Machine learning methods in physical therapy: A scoping review of applications in clinical context.

BACKGROUND: Machine learning (ML) efficiently processes large datasets, showing promise in enhancing clinical practice within physical therapy. OBJECTIVE: The aim of this scoping review is to provide an overview of studies using ML approaches in clinical settings of physical therapy. DATA SOURCES: A scoping review was performed in PubMed, EMBASE, PEDro, Cochrane, Web of Science, and Scopus. SELECTION CRITERIA: We included studies utilizing ML methods. ML was defined as the utilization of computational systems to encode patterns and relationships, enabling predictions or classifications with minimal human interference. DATA EXTRACTION AND DATA SYNTHESIS: Data were extracted regarding methods, data types, performance metrics, and model availability. RESULTS: Forty-two studies were included. The majority were published after 2020 (n = 25). Fourteen studies (33.3%) were in the musculoskeletal physical therapy field, nine (21.4%) in neurological, and eight (19%) in sports physical therapy. We identified 44 different ML models, with random forest being the most used. Three studies reported on model availability. We identified several clinical applications for ML-based tools, including diagnosis (n = 14), prognosis (n = 7), treatment outcomes prediction (n = 7), clinical decision support (n = 5), movement analysis (n = 4), patient monitoring (n = 3), and personalized care plan (n = 2). LIMITATION: Model performance metrics, costs, model interpretability, and explainability were not reported. CONCLUSION: This scope review mapped the emerging landscape of machine learning applications in physical therapy. Despite the growing interest, the field still lacks high-quality studies on validation, model availability, and acceptability to advance from research to clinical practice.

Contents and delivery methods of pain neuroscience education in pediatrics: A scoping review.

BACKGROUND: Pain is prevalent among children and adolescents. The development and implementation of Pain Neuroscience Education (PNE) strategies tailored to this population remains overlooked in contrast to the adult population. OBJECTIVE: This study sought to identify the content, delivery methods, and dosage of PNE for children and adolescents available in the literature. METHOD: We systematically searched PubMed, EMBASE, Physiotherapy Evidence Database, Scopus, Web of Science, Cochrane Library, PsycINFO, and clinical trial registration databases. Inclusion criteria consisted of studies that involved children submitted to a PNE program in community, school, clinics, hospitals or child development centers. We considered studies that included children with and without pain who received PNE strategies associated or not with self-motivational interventions. Studies focusing on psychological interventions were excluded. We extracted data on authors, publication year, country, sample characteristics, health condition, PNE content, study design, context, outcomes, duration, follow-up, main results, dropout, and adverse effects. Data extracted were qualitatively organized. RESULTS: A total of 805 studies were initially reviewed. The final sample comprised 17 studies. Common PNE topics included pain neurophysiology, biopsychosocial influences, pain concepts, self-management, and coping strategies. Delivery methods ranged from slideshows and videos to booklets, with sessions lasting 8-60 min. Schools were the most common setting for these interventions. CONCLUSION: Our review demonstrates the diversity in PNE content, delivery methods, and intervention dosages among the included studies. Most studies occurred in school settings, potentially limiting its generalizability for clinical contexts.

Pain intensity scales: A cross-sectional study on the preferences and knowledge of physiotherapists and participants with musculoskeletal pain.

BACKGROUND: Subjective pain intensity can be measured using instruments like the Faces Pain Scale-Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Pain Rating Scale (NPRS), and Visual Analogue Scale (VAS). However, information on physiotherapists' and patients' knowledge and preference for these tools is scarce. OBJECTIVE: We investigated the knowledge and preference of physiotherapists and participants with musculoskeletal pain (MP) regarding the pain intensity measurement scales. METHODS: This cross-sectional study consisted of physiotherapists and participants with MP. Physiotherapists were recruited via social media for an online open survey, gathering sociodemographic, professional data, and their knowledge and preferences for pain intensity scales. Participants over 18 with MP, participated in interviews focusing on their familiarity and preferences for pain intensity scales. Data was analyzed descriptively, and Chi-squared test evaluated scale preferences. RESULTS: We included 352 physiotherapists (mean experience = 10.5 years) and 94 participants with MP. Of the physiotherapists, 94.3% were familiar with pain scales, but 30.4% struggled to differentiate them. The NPRS was the most used (56.3%) and preferred scale (52.4%). Among participants with MP, unfamiliarity was noted with all scales. After instruction, 46% preferred FPS-R, with preference varying by income and education levels (p < 0.001). CONCLUSION: We found a knowledge gap among physiotherapists in identifying pain intensity scales, with a preference for the NPRS among those familiar with the scales. Participants with MP had limited familiarity with these scales. After instructions, these participants preferred the FPS-R, particularly those with lower income and education levels.

