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Objective: The long-lasting persistence of autoantibodies stands as one of the hypotheses explaining the multisystemic manifestations seen in individuals with post-COVID-19 condition. The current review offers restricted insights into the persistence of autoantibodies in plasma/serum in people with post-COVID symptoms., Methods: PubMed/MEDLINE, CINAHL, EMBASE, and Web of Science databases, as well as on medRxiv and bioRxiv preprint servers were searched up to January 5 th , 2024. Papers investigating the presence of autoantibodies in plasma/serum samples in people with post-COVID symptoms were included. The Newcastle-Ottawa Scale (NOS) was used to assess methodological quality., Results: From 162 identified records, five articles met all inclusion criteria; four studies included infected controls with no post-COVID symptoms whereas all five studies included non-infected controls (410 COVID-19 survivors with post-COVID symptoms, 223 COVID-19 survivors with no post-COVID symptoms as controls and 266 non-infected healthy controls). Four studies concluded that the presence of autoantibodies had a potential (but small) role in post-COVID-19 condition whereas one study concluded that autoantibodies were not associated. Quality assessment showed all studies had high methodological quality., Conclusion: Although evidence suggests that persistent autoantibodies can be associated with post-COVID symptoms, the clinical relevance of their presence seems modest at this stage. Current results highlight further research to clarify the role of autoantibodies in the development of post-COVID symptoms, guiding the development of tailored diagnostic and treatment approaches to enhance patient outcomes., Systematic Review Registration: https://osf.io/vqz28., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Notarte, Carandang, Velasco, Pastrana, Ver, Manalo, Ng, Grecia, Lippi, Henry and Fernández-de-las-Peñas.)

It is known that SARS-CoV-2 can translocate via membrane ACE2 exopeptidase into the host cells, and thus hypomethylation of ACE2 possibly upregulates its expression, enhancing the risk of SARS-CoV-2 infection. This study investigated if DNA methylation levels of the ACE2 promoter are associated with the development of post-COVID-19 symptomatology in a cohort of COVID-19 survivors who had been previously hospitalized. Non-stimulated saliva samples were obtained from 279 (51.5 male, mean age: 56.5 ± 13.0 years old) COVID-19 survivors who were hospitalized during the first wave of the pandemic. A face-to-face interview in which patients described the presence of post-COVID-19 symptoms (defined as a symptom that started no later than three months after SARS-CoV-2 infection) that they suffered from to an experienced healthcare trainer was conducted. Methylation of five CpG dinucleotides in the ACE2 promoter was quantified using bisulfite pyrosequencing. The percentage of methylation (%) was associated with the presence of the following reported post-COVID-19 symptoms: fatigue, dyspnea at rest, dyspnea at exertion, brain fog, memory loss, concentration loss, or gastrointestinal problems. Participants were assessed a mean of 17.8 (SD: 5.3) months after hospitalization. At that time, 88.1% of the patients experienced at least one post-COVID-19 symptom (mean number for each patient: 3.0; SD: 1.9 post-COVID-19 symptoms). Dyspnea at exertion (67.3%), fatigue (62.3%), and memory loss (31.2%) were the most frequent post-COVID-19 symptoms in the sample. Overall, the analysis did not reveal any difference in the methylation of the ACE2 promoter in any of the CpG locations according to the presence or absence of fatigue, dyspnea at rest, dyspnea at exertion, memory loss, brain fog, concentration loss, and gastrointestinal problems. This study did not find an association between methylation of ACE2 promoter and the presence of post-COVID-19 fatigue, dyspnea, cognitive or gastrointestinal problems in previously hospitalized COVID-19 survivors.

Background: Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated., Objective: To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain., Methods: Thirty-one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)., Results: The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale., Conclusion: Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia., (© 2024 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

The aim of this study was to investigate the effects of administrating Remdesivir at the acute COVID-19 phase on developing post-COVID symptoms in previously hospitalized COVID-19 survivors by controlling factors such as age, sex, body mass index, and vaccination status. A case-control study was performed. Hospitalized COVID-19 survivors who had received intravenous Remdesivir during the acute phase (n = 216) were matched by age, sex, body mass index, and vaccination status with survivors who did not receive antiviral treatment (n = 216). Participants were asked to self-report the presence of any post-COVID symptom (defined as a symptom that started no later than three months after infection) and whether the symptom persisted at the time of study (mean: 18.4, SD: 0.8 months). Anxiety levels (HADS-A), depressive symptoms (HADS-D), sleep quality (PSQI), and severity/disability (FIC) were also compared. The multivariate analysis revealed that administration of Remdesivir at the acute COVID-19 phase was a protective factor for long-term COVID development (OR0.401, 95%CI 0.256-0.628) and specifically for the following post-COVID symptoms: fatigue (OR0.399, 95%CI 0.270-0.590), pain (OR0.368, 95% CI 0.248-0.548), dyspnea at rest (OR0.580, 95%CI 0.361-0.933), concentration loss (OR0.368, 95%CI 0.151-0.901), memory loss (OR0.399, 95%CI 0.270-0.590), hair loss (OR0.103, 95%CI 0.052-0.207), and skin rashes (OR0.037, 95%CI 0.005-0.278). This study supports the potential protective role of intravenous administration of Remdesivir during the COVID-19 acute phase for long-lasting post-COVID symptoms in previously hospitalized COVID-19 survivors.

