck pain patients with vertigo. These disorders can be explained by impaired cervical proprioception and neck movement limitations. Headache was more frequent in these patients.     

Cervical lateral glide increases nociceptive flexion reflex threshold but not pressure or thermal pain thresholds in chronic whiplash associated disorders: A pilot randomised controlled trial

Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p = 0.04). PPTs at the cervical spine increased following both SMT (mean ± SE: 24.1 ± 7.3%) and manual contact (21 ± 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD.     

Hypoaesthesia occurs with sensory hypersensitivity in chronic whiplash--further evidence of a neuropathic condition

Hypersensitivity to a variety of stimuli has been shown in whiplash associated disorders and may be indicative of peripheral nerve involvement. This cross-sectional study utilised Quantitative sensory testing (QST) including vibration, thermal, electrical detection thresholds as an indirect measure of primary afferents that mediate innocuous and painful sensation. Pain thresholds and psychological distress (SCL-90-R) were also measured. Thirty-one subjects with chronic whiplash (>3 months, NDI: 49+/-17) and 31 controls participated. The whiplash group demonstrated elevated vibration, heat and electrical detection thresholds at most hand sites compared to controls (p<0.05). Electrical detection thresholds in the lower limb were no different from controls (p=0.83). Mechanical and cold pain thresholds were lower in the whiplash group (p<0.05) with no group difference in heat pain thresholds (p>0.1). SCL-90 scores were higher in the whiplash group but did not impact on any of the sensory measures. A combination of pain threshold and detection measures best predicted the whiplash group. Sensory hypoaesthesia and hypersensitivity co-exist in the chronic whiplash condition. These findings may indicate peripheral afferent nerve fibre involvement but could be a further manifestation of disordered central pain processing.     

Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial

BackgroundProprioceptive neuromuscular facilitation training and general trunk exercises have been applied to treat chronic low back pain patients. However, there is currently little study to support the use of one treated intervention over the other to improve clinical outcomes and balance ability.ObjectiveTo examine the effects of proprioceptive neuromuscular facilitation training on pain intensity, disability and static balance ability in working-age patients with chronic low back pain.MethodsForty-four chronic low back pain participants aged 18–50 years were randomized either to a three-week proprioceptive neuromuscular facilitation training or to a control group receiving general trunk exercises. Pain intensity, disability and static balance ability were measured before and after the three-week intervention.ResultsThe proprioceptive neuromuscular facilitation training intervention showed a statistically significantly greater reduction in pain intensity and improved functional disability than the controls at three weeks (between-group difference: pain intensity 1.22 score, 95% CI: 0.58 to 1.88, p < 0.001; disability 2.23 score, 95% CI: 1.22 to 3.24, p < 0.001. The proprioceptive neuromuscular facilitation training intervention also had statistically better parameters of static balance ability than the control group (between-group difference: ellipse sway area during eye opened and closed conditions 129.09 mm², 95% CI: 64.93 to 175.25, p < 0.01 and 336.27 mm², 95% CI: 109.67 to 562.87, p < 0.05, respectively; the centre of pressure velocity during eye opened and eye closed conditions 6.68 mm/s, 95% CI: 4.41 to 8.95, p < 0.01 and 6.77 mm/s, 95% CI: 4.01 to 9.54, p < 0.01, respectively).ConclusionThe three-week proprioceptive neuromuscular facilitation training provides better pain intensity, disability and static balance ability than general trunk exercises for working-age individuals with chronic low back pain but the effects do not reach the clinical meaningful level. The therapists should consider carefully when making recommendations regarding these interventions, taking into account effectiveness and costs.     

