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Background. Numerous instruments are available to measure the impact of chronic pain, yet most have been developed with little or no patient involvement. This study seeks to start bridging that gap by determining which health aspects or attributes (to be included in a future instrument) are considered most important by people with chronic pain. Objective. The goal of this study was to reveal which attributes reflecting impact of chronic pain are considered most important by people with chronic pain and to analyze differences in importance according to gender, age categories, diagnostic subgroups, and pain intensity categories. Design. This study used a sequential explanatory mixed-methods design: literature search, focus group meetings, and online survey. Methods. First, a literature search was performed to identify the attributes in existing instruments. In 68 instruments meeting inclusion criteria, 155 unique attributes were identified, 85 of which remained after applying the exclusion criteria. Second, 2 focus group meetings, with 6 and 4 patients, respectively, were held to verify that no attributes had been missed. Three attributes were subsequently added. Third, individuals with chronic pain were then sent an online survey through several patient organizations. Results. A total of 939 patients were asked to select the 8 attributes they deemed most important, which resulted in the following list: fatigue, social life, cramped muscles, sleeping, housekeeping, concentration, not being understood, and control over pain. The importance assigned to these 8 attributes varied slightly according to age, gender, and diagnostic subgroup. Limitations. Participation rate could not be established because of the online survey. Conclusions. Attributes reflecting impact of chronic pain deemed most important by patients are revealed. Importance of impact differs according to subgroups. The 'patients-first' methodology used here revealed attributes that were not comprehensively covered in currently available instruments for measuring the impact of chronic pain., Health-related quality of life (HRQoL)--embracing functionality, social interaction, and physical, emotional, and psychological well-being--is reduced in people who suffer from chronic pain. (1,2) There are numerous instruments to measure distinct [...]

Pulmonary rehabilitation (PR) is a complex intervention that has been shown to improve exercise capacity and quality of life, reduce dyspnea, and decrease the risk of exacerbations and hospitalization. Although [...]

Background. Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. Objective. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. Design. The design was a prospective, single-blind, multicenter, superiority, cluster-randomized controlled trial. Setting. The setting included 143 primary care physical therapist practices. Participants. The participants were 208 people who had hip/knee OA and were 40 to 80 years of age. Intervention. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. Measurements. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions. Results. The e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy. Limitations. The response rate at 12 months was 65%. Conclusions. The blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA., Osteoarthritis (OA) is the most common chronic condition of the joints. (1) Prevalence of this rheumatic disease increases with age and mostly affects the hip and knee. Based on radiographic [...]

The implementation of recent Centers for Disease Control and Prevention recommendations to move away from opioids and toward nonpharmacological therapies for the treatment of chronic pain could involve a difficult transition period for patients and practitioners. The focus of treatment should shift from eliminating pain completely to minimizing the impact of pain on quality of life. Many patients with chronic pain take opioids either because opioids were previously prescribed as a first-line treatment for chronic pain, on the basis of old standards of care, or because opioids were initially prescribed for acute pain. Patients currently taking opioids will need a tapering period during which they transition their pain management to interdisciplinary care and nonpharmacological treatments. To provide useful treatment options, physical therapists need to have a good understanding of the neuroscientific mechanisms of chronic pain, biopsychosocial components of chronic pain management, issues related to opioid use, and pain management strategies used by other health care professionals. Armed with knowledge and good communication skills, physical therapists can work within an interdisciplinary team to adapt care to each patient's needs and abilities. This perspective article provides guidance for physical therapists to effectively treat patients with chronic pain during the opioid tapering process. A framework has been created to help health care providers structure their reasoning as they collaborate to develop a unique approach for each patient., The implementation of recent Centers for Disease Control and Prevention (CDC) recommendations to move away from opioids and toward nonpharmacological therapies for the treatment of chronic pain could involve a [...]