One spinal manipulation session reduces local pain sensitivity but does not affect postural stability in individuals with chronic low back pain: a randomised, placebo-controlled trial.

BACKGROUND: Clinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity. METHODS: A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant's perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes. RESULTS: Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants' perceived treatment allocation did not affect the outcomes. CONCLUSION: One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant's belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.

Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review.

OBJECTIVES: To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions. STUDY DESIGN AND SETTING: A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM. RESULTS: The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use. CONCLUSION: No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.

TRANSCRIPTOMIC DIFFERENCES IN PERIPHERAL MONOCYTE POPULATIONS IN SEPTIC PATIENTS BASED ON OUTCOME.

ABSTRACT: Postsepsis early mortality is being replaced by survivors who experience either a rapid recovery and favorable hospital discharge or the development of chronic critical illness with suboptimal outcomes. The underlying immunological response that determines these clinical trajectories remains poorly defined at the transcriptomic level. As classical and nonclassical monocytes are key leukocytes in both the innate and adaptive immune systems, we sought to delineate the transcriptomic response of these cell types. Using single-cell RNA sequencing and pathway analyses, we identified gene expression patterns between these two groups that are consistent with differences in TNF-α production based on clinical outcome. This may provide therapeutic targets for those at risk for chronic critical illness in order to improve their phenotype/endotype, morbidity, and long-term mortality.

Pain and disability were related to Y-balance test but not with proprioception acuity and single-leg triple-hop test in patients with patellofemoral pain: A cross-sectional study.

INTRODUCTION: Patellofemoral pain is a common complaint between physically active subjects. Patients with patellofemoral pain present limitations to performing daily activities. Pain could alter proprioceptive acuity and lead to movement impairment. The aim of this study was to investigate the relationship of pain and disability with proprioception acuity and physical performance in patients with patellofemoral pain. METHODS: Forty-eight patients with patellofemoral pain [age 31.15 (5.91) years; 30 (62.50%) males] were recruited. Data collected included pain intensity, pain duration, disability, joint position sense (JPS) test at 20° and 60° of knee flexion, and physical performance tests (Single-Leg Triple-Hop Test and Y- Balance Test). Spearman's rank correlation coefficient (rs) and 95% confidence intervals (CI) were computed to assess the relationship between the variables. RESULTS: Pain intensity was correlated with Y-Balance Test posteromedial component (rs = -0.32, 95%CI = -0.55 to -0.03, p = 0.029) and the composite score (rs = -0.35, 95%CI = -0.58, -0.07, p = 0.015). Pain duration was correlated with Y-Balance Test posterolateral component (rs = -0.23, 95% CI = -0.53 to -0.01, p = 0.047). Disability was correlated with Y-Balance Test posteromedial component (rs = 0.41, 95% CI = 0.14 to 0.62, p = 0.004). Pain and disability were not correlated with JPS and the Single-Leg Triple-Hop Test. CONCLUSION: Pain and disability were related to Y-Balance Test but not to proprioceptive acuity and Single-Leg Triple-Hop Test in patients with patellofemoral pain.