Objective: The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE)., Methods: Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5-C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, width) of the common wrist extensor tendon and extensor carpi radials brevis muscle as well as thickness of supinator muscle were assessed., Results: Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space at the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123-0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268-0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side., Conclusions: This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE., Impact Statement: Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Clinical practice guidelines recommend the radial nerve mechanosensitivity evaluation in patients with lateral epicondylalgia. Despite different positions and sequences having been described, no research analyzed how each variation triggers symptoms associated with lateral epicondylalgia. The aim of this study was to explore the effects of different positions and sequences in the upper limb neural tension test 2b (ULNT2b) in symptom responses in patients with lateral epicondylalgia., Methods: In this observational study, 66 patients underwent 4 test conditions: standard ULNT2b, ULNT2b proximal to distal, ULNT2B with resisted supination, and resisted supination isolated. Paresthesia sensations, symptom reproduction, pain intensity (measured using a visual analog scale), and distribution of painful symptoms data were collected., Results: Significant differences in paresthesia sensations were observed between groups, with significant differences between the standard ULNT2B and other ULNT variations or resisted supination maneuvers. Symptom reproduction also differed significantly across groups, with significant differences between the standard ULNT2B and other ULNT or resisted supination tests. The positive/negative test and percentage of distribution of painful symptoms scores varied significantly across 4 conditions in both lateral and frontal views. Although pain intensity scores during tests were comparable among the tests, distribution of painful symptoms differed significantly., Conclusion: Variations in the ULNT2b test can affect symptom responses in patients with lateral epicondylalgia. The standard ULNT2b test appears more effective at reproducing symptoms, intensity of paresthesia, and distribution of painful symptoms compared to other ULNT variations and the resisted supination test., Impact: ULNT2b sequences have been shown to elicit varying responses concerning paresthesia, replication of familiar symptoms, positive/negative test results, and distribution of painful symptoms. Clinicians should consider specific test variations during the patients' radial nerve mechanosensitivity assessment to identify aggravating factors reproducing recognizable symptoms. A control group of asymptomatic participants and the role of presence of other comorbidities, psychological factors, or the duration of symptoms were not considered in this study and might play an important role influencing the results of the tests., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: This systematic review and meta-analysis aimed to determine the effectiveness of psychologically informed practice (PIP) with behavioural graded activity (BGA) compared to (1) waitlist controls (WLC), (2) other interventions (OI), (3) PIP alone or (4) BGA alone in cancer patients and survivors (CPaS)., Methods: PubMed, Web of Science and Embase were screened for randomised controlled trials encompassing BGA + PIP in CPaS. Effect sizes were inventoried for outcomes regarding physical activity (PA), quality of life (QoL) and debilitating symptoms (DS), which were assessed at four time points: post-intervention (PI), follow-up F1 (1 to 3 months), F2 (4 to 6 months) and F3 (> 6 months). The quality of the evidence was classified by the GRADE approach., Results: Thirty-three studies were found eligible, comprising 4330 participants. Significant effects with low heterogeneity of PIP + BGA comparing to WLC were found for anxiety (SMD - 1.29 [-1.71; - 0.86]), depression (SMD - 0.79 [- 1.10; - 0.48]), functional impairment (SMD - 0.72 [- 0.95; - 0.50]), PA (self-reported: (SMD - 0.58 [- 0.84; - 0.32]) and objectively measured: (SMD - 0.51 [- 0.90; - 0.13])) and social impairment (SMD - 0.33 [- 0.58; - 0.08]). When comparing PIP + BGA to OI, fatigue (SMD - 0.35 [- 0.51; - 0.20]) and PA (SMD - 0.26 [- 0.41; - 0.11]) at PI, and fatigue (SMD - 0.34 [- 0.58; - 0.10]) at F1 were found significant with low heterogeneity. No significant effects were observed in the meta-analyses of studies comparing PIP + BGA to BGA or PIP alone., Conclusions: PIP with BGA has a favourable effect on DS, PA and QoL in CPaS when compared to non-behavioural interventions such as WLC, usual care and education. However, further research is needed on 'how' and 'when' PIP + BGA should be provided in cancer rehabilitation., Implications for Cancer Survivors: PIP + BGA has the potential to facilitate CPaS to reach the recommended amount of PA and reduce DS., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The aim of the study was to compare the effectiveness of a telerehabilitation exercise program versus "wait-and-see" on physical exertion, quality of life, dyspnea severity, heart rate, and oxygen saturation in patients with post-COVID fatigue and dyspnea., Design: Sixty-four patients were enrolled in this randomized clinical trial. A telerehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes, and the 6-min walking test were assessed at baseline, after the program and at 1- and 3-mo follow-up periods., Results: The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life, and 6-min walking test (all, P < 0.001). In addition, patients undergoing the telerehabilitation program reported lower exertion scores at rest and after the 6-min walking test (both, P < 0.001). Between-group oxygen saturation differences were found at rest ( P < 0.001), but not after the 6-min walking test ( P = 0.024). Finally, significant between-group differences were found for heart rate after the 6-min walking test ( P < 0.001)., Conclusions: Although both groups showed a significant improvement after 3 mos of follow-up, the group receiving the telerehabilitation program described a greater improvement compared with the group receiving no intervention., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Percutaneous electrical nerve stimulation (PENS) appears to be effective for the treatment of musculoskeletal pain. The aim of this trial was to investigate the effects on disability and pain, as well as on the psychological aspects of adding PENS into an exercise program in patients with subacromial pain syndrome. Methods: A randomized, parallel-group clinical trial was conducted. Sixty patients with subacromial pain were allocated into exercise alone (n = 20), exercise plus PENS (n = 20), or exercise plus placebo PENS (n = 20) groups. Patients in all groups performed an exercise program twice daily for 3 weeks. Patients allocated to the PENS group also received four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves. Patients allocated to the exercise plus placebo PENS received a sham PENS application. The primary outcome was related disability (Disabilities of the Arm, Shoulder, and Hand, DASH). Secondary outcomes included mean pain, anxiety levels, depressive symptoms, and sleep quality. They were assessed at baseline, one week after, and one and three months after. An analysis was performed using intention-to-treat with mixed-models ANCOVAs. Results : The results revealed no between-group differences for most outcomes (related disability: F = 0.292, p = 0.748, n 2 p = 0.011; anxiety: F = 0.780, p = 0.463, n 2 p = 0.027; depressive symptoms: F = 0.559, p = 0.575, n 2 p = 0.02; or sleep quality: F = 0.294, p = 0.747, n 2 p = 0.01); both groups experienced similar changes throughout the course of this study. Patients receiving exercise plus PENS exhibited greater improvement in shoulder pain at one month than those in the exercise (Δ -1.2, 95%CI -2.3 to -0.1) or the placebo (Δ -1.3, 95%CI -2.5 to -0.1) groups. Conclusions: The inclusion of four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves into an exercise program did not result in better outcomes in our sample of patients with subacromial pain syndrome at one and three months after treatment.

This population-based study investigated the prevalence of de novo, multitype, post-coronavirus disease (COVID) pain and its associated risk factors in previously hospitalized coronavirus disease 2019 (COVID-19) survivors. The nationwide, cross-sectional study included a cohort of Danish residents previously hospitalized due to severe acute respiratory syndrome coronavirus-2 infection between March 2020 and December 2021. Demographic data, preexisting medical comorbidities, previous pain-related symptoms, medication use for pain management, pain intensity (4-point scale), and development of de novo, multitype, post-COVID pain were collected by a self-reported survey distributed via e-Boks (a secured national digital mail system used in Denmark to provide public information to residents). The sample comprised 4,712 previously hospitalized COVID-19 survivors (48.6% women, mean age: 60.1 ± 15.6 years). At the time of the study (21 ± 6 months after hospitalization), 18.0% (847) reported the presence of de novo, multitype, post-COVID pain, and 38.6% of any pain. A multivariate analysis revealed that female sex (Odds Ratio (OR) 1.711, 95% Confidence Interval (CI) 1.444-2.023), higher body mass index (OR 1.032, 95% CI 1.019-1.045), intensive care unit admission (OR 1.597, 95% CI 1.324-1.926), previous history of whiplash (OR 2.471, 95% CI 1.004-6.081), anxiety (OR 3.626, 95% CI 1.335-9.708), and younger age (OR .982, 95% CI .976-.987) were factors associated with development of de novo, multitype, post-COVID pain. High income (OR .635, 95% CI .494-.817) and high educational level (OR .774, 95% CI .609-.984) were protective factors. In conclusion, multitype pain as a de novo post-COVID symptom was present in 18.0% of previously hospitalized COVID-19 survivors more than 1 year after hospital discharge and as such can be considered as adding to the global burden of chronic pain. PERSPECTIVE: The study investigates the prevalence of de novo, multitype, post-COVID pain in previously hospitalized COVID-19 survivors. This article presents potential risk factors associated with developing new pain symptoms. The results will contribute to understanding the possibility of predicting postinfectious pain from COVID-19 for future analysis., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Patients with fibromyalgia syndrome tend to report deficits in cognitive functions; however, there is no clear consensus on which cognitive domains are impaired. The aim of this study was to compare the differences in cognitive performance between a group of patients with fibromyalgia syndrome and a group of pain-free subjects controlling for the covariables anxiety, depression, and sleep quality. In total, 130 patients with fibromyalgia syndrome and 111 pain-free subjects with an average age of 54.96 years completed the evaluation protocol consisting of sociodemographic data, psychological data, and neurocognitive tests. All data were collected from May 2022 to May 2023. Multivariate analyses of covariance (MANCOVAs) were conducted to assess intergroup differences in all neurocognitive tests. MANCOVA analyses showed that the group of patients with fibromyalgia showed a worse cognitive performance than the group of pain-free subjects after controlling for anxiety, depression, and sleep quality. This study found that fibromyalgia patients exhibited worse cognitive performance and executive function than pain-free subjects. Thus, cognitive performance seems to not be related with anxiety, depression, or sleep quality in our sample of women with FMS.

