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1.
Sensors (Basel) ; 24(7)2024 Mar 30.
Article in English | MEDLINE | ID: mdl-38610440

ABSTRACT

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO's healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson's Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso®, HAL®, Stride Management Assist®, Honda Walking Assist®, Lokomat®, Walkbot®, Healbot®, Keeogo Rehab®, EX1®, overground wearable exoskeletons, Eksoband®, powered ankle-foot orthoses, HAL® lumbar type, Human Body Posturizer®, Gait Enhancing and Motivation System®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults.


Subject(s)
Exoskeleton Device , Healthy Aging , Humans , Aged , Postural Balance , Time and Motion Studies , World Health Organization
2.
Disabil Rehabil ; : 1-17, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38557249

ABSTRACT

PURPOSE: This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy. METHODS: A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed. RESULTS: In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I2 = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I2 = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I2 = 0%, p = 0.50). CONCLUSION: Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.


As stroke is known to cause long term disability, the implementation of strengthening interventions in rehabilitation becomes an indispensable part to optimize recovery.Peripheral electrical stimulation might be a useful intervention since it has the potential to repetitively activate the sensory-motor system via electrical pulses to nerves and muscles of the paretic limb.Results of the meta-analysis indicate a beneficial effect of electrotherapy on muscle strength when compared to conventional and sham therapy, and muscle thickness when compared to conventional therapy.

3.
BMJ Open ; 14(1): e075779, 2024 01 17.
Article in English | MEDLINE | ID: mdl-38233049

ABSTRACT

INTRODUCTION: Current treatments for pain in breast cancer survivors (BCSs) are mostly biomedically focused rather than biopsychosocially driven. However, 22% of BCSs with pain are experiencing perceived injustice, which is a known predictor for adverse pain outcomes and opioid prescription due to increased maladaptive pain behaviour. Educational interventions such as pain neuroscience education (PNE) are suggested to target perceived injustice. In addition, motivational interviewing can be an effective behavioural change technique. This trial aims to examine whether perceived injustice-targeted PNE with the integration of motivational interviewing is superior to biomedically focused pain education in reducing pain after 12 months in BCS with perceived injustice and pain. In addition, improvements in quality of life, perceived injustice and opioid use are evaluated, and a cost-effectiveness analysis will finally result in a recommendation concerning the use of perceived injustice-targeted PNE in BCSs with perceived injustice and pain. METHODS AND ANALYSIS: This two-arm multicentre randomised controlled trial will recruit female BCS (n=156) with pain and perceived injustice. Participants will be randomly assigned to perceived injustice-targeted PNE or biomedically focused pain education in each centre. Both interventions include an online session, an information leaflet and three one-to-one sessions. The primary outcome (pain), secondary outcomes (quality of life, perceived injustice and outcomes for cost-effectiveness analysis) and explanatory outcomes (pain phenotyping, sleep, fatigue and cognitive-emotional factors) will be assessed at baseline and at 0, 6, 12 and 24 months postintervention using self-reported questionnaires online. Treatment effects over time will be evaluated using linear mixed model analyses. Additionally, a cost-utility analysis will be done from a healthcare payer and societal perspective. ETHICS AND DISSEMINATION: The ethical agreement was obtained from the Main Ethics Committee (B.U.N.1432020000068) at the University Hospital Brussels and all other participating hospitals. Study results will be disseminated through presentations, conferences, social media, press and journals. TRIAL REGISTRATION NUMBER: NCT04730154.


Subject(s)
Breast Neoplasms , Cancer Survivors , Humans , Female , Breast Neoplasms/complications , Quality of Life , Analgesics, Opioid , Pain , Randomized Controlled Trials as Topic , Multicenter Studies as Topic
4.
BMJ Open ; 14(1): e074258, 2024 01 10.
Article in English | MEDLINE | ID: mdl-38199628