Falta de conhecimento sobre os fatores de risco não ocupacionais da dor lombar entre profissionais de saúde ocupacional brasileiros: um estudo observacional transversal / Lack of knowledge about non-occupational low back pain risk factors among brazilian occupational health professionals: a cross-sectional observational study

INTRODUÇÃO: A dor lombar possui alta prevalência, sendo uma das principais causas de incapacidade no Brasil e no mundo. A dor lombar apresenta etiologia multifatorial, sendo extremamente comum em trabalhadores. OBJETIVOS: Verificar o conhecimento sobre os fatores de risco para dor lombar, crenças e atitudes sobre o manejo da dor lombar entre profissionais de saúde (fisioterapeutas e ergonomistas) atuantes na área ocupacional. MATERIAIS E MÉTODOS: Foi realizado um estudo observacional transversal com 81 profissionais de saúde ocupacional brasileiros. Os participantes preencheram um questionário eletrônico composto por dados profissionais, sociodemográficos, itens sobre fatores de risco para dor lombar e a Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Conhecimentos, crenças e atitudes foram analisados por meio do teste do qui-quadrado para fatores de risco para dor lombar e um modelo de regressão linear para crenças e atitudes dos profissionais de saúde. RESULTADOS: Obesidade (7,4%), ficar sentado mais de 2 horas (8,6%), atividade física (9,9%), falta de apoio psicossocial no trabalho (11,1%) e consumo de álcool (37,0%), apresentaram os menores índices de conhecimento sobre fatores de risco da dor lombar pelos profissionais. Itens sobre saúde geral apresentaram o menor conhecimento. Uma orientação biomédica e psicossocial equilibrada de crenças e atitudes sobre o manejo da dor lombar foi observada. CONCLUSÃO: Profissionais de saúde ocupacional brasileiros carecem de conhecimento sobre os fatores de risco não ocupacionais da dor lombar, especialmente o estado geral de saúde. Esses profissionais também possuem conceitos biomédicos e psicossociais equilibrados no manejo da dor lombar.

INTRODUCTION: Low back pain (LBP) is highly prevalent and is one of the main causes of disability in Brazil and around the world. LBP presents a multifactorial etiology, being extremely common in workers. OBJECTIVE: This study aimed to verify the knowledge about the LBP risk factors, beliefs and attitudes about the management of LBP among health professionals (physiotherapists and ergonomists) working in the occupational area. MATERIALS AND METHODS: A cross-sectional observational study was conducted with 81 Brazilian occupational health professionals. Participants completed an electronic questionnaire comprising professional data, sociodemographics, items about LBP risk factors, and the Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Knowledge, beliefs and attitudes were analyzed using the chi-square test for LBP risk factors and the linear regression model for health professionals' beliefs and attitudes. RESULTS: Obesity (7.4%), sitting for more than 2 hours (8.6%), physical activity (9.9%), lack of psychosocial support at work (11.1%) and consuming alcohol (37.0%) presented the lowest rate of knowledge about LBP risk factors by professionals. Items about general health showed the lowest knowledge. A balanced biomedical and psychosocial orientation of beliefs and attitudes about managing LBP was observed. CONCLUSION: Brazilian occupational health professionals lack knowledge about non-occupational LBP risk factors, especially general health status. These professionals also have balanced biomedical and psychosocial concepts in managing LBP.

Uncovering emotional and network dynamics in the speech of patients with chronic low back pain.

BACKGROUND: Computational linguistics allows an understanding of language structure and different forms of expression of patients' perceptions. AIMS: The aims of this study were (i) to carry out a descriptive analysis of the discourse of people with chronic low back pain using sentiment analysis (SA) and network analysis; (ii) to verify the correlation between patients' profiles, pain intensity and disability levels with SA and network analysis; and (iii) to identify clusters in our sample according to language and SA using an unsupervised machine learning technique. METHODS: We performed a secondary analysis of a qualitative study including participants with chronic non-specific low back pain. We used the data related to participants' feelings when they received the diagnosis. The SA and network analysis were performed using the Valence Aware Dictionary and sEntiment Reasoner, and the Speech Graph, respectively. Clustering was performed using the K-means algorithm. RESULTS: In the SA, the mean composite score was -0.31 (Sd. = 0.58). Most participants presented a negative discourse (n = 41; 72%). Word Count (WC) and Largest Strongly connected Component (LSC) positively correlated with education. No statistically significant correlations were observed between pain intensity, disability levels, SA, and network analysis. Two clusters were identified in our sample. CONCLUSION: The SA showed that participants reported their feeling when describing the moment of the diagnosis using sentences with negative discourse. We did not find a statistically significant correlation between pain intensity, disability levels, SA, and network analysis. Education level presented positive correlation with WC and LSC.

