Patient-Specific Functional Scale Research Articles

Mechanical diagnosis and therapy in musculoskeletal pain of individuals with spinal cord injury

Context/Objective Musculoskeletal pain (MSKP) has high prevalence in individuals with spinal cord injury (SCI). Mechanical Diagnosis and Therapy (MDT) is a method focused on identifying the pain source in the musculoskeletal system and presents good results in pain relief in people without neurological impairment. However, no studies have investigated the use of MDT in SCI population. The objective was to evaluate the applicability and outcomes of MDT treatment in pain relief and independence improvement in daily activities of individuals with SCI presenting MSKP. Design Single-arm trial. Setting Rehabilitation Hospital Participants Twenty-four individuals with SCI who presented MSKP. Intervention MDT-certified physical therapist conducted assessments and treatments of pain according to the MDT approach. Outcomes Measures Numeric rating scale (NRS) was used to measure pain and Pain Disability Index (PDI) and Patient-Specific Functional Scale (PSFS) to evaluate daily activities. Results Significant median decreases were found for NRS (from 7 to 2) and PDI (from 27 to 8) after MDT, whereas PSFS score presented a significant mean increase (from 3.2–7.7). The average decrease in pain after MDT treatment was 70.9% (5.36 on the NRS). Conclusion MDT can reduce pain and enhance independence in daily activities in individuals with SCI and MSKP.

The Patient-Specific Functional Scale: How Close are We to Reaching the Mark?

The Patient Specific Functional Scale (PSFS) has been found to be a reliable and valid measure of physical function in patients with musculoskeletal and non-musculoskeletal disorders. However, the clinimetric properties of the PSFS are more strongly supported in musculoskeletal populations than in non-musculoskeletal populations.

Physical functioning post-COVID-19 and the recovery process: a mixed methods study

Purpose To describe physical functioning after severe COVID-19-infection. Materials and method An explanatory sequential mixed method design was used. Thirty-nine participants performed tests and answered questionnaires measuring physical functioning six months after hospitalisation due to COVID-19. Thirty of these participants participated in semi-structured interviews with questions regarding how they perceived their physical functioning and recovery from COVID-19 at 12 months post-hospitalisation. Results At six months, physical functioning measured via chair stand test and hip-worn accelerometers was lower than normal reference values. There was a reduction in breathing muscle strength. Participants estimated their functional status during different activities as lower compared to those before COVID-19-infection, measured with a patient-specific functional scale. At one year after infection, there were descriptions of a rough recovery process and remaining symptoms. Conclusion Patients recovering from severe COVID-19 seem to have reduced physical functioning and activity levels, and they perceive their recovery to be slow and difficult. They experienced a lack of clinical support and contradictory advice regarding rehabilitation. Coaching in returning to physical functioning after the infection needs to be better co-ordinated and there is a need for guidelines for health professionals to avoid patients receiving contradictory advice.

Development and measurement properties of the PEM/PESE activity questionnaire (PAQ).

Existing instruments often are inappropriate to measure the effects of post-exertional malaise (PEM) and post-exertional symptom exacerbation (PESE) on activities of daily living (ADLs). A validated questionnaire to measure self-reported ability with ADLs would advance research and clinical practice in conditions like myalgic encephalomyelitis and Long Covid. Determine the measurement properties of the PEM/PESE Activity Questionnaire (PAQ). The PAQ is adapted from the Patient Specific Functional Scale. Respondents rated three self-selected ADLs on two 0-100 scales, including current performance compared to (1) a 'good day' and (2) before illness. Respondents provided a Burden of Functioning rating on a 0-100 scale, anchored at 0 being the activity took "No time, effort, and resources at all" and 10 being "All of my time, effort, and resources." Respondents took the PAQ twice, completing a demographic questionnaire after the first PAQ and before the second PAQ. Descriptive statistics and intraclass correlation coefficients were calculated for each scale to assess test-retest reliability. Minimum detectable change outside the 95% confidence interval (MDC95) was calculated. Ceiling and floor effects were determined when the MDC95 for average and function scores crossed 0 and 100, respectively. n = 981 responses were recorded, including n = 675 complete surveys. Test-retest reliability was generally fair to excellent, depending on function and scale. MDC95 values generally indicated scale responsiveness. Ceiling and floor effects were noted infrequently for specific functions. The PAQ is valid, reliable, and sensitive. Additional research may explore measurement properties involving functions that were infrequently selected in this sample.