ABSTRACT

INTRODUCTION: Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation are promising pathways for pain relief in response to exercise therapy in patients with KOA: MST has the potential to decrease inflammation and BGA has the potential to decrease central sensitisation. Hence, this study aims to examine inflammation and central sensitisation as mediators for the effect of MST and/or BGA on pain in patients with KOA. METHODS AND ANALYSIS: The Knee OsteoArthritis PAIN trial started on 10 January 2020 (anticipated end: April 2024). The three-arm clinical trial aims to recruit 90 KOA patients who will be randomly allocated to 12 weeks of (1) MST, (2) BGA or (3) care as usual. Assessments will be performed at baseline, 13 and 52 weeks after finishing the intervention. Outcomes, including pain (Knee injury and Osteoarthritis Outcome Score), were chosen in line with the OARSI recommendations for clinical trials of rehabilitation interventions for OA and the IMMPACT/OMERACT recommendations for the assessment of physical function in chronic pain clinical trials. Inflammation as well as features of central sensitisation (including conditioned pain modulation, offset analgesia, temporal summation of pain and event-related potentials following electrical stimulation), will be considered as treatment mediators. A multiple mediators model will be estimated with a path-analysis using structural equation models. In July 2023, all 90 KOA patients have been included and 42 participants already finished the study. ETHICS AND DISSEMINATION: This study obtained ethics approval (B.U.N. 143201941843). Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists and clinicians. TRIAL REGISTRATION NUMBER: NCT04362618.


Subject(s)
Chronic Pain , Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/complications , Osteoarthritis, Knee/therapy , Exercise Therapy , Inflammation , Pain Management , Randomized Controlled Trials as Topic
5.
Ann Rheum Dis ; 83(6): 730-740, 2024 May 15.
Article in English | MEDLINE | ID: mdl-38212040

ABSTRACT

INTRODUCTION: Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed. METHODS: The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed. RESULTS: The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work. CONCLUSIONS: The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.


Subject(s)
Exercise Therapy , Osteoarthritis, Hip , Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/therapy , Osteoarthritis, Knee/rehabilitation , Osteoarthritis, Hip/therapy , Osteoarthritis, Hip/rehabilitation , Exercise Therapy/methods , Patient Education as Topic/methods , Europe , Self-Management/methods , Self-Help Devices , Evidence-Based Medicine , Weight Loss
6.
Assist Technol ; 36(1): 51-59, 2024 01 02.
Article in English | MEDLINE | ID: mdl-37115650

ABSTRACT

The implementation of technology in healthcare shows promising results and provides new opportunities in rehabilitation. However, the adoption of technology into daily care is largely dependent on the acceptance rate of end-users. This study aims to gather information from healthcare professionals on the development of new assistive technology that match users' needs using the Comprehensive Assistive Technology model. In total 27 healthcare professionals (12 occupational therapists, 8 physiotherapists, 3 nurses, 2 allied health directors, a physician and a speech therapist) attended one of four online focus group discussions. These focus group discussions were structured using a question guide based on three predefined scenarios. Recordings were transcribed and data was analyzed using a thematic analysis (NVivo). Major themes identified in this study were safety, price and usability. Healthcare professionals focused on both functional capabilities of the user, as well as behavioral aspects of usability and attitude toward technology. Furthermore, the need for assistive technology that were catered toward the limitations in activity and user experience, was highlighted extensively. Based on information gathered from healthcare professionals a user-centered approach in development of safe, low-cost devices that maximize both functional outcomes and user acceptance, could potentially increase the adoption of new technology in rehabilitation.


Subject(s)
Self-Help Devices , Humans , Health Personnel , Delivery of Health Care , Focus Groups
7.
Sensors (Basel) ; 23(21)2023 Oct 25.
Article in English | MEDLINE | ID: mdl-37960398

ABSTRACT

The integration of Deep Learning (DL) models with the HoloLens2 Augmented Reality (AR) headset has enormous potential for real-time AR medical applications. Currently, most applications execute the models on an external server that communicates with the headset via Wi-Fi. This client-server architecture introduces undesirable delays and lacks reliability for real-time applications. However, due to HoloLens2's limited computation capabilities, running the DL model directly on the device and achieving real-time performances is not trivial. Therefore, this study has two primary objectives: (i) to systematically evaluate two popular frameworks to execute DL models on HoloLens2-Unity Barracuda and Windows Machine Learning (WinML)-using the inference time as the primary evaluation metric; (ii) to provide benchmark values for state-of-the-art DL models that can be integrated in different medical applications (e.g., Yolo and Unet models). In this study, we executed DL models with various complexities and analyzed inference times ranging from a few milliseconds to seconds. Our results show that Unity Barracuda is significantly faster than WinML (p-value < 0.005). With our findings, we sought to provide practical guidance and reference values for future studies aiming to develop single, portable AR systems for real-time medical assistance.