The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study

ObjectiveTo establish if health literacy (HL) is linked to poorer outcomes and behaviours in patients with chronic pain.DesignA prospective cross-sectional observational study.SettingMultidisciplinary out-patient pain clinics in three university teaching hospitals.PatientsNew patients (n = 131) referred to the pain clinic with a history of chronic pain (>12 weeks).MethodsA questionnaire was distributed to chronic pain patients attending their first appointment. Those eligible for inclusion were newly referred patients who had pain lasting longer than three months. The questionnaire comprised the following sections: demographics, chronic pain status and disease-related knowledge, quality of life (SF-36), beliefs (Beliefs About Pain Control Questionnaire), and a validated HL tool (Newest Vital Sign).ResultsOf the 131 participants recruited, 54% had inadequate HL. The group was subsequently stratified according to HL level. In bivariate analysis, inadequate HL was associated with older age (p < 0.001), being unemployed or retired (p = 0.005), less education (p < 0.001), lower income, increased comorbidities (p = 0.038), being less likely to utilise allied health services (p = 0.001), poorer disease-related knowledge (p = 0.002), and poorer beliefs about pain (p < 0.05). In multivariate analysis, disease-related knowledge (OR 2.5, 95%CI 1.0 to 6.3, p = 0.05) and beliefs about pain (B = −2.3, S.E = 0.9, p = 0.01) remained independently associated with HL.ConclusionInadequate HL is prevalent in chronic pain patients, and may impact on the development of certain characteristics necessary for effective self-management.     

The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain

Extensive computer use amongst office workers has lead to an increase in work-related neck pain. Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors. This study compared the activity (surface electromyography) of the three portions of the trapezius in healthy controls (n = 20) to a neck pain group with poor scapular posture (n = 18) during the performance of a functional typing task. A scapular postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater activity in the middle trapezius (MT) (p = 0.02) and less activity in the lower trapezius (LT) (p = 0.03) than the control group. Following correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions (p = 0.09; p = 0.91). These findings indicate that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals.     

Multimodal group rehabilitation compared to usual care for patients with chronic neck pain: A pilot study

The aim of this pilot randomised controlled trial (RCT) was to compare multimodal group rehabilitation to usual care physiotherapy for patients with chronic neck pain (CNP). Participants (n = 14) were randomly assigned to one of two interventions, multimodal group rehabilitation or usual care physiotherapy. Multimodal group rehabilitation involved stability, strengthening and proprioceptive exercises along with an educational programme. Patients attended for 1 h, once a week for six weeks. The usual care group was treated as deemed appropriate by their physiotherapist. A blinded assessor recorded baseline and post-intervention scores of disability and pain using the neck disability index (NDI) and the 0–10 pain numerical rating scale (NRS), respectively. One participant from each group dropped out before receiving any intervention. Post-intervention both groups significantly improved in both function and pain scores (p ≤ 0.01). The mean change in the NDI scores for the multimodal group versus the usual care group were 12.3 ± 5.3% and 7.4 ± 4.8%, and pain NRS score changes were 4.6 ± 2.3 and 4.5 ± 2.2, respectively. There was no significant difference in improvements in disability (p = 0.84) or pain (p = 0.67) between groups. These results warrant further investigation of multimodal group rehabilitation for CNP, and provide data to inform an appropriately powered full-scale RCT with long-term follow-up.     

A contemporary neuroscience approach compared to biomedically focused education combined with symptom-contingent exercise therapy in people with chronic whiplash associated disorders: a randomized controlled trial protocol

BackgroundTo address the need for a better treatment of chronic whiplash associated disorders (WAD), a contemporary neuroscience approach can be proposed.ObjectiveTo examine the effectiveness of a contemporary neuroscience approach, comprising pain neuroscience education, stress management, and cognition-targeted exercise therapy versus conventional physical therapy for reducing disability (primary outcome measure) and improving quality of life and reducing pain, central sensitization, and psychological problems (secondary outcome measures) in people with chronic WAD.MethodsThe study is a multi-center, two-arm randomized, controlled trial with 1-year follow-up and will be performed in two university-based and one regional hospital. People with chronic WAD (n = 120) will be recruited. The experimental group will receive pain neuroscience education followed by cognition-targeted exercise therapy, and stress management. The control group will receive biomedically focused education followed by graded and active exercise therapy focusing on muscle endurance, strength, and flexibility, and ergonomic principles. The treatment will have a duration of 16 weeks. Functional status (Neck Disability Index) is the primary outcome measure. Secondary outcome measures include quality of life, pain, central sensitization, and psychological and socio-economic factors. In addition, electroencephalography will measure brain activity at rest and during a conditioned pain modulation paradigm. Assessments will take place at baseline, immediately post-treatment and at 6 and 12 months follow-up.ConclusionsThis study will examine whether a contemporary neuroscience approach is superior over conventional physical therapy for improving functioning, quality of life, and reducing pain, central sensitization, and psychological problems in people with chronic WAD.     