Comparison between two patient-reported outcome measures for patients with cervical radiculopathy: A think-aloud study

BackgroundThe Cervical Radiculopathy Impact Scale (CRIS) and Patient Specific Functional Scale 2.0 (PSFS 2.0) are patient-reported outcome measures (PROMs) used to assess activity limitations in patients with cervical radiculopathy (CR). This study a) compared the CRIS subscale 3 and the PSFS 2.0 in patients with CR with respect to completeness and patient preference, b) established the correlation between both PROMs in assessing the individual patient's level of functional limitations and c) assessed the frequency of reported functional limitations. MethodsParticipants with CR participated in semi-structured, individual, face-to-face interviews as part of a “think-aloud” process; verbalising their thoughts while completing both PROMs. Sessions were digitally recorded and transcribed verbatim for analysis. ResultsTwenty-two patients were recruited. The most frequently reported functional limitation on the CRIS was: ‘working at a computer’ (n = 17) and overhead activities' (n = 10) for the PSFS 2.0. There was significant moderate positive correlation between the scores on the PSFS 2.0 and the CRIS (Spearman's r = 0.55, n = 22 p = .008). Most patients (n = 18; 82%) preferred the ability to present their own individual functional limitations of the PSFS 2.0. Eleven participants (50%) preferred the 11-point scale of the PSFS 2.0 over the 5-point Likert scale scoring option of the CRIS. ConclusionBoth easy to complete PROMs capture functional limitations in patients with CR. Most patients prefer the PSFS 2.0 over the CRIS. The wording and layout of both PROMs need refinement to enhance user-friendliness and avoid misinterpretation.

Do intra-articular temporomandibular disorders show an association between physical bite function, self-perceived bite limitation and kinesiophobia? A case-control study

BackgroundLittle is known about the impact of intra-articular temporomandibular disorders (TMDs) on bite function, or how bite impairments in this subgroup relate to self-perceived bite limitation or kinesiophobia. This presents a challenge to practitioners involved in delivering care. ObjectivesTo determine what bite impairments are associated with intra-articular TMDs, and explore how these impairments relate to self-perceived bite limitations and kinesiophobia. DesignObservational, case-control study. MethodSixty participants (n = 30 intra-articular TMDs, n = 30 healthy controls) were recruited via convenience sampling. Bite function was explored using pain-free bite force and bite endurance/steadiness (submaximal bite hold) measures. Self-perceived bite function and kinesiophobia were evaluated via the Patient specific functional scale (PSFS) and the Tampa Scale for kinesiophobia of Temporomandibular disorders (TSK-TMD) respectively. Between-group data were compared and associations between physical bite impairments, self-perceived bite limitation and kinesiophobia were explored in the intra-articular TMD group. ResultsPain-free bite force was significantly impaired in the intra-articular TMD group (−108N, p < 0.01, d = 0.9), and this impairment demonstrated moderate association with degree of kinesiophobia (p < 0.01, r = −0.4). No significant between-group difference was observed for bite endurance or force steadiness (p > 0.05). No association was observed between pain-free bite force and self-perceived bite limitation, or self-perceived bite limitation and kinesiophobia (p > 0.05). ConclusionsImpaired pain-free bite force appears to be an important feature of intra-articular TMDs which should be considered within management. Kinesiophobia may be important to consider when assessing bite function in this subgroup. Future research is needed to guide optimal interventions and inform subsequent management guidelines.

