The Push Forward in Rehabilitation: Validation of a Machine Learning Method for Detection of Wheelchair Propulsion Type.

Within rehabilitation, there is a great need for a simple method to monitor wheelchair use, especially whether it is active or passive. For this purpose, an existing measurement technique was extended with a method for detecting self- or attendant-pushed wheelchair propulsion. The aim of this study was to validate this new detection method by comparison with manual annotation of wheelchair use. Twenty-four amputation and stroke patients completed a semi-structured course of active and passive wheelchair use. Based on a machine learning approach, a method was developed that detected the type of movement. The machine learning method was trained based on the data of a single-wheel sensor as well as a setup using an additional sensor on the frame. The method showed high accuracy (F1 = 0.886, frame and wheel sensor) even if only a single wheel sensor was used (F1 = 0.827). The developed and validated measurement method is ideally suited to easily determine wheelchair use and the corresponding activity level of patients in rehabilitation.

The influence of pain catastrophizing and central sensitization on the reported pain after hip arthroscopy.

PURPOSE: This study was conducted to investigate whether the pain catastrophizing scale (PCS) and the central sensitization inventory (CSI) are predictive factors for the reported pain after hip arthroscopy. METHODS: A total of 37 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome and labral tears were prospectively enrolled. All patients completed the PCS and CSI before hip arthroscopy. Postoperative pain was measured with the numeric rating scale (NRS) weekly the first 12 weeks after surgery by electronic diary. RESULTS: At baseline, univariate analyses showed that both the CSI and PCS were significantly associated with the NRS outcome (p < 0.01). During 12 weeks follow-up, a significant decrease on the NRS was observed (p < 0.01). Univariate analyses showed that both the CSI and PCS were significantly associated with the NRS during follow-up. Multivariate mixed model analysis showed that only the PCS remained significantly associated with the NRS outcome with a ß of 0.07 (95% CI 0.03-0.11, p < 0.01). CONCLUSION: Results indicate that both the PCS and CSI are associated with the reported postoperative pain after hip arthroscopy. The PCS and CSI may be useful in daily practice to identify patients that possibly benefit from pain catastrophizing reduction therapy (e.g. counseling) prior to surgery. LEVEL OF EVIDENCE: IV.

Factors Associated With Sleep Quality in Patients With Chronic Widespread Pain Attending Multidisciplinary Treatment.

PURPOSE: (1) To investigate the prevalence of poor sleep quality and (2) to explore the associations between clinical, cognitive, and emotional factors and quality of sleep in patients with chronic widespread pain (CWP) receiving multidisciplinary treatment. METHOD: Baseline data were used from 163 patients with CWP referred for multidisciplinary treatment. Linear regression models were used to assess the relationship of clinical (pain, fatigue, pain interference, and disability), emotional (anxiety, depression, and psychological distress), and cognitive factors (catastrophizing, acceptance, self-efficacy, kinesiophobia and illness beliefs) with sleep quality, as measured using the Pittsburgh Sleep Quality Index. RESULTS: Poor sleep quality was found in 92% of the patients. The multivariable model showed that a higher level of fatigue (b = 1.77, standard error [SE] = 0.62, ß = 0.21, t = 2.87, P < 0.01), psychological distress (b = 0.02, SE = 0.01, ß = 0.27, t = 3.50, P < 0.01), and more concerns about the illness (b = 0.46, SE = 0.18, ß = 0.20, t = 2.57, P = 0.01) were independently associated with poorer quality of sleep. The overall linear regression model explains 27.9% of sleep quality. CONCLUSIONS: The high prevalence of poor sleep quality in patients with CWP referred for multidisciplinary treatment emphasizes the need to target sleep during treatment. Further research is needed to disentangle the cause-effect relationship between fatigue, psychological distress, and concerns about the illness and poor sleep (note: this abstract has been published before [Ann Rheum Dis. 2018;77:A1788]).

Fatigue in patients with chronic widespread pain participating in multidisciplinary rehabilitation treatment: a prospective cohort study.

PURPOSE: To explore the associations between (improvement in) fatigue and (improvement in) clinical and cognitive factors in patients with chronic widespread pain (CWP), participating in multidisciplinary rehabilitation treatment. METHODS: Data were used from baseline, 6 and 18 months of follow-up during a prospective cohort study of 120 CWP patients who completed multidisciplinary rehabilitation treatment. Cross-sectional and longitudinal relationships were analyzed between fatigue, clinical (i.e. pain, interference of pain and depression) and pain related cognitive factors (i.e. negative emotional cognitions, active cognitive coping, and control and chronicity beliefs). RESULTS: Higher levels of pain, interference of pain, depression, negative emotional cognitions, and negative control and chronicity beliefs were associated with a higher level of fatigue. Improvement in depression was related to improvement in fatigue. CONCLUSIONS: In CWP patients, worse clinical status, and dysfunctional pain-related cognitions are associated with a higher level of fatigue. Our results suggest that improvement in depression might be a mechanism of improvement in fatigue. Furthermore, improvement in fatigue seems to be independent of improvement in pain related cognitions. Targeting fatigue in multidisciplinary pain treatment may need specific strategies. IMPLICATIONS FOR REHABILITATION: Improvement in depression may be a mechanism of change to improve the level of fatigue in CWP. Improvement in dysfunctional (pain related) cognitions seems to be independent of improvement in fatigue. Targeting fatigue in multidisciplinary treatment may need specific strategies (e.g. additional interventions focusing on reducing fatigue and specific attention to improvement of sleep).

Cognitive mechanisms of change in multidisciplinary treatment of patients with chronic widespread pain: a prospective cohort study.