Lumbar extensor muscle force control is associated with disability in people with chronic low back pain

BackgroundThe ability to control lumbar extensor force output is necessary for daily activities. However, it is unknown whether this ability is impaired in chronic low back pain patients. Similarly, it is unknown whether lumbar extensor force control is related to the disability levels of chronic low back pain patients.MethodsThirty-three chronic low back pain and 20 healthy people performed lumbar extension force-matching task where they increased and decreased their force output to match a variable target force within 20%–50% maximal voluntary isometric contraction. Force control was quantified as the root-mean-square-error between participants' force output and target force across the entire, during the increasing and decreasing portions of the force curve. Within- and between-group differences in force-matching error and the relationship between back pain group's force-matching results and their Oswestry Disability Index scores were assessed using ANCOVA and linear regression respectively.FindingsBack pain group demonstrated more overall force-matching error (mean difference = 1.60 [0.78, 2.43], P < 0.01) and more force-matching error while increasing force output (mean difference = 2.19 [1.01, 3.37], P < 0.01) than control group. The back pain group demonstrated more force-matching error while increasing than decreasing force output (mean difference = 1.74, P < 0.001, 95%CI [0.87, 2.61]). A unit increase in force-matching error while decreasing force output is associated with a 47% increase in Oswestry score in back pain group (R² = 0.19, P = 0.006).InterpretationLumbar extensor muscle force control is compromised in chronic low back pain patients. Force-matching error predicts disability, confirming the validity of our force control protocol for chronic low back pain patients.     

The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain

Deep cervical flexor muscle (DCF) activation is impaired with neck pain. This study investigated the effects of low load cranio-cervical flexion (C-CF) and neck flexor strengthening exercises on spatial and temporal characteristics of DCF activation during a neck movement task and a task challenging the neck's postural stability. Forty-six chronic neck pain subjects were randomly assigned to an exercise group and undertook a 6-week training program. Electromyographic (EMG) activity was recorded from the DCF, sternocleidomastoid (SCM) and anterior scalene (AS) muscles pre and post intervention during the cranio-cervical flexion test (CCFT) and during perturbations induced by rapid, unilateral shoulder flexion and extension. C-CF training increased DCF EMG amplitude and decreased SCM and AS EMG amplitude across all stages of the CCFT (all P < 0.05). No change occurred in DCF EMG amplitude following strength training. There was no significant between group difference in pre-post intervention change in relative latency of DCF but a greater proportion of the C-CF group shortened the relative latency between the activation of the deltoid and the DCF during rapid arm movement compared to the strength group (P < 0.05). Specific low load C-CF exercise changes spatial and temporal characteristics of DCF activation which may partially explain its efficacy in rehabilitation.     