To investigate the association between three selected pain polymorphisms and clinical, functional, sensory-related, psychophysical, psychological or cognitive variables in a sample of women with fibromyalgia (FMS). One hundred twenty-three (n = 123) women with FMS completed demographic (age, height, weight), clinical (years with pain, intensity of pain at rest and during daily living activities), functional (quality of life, physical function), sensory-related (sensitization-associated and neuropathic-associated symptoms), psychophysical (pressure pain thresholds), psychological (sleep quality, depressive and anxiety level) and cognitive (pain catastrophizing, kinesiophobia) variables. Those three genotypes of the OPRM1 rs1799971, HTR1B rs6296 and COMT rs4680 single nucleotide polymorphisms were obtained by polymerase chain reactions from no-stimulated whole saliva collection. No significant differences in demographic, clinical, functional, sensory-related, psychophysical, psychological and cognitive variables according to OPRM1 rs1799971, HTR1B rs6296 or COMT rs4680 genotype were identified in our sample of women with FMS. A multilevel analysis did not either reveal any significant gene-to-gene interaction between OPRM1 rs1799971 x HTR1B rs6296, OPRM1 rs1799971 x COMT rs4680 and HTR1B rs6296 x COMT rs4680 for any of the investigated outcomes. This study revealed that three single nucleotide polymorphisms, OPRM1 rs1799971, HTR1B rs6296 or COMT rs4680, mostly associated with chronic pain were not involved in phenotyping features of FMS. Potential gene-to-gene interaction and their association with clinical phenotype in women with FMS should be further investigated in future studies including large sample sizes., (© 2024. The Author(s).)

Background: Evidence suggests the plantar fascia and its interphase with the flexor digitorum brevis muscle can play a relevant role in plantar heel pain. Needling interventions could offer an appropriate treatment strategy to addressing this interface., Objective: We compared the accuracy and safety of ultrasound-guided versus palpation-guided procedures for the proper targeting of the interface between the plantar fascia and the flexor digitorum brevis with a solid needle., Methods: A crossover cadaveric study was conducted. Five experienced therapists performed a series of 20 needle insertions each (n = 100 in total, 10 landmark-guided and 10 ultrasound-guided) on 10 anatomical samples. The therapists were instructed to accurately place the needle on the interface between the plantar fascia and the flexor digitorum brevis muscle. The distance of the tip of the needle to the identified target (accuracy), the surrounding sensitive structures targeted (safety), the time needed for the procedure, the number of needle passes, and the needle length outside the skin were assessed., Results: The ultrasound-guided technique was associated with a significantly higher accuracy ( p < 0.001) but without differences in safety ( p = 0.249) as compared to the palpation-guided procedure., Conclusion: Our results suggest that ultrasound-guided insertion exhibits greater accuracy but not greater safety than palpation-guided insertion when targeting the interface between the plantar fascia and the flexor digitorum brevis.

The SARS-CoV-2 VIrus PERsistence (VIPER) study investigated the presence of long-lasting SARS-CoV-2 RNA in plasma, stool, urine, and nasopharyngeal samples in COVID-19 survivors. The presence of SARS-CoV-2 RNA reverse transcription polymerase chain reactions (RT-PCR) were analyzed within plasma, stool, urine, and nasopharyngeal swab samples in COVID-19 survivors with post-COVID symptoms and a comparison group of COVID-19 survivors without post-COVID symptoms matched by age, sex, body mass index and vaccination status. Participants self-reported the presence of any post-COVID symptom (defined as a symptom that started no later than 3 months after the initial infection). Fifty-seven (57.9% women, age: 51.1, standard deviation [SD]: 10.4 years) previously hospitalized COVID-19 survivors with post-COVID symptoms and 55 (56.4% women, age: 50.0, SD: 12.8 years) matched individuals who had a past SARS-CoV-2 infection without post-COVID symptoms were evaluated 27 (SD 7.5) and 26 (SD 8.7) months after hospital discharge, respectively. The presence of SARS-CoV-2 RNA was identified in three nasopharyngeal samples of patients with post-COVID symptoms (5.2%) but not in plasma, stool, or urine samples. Thus, SARS-CoV-2 RNA was not identified in any sample of survivors without post-COVID symptoms. The most prevalent post-COVID symptoms consisted of fatigue (93%), dyspnea, and pain (both, 87.7%). This study did not find SARS-CoV-2 RNA in plasma, stool, or urine samples, 2 years after the infection. A prevalence of 5.2% of SARS-CoV-2 RNA in nasopharyngeal samples, suggesting a potential active or recent reinfection, was found in patients with post-COVID symptoms. These results do not support the association between SARS-CoV-2 RNA in plasma, stool, urine, or nasopharyngeal swab samples and post-COVID symptomatology in the recruited population., (© 2024 The Authors. Journal of Medical Virology published by Wiley Periodicals LLC.)

Purpose: Shear-wave elastography (SWE) provides quantitative and absolute metrics for analyzing the elasticity of soft tissues. Despite the anterior scalene muscle (AS) is a key structure in patients with neck pain and nerve compressive syndromes, the majority of SWE studies only included asymptomatic subjects. This study aimed to analyze the Young's modulus and shear wave speed test-retest reliability in a sample of patients with neck pain symptoms to characterize the AS stiffness., Methods: A diagnostic accuracy study acquiring a set of ultrasound images at C7 level in 42 patients with mechanical neck pain by one experienced examiner. After blinding the participants' identity, trial and side, the Young's modulus and shear wave velocity were measured by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC) and coefficient of variation (CV%) were calculated., Results: The sample reported moderate pain intensity (5.9/10 points) and disability (17.38/100 points). AS stiffness metrics assessed showed no significant differences between males and females, left and right side nor painful and non-painful side. (all, p > 0.05). Intra-examiner reliability was excellent for calculating the Young's modulus for shear wave speed (ICC > 0.90)., Conclusion: The results support the use of this procedure for assessing the AS stiffness in populations with mechanical neck pain as excellent reliability estimates were obtained. However, future research should analyze case-control differences and the association between SWE metrics with clinical severity indicators., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy., Design: Randomized, single-blinded, multicenter, parallel-group trial., Setting: Thirteen outpatient physical therapy clinics in nine different US states., Participants: One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized., Intervention: Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone., Main Measures: The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake., Results: The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group., Conclusions: The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy. Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017., Competing Interests: Declaration of Conflicting InterestsJ.D. is the Director of the American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy. The American Academy of Manipulative Therapy provides postgraduate training programs in musculoskeletal sonography, vestibular rehabilitation, spinal manipulation, spinal mobilization, dry needling, extremity manipulation, extremity mobilization, instrument-assisted soft-tissue mobilization, therapeutic exercise, and differential diagnosis to licensed physical therapists, dentists, osteopaths, and medical doctors. J.D., I.Y., P.B., P.G., and N.Z. are senior faculty of the American Academy of Manipulative Therapy Fellowship. None of the authors were directly involved with subject recruitment, treatment sessions, or data collection. None of the treating therapists were reimbursed in any way for subject recruitment, treatment sessions, or data collection. The other authors declare that they have no competing interests.

Objective: This cohort study used Sankey plots and exponential bar plots for visualizing the fluctuating nature and trajectory of post-COVID pain in previously hospitalized COVID-19 survivors., Methods: A cohort of 1266 subjects hospitalised because of COVID-19 during the first wave of the pandemic were scheduled for a telephone interview at 8.4 (T1), 13.2 (T2), and 18.3 (T3) months in average after hospitalization for collecting data about post-COVID pain. Patients were asked for about pain symptomatology that was attributed to the infection. Hospitalization and clinical data were collected from medical records., Results: The prevalence of myalgia as COVID-19-associated symptom was 29.82% (n = 389) at hospitalization (T0). The prevalence of post-COVID pain was 41.07% (n = 520) at T1, 34.29% (n = 434) at T2, and 28.47% (n = 360) at T3. The recovery exponential curve revealed a decrease trend visualizing that post-COVID pain improved over the time span investigated. Pain in the lower extremity and widespread pain were the most prevalent locations. Female sex (OR 1.507, 95% CI 1.047-2.169), pre-existing pain symptoms (OR 1.724, 95% CI 1.237-2.403), headache as onset-symptom (OR 2.374, 95% CI 1.550-3.639), days at hospital (OR 1.012, 95% CI 1.000-1.025), and presence of post-COVID pain at T1 (OR 13.243, 95% CI 9.428-18.601) were associated with post-COVID pain at T2. Only the presence of post-COVID pain at T1 (OR 5.383, 95% CI 3.896-7.439) was associated with post-COVID pain at T3., Conclusion: Current results show a fluctuating evolution with a decreasing tendency of post-COVID pain during the first years after hospitalization. The development of post-COVID pain soon after SARS-CoV-2 infection predispose for long-lasting chronic pain., Competing Interests: The authors have no conflict of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)