UTILIZATION OF VIRTUAL CARE IN POSTOPERATIVE TOTAL KNEE ARTHROPLASTY: ASSESSMENT OF OUTCOME AND PATIENT CHALLENGES

Virtual physiotherapy has been provided to hundreds of patients at the Holland Centre during the COVID pandemic. As we plan for virtual care to be one part of our care delivery we want to evaluate it and ensure the care delivery is safe and effective.The objectives of this project was two-fold: 1) to examine the outcome of virtual physiotherapy and/ or a hybrid of virtual and in-person care in patients who received post-operative treatment following total knee replacement at the Holland Centre, 2) to explore the challenges of virtual care participation in the joint replacement population.Patients who received either virtual care or a combination of in-person and virtual care (hybrid model) based on the patients’ needs were included. Patient-related outcomes were the Patient Specific Functional Scale (PSFS) and pain scale. Flexion and extension range of motion were measured before and after treatment. A modified Primary Care Patient Experience Virtual Care Survey was used to examine barriers for virtual care.Sixty patients, mean age 68(8), ranging between 45-83 years, 34(57%) females, who received either virtual care or a combination of in-person and virtual care based on the patients’ needs were included. Patients showed improvement in the PSFS and pain scores (p&lt;0.0001). Flexion (p&lt;0.0001) and extension (p=0.02) improved at a statistically significant level. A separate sample (N=54) (age range 50-85 years) completed the patient experience survey.A well-designed post-operative virtual physiotherapy program, initially implemented to maintain continuity of care during the pandemic, continues to be an important part of our model of care as we normalize our activities. Clear understanding of barriers to virtual care and mitigation strategies will help us create virtual care standards, meet our patient needs, optimize our care delivery and potentially increase the use of virtual rehab in the future.

SupportPrim—a computerized clinical decision support system for stratified care for patients with musculoskeletal pain complaints in general practice: study protocol for a randomized controlled trial

BackgroundMusculoskeletal disorders represented 149 million years lived with disability world-wide in 2019 and are the main cause of years lived with disability worldwide. Current treatment recommendations are based on “one-size fits all” principle, which does not take into account the large degree of biopsychosocial heterogeneity in this group of patients. To compensate for this, we developed a stratified care computerized clinical decision support system for general practice based on patient biopsychosocial phenotypes; furthermore, we added personalized treatment recommendations based on specific patient factors to the system. In this study protocol, we describe the randomized controlled trial for evaluating the effectiveness of computerized clinical decision support system for stratified care for patients with common musculoskeletal pain complaints in general practice. The aim of this study is to test the effect of a computerized clinical decision support system for stratified care in general practice on subjective patient outcome variables compared to current care.MethodsWe will perform a cluster-randomized controlled trial with 44 general practitioners including 748 patients seeking their general practitioner due to pain in the neck, back, shoulder, hip, knee, or multisite. The intervention group will use the computerized clinical decision support system, while the control group will provide current care for their patients. The primary outcomes assessed at 3 months are global perceived effect and clinically important improvement in function measured by the Patient-Specific Function Scale (PSFS), while secondary outcomes include change in pain intensity measured by the Numeric Rating Scale (0–10), health-related quality of life (EQ-5D), general musculoskeletal health (MSK-HQ), number of treatments, use of painkillers, sick-leave grading and duration, referral to secondary care, and use of imaging.DiscussionThe use of biopsychosocial profile to stratify patients and implement it in a computerized clinical decision support system for general practitioners is a novel method of providing decision support for this patient group. The study aim to recruit patients from May 2022 to March 2023, and the first results from the study will be available late 2023.Trial registrationThe trial is registered in ISRCTN 11th of May 2022: 14,067,965.