Comparison Between Neck Pain Disability and Cervical Range of Motion in Patients With Episodic and Chronic Migraine: A Cross-Sectional Study

ObjectiveThe purpose of this study was to evaluate neck pain–related disability and cervical range of motion (CROM) in patients with episodic migraine (EM) and chronic migraine (CM) and to examine the correlation of both outcomes.MethodsThis cross-sectional study consisted of 91 patients with EM and 34 with CM. Cervical range of motion was measured with the CROM device, and pain during the cervical movement was recorded. Self-reported disability related to neck pain was assessed with the Neck Disability Index.ResultsPatients with CM showed higher Neck Disability Index scores and more moderate and severe disability (P = .01). Severe disability as a result of neck pain was associated with 7.6-fold risk of developing CM (P = .003). No significant differences in CROM were identified between groups. Moderate negative correlations between CROM and disability were found for 4 motions within the CM group (− 0.60 < r < − 0.39) and with 3 in the EM group (− 0.48 < − 0.45). Disability was positively and moderately correlated to pain evoked during CROM in both groups (0.34 < r < 0.51).ConclusionThis study found that neck pain was highly prevalent in patients with migraine. Neck pain–related disability increased with increased frequency of the migraine attacks and was associated with the risk of migraine chronicity. The correlation between CROM and neck pain disability was more evident in patients with CM and in patients with pain during cervical movement.     

Pain Catastrophizing and Pain-Related Fear in Osteoarthritis Patients: Relationships to Pain and Disability

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps ≤ 0.05) of variance in measures of pain (partial r² [pr²] = 0.10), psychological disability (pr² = 0.20), physical disability (pr² = 0.11), and gait velocity at normal (pr² = 0.04), fast (pr² = 0.04), and intermediate speeds (pr² = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr² = 0.07) and walking at a fast speed (pr² = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.     

Walking speed best explains perceived locomotion ability in ambulatory people with chronic stroke,assessed by the ABILOCO questionnaire

BackgroundThe identification of the predictors of locomotion ability could help professionals select variables to be considered during clinical evaluations and interventions.ObjectiveTo investigate which impairment measures would best predict locomotion ability in people with chronic stroke.MethodsIndividuals (n = 115) with a chronic stroke were assessed. Predictors were characteristics of the participants (i.e. age, sex, and time since stroke), motor impairments (i.e. muscle tonus, strength, and motor coordination), and activity limitation (i.e. walking speed). The outcome of interest was the ABILOCO scores, a self-reported questionnaire for the assessment of locomotion ability, designed specifically for individuals who have suffered a stroke.ResultsAge, sex, and time since stroke did not significantly correlate with the ABILOCO scores (−0.07 < ρ < 0.05; 0.48 < p < 0.99). Measures of motor impairments and walking speed were significantly correlated with the ABILOCO scores (−0.25 < r < 0.57; p < 0.001), but only walking speed and strength were kept in the regression model. Walking speed alone explained 35% (F = 55.5; p < 0.001) of the variance in self-reported locomotion ability. When strength was included in the model, the explained variance increased to 37% (F = 31.4; p < 0.001).ConclusionsWalking speed and lower limb strength best predicted locomotion ability as perceived by individuals who have suffered a stroke.     

The interrater reliability of a pain mechanisms-based classification for patients with nonspecific neck pain

ObjectiveTo examine the interrater reliability and agreement of a pain mechanisms-based classification for patients with nonspecific neck pain (NSNP).MethodsDesign – Observational, cross-sectional reliability study with a simultaneous examiner design. Setting: University hospital-based outpatient physical therapy clinic. Participants: A random sample of 48 patients, aged between 18 and 75 years old, with a primary complaint of neck pain was included. Interventions: Subjects underwent a standardized subjective and clinical examination, performed by 1 experienced physical therapist. Two assessors independently classified the participants’ NSNP on 3 main outcome measures. Main outcome measures: The Cohen kappa, percent agreement, and 95% confidence intervals (CIs) were calculated to determine the interrater reliability for (1) the predominant pain mechanism; (2) the predominant pain pattern; and (3) the predominant dysfunction pattern (DP).ResultsThere was almost perfect agreement between the 2 physical therapists’ judgements on the predominant pain mechanism, kappa = .84 (95% CI, .65–1.00), p < .001. There was substantial agreement between the raters’ judgements on the predominant pain pattern and predominant DP with respectively kappa = .61 (95% CI, .42–.80); and kappa = .62 (95% CI, .44–.79), p < .001.Conclusion(s)The proposed classification exhibits substantial to almost perfect interrater reliability. Further validity testing in larger neck pain populations is required before the information is used in clinical settings.Clinical trial registration numberNCT03147508 (https://clinicaltrials.gov/ct2/show/NCT03147508).     

