Tactile acuity and active joint repositioning sense in individuals with and without chronic low back pain: a cross-sectional study.

BACKGROUND: Sensorimotor dysfunction, as measured by tactile acuity and active joint repositioning, has been identified as a contributing factor of chronic low back pain (CLBP). Existing research suggests that further research is necessary to improve the characterization of sensorimotor perception in patients with CLBP. OBJECTIVES: The main aim is to investigate whether tactile acuity and repositioning errors differ between individuals with CLBP and controls without CLBP. A secondary aim was to investigate the association between age, body mass index (BMI) and physical activity, and tactile acuity and repositioning sense. METHODS: Cross-sectional study. Sixty-eight participants (36 with, 32 without CLBP) were examined. Two-Point Discrimination (TPD) test (four measures: horizontal and vertical run, left and right side) and Active Joint Reposition Sense (AJRS) test (2 directions: to flexion and to extension) were used. RESULTS: No differences were found for TPD (right horizontal run: p = .069; left horizontal run: p = .066; right vertical run: p = .933; left vertical run: p = .285) or AJRS (flexion: p = .792; extension: p = .956) between participants with and without CLBP. Older subjects had significantly worse tactile acuity (3 sites, p = .018, p = .004, p = .041) and worse repositioning sense (2 directions, p = .026, p = .040,) than younger subjects. Individuals with BMI ≥ 25 had significantly worse TPD compared to individuals with normal weight (2 sites, p = .028, p = .020). CONCLUSIONS: Individuals with CLBP did not have impaired tactile and repositioning accuracy when compared to controls without CLBP. Future studies comparing sensorimotor performance should consider age and BMI as potential confounding factors.

A Practice Guide for Physical Therapists Prescribing Physical Exercise for Older Adults.

INTRODUCTION: Physical activity and exercise are protective factors for physical and cognitive decline in older adults, but recent studies reveal that a large percentage of this population do not practice exercise at the levels recommended by international guidelines. The frequency, intensity, type, time, volume, and progression (FITT-VP) principles are a widely used method for prescribing physical exercise, allowing the development of a personalized exercise program that meets the needs of each individual. OBJECTIVES: This masterclass is intended to serve as a professional application tool for physical therapists who prescribe physical exercise for older adults. We present a section for each FITT-VP principle to facilitate handling these principles individually when prescribing exercise for this population. METHODS: Review of the scientific literature and international guidelines on the prescription of physical exercises for older adults. RESULTS: Aerobic, mobility, resistance, balance, and flexibility exercises, as well as functional training, should be included in an exercise program for older adults, which should be progressed using different methods for each of the exercise modalities. CONCLUSIONS: An exercise program for older adults should integrate different exercise modalities. Exercise progression should be performed following the FITT-VP principles and some specific progression factors recommended for each exercise modality. SIGNIFICANCE: Considering the challenge faced by clinicians in designing a viable exercise program for older adults that responds to international recommendations, with this masterclass we hope to help physical therapists to plan an exercise program that is feasible and at the same time, responds to the expected needs of this population.

Associations between pain intensity, pain sensitivity, demographics, psychological factors, disability, physical activity, pain phenotype and COVID-19 history in low back pain: An observational study.

BACKGROUND AND PURPOSE: Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self-reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID-19 and pain intensity and sensitivity in patients with chronic non-specific low back pain (LBP). METHODS: This was a cross-sectional secondary analysis with 83 participants with chronic non-specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used. RESULTS: The model for pain intensity explained 34% of its variance (Adjusted R2 = -0.343, p < 0.001), with depression and anxiety (p = 0.008) and disability (p = 0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2 = 0.344, p < 0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p < 0.05) and 15% of the variance at a distant body site (Adjusted R2 = 0.148, p = 0.018) with sex and BMI reaching statistical significance (p < 0.05). DISCUSSION: This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI.

Predictors of improvement in community adolescents with chronic neck pain: A secondary analysis using different improvement criteria.