Background. There is significant need for trials evaluating the long-term effectiveness of a rigorous program of perioperative behavioral therapy with pelvic floor muscle training (BPMT) in women undergoing transvaginal reconstructive surgery for prolapse. Objective. The purpose of this study was to evaluate the effect of perioperative BPMT on health-related quality of life (HRQOL) and sexual function following vaginal surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Design. This study is a secondary report of a 2 x 2 factorial randomized controlled trial. Setting. This study was a multicenter trial. Participants. Participants were adult women with stage 2-4 POP and SUI. Intervention. Perioperative BPMT versus usual care and sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS) were provided. Measurements. Participants undergoing transvaginal surgery (SSLF or ULS for POP and a midurethral sling for SUI) received usual care or five perioperative BPMT visits. The primary outcome was change in body image and in Pelvic Floor Impact Questionnaire (PFIQ) short-form subscale, 36-item Short-Form Health Survey (SF-36), Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire short form (PISQ-12), Patient Global Impression of Improvement (PGII), and Brink scores. Results: The 374 participants were randomized to BPMT (n = 186) and usual care (n = 188). Outcomes were available for 137 (74%) of BPMT participants and 146 (78%) of the usual care participants at 24 months. There were no statistically significant differences between groups in PFIQ, SF-36, PGII, PISQ-12, or body image scale measures. Limitations. The clinicians providing BPMT had variable expertise. Findings might not apply to vaginal prolapse procedures without slings or abdominal apical prolapse procedures. Conclusions. Perioperative BPMT performed as an adjunct to vaginal surgery for POP and SUI provided no additional improvement in QOL or sexual function compared with usual care., Conservative therapy including pelvic floor muscle exercises, biofeedback, and lifestyle/behavioral interventions are effective for many pelvic symptoms, including urinary incontinence and mild to moderate prolapse. (1-4) However, pelvic surgeons do [...]

Background. The Motor Activity Log (MAL) and Lower-Functioning MAL (LF-MAL) are used to assess the amount of use of the more impaired arm and the quality of movement during activities [...]

Background. An increasing variety of short functional exercise tests are reported in people with chronic obstructive pulmonary disease (COPD). Systematic review of the psychometric properties of these exercise tests is [...]

Background. Total knee arthroplasty (TKA) is associated with declines in hip abductor (HA) muscle strength; however, a longitudinal analysis demonstrating the influence of TKA on trajectories of HA strength change [...]

Background: Back problems and urinary incontinence (UI) have been found to co-occur more frequently than would be predicted by chance. Objective: The aim of this study was to estimate the [...]

Background. Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear. Purpose. The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP. Data Sources. MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014. Study Selection. The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure. Data Extraction. Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded. Data Synthesis. Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval -0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category. Limitations. Gait speed was the only outcome measure analyzed. Conclusions. Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation., Cerebral palsy (CP) is the most prevalent physical disability in children, affecting 3.6 per 1,000 live births in the United States. (1) The motor impairments are often accompanied by sensory, [...]

Background. Almost 1 person in 1,000 experiences a stroke annually in France. Health-related quality-of-life (HRQoL) measurement with specific questionnaires is useful to study the consequences of stroke on patients' daily lives. Objective. The purpose of this study was to validate the French version of the Stroke Impact Scale (SIS) questionnaire, as no disease-specific questionnaire was validated in French heretofore. Methods. Two hundred eighty-eight patients with stroke were classified into 2 groups (158 acute, 130 chronic). Rate of item completion, test-retest reliability, sensitivity to change, and construct validity, convergent validity, and discriminant validity of the questionnaire were assessed. Acute group patients were recruited during the first month poststroke and followed for 3 months. Chronic group patients (stroke dating from 1 year) were recruited from outpatient consultations. The first 100 patients in the chronic group were called back 15 days after inclusion for test-retest measurements. The Barthel Index, Hospital Anxiety and Depression Scale (HADS), and Duke Health Profile questionnaires were administered. Results. The French version of the SIS was well accepted by all participants. It had good reproducibility. Cronbach alpha was 89% for all scales. A ceiling effect was noted in the majority of scales. Physical domains were significantly correlated to other measures of physical capacity (Barthel Index and Duke Health Profile; Spearman coefficients were between .5 and .73), and the emotional and social domains were significantly correlated to almost all domains of the Duke Health Profile. Psychometric properties were similar to those of the US version. Responsiveness was good for physical and emotional domains. Limitations. Validation was conducted only on people who were able to answer the questionnaire. Conclusions. The French SIS version presents good psychometric properties, except for ceiling effect. This is the first stroke-specific questionnaire evaluating perceived health after stroke to be validated in France and could be useful for further investigations of HRQoL after stroke., As in all industrialized countries, France is confronted with an increasing frequency of cerebrovascular events. Indeed, stroke is the fifth most prevalent cause of moderate to severe physical disability in [...]