The aims of this study were to phenotype pain in patients with interstitial lung disease (ILD) by investigating the association between sensitization-associated symptoms with quality of life, anxiety/depression, pain catastrophizing, and kinesiophobia levels and identifying those risk factors explaining the variance of quality of life in individuals with ILD and pain. One hundred and thirty-two (38.6% women, mean age: 70, standard deviation: 10.5 years) patients with ILD completed clinical (age, sex, height, weight), psychological (Hospital Anxiety and Depression Scale [HADS] and the Pittsburgh Sleep Quality Index), and health-related quality of life (EQ-5D-5L) variables, as well as the Central Sensitization Inventory (CSI), the Self-Report Leeds Assessment of Neuropathic Symptoms (S-LANSS), Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia (TSK-11) questionnaires. The prevalence of sensitization-associated symptomatology (CSI), neuropathic-like features (S-LANSS), anxiety symptoms, depressive symptoms, or poor sleep was 20.5%, 23.5%, 23.6%, 22.9%, or 51.6%. Significant associations between CSI, S-LANSS, HADS-A, HADS-D, Pain Catastrophizing Scale, TSK-11, and EQ-5D-5L (.220 < r < .716) were found. The regression analysis revealed that CSI, TSK-11, and HADS-D explained 44.8% of the variance of EQ-5D-5L (r 2 adjusted: .448). This study found the presence of sensitization-associated and neuropathic-like symptoms as well as other central nervous system-derived symptoms, such as anxiety, depression, poor sleep, pain catastrophizing, and kinesiophobia in 25% of ILD patients with pain. Sensitization-associated symptoms, depression, and kinesiophobia were associated with a worse quality of life. These findings would support that individuals with ILD can exhibit different pain phenotypes, including nociplastic-like pain phenotype based on self-reported measurements. PERSPECTIVE: Pain in patients with ILD can fulfill features of different phenotypes, including nociplastic pain, when sensory, emotional, and cognitive mechanisms are involved at the same time., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Background: This exploratory study evaluated the presence of sensitization-associated and neuropathic-like symptoms and identified their association with pressure sensitivity, pain, and disability in patients with cervical dystonia (CD). Methods: Thirty-one patients with CD (74.2% women, age: 61.2 years, SD 10.1) participated. Data collected included clinical variables, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the Central Sensitization Inventory (CSI), the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI), as well as widespread pressure pain thresholds (PPTs). Results: Patients with CD with pain ( n = 20, 64.5%) showed higher scores on the TWSTRS disability subscale and the CSI ( p < 0.001), and lower PPTs ( p < 0.05). Fifteen patients (15/31, 48%) showed sensitization-associated symptoms (CSI ≥ 40), whereas five of the patients with pain (5/20, 25%) exhibited neuropathic-like symptoms (S-LANSS ≥ 12). The CSI and S-LANSS were positively associated with the TWSTRS, HADS-A and HADS-D, and negatively associated with PPTs. HADS-D and S-LANSS explained 72.5% of the variance of the CSI (r 2 : 0.725), whereas CSI explained 42.3% of the variance of the S-LANSS (r 2 : 0.423). Conclusions: Pain is an important source of disability in CD, and may be a consequence of different mechanisms, including sensitization.

Objective: The aims of this study were to assess the psychological, functional, and physical differences between patients with femoroacetabular impingement (FAI) syndrome and individuals who were asymptomatic (controls) to analyze clinical differences among 4 subtypes of FAI (cam type, cam type with labral tear, pincer type, and pincer type with labral tear), to calculate the correlations among the variables described, and to identify risk factors contributing to the hip function variance., Methods: A case-control study was conducted at a hospital rehabilitation unit with a cohort of individuals who were asymptomatic (controls) and a cohort of patients with FAI. Sociodemographic characteristics, pain intensity, psychological health status, hip range of motion (RoM), hip isometric strength, and hip function were assessed., Results: A total of 69 controls and 69 patients with FAI were analyzed. Although sociodemographic characteristics were comparable between samples, poorer hip RoM, strength, and psychological health were found for the cases. FAI subtypes showed no significant pain intensity, psychological health, or RoM differences (except for hip adduction), but hip strength differed among FAI subtypes. Multiple significant correlations between psychological health, pain intensity, RoM, strength, and hip function were found. The variance values of the International Hip Outcome Tool, Hip Outcome Score (HOS) for daily living activities, and HOS for sports activities were partially explained (47.6%, 36.0%, and 21.6%, respectively) on the basis of kinesiophobia, hip strength, self-efficacy, and anxiety., Conclusion: Patients with FAI showed poorer psychological health, hip RoM, and strength than individuals who were asymptomatic and had similar sociodemographic characteristics. FAI subtype influenced the patients' clinical presentations. Hip strength, kinesiophobia, anxiety, and self-efficacy should be targeted for improving hip function, as they have been demonstrated to be important contributors to hip disability., Impact: This study demonstrated that pain catastrophizing, hip strength, and hip adduction differed among FAI subtypes. However, hip function and pain intensity were comparable between FAI subtypes., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background Context: Nonoperative management of lumbar spinal stenosis (LSS) includes activity modification, medication, injections, and physical therapy. Conventional physical therapy includes a multimodal approach of exercise, manual therapy, and electro-thermal modalities. There is a paucity of evidence supporting the use of spinal manipulation and dry needling as an adjunct to conventional physical therapy in patients with LSS., Purpose: This study aimed to determine the effects of adding thrust spinal manipulation and electrical dry needling to conventional physical therapy in patients with LSS., Study Design/setting: Randomized, single-blinded, multi-center, parallel-group clinical trial., Patient Sample: One hundred twenty-eight (n=128) patients with LSS from 12 outpatient clinics in 8 states were recruited over a 34-month period., Outcome Measures: The primary outcomes included the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI). Secondary outcomes included the Roland Morris Disability Index (RMDI), Global Rating of Change (GROC), and medication intake. Follow-up assessments were taken at 2 weeks, 6 weeks, and 3 months., Methods: Patients were randomized to receive either spinal manipulation, electrical dry needling, and conventional physical therapy (MEDNCPT group, n=65) or conventional physical therapy alone (CPT group, n=63)., Results: At 3 months, the MEDNCPT group experienced greater reductions in overall low back, buttock, and leg pain (NPRS: F=5.658; p=.002) and related-disability (ODI: F=9.921; p<.001; RMDI: F=7.263; p<.001) compared to the CPT group. Effect sizes were small at 2 and 6 weeks, and medium at 3 months for the NPRS, ODI, and RMDI. At 3 months, significantly (p=.003) more patients in the MEDNCPT group reported a successful outcome (GROC≥+5) than the CPT group., Conclusion: Patients with LSS who received electrical dry needling and spinal manipulation in addition to impairment-based exercise, manual therapy and electro-thermal modalities experienced greater improvements in low back, buttock and leg pain and related-disability than those receiving exercise, manual therapy, and electro-thermal modalities alone at 3 months, but not at the 2 or 6 week follow-up., Competing Interests: Declarations of Competing Interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To apply Sankey plots and exponential bar plots for visualizing the evolution of anxiety/depressive symptoms and poor sleep in previously hospitalized COVID-19 survivors., Methods: A sample of 1266 subjects who were hospitalized due to a SARS-CoV-2 from March-May 2020 were assessed at 8.4 (T1), 13.2 (T2) and 18.3 (T3) months after hospitalization. The Hospital Anxiety and Depression Scale was used to determine anxiety (HADS-A) and depressive (HADS-D) symptoms. The Pittsburgh Sleep Quality Index (PSQI) evaluated sleep quality. Clinical features, onset symptoms and hospital data were collected from medical records., Results: Sankey plots revealed that the prevalence of anxiety symptomatology (HADS-A ≥ 8 points) was 22.5% (n = 285) at T1, 17.6% (n = 223) at T2, and 7.9% (n = 100) at T3, whereas the prevalence of depressive symptoms (HADS-D ≥ 8 points) was 14.6% (n = 185) at T1, 10.9% (n = 138) at T2, and 6.1% (n = 78) at T3. Finally, the prevalence of poor sleep (PSQI≥8 points) decreased from 32.8% (n = 415) at T1, to 28.8% (n = 365) at T2, and to 24.8% (n = 314) at T3. The recovery curves show a decrease trend visualizing that these symptoms recovered the following years after discharge. The regression models did not reveal medical records associated with anxiety/depressive symptoms or poor sleep., Conclusion: The use of Sankey plots shows a fluctuating evolution of anxiety/depressive symptoms and poor sleep during the first years after the infection. In addition, exponential bar plots revealed a decrease prevalence of these symptoms during the first years after hospital discharge. No risk factors were identified in this cohort., Competing Interests: Declaration of competing interest No conflict of interest is declared by any of the authors., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes., Competing Interests: Declaration of interests BM received consultation fees from Haleon, GSK, and Grünenthal, and honoraria from Haleon, GSK, Grünenthal, Krka, Mundipharma, and Viatris, is the past president of the European Pain Federation and program director of the Belgian Interuniversity Course in Pain Management. AC received payment for work as group tutor for the course in Clinimetrics (EpidM, Amsterdam, Netherlands). JN and the Vrije Universiteit Brussel received lecturing or teaching fees from various professional associations and educational organisations. EKo received royalties for textbook chapters from Liber and Studentlitteratur, payment for a lecture from Eli Lilly, and is a member of the scientific board of the Swedish Rheumatism Association. PH received travel support from the German Osteopathic Society, the Icelandic Physiotherapy Association, and the Finish Musculoskeletal Medicine Society. All other authors declared no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

