Relationship Between Central Sensitization-Related Symptoms and Pain-Related Disability After Cervical Spine Surgery: A Structural Equation Model.

BACKGROUND: It is unknown if central sensitization (CS)-related symptoms have an intermediate role that might explain how disability develops from pain after cervical spinal surgery. AIMS: The study aim was to investigate the role of CS-related symptoms in the relationship between pain and disability reported after cervical spinal surgery. DESIGN: Cross-sectional study. SETTINGS: Tertiary care spinal surgery center. PARTICIPANTS/SUBJECTS: The participants included individuals with a cervical degenerative condition who had undergone surgery. METHODS: The following patient-reported outcome measures were evaluated: (1) Numerical Rating Scale; (2) Neck Disability Index; and (3) Short Form of the Central Sensitization Inventory. A hypothesized model containing the CS-related symptoms and the relationships between pain and disability was constructed and tested by structural equation modeling. RESULTS: Questionnaires were mailed to 280 individuals, and responses were obtained from 145 participants. Of these respondents, 99 (68.3%) were males and 46 (31.7%) were females, with a mean age of 64.4 ± 12.3 years. The latent variable for pain, represented by the neck (coefficient: 0.856, p < .001) and upper limb pain (0.568, p < .001), influenced CS-related symptoms (coefficient: 0.504, p < .001). Pain directly affected disability (coefficient: 0.497, p < .001) and indirectly through CS-related symptoms. Bootstrap analysis confirmed this indirect effect (point estimate: 2.85, 95% confidence interval: 1.04 to 6.30, p = .04). CONCLUSIONS: The results revealed that neck and upper limb pain affected disabilities both directly and through CS-related symptoms. Future research should focus on the efficacy of biopsychosocial approaches for patients after cervical spine surgery with a high risk of disability due to CS-related symptoms.

Influence of Pain Self-Efficacy and Gender on Disability in Postoperative Cervical Myelopathy.

BACKGROUND: Pain self-efficacy and gender may influence disability in patients with musculoskeletal disorders. The direct and interactive influence of pain self-efficacy and gender on postoperative disability with degenerative cervical myelopathy (DCM) is unclear. AIM: This study aimed to determine the effects of age, pain, and pain self-efficacy on disability postoperatively in patients with DCM, and explore whether these effects differ by gender. METHOD: A total of 180 participants who underwent DCM surgery were consecutively recruited. The following were evaluated: (1) demographic/descriptive data (age, gender, diagnosis, surgery date, procedure); (2) numerical rating scale pain and dysesthesia intensity; (3) Neck Disability Index; and (4) Pain Self-Efficacy Questionnaire. Hierarchical multiple regression analysis and simple slope analysis determined the effect of patients' biologic and psychosocial factors, and their interaction in terms of disability. RESULTS: The responses of 82 participants were analyzed. The hierarchical multiple regression final model analysis determined 57.1% participant disability variance; gender (B = 3.388; p < .01); pain (B = 3.574; p < .01); pain self-efficacy (B = -0.229; p < .01); age and gender (B = -0.201; p < .05); pain and gender (B = -3.749; p < .01); pain self-efficacy and gender (B = -0.304; p < .01) were significantly associated with disability. Simple slope test indicated that women showed weaker pain associations and stronger age and pain self-efficacy associations with disability than men. CONCLUSIONS: Pain self-efficacy improvement should be focused on after surgery in patients with DCM, especially women.

Confirmatory factor analysis of the Japanese Health Locus of Control scales among people with musculoskeletal disorders.

