Objectives To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide ... more Objectives To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies. Methods We implemented a multi-stage mixedmethods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus. Results 38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains. Conclusions The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains.
Medicine and Science in Sports and Exercise, Aug 19, 2019
This study aimed to investigate the effect of unsupervised isometric exercise compared to a wait-... more This study aimed to investigate the effect of unsupervised isometric exercise compared to a wait-and-see approach on pain, disability, global improvement and pain-free grip strength in individuals with lateral elbow tendinopathy (LET). METHODS: Forty participants with unilateral LET of at least 6 weeks" duration were randomised to either wait-and-see (N=19) or a single supervised instruction session by a physiotherapist, followed by an 8-week unsupervised daily program of progressive isometric exercise (N=21). Primary outcomes were Patient-Rated Tennis Elbow Evaluation (PRTEE), global rating of change on a 6-point scale (GROC, dichotomised to success and no success) and pain-free grip strength at 8 weeks. Secondary outcomes were resting and worst pain on an 11-point numerical rating scale (NRS), and thermal and pressure pain thresholds as a measure of pain sensitivity. RESULTS: Thirtynine (98%) participants completed 8-week measurements. The exercise group had lower PRTEE scores compared to wait-and-see at 8 weeks (standardised mean difference (SMD)-0.92, 95% CI-1.58 to-0.26). No group differences were found for success on GROC (29% exercise vs 26% wait-and-see (risk difference 2.3%, 95% CI-24.5 to 29.1)), or pain-free grip strength (SMD-0.33, 95% CI-0.97 to 0.30). No differences were observed for all secondary outcomes except for worst pain, which was moderately lower in the exercise group (SMD-0.80, 95% CI-1.45 to-0.14). CONCLUSION: Unsupervised isometric exercise was effective in improving pain and disability, but not perceived rating of change and pain-free grip strength when compared to waitand-see at 8 weeks. With only one out of the three primary outcomes being significantly different following isometric exercises, it is doubtful if this form of exercise is efficacious as a sole treatment.
Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between −0.15 and 0.11, P ≥ 0.08; total: β between −0.27 and −0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.
Journal of Orthopaedic & Sports Physical Therapy, Jun 1, 2022
To identify and describe the psychological and psychosocial constructs and outcome measures used ... more To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research.
Background Lateral elbow tendinopathy (LET) is a common condition that can cause signi cant disab... more Background Lateral elbow tendinopathy (LET) is a common condition that can cause signi cant disability and associated socioeconomic cost. Although it has been widely researched, outcome measures are highly variable which restricts evidence synthesis across studies. In 2019 a working group of international experts, health care professionals and patients, in the eld of tendinopathy (International Scienti c Tendinopathy Symposium Consensus (ICON) Group) published the results of a consensus exercise de ning the nine core domains that should be measured in tendinopathy research. The aim of this study is to develop a Core Outcome Set (COS) for LET mapping to these core domains. The primary output will provide a template for future outcome evaluation of LET. In this protocol we detail the methodological approach to the COS-LET development. Methods This study will employ a three-phase approach. (1) A systematic review of studies investigating LET will produce a comprehensive list of all instruments currently employed to quantify treatment effect or outcome. (2) Instruments will be matched to the list of nine core tendinopathy outcome domains by a Steering Committee of clinicians and researchers with a specialist interest in LET resulting in a set of candidate instruments. (3) An International three-stage Delphi Study will be conducted involving experienced clinicians, researchers and patients. Within this Delphi Study candidate instruments will be selected based upon screening using the Outcome Measures in Rheumatology (OMERACT) truth, feasibility and discrimination lters with a threshold of 70% agreement set for consensus. Conclusions There is currently no COS for the measurement or monitoring of LET in trials or clinical practice. The output from this project will be a minimum COS recommended for use in all future English-language studies related to LET. The ndings will be published in a high-quality journal and disseminated widely using professional networks, social media and via presentation at international conferences. Key Points There is wide variability in the outcome measures used in lateral elbow tendinopathy research. This protocol outlines the methodology used to derive a standardised set of validated outcome measures. The Core Outcome Set-Lateral Elbow Tendinopathy (COS-LET) will provide guidance on the minimum recommended outcomes to be used in future research, which, If implemented broadly, with
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cuto...
