Verbal Instructions Research Articles

Test–retest and inter-rater reliability of lumbar range of motion procedure using back range of motion instrument

IntroductionTo investigate the test–retest and inter-rater reliability of a new protocol using the back range of motion instrument (BROM II) to measure the lumbar range of motion (LROM).MethodsFive raters and twenty healthy subjects participated in this study. Before the measurement, all raters and all subjects were asked to watch a 4-minute video clip demonstrating the rating method. The raters and the subjects were then asked to practice the testing protocol until they thoroughly understood it. The subjects were asked to move the lumbar spine in six directions, with consistent verbal instruction. The raters measured the subjects’ LROM twice and were blinded to the data. The intraclass correlation coefficients were used to estimate the test–retest and inter-rater reliability of the LROM.ResultsThe results showed that the intra-rater reliability [ICC(3,1)] was good-to-excellent, ranging from 0.82 to 0.98, except for the LROM in the right rotation, which was moderate-to-good, ranging from 0.74 to 0.97. The inter-rater reliability [ICC(2,1)] was good-to-excellent, ranging from 0.78 to 0.87.ConclusionsThe intra- and inter-rater reliability of this protocol in measuring LROM obtained by the BROM II were reliable and suitable for both teaching and research.

“Introjecting” imagery: A process model of how minds and bodies are co-enacted

Somatic practices frequently use imagery, typically via verbal instructions, to scaffold sensorimotor organization and experience, a phenomenon we term “introjection”. We argue that introjection is an imagery practice in which sensorimotor and conceptual aspects are co-orchestrated, suggesting the necessity of crosstalk between somatics, phenomenology, psychology, embodied-enactive cognition, and linguistic research on embodied simulation. We presently focus on the scarcely addressed details of the process necessary to enact instructions of a literal or metaphoric nature through the body. Based on vignettes from dance, Feldenkrais, and Taichi practice, we describe introjection as a complex form of processual sense-making, in which context-interpretive, mental, attentional and physical sub-processes recursively braid. Our analysis focuses on how mental and body-related processes progressively align, inform and augment each other. This dialectic requires emphasis on the active body, which implies that uni-directional models (concept ⇒ body) are inadequate and should be replaced by interactionist alternatives (concept ⇔ body). Furthermore, we emphasize that both the source image itself and the body are specifically conceptualized for the context through constructive operations, and both evolve through their interplay. At this level introjection employs representational operations that are embedded in enactive dynamics of a fully situated person.

A new EEG neurofeedback training approach in sports: the effects function-specific instruction of Mu rhythm and visuomotor skill performance.

Achieving optimal visuomotor performance in precision sports relies on maintaining an optimal psychological state during motor preparation. To uncover the optimal psychological state, extensive EEG studies have established a link between the Mu rhythm (8-13 Hz at Cz) and cognitive resource allocation during visuomotor tasks (i.e., golf or shooting). In addition, the new approach in EEG neurofeedback training (NFT), called the function-specific instruction (FSI) approach, for sports involves providing function-directed verbal instructions to assist individuals to control specific EEG parameters and align them with targeted brain activity features. While this approach was initially hypothesized to aid individuals in attaining a particular mental state during NFT, the impact of EEG-NFT involving Mu rhythm on visuomotor performance, especially when contrasting the traditional instruction (TI) approach with the FSI approach, underscores the necessity for additional exploration. Hence, the objective of this study is to investigate the impact of the FSI approach on modulating Mu rhythm through EEG-NFT in the context of visuomotor performance. Thirty novice participants were recruited and divided into three groups: function-specific instruction (FSI, four females, six males; mean age = 27.00 ± 7.13), traditional instruction (TI, five females, five males; mean age = 27.00 ± 3.88), and sham control (SC, five females, five males; mean age = 27.80 ± 5.34). These groups engaged in a single-session EEG-NFT and performed golf putting tasks both before and after the EEG-NFT. The results showed that within the FSI group, single-session NFT with augmented Mu power led to a significant decrease in putting performance (p = 0.013). Furthermore, we noted a marginal significance indicating a slight increase in Mu power and a reduction in the subjective sensation of action control following EEG-NFT (p = 0.119). While there was a positive correlation between Mu power and mean radial error in golf putting performance (p = 0.043), it is important to interpret this relationship cautiously in the context of reduced accuracy in golf putting. The findings emphasize the necessity for extended investigation to attain a more profound comprehension of the nuanced significance of Mu power in visuomotor performance. The study highlights the potential effectiveness of the FSI approach in EEG-NFT and in enhancing visuomotor performance, but it also emphasizes the potential impact of skill level and attentional control, particularly in complex visuomotor tasks.

