Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis.

BACKGROUND: A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined. OBJECTIVES: The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain. METHODS: For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain. CONCLUSIONS: Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.

Differences in movement limitations in different low back pain severity in functional tests using an RGB-D camera.

Low back pain (LBP) can lead to motor control disturbance which can be one of the causes of reoccurrence of the complaint. It is important to improve our knowledge of movement related disturbances during assessment in LBP and to classify patients according to the severity. The aim of this study is to present differences in kinematic variables using a RGB-D camera in order to classify LBP patients with different severity. A cross-sectional study was carried out. Subjects with non-specific subacute and chronic LBP were screened 6 weeks following an episode. Functional tests were bending trunk test, sock test and sit to stand test. Participants performed as many repetitions as possible during 30 s for each functional test. Angular displacement, velocity and acceleration, linear acceleration, time and repetitions were analysed. Participants were divided into two groups to determine their different LBP severity with a k-means clusters according to the results obtained in Roland Morris questionnaire (RMQ). Comparing different severity groups based on RMQ score (high impact = 17.15, low impact = 7.47), bending trunk test obtained significative differences in linear acceleration (p = 0.002-0.01). The differences of total linear acceleration during the Sit to Stand test were significative (p = 0.004-0.02). Sock test showed not significative differences between groups (p > 0.05). Linear acceleration variables during Sit to Stand test and Bending trunk test were significatively different between the different severity groups. RGB-D camera system and functional tests can detect kinematic differences in different type of LBP according to the functionality. Trial registration: ClinicalTrials.gov NCT03293095 "Functional Task Kinematic in Musculoskeletal Pathology" September 26, 2017.

Low-Energy Extracorporeal Shockwave Therapy as a Therapeutic Option for Patients with a Secondary Late-Stage Fibro-Lymphedema After Breast Cancer Therapy: A Pilot Study.

Background: Secondary lymphedema (LE) can occur after breast cancer (BC) therapy with axillary lymph node surgery and/or radiotherapy. Reported incidence varies around 20%. The aim of this study was to see whether low-energy extracorporeal shockwave therapy (ESWT) is a therapeutic option in end-stage secondary upper limb fibro-LE. Methods and Results: A pilot study was performed on 10 adult patients who presented with an end-stage LE after BC treatment. They were all treated with usual physical therapy and all had lymphatic surgery before. Eight sessions of ESWT were applied, 2600 shocks at 0.1 mJ/mm2, 2/week during 4 weeks. Upper limb volume decreased nonsignificantly, from 3086.4 ± 539.47 to 2909.1 ± 471.60 mL. Mean circumference of the upper limb was significantly decreased from 32.3 ± 3.01 to 31.4 ± 2.71 cm at the height of the upper arm, from 29.1 ± 2.89 to 28.1 ± 2.71 cm at the height of the elbow, and from 27.5 ± 4.08 to 26.8 ± 3.75 cm at the height of the forearm. Subjective measurements by visual analog scale showed significant decrease in both hardness from 57.3 ± 15.84 to 24.4 ± 21.89 mm and subjective feeling of edema from 44.2 ± 16.90 to 23.2 ± 21.16 mm. No adverse features were reported. Conclusion: We added some evidence that low-energy ESWT is well supported and has additional benefits also in longstanding fibro-lipo-LE on swelling of the arm leading to more subjective comfort for the patients.

Validation, Reliability, and Responsiveness Outcomes Of Kinematic Assessment With An RGB-D Camera To Analyze Movement In Subacute And Chronic Low Back Pain.

BACKGROUND: The RGB-D camera is an alternative to asses kinematics in order to obtain objective measurements of functional limitations. The aim of this study is to analyze the validity, reliability, and responsiveness of the motion capture depth camera in sub-acute and chronic low back pain patients. METHODS: Thirty subjects (18-65 years) with non-specific lumbar pain were screened 6 weeks following an episode. RGB-D camera measurements were compared with an inertial measurement unit. Functional tests included climbing stairs, bending, reaching sock, lie-to-sit, sit-to-stand, and timed up-and-go. Subjects performed the maximum number of repetitions during 30 s. Validity was analyzed using Spearman's correlation, reliability of repetitions was calculated by the intraclass correlation coefficient and the standard error of measurement, and receiver operating characteristic curves were calculated to assess the responsiveness. RESULTS: The kinematic analysis obtained variable results according to the test. The time variable had good values in the validity and reliability of all tests (r = 0.93-1.00, (intraclass correlation coefficient (ICC) = 0.62-0.93). Regarding kinematics, the best results were obtained in bending test, sock test, and sit-to-stand test (r = 0.53-0.80, ICC = 0.64-0.83, area under the curve (AUC) = 0.55-84). CONCLUSION: Functional tasks, such as bending, sit-to-stand, reaching, and putting on sock, assessed with the RGB-D camera, revealed acceptable validity, reliability, and responsiveness in the assessment of patients with low back pain (LBP). TRIAL REGISTRATION: ClinicalTrials.gov NCT03293095 "Functional Task Kinematic in Musculoskeletal Pathology" September 26, 2017.