Subject(s)
Augmented Reality , Deep Learning , Humans , Reproducibility of Results , Machine Learning
8.
PeerJ ; 11: e16036, 2023.
Article in English | MEDLINE | ID: mdl-37872951

ABSTRACT

Background: During hospitalization older adults have a high risk of developing functional impairments unrelated to the reasons for their admission. This is termed hospital-associated disability (HAD). This systematic review aimed to assess the incidence of HAD in older adults admitted to acute care with two outcomes: firstly in at least one activity of daily living from a set of functional tasks (e.g., Katz Index) and secondly the incidence of functional decline in an individual functional task (e.g., bathing), and to identify any tools or functional tasks used to assess activities of daily living (ADL) in hospitalized older patients. Methods: A rapid systematic review was performed according to the recommendations of the Cochrane Rapid Reviews Methods Group and reported the data according the PRISMA statement. A literature search was performed in Medline (via Ovid), EMBASE, and Cochrane Central Register of Controlled Trials databases on 26 August 2021. Inclusion criteria: older adults (≥65 years), assessment of individual items of activities of daily living at baseline and discharge. Exclusion criterion: studies investigating a specific condition that could affect functional decline and studies that primarily examined a population with cognitive impairment. The protocol was registered on OSF registries (https://osf.io/9jez4/) identifier: DOI 10.17605/OSF.IO/9JEZ4. Results: Ten studies were included in the final review. Incidence of HAD (overall score) was 37% (95% CI 0.30-0.43). Insufficient data prevented meta-analysis of the individual items. One study provided sufficient data to calculate incidence, with the following values for patients' self-reported dependencies: 32% for bathing, 27% for dressing, 27% for toileting, 30% for eating and 27% for transferring. The proxy reported the following values for patients' dependencies: 70% for bathing, 66% for dressing, 70% for toileting, 61% for eating and 59% for transferring. The review identified four assessment tools, two sets of tasks, and individual items assessing activities of daily living in such patients. Conclusions: Incidence of hospital-associated disability in older patients might be overestimated, due to the combination of disease-related disability and hospital-associated disability. The tools used to assess these patients presented some limitations. These results should be interpreted with caution as only one study reported adequate information to assess the HAD incidence. At the item level, the latter was higher when disability was reported by the proxies than when it was reported by patients. This review highlights the lack of systematic reporting of data used to calculate HAD incidence. The methodological quality and the risk of bias in the included studies raised some concerns.


Subject(s)
Activities of Daily Living , Self Care , Humans , Aged , Incidence , Hospitalization , Hospitals
9.
BMJ Open ; 13(10): e073163, 2023 10 04.
Article in English | MEDLINE | ID: mdl-37793919

ABSTRACT

BACKGROUND: The increasing prevalence of knee osteoarthritis and total knee arthroplasty (TKA) impose a significant socioeconomic burden in developed and developing countries. Prehabilitation (rehabilitation in the weeks immediately before surgery) may be crucial to prepare patients for surgery improving outcomes and reducing assistance costs. Moreover, considering the progress of telemedicine, candidates for TKA could potentially benefit from a tele-prehabilitation programme. We aim to evaluate the effects of a home-based tele-prehabilitation program for patients waiting for total knee replacement. METHODS AND ANALYSIS: Forty-eight male patients, aged 65-80, on a waiting list for TKA will be recruited and randomly assigned to the tele-prehabilitation intervention or control groups. Both groups will undergo the same 6-week exercise program (five sessions/week) and the same educational session (one per week). The tele-prehabilitation group will perform asynchronous sessions using a tablet, two accelerometers and a balance board (Khymeia, Padova, Italy), while the control group will use a booklet. The Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire, at the end of the prehabilitation, will be the primary outcome. Secondary outcomes will include self-reported outcomes, performance tests and change in expressions of blood and muscle biomarkers. Ten healthy subjects, aged 18-30, will be also recruited for muscle and blood samples collection. They will not undergo any intervention and their data will be used as benchmarks for the intervention and control groups' analyses. ETHICS AND DISSEMINATION: This randomised controlled trial will be conducted in accordance with the ethical principles of the Declaration of Helsinki. This study has been approved by the Ethics Committee of Vita-Salute San Raffaele University (Milan, Italy. No. 50/INT/2022). The research results will be published in peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05668312.