Brand transcreation as multimodal configuration

Abstract This article aims at revisiting some key concepts in translation studies by taking into account a new translation or multimodal practice called brand transcreation. Unlike translation proper or brand design proper, brand transcreation involves interlingual and multimodal production in the target culture. It relies on verbal instructions rather than the source text, and intersemiotically, transforms verbal messages into polished multimodal products. Using the systemic-functional sociosemiotic framework, this study delves into the types and dynamic orchestration of semiotic modes involved in two successful brand transcreations from a producer-researcher perspective. The findings reveal that brand transcreation can be defined as a goal-oriented textual production that configures multiple modes and serves specific communicative purposes. In this regard, the concepts of texts, contexts, meaning, and particularly (the categorization of) translation have evolved and require reconsideration.

Exploring running styles in the field through cadence and duty factor modulation

According to the dual-axis model, running styles can be defined by cadence and duty factor, variables that have been associated with running performance, economy and injury risk. To guide runners in exploring different running styles, effective instructions to modulate cadence and duty factor are needed. Such instructions have been established for treadmill running, but not for overground running, during which speed can be varied. In this study, five participants completed eight field training sessions over a 4-week training period with acoustic instructions to modulate cadence, duty factor, and, in combination, running style. Instructions were provided via audio files. Running data were collected with sports watches. Participants’ experiences with guided-exploration training were evaluated with the user experience questionnaire. Data analysis revealed acoustic pacing and verbal instructions to be effective in respectively modulating cadence and duty factor, albeit with co-varying effects on speed and the non-targeted variable (i.e. duty factor or cadence). Combining acoustic pacing and verbal instructions mitigated these co-varying effects considerably, allowing for running-style modulations in intended directions (particularly towards the styles with increased cadence and increased duty factor). User experience of this form of guided-exploration training was overall positive, but could be improved in terms of autonomy (dependability). In conclusion, combining acoustic pacing and verbal instructions for running-style modulation is effective in overground running.

Effect of augmented feedback on classical ballet jump kinematics: A single-blind randomized controlled trial

BackgroundAugmented feedback strategies have been demonstrated to enhance jump-related biomechanics. Nevertheless, its effect on classical ballet is still unknown. The purpose of this study was to investigate whether a multimodal augmented feedback session is effective for improving lower limb and trunk kinematics during a classical ballet single-leg jump. MethodsIn a single-blind randomized controlled trial, 36 amateur classical ballet dancers were randomly assigned to either a control group (n = 18) to receive a brief warm-up session, or an augmented feedback group (n = 18) to receive, in addition to a brief warm-up session, a combined visual feedback session associated with verbal instruction. Hip kinematics in the frontal and transversal planes and knee and trunk kinematics in the frontal plane were analysed at baseline, immediate post-intervention, and one-week post-intervention. Intervention effects were analysed using a two-way, mixed model, repeated-measures analysis of variance. ResultsNo interaction effects were observed, indicating that a single session of multimodal augmented feedback was insufficient to improve lower limb and trunk kinematics during a classical ballet single-leg jump in amateur classical ballet dancers. ConclusionA single session of multimodal augmented feedback should not be used as the sole component in prevention programs intended to improve jump-related kinematics in amateur classical ballet dancers.