Clinical phenotypes and prognostic factors in persons with hip osteoarthritis undergoing total hip arthroplasty: protocol for a longitudinal prospective cohort study (HIPPROCLIPS)

BackgroundLarge heterogeneity exists in the clinical manifestation of hip osteoarthritis (OA). It is therefore not surprising that pain and disability in individuals with hip OA and after total hip arthroplasty (THA) cannot be explained by biomedical variables alone. Indeed, also maladaptive pain-related cognitions and emotions can contribute to pain and disability, and can lead to poor treatment outcomes. Traumatic experiences, mental disorders, self-efficacy and social support can influence stress appraisal and strategies to cope with pain, but their influence on pain and disability has not yet been established in individuals with hip OA undergoing THA. This study aims (1) to determine the influence of traumatic experiences and mental disorders on pain processing before and shortly after THA (2) to identify preoperative clinical phenotypes in individuals with hip OA eligible for THA, (3) to identify pre- and early postoperative prognostic factors for outcomes in pain and disability after THA, and (4) to identify postoperative clinical phenotypes in individuals after THA.MethodsThis prospective longitudinal cohort study will investigate 200 individuals undergoing THA for hip OA. Phenotyping variables and candidate prognostic factors include pain-related fear-avoidance behaviour, perceived injustice, mental disorders, traumatic experiences, self-efficacy, and social support. Peripheral and central pain mechanisms will be assessed with thermal quantitative sensory testing. The primary outcome measure is the hip disability and osteoarthritis outcome score. Other outcome measures include performance-based measures, hip muscle strength, the patient-specific functional scale, pain intensity, global perceived effect, and outcome satisfaction. All these measurements will be performed before surgery, as well as 6 weeks, 3 months, and 12 months after surgery. Pain-related cognitions and emotions will additionally be assessed in the early postoperative phase, on the first, third, fifth, and seventh day after THA. Main statistical methods that will be used to answer the respective research questions include: LASSO regression, decision tree learning, gradient boosting algorithms, and recurrent neural networks.DiscussionThe identification of clinical phenotypes and prognostic factors for outcomes in pain and disability will be a first step towards pre- and postoperative precision medicine for individuals with hip OA undergoing THA.Trial registrationClinicalTrials.gov: NCT05265858. Registered on 04/03/2022.

Bridging gaps across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases: Results from a stepped-wedge cluster randomized controlled trial

Objective To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. Design A pragmatic stepped-wedge cluster randomized trial. Setting Eight rehabilitation centers in secondary healthcare, Norway. Participants A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). Interventions A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients’ needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. Main measures Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients’ goal attainment measured by the Patient Specific Functional Scale (0–10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. Results No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: −0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. Conclusion The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group.

Measurement Properties of the Patient-Specific Functional Scale in Rehabilitation for Patients With Stroke: A Prospective Observational Study.

This study investigated the validity, reliability, responsiveness, and interpretability of the Patient-Specific Functional Scale (PSFS) in subacute stroke rehabilitation to determine its suitability to measure patient-identified rehabilitation goals. A prospective observational study was designed according to the checklist from Consensus-Based Standards for Selecting Health Measurement Instruments. Seventy-one patients diagnosed with stroke were recruited in the subacute phase from a rehabilitation unit in Norway. The International Classification of Functioning, Disability and Health was used to assess the content validity. Assessment of construct validity was based on hypotheses for correlation of the PSFS and comparator measurements. We assessed reliability by calculating the Intraclass Correlation Coefficient (ICC) (3.1) and the standard error of measurement. The assessment of responsiveness was based on hypotheses for the correlation of change scores between the PSFS and the comparator measurements. A receiver operating characteristic analysis was conducted to assess responsiveness. The smallest detectable change and minimal important change were calculated. Eighty percent of the PSFS items were classified as activities and participation in the International Classification of Functioning, Disability and Health, indicating satisfactory content validity. The reliability was satisfactory with an ICC of 0.81 (95% CI = 0.69-0.89). The standard error of measurement was 0.70 point, and the smallest detectable change was 1.94 points. Five of 7 hypotheses were confirmed for construct validity, and 5 of 6 were confirmed for responsiveness, indicating moderate construct validity and high responsiveness. Assessing responsiveness with a criterion approach resulted in an area under the curve of 0.74. A ceiling effect was identified for 25% of the participants 3months after discharge. The minimal important change was estimated to be 1.58 points. This study demonstrates satisfactory measurement properties for the PSFS in individuals undergoing inpatient stroke rehabilitation. This study supports the use of the PSFS to document and monitor patient-identified rehabilitation goals in patients receiving subacute stroke rehabilitation when applied using a shared decision approach.