Journal of Orthopaedic & Sports Physical Therapy
To identify and describe the psychological and psychosocial constructs and outcome measures used ... more To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research.
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Background: Exercise is the cornerstone of conservative management for persistent pain. While exe... more Background: Exercise is the cornerstone of conservative management for persistent pain. While exercise is effective in the treatment of persistent pain, systematic reviews demonstrate, at best, small to moderate effects on pain. Thus, novel approaches that could enhance the hypoalgesic effects of exercise are warranted. Transcranial direct current stimulation (tDCS), a safe, painless non-invasive brain stimulation technique is capable of modulating pain processing and provides a promising avenue to boost the hypoalgesic response to exercise. Here, we explored whether the application of tDCS prior to a single bout of exercise would facilitate exercise-induced hypoalgesia in healthy individual's experiencing persistent experimental muscle pain. Methods: Twenty healthy subjects were recruited for this pilot randomised, double blinded, sham-controlled experimental trial. All subjects attended two experimental sessions (Days 0 and 2). On Day 0, subjects were injected with nerve growth factor into their right forearm extensor muscle to induce persistent elbow pain over two consecutive days. Two days later (Day 2), each subject performed a single bout of exercise (3-minute isometric gripping task using their right arm) immediately after 20min of either active (intervention) or sham (placebo) tDCS over the motor cortex. Pain sensitivity (pressure pain thresholds [PPTs]), muscle soreness (7-point numerical rating scale), and descending pain inhibition (condition pain modulation [CPM]) were assessed prior to injection, before tDCS on Day 2, and immediately after and 15 min post exercise. Results: PPTs did not differ between the intervention and sham group at any time point (p > 0.72 for all). Muscle soreness and CPM were similar for both groups following exercise (p > 0.28 for both). Discussion: tDCS does not augment the EIH response in healthy individuals experiencing persistent muscle pain, nor does it impact CPM. The findings of this preliminary exploration suggests that tDCS over the motor cortex may not enhance the hypoalgesic effects of exercise more, than exercise alone. Larger experimental trials are required to confirm these findings.
Аннотация. В статье рассматривается проблема профессионального самовоспитания будущих специалисто... more Аннотация. В статье рассматривается проблема профессионального самовоспитания будущих специалистов на разных этапах обучения в вузе. Объектом исследования является профессиональное самовоспитание студентов, главной целью исследования стало выявление особенностей организации и содержания профессионального самовоспитания студентов. Ключевые слова: профессиональное самовоспитание, воспитание, мотивирующие факторы самовоспитания, препятствующие факторы самовоспитания.
Context. Selecting a cluster in proper motion space is an established method for identifying memb... more Context. Selecting a cluster in proper motion space is an established method for identifying members of a star-forming region. The first data release from Gaia (DR1) provides an extremely large and precise stellar catalogue, which when combined with the Tycho-2 catalogue gives the 2.5 million parallaxes and proper motions contained within the Tycho-Gaia Astrometric Solution (TGAS). Aims. We aim to identify new member candidates of the nearby Upper Scorpius subgroup of the Scorpius-Centaurus Complex within the TGAS catalogue. In doing so, we also aim to validate the use of a density-based clustering algorithm (DBSCAN) on spatial and kinematic data as a robust member selection method. Methods. We constructed a method for member selection using a density-based clustering algorithm (DBSCAN) applied over proper motion and distance. We then applied this method to Upper Scorpius and evaluated the results and performance of the method. Results. We identified 167 member candidates of Upper Scorpius, of which 78 are new, distributed within a 10 • radius from its core. These member candidates have a mean distance of 145.6 ± 7.5 pc and a mean proper motion of (−11.4, −23.5) ± (0.7, 0.4) mas yr −1. These values are consistent with measured distances and proper motions of previously identified bona fide members of the Upper Scorpius association.
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p ¼ 0.04). PPTs at the cervical spine increased following both SMT (mean AE SE: 24.1 AE 7.3%) and manual contact (21 AE 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD.
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p = 0.04). PPTs at the cervical spine increased following both SMT (mean +/- SE: 24.1 +/- 7.3%) and manual contact (21 +/- 8.4%) with no difference between interventions. There was n...
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p ¼ 0.04). PPTs at the cervical spine increased following both SMT (mean AE SE: 24.1 AE 7.3%) and manual contact (21 AE 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD.