In people with nonspecific chronic spinal pain (nCSP), disability and quality of life are associated with clinical, cognitive, psychophysical, and demographic variables. However, evidence regarding the interactions between these variables is only limited to this population. Therefore, this study aims to explore path models explaining the multivariate contributions of such variables to disability and quality of life in people with nCSP. This secondary analysis uses baseline data from a randomized controlled trial including 120 participants with nCSP. Structural equation modeling was used to explore path models for the Pain Disability Index (PDI), the Short Form 36-item physical (SF-36 PC), and mental (SF-36 MC) component scores. All models included sex, pain catastrophizing, kinesiophobia, hypervigilance, and pain intensity. Additionally, the PDI and SF-36 PC models included pressure pain thresholds (PPTs) at the dominant pain site (ie, neck or low back). Significant associations were found between sex, pain cognitions, pain intensity, and PPTs. Only pain catastrophizing significantly directly influenced the PDI (P ≤ .001) and SF-36 MC (P = .014), while the direct effects on the SF-36 PC from kinesiophobia (P = .008) and pain intensity (P = .006) were also significant. However, only the combined effect of all pain cognitions on the SF-36 PC was mediated by pain intensity (P = .019). Our findings indicate that patients' pain-related cognitions have an adverse effect on their physical health-related quality of life via a negative influence on their pain intensity in people with nCSP. PERSPECTIVE: This secondary analysis details a network analysis confirming significant interactions between sex, pain cognitions, pain intensity, and PPTs in relation to disability and health-related quality of life in people with chronic spinal pain. Moreover, its findings establish the importance of pain cognitions and pain intensity for these outcomes. TRIALS REGISTRATION: Clinicaltrials.gov (NCT02098005)., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Viral persistence is one of the main hypotheses explaining the presence of post-COVID symptoms. This systematic review investigated the presence of SARS-CoV-2 RNA in plasma, stool, urine, and nasal/oral swab samples in individuals with post-COVID symptomatology., Content: MEDLINE, CINAHL, PubMed, EMBASE, Web of Science databases, as well as medRxiv/bioRxiv preprint servers were searched up to November 25th, 2023. Articles investigating the persistence of SARS-CoV-2 RNA in plasma, stool, urine or nasal/oral swab samples in patients with post-COVID symptoms were included. Methodological quality was assessed using the Newcastle-Ottawa Scale or Cochrane's Risk of Bias (Rob) tool., Summary: From 322 studies identified, six studies met all inclusion criteria. The sample included 678 COVID-19 survivors (52 % female, aged from 29 to 66 years). The methodological quality was moderate in 88 % of the studies (n=5/6). Three papers investigated the presence of SARS-CoV-2 RNA in plasma, three studies in nasal/oral swabs, two studies in stool samples, one in urine and one in saliva. The follow-up was shorter than two months (<60 days after) in 66 % of the studies (n=4/6). The prevalence of SARS-CoV-2 RNA ranged from 5 to 59 % in patients with post-COVID symptoms the first two months after infection, depending on the sample tested, however, SARS-CoV-2 RNA was also identified in COVID-19 survivors without post-COVID symptoms (one study)., Outlook: Available evidence can suggest the presence of persistent SARS-CoV-2 RNA in post-COVID patients in the short term, although the biases within the studies do not permit us to make firm assumptions. The association between post-COVID symptoms and SARS-CoV-2 RNA in the samples tested is also conflicting. The lack of comparative group without post-COVID symptoms limits the generalizability of viral persistence in post-COVID-19 condition., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

The aim of this study was to identify the association between four selected inflammatory polymorphisms with the development of long-term post-COVID symptoms in subjects who had been hospitalized due to SARS-CoV-2 infection during the first wave of the pandemic. These polymorphisms were selected as they are associated with severe COVID-19 disease and cytokine storm, so they could be important to prognoses post-COVID. A total of 408 (48.5% female, age: 58.5 ± 14.0 years) previously hospitalized COVID-19 survivors participated. The three potential genotypes of the following four single-nucleotide polymorphisms, IL-6 rs1800796 , IL-10 rs1800896 , TNF-α rs1800629 , and IFITM3 rs12252 , were obtained from non-stimulated saliva samples of the participants. The participants were asked to self-report the presence of any post-COVID symptoms (defined as symptoms that had started no later than one month after SARS-CoV-2 acute infection) and whether the symptoms persisted at the time of the study. At the time of the study (mean: 15.6, SD: 5.6 months after discharge), 89.4% of patients reported at least one post-COVID symptom (mean number of symptoms: 3.0; SD: 1.7). Fatigue (69.3%), pain (40.9%), and memory loss (27.2%) were the most prevalent post-COVID symptoms in the total sample. Overall, no differences in the post-COVID symptoms depending on the IL-6 rs1800796 , IL-10 rs1800896 , TNF-α rs1800629 , and IFITM3 rs12252 genotypes were seen. The four SNPs assessed, albeit having been previously associated with inflammation and COVID-19 severity, did not cause a predisposition to the development of post-COVID symptoms in the previously hospitalized COVID-19 survivors.

Purpose: Preliminary evidence suggests a potential effect of antiviral medication used during the acute COVID-19 phase for preventing long-COVID. This review investigates if having received pharmacological treatment during acute SARS-CoV-2 infection may reduce the risk of long-COVID., Methods: MEDLINE, CINAHL, PubMed, EMBASE, Web of Science databases, as well as medRxiv/bioRxiv preprint servers were searched up to July 15th, 2023. Articles comparing the presence of long-COVID symptoms between individuals who received or not a specific medication, particularly antivirals, during the acute phase of SARS-CoV-2 infection were included. Methodological quality was assessed using the Newcastle-Ottawa Scale or Cochrane's Risk of Bias (Rob) tool., Results: From 517 studies identified, 6 peer-reviewed studies and one preprint met all inclusion criteria. The sample included 2683 (n = 4) hospitalized COVID-19 survivors and 307,409 (n = 3) non-hospitalized patients. The methodological quality was high in 71% of studies (n = 5/7). Two studies investigating the effects of Nirmaltrevir/Ritonavir and three studies the effect of Remdesivir reported conflicting results on effectiveness for preventing long-COVID. Three studies investigating the effects of other medication such as Dexamethasone (n = 2) or Metformin (n = 1) found positive results of these medications for preventing long-COVID., Conclusion: Available evidence about the effect of medication treatment with antivirals during acute COVID-19 and reduced risk of developing long-COVID is conflicting. Heterogeneous evidence suggests that Remdesivir or Nirmaltrevir/Ritonavir could have a potential protective effect for long-COVID. A limited number of studies demonstrated a potential benefit of other medications such as Dexamethasone or Metformin, but more studies are needed., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups ( p > 0. 00625). However, group effects were found for APD and MEI of the CM ( p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability ( p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.