Background. Transcutaneous electrical nerve stimulation (TENS) is often used for management of chronic pain. Objective. The purpose of this study was to investigate whether TENS altered postincisional allodynia, substance P, and proinflammatory cytokines in a rat model of skin-muscle incision and retraction (SMIR). Design. This was an experimental study. Methods. High-frequency (100-Hz) TENS therapy began on postoperative day 3 and was administered for 20 minutes daily to SMIR-operated rats by self-adhesive electrodes delivered to skin innervated via the ipsilateral dorsal rami of lumbar spinal nerves L1-L6 for the next 27 days. The expressions of substance P, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL- 1β) in the spinal cord and mechanical sensitivity to von Frey stimuli (4g and lOg) were evaluated. Results. The SMIR-operated rats displayed a marked hypersensitivity to von Frey stimuli on postoperative day 3. In contrast to the SMIR-operated rats, SMIR- operated rats after TENS administration showed a quick recovery of mechanical hypersensitivity. On postoperative days 3, 16, and 30, SMIR-operated rats exhibited an upregulation of substance P and cytokines (TNF-α, IL-6, and IL-1β) in the spinal cord, whereas SMIR-operated rats after TENS therapy inhibited that upregulation. By contrast, the placebo TENS following SMIR surgery did not alter mechanical hypersensitivity and the levels of spinal substance P, TNF-α, IL-6, and IL-1β. Limitations. The experimental data are limited to animal models and cannot be generalized to postoperative pain in humans. Conclusions. The results revealed that TENS attenuates prolonged postoperative allodynia following SMIR surgery. Increased levels of spinal substance P and proinflammatory cytokines, activated after SMIR surgery, are important in the processing of persistent postsurgical allodynia. The protective effect of TENS may be related to the suppression of spinal substance P and proinflammatory cytokines in SMIR- operated rats., Prolonged postincisional pain is a major factor in reducing quality of life (1) and increasing the utilization of health services. (2, 3) Although postsurgical pain can be managed by administration [...]

Background. After total hip arthroplasty (THA), patients today (who tend to be younger and more active than those who previously underwent this surgical procedure) have high expectations regarding functional outcome. Therefore, patients need to be well informed about recovery of physical functioning after THA. Purpose. The purpose of this study was to review publications on recovery of physical functioning after THA and examine the degree of recovery with regard to 3 aspects of functioning (ie, perceived physical functioning, functional capacity to perform activities, and actual daily activity in the home situation). Data Sources. Data were obtained from the MEDLINE and EMBASE databases from inception to July 2009, and references in identified articles were tracked. Study Selection. Prospective studies with a before-after design were included. Patients included in the analysis had to have primary THA for osteoarthritis. Data Extraction and Synthesis. Two reviewers independently checked the inclusion criteria, conducted the risk of bias assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model. Results. A total of 31 studies were included. For perceived physical functioning, patients recovered from less than 50% preoperatively to about 80% of that of controls (individuals who were healthy) 6 to 8 months postsurgery. On functional capacity, patients recovered from 70% preoperatively to about 80% of that of controls 6 to 8 months postsurgery. For actual daily activity, patients recovered from 80% preoperatively to 84% of that of controls at 6 months postsurgery. Limitations. Only a few studies were retrieved that investigated the recovery of physical functioning longer than 8 months after surgery. Conclusions. Compared with the preoperative situation, the 3 aspects of physical functioning showed varying degrees of recovery after surgery. At 6 to 8 months postoperatively, physical functioning had generally recovered to about 80% of that of controls., When conservative treatment fails to alleviate pain and dysfunction of the hip caused by osteoarthritis (OA), total hip arthroplasty (THA) is a cost-effective surgical treatment that can provide significant pain [...]

Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers Steinhauser KE, Christakis NA, Clipp EC, et al (Veterans Affairs Medical Center, Durham, NC), [...]

Fuchs-Climent D, Le Gallais D, Varray A, et al (Laboratoire de Physiologie des Interactions, Service Central de Physiologie; Laboratoire Interface Biopsychosociale, Hopital Arnaud de Villeneuve, Universite Montpellier, Montpellier; La Clinique [...]

There are 3 types of health-related quality-of-life instruments: discriminative, predictive, and evaluative. (1) Each type of instrument has different characteristics and is selected based on its intended use. The purpose [...]