[Purpose] To determine whether the 25-item Japanese Health Locus of Control (25-JHLC) scale satisfies a 5-factor structure among Japanese with musculoskeletal disorders. [Participants and Methods] The primary inclusion criterion was people undergoing physical therapy for musculoskeletal disorders in two medical facilities. The 25-JHLC scale and demographic data were obtained by conducting an anonymous survey. Confirmatory factor analysis was used to analyze data from the 25-JHLC scale in 200 patients with musculoskeletal disorders. Fits for the 5-factor structure (1-internal; 2-family; 3-professional; 4-chance; and 5-supernatural) and the 2-factor structure (1-internal; and 2-external, including family, professional, chance, and supernatural) were studied. The goodness-of-fit criteria included chi-squared/degree of freedom, goodness-of-fit index, adjusted goodness-of-fit index, and root mean square error of approximation. [Results] The mean (standard deviation) age of the participants was 46.3 (18.3) years of age. The 2-factor structure satisfied no criteria; however, the 5-factor structure satisfied two criteria for acceptable fit (chi-squared/degree of freedom, and root mean square error of approximation). [Conclusion] This study found that the 5-factor structure of the 25-JHLC scale can be accepted to some extent among Japanese with musculoskeletal disorders without comorbidities.

Cross-cultural adaptation of the pain understanding and confidence questionnaire into Japanese.

[Purpose] This study aimed to develop a culturally adapted Japanese version of the Pain Understanding and Confidence Questionnaire (PUnCQ). The first-factor structure describes management from 12 perspectives for a case vignette of chronic pain and determines whether the management is based on a biomedical or biopsychosocial perspective. The second-factor structure evaluates the confidence level in management skills for the same case from 21 perspectives. [Participants and Methods] We conducted a cross-cultural adaptation based on five stages according to Beaton's guidelines (two forward translations, creation of an integrated forward translation version, two backward translations, creation of a provisional Japanese version, and a pilot test). In the pilot test, we asked 40 Japanese physical therapists to rate their understanding of the PUnCQ descriptions on a five-point Likert scale (1, not at all understandable; 5, completely understandable) and provide comments when they rated 1 to 3. We repeated revisions and pilot tests until less than 10% of the respondents rated 1 for all descriptions. [Results] By conducting two rounds of the pilot test, all items of descriptions satisfied the preestablished criteria. [Conclusion] A Japanese version of the PUnCQ was developed.

Development and validity assessment of a Japanese version of the Exercise Adherence Rating Scale in participants with musculoskeletal disorders.

BACKGROUND: Exercise adherence is important for achieving a long-term effect from musculoskeletal management. The Exercise Adherence Rating Scale (EARS), which was developed in 2017 as a patient reported outcome measure to assess exercise adherence in those with chronic low back pain in the UK, has demonstrated acceptable validity and reliability and is a robust measure of exercise adherence. This study aimed to undertake cross-cultural adaptation of the EARS into Japanese and investigate its structural validity in participants with musculoskeletal disorders. METHODS: The current study was composed of two phases, where a provisional Japanese version of the EARS was developed employing an international guideline for cross-cultural adaptation (Phase A), and structural validity was then evaluated using the Rasch analysis (Phase B). Participants with musculoskeletal disorders who have individualized home exercises prescribed by a physical therapist were recruited. RESULTS: In Phase A, the pilot testing was conducted twice because the initial testing detected some uncertainty revealed in comments from 17 participants (5 males and 12 females, 18-79 years of age) about which activities and exercises were supposed to be included. We therefore modified the draft by identifying a person who prescribed/recommended activities and exercises as per the Working Alliance Inventory. The second pilot testing using this draft recruited 30 participants (6 males and 24 females, 18-79 years of age), who provided no further comments, demonstrating the Japanese version of the EARS (EARS-J) had been successfully developed. In Phase B, data from 200 participants who completed the EARS-J (63 males and 127 females, mean ± SD of age = 53.6 ± 17.0) were analyzed using the Andrich's Rating Scale Model. Rasch statics indicated unidimensionality of the six items of the EARS-J. The Cronbach α was 0.77. Substantial ceiling effect (21.0%) was observed, with no floor effect (0.5%). CONCLUSIONS: A Japanese version of the EARS has been developed, which demonstrated acceptable structural validity with the evidence of unidimensionality in the Rasch analysis in Japanese people with musculoskeletal disorders who were prescribed individualized home exercises. However, there was a substantial ceiling effect and further studies are required to comprehensively establish validity and reliability of the EARS-J.

Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review.

BACKGROUND: To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI. METHODS: A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach. RESULTS: Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture. CONCLUSIONS: This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.

Association between central sensitivity syndrome and psychological factors in people with presurgical low back pain: A cross-sectional study.