Lower-extremity kinematics and kinetics differ based on drop vertical jump variation: An assessment of methodology for a return-to-play protocol using motion analysis

BackgroundThe drop vertical jump (DVJ) is commonly used in return-to-play evaluations to assess movement quality and risk during a dynamic task. However, across biomechanics literature, a multitude of DVJ variations have been used, influencing the generalizability and potential interpretation of the reported findings. Research questionThe purpose of this study was to identify differences in lower extremity kinematics and kinetics between DVJ variations that differ based on horizontal jump distance, verbal instructions, and the use of a jump target. MethodsA single-group repeated measures design was used in a laboratory setting. Twenty participants were tested, and three-dimensional angles and moments of the pelvis, hip, knee, and ankle were computed. Wilcoxon signed rank tests were performed to determine differences between DVJ variations. ResultsReduced knee flexion at initial contact and greater knee extensor moments across the descent phase were observed with increased horizontal jump distance. Additionally, both verbal instructions and a jump target influenced movement strategies at the pelvis, hip, and knee. Ground reaction forces were found to be similar across conditions and jump height following the first landing increased with a target. SignificanceAlthough subtle, the biomechanical differences observed between task variations emphasize the importance of standardizing motion analysis protocols for research and clinical decision-making. Given the findings of the current study, the authors recommend using the Half Height variation in patients treated for a knee injury as it will likely be the most indicative of movement quality.

A study of the mechanism for intergenerational transmission of gender roles in single-parent families

The divorce rate in China is rising yearly, and the concept of marriage is changing, triggering many social topics related to single parents. Among them, gender-awareness education for children in single-parent families is particularly worthy of attention, as there has been insufficient exploration of how parents transfer their gender role concepts to their children. This study conducted in-depth interviews with 58 single parents and children from 29 families in Suzhou and constructed the mechanism for intergenerational transmission of gender roles in single-parent families based on grounded theory. It found that single parents' gender stereotypes, the starting point of the intergenerational transmission mechanism, have been diluted. It affords them a more enlightened attitude towards child-rearing style, and they expect more equality in the gender role of their offspring. However, in some parents' actual parenting process, when the children's sexualization behaviours exceed their acceptance range, they will communicate with children in an authoritative and didactic way to “correct” the children's behaviour. In addition to direct verbal instruction, parents' expectations of their children's gender roles will be implicitly conveyed through various parent-child interactions in daily life to affect the formation of their children's gender roles. In the intergenerational transmission of gender roles, external people (such as grandparents, teachers and peer groups) have horizontal socialisation effects on children to modify or strengthen the results of gender education from their parents. Under the comprehensive influence of the above factors, the children's gender roles are finally determined. These studies expand previous theories and studies and have significant theoretical and practical implications.

Effect of verbal instructions on trunk muscle activity during volitional preemptive abdominal contraction

ObjectiveThis study investigated the effect of Verbal Instruction (VI) strategies on trunk muscle contraction among healthy subjects. The effect of three VI Abdominal Drawing-In Maneuver (ADIM) and two VI Abdominal Bracing Maneuver (ABM) strategies on left Internal (LIO) and External Oblique (LEO) and bilateral superficial Multifidi (sMf) activation was examined. DesignWithin-subjects, repeated measure design. MethodsSurface EMG (sEMG) measured LIO, LEO, and sMf activity in 28 subjects (mean age 23.5 ± 5.5 years). Testing included five supine hook-lying and five quiet standing conditions. ResultsOne-way ANOVAs demonstrated no significant main effect for ADIM or ABM in supine or standing (p > .05). Muscle activation amplitudes during VPAC conditions demonstrated higher mean values for standing versus supine (p < .05) except for two conditions involving LEO. Friedman Tests for dominant strategy demonstrated a significant main effect for ADIM-VI and ABM-VI strategies. Post-hoc testing generally showed the dominant strategy to be significantly higher versus others. ConclusionNo single preferred VI cue for ADIM or ABM was observed. Each subject's dominant strategy dictated the most suitable VI. Standing was preferred for LIO and sMf activation, whereas position did not change LEO activation. Non-significant correlations between all muscle pairings during all ADIM and ABM strategies were observed. These findings may suggest the need for healthcare providers who understand the intricacies of trunk stability to teach and monitor VPAC with either ADIM or ABM options.

Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review

BackgroundChildbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life, cohabitation, and work. There is currently no up-to-date literature study on the effect of pelvic floor muscle training with feedback from a physiotherapist, which involves verbal instructions based on vaginal and anal digital palpation, compared to treatment without feedback (e.g., recommendations for pelvic floor muscle training).AimThe objective of this systematic review was to examine the scientific evidence regarding the impact of pelvic floor muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and anal incontinence in women during the first six months following vaginal delivery, compared to treatment without feedback.MethodsThe literature search was conducted in the databases PubMed, Cochrane, and CINAHL. In addition, a manual search was conducted. The search terms consisted of MeSH terms and synonyms in the respective search block including population, intervention, and study design, as well as the terms pelvic floor and postpartum. An evaluation of each included study was conducted for methodological quality, evidence value, and clinical relevance.ResultsEight studies were included, three of which showed a significant difference between groups, in favor of the intervention group that received pelvic floor muscle training with feedback from a physiotherapist and/or biofeedback. Due to the varying results and insufficient quality for the majority of the studies, the scientific basis was considered insufficient.ConclusionThe scientific evidence for pelvic floor muscle training with feedback from a physiotherapist or biofeedback on postpartum urinary and anal incontinence compared to treatment without feedback is considered insufficient. Further research on the subject is needed. The study is registered in PROSPERO CRD42022361296.

Empathic Accuracy, Mindfulness, and Facial Emotion Recognition: An Experimental Study

Background and Objectives: Empathic accuracy, i.e., the degree to which one is able to accurately infer the emotions of others, may be acutely malleable. We examined this idea by testing the immediate effect of a brief mindfulness intervention or facial emotion recognition training. Methods: Participants were English- or Dutch-speaking psychology students who were assigned to one of three brief intervention conditions (all instructions given in English): (1) verbal instructions for practicing awareness of their body (mindfulness, n = 23); (2) verbal and visual instructions regarding the detection of visual cues for anger, fear, sadness, and happiness (facial emotion recognition training, n = 23); or (3) a verbal, neutral didactic lecture on mindfulness (control, n = 23). Subsequently, participants completed a Dutch-language empathic accuracy task. Results: There was no significant overall difference in empathic accuracy between the three participant subgroups, suggesting no effect of the two target interventions. Nonetheless, even though empathic accuracy appeared unaltered by facial emotion recognition training among participants who understood Dutch well, it was better after this intervention than after the control intervention among participants with a relatively limited understanding of Dutch. Limitations: The study used a small convenience sample. The control condition was listening to a lecture on mindfulness. Empathic accuracy was not assessed at baseline. Moreover, we did not formally assess language understanding, as we did not predict its presumed impact a priori. Conclusions: A better study design is needed to find out whether facial emotion recognition training can help improve empathic accuracy when the understanding of verbal cues is limited.

Better safe than sorry?-On the influence of learned safety on pain perception.

The experience of threat was found to result-mostly-in increased pain, however it is still unclear whether the exact opposite, namely the feeling of safety may lead to a reduction of pain. To test this hypothesis, we conducted two between-subject experiments (N = 94; N = 87), investigating whether learned safety relative to a neutral control condition can reduce pain, while threat should lead to increased pain compared to a neutral condition. Therefore, participants first underwent either threat or safety conditioning, before entering an identical test phase, where the previously conditioned threat or safety cue and a newly introduced visual cue were presented simultaneously with heat pain stimuli. Methodological changes were performed in experiment 2 to prevent safety extinction and to facilitate conditioning in the first place: We included additional verbal instructions, increased the maximum length of the ISI and raised CS-US contingency in the threat group from 50% to 75%. In addition to pain ratings and ratings of the visual cues (threat, safety, arousal, valence, and contingency), in both experiments, we collected heart rate and skin conductance. Analysis of the cue ratings during acquisition indicate successful threat and safety induction, however results of the test phase, when also heat pain was administered, demonstrate rapid safety extinction in both experiments. Results suggest rather small modulation of subjective and physiological pain responses following threat or safety cues relative to the neutral condition. However, exploratory analysis revealed reduced pain ratings in later trials of the experiment in the safety group compared to the threat group in both studies, suggesting different temporal dynamics for threat and safety learning and extinction, respectively. Perspective: The present results demonstrate the challenge to maintain safety in the presence of acute pain and suggest more research on the interaction of affective learning mechanism and pain processing.