Tratamento manipulativo osteopático em paciente com síndrome da pessoa rígida e miastenia gravis: relato de caso / Osteopathic manipulative treatment in person with stiff person syndrome and myasthenia gravis: case report

Introdução: Síndrome da Pessoa Rígida (SPR) é uma doença neurológica autoimune rara caracterizada pela rigidez e espasmos musculares episódicos dolorosos, especialmente no tronco e extremidades do corpo, gerando comprometimento funcional importante. Existe uma lacuna de conhecimento sobre os possíveis efeitos do tratamento manipulativo osteopático (TMO) nos sintomas motores de pessoas com SPR. Objetivos: Descrever os efeitos do TMO na tontura, equilíbrio e amplitude de movimento (ADM) cervical em uma pessoa com a SPR e miastenia gravis. Método: Relato de caso baseado no TMO em uma mulher com SPR e miastenia grave. As seguintes avaliações foram utilizadas: Inventário de Brazilian Version of the Dizziness Handicap Inventory (DHI), Fall Efficacy Scale (FES I ­ Brazil), Timed Get Up and Go Test (TUG), Teste de Sentar e Levantar 5 vezes, goniometria dos movimentos da coluna cervical. Resultados: Nenhum resultado expressivo foi obtido pela FES-I (-1,8%) e DHI (0%). Para os testes funcionais (TUG e Sentado para de pé 5 vezes) observamos melhora de 5,8% e 6,7%, respectivamente, após o tratamento. A ADM cervical melhorou substancialmente em todos os movimentos avaliados (flexão: 60%, extensão: 28%, rotação direita: 33%, rotação esquerda:38%, inclinação lateral direita: 77%, inclinação lateral esquerda: 87%). Conclusão: O TMO proposto pareceu ser importante para melhora da ADM cervical no caso relatado. Medo de quedas, impacto da tontura na qualidade de vida e funcionalidade de membros inferiores não demonstrou melhoras após o TMO.

Introduction: Stiff Person Syndrome (SPS) is a rare neurological autoimmune disease characterized by stiffness and painful episodic muscle spasms, especially in the trunk and extremities of the body, causing significant functional impairment in affected individuals. There is a gap in knowledge about the possible effects of an osteopathic manipulative treatment (OMT) on the motor symptoms of people with SPS. Objectives: To describe the effects of an OMT on dizziness, balance deficit, and cervical range of motion (ROM) in a patient with SPS and myasthenia gravis. Methods: This is a case report on an OMT intervention in a woman with SPS and myasthenia gravis. The following assessments were used: Brazilian Version of the Dizziness Handicap Inventory (DHI), Fall Efficacy Scale (FES I ­ Brazil), Timed Get Up and Go Test (TUG), Stand Up Test 5 times, goniometry of cervical movements. Results: No expressive results were obtained for FES I ­ Brazil (-1.8%) and DHI (0%). For the functional tests (TUG and Sit and stand up 5x) we observed an improvement of 5.8% and 6.7%, respectively, after treatment. The cervical ROM improved substantially in all movements tested (flexion: 60%, extension: 28%, right rotation: 33%, left rotation: 38%, right side bending: 77%, left side bending: 87%). Conclusion: The proposed OMT appears to be important for the improvement of cervical ROM in this case. Fear of falls, impact of dizziness on quality of life, and lower limb functionality did not demonstrate meaningful improvements after the OMT.

Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? - a diagnostic accuracy study.