BACKGROUND: Interventions based on pain neuroscience education and exercise have emerged as effective in the management of chronic neck pain in adolescents. No studies have explored factors that might be associated with recovery in adolescents with neck pain. OBJECTIVE: To explore predictors of improvement after an intervention based on exercise and pain neuroscience education. DESIGN: Secondary analysis of a randomized trial. SETTING: Community. PARTICIPANTS: 127 community adolescents with neck pain. INTERVENTIONS: Blended-learning intervention based on exercise and pain neuroscience education. MAIN OUTCOME MEASURES: A set of variables including sociodemographic data, pain characteristics, physical activity, disability, sleep, catastrophizing, fear of movement, self-efficacy, symptoms of central sensitization, knowledge of pain neuroscience, pressure pain thresholds, and neck muscles endurance were used to predict a clinical response at 1 week after intervention and at 6-month follow-up. RESULTS: Different predictors of improvement and non-improvement to intervention were found, but common predictors were not found for all the improvement criteria explored and time points. CONCLUSIONS: These findings suggest that using different criteria to characterize adolescents with neck pain as improved and non-improved after pain neuroscience education and exercise have an effect on the variables associated with a response to the intervention.

Impact of different CRPS phenotypes and diagnostic criteria on quantitative sensory testing outcomes: systematic review and meta-analysis.

OBJECTIVES: This review and meta-analysis evaluated the impact of diagnostic criteria and clinical phenotypes on quantitative sensory testing (QST) outcomes in patients with complex regional pain syndrome (CRPS). METHODS: Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes between CRPS-I vs II, warm vs cold CRPS, upper vs lower limb CRPS, males vs females, or using Budapest vs older IASP criteria were included. RESULTS: Studies investigating QST differences between CRPS-I vs II (n = 4), between males vs females (n = 2), and between upper and lower limb CRPS (n = 2) showed no significant differences. Four studies compared QST outcomes in warm vs cold CRPS, showing heat hyperalgesia in warm CRPS, with thermal and mechanical sensory loss in cold CRPS. Although CRPS diagnosed using the Budapest criteria (24 studies) vs 1994 IASP criteria (13 studies) showed similar sensory profiles, there was significant heterogeneity and low quality of evidence in the latter. CONCLUSIONS: Based on the findings of this review, classifying CRPS according to presence or absence of nerve lesion into CRPS-I and II, location (upper or lower limb) or according to sex might not be clinically relevant as all appear to have comparable sensory profiles that might suggest similar underlying mechanisms. In contrast, warm vs cold phenotypes exhibited clear differences in their associated QST sensory profiles. To the extent that differences in underlying mechanisms might lead to differential treatment responsiveness, it appears unlikely that CRPS-I vs II, CRPS location, or patient sex would prove useful in guiding clinical management.

Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain - A Systematic Review with Meta-Analysis.

OBJECTIVE: To investigate up-to-date evidence of the effectiveness of neural mobilisation techniques compared with any type of comparator in improving pain, function, and physical performance in people with musculoskeletal pain. DATA SOURCES: The following sources were consulted: PubMed, Web of Science, CENTRAL, CINAHL, Scopus, and PEDro databases; scientific repositories; and clinical trial registers. The last search was performed on 01/06/2023. METHODS: Two reviewers independently assessed the studies for inclusion. We included randomised, quasi-randomised, and crossover trials on musculoskeletal pain in which at least one group received neural mobilisation (alone or as part of multimodal interventions). Meta-analyses were performed where possible. The RoB 2 and the Grading of Recommendations Assessment, Development and Evaluation tools were used to assess risk of bias and to rate the certainty of evidence, respectively. RESULTS: Thirty-nine trials were identified. There was a significant effect favouring neural mobilisation for pain and function in people with low back pain, but not for flexibility. For neck pain, there was a significant effect favouring neural mobilisation as part of multimodal interventions for pain, but not for function and range of motion. Regarding other musculoskeletal conditions, it was not possible to conclude whether neural mobilisation is effective in improving pain and function. There was very low confidence for all effect estimates. CONCLUSIONS: Neural mobilisation as part of multimodal interventions appears to have a positive effect on pain for patients with low back pain and neck pain and on function in people with low back pain. For the other musculoskeletal conditions, results are inconclusive.

A single session of action observation therapy versus observing a natural landscape in adults with chronic neck pain - a randomized controlled trial.