Narrating the route: route memorability in navigation instructions augmented with narrative–results from a user study

ABSTRACT From oral histories to mnemonic devices, humans have an excellent ability to remember object sequences and their relationships inside of narratives. In pedestrian wayfinding, remembering landmarks and their relationships is considered key to learning routes. This research explores whether augmenting verbal route instructions with a narrative increases the memorability of a route. Narrative theory is applied as a framework to develop narrative-based navigation instructions, which were tested in a field study (N = 18). After learning a route, participants recalled the route verbally, completed a photo-based landmark sequencing task and discussed their answers. One week later, a route recognition task and a second photo-based landmark sequencing task was completed online. Results show few significant differences between the two groups when compared quantitatively. However, during interviews, the narrative group repeatedly cited the narrative when remembering the route. The results suggest that incorporating narratives into route directions can be further explored, and that some novel direction types may not be well-measured using quantitative methods. This research confirms the prowess of landmark-based instructions to facilitate route memory, contributes to the growing body of work augmenting landmark-based route directions with detailed information, and further encourages designers to consider alternate route communication methods.

Lessons from Skill Acquisition to Guide Student-Athletes’ Leadership Development

Given the stance of education-based sport entities (i.e., NFHS) that sport participation leads to leadership development, this article aims to provide coaches and practitioners several strategies to teach leadership skills anchored in principles from skill acquisition literature. The principles explored include (1) identification of skill abilities, (2) demonstration, (3) verbal instruction, (4) specificity and (5) feedback. Following a continuum describing life skill acquisition (including structuring the sport context, facilitating a positive climate, discussing life skills, and practicing life skills), examples are provided of how to enhance leadership skill development.

The effect of verbal instructions while using digital indoor wayfinding devices on gender, performance, and self-reported strategies

Studies indicate that verbal instructions may impact associations between gender and wayfinding performance (measured via relative direction pointing accuracy and walking pace). Following the increasing use of digital navigation applications in indoor environments, and their implications on acquiring and processing spatial information, the aim of this study is to evaluate the stability of previously established associations. The study included 34 participants (16 females) aged 24–34 and was conducted in an indoor hospital setting. In addition to using a navigation application, one of three types of verbal instructions (route, survey, or none) were given in each wayfinding scenario. Self-reported wayfinding strategies were also assessed. The findings indicate that male participants made fewer pointing accuracy errors and walked faster than females, regardless of the type of instructions given, implying that the impact of naturally employed wayfinding strategies by gender (route for females; survey for males) on wayfinding performance may be more dominant than that of navigational devices. In addition, when males and females were exposed to their unnatural wayfinding strategy, no significant differences were seen in either group's self-reported wayfinding strategies. These findings may suggest that applying survey knowledge to females may improve their indoor wayfinding.

24 Individual Differences in CAMCOG-DS Performance in Children and Adults with Down's Syndrome and Relationship to Language and Reasoning