Subject(s)
Arthroplasty, Replacement, Knee , Osteoarthritis, Knee , Humans , Male , Preoperative Exercise , Exercise Therapy/methods , Osteoarthritis, Knee/surgery , Costs and Cost Analysis , Treatment Outcome , Randomized Controlled Trials as Topic
10.
Age Ageing ; 52(Suppl 4): iv26-iv43, 2023 10 28.
Article in English | MEDLINE | ID: mdl-37902527

ABSTRACT

BACKGROUND: Vitality capacity (VC) is a key domain of intrinsic capacity (IC) and is the underlying biophysiological aspect of IC. Energy and metabolism (E&M) is one of the domains of VC. Fatigue is one of the main characteristics of E&M. OBJECTIVE: The aims of this umbrella review are (i) to identify the available instruments suitable for measuring fatigue in community-dwelling older adults and (ii) to critically review the measurement properties of the identified instruments. DESIGN: Umbrella review. SETTING: Healthcare. SUBJECTS: Community-dwelling older adults. METHODS: PubMed and Web of Knowledge were systematically screened for systematic reviews and meta-analysis reporting on fatigue instruments resulting in 2,263 articles (last search 5 December 2022). The COSMIN checklist was used to appraise psychometric properties and the AMSTAR for assessing methodological quality. Data on fatigue instruments, construct, reference period, assessment method, validated population, reliability, validity, responsiveness and predictive validity on negative health outcomes were extracted. RESULTS: 10 systematic reviews and 1 meta-analysis were included in this study. 70 fatigue instruments were identified in the literature and 21 were originally designed for fatigue. The Fatigue Severity Scale (FSS), Pittsburgh Fatigability Scale (PFS) and Visual Analogue scale (VAS-F), Fatigue Impact Scale (FIS) and the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) presented good psychometric properties. CONCLUSIONS: The FSS, FIS, FACIT-F, PFS and the VAS-F presented good psychometric properties in various conditions. Therefore, these instruments could be used to quantify trajectories in the domain E&M in the context of VC in community-dwelling older adults.


Subject(s)
Checklist , Independent Living , Humans , Aged , Reproducibility of Results , Systematic Reviews as Topic , Fatigue/diagnosis
11.
Pilot Feasibility Stud ; 9(1): 166, 2023 Sep 28.
Article in English | MEDLINE | ID: mdl-37759324

ABSTRACT

BACKGROUND: Long COVID is suggested to be present in 14 to 43% of COVID 19-survivors. Literature on this new condition states a need for a multidisciplinary approach including physical exercise and nutrition. The aim of the current pilot study is to investigate the feasibility of the proposed protocol to prepare for a randomized controlled study that addresses the effectiveness of a personalized multimodal treatment compared to standard physiotherapy. METHODS: This is a protocol of the UNLOCK (Nutrition and LOComotoric rehabilitation in long COVID) study, a pragmatic, single center, randomized controlled pilot trial with two groups. Patients with persisting symptoms related to a SARS-CoV-2 infection will receive either standard physiotherapy or a personalized multimodal treatment for a period of 12 weeks, consisting of individualized physical exercise program combined with individualized nutritional therapy. They will be followed-up at 6, 12, and 18 weeks after randomization. DISCUSSION: A multidisciplinary approach for dealing with long COVID is needed. Because of the lack of clear data and the fact that this is a very heterogenic group, we aim to prepare and optimize a randomized controlled study that addresses the effectiveness of a personalized multimodal treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05254301 (since February 24, 2022).