Deprescribing initiative of NSAIDs (DIN): Pharmacist-led interventions for pain management in a federal correctional setting.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for management of pain and inflammation. However, these medications are associated with adverse outcomes such as dyspepsia and acute myocardial infarction, especially with long-term uses. We sought to determine the effect of a pharmacist-led deprescribing intervention on oral NSAID use among patients in federal custody. Clinical pharmacists from Correctional Services Canada (CSC) conducted a prospective case series of adult patients with chronic noncancer pain who were on long-term NSAIDs (defined as >90 days supply in the past 120 days) in 3 CSC institutions in British Columbia, Canada. CSC clinical pharmacists met with patients to perform medication reviews and identify drug-related problems, with a focus on analgesic therapy. Pharmacist-led interventions were implemented in consultation with the primary care team to address these drug-related problems. Patient progress was monitored weekly for 3 months. Function, quality of life and pain severity scores (modified SPAASMS, Patient-Specific Functional Scale [PSFS] and visual analog scale [VAS] scores) were compared at baseline, 6 weeks and 3 months postintervention. Patient satisfaction survey results were also collected at 3 months. A total of 53 patients received clinical pharmacist interventions. Modified SPAASMS, PSFS and VAS scores were collected at baseline, 6 weeks and 3 months from 38 patients (some were lost to follow-up when released back into the community). All 38 patients demonstrated clinically significant improvements to all 3 pain scales at 3 months (mean SPAASMS scores decreased by 7 points, mean PSFS scores increased by 2 points, mean VAS scores decreased by 2 points). Twenty-four of 31 patients who completed the patient satisfaction survey agreed that their overall health and well-being improved because of the visit they received from the pharmacist. Clinical pharmacist-led interventions in CSC have shown to reduce oral NSAID use as well as contribute positively to patient pain scores.

A Physical Therapy Approach for Evaluation and Treatment of Complex Regional Pain Syndrome-1 via Telemedicine: A Case Report

BACKGROUND: There is a lack of evidence supporting virtual physical therapy for patients with chronic regional pain syndrome-I (CRPS-1). CASE PRESENTATION: A 51-year-old female presented to physical therapy via telemedicine for an evaluation and treatment of chronic regional pain syndrome-I of her left foot. Chief complaints included pain, intolerance to gravity-dependent positions such as sitting, standing, and walking, and sensitivity to touch and temperature. Signs and symptoms were consistent with the diagnosis of CRPS-1. The treatment sessions were performed through a 2-way video conferencing system accessed on both party's laptops. The physical therapist guided the patient through interventions that were feasible to perform in the constructs of her home without additional external support. Treatment included pain neuroscience education, desensitization, graded motor imagery, strengthening, and neurodynamic mobilizations. OUTCOME AND FOLLOW-UP: At eight weeks, the patient made significant improvements in function consistent with her increased score from 9/30 to 21/30 on the Patient Specific Functional Scale (PSFS). Additionally, the patient demonstrated improved tolerance to temperature changes and gravity-dependent positioning without adverse effects such as blisters or edema. This was further recognized by her ability to shower for 8-10 minutes with warm water and sleep without elevating her leg, both of which she was unable to perform at the start of her care. DISCUSSION: This case study reviews the effects of a multimodal treatment approach with the inclusion of interventions that target the central and peripheral nervous systems. Furthermore, the efficacy of telemedicine as a delivery of care model is explored in this subgroup of the chronic pain population. JOSPT Cases 2023;3(1):21–25. Epub: 12 January 2023. doi:10.2519/josptcases.2023.10825