Objective:The Cambridge Cognitive Examination for Down's Syndrome (CAMCOG-DS) was developed to assess cognitive functioning and dementia-related cognitive decline in people with Down's Syndrome (DS). It has been translated into different languages and is often used in international studies. Although adapted for people with intellectual disabilities (ID), many tasks involve verbal responses and instructions are presented orally. Therefore, the administration for people with severe language deficits can be challenging. The aim of this retrospective data analysis is to examine the influence of language ability and reasoning on CAMCOG-DS performance. Study 1 examined the relationship between CAMCOG-DS, picture naming, single word comprehension and reasoning in adults with DS. Study 2 replicates and broadens the findings in a sample of children and adults with DS.Participants and Methods:Study 1 included 40 adults with DS between 18 and 51 years (M = 28.6, SD = 8.4). 25 had a mild and 15 a moderate ID. CAMCOG-DS, the short form of the Boston Naming test (BNT), a test for single word comprehension from the Werdenfelser Testbatterie (WTB) and the Colored Progressive Matrices (CPM) were administered. Study 2 included 38 participants between 8 and 59 years (23 children, M = 11.4; 15 adults; M = 31.3). 3 had a borderline, 23 a mild, and 12 a moderate ID. The same tasks as in Study 1 were applied, but the CPM was replaced by its successor, the Raven's 2.Results:In Study 1, participants with mild ID performed better in all tasks than those with moderate ID (p &lt; .05). Moderate relationships were found between CAMCOG-DS total score and the language tasks (r = .56 and r = .46), which remained significant when level of ID was controlled for. There was also a moderate relationship between CAMCOG-DS and reasoning (r = .46). Regression analysis showed that BNT performance predicted CAMCOG-DS performance (R2 = .31). In Study 2, those with mild ID, compared to those with moderate ID, performed better in all tasks (p &lt; .05), however, regarding the CAMCOG-DS and language tasks, this effect was larger in adults than in children. Adults performed better than children in the CAMCOG-DS and BNT (p &lt; .05), but not in single word comprehension or reasoning. As in Study 1, moderate to large correlations were revealed between CAMCOG-DS and language tasks and between CAMCOG-DS and reasoning (r &gt; .52), remaining significant when age and ID level were controlled for. Regression analysis showed that both naming and reasoning but not single word comprehension or age predicted CAMCOG-DS performance (R2 = .69), however, performance was best predicted by naming (R2 = .65).Conclusions:Our results suggest that language ability and reasoning relate to CAMCOG-DS performance, which is best predicted by BNT picture naming. This should be considered in CAMCOG-DS interpretation, as the capabilities of patients with lesser language ability might be underestimated. Future developments of dementia assessments for people with ID should include more nonverbal tasks.

The practice of metaphor in conversation: an ecological integrational approach

In this study an integrational linguistic approach to metaphor is used in the context of an ecological psychology study of novel metaphor creation by adults in a structured conversation setting. This paper forms an example of the proposed complementarity of integrational linguistics (Harris, 1981) and ecological psychology (Gibson, 1979; Jones and Read, 2023) by providing a study of novel metaphor that eschews the traditional “coded carrier of message” assumptions about language, as well as the traditional “knowledge is mental representation” assumptions of representationalist cognitive psychology. Instead, novel metaphor is presented as the sine qua non of the creation of signs in the process of communication, and that creation is proposed to be founded on the perception of invariants across different naturally occurring kinds of objects and events (cf., Read & Szokolszky, 2016). The practice of metaphor is taken as a special case of perceptually guided kinematic semiology. This study describes the practice of metaphor by adults in a structured experimental situation designed to present metaphoric resemblance and to encourage the practice of metaphor with guiding verbal instructions. Such a study allows explication of the integrational method as applied to structured conversational settings. Although the conversation and context were designed to draw attention to metaphoric resemblance and to encourage verbal metaphor, not everyone practiced metaphor, showing that the practice is not determined by context. When metaphor was created, the form often mirrored the perceptual invariants available to the perceiver, i.e., motion or stationary resemblances. No one created exactly the same metaphor even in this consistent context, which emphasizes the creative aspect of metaphor as a prototype of sign creation, with its core properties of novelty, enhanced interest and noticeableness. I make the following central points: communicating by creating and integrating signs is the foundation of language; metaphor is the prototype of the creation of signs, the creation of novel metaphor in conversation is a practice that enhances communication, even in structured experimental settings; and conversation can be studied as the ongoing process of sign integration, that is, as perceptually guided kinematic semiology. The current study shows that metaphor as a practice in conversation is closely coordinated with the perception of metaphoric resemblance and the request to talk about objects and events that are alike metaphorically. Finally, it is argued that direct perception is the best approach on which to found an account of metaphor in communication.