Objectives To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide ... more Objectives To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies. Methods We implemented a multi-stage mixedmethods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus. Results 38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains. Conclusions The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains.
Medicine and Science in Sports and Exercise, Aug 19, 2019
This study aimed to investigate the effect of unsupervised isometric exercise compared to a wait-... more This study aimed to investigate the effect of unsupervised isometric exercise compared to a wait-and-see approach on pain, disability, global improvement and pain-free grip strength in individuals with lateral elbow tendinopathy (LET). METHODS: Forty participants with unilateral LET of at least 6 weeks" duration were randomised to either wait-and-see (N=19) or a single supervised instruction session by a physiotherapist, followed by an 8-week unsupervised daily program of progressive isometric exercise (N=21). Primary outcomes were Patient-Rated Tennis Elbow Evaluation (PRTEE), global rating of change on a 6-point scale (GROC, dichotomised to success and no success) and pain-free grip strength at 8 weeks. Secondary outcomes were resting and worst pain on an 11-point numerical rating scale (NRS), and thermal and pressure pain thresholds as a measure of pain sensitivity. RESULTS: Thirtynine (98%) participants completed 8-week measurements. The exercise group had lower PRTEE scores compared to wait-and-see at 8 weeks (standardised mean difference (SMD)-0.92, 95% CI-1.58 to-0.26). No group differences were found for success on GROC (29% exercise vs 26% wait-and-see (risk difference 2.3%, 95% CI-24.5 to 29.1)), or pain-free grip strength (SMD-0.33, 95% CI-0.97 to 0.30). No differences were observed for all secondary outcomes except for worst pain, which was moderately lower in the exercise group (SMD-0.80, 95% CI-1.45 to-0.14). CONCLUSION: Unsupervised isometric exercise was effective in improving pain and disability, but not perceived rating of change and pain-free grip strength when compared to waitand-see at 8 weeks. With only one out of the three primary outcomes being significantly different following isometric exercises, it is doubtful if this form of exercise is efficacious as a sole treatment.
Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between −0.15 and 0.11, P ≥ 0.08; total: β between −0.27 and −0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.
Journal of Orthopaedic & Sports Physical Therapy, Jun 1, 2022
To identify and describe the psychological and psychosocial constructs and outcome measures used ... more To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research.
Background Lateral elbow tendinopathy (LET) is a common condition that can cause signi cant disab... more Background Lateral elbow tendinopathy (LET) is a common condition that can cause signi cant disability and associated socioeconomic cost. Although it has been widely researched, outcome measures are highly variable which restricts evidence synthesis across studies. In 2019 a working group of international experts, health care professionals and patients, in the eld of tendinopathy (International Scienti c Tendinopathy Symposium Consensus (ICON) Group) published the results of a consensus exercise de ning the nine core domains that should be measured in tendinopathy research. The aim of this study is to develop a Core Outcome Set (COS) for LET mapping to these core domains. The primary output will provide a template for future outcome evaluation of LET. In this protocol we detail the methodological approach to the COS-LET development. Methods This study will employ a three-phase approach. (1) A systematic review of studies investigating LET will produce a comprehensive list of all instruments currently employed to quantify treatment effect or outcome. (2) Instruments will be matched to the list of nine core tendinopathy outcome domains by a Steering Committee of clinicians and researchers with a specialist interest in LET resulting in a set of candidate instruments. (3) An International three-stage Delphi Study will be conducted involving experienced clinicians, researchers and patients. Within this Delphi Study candidate instruments will be selected based upon screening using the Outcome Measures in Rheumatology (OMERACT) truth, feasibility and discrimination lters with a threshold of 70% agreement set for consensus. Conclusions There is currently no COS for the measurement or monitoring of LET in trials or clinical practice. The output from this project will be a minimum COS recommended for use in all future English-language studies related to LET. The ndings will be published in a high-quality journal and disseminated widely using professional networks, social media and via presentation at international conferences. Key Points There is wide variability in the outcome measures used in lateral elbow tendinopathy research. This protocol outlines the methodology used to derive a standardised set of validated outcome measures. The Core Outcome Set-Lateral Elbow Tendinopathy (COS-LET) will provide guidance on the minimum recommended outcomes to be used in future research, which, If implemented broadly, with
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cuto...