BACKGROUND: People with neuropathic-like symptoms had more unfavourable pain features than people with nociceptive. Moreover, deficient conditioned pain modulation is common in people with neuropathic-like symptoms. PainDETECT questionnaire have been used to assess the central sensitisation sign and symptoms. However, whether the painDETECT questionnaire can identify the conditioned pain modulation's impairment is still unknown. Therefore, the current study aimed to evaluate the diagnostic accuracy of the painDETECT questionnaire in detecting the impairment of conditioned pain modulation in people with musculoskeletal pain. METHODS: We conducted a diagnostic accuracy comparing the painDETECT questionnaire (index method) with the cold pressor test, the psychophysical test used to assess the conditioned pain modulation (reference standard). We determined diagnostic accuracy by calculating sensitivity, specificity, predictive values, and likely hood ratios. RESULTS: We retrospectively enrolled 308 people with musculoskeletal pain in outpatient departments. Most participants were female (n 20 = 220, 71.4%) and had a mean age of 52.2 (± 15.0) years. One hundred seventy-three (56.1%) participants were classified as nociceptive pain, 69 (22.4%) as unclear, and 66 (21.4%) as neuropathic-like symptoms. According to the cold pressor test, 60 (19.4%) participants presented impairment of conditioned pain modulation. The cutoff point of 12 of the painDETECT questionnaire showed values of diagnostic accuracy below 70% compared to the cold pressor test, except for a negative predictive value [76.9 95% Confidence Interval (CI) 71.7 to 81.5]. The cutoff point 19 showed high specificity (78.6%, 95% CI 73.0 to 83.5), high negative predictive value (80.5%, 95% CI 78.1 to 82.7), and accuracy of 67.5% compared to the cold pressor test. CONCLUSION: The painDETECT questionnaire seems valuable for ruling out people with musculoskeletal pain and impairment of conditioned pain modulation.

Cross-cultural adaptation of the Parental Perceptions of Children's Exposure to Tobacco Smoke instrument to the Brazilian context.

OBJECTIVE: To perform a cross-cultural adaptation of the Parental Perceptions of Children's Exposure to Tobacco Smoke (PPE) instrument to the Brazilian context. RESULTS: The cross-cultural adaptation process was performed in 10 stages. Four translators, eight specialists, and 35 primary care users participated in the study. Both translations were similar. The synthesis version that was back-translated was equivalent to the original. The committee of experts scored all items in the content validity index as 3 or 4, suggesting only small changes such as changing "photo" to "image" and "service balcony" to "service area". After the completion of the first sequence of pretests, some adjustments were required by the committee of experts for the second round. The form of application of the self-administered questionnaire for the interview was changed, the Likert scale was reduced from 7 to 5 points, and the option "I don't know" was added to questions 18, 19, and 20. After these adjustments, the instrument was well accepted by the study population and presented good internal consistency (Cronbach's α score = 0.82). The PPE instrument, which assesses the perception of parents about their children's exposure to cigarette smoke, was satisfactorily translated and adapted to the Brazilian context.

Better Work Ability Is Associated With Lower Levels of Both Occupational Stress and Occupational Physical Activity in Professional Drivers: A Cross-sectional Study.

OBJECTIVE: The aim of the study is to investigate the association of sociodemographic factors, lifestyle, work organization, and professional profile with work ability in professional drivers. METHODS: This is a cross-sectional study with 449 drivers in Curitiba, Paraná (Brazil). Participants were assessed regarding their work ability (Work Ability Index [WAI]), sociodemographic, lifestyle (physical activity [Baecke's questionnaire] and stress [Work Stress Scale]), work organization, and professional profile using self-completion instruments. The association of WAI with sociodemographic factors, lifestyle, work organization, and professional profile was determined by multivariable ordinal logistic regression models. RESULTS: Lifestyle factors best explained the WAI variability. The WAI was inversely associated with stress and occupational physical activities but directly associated with leisure activities and locomotion and leisure-time physical exercise. CONCLUSIONS: Our data also challenge the concept that sociodemographic information and ergonomics organization influence determining the work ability of this population.

Anterior component of Y-Balance test is correlated to ankle dorsiflexion range of motion in futsal players: A cross-sectional study.

BACKGROUND AND PURPOSE: Restricted dorsiflexion range of motion (DFROM) could impact dynamic balance in sports. This study aimed to investigate the relationship between dorsiflexion range of motion and the Y-Balance Test (YBT) in elite futsal players. METHODS: Sixty-one asymptomatic male futsal players (mean age 26.57 (5.64) years, a mean body mass index of 25.40 (2.69) kg/m2 ) were included. DFROM was measured by the weight-bearing lunge test (WBLT). DFROM data were obtained using smartphone-based motion capture. The Pearson correlation coefficient verified the correlation between the variables. RESULTS: Dominant and nondominant leg ankle DFROM was significantly correlated with the anterior component of YBT (r = 0.27 and 0.51, respectively). The posteromedial component and the composite score of the YBT were also significantly correlated with nondominant leg ankle DFROM (r = 0.31 and 0.34, respectively)]. The other measures were not statistically significant. DFROM explained between 7% and 24% of the variation of the distances reached in the YBT. CONCLUSION: Dorsiflexion range of motion measured by weight bearing lunge test is positively correlated with dynamic balance in futsal players.