Postoperative Physical Therapy Following Balloon Kyphoplasty for Management of Vertebral Burst Fracture: A Case Report

BACKGROUND: There is paucity in the literature regarding physical therapy (PT) utilization for postoperative management following balloon kyphoplasty (BKP). CASE PRESENTATION: A 74-year-old female with osteoporosis and multiple sclerosis presented with a vertebral burst fracture following a fall. The patient was successfully treated with transforaminal epidural for radiculopathy but underwent a BKP due to worsening low back pain. The patient was referred to PT and began 6 weeks after BKP due to residual low back pain and limitations in functional mobility. OUTCOME AND FOLLOW-UP: Significant improvements in Oswestry Disability Index, Patient-Specific Functional Scale, numeric pain-rating scale, and 5 times sit-to-stand were demonstrated following 16 weeks of postoperative PT without adverse events. DISCUSSION: Physical therapy following BKP may reduce pain and fall risk while improving quality of life without adverse events in patients with vertebral burst fracture on an individual basis. JOSPT Cases 2023;3(1):81–95. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11399

Education to keep the abdomen relaxed versus contracted during pilates in patients with chronic low back pain: study protocol for a randomised controlled trial

BackgroundLow back pain is a very common symptom frequently characterized as a biopsychosocial problem. This study aims to investigate the effectiveness of education to keep the abdomen relaxed versus contracted during Pilates exercises in patients with primary chronic low back pain.MethodsTwo-group randomised controlled trial with allocation of parallel groups and intention-to-treat-analysis. This study will be conducted in Lavras, MG, Brazil. A total of 152 participants will be randomised into two groups that will be treated with Pilates exercises for 12 weeks (twice a week for 60 minutes). Recruitment began in May 2022. The control group will receive guidance on the specific activation of the center of strength (the powerhouse), while the experimental group will receive guidance to perform the exercises in a relaxed and smooth way. Primary outcomes will be pain intensity (Numeric Pain Rating Scale) and disability (Rolland-Morris Questionnaire) 12 weeks post randomisation. Secondary outcomes will be global improvement (Perception of Global Effect Scale) and specific functionality (Patient-specific Functional Scale). The outcomes will be analyzed using repeated-measure linear mixed models. The assessors were not considered blinded because the participants were not blinded, and outcomes were self-reported.DiscussionThe findings of this study will help in clinical decision-making concerning the need to demand abdominal contraction during the exercises, understanding if it’s a fundamental component for the effectiveness of the Pilates method for this population.Trial registrationThis trial was prospectively registered in the Clinical Trials (NCT05336500) in April 2022.

The Effectiveness of Exercise Physiology Services During the COVID-19 Pandemic: A Pragmatic Cohort Study

BackgroundThe COVID-19 pandemic markedly changed how healthcare services are delivered and telehealth delivery has increased worldwide. Whether changes in healthcare delivery borne from the COVID-19 pandemic impact effectiveness is unknown. Therefore, we examined the effectiveness of exercise physiology services provided during the COVID-19 pandemic.MethodsThis prospective cohort study included 138 clients who received exercise physiology services during the initial COVID-19 pandemic. Outcome measures of interest were EQ-5D-5L, EQ-VAS, patient-specific functional scale, numeric pain rating scale and goal attainment scaling.ResultsMost (59%, n = 82) clients received in-person delivery only, whereas 8% (n = 11) received telehealth delivery only and 33% (n = 45) received a combination of delivery modes. Mean (SD) treatment duration was 11 (7) weeks and included 12 (6) sessions lasting 48 (9) minutes. The majority (73%, n = 101) of clients completed > 80% of exercise sessions. Exercise physiology improved mobility by 14% (β = 0.23, P = 0.003), capacity to complete usual activities by 18% (β = 0.29, P < 0.001), capacity to complete important activities that the client was unable to do or having difficulty performing by 54% (β = 2.46, P < 0.001), current pain intensity by 16% (β = − 0.55, P = 0.038) and goal attainment scaling t-scores by 50% (β = 18.37, P < 0.001). Effectiveness did not differ between delivery modes (all: P > 0.087).ConclusionsExercise physiology services provided during the COVID-19 pandemic improved a range of client-reported outcomes regardless of delivery mode. Further exploration of cost-effectiveness is warranted.