BACKGROUND: Action observation (AO) has emerged as a potential neurorehabilitation therapy for patients with neck pain (NP), but evidence of its effectiveness is scarce. This study aims to assess the effect of a single session of AO when compared to observing a natural landscape on NP intensity, fear of movement, fear-avoidance beliefs, neck muscles' strength, pressure pain threshold, and tactile acuity. METHODS: Sixty participants with NP were randomly allocated to the AO group (n = 30) or control group (n = 30). Both groups watched an 11-minute video: the AO group watched a video of a person matched for age and sex performing neck exercises, while the control group watched a video of natural landscapes. Neck pain intensity, fear of movement, fear-avoidance beliefs, tactile acuity, pressure pain thresholds, and neck muscle strength were assessed both at baseline and post-intervention. General linear models of repeated measures (ANCOVA of two factors) were used to explore between-group differences at post-intervention. RESULTS: There was a significant main effect of time for pain intensity (p = 0.02; η2p = 0.09; within-group mean change and 95% CI: AO=-1.44 (-2.28, -0.59); control=-1.90 (-2.74, -1.06), but no time versus group interaction (p = 0.46). A time versus group significant interaction was found for one out of the six measurement sites of two-point discrimination and the neck flexors strength (p < 0.05) favoring the control group. No other statistically significant differences were found for the remaining variables). CONCLUSIONS: Results suggest a similar acute benefit for both a single session of AO and observing natural landscapes for promoting hypoalgesia, but no impact on kinesiophobia, fear-avoidance beliefs, or pressure pain thresholds. Also, AO had no positive effect on two-point discrimination and muscle strength. Further research is needed, with longer interventions. TRIAL REGISTRATION: Clinialtrials.gov (NCT05078489).

Pain intensity and pain sensitivity are not increased by a single session of high-intensity interval aerobic exercise in individuals with chronic low back pain: A randomized and controlled trial.

BACKGROUND: Evidence on the acute impact of high-intensity interval aerobic exercise on pain is scarce. This type of exercise might be perceived as increasing pain intensity and pain sensitivity negatively impacting adherence. More evidence on the acute effects of high-intensity interval aerobic exercise in individuals with low back pain (LBP) is needed. OBJECTIVES: To compare the acute effects of a single session of high-intensity interval aerobic exercise, continuous moderate-intensity aerobic exercise, and no exercise on pain intensity and pain sensitivity in patients with chronic non-specific LBP. DESIGN: Randomized controlled trial with three arms. METHOD: Participants were randomly assigned to one of three groups (i) continuous moderate-intensity aerobic exercise, ii) high-intensity interval aerobic exercise, and iii) no intervention. Measures of pain intensity and pressure pain threshold (PPT) at the lower back and at a distant body site (upper limb) were taken before and after 15 min of exercise. RESULTS: Sixty-nine participants were randomized. A significant main effect of time was found for pain intensity (p = 0.011; η2p = 0.095) and for PPT at the lower back (p < 0.001; η2p = 0.280), but not a time versus group interaction (p > 0.05). For PPT at the upper limb, no main effect of time or interaction was found (p > 0.5). CONCLUSIONS: Fifteen minutes of high-intensity interval aerobic exercise does not increase pain intensity or pain sensitivity compared to both moderate-intensity continuous aerobic exercise and no exercise, suggesting that high-intensity interval aerobic exercise can be used in clinical practice and patients reassured that it is unlikely to increase pain.

Consensus on the Terms and Procedures for Planning and Reporting a Usability Evaluation of Health-Related Digital Solutions: Delphi Study and a Resulting Checklist.