BACKGROUND: Low back pain (LBP) is a major problem; it causes significant burden, incurs considerable economic and human costs, and adversely affects the quality of life (QoL). Central sensitivity syndrome (CSS) is known as a group of overlapping conditions that share a common pathophysiological mechanism of central sensitization. Previous studies have shown that CSS is present in several disorders. However, it has been studied for people with presurgical LBP. The purpose of the study was to investigate the proportion of patients with CSS for presurgical LBP and to analyse the association of CSS with clinical symptoms and psychological factors. METHODS: Data of demographics, the central sensitization inventory (CSI), psychological measures, clinical symptoms of 238 patients with presurgical LBP were evaluated. The patients were divided into two groups depending on the CSI scores (≥40 and < 40). The two groups were compared, and the correlation between the CSI scores and other outcomes was analysed. Furthermore, multiple regression analysis was performed to identify factors contributing to the CSI scores. RESULTS: 13.0% of participants were CSS. All outcomes were significantly different between the groups and significant associations were found between the CSI scores and all other outcomes. In addition, Pain Catastrophizing Scale (PCS) was most significant associated scale for the CSI scores. CONCLUSION: We found that certain patients had CSS with presurgical LBP. The CSI scores were significantly associated with the majority of the factors. The PCS was the factor with the most influence on the CSI scores.

Patterns of physical activity and exercise after lumbar surgery among Japanese patients with lumbar spinal stenosis.

[Purpose] The purpose of this study was to assess the feasibility of classifying the patterns of physical activity and exercise after surgery for lumbar spinal stenosis in Japanese patients and describe the characteristics of the patient groups. [Participants and Methods] We evaluated Japanese patients diagnosed as having lumbar spinal stenosis and underwent surgery. The frequencies of the 15 types of physical activity and exercise recommended in Kenko Nippon 21 (Japanese policy for health promotion) were investigated by mail. The study included 102 respondents (median age, 69 years [range, 34-88 years]; 55 males and 47 females). A hierarchical cluster analysis was used for grouping according to the physical activity and exercise patterns. The Holm method and residual analysis were used for comparisons of the frequencies of the physical activity and exercise patterns and basic demographics among the groups. [Results] Three clusters, namely clusters A (younger), B (frail older), and C (active older), were identified from the dendrogram. The participants in cluster A frequently performed paid work. In cluster B, the frequencies of all the physical activity and exercise patterns were low. The older people in cluster C regularly performed stretching/light-intensity exercises, walking, muscle-strengthening exercises, and house and garden maintenance tasks. [Conclusion] We found that the physical activity and exercise after lumbar surgery in Japanese patients could be divided into three patterns.

Effect of modified basic oxygen furnace slag on the controlled release of nitrate nitrogen and the functional microbial community in soil.

The specific surface area and active adsorption sites of basic oxygen furnace (BOF) slag increase after BOF modification. The addition of modified BOF slag to the soil may enable the control of nitrate nitrogen (NO3-N) leaching and also affect the functional microflora in the soil. In this study, soil column leaching experiments were conducted to explore the effects of adding modified slag to the soil on the controlled release of NO3-N and the main functional microbial communities involved in nitrification and denitrification processes. The experimental design included seven column groups: a soil control group (CT); soil groups with 2.5%, 5%, and 10% raw slag (S1, S2, S3); and soil groups with 2.5%, 5%, and 10% modified slag (MS1, MS2, MS3) that were subjected to three cycles of leaching, each of which were comprised of five leaching treatments. After the three cycles of leaching, significantly less NO3-N had leached from the modified slag group compared to the CT and the raw slag groups (P < 0.05). Although both slag treatments increased soil pH and decreased the oxidation reduction potential of the soil leaching solution, the addition of modified slag had less effect on soil pH than the addition of raw slag. During column leaching, the group with modified slag had a higher gene abundance of functional microflora compared with the group with raw slag. Similarly, the modified slag group had a higher diversity and richness of denitrifying bacteria, ammonia-oxidizing archaea, and ammonia-oxidizing bacteria than the raw slag group. In conclusion, the addition of modified slag to soil effectively decreased the NO3-N leaching and had relatively little effect on the functional microbial community in the soil.