Dorsal proximal interphalangeal joint tenderness is associated with prolonged postoperative pain after A1 pulley release for trigger fingers

BackgroundIn some trigger finger patients, tenderness is found in the dorsal proximal interphalangeal (PIP) joint. The etiology and prevalence of this condition are unclear. Furthermore, surgical outcomes for trigger fingers with coexisting dorsal PIP tenderness have not been reported. This study (1) determined the prevalence and risk factors for PIP joint tenderness in trigger fingers and (2) compared postoperative outcomes for trigger fingers with and without joint tenderness.MethodsThis prospective cohort study was conducted between August 2018 and March 2020. We enrolled 190 patients diagnosed with single-digit trigger fingers undergoing open A1 pulley release. The incidence, demographic data, and surgical outcomes of patients with dorsal PIP tenderness were investigated. Factors associated with tenderness were analyzed, including patient occupation, finger involvement, trigger finger grading, duration of symptoms, previous corticosteroid injections, and presence of diabetes mellitus. A numeric pain scale, a patient-specific functional scale, and the range of motion were evaluated preoperatively and 1, 2, and 6 weeks after surgery, with telephone follow-ups at 3 and 6 months.ResultsOf 190 patients, 46.8% had tenderness of the dorsal PIP joint. Patients with joint tenderness had significantly more overall postoperative pain for up to 6 weeks and reported residual minor pain for up to 3 months. The functional scale and range of motion of the 2 groups did not differ during follow-up. The only risk factor observed was the occupation of the patients.ConclusionDorsal PIP tenderness is more common in trigger fingers than previously thought. It is also associated with higher and prolonged levels of postoperative pain after A1 pulley release. Therefore, patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after surgery.Level of EvidenceII

Pain-related interference and pain-related psychosocial factors of three different subgroups of patients with chronic low back pain

BackgroundLow back pain (LBP) subgroup identification and management are a research priority. The clarification of subgroup differences could assist clinicians in clinical decisions contributing to a tailored treatment. ObjectivesTo compare pain-related interference and pain-related psychosocial factors among subgroups of chronic low back pain (localised low back pain, peripheral neuropathic back pain, and widespread pain). DesignCross-sectional study. MethodsA cross-sectional study was conducted on 444 participants with chronic low back pain. Pain-related interference was investigated by the Brief Pain Inventory and Patient-Specific Functional Scale. Pain-related psychosocial factors assessment included psychosocial factors from Brief Screening Questions and maladaptive beliefs from Back Beliefs Questionnaire, self-efficacy, and expectation questions. Participants’ characteristics, pain-related interference, and pain-related psychosocial factors were compared among the three groups. ResultsA one-way ANCOVA presented statistically significant differences among the groups for current pain intensity [F(2,441) = 6.77, p = 0.001], pain duration [F(2,425) = 9.83, p < 0.001], pain-related interference by Brief Pain Inventory [F(2,441) = 11.97, p < 0.001], and pain-related psychosocial factors regarding symptoms of anxiety [F(2,441) = 3.85, p = 0.022], symptoms of depression [F(2,441) = 6.74, p = 0.001], social isolation [F(2,441) = 6.54, p = 0.002], catastrophising [F(2,441) = 9.72, p < 0.001], perceived stress [F(2,441) = 3.93, p = 0.020], maladaptive beliefs [F(2,441) = 6.89, p = 0.001], and expectation [F(2,441) = 6.66, p = 0.001]. ConclusionParticipants with widespread pain presented higher pain-related interference and pain-related psychosocial factors compared to the localised low back pain group. Participants with peripheral neuropathic back pain and widespread pain presented with similar characteristics.