言传身教：中国教育中的历史传承及当代价值

The professional ethical standards for university teachers explicitly outline the requirements for ‘teaching and educating’, yet challenges persist in actual teaching practices. This paper delves into the historical legacy of teaching by verbal instruction and personal example within the Chinese education domain, examining its role and significance in contemporary higher education. It commences by investigating the cultural underpinnings of teaching by verbal instruction and personal example and highlights the symbiotic relationship between ‘teaching’ and ‘learning’ as espoused by ancient educators. This underscores the impact of educators’ words and actions on students and showcases the constructive influence of educators’ moral character and elevated moral values through historical exemplars and educational instances. In the contemporary educational environment, education is not only about imparting knowledge, but also guiding students’ values and personality shaping. In the era of digitization and networking, the role of teachers in teaching by verbal instruction and personal example remains crucial. Teachers are entrusted with the task of molding students through their own conduct and attitudes, both within and beyond the classroom, fostering their virtuous character and values. Ultimately, this paper proposes avenues to attain the objective of teaching by verbal instruction and personal example. Beyond the personal development and introspection of educators, it underscores the necessity for schools and society to collaborate in crafting an inclusive educational environment conducive to nurturing individuals possessing both professional competence and noble moral character.

Group-based PFMT programme for preventing and/or treating UI in pregnant women: protocol of a randomized controlled feasibility study

BackgroundUrinary incontinence (UI) is a prevalent health problem in women worldwide. Many women experience UI during pregnancy. The National Institute for Health and Care Excellence (NICE) recommended pelvic floor muscle training (PFMT) as the first-line conservative treatment for UI. However, it is not widely implemented due to the limited number of healthcare trainers. Group-based PFMT has been used with older women and a limited number of maternity studies. But the effectiveness of the group-based PFMT needs to be investigated because the overall quality of the studies is low. Therefore, this study aims to assess the feasibility of delivering a group-based PFMT programme for pregnant women in Nanjing city.MethodsThis feasibility study will be conducted in Nanjing Maternity and Child Health Care Hospital in China, using a mixed methods design to investigate the feasibility and acceptability of delivering group-based PFMT to pregnant women. Pregnant women with or without the symptoms of UI will be included. This study aims to recruit 48 pregnant women with 24 in each arm. Participants will receive either the group-based PFMT delivered by a midwife or usual antenatal care which includes only verbal instruction on PFMT. The study will assess the completion rates, acceptability of outcome measures, recruitment and retention rate and calculate an appropriate sample size for a future study.DiscussionThe results of this study will inform the design and implementation of a definitive randomized clinical trial to explore the effectiveness of the intervention.Trial registrationClinicalTrials.gov, NCT05242809.

Creating Placebo Nonresponders in the Lab

Conditioning and expectation are known to be the main mechanisms of placebo analgesia. They may operate together, so that expectations may be enhanced by a conditioning procedure. Although most of the studies have tried to potentiate expectations through conditioning in order to generate good placebo responders, a few studies have tried to mismatch conditioning and expectations in order to investigate the subsequent administration of a placebo. In this study, we want to further investigate this mismatch. We generated incongruent associations during a conditioning procedure in which the study participants did not get what they expected. In fact, although the participants received verbal instructions of pain decrease following the administration of a placebo, we surreptitiously increased the painful electric stimulation. Two pairings of these incongruent associations (mismatch between what was expected and what was experienced) disrupted expectations of analgesia as well as the placebo effect, as assessed by measuring electric pain thresholds on the hand. The effects of mismatch conditioning on the hand extended to the contralateral arm and to a different type of pain (tourniquet), which suggests that local mismatch conditioning may affect the whole body. In all cases, expectations predicted placebo analgesia. These findings indicate that placebo nonresponders can be created in the laboratory by acting on expectations and that local effects can be generalized to other parts of the body. They also stress the importance of expectations in the therapeutic outcome, with important implications for clinical trials. PerspectiveBy using mismatch conditioning, in which study participants did not get what they expected, we reduced expectations of analgesia, and this reduction abolished placebo analgesia. This effect extended to other parts of the body and other types of pain, which indicates that placebo nonresponders can be created in the laboratory.