12.
J Clin Med ; 12(18)2023 Sep 05.
Article in English | MEDLINE | ID: mdl-37762721

ABSTRACT

Fatigue and pain are the most common side effects impacting quality of life (QoL) in cancer survivors. Recent insights have shown that perceived injustice (PI) can play a substantial role in these side effects, but research on cancer survivors is scarce. Furthermore, guidelines for recognizing clinically relevant levels of PI in cancer survivors are missing. The aims of this study are to provide a clinically relevant cut-off for PI and to explore relationships between personal characteristics, symptoms, and QoL with PI. This multicenter, cross-sectional study uses the Injustice Experience Questionnaire (IEQ), Numeric Pain Rating Scale (NPRS), Patient-Specific Complaints (PSC), Multidimensional Fatigue Index (MFI), and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 (EORTC-QLQ-C30). A clinical cut-off for PI was identified based on the 75th percentile of IEQ scores. Univariate and multivariate regressions explored the relationship between PI and personal characteristics (sex, age, cancer type, treatment type), symptoms (pain intensity, fatigue), and QoL (daily activity complaints, cancer-related QoL). Cancer survivors (n = 121) were included, and a cut-off of 20 was identified. Significant indirect associations were found between chemotherapy, NPRS, PSC, MFI, and EORTC-QLQ-C30 with PI. In the multivariate model, only MFI (B = 0.205; 95% CI: 0.125-0.018) and age (B = 0.086; 95% CI: -0.191-0.285) maintained a significant association with PI.

13.
Gerontology ; 69(10): 1259-1268, 2023.
Article in English | MEDLINE | ID: mdl-37276855

ABSTRACT

INTRODUCTION: Fatigue resistance (FR) can be assessed as the time during which grip strength (GS) drops to 50% of its maximum during a sustained maximal voluntary contraction. For the first time, we compared force-time characteristics during FR test between two different handgrip systems and investigated age- and clinical-related differences in order to verify if a briefer test protocol (i.e., until 75%) could be sufficiently informative. METHODS: A cohort of young healthy controls (Y, <30 y, 24 ± 3 y, 54% women), middle-aged (MA, 30-65 y, 47 ± 11 y, 54% women), and older (OLD, >65 y, 77 ± 7 y, 50% women) community-dwelling persons, and hospitalized geriatric patients (HOSP, 84 ± 5 y, 50% women) performed the FR test. For this purpose, an adapted vigorimeter (original rubber bulb of the Martin Vigorimeter connected to a Unik 5000 pressure gauge) here defined as "pneumatic handgrip system" (Pneu) and Dynamometer G200 system (original Jamar Dynamometer handle with an in-build strength gauge) here defined as "hydraulic handgrip system" (Hydr) were used. Force-time curves were analysed from 100% to 75% and from 75% to 50% of the initial maximal GS during the FR test. The area under the curve (GW) was calculated by integrating the actual GS at each time interval (i.e., 1/5,000 s) and corrected for body weight (GW/body weight). RESULTS: For both systems, we found fair associations between FR100-50 and FR100-75 (Pneu mean difference = 50.1 s [95% CI: 47.9-52.4], r2 = 0.48; Hydr mean difference = 28.4 s [95% CI: 27.0-29.7], r2 = 0.52, all p < 0.001) and also moderate associations between GW(100-50)/body weight and GW(100-75)/body weight (Pneu mean difference = 32.1 kPa*s/kg [95% CI: 30.6-33.6], r2 = 0.72; Hydr mean difference = 8.1 kg*s/kg [95% CI: 7.7-8.6], r2 = 0.68, all p < 0.001). Between MA and OLD, we found a significant age-related difference in the GW results in the first 25% strength decay for Pneu (10.2 ± 0.6 kPa*s/kg against 7.1 ± 1.2 kPa*s/kg, respectively). CONCLUSION: The brief test protocol is valid. Differences within the first 25% strength decay in GW between OLD and HOSP were identified when using Pneu but not when using Hydr. Therefore, a brief FR test protocol using a continuous registration of the strength decay seems to be sufficiently informative in a clinical setting to appraise muscle fatigability, however, only when using a Pneu system.