Thermodynamic criteria of the end-of-life silicon wafers refining for closing the recycling loop of photovoltaic panels.

The collected end-of-life (EoL) silicon wafers from the discharged photovoltaic (PV) panels are easily contaminated by impurities such as doping elements and attached materials. In this study, the thermodynamic criteria for EoL silicon wafers refining using three most typical metallurgical refining processes: oxidation refining, evaporation refining, and solvent refining were systemically and quantitatively evaluated. A total of 42 elements (Ag, Al, Au, B, Be, Bi, C, Ca, Ce, Co, Cr, Cu, Fe, Ga, Gd, Ge, Hf, In, La, Mg, Mn, Mo, Na, Nb, Ni, Os, P, Pb, Pd, Pt, Re, Ru, Sb, Sn, Ta, Ti, U, V, W, Y, Zn, Zr) that are likely to be contained in the collected EoL silicon-based PV panels were considered. The principal findings are that the removal of aluminum, beryllium, boron, calcium, gadolinium, hafnium, uranium, yttrium, and zirconium into the slag, and removal of antimony, bismuth, carbon, lead, magnesium, phosphorus, silver, sodium, and zinc into vapor phase is possible. Further, solvent refining process using aluminum, copper, and zinc as the solvent metals, among the considered 14 potential ones, was found to be efficient for the EoL silicon wafers refining. Particularly, purification of the phosphorus doped n-type PV panels using solvent metal zinc and purification of the boron doped p-type PV panels using solvent metal aluminum are preferable. The efficiency of metallurgical processes for separating most of the impurity elements was demonstrated, and to promote the recycling efficiency, a comprehensive management and recycling system considering the metallurgical criteria of EoL silicon wafers refining is critical.

The stability of the compounds formed in the process of removal Pb(II), Cu(II) and Cd(II) by steelmaking slag in an acidic aqueous solution.

The potential feasibility of steel slag as a low cost removal agent for heavy metal ions Pb(II), Cu(II) and Cd(II) in acidic conditions was investigated in this study. The initial pH effect on heavy metal ion removal efficiency, the compounds formed after heavy metal ion removal, and the binding force of metals with the compounds were determined. The results showed that the efficiency of removing heavy metal ions by steel slag was low at low initial pH levels, yet it sharply increased and then became stable as the initial pH increased. The pseudo-second order model provided the best description for the removal of Pb, Cu, and Cd ions, indicating that the predominant heavy metal ion removal mechanism was chemisorption. The images obtained by the Fourier transform infrared spectroscopy (FTIR) and the X-ray diffraction (XRD) analysis indicated that the main compounds formed after the removal of Pb, Cu, and Cd ions by steel slag in an aqueous solution were heavy metal ferrites, silicates, carbonates, hydroxides and oxides. Sequential extraction experiments showed that these three heavy metals bond to the compounds mainly in the carbonate fraction (F2), the Fe oxide bound fractions (F3 (a) and F3 (c)), and the residual fraction (F4) in which F2 corresponded to the carbonates, and F3(a), F3(c) and F4 corresponded to the amorphous or crystalline ferrites and silicates, respectively. The F3 (a), F3 (c) and F4 are relatively stable and do not tend to re-release metal ions in acidic solutions. However, F2 and heavy metal hydroxides have relatively low stability and dissolve readily, re-leaching heavy metal ions into the acid solution. When these three heavy metal ion mixtures were removed by steel slag, the Pb, Cu and Cd deposits were at higher levels in the F3 and F4 fractions. Therefore, it was concluded that the co-existence of heavy metal ions in an aqueous solution is beneficial for their removal by steel slag in acidic conditions.

Allosteric activation of cytochrome P450 3A4 by efavirenz facilitates midazolam binding.