Purpose: Although previous studies have highlighted the clinical relevance of the anterior scalene muscle (AS) in patients with neck pain or nerve compressive syndromes, evidence reporting the diagnostic accuracy of shear wave elastography (SWE) for assessing the AS stiffness properties is lacking. This study aimed to analyze the SWE inter-examiner reliability for calculating the Young's modulus and shear wave speed of the AS muscle in asymptomatic subjects., Materials and Methods: Using a linear transducer, ultrasound images of the antero-lateral neck region at the C7 level were acquired in 35 healthy volunteers by one experienced examiner and one novice examiner. After codifying the images to blind the participants' identity, the trial, and the side, Young's modulus and shear wave speed were obtained by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC), and coefficient of variation (CV%) were calculated., Results: The assessed AS metrics showed no side-to-side differences (p>0.05). Sex differences were found for muscle size (p=0.002), but muscle brightness and stiffness were similar (p>0.05). Inter-examiner reliability was good for determining the AS muscle stiffness (ICC = 0.881 for Young's modulus and 0.850 for shear wave speed)., Conclusion: The obtained results suggest that assessing the AS stiffness properties in asymptomatic subjects is a reliable procedure. Further studies should verify the SWE capacity for discriminating healthy and clinical populations and identify potential factors contributing to the variance of measurement errors., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

The COVID-19 pandemic has significantly affected the clinical practice of healthcare professionals. This study aimed to explore the perspectives of COVID-19 survivors regarding the healthcare they received during their stay in the Intensive Care Unit (ICU) and the inpatient COVID-19 ward. A qualitative case-study approach was implemented. Participants were recruited using non-probabilistic purposeful sampling strategy. Inclusion criteria included patients aged ≥18 years who received follow-up from the Pulmonology service at a Hospital in de North of Spain, were diagnosed with COVID-19 and bilateral pneumonia, and were admitted to the ICU before being transferred to a COVID-19 inpatient ward. Data was collected through in-depth interviews and researchers' field notes, and thematic analysis was performed. Techniques such as credibility, transferability, dependability, and confirmability were employed to ensure the trustworthiness of the data. A total of 25 individuals (six women) were included in the study. Three main themes emerged from the analysis: common challenges faced in both units, coping with the hospital stay, and developing strategies. Findings highlighted the need to improve information dissemination, individualize care, and enhance direct patient interaction. Moreover, the study shed light on the psychological impact of hospitalization and ICU experience, including feelings of loneliness, confinement, and the lack of memories from the ICU stay, as well as the influence of care and healthcare language. Finally, strategies such as keeping the mind occupied and maintaining self-discipline were identified as crucial during hospitalization. These findings provide valuable insights for healthcare professionals in delivering care to individuals with COVID-19 in the ICU and hospital ward settings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

The COVID-19 pandemic has affected millions of individuals worldwide. Pain has emerged as a significant post-COVID-19 symptom. This study investigated the incidence, characteristics, and risk factors of post-COVID chronic pain (PCCP) in Thailand. A cross-sectional study was conducted in participants who had been infected, including those hospitalized and monitored at home by SARS-CoV-2 from August to September 2021. Data were collected for screening from medical records, and phone interviews were done between 3 to 6 months post-infection. Participants were classified into 1) no-pain, 2) PCCP, 3) chronic pain that has been aggravated by COVID-19, or 4) chronic pain that has not been aggravated by COVID-19. Pain interference and quality of life were evaluated with the Brief Pain Inventory and EuroQol Five Dimensions Five Levels Questionnaire. From 1,019 participants, 90% of the participants had mild infection, assessed by WHO progression scale. The overall incidence of PCCP was 3.2% (95% CI 2.3-4.5), with 2.8% (95% CI 2.0-4.1) in mild infection, 5.2% (95% CI 1.2-14.1) in moderate infection and 8.5% (95% CI 3.4-19.9) in severe infection. Most participants (83.3%) reported pain in the back and lower extremities and were classified as musculoskeletal pain and headache (8.3%). Risk factors associated with PCCP, included female sex (relative risk [RR] 2.2, 95% CI 1.0-4.9) and greater COVID-19 severity (RR 3.5, 95% CI 1.1-11.7). Participants with COVID-19-related exacerbated chronic pain displayed higher pain interferences and lower utility scores than other groups. In conclusion, this study highlights the incidence, features, and risk factors of post-COVID chronic pain (PCCP) in Thailand. It emphasizes the need to monitor and address PCCP, especially in severe cases, among females, and individuals with a history of chronic pain to improve their quality of life in the context of the ongoing COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wangnamthip et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The levator scapulae muscle is a key structure in the etiopathology of neck and shoulder musculoskeletal pain. Although previous studies used shear-wave elastography (SWE) for characterizing this muscle elasticity, limited evidence assessed the inter-examiner reliability of this procedure. This study aimed to analyze the inter-examiner reliability for calculating Young's modulus and shear wave speed in a cohort of participants with and without chronic neck pain. A diagnostic accuracy study was conducted, acquiring a set of SWE images at the C5 level in participants with and without neck pain (n = 34 and 33, respectively) by two examiners (one experienced and one novel). After blinding the participants' identity, examiner involved, and side, the stiffness indicators were calculated by an independent rater in a randomized order. Intra-class correlation coefficients (ICC), standard error of measurement, minimal detectable changes, and coefficient of variation were calculated. Both cohorts had comparable sociodemographic characteristics ( p > 0.05). No significant levator scapulae elasticity differences were found between genders, sides, or cohorts (all, p > 0.05). Inter-examiner reliability for calculating Young's modulus and shear wave speed was moderate-to-good for assessing asymptomatic individuals (ICC = 0.714 and 0.779, respectively), while poor-to-moderate in patients with neck pain (ICC = 0.461 and 0.546, respectively). The results obtained in this study support the use of this procedure for assessing asymptomatic individuals. However, reliability estimates were unacceptable to support its use for assessing elasticity in patients with chronic neck pain. Future studies might consider that the shear wave speed is more sensitive to detect real changes in comparison with Young's modulus.

Objective: To calculate the minimal clinically important differences (MCIDs) for hand pain intensity and the Boston Carpal Tunnel Questionnaire (BCTQ) in a sample of women with carpal tunnel syndrome (CTS)., Design: Secondary analysis of a randomized controlled trial., Setting: A Hospital Rehabilitation Unit., Participants: One hundred twenty women with clinical and electromyographic diagnosis of CTS who were randomly assigned into 2 groups (N=120)., Interventions: One group received 3 sessions of manual physical therapy (n=60) and the other group received surgery (n=60)., Main Outcome Measures: Mean and the worst pain intensity (numerical pain rate scale, 0-10 points) and functional status and symptoms' severity subscales of the BCTQ questionnaire were assessed before and 1 month after treatment. The Global Rating of Change (GROC) was used as the anchor variable for determining the MCID., Results: A change of 1.5 and 2.5 points in mean and the worst pain intensity represents the MCID for Numerical Pain Rating Scale, whereas a change of 0.23 and 0.64 points in functional status and symptoms' severity represents the MCID for each subscale of the BCTQ. All variables showed acceptable discrimination between patients classified as "improved" and those classified as "stable/not improved" (area under the curve≥0.72). Mean pain intensity (Youden index, 0.53; sensitivity: 73.3%; specificity: 80%) and symptoms' severity (Youden index, 0.69; sensitivity: 90%; specificity: 77.8%) showed the best discriminative ability expressed as a percentage of prediction. Participants classified as "improved" had significantly greater improvements in pain intensity, functional status, and symptoms' severity compared with those classified as "stable/not improved"., Conclusion: A change of 1.5 and 2.5 points in mean and the worst pain and a change of 0.23 and 0.64 points in functional status and symptoms' severity represents the MCID for pain intensity and BCTQ in women with CTS 1 month after treatment., (Copyright © 2023 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