14.
Exerc Immunol Rev ; 29: 22-53, 2023.
Article in English | MEDLINE | ID: mdl-37358362

ABSTRACT

Background: In the pathogenesis of knee osteoarthritis (KOA), inflammatory mediators play an important role. However, the precise underlying mechanism by which regular exercise therapy (ET) exert effects on the immune system in KOA patients is unknown. Objectives: The aim of this systematic review was to investigate the basal and acute effects of ET on inflammatory biomarkers and brain derived neurotrophic factor (BDNF) in KOA patients. Methods: PubMed, Web Of Science and PEDro were systematically searched for appropriate studies. If possible, a meta-analysis was performed or an approximation of the effect size (ES) was calculated. Risk of bias was scored using the Cochrane ROB 2.0 or ROBINS-tools. Results: Twenty-one studies involving 1374 participants were included. Fifteen articles focused on basal exercise effects, four on acute effects, and two on both. Biomarker analysis (n=18) was performed in synovial fluid (n=4) or serum/plasma (n=17). A meta-analysis demonstrated that basal CRP was reduced in KOA patients 6-18 weeks weeks after ET (MD: -0.17;95%CI[-0.31;-0.03]), while IL-6 (MD: 0.21;95%CI[-0.44;0.85]), and TNF-α (MD: -0.57;95%CI[-1.47;0.32]), levels did not significantly change. Also, sTNFR1/2 did not change significantly after ET. For other biomarkers, insufficient data were available to perform a meta-analysis. Nevertheless, a low degree of evidence was found for a decrease in IL-6 (ES:-0.596 & -0.259 & -0.513), an increase in sTNFR1 (ES:2.325), a decrease in sTNFR2 (ES:-0.997) and an increase in BDNF (ES:1.412). Locally, intra-articular IL-10 (ES:9.163) increased, and IL1ß (ES:-6.199) and TNF-α decreased (ES:-2.322) after ET. An acute exercise session elicited a myokine response (ES IL-6:0.314), and an increase in BDNF (no ES-data). No inflammatory effect (ES CRP:0.052; ES TNF-α:-0.019 & 0.081) following an acute bout of training was found. However, a single bout of exercise elicited a decrease in intra-articular IL-10 (no ES-data). Conclusion: ET can induce circulatory and intra-articular anti-inflammatory effects in patients with KOA. The antiinflammatory properties have important implications for informing these patients and clinicians about the underlying effects of ET.


Subject(s)
Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/therapy , Brain-Derived Neurotrophic Factor , Interleukin-10 , Tumor Necrosis Factor-alpha , Interleukin-6 , Biomarkers
15.
Article in English | MEDLINE | ID: mdl-37239524

ABSTRACT

OBJECTIVE: To identify metabolic factors and inflammatory markers that are predictive of postoperative total knee arthroplasty (TKA) outcome. METHOD: A systematic search of the existing literature was performed using the electronic databases PubMed, Web of Science and Embase until the 1st of August 2022. Studies that evaluated the influence of metabolic or inflammatory markers (I) on postsurgical outcome (O) in end-stage knee osteoarthritis patients awaiting primary TKA (P) were included in this review. RESULTS: In total, 49 studies were included. Risk of bias of the included studies was low for one study, moderate for 10 studies and high for the remaining 38 studies. Conflicting evidence was found for the influence of body mass index, diabetes, cytokine levels and dyslipidaemia on pain, function, satisfaction and quality of life at more than six months after TKA. CONCLUSIONS: Several limitations such as not taking into account known confounding factors, the use of many different outcome measures and a widely varying follow-up period made it challenging to draw firm conclusions and clinical implications. Therefore large-scaled longitudinal studies assessing the predictive value of metabolic and inflammatory factors pre-surgery in addition to the already evidenced risk factors with follow-up of one year after TKA are warranted.