1. The purpose of this study is to investigate the heteroactivation mechanism of CYP3A4 by efavirenz, which enhances metabolism of midazolam in vivo, in terms of its binding to CYP3A4 with in vitro spectroscopic methods. 2. Efavirenz exhibited a type II spectral change with binding to CYP3A4 indicating a possible inhibitor. Although dissociation constant (K d) was approximated as 520 µM, efavirenz enhanced binding affinity of midazolam as a co-existing drug with an estimated iK d value of 5.6 µM which is comparable to a clinical concentration. 3. Efavirenz stimulated the formation of 1'-hydroxymidazolam, and the product formation rate (V max) concentration-dependently increased without changing the K m. Besides, an efavirenz analogue, [6-chloro-1,4-dihydro-4-(1-pentynyl)-4-(trifluoromethyl)-2H-3,1-benzoxazin-2-one] (efavirenz impurity) slightly facilitated the binding affinity of midazolam in a concentration-dependent manner. These results propose that efavirenz affects midazolam-binding via binding to the peripheral site which is apart from the active site of CYP3A4. 4. A molecular dynamics simulation also suggested the bound-efavirenz was repositioned to effector-binding site. As a consequence, our spectroscopic studies clarified the heteroactivation of CYP3A4 caused by efavirenz with a proper affinity to the peripheral site, and we concluded the method can be a useful tool for characterising the potential for drug-drug interactions.

Combination of antithrombin and recombinant thrombomodulin attenuates leukocyte-endothelial interaction and suppresses the increase of intrinsic damage-associated molecular patterns in endotoxemic rats.

INTRODUCTION: Both antithrombin (AT) and thrombomodulin are key players in physiological anticoagulant systems. Because the levels of both factors are known to decrease significantly during severe sepsis, we hypothesized that a combination therapy would be effective. METHODS: A sepsis model was established using the intravenous infusion of lipopolysaccharide (LPS). A dose of 125 IU/kg of AT, 0.25 mg/kg of recombinant thrombomodulin, or a combination of both agents was injected immediately after LPS infusion (n = 7, each). Intravital observation of the mesenteric microcirculation was performed, and leukocyte adhesion and blood flow were calculated at 3 h after LPS infusion. Immediately after the observation, blood samples were obtained and coagulation markers, organ damage markers, the circulating levels of nucleosome and high-mobility group box 1 were measured. RESULTS: Microscopic findings revealed the suppression of leukocyte adhesion and thrombus formation in the combination group. The number of adhesive leukocytes on the endothelium was significantly suppressed (P < 0.01), and the blood flow in venules was better maintained in the combination group compared with the placebo control (P < 0.01). The blood samples showed the suppressed activation in coagulation, no significant changes were observed in the organ damage markers in the treatment groups. The circulating levels of nucleosome and high-mobility group box 1 were both decreased significantly in the combination group compared with the placebo control (P < 0.01). CONCLUSIONS: The coadministration of AT and recombinant thrombomodulin is effective for the suppression of leukocyte activation and cell death during sepsis.

Is the neutrophil a 'prima donna' in the procoagulant process during sepsis?

Activation of the coagulation system is a fundamental host defense mechanism. Microorganisms that have invaded the body are trapped and disposed of in clots. Monocytes/macrophages are widely accepted as the main players in the procoagulant process; however, recent evidence suggests that neutrophils also play important roles. Tissue factor, which initiates the extrinsic coagulation cascade, is reportedly expressed on the surface of neutrophils, as well as on microparticles derived from neutrophils. Neutrophil extracellular traps (NETs) are another source of tissue factor. The components of NETs, such as DNA, histones, and granule proteins, also provide procoagulant activities. For instance, DNA initiates the intrinsic pathway, histones are a strong generator of thrombin, and granule proteins such as neutrophil elastase, cathepsin G and myeloperoxidase contribute to the suppression of the anticoagulation systems. Although understanding of the mechanisms that are involved in coagulation/fibrinolysis in sepsis has gradually progressed, the impact of neutrophils on thrombogenicity during sepsis remains to be addressed. Since the importance of the connection between coagulation and inflammation is advocated nowadays, further research on neutrophils is required.

Effect of hemoperfusion using polymyxin B-immobilized fibers on acute lung injury in a rat sepsis model.

