The collection and reporting of measures of deprivation in musculoskeletal research: An international survey study.

BACKGROUND: The reporting of deprivation measures is typically poor in musculoskeletal (MSK) research. AIMS: To explore MSK researcher's perspectives on the deprivation indices and measures that are, or could be, collected and reported in their studies, and potential barriers and facilitators to collecting these data. MATERIALS & METHODS: An online international survey was undertaken to determine knowledge, use and reporting of deprivation indices and measures by MSK researchers and the factors which influence this. Data were analysed using descriptive statistics. RESULTS: 42 respondents from 16 countries completed the survey. The index of multiple deprivation was the most well-known measure (26%) although only 17% had reported data from this index. Most commonly reported markers of deprivation were: employment (60%), education (60%) and ethnicity (50%). Most common barriers to collecting these data included: uncertainty on perceived importance of deprivation measures (79%), what should be collected (71%), and concerns on missing data and sensitivities from participants reluctant to provide this information (33%). Consensus on necessary measures to be collected and reported (88%) and improved awareness of the relationship between deprivation and MSK health (79%) were considered key activities to improve deprivation recording in MSK research. DISCUSSION & CONCLUSION: There is poor awareness of the collection and reporting of deprivation measures in MSK research. Greater understanding on the importance of these data in reducing inequalities in MSK care is needed to facilitate improvement. This would enable greater assessment of generalisability and to assess whether interventions have different effects in people from different socio-economic groups.

Prism adaptation treatment for upper-limb complex regional pain syndrome: a double-blind randomized controlled trial.

ABSTRACT: Initial evidence suggested that people with complex regional pain syndrome (CRPS) have reduced attention to the affected side of their body and the surrounding space, which might be related to pain and other clinical symptoms. Three previous unblinded, uncontrolled studies showed pain relief after treatment with prism adaptation, an intervention that has been used to counter lateralised attention bias in brain-lesioned patients. To provide a robust test of its effectiveness for CRPS, we conducted a double-blind randomized controlled trial of prism adaptation for unilateral upper-limb CRPS-I. Forty-nine eligible adults with CRPS were randomized to undergo 2 weeks of twice-daily home-based prism adaptation treatment (n = 23) or sham treatment (n = 26). Outcomes were assessed in person 4 weeks before and immediately before treatment, and immediately after and 4 weeks after treatment. Long-term postal follow-ups were conducted 3 and 6 months after treatment. We examined the effects of prism adaptation vs sham treatment on current pain intensity and the CRPS symptom severity score (primary outcomes), as well as sensory, motor, and autonomic functions, self-reported psychological functioning, and experimentally tested neuropsychological functions (secondary outcomes). We found no evidence that primary or secondary outcomes differed between the prism adaptation and sham treatment groups when tested at either time point after treatment. Overall, CRPS severity significantly decreased over time for both groups, but we found no benefits of prism adaptation beyond sham treatment. Our findings do not support the efficacy of prism adaptation treatment for relieving upper-limb CRPS-I. This trial was prospectively registered (ISRCTN46828292).

Disputing space-based biases in unilateral complex regional pain syndrome.

There is some evidence that people with Complex Regional Pain Syndrome (CRPS) show reduced attention to the affected relative to unaffected limb and its surrounding space, resembling hemispatial neglect after brain injury. These neuropsychological symptoms could be related to central mechanisms of pathological pain and contribute to its clinical manifestation. However, the existing evidence of changes in spatial cognition is limited and often inconsistent. We examined visuospatial attention, the mental representation of space, and spatially-defined motor function in 54 people with unilateral upper-limb CRPS and 22 pain-free controls. Contrary to our hypotheses and previous evidence, individuals with CRPS did not show any systematic spatial biases in visuospatial attention to or representation of the side of space corresponding to their affected limb (relative to the unaffected side). We found very little evidence of directional slowing of movements towards the affected relative to unaffected side that would be consistent with motor neglect. People with CRPS were, however, slower than controls to initiate and execute movements with both their affected and unaffected hands, which suggests disrupted central motor networks. Finally, we found no evidence of any clinical relevance of changes in spatial cognition because there were no relationships between the magnitude of spatial biases and the severity of pain or other CRPS symptoms. The results did reveal potential relationships between CRPS pain and symptom severity, subjective body perception disturbance, and extent of motor impairment, which would support treatments focused on normalizing body representation and improving motor function. Our findings suggest that previously reported spatial biases in CRPS might have been overstated.

Introducing Acceptance and Commitment Therapy to a physiotherapy-led pain rehabilitation programme: an Action Research study.

BACKGROUND: Recent developments in pain rehabilitation emphasise the importance of promoting psychological flexibility. Acceptance and Commitment Therapy (ACT) is one approach that has been shown to be effective for the treatment of chronic musculoskeletal pain. However, studies have shown that introducing innovative approaches such as ACT into established health care can cause some anxiety for professional groups. We used Action Research to evaluate the implementation of ACT to a physiotherapy-led pain rehabilitation programme. METHODS: All staff in the pain service were invited to participate. Participants took part in focus groups, engaged in reflective sessions/meetings and completed reflective diaries. The analysis was undertaken by an experienced qualitative researcher using constant comparison. Participants reviewed emerging themes and validated the findings. RESULTS: Four key themes emerged from the study: (a) the need to see pain as an embodied, rather than dualistic, experience; (b) the need for a more therapeutic construction of 'acceptance'; (c) value-based goals as profound motivation for positive change; and (d) it's quite a long way from physiotherapy. Integral to a therapeutic definition of acceptance was the challenge of moving away from 'fixing' towards 'sitting with'. Participants described this as uncomfortable because it did not fit their biomedical training. CONCLUSION: This article describes how Action Research methodology was used in the introduction of ACT to a physiotherapy-led pain rehabilitation programme. The innovation of this study is that it helps us to understand the potential barriers and facilitators to embedding an ACT philosophy within a physiotherapy setting.