Subject(s)
Arthroplasty, Replacement, Knee , Osteoarthritis, Knee , Humans , Arthroplasty, Replacement, Knee/adverse effects , Osteoarthritis, Knee/surgery , Quality of Life , Outcome Assessment, Health Care , Longitudinal Studies , Treatment Outcome , Knee Joint
16.
Pain Physician ; 26(2): E1-E49, 2023 03.
Article in English | MEDLINE | ID: mdl-36988358

ABSTRACT

BACKGROUND: Perceived injustice (PI) is a multidimensional appraisal cognition comprising the severity of loss consequent to injury, blame, a sense of unfairness, and/or irreparability of loss. PI gained increasing interest in pain research since it potentially contributes to the experience and burden of (chronic) pain. OBJECTIVES: This systematic review aimed to determine the prevalence of PI and factors associated with PI in people with pain. STUDY DESIGN: Systematic review with meta-analysis. METHODS: Web of Science, PubMed, and Embase were screened for cross-sectional or cohort studies encompassing human patients who were diagnosed with a condition causing pain and reported prevalence rates for PI and/or associations between a factor and PI. Meta-analyses were carried out, and subgroup analyses were undertaken based on the methodological quality of the studies, the type of pain population, and whether the outcome measure was valid or not in case of heterogeneity (P < 0.05). RESULTS: Fifty-four studies were found eligible. The prevalence of PI ranged from 23% to 77% (I2 = 99%, P < 0.001). Association with PI, assessed using the Injustice Experienced Questionnaire, were found with pain catastrophizing (pooled Pearson's r [rp] = 0.66 [0.64, 0.69], P < 0.00001), posttraumatic stress (rp = 0.63 [0.59, 0.67], P < 0.00001), anger (rp = 0.59 [0.49, 0.67], P < 0.00001), anxiety (rp = 0.59 [0.52, 0.64], P < 0.00001), pain acceptance (rp = -0.59 [-0.66, -0.49], P < 0.00001), depressive symptoms (rp = 0.57 [0.52, 0.60], P < 0.00001), kinesiophobia (rp = 0.57 [0.50, 0.64], P < 0.00001), academic functioning (rp = -0.54 [-0.65, -0.41], P < 0.00001), disability (rp = 0.53 [0.47, 0.59], P < 0.00001), emotional functioning (rp = -0.52 [-0.64, -0.39], P < 0.00001), pain interference (rp = 0.49 [0.35, 0.60], P < 0.00001), state anger (rp = 0.48 [0.41, 0.54], P < 0.00001), mental functioning (rp = -0.48 [-0.57, -0.38], P < 0.00001), symptoms of central sensitization (rp = 0.47 [0.39, 0.55], P < 0.00001), social functioning (rp = -0.47 [-0.60, -0.31], P < 0.00001), and physical functioning (rp = -0.43 [-0.53, -0.33], P < 0.00001), pain perceptions (rp = 0.40 [0.40, 0.64], P < 0.00001), trait anger (rp = 0.40 [0.29, 0.49], P < 0.00001), pain intensity (rp = 0.37 [0.33, 0.42], P < 0.00001), and anger inhibition (rp = 0.35 [0.26, 0.43], P < 0.00001). LIMITATIONS: Some articles had to be excluded due to the absence of a full-text version. The findings can largely be applied to developed and high-income countries, but further research is needed in developing countries. Also, no validated cutoff values were available for the National Institutes of Health to determine the methodological quality of the included studies. Lastly, high heterogeneity was observed in many of the performed analyses. However, this was addressed by performing subgroup analyses, which could decrease heterogeneity in some cases. CONCLUSIONS: The prevalence of PI was >= 33% in 75% of the studies indicating that PI is important to consider in people with pain. There is evidence for the association of PI with psychological, pain, and quality of life characteristics in people with pain. The associations of PI with personal, injury, and recovery characteristics were overall not significant or negligible.


Subject(s)
Chronic Pain , Quality of Life , Humans , Cross-Sectional Studies , Quality of Life/psychology , Prevalence , Chronic Pain/epidemiology , Chronic Pain/psychology , Pain Perception
17.
J Cancer Surviv ; 2023 Jan 26.
Article in English | MEDLINE | ID: mdl-36701101