BACKGROUND: Usability evaluation both by experts and target users is an integral part of the process of developing and assessing digital solutions. Usability evaluation improves the probability of having digital solutions that are easier, safer, more efficient, and more pleasant to use. However, despite the widespread recognition of the importance of usability evaluation, there is a lack of research and consensus on related concepts and reporting standards. OBJECTIVE: The aim of the study is to generate consensus on terms and procedures that should be considered when planning and reporting a study on a usability evaluation of health-related digital solutions both by users and experts and provide a checklist that can easily be used by researchers when conducting their usability studies. METHODS: A Delphi study with 2 rounds was conducted with a panel of international participants experienced in usability evaluation. In the first round, they were asked to comment on definitions, rate the importance of preidentified methodological procedures using a 9-item Likert scale, and suggest additional procedures. In the second round, experienced participants were asked to reappraise the relevance of each procedure informed by round 1 results. Consensus on the relevance of each item was defined a priori when at least 70% or more experienced participants scored an item 7 to 9 and less than 15% of participants scored the same item 1 to 3. RESULTS: A total of 30 participants (n=20 females) from 11 different countries entered the Delphi study with a mean age of 37.2 (SD 7.7) years. Agreement was achieved on the definitions for all usability evaluation-related terms proposed (usability assessment moderator, participant, usability evaluation method, usability evaluation technique, tasks, usability evaluation environment, usability evaluator, and domain evaluator). A total of 38 procedures related to usability evaluation planning and reporting were identified across rounds (28 were related to usability evaluation involving users and 10 related to usability evaluation involving experts). Consensus on the relevance was achieved for 23 (82%) of the procedures related to usability evaluation involving users and for 7 (70%) of the usability evaluation procedures involving experts. A checklist was proposed that can guide authors when designing and reporting usability studies. CONCLUSIONS: This study proposes a set of terms and respective definitions as well as a checklist to guide the planning and reporting of usability evaluation studies, constituting an important step toward a more standardized approach in the field of usability evaluation that may contribute to enhancing the quality of planning and reporting usability studies. Future studies can contribute to further validating this study work by refining the definitions, assessing the practical applicability of the checklist, or assessing whether using this checklist results in higher-quality digital solutions.

A Feasibility Study of Pain Neuroscience Education and Exercise for Community-Dwelling Older Adults With Chronic Pain.

BACKGROUND AND PURPOSE: Pain prevalence in older adults is high and greatly impacts their functioning. The primary aim of this study was to determine the feasibility of an intervention consisting of pain neuroscience education (PNE) plus exercise for community-dwelling older adults attending primary care, by assessing recruitment rates (inclusion, refusal, and exclusion rates), adverse events, and acceptability of the intervention. Secondary aims were to establish suitable procedures for delivering the intervention and assess the feasibility of data collection for psychosocial and physical functioning. METHODS: A mixed-methods feasibility study with 2 groups was conducted. One group received 8 weekly 75-minute sessions of PNE plus exercise (PNE+E) and the other received usual care (UC), which consisted of appointments with the general practitioner. Inclusion, refusal, exclusion, and retention rates, dropouts, and adverse events were assessed. The Brief Pain Inventory, the Pain Catastrophizing Scale, the Tampa Scale, the Geriatric Depression Scale, the World Health Organization Disability Assessment Schedule, the 4-meter walk gait speed test and the 5 times sit-to-stand tests were used for assessment. A focus group interview was conducted with participants from the PNE+E group. Descriptive statistics were used for quantitative data and thematic analysis for qualitative data. RESULTS AND DISCUSSION: Of 61 participants recruited, 33 (PNE+E = 22; UC = 11) entered the study, and 24 completed the intervention (PNE+E = 15; UC = 9). The inclusion rate was 54%, the refusal rate was 21%, the exclusion rate was 35%, the dropout rate was 32% in the PNE+E and 18% in the UC, and the retention rate was 68% in the PNE+E group and 82% in the UC group. No adverse events were reported and the intervention was well accepted by participants. Data collection for the clinical outcomes was feasible and results suggested higher improvements in the PNE+E group than in the UC group. CONCLUSION: PNE+E is possible to implement, safe, and well accepted by community-dwelling older adults independent of their education level. This study informs future studies on practical and methodological strategies that should be considered when designing a PNE+E intervention for older adults, such as adapting the language of the PNE to participants, using relatable metaphors, and encouraging written and exercise homework.

Systematic review and meta-analysis on the association between chronic low back pain and cognitive function.