Exploratory analysis of 5 supervised machine learning models for predicting the efficacy of the endogenous pain inhibitory pathway in patients with musculoskeletal pain.

OBJECTIVES: The identification of factors that influence the efficacy of endogenous pain inhibitory pathways remains challenging due to different protocols and populations. We explored five machine learning (ML) models to estimate the Conditioned Pain Modulation (CPM) efficacy. DESIGN: Exploratory, cross-sectional design. SETTING AND PARTICIPANTS: This study was conducted in an outpatient setting and included 311 patients with musculoskeletal pain. METHODS: Data collection included sociodemographic, lifestyle, and clinical characteristics. CPM efficacy was calculated by comparing the pressure pain thresholds before and after patients submerged their non-dominant hand in a bucket of cold water (cold-pressure test) (1-4 °C). We developed five ML models: decision tree, random forest, gradient-boosted trees, logistic regression, and support vector machine. MAIN OUTCOME MEASURES: Model performance were assessed using receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, recall, F1-score, and the Matthews Correlation Coefficient (MCC). To interpret and explain the predictions, we used SHapley Additive explanation values and Local Interpretable Model-Agnostic Explanations. RESULTS: The XGBoost model presented the highest performance with an accuracy of 0.81 (95% CI = 0.73 to 0.89), F1 score of 0.80 (95% CI = 0.74 to 0.87), AUC of 0.81 (95% CI: 0.74 to 0.88), MCC of 0.61, and Kappa of 0.61. The model was influenced by duration of pain, fatigue, physical activity, and the number of painful areas. CONCLUSIONS: XGBoost showed potential in predicting the CPM efficacy in patients with musculoskeletal pain on our dataset. Further research is needed to ensure the external validity and clinical utility of this model.

Pain interference, neuropathic-like symptoms, pain intensity, and symptoms of central sensitization negatively impact individual's disability after Chikungunya fever: cross-sectional study / Interferência da dor, sintomas do tipo neuropático, intensidade da dor e sintomas de sensibilização central afetam negativamente a capacidade funcional dos indivíduos após a febre Chicungunha: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Particular pain features, such as pain interference, neuropathic-like symptoms, and central sensitization (CS) symptoms may be present in patients with Chikungunya fever and lead to functional limitations. The present study aimed to assess the association between pain characteristics and the disability in participants affected by Chikungunya fever in the chronic phase. METHODS: A cross-sectional study was conducted with 36 participants who filled out a sociodemographic, pain characteristics (pain interference - Brief Pain Inventory, neuropathic-like symptoms - PainDETECT Questionnaire, and CS-related signs and symptoms - Central Sensitization Inventory) and disability (Health Assessment Questionnaire) questionnaires. The Spearman correlation test (rho) verified the relationship between the outcomes. RESULTS: Most of the participants were female (77%), with a mean age of 43 years. Twenty-seven (75%) participants presented nociceptive pain and 11 (30%) had central sensitization symptoms. There was a high positive correlation between the presence of neuropathic-like symptoms and disability (rho=0.71; p<0.001) and pain intensity and disability (rho=0.76; p<0.001). A moderate positive correlation was found between the central sensitization symptoms and disability (rho=0.51; p=0.002). Moreover, there is a low positive correlation between pain interference in an individual's life and disability (rho=0.34; p=0.041). CONCLUSION: Patients in chronic phase of Chikungunya fever revealed mild pain intensity and predominance of nociceptive pain. Pain interference, neuropathic-like symptoms, and central sensitization symptoms negatively impact individual's disability after Chikungunya fever.