Direct hemoperfusion using polymyxin B-immobilized column (PMX-DHP) is recognized as an effective treatment for septic shock. However, whether its efficacy is limited to cardiovascular dysfunction remains unknown. Therefore, we planned to examine the effects of PMX-DHP in an acute lung injury model. [Materials and methods] Rats were assigned to either PMX-DHP group or control group (n= 7 in each). A lung injury was created by the intratracheal instillation of LPS. In PMX-DHP group, an arteriovenous extracorporeal circuit using PMX column was applied for three hours. The same procedure using a dummy column was applied in control group. The lung microcirculation was observed, and adherent leukocytes, RBC velocity, and the arterial PaO2 were calculated. Pathological changes and the wet/dry weight ratio of the lungs were examined. [Results] Adherent leukocytes and platelets to the lung venules were recognized at 3 hours, and their numbers increased over time. Treatment with PMX-DHP significantly suppressed these events and helped maintenance of the blood flow and PaO2 levels. The lung edema and the histologic damages were also suppressed. [Conclusions] PMX-DHP improved the microcirculation by suppressing leukocyte and platelet adhesion. PMX-DHP had beneficial effects in a model for acute lung injury.

Influence of radiological factors, psychosocial factors, and central sensitization-related symptoms on clinical symptoms in patients with lumbar spinal canal stenosis.

BACKGROUND: No study to date has concurrently evaluated the impact of radiological factors, psychosocial factors, and central sensitization (CS) related symptoms in a single lumbar spinal canal stenosis (LSS) patient cohort. OBJECTIVE: To investigate the associations between these factors and clinical symptoms in LSS patients. METHODS: We recruited 154 patients with LSS scheduled for surgery. Patient-reported outcome measures and imaging evaluation including clinical symptoms, psychosocial factors, CS-related symptoms, and radiological classifications. Spearman's rank correlation coefficient and multiple regression analyses were employed. RESULTS: Spearman's correlation revealed CS-related symptoms positively correlated with low back pain (r= 0.25, p< 0.01), leg pain (r= 0.26, p< 0.01), and disability (r= 0.32, p< 0.01). Pain catastrophizing positively correlated with leg pain (r= 0.23, p< 0.01) and disability (r= 0.36, p< 0.01). Regression analysis showed that pain catastrophizing was associated with disability (ß= 0.24, 95%CI = 0.03-0.18), and CS-related symptoms with low back pain (ß= 0.28, 95%CI = 0.01-0.09). Radiological classifications were not associated with clinical symptoms. CONCLUSION: Our findings suggest that psychosocial factors and CS-related symptoms, rather than radiological factors, seem to contribute to clinical symptoms in patients with LSS.

Effectiveness of telerehabilitation based on real-time intervention between therapist and participants for improving physical function, activities of daily living and quality of life in people with stroke: A systematic review protocol.

BACKGROUND: There is a call for gathering more evidence on the effectiveness of telerehabilitation in stroke. In particular, a previous systematic review reported substantial variability in the types of technologies used in telerehabilitation interventions. The purpose of this study will be to summarize and synthesize findings on the effects of telerehabilitation based on real-time intervention between therapist and participants for patients with stroke. METHODS AND ANALYSIS: This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. This systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 25 May 2023 (registration number: CRD420234265527). Electronic searches will be performed in the following databases: MEDLINE, Pubmed, Web of Science, PsycINFO and CINAHL electronic databases, using a date range from inception to November 2023. We will include only randomized controlled trials for patients diagnosed with stroke who received telerehabilitation based on real-time interaction between therapist and patients. The exploration will be restricted to publications in the English language. Physical function, activities of daily living and quality of life are the outcomes. We will examine the changes of the outcomes at baseline, at the end of the intervention, and at specific time points during the follow-up after the intervention. DISCUSSION: This systematic review will provide evidence regarding telerehabilitation for people with stroke.

Health-Related Quality of Life is Associated With Pain, Kinesiophobia, and Physical Activity in Individuals Who Underwent Cervical Spine Surgery.