This survey investigated the prevalence of de novo widespread musculoskeletal post-COVID pain and risk factors for its development in nonhospitalized COVID-19 survivors. A nationwide exploratory cross-sectional study was conducted, including a cohort of 593,741 Danish residents who had suffered from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from March 2020 to December 2021. A questionnaire was distributed to the Danish population via the digital mail system (e-Boks). Self-reported demographic data, previous medical comorbidities (diagnosed), socioeconomic data, time of infection, prior chronic pain conditions (diagnosed), development of de novo widespread pain after infection, pain medication, and pain intensity information were collected. Responders consisted of 130,443 nonhospitalized participants (58.2% women; mean age: 50.2 years). At a mean of 14.4 (standard deviation 6.0) months after infection, 6,875 (5.3%) patients reported the presence of de novo widespread musculoskeletal post-COVID pain. Almost 75% of the patients reported a moderate to severe intensity of the pain. In conclusion, de novo widespread post-COVID pain was present in 5.3% of nonhospitalized COVID-19 survivors 1 year after infection (14.4 ± 6.0 months). Older age, female sex, higher BMI, and history of migraine, whiplash, stress, type-2 diabetes, neurological disorders, and lower socioeconomic status were risk factors associated with the development of de novo widespread post-COVID pain in nonhospitalized patients. As de novo widespread pain is considered a sign of sensitization, this group will require specialized pain management attention. PERSPECTIVE: This article presents de novo widespread post-COVID pain prevalence in a cohort of 130,443 citizens infected with COVID-19. The study identifies potential risk factors associated with the development of these new pain symptoms. The results may increase focus on this patient group and potentially help identify predictors for postinfection pain development., (Copyright © 2023 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Pain drawings (PDs) are used for assessing pain extent as a complementary outcome to other pain measurements, consisting of shading a body chart template to report the location and extent of pain. However, the accuracy and reliability of digital PDs remain controversial due to the heterogeneity of methods used. This study aimed to develop an easy-to-use application for assessing its diagnostic accuracy in comparison with the classic paper-and-pencil method., Methods: A test-retest reliability study was conducted, recruiting 95 patients with musculoskeletal pain symptoms. Participants shaded 2 sets of 3 different PDs (paper-and-pencil PD, digital PD using the finger and digital PD using the digital stylus). Intraclass correlation coefficients (ICC), standard error of measurement and minimal detectable changes (MDC) were calculated for each method. Finally, repeated measure analysis of variance assessed the mean differences between trials and methods and the convergent validity between methods was calculated using Pearson's correlation coefficients., Results: All methods were excellently reliable (all, ICC>0.94). However, digital PDs obtained higher ICCs (ICC≥0.970) and greater accuracy to detect whether changes reflect a real change and are not due to a measurement errors (MDC = 0.72%-0.80 % for digital PDs versus MDC = 1.13 % for paper-and-Pencil PDs). No significant score differences were found among the instruments for assessing pain extent (p > 0.05). Finally, the PAIN EXTENT app showed adequate convergent validity (r > 0.850)., Conclusion: The PAIN EXTENT app is a fast and easy-to-use instrument compatible with operative systems and devices commonly used for assessing and monitoring pain extent in the clinical and research settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Ultrasound guided-percutaneous electrical nerve stimulation appears to be effective in the treatment of chronic musculoskeletal pain., Objective: To investigate the immediate effects of one session of percutaneous electrical nerve stimulation on the radial nerve in patients with lateral elbow pain., Methods: A randomized clinical trial was conducted. Sixty patients with chronic lateral elbow pain were allocated into real-percutaneous electrical nerve stimulation ( n  = 30) or sham-percutaneous electrical nerve stimulation ( n  = 30) where the patients received one-single session of the real or sham percutaneous stimulation on the radial nerve, respectively. Pressure pain thresholds, pain intensity, pain-free grip strength, and the self-perceived improvement were evaluated after the intervention., Results: Significant differences between groups for pain intensity (-11.55, 95% CI -21.79 to -1.30, p  < .028), but not for pressure pain threshold or pain-free grip strength, were found. Patients receiving real-percutaneous stimulation had significant improvement in pain-free grip strength on the treated side. The proportion of individuals reporting moderate to large self-perceived improvement (≥4) was significantly higher ( p  = .026) after real-percutaneous stimulation than after sham-percutaneous stimulation., Conclusion: A single session of real-percutaneous electrical nerve stimulation targeting the radial nerve in subjects with lateral elbow pain decreased pain intensity between groups and increased pain-free grip strength on the treated side but not between groups.

The presence of symptoms after an acute SARS-CoV-2 infection (long-COVID) has become a worldwide healthcare emergency but remains underestimated and undertreated due to a lack of recognition of the condition and knowledge of the underlying mechanisms. In fact, the prevalence of post-COVID symptoms ranges from 50% during the first months after the infection up to 20% two-years after. This perspective review aimed to map the existing literature on post-COVID symptoms and to identify gaps in the literature to guide the global effort toward an improved understanding of long-COVID and suggest future research directions. There is a plethora of symptomatology that can be due to COVID-19; however, today, there is no clear classification and definition of this condition, termed long-COVID or post-COVID-19 condition. The heterogeneity in the symptomatology has led to the presence of groups/clusters of patients, which could exhibit different risk factors and different mechanisms. Viral persistence, long-lasting inflammation, immune dysregulation, autoimmune reactions, reactivation of latent infections, endothelial dysfunction and alteration in gut microbiota have been proposed as potential mechanisms explaining the complexity of long-COVID. In such an equation, viral biology (e.g., re-infections, SARS-CoV-2 variants), host biology (e.g., genetics, epigenetics) and external factors (e.g., vaccination) should be also considered. These various factors will be discussed in the current perspective review and future directions suggested.

The Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has provoked billions of infections worldwide. Several meta-analyses have observed that up to 50% of individuals who had survived to a SARS-CoV-2 acute infection suffer from post-COVID symptoms lasting for weeks or months and up to one year after infection. The prevalence of post-COVID pain ranges between 10% to 20% when assessed with other overall post-COVID symptoms and can reach up to 50% to 60% when investigated specifically. The most common musculoskeletal manifestations of post-COVID-19 condition include fatigue, myalgia, arthralgia or back pain. Despite pain of musculoskeletal origin is one of the most prevalent post-COVID pain symptoms, the exact pathophysiological mechanisms of musculoskeletal post-COVID pain are not completely understood. Studies have reported the complexity of post-COVID pain including immune, biological, and psychological factors, and more recently, they have suggested that genetic and epigenetic factors may also play a potential role, highlighting the need for further investigation into these mechanisms. Its management is still controversial, as no specific guideline for treating musculoskeletal post-COVID pain has been proposed with only general consideration about the relevance of multidisciplinary and multimodal treatment approaches. In this paper we will highlight the clinical features, the mechanism, and the management possibilities of musculoskeletal post-COVID pain.