This study aimed to identify and assess the evidence on the association between idiopathic chronic low back pain (LBP) and cognitive function in individuals with LBP. A secondary aim was to explore whether changes in cognitive function are associated with pain characteristics and psychological factors (eg, catastrophizing and fear of movement). Eleven studies were included in this systematic review, and four meta-analyses were conducted. Low to very low-quality evidence suggests impaired cognitive function in individuals with LBP compared to asymptomatic controls for problem solving (k = 5; d = 0.33; CI = 0.16-0.50; z = 3.85 p = 0.0001), speed of information processing (k = 5; d = 0.44; CI = 0.22-0.65; z = 4.02 p < 0.0001), working memory (k = 6; d = 0.50; CI = 0.34-0.66; z = 6.09 p < 0.0001), and delayed memory (k = 3; d = 0.34; CI = 0.07-0.6, z = 2.49 p = 0.02). The association between LBP intensity and psychological factors and cognitive function was inconclusive. More studies are needed to explore these associations and improve evidence in this field. The results of this study suggest that cognitive aspects should be considered during the rehabilitation process of patients with LBP and raise further questions, including whether individuals with LBP are at a greater risk of developing dementia or whether targeting cognitive function will increase the probability of success of LBP treatment. These questions should, also, be considered in future studies.

A systematic search and assessment of the quality and characterisation of free mobile applications targeting knee pain.

Knee pain has an incidence of approximately 25% in adults and its prevalence has been increasing in the last 20 years. The use of smartphones and mobile applications (apps) has also increased in the 'Health and Fitness' field, which might be a useful complement in the rehabilitation process of these patients. However, it is necessary to investigate the quality of these mobile applications. AIM: This study aimed to assess free mobile apps targeting knee pain and to characterise and critically analyse the interventions described in them. METHODS: A systematic search was performed in the Apple store, Play Store and Microsoft Store. RESULTS: A total of 26 applications met the inclusion criteria and were evaluated using the Mobile Apps Rating Scale (MARS), and for their content against guidelines on knee pain intervention. The mean MARS total score was 3.3 (±0.5) and the mean subjective quality score was 2.1 (±0.9) out of a maximum of 5 points each. Most apps combined different types of exercises 88% and included both exercise and pain education (62%). RESULTS: These results suggest a need to improve the quality of these apps aiming to create more engagement and improve app usage. Additionally, as health apps may be useful in pain management and be an alternative to complement rehabilitation, the involvement of health professionals is important during the development process of the apps including evidence-based content and progression recommendations.

Perceptions on Extending the Use of Technology after the COVID-19 Pandemic Resolves: A Qualitative Study with Older Adults.

The COVID-19 pandemic of the last two years has affected the lives of many individuals, especially the most vulnerable and at-risk population groups, e.g., older adults. While social distancing and isolation are shown to be effective at decreasing the transmission of the virus, these actions have also increased loneliness and social isolation. To combat social distancing from family and friends, older adults have turned to technology for help. In the health sector, these individuals also had a variety of options that strengthened eHealth care services. This study analyzed the technologies used during the COVID-19 pandemic by a group of older people, as well as explored their expectations of use after the pandemic period. Qualitative and ethnographic interviews were conducted with 10 Portuguese older adults, and data were collected over a period of seven months between 2020 and 2021. The research demonstrated that the use of current and new technologies in the post-pandemic future is likely to be related to overcoming: (i) insecurity regarding privacy issues; (ii) difficulties in using technologies due to the level of use of digital technology; and (iii) the human distancing and impersonal consequences of using these technologies.

Defining Recommendations to Guide User Interface Design: Multimethod Approach.