OBJECTIVE: To evaluate the contribution of improvement in negative emotional cognitions, active cognitive coping, and control and chronicity beliefs to the outcome of multidisciplinary treatment in patients with chronic widespread pain. DESIGN: Prospective cohort study. PATIENTS: A total of 120 subjects diagnosed with chronic widespread pain, who completed a multidisciplinary pain programme. METHODS: Data from baseline, 6 months and 18 months follow-up measurements were analysed. Longitudinal relationships were analysed between changes in cognitions and outcome, using generalized estimated equations. Outcome domains included: pain, interference of pain in daily life, depression, and global perceived effect. Cognitive domains included: negative emotional cognitions, active cognitive coping and control and chronicity beliefs. RESULTS: Improvements in negative emotional cognitions were associated with improvements in all outcome domains, in particular with improvement in interference of pain with daily life and depression (between baseline and 6 months, and 6 and 18 months). Improvements in active cognitive coping were associated with improvements in interference of pain in daily life (between baseline and 6 months). Improvements in control and chronicity beliefs were associated with improvements in pain and depression (between 6 and 18 months). CONCLUSION: Improvement in negative emotional cognitions seems to be a key mechanism of change in multidisciplinary treatment of chronic widespread pain. Improvement in active cognitive coping and improvement in control and chronic timeline beliefs may also constitute mechanisms of change, although the evidence is less strong.

Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study.

BACKGROUND: The effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. The considerable heterogeneity among patients is a likely explanation. Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness. The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP. METHODS: Data were used from baseline and 6 months follow-up measurements of a prospective cohort study of 120 CWP. Regression models were used to assess whether baseline variables predicted treatment outcome. Outcome domains included: pain, pain interference, depression, and global perceived effect (GPE). Potential predictors included: psychological distress, illness and self-efficacy beliefs, fear-avoidance beliefs and behaviour, symptoms, disability, and socio-demographic factors. RESULTS: Greater improvement in pain was predicted by more pain at baseline and male gender. Greater improvement in interference of pain in daily life was predicted by more interference of pain in daily life at baseline, lower levels of anxiety, a stronger belief in personal control, less belief in consequences, male gender, and a higher level of education. Greater improvement in depression was predicted by higher baseline values of depression, stronger beliefs in personal control, and a higher level of education. Better outcome on GPE was predicted by less pain, less fatigue, and a higher level of education. CONCLUSION: Less anxiety, stronger beliefs in personal control, less belief in consequences, less pain, less fatigue, higher level of education, and male gender are predictors of better outcome of multidisciplinary treatment in CWP. Tailoring treatment to these specific patient characteristics or selecting eligible patients for multidisciplinary treatment may further improve treatment outcome.

Predictors of multidisciplinary treatment outcome in fibromyalgia:a systematic review.

PURPOSE: To identify outcome predictors for multidisciplinary treatment in patients with chronic widespread pain (CWP) or fibromyalgia (FM). METHODS: A systematic literature search in PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Pedro. Selection criteria included: age over 18; diagnosis CWP or FM; multidisciplinary treatment; longitudinal study design; original research report. Outcome domains: pain, physical functioning, emotional functioning, global treatment effect and 'others'. Methodological quality of the selected articles was assessed and a qualitative data synthesis was performed to identify the level of evidence. RESULTS: Fourteen studies (all with FM patients) fulfilled the selection criteria. Six were of high quality. Poorer outcome (pain, moderate evidence; physical functioning and quality of life, weak evidence) was predicted by depression. Similarly, poorer outcome was predicted by the disturbance and pain profile of the Minnesota Multiphasic Personality Inventory (MMPI), strong beliefs in fate and high disability (weak evidence). A better outcome was predicted by a worse baseline status, the dysfunctional and the adaptive copers profile of the Multidimensional Pain Inventory (MPI), and high levels of pain (weak evidence). Some predictors were related to specific multidisciplinary treatment (weak evidence). Inconclusive evidence was found for other demographic and clinical factors, cognitive and emotional factors, symptoms and physical functioning as predictors of outcome. DISCUSSION: It was found that a higher level of depression was a predictor of poor outcome in FM (moderate evidence). In addition, it was found that the baseline status, specific patient profiles, belief in fate, disability, and pain were predictors of the outcome of multidisciplinary treatment. Our results highlight the lack of high quality studies for evaluating predictors of the outcome of multidisciplinary treatment in FM. Further research on predictors of multidisciplinary treatment outcome is needed.

Overlap of cognitive concepts in chronic widespread pain: an exploratory study.

BACKGROUND: A wide variety of cognitive concepts have been shown to play an important role in chronic widespread pain (CWP). Although these concepts are generally considered to be distinct entities, some might in fact be highly overlapping. The objectives of this study were to (i) to establish inter-relationships between self-efficacy, cognitive coping styles, fear-avoidance cognitions and illness beliefs in patients with CWP and (ii) to explore the possibility of a reduction of these cognitions into a more limited number of domains. METHODS: Baseline measurement data of a prospective cohort study of 138 patients with CWP were used. Factor analysis was used to study the associations between 16 different cognitive concepts. RESULTS: Factor analysis resulted in three factors: 1) negative emotional cognitions, 2) active cognitive coping, and 3) control beliefs and expectations of chronicity. CONCLUSION: Negative emotional cognitions, active cognitive coping, control beliefs and expectations of chronicity seem to constitute principal domains of cognitive processes in CWP. These findings contribute to the understanding of overlap and uniqueness of cognitive concepts in chronic widespread pain.