Objectives: The aims of the study are to analyze and describe the accuracy of an ultrasound-guided approach to target the L5 root in cadaveric specimens and evaluate whether gender differences exist., Design: A cross-anatomical study on 40 cadaver L5 nerve roots was performed. A needle was introduced until contacting the L5 nerve root using ultrasound guidance. After that, specimens were frozen and studied by a cross-anatomical view to see the needle's path. The angulation, length, distance from the vertebral spine, the relevant ultrasound anatomical references, and the accuracy of the procedure were evaluated., Results: The needle tip reached the L5 root at a 72.5% rate. The mean angulation degrees of the needle relative to the skin surface were 75.53 ± 10.17 degrees, the length of the needle inserted was 5.83 ± 0.82 cm, and the distance from the vertebral spine to the point of entry of the needle was 5.39 ± 1.44 cm., Conclusions: An ultrasound-guided technique can potentially be an accurate technique to perform invasive procedures on the L5 root. There were statistically significant differences between males and females in the length of the needle introduced. If the L5 root is not clearly visualized, ultrasound will not be the technique of choice., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Evidence suggests that individuals who had survived to coronavirus disease, 2019 (COVID-19) could develop neuropathic post-COVID pain. This study investigated the association of serological biomarkers and treatments received during hospitalization with development of neuropathic-associated symptoms., Methods: One hundred and eighty-three ( n  = 183) previously hospitalized COVID-19 survivors during the first wave of the pandemic were assessed in a face-to-face interview 9.4 months after hospitalization. Nineteen serological biomarkers, hospitalization data, and treatment during hospitalization were obtained from medical records. Neuropathic pain symptoms (Self-Report Leeds Assessment of Neuropathic Scale), sleep quality (Pittsburgh Sleep Quality Index), pain catastrophizing (Pain Catastrophizing Scale) and anxiety/depressive levels (Hospital Anxiety and Depression Scale) were assessed., Results: The prevalence of post-COVID pain was 40.9% ( n  = 75). Fifteen (20%) patients reported neuropathic symptoms. Overall, no differences in hospitalization data and serological biomarkers were identified according to the presence or not of neuropathic-associated symptoms. Patients with post-COVID pain had the highest neutrophil count, and post hoc analysis revealed that patients with neuropathic post-COVID associated symptoms had lower neutrophil count ( p  = 0.04) compared with those without neuropathic pain, but differences were small and possible not clinically relevant. No differences in fatigue, dyspnea, brain fog, anxiety or depressive levels, poor sleep, or pain catastrophism between patients with and without neuropathic symptoms were found., Conclusion: It seems that neuropathic-like post-COVID pain symptoms are not associated with neither of assessed serological biomarkers at hospital admission nor hospitalization treatments received in this cohort of hospitalized COVID-19 survivors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer LF declared a shared affiliation with the author CF-d-l-P to the handling editor at the time of review., (Copyright © 2023 Fernández-de-las-Peñas, Guijarro, Velasco-Arribas, Torres-Macho, Franco-Moreno, Truini, Pellicer-Valero and Arendt-Nielsen.)

Objective: This study aimed to apply Sankey plots and exponential bar plots for visualizing the trajectory of post-COVID brain fog, memory loss, and concentration loss in a cohort of previously hospitalized COVID-19 survivors., Methods: A sample of 1,266 previously hospitalized patients due to COVID-19 during the first wave of the pandemic were assessed at 8.4 (T1), 13.2 (T2), and 18.3 (T3) months after hospital discharge. They were asked about the presence of the following self-reported cognitive symptoms: brain fog (defined as self-perception of sluggish or fuzzy thinking), memory loss (defined as self-perception of unusual forgetfulness), and concentration loss (defined as self-perception of not being able to maintain attention). We asked about symptoms that individuals had not experienced previously, and they attributed them to the acute infection. Clinical and hospitalization data were collected from hospital medical records., Results: The Sankey plots revealed that the prevalence of post-COVID brain fog was 8.37% ( n  = 106) at T1, 4.7% ( n  = 60) at T2, and 5.1% ( n  = 65) at T3, whereas the prevalence of post-COVID memory loss was 14.9% ( n  = 189) at T1, 11.4% ( n  = 145) at T2, and 12.12% ( n  = 154) at T3. Finally, the prevalence of post-COVID concentration loss decreased from 6.86% ( n  = 87) at T1, to 4.78% ( n  = 60) at T2, and to 2.63% ( n  = 33) at T3. The recovery exponential curves show a decreasing trend, indicating that these post-COVID cognitive symptoms recovered in the following years after discharge. The regression models did not reveal any medical record data associated with post-COVID brain fog, memory loss, or concentration loss in the long term., Conclusion: The use of Sankey plots shows a fluctuating evolution of post-COVID brain fog, memory loss, or concentration loss during the first years after the infection. In addition, exponential bar plots revealed a decrease in the prevalence of these symptoms during the first years after hospital discharge. No risk factors were identified in this cohort., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Fernández-de-las-Peñas, Cancela-Cilleruelo, Rodríguez-Jiménez, Arias-Navalón, Martín-Guerrero, Pellicer-Valero, Arendt-Nielsen and Cigarán-Méndez.)

Background: This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP)., Method: Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken., Results: A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of -1.009 ( p < 0.05) and -1.701 ( p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference ( p < 0.001) in the fourth session between the groups. The MD in FABQ was -5.036 ( p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up., Conclusion: FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.

Objective: This randomized clinical trial investigated if the application of percutaneous electrolysis (PE) enhances endogenous pain mechanisms (EPM) when compared with a simple needle application (acting as sham)., Methods: Forty-six asymptomatic subjects, aged 18-40 years, were randomized into three groups receiving a single ultrasound-guided PE intervention consisting of a needle insertion on the lateral epicondyle: sham (without electrical current), low-intensity (0.3 mA, 90s), or high-intensity (three pulses of 3 mA, 3s) PE. Widespread pressure pain thresholds (PPT), conditioned pain modulation (CPM), and temporal summation (TS) were bilaterally assessed in the lateral epicondyle, bicipital groove, transverse process of C5 and tibialis anterior muscle. Outcomes were obtained by an assessor blinded to the treatment allocation of the subjects., Results: No significant changes in CPM were observed in either group (omnibus ANOVA all, P > .05). A significant bilateral increase in PPT in the lateral epicondyle in the high intensity group as compared with the sham group was observed (P < .01). A significant decrease of TS in both low (P = .002) and high (P = .049) intensity groups on the right, but not on the left, tibialis anterior was also observed when compared with the sham group., Conclusions: One session of PE is able to slightly stimulate modulatory pathways related to nociceptive gain, particularly pressure pain sensitivity and temporal summation but not conditioning pain modulation, when compared with a sham needle intervention, with changes even contralaterally. No significant differences were found between low- and high-intensity doses of percutaneous electrolysis., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. This study aimed to determine the test-retest reliability of the IC test., Methods: A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated., Results: The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values., Conclusion: The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.

Knee and hip osteoarthritis are highly prevalent in the older population. Management of osteoarthritis-related pain includes conservative or surgical treatment. Although knee or hip joint replacement is associated with positive outcomes, up to 30% of patients report postoperative pain in the first two years. This study aimed to synthesize current evidence on prognostic factors for predicting postoperative pain after knee or hip replacement. An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for prognostic preoperative factors predictive of postoperative chronic pain (>6 months after surgery) in patients who had received knee or hip replacement. Searches were conducted in MEDLINE, CINAHL, PubMed, PEDro, SCOPUS, Cochrane Library, and Web of Science databases from inception up to 5 August 2022 for reviews published in the English language. A narrative synthesis, a risk of bias assessment, and an evaluation of the evidence confidence were performed. Eighteen reviews (nine on knee surgery, four on hip replacement, and seven on both hip/knee replacement) were included. From 44 potential preoperative prognostic factors, just 20 were judged as having high or moderate confidence for robust findings. Race, opioid use, preoperative function, neuropathic pain symptoms, pain catastrophizing, anxiety, other pain sites, fear of movement, social support, preoperative pain, mental health, coping strategies, central sensitization-associated symptoms, and depression had high/moderate confidence for an association with postoperative chronic pain. Some comorbidities such as heart disease, stroke, lung disease, nervous system disorders, and poor circulation had high/moderate confidence for no association with postoperative chronic pain. This review has identified multiple preoperative factors (i.e., sociodemographic, clinical, psychological, cognitive) associated with postoperative chronic pain after knee or hip replacement. These factors may be used for identifying individuals at a risk of developing postoperative chronic pain. Further research can investigate the impact of using such prognostic data on treatment decisions and patient outcomes.