OBJECTIVE: To determine the association between health-related quality of life (HRQOL) and neck pain, kinesiophobia, and modalities of physical activity in individuals with postoperative degenerative cervical myelopathy and radiculopathy (DCM/R) because postoperative pain after cervical spine surgery is likely to persist, causing kinesiophobia and avoidance of physical activity. METHODS: A questionnaire was distributed to 280 individuals with DCM/R. The questionnaire comprised the following four items: HRQOL (EuroQol 5-dimensions 5-level), neck pain (numerical rating scale [NRS]), kinesiophobia (11-item Tampa Scale for Kinesiophobia [TSK-11]), and physical activity (paid work, light exercise, walking, strength training, and gardening). Hierarchical multiple regression analysis was performed using the NRS, TSK-11, and physical activity as independent variables. RESULTS: In total, 126 individuals provided analyzable responses (45.0%). After including the NRS score as an independent variable to the multiple regression equation for participants' background, the independent rate of the regression equation significantly improved by only 4.1% (R2=0.153). The addition of the TSK-11 score significantly improved this effect by 11.1% (R2=0.264). Finally, the addition of physical activity also significantly improved the explanatory rate by 9.9% (R2=0.363). CONCLUSION: Neck pain, kinesiophobia, and physical activity (specifically paid work and walking) were independently associated with HRQOL in individuals with postoperative DCM/R.

Physical therapist-led interventions based on the biopsychosocial model provide improvement in disability and pain for spinal disorders: A systematic review and meta-analysis.

OBJECTIVE: To summarize the effects of physical therapist-led interventions based on the biopsychosocial (BPS) model in spinal disorders compared to interventions with no BPS model through a systematic review and meta-analysis of randomized-controlled trials. TYPE: Systematic review and meta-analysis. LITERATURE SURVEY: We searched the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL, and PEDro up to October 27, 2022. METHODOLOGY: Pain intensity and disability were primary outcomes and psychological factors were secondary outcomes in spinal disorders. The included intervention was physical therapist-led interventions based on the BPS model. The control group received no physiotherapy intervention for BPS. Pooled effects were analyzed as standardized mean differences (SMDs) and 95% confidence intervals (CIs), and the random-effects model was used for the meta-analysis. The subgroup analysis was divided into low back pain group and neck pain group. Another subgroup analysis was conducted only of the groups that had received training of the BPS model. SYNTHESIS: Fifty-seven studies with 5471 participants met the inclusion criteria. For pain intensity, there was a statistically significant effect for the BPS model led by physical therapists in the short, medium, and long terms. The SMDs with 95% CIs were -0.44 (-0.62, -0.27), -0.24 (-0.37, -0.12), and -0.17 (-0.28, -0.06), respectively. Outcomes were clinically significant, except in the long term. For disability, there was a statistically significant effect in the short, medium, and long terms. The SMDs with 95% CIs were -0.48 (-0.69, -0.27), -0.44 (-0.64, -0.25), and -0.37 (-0.58, -0.15), respectively. All periods were clinically significant. The quality of the evidence was low for all of the main outcomes for all of the terms. CONCLUSION: Physical therapist-led interventions based on the BPS model effectively improve pain intensity and disability in patients with spinal disorders based on low-quality evidence.

Relationship between disability and physical activity frequency after cervical spine surgery: A linear mixed model analysis.

BACKGROUND: There is a paucity of data on physical activity and its effects in patients after cervical spine surgery. OBJECTIVE: This study aimed to examine the association between physical activity and disability in patients after cervical spine surgery while also considering age, sex, pain, and central sensitization (CS)-related symptoms. METHODS: Participants included individuals with a cervical degenerative condition who had undergone surgery. Neck disability index, physical activity frequency, numerical rating scale for pain intensity, and short form of the CS inventory were recorded more than 1 year postoperatively. The linear mixed model was performed to examine the association between physical activity and disability. RESULTS: The responses of 145 participants were analyzed. The linear mixed model results showed that the stretching and light-intensity exercise frequency (ß=-0.14, p= 0.039) was independently associated with disability, adjusted for age, sex, pain, and CS-related symptoms. Conversely, other physical activities, such as walking and muscle strength exercises, were not associated with a disability. CONCLUSION: The findings emphasize the importance of performing regular physical activity, regardless of pain and CS-related symptoms.