Treating low back pain resulted from lumbar degenerative instability using Chinese Tuina combined with core stability exercises: A randomized controlled trial

BackgroundThe therapeutic effect of Tuina combined with core stability exercises on low back pain resulted from lumbar degenerative instability is unclear. This article aims to evaluate whether core stability exercises can improve the effect of Tuina in this regard.MethodsThis trial was designed as a randomized controlled trial and carried out in Qingzhou hospital of Traditional Chinese medicine between June 2011 and June 2013. Eighty-eight patients with low-grade lumbar degenerative instability were included and divided randomly into experimental and control groups, 44 in each. The experimental group were treated using Tuina combined with core stability exercises, but the control group using Tuina alone. The evaluation of Visual analogue scale (VAS), Japanese Orthopaedic Association scores (JOA) and recurrence rate were performed.ResultsTwo weeks after treatment, JOA scores increased (p < 0.05) and VAS decreased (p < 0.05) significantly when compared with those before treatment in both groups, but there was no significant difference (p > 0.05) between the two groups. At the end of six weeks, VAS scores (p < 0.05) decreased and JOA scores (p < 0.05) increased significantly when compared to those before treatment in both groups. In addition, the VAS (p < 0.05) scores were significantly lower, JOA scores (p < 0.05) were significantly higher in experimental group than those in control group. At the final follow-up, seven cases (17.1%) in experimental group and eighteen (43.9%) in control group recurred, the control group has a significantly higher recurrence rate (p < 0.05). No adverse events occurred in the trial.ConclusionsChinese Tuina combined with core stability exercises has better effect than Tuina alone in treating low back pain resulted from low-grade lumbar degenerative instability.     

The relationship between psychological distress and free-living physical activity in individuals with chronic low back pain

The aim of this cross-sectional pilot-study was to investigate the relationship between psychological distress and free-living physical activity (PA) in individuals with chronic low back pain (CLBP). Thirty-eight participants with non-specific CLBP (29 = distressed; 9 = non-distressed) were recruited. PA levels were measured using an accelerometer (activPAL? activity monitor) over a one week period. The following parameters of physical activity were recorded: time upright (standing or walking), time standing, time walking, and step count. Psychological distress was assessed using a modified version of the distress risk assessment method (DRAM) which is a combination of somatic anxiety and depressive symptoms. The Distressed group spent significantly less time upright over a mean 24 h day (?1.47 h, 95% CI ?2.70 to ?0.23 h, p < 0.05), attributable to 1.01 h less standing and 0.46 h less walking. Depressive symptoms were a statistically significant independent predictor of time upright (β = ?0.49, p < 0.05). This pilot-study found that individuals with CLBP and elevated levels of distress spend less time upright than their non-distressed counterparts. Clinically, when treating individuals with CLBP and elevated distress levels, free-living PA may be low and interventions aimed at increasing upright activity may be appropriate.     