RESUMO JUSTIFICATIVA E OBJETIVOS: Características particulares da dor, como interferência da dor, sintomas do tipo neuropático e sintomas de sensibilização central (SC), podem estar presentes em pacientes com febre Chicungunha e levar a limitações funcionais. O presente estudo teve como objetivo avaliar a correlação entre as características da dor e a capacidade funcional em participantes acometidos pela febre Chicungunha na fase crônica. MÉTODOS: Foi realizado um estudo transversal com 36 participantes que preencheram questionários sociodemográficos, de características de dor (interferência da dor - Inventário Breve de Dor, sintomas do tipo neuropático - questionário PainDETECT, e sinais e sintomas relacionados à SC - Inventário de Sensibilização Central) e de capacidade funcional (Health Assessment Questionnaire). O teste de correlação de Spearman (rho) verificou a relação entre os desfechos. RESULTADOS: A maioria dos participantes era do sexo feminino (77%), com média de idade de 43 anos. Vinte e sete (75%) participantes apresentaram dor nociceptiva e 11 (30%) apresentaram sintomas de sensibilização central. Houve alta correlação positiva entre a presença de sintomas do tipo neuropático e capacidade funcional (rho=0,71; p<0,001) e intensidade da dor e capacidade funcional (rho=0,76; p<0,001). Foi encontrada uma correlação positiva moderada entre os sintomas de sensibilização central e a capacidade funcional (rho=0,51; p=0,002). Além disso, há uma correlação positiva baixa entre a interferência da dor na vida do indivíduo e a capacidade funcional (rho=0,34; p=0,041). CONCLUSÃO: Pacientes em fase crônica da febre Chicungunha apresentaram intensidade de dor leve e predominância de dor nociceptiva. A interferência da dor, os sintomas do tipo neuropático e os sintomas de sensibilização central afetam negativamente a capacidade funcional do indivíduo após a febre Chicungunha.

Neuropathic-like symptoms and central sensitization related signs and symptoms negatively affect the functional performance of patients with knee osteoarthritis - a cross-sectional study.

Objective: This study aimed to compare the functional performance among participants with a neuropathic-like symptoms (NS) and central sensitization related signs and symptoms (CS), and their knee osteoarthritis (OA) counterparts. Methods: A cross-sectional observational study was conducted with 125 participants with knee OA (94 females, mean age 63.1 â€‹± â€‹7.4 years). Participants completed a self-reported questionnaire with personal and clinical features and musculoskeletal pain characteristics, including NS (PainDETECT), CS (Central Sensitization Inventory, CSI), and conditioned pain modulation. Self-reported functional disability (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) and functional mobility (Timed Up and Go, TUG) were compared among patients with NS, CS, and their knee OA counterparts using the one-way analysis of variance (ANOVA). Results: Thirty-three (26.4%) participants had NS and CS, eighteen (14.4%) had NS, twenty-seven (21.6%) participants had CS, and 47 (37.6%) had knee OA with no NS or CS. A one-way ANOVA revealed greater functional limitation in the group with NS and CS (mean â€‹= â€‹67.5 â€‹± â€‹12.0) or NS (mean â€‹= â€‹56.7 â€‹± â€‹17.5) than the group without these symptoms (mean â€‹= â€‹32.0 â€‹± â€‹20.7) with a statistical significance difference [F(3, 121) â€‹= â€‹29.434, p â€‹< â€‹0.001] in the WOMAC Total score. The group with NS and CS (mean â€‹= â€‹19.2 â€‹± â€‹7.4) or NS (mean â€‹= â€‹16.3 â€‹± â€‹6.3) had slower velocity than the group without these symptoms (mean â€‹= â€‹11.6 â€‹± â€‹3.5) with a statistical significance difference [F(3,121) â€‹= â€‹10.045, p â€‹< â€‹0.001] in the TUG test. Conclusion: Participants with knee osteoarthritis and NS or CS pain phenotype have greater functional limitations than their counterparts.

Prevalence of Nonsteroidal Antiinflammatory Drugs Prescribed for Osteoarthritis: A Systematic Review and Meta-Analysis of Observational Studies.