Functional Ability and Quality of Life Status following Manual Therapy and Specific Exercise Conditioning in Subacromial Impingement Syndrome: A Randomised Controlled Study

Introduction: Subacromial Impingement Syndrome (SIS) is a common shoulder problem that leads to considerable functional loss and a decline in Quality of Life (QoL). Conservative treatment is the first line of management, often multimodal where physiotherapy is commonly recommended. But limited information is available regarding the combined effect of various treatments. Aim: To evaluate the combined effect of manual therapy and specific exercise conditioning in improving function and QoL among patients with SIS and also to compare with the conventional therapy. Materials and Methods: This single-blinded randomised controlled study was conducted in the rehabilitation center, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India, from January 2017 to February 2020. A total of 126 subjects were recruited and randomly allocated into two groups: Group 1 (n=63) received manual therapy and eccentric exercise, Group 2 (n=63) received conventional exercise, spread over three weeks followed by a home program for another nine weeks. Regional and self-rated functional limitations were obtained using the Shoulder Pain and Disability Index (SPADI) and Patient Specific Functional Scale (PSFS) at baseline, after 10 sessions of treatment and follow-up at 12 weeks with other clinical outcomes. A short form health survey (SF 36) was used to obtain QOL status at baseline and followup at 12 weeks. Data were analysed using one-way analysis of variance, and unpaired t-test. Results: The mean age was 45.02±10.30 years and 45.12±11.42 years in groups 1 and 2, respectively. Male to female ratio was 25:21 and 30:21 in groups 1 and 2, respectively. All outcomes improved by three weeks and during follow-up at 12 weeks in both groups (p-value &lt;0.00001 and p-value &lt;0.0005, respectively). However, on between group analysis significant improvement was observed with pain intensity (p-value &lt;0.0005), range (p-value &lt;0.05), external rotator strength (p-value=0.016) and PSFS score (p-value=0.014) by three weeks. External rotator strength (p-value&lt;0.0005), SPADI (p-value &lt;0.0005), PSFS (p-value=0.035), physical (p-value &lt;0.008) and mental (p-value &lt;0.006) cumulative scores of SF 36 had significant improvement in group 1 during follow-up at 12 weeks. Conclusion: The combined effect of manual therapy and specific exercise conditioning improved regional, self-rated functional ability and QoL among individuals with SIS.

Effect of Pain Neuroscience Education with Conventional Physiotherapy via Telerehabilitation on Pain Catastrophizing and Function in Patients with Osteoarthritis Knee: A Randomized Controlled Trial.

By explaining to the patient the biological processes underneath their pain condition, pain neuroscience education (PNE) is a form of educational intervention that aims to relieve pain and impairment. Patients with knee osteoarthritis (OA) referred to outpatient physiotherapy clinic in India during August 2021 to June 2022 were asked to participate. Out of the eligible patients, 35 were randomly assigned to PNE group and 35 to the control group. Self-reports of Pain Catastrophizing Scale (PCS), Patient Specific Function Scale (PSFS), and Numerical Pain Rating Scale (NPRS) were recorded at baseline (T1) and at 2 weeks (T2). After 2 weeks of follow-up, all the three outcome measures were found to be significant in the PNE group. The results of the unpaired t-test revealed statistically significant result posttest for PCS (mean difference 11.4) and NPRS (mean difference 1.20). There was no mean difference found in the patient function (PSFS) between groups. The results suggest that adding a program of PNE to conventional physiotherapy exercises led to a greater reduction in pain catastrophization, patient-specific function, and pain intensity rather than conventional physiotherapy alone in patients with knee OA at 2 weeks' follow-up.