Comparison of the repercussions of cLBP in four French-speaking countries

IntroductionSociocultural factors may influence the impact of chronic low back pain (cLBP) on patients. The goal of this study was to compare pain and disability levels, and psychobehavioural parameters in four French-speaking countries in patients with cLBP.MethodsTwo hundred and seventy-eight patients were included: 83 in France, 36 in Morocco, 75 in the Ivory Coast and 84 in Tunisia. Demographic data were collected; pain was assessed using a visual analogue scale (VAS), disability with the Quebec scale, psychobehavioural factors by the hospital anxiety depression scale (HAD), the fear and avoidance beliefs questionnaire (FABQ) and the coping strategy questionnaire (CSQ). A Student t-test was used to compare means. Anova (covariance) was used to test for a “Country Effect”, i.e. the incidence of country on outcomes.OutcomesThere was no difference in disability levels between countries. A “country effect” was found (p < 0.001) for pain (F = 2.707), anxiety (F = 3.467), depression (F = 5.137), fear and avoidance beliefs regarding professional activity (F = 1.974) and physical activity (F = 5.076), strategy of distraction, dramatization, efforts to ignore pain, prayer, seeking social support and reinterpretation (p < 0.01). Pain level was higher in Morocco (p < 0.05); anxiety, depression, fear and avoidance beliefs about physical activities were higher in Tunisia (p < 0.05) and fear and avoidance beliefs about professional activities were higher in the Ivory Coast (p < 0.01). Among the coping strategies used, distraction, dramatization, prayer and search for social support were used more in the Ivory Coast; reinterpretation in Tunisia; seeking social support was less common in France.ConclusionIn this population of patients with cLBP, despite similar disability levels across the four French-speaking countries, there were considerable variations in pain level and psychobehavioural repercussions.     

Relation of atrial fibrillation (AF) and change of lipoproteins: Male patients with AF exhibited severe pro-inflammatory and pro-atherogenic properties in lipoproteins

ObjectivesThis study was designed to search putative biomarkers for detection of relatively young-onset atrial fibrillation (AF).Design and methodsWe analyzed serum lipoproteins from male patients with paroxysmal AF (48 ± 9 years old, n = 29) and controls with similar age (50 ± 10 years old, n = 27), who visited our hospital for radiofrequency catheter ablation due to paroxysmal supraventricular tachycardia.ResultsAlthough the AF group showed normal serum cholesterol level, they exhibited 16% lower HDL-cholesterol and 13% higher serum cholesteryl ester transfer protein activity than those of the control group. The AF group showed elevated levels of serum triglyceride (TG) and C-reactive protein with hyperuricemia. However, there was no difference between serum levels of creatinine, troponin I, and serum amyloid A. All lipoproteins from the AF group contained higher level of TG, oxidized species, and advanced glycated end products. LDL from the AF group (AF-LDL) showed 2.7-fold more content of malondialdehyde than the control group (p < 0.04) and exhibited higher sensitivity of oxidation. HDL-associated paraoxonase from the AF group showed impaired antioxidant ability and lowered expressional level of apoA-I (p < 0.01) and paraoxonase (p < 0.005) in HDL₃.ConclusionLipoprotein properties were severely impaired in the AF group with increased extent of oxidation and inflammation. The modified lipoprotein properties with impaired antioxidant functions can be used as a putative biomarker for prognostic detection for the relatively young onset AF.     

Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare – A randomised controlled trial

A large proportion of patients who consult primary healthcare for musculoskeletal pain are referred for orthopaedic consultation, but only a small number of these patients are appropriate for orthopaedic intervention. Experienced physiotherapists have the appropriate knowledge to manage musculoskeletal disorders. The primary aim of this randomised study was therefore to evaluate a screening by a physiotherapist of patients referred for orthopaedic consultation compared to standard practice in primary care.Patients referred for orthopaedic consultation (n = 203) were randomised to physiotherapy screening or standard practice. Selection accuracy for orthopaedic intervention and other referrals were analysed with proportion analysis. Patient views of the quality of care were analysed with Mann–Whitney U-test, waiting time with Independent t-test.There was higher selection accuracy for orthopaedic intervention in the physiotherapy screening group (p = 0.002). A smaller proportion of patients in the screening group were referred back to their general practitioner (GP) (p < 0.001) and a larger proportion to the physiotherapy clinic (p < 0.001) compared to standard practice. The proportion of patients referred for further investigations was significantly lower in the physiotherapy screening group (p < 0.039). Waiting time was shorter in the screening group (p < 0.001). A large proportion of the patients reported no hesitation to attend the clinic for future care, no difference between the groups (p < 0.95).The findings in this study suggest that an experienced physiotherapist effectively can screen patients referred for orthopaedic consultation in primary healthcare.