OBJECTIVE: Our systematic review aimed to investigate the proportion of participants with osteoarthritis who were prescribed nonsteroidal antiinflammatory drugs (NSAIDs) by their health care provider. METHODS: Electronic databases were searched for observational studies reporting NSAID prescribing to participants with diagnosed osteoarthritis of any region. Risk of bias was assessed using a tool designed for observational studies measuring prevalence. Random and fixed-effects meta-analysis was used. Meta-regression investigated study-level factors associated with prescribing. The overall evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS: Fifty-one studies were included, published between 1989 and 2022, with 6,494,509 participants. The mean age of participants was 64.7 years (95% confidence interval [95% CI] 62.4, 67.0; n = 34 studies). Most studies were from Europe and Central Asia (n = 23 studies), and North America (n = 12 studies). Most studies were judged to be at low risk of bias (75%). Heterogeneity was eliminated when removing studies with a high risk of bias, to give a pooled estimate of NSAIDs prescribing to participants with osteoarthritis of 43.8% (95% CI 36.8, 51.1; moderate quality of evidence). Meta-regression determined that prescribing was associated with year (decreased prescribing over time; P = 0.05) and geographic region (P = 0.03; higher in Europe and Central Asia and in South Asia than in North America) but not with clinical setting. CONCLUSION: Data from over 6.4 million participants with osteoarthritis between 1989 and 2022 indicate that NSAID prescribing has decreased over time and that prescribing differs between geographic locations.

A genomic data archive from the Network for Pancreatic Organ donors with Diabetes.

The Network for Pancreatic Organ donors with Diabetes (nPOD) is the largest biorepository of human pancreata and associated immune organs from donors with type 1 diabetes (T1D), maturity-onset diabetes of the young (MODY), cystic fibrosis-related diabetes (CFRD), type 2 diabetes (T2D), gestational diabetes, islet autoantibody positivity (AAb+), and without diabetes. nPOD recovers, processes, analyzes, and distributes high-quality biospecimens, collected using optimized standard operating procedures, and associated de-identified data/metadata to researchers around the world. Herein describes the release of high-parameter genotyping data from this collection. 372 donors were genotyped using a custom precision medicine single nucleotide polymorphism (SNP) microarray. Data were technically validated using published algorithms to evaluate donor relatedness, ancestry, imputed HLA, and T1D genetic risk score. Additionally, 207 donors were assessed for rare known and novel coding region variants via whole exome sequencing (WES). These data are publicly-available to enable genotype-specific sample requests and the study of novel genotype:phenotype associations, aiding in the mission of nPOD to enhance understanding of diabetes pathogenesis to promote the development of novel therapies.

Mediation Analysis in Manual Therapy Research.

Objective: The purpose of this study was to illustrate the applicability of mediation analysis in the manual therapy field by assessing whether pain intensity, duration of pain, or the change in systolic blood pressure mediated the heart rate variability (HRV) of patients with musculoskeletal pain who received manual therapy. Methods: A secondary data analysis from a 3-arm, parallel, randomized, placebo-controlled, assessor-blinded, superiority trial was performed. Participants were randomized into spinal manipulation, myofascial manipulation, or placebo groups. Cardiovascular autonomic control was inferred from resting HRV variables (low-high frequency power ratio; LF/HF) and blood pressure responsiveness to a sympathoexcitatory stimulus (cold pressor test). Pain intensity and duration were assessed. Mediation models analyzed whether pain intensity, duration, or blood pressure independently affected the improvement of the cardiovascular autonomic control of patients with musculoskeletal pain after intervention. Results: The first assumption of mediation was met for LF/HF with statistical evidence of a total effect of spinal manipulation, as compared with placebo on HRV outcomes (ß = 0.77 [0.17-1.30]); second and third assumptions showed no statistical evidence of a relationship between the intervention and pain intensity (ß = -5.30 [-39.48 to 28.87]), pain intensity, and LF/HF (ß = 0.00 [-0.01 to 0.01]). Conclusion: In this study of causal mediation analysis, the baseline pain intensity, duration of pain, and responsiveness of the systolic blood pressure to a sympathoexcitatory stimulus did not mediate the effects of the spinal manipulation on the cardiovascular autonomic control of patients with musculoskeletal pain. Accordingly, the immediate effect of spinal manipulation on the cardiac vagal modulation of patients with musculoskeletal pain may more likely be related to the intervention rather than the mediators investigated.