ABSTRACT

PURPOSE: This systematic review and meta-analysis aimed to determine the effectiveness of psychologically informed practice (PIP) with behavioural graded activity (BGA) compared to (1) waitlist controls (WLC), (2) other interventions (OI), (3) PIP alone or (4) BGA alone in cancer patients and survivors (CPaS). METHODS: PubMed, Web of Science and Embase were screened for randomised controlled trials encompassing BGA + PIP in CPaS. Effect sizes were inventoried for outcomes regarding physical activity (PA), quality of life (QoL) and debilitating symptoms (DS), which were assessed at four time points: post-intervention (PI), follow-up F1 (1 to 3 months), F2 (4 to 6 months) and F3 (> 6 months). The quality of the evidence was classified by the GRADE approach. RESULTS: Thirty-three studies were found eligible, comprising 4330 participants. Significant effects with low heterogeneity of PIP + BGA comparing to WLC were found for anxiety (SMD - 1.29 [-1.71; - 0.86]), depression (SMD - 0.79 [- 1.10; - 0.48]), functional impairment (SMD - 0.72 [- 0.95; - 0.50]), PA (self-reported: (SMD - 0.58 [- 0.84; - 0.32]) and objectively measured: (SMD - 0.51 [- 0.90; - 0.13])) and social impairment (SMD - 0.33 [- 0.58; - 0.08]). When comparing PIP + BGA to OI, fatigue (SMD - 0.35 [- 0.51; - 0.20]) and PA (SMD - 0.26 [- 0.41; - 0.11]) at PI, and fatigue (SMD - 0.34 [- 0.58; - 0.10]) at F1 were found significant with low heterogeneity. No significant effects were observed in the meta-analyses of studies comparing PIP + BGA to BGA or PIP alone. CONCLUSIONS: PIP with BGA has a favourable effect on DS, PA and QoL in CPaS when compared to non-behavioural interventions such as WLC, usual care and education. However, further research is needed on 'how' and 'when' PIP + BGA should be provided in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS: PIP + BGA has the potential to facilitate CPaS to reach the recommended amount of PA and reduce DS.

18.
Braz J Phys Ther ; 26(6): 100453, 2022.
Article in English | MEDLINE | ID: mdl-36279767

ABSTRACT

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


Subject(s)
Musculoskeletal Pain , Phobic Disorders , United States , Adult , Humans , Longitudinal Studies , Cross-Sectional Studies
19.
J Rehabil Med ; 54: jrm00308, 2022 Oct 04.
Article in English | MEDLINE | ID: mdl-35848335

ABSTRACT

BACKGROUND: Rehabilitation is important in the first months after a stroke for recovery of functional ability, but it is also challenging, since distinct recovery trajectories are seen. Therefore, studying the early changes in muscle characteristics over time (e.g. muscle strength, muscle mass and muscle volume), which are known to be associated with functional abilities, may deepen our understanding of underlying recovery mechanisms of stroke survivors. OBJECTIVE: This systematic review aims to describe the longitudinal changes in skeletal muscles, including muscle strength, muscle mass and muscle volume, during the first 3 months post-stroke. METHODS: Electronic searches were conducted in Medline, Scopus and CENTRAL. Longitudinal cohort studies or controlled interventional trials that report data about patients in the first 3 months after stroke were identified. Skeletal muscle characteristics should be measured at least twice within 3 months post-stroke by objective, quantitative assessment methods (e.g. dynamometry, ultrasound, computed tomography). Effect sizes were calculated as Hedges' g using standardized mean differences. RESULTS: A total of 38 studies (1,097 subjects) were found eligible. Results revealed an mean increase on the paretic side for upper and lower limb muscle strength (small to moderate effect sizes), whereas muscle thickness decreased (moderate to large effect sizes). Similar, but smaller, effects were found on the non-paretic side. There were insufficient data available to draw conclusions about lean muscle mass and muscle cross-sectional area. No studies aimed at investigating distinct trajectories of the muscle changes. CONCLUSION: Muscle strength and thickness changes during the first 3 months after stroke in both the paretic and non-paretic side. Future studies should aim to understand "how" the stroke-induced muscle strength changes are achieved. Exploring existing data from longitudinal studies, by using cluster analyses, such as pattern recognition, could add to the current knowledge-base.


Subject(s)
Muscular Diseases , Stroke Rehabilitation , Stroke , Humans , Longitudinal Studies , Muscle, Skeletal/diagnostic imaging , Paresis/complications , Stroke/complications , Stroke Rehabilitation/methods
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