BACKGROUND: For the development of digital solutions, different aspects of user interface design must be taken into consideration. Different technologies, interaction paradigms, user characteristics and needs, and interface design components are some of the aspects that designers and developers should pay attention to when designing a solution. Many user interface design recommendations for different digital solutions and user profiles are found in the literature, but these recommendations have numerous similarities, contradictions, and different levels of detail. A detailed critical analysis is needed that compares, evaluates, and validates existing recommendations and allows the definition of a practical set of recommendations. OBJECTIVE: This study aimed to analyze and synthesize existing user interface design recommendations and propose a practical set of recommendations that guide the development of different technologies. METHODS: Based on previous studies, a set of recommendations on user interface design was generated following 4 steps: (1) interview with user interface design experts; (2) analysis of the experts' feedback and drafting of a set of recommendations; (3) reanalysis of the shorter list of recommendations by a group of experts; and (4) refining and finalizing the list. RESULTS: The findings allowed us to define a set of 174 recommendations divided into 12 categories, according to usability principles, and organized into 2 levels of hierarchy: generic (69 recommendations) and specific (105 recommendations). CONCLUSIONS: This study shows that user interface design recommendations can be divided according to usability principles and organized into levels of detail. Moreover, this study reveals that some recommendations, as they address different technologies and interaction paradigms, need further work.

Pain neuroscience education and graded exposure versus Pilates and postural education: A pilot study in an occupational context.

INTRODUCTION: Pain neuroscience education (PNE) and graded exposure have not been explored in occupational settings for low back pain (LBP). AIM: To pilot feasibility and assess preliminary effectiveness of PNE and graded exposure for LBP. METHODS: A pilot study where workers were randomized to either PNE and graded exposure or Pilates and postural education. Both interventions consisted of weekly individual face-to-face sessions for 8 weeks (a total of 8 sessions). The primary outcome was pain intensity. Secondary outcomes were disability, catastrophizing, fear-avoidance, sleep, endurance of back extensor muscles, and patient's perceived impression of change. RESULTS: Seventeen participants entered the PNE and graded exposure group and 20 the Pilates and postural education group. PNE and graded exposure were feasible to implement. Between-group comparisons suggest higher improvements in the PNE group for extensor muscle endurance (p < .001, η2p = .29), pain catastrophizing (p < .001; η2p = .56) and fear-avoidance related to physical activity (p < .001; η2p = .48) and work (p < .001; η2p = .47). In the PNE group, at least 13 (76.5%) participants reported being at least "moderately better" against 6 (30%) participants in the Pilates group. CONCLUSION: PNE and graded exposure can be successfully implemented in an occupational context and is potentially more beneficial than Pilates and postural education for extensor muscle endurance, catastrophizing, and fear avoidance and similarly as beneficial for pain intensity and disability. Further studies are needed to confirm these results.

The impact of users' cognitive function on evaluator perceptions of usability.

To explore the association between the user's cognitive function and usability reported by the evaluator. A cross-sectional study was conducted with a community-based sample. Data about participants' age, sex, education, sleep quantity, subjective memory complaints, and cognitive function were collected. A usability session was conducted to evaluate a digital solution called Brain on Track. Independent linear-regression analyses were used to explore univariable and multivariable associations between evaluator-reported usability assessment and the users' cognitive function, age, sex, education, sleep quantity, and subjective memory complaints. A total of 238 participants entered this study, of which 161 (67.6%) were females and the mean age was 42 (SD 12.9) years old. All variables (age, education, sleep quantity, subjective memory complaints and cognitive function) except sex were significantly associated with evaluator-reported usability in the univariable analysis (p < 0.05). Cognitive function, age, education, and subjective memory complaints remained significant in the multivariable model (F = 38.87, p < 0.001) with an adjusted R2 of 0.391. Cognition scores alone showed an adjusted R2 of 0.288. This work suggests that cognitive function impacts evaluator reported usability, alongside other users' characteristics and needs to be considered in the usability evaluation.

Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial.

OBJECTIVE: Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP). METHODS: A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up. RESULTS: There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found. CONCLUSION: Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.

Impact of Sex, Sleep, Symptoms of Central Sensitization, and Psychosocial Factors in Adolescents with Chronic Musculoskeletal Pain: An Exploratory Study.