Journal of Orthopaedic & Sports Physical Therapy
To identify and describe the psychological and psychosocial constructs and outcome measures used ... more To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research.
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Background: Exercise is the cornerstone of conservative management for persistent pain. While exe... more Background: Exercise is the cornerstone of conservative management for persistent pain. While exercise is effective in the treatment of persistent pain, systematic reviews demonstrate, at best, small to moderate effects on pain. Thus, novel approaches that could enhance the hypoalgesic effects of exercise are warranted. Transcranial direct current stimulation (tDCS), a safe, painless non-invasive brain stimulation technique is capable of modulating pain processing and provides a promising avenue to boost the hypoalgesic response to exercise. Here, we explored whether the application of tDCS prior to a single bout of exercise would facilitate exercise-induced hypoalgesia in healthy individual's experiencing persistent experimental muscle pain. Methods: Twenty healthy subjects were recruited for this pilot randomised, double blinded, sham-controlled experimental trial. All subjects attended two experimental sessions (Days 0 and 2). On Day 0, subjects were injected with nerve growth factor into their right forearm extensor muscle to induce persistent elbow pain over two consecutive days. Two days later (Day 2), each subject performed a single bout of exercise (3-minute isometric gripping task using their right arm) immediately after 20min of either active (intervention) or sham (placebo) tDCS over the motor cortex. Pain sensitivity (pressure pain thresholds [PPTs]), muscle soreness (7-point numerical rating scale), and descending pain inhibition (condition pain modulation [CPM]) were assessed prior to injection, before tDCS on Day 2, and immediately after and 15 min post exercise. Results: PPTs did not differ between the intervention and sham group at any time point (p > 0.72 for all). Muscle soreness and CPM were similar for both groups following exercise (p > 0.28 for both). Discussion: tDCS does not augment the EIH response in healthy individuals experiencing persistent muscle pain, nor does it impact CPM. The findings of this preliminary exploration suggests that tDCS over the motor cortex may not enhance the hypoalgesic effects of exercise more, than exercise alone. Larger experimental trials are required to confirm these findings.
Аннотация. В статье рассматривается проблема профессионального самовоспитания будущих специалисто... more Аннотация. В статье рассматривается проблема профессионального самовоспитания будущих специалистов на разных этапах обучения в вузе. Объектом исследования является профессиональное самовоспитание студентов, главной целью исследования стало выявление особенностей организации и содержания профессионального самовоспитания студентов. Ключевые слова: профессиональное самовоспитание, воспитание, мотивирующие факторы самовоспитания, препятствующие факторы самовоспитания.
Context. Selecting a cluster in proper motion space is an established method for identifying memb... more Context. Selecting a cluster in proper motion space is an established method for identifying members of a star-forming region. The first data release from Gaia (DR1) provides an extremely large and precise stellar catalogue, which when combined with the Tycho-2 catalogue gives the 2.5 million parallaxes and proper motions contained within the Tycho-Gaia Astrometric Solution (TGAS). Aims. We aim to identify new member candidates of the nearby Upper Scorpius subgroup of the Scorpius-Centaurus Complex within the TGAS catalogue. In doing so, we also aim to validate the use of a density-based clustering algorithm (DBSCAN) on spatial and kinematic data as a robust member selection method. Methods. We constructed a method for member selection using a density-based clustering algorithm (DBSCAN) applied over proper motion and distance. We then applied this method to Upper Scorpius and evaluated the results and performance of the method. Results. We identified 167 member candidates of Upper Scorpius, of which 78 are new, distributed within a 10 • radius from its core. These member candidates have a mean distance of 145.6 ± 7.5 pc and a mean proper motion of (−11.4, −23.5) ± (0.7, 0.4) mas yr −1. These values are consistent with measured distances and proper motions of previously identified bona fide members of the Upper Scorpius association.
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p ¼ 0.04). PPTs at the cervical spine increased following both SMT (mean AE SE: 24.1 AE 7.3%) and manual contact (21 AE 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD.
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p = 0.04). PPTs at the cervical spine increased following both SMT (mean +/- SE: 24.1 +/- 7.3%) and manual contact (21 +/- 8.4%) with no difference between interventions. There was n...
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p ¼ 0.04). PPTs at the cervical spine increased following both SMT (mean AE SE: 24.1 AE 7.3%) and manual contact (21 AE 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD.
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Papers by Viana Vuvan