An evaluation of a one-day pain science education event in a high school setting targeting pain related beliefs, knowledge, and behavioural intentions.

BACKGROUND: Persistent pain is a common condition affecting one in four UK adults. Public understanding of pain is limited. Delivering pain education within schools may improve public understanding in the longer term. OBJECTIVE: To evaluate the impact of a one-day Pain Science Education (PSE) event on sixth form/high school students' pain beliefs, knowledge and behavioural intention. METHODS: Exploratory, single-site, mixed-methods, single-arm study involving secondary school students ≥16 years old attending a one-day PSE event. Outcome measures included the Pain Beliefs Questionnaire (PBQ), Concepts of Pain Inventory (COPI-ADULT), a vignette to assess pain behaviours; and thematic analysis of semi-structured interviews. RESULTS: Ninety (mean age 16.5 years, 74% female) of the 114 attendees, agreed to participate in the evaluation. PBQ scores improved on the Organic beliefs subscale [mean difference -5.9 (95% CI -6.8, -5.0), P < 0.01] and Psychosocial Beliefs subscale [1.6 (1.0, 2.2) P < 0.01]. The COPI-Adult revealed an improvement [7.1 (6.0-8.1) points, P < 0.01] between baseline and post intervention. Pain behavioural intentions improved post education for work, exercise, and bed rest related activities (p < 0.05). Thematic analysis of interviews (n = 3) identified increased awareness of chronic pain and its underpinning biology, beliefs that pain education should be widely available, and that pain management should be holistic. CONCLUSIONS: A one-day PSE public health event can improve pain beliefs, knowledge and behavioural intentions in high school students and increase openness to holistic management. Future controlled studies are needed to confirm these results and investigate potential long-term impacts.

Test-retest reliability of the two-point discrimination test on the sole of the foot in people with multiple sclerosis.

BACKGROUND: Two-point discrimination (TPD) is an assessment of tactile acuity. People with multiple sclerosis (MS) can have reduced foot sole tactile acuity, which has been linked to impaired balance. OBJECTIVE: To quantify the test-retest reliability of TPD on the sole of the foot in people with MS. APPROACH: 41 participants (32 females), with mean (SD) age of 60 (9) years, and Expanded Disability Status Scale of <7.5, had their TPD measured at the head of the first metatarsal and the heel on two occasions, 2-14 d apart. Mean systematic change, within-subjects SD, limits of agreement (LOA), coefficient of variation and the intraclass correlation coefficient (ICC) were quantified as point estimates (95% CI). MAIN RESULTS: Systematic learning effects were evident. The within-subjects SD at the metatarsal and the heel was 6.7 mm (5.5-8.6) and 8.3 mm (6.7-10.8), and the LOAs were 18.6 mm (15.2-24.) and 23.7 mm (18.7-30.1), respectively. ICCs for metatarsal and heel was 0.87 (0.76-0.93) and 0.90 (0.80-0.95), respectively, but these were likely inflated by sample heterogeneity. SIGNIFICANCE: In people with MS, TPD on the sole of the foot has an adequate test-retest reliability for research purposes, but there is substantial measurement variability for individual patients.

Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review.

Worldwide prevalence of adult overweight and obesity is a growing public health issue. Adults with overweight/obesity often have chronic musculoskeletal pain. Using a mixed-methods review, we aimed to quantify the effectiveness and explore the appropriateness of weight loss interventions for this population. Electronic databases were searched for studies published between 01/01/90 and 01/07/16. The review included 14 randomized controlled trials that reported weight and pain outcomes and three qualitative studies that explored perceptions of adults with co-existing overweight/obesity and chronic musculoskeletal pain. The random-effects pooled mean weight loss was 4.9 kg (95%CI:2.9,6.8) greater for intervention vs control. The pooled mean reduction in pain was 7.3/100 units (95%CI:4.1,10.5) greater for intervention vs control. Study heterogeneity was substantial for weight loss (I2  = 95%, tau = ±3.5 kg) and pain change (I2  = 67%, tau = ±4.1%). Meta-regression slopes for the predictors of study quality, mean age and baseline mean weight on mean study weight reduction were shallow and not statistically significant (P > 0.05). The meta-regression slope between mean pain reduction and mean weight lost was shallow, and not statistically significant, -0.09 kg per unit pain score change (95%CI:-0.21,0.40, P = 0.54). Meta-synthesis of qualitative findings resulted in two synthesized findings; the importance of healthcare professionals understanding the effects of pain on ability to control weight and developing management/education programmes that address comorbidity.

Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women.

STUDY DESIGN: Cross-sectional repeated measures. OBJECTIVES: To quantify the effects of posture and measurement site on the inter-recti distance (IRD) and investigate the reliability of IRD measurement using ultrasound imaging in different postures. BACKGROUND: The linea alba connects the rectus abdominis muscles anteriorly and the width is known as the IRD. The IRD is usually measured in crook-lying and is the primary outcome measure to assess for a divarication of recti abdominis (DRA). The effects of posture and measurement site on the IRD have not been investigated. METHODS: Ultrasound imaging was used to measure IRD in 41 women ≥8 weeks postpartum. The IRD was measured at three sites (superior-umbilicus, umbilicus and inferior-umbilicus), in three postures (crook-lying, sitting and standing), and repeated one-week later. The effects of posture and site were investigated using one-way ANOVAs. Reliability was analysed using Intraclass correlation coefficients (ICCs), Bland Altman analyses, standard error