OBJECTIVE: This study aimed to explore and compare the associations of psychosocial factors, sleep, and central sensitization with chronic neck, back, limb, and multiregional pain and disability. METHODS: One thousand seven hundred thirty (n = 1,730) adolescents responded to an online questionnaire containing questions about sociodemographic data, as well as the Nordic Musculoskeletal Questionnaire; the International Physical Activity Questionnaire; the Functional Disability Inventory; the Depression, Anxiety, and Stress Scale; the Basic Scale on Insomnia Complaints and Quality of Sleep; the Pain Catastrophizing Scale; the Tampa Scale of Kinesiophobia; the Child Self-Efficacy Scale; and the Central Sensitization Inventory. Univariable and multivariable regression analysis were used to assess the associations between these variables and pain and disability. RESULTS: Groups were categorized into those with neck (n = 54), back (n = 80), upper limb (n = 52), lower limb (n = 109), or multiregional (n = 1,140) pain. Multivariable analysis showed that symptoms of central sensitization increased the odds of neck, back, and multiregional pain; depression, anxiety and stress, and physical activity increased the odds of multiregional pain; and fear of movement increased the odds of lower limb pain. Female gender increased the odds of pain in all groups, except in the lower limb group. Depression, anxiety, and stress also remained associated with disability in neck, back, upper limb, and multiregional pain; poorer sleep remained associated with disability in neck, upper limb, and multiregional pain; catastrophizing remained associated with back and multiregional pain; and fear of movement and symptoms of central sensitization were associated with disability only in multiregional pain. CONCLUSIONS: There are similar but also different variables associated with the presence of pain and disability in the neck, back, limbs, and multiregional pain.

Effectiveness of neural mobilization on pain intensity, disability, and physical performance in adults with musculoskeletal pain-A protocol for a systematic review of randomized and quasi-randomized controlled trials and planned meta-analysis.

Recent studies show that musculoskeletal conditions contribute significantly to years lived with disability considering the entire global population. Pain and functional disability are the main problems that people with these conditions suffer. Neural mobilization has been shown to be an effective intervention in the treatment of musculoskeletal pain within individual trials, also contributing to improved functionality. Some systematic reviews have been carried out during the last years with the aim of synthesizing the scientific evidence on the use of neural mobilization techniques in the treatment of musculoskeletal disorders. However, they varied a lot in the methodological approaches and, consequently, in the findings and conclusions. Thus, this document is a planned protocol of a comprehensive systematic review with meta-analysis that we intend to carry out to review the scientific literature regarding up-to-date evidence on the use of neural mobilization in the management of people suffering from musculoskeletal pain disorders. The study designs that we will consider as inclusion criteria will be randomized and quasi-randomized clinical trials. The target population will be adults and older adults with musculoskeletal pain. Any controlled trial using any neural mobilization technique as an intervention in one of the trial groups will be included. The main outcomes of interest will be pain, functional status, and physical performance tests (muscle strength, flexibility, and balance). There will be no restrictions on follow-up time or type of setting. The risk of bias of the included studies will be assessed by the RoB 2 tool and the certainty of the evidence will be evaluated using the comprehensive Assessment, Development and Assessment of Assessment Recommendation (GRADE) approach. We intend to present the findings through narrative descriptions and, if possible, through meta-analytic statistics. Trial registration: PROSPERO registration number. CRD42021288387.

Characterisation and assessment of the most popular mobile apps designed for neck pain self-management: A systematic search in app stores.

PURPOSE: This study aimed to assess commonly downloaded apps targeting neck pain (NP) using the Mobile Apps Rating Scale (MARS), to characterise the interventions described in the apps and to correlate the ratings of quality retrieved from app stores against the ratings of quality assessed using MARS. MATERIALS AND METHODS: A systematic search was conducted at the Apple App Store, Google Play, Windows Phone Store and Huawei App Gallery. Mobile apps with 100 or more ratings, a user rating of 4 or higher and which were available for free were retrieved for assessment. RESULTS: A total of 17 apps met the inclusion criteria. The mean user rating was 4.4 ± 0.28, the mean MARS score was 4.0 ± 0.58 and the correlation between user ratings and MARS total scores and subdomains varied between a maximum of 0.41 (p > 0.05) and a minimum of -0.11 (p > 0.05). All apps included exercise but only 5 (29%) included an educational component. CONCLUSIONS: The most downloaded apps on NP available for free in app stores are, generally, of acceptable quality as assessed by the MARS total score, target exercise, but fail to include an appropriate educational component. The user rating available in app stores is not an indicator of the quality of the apps. Therefore, health professionals should carefully assess the mobile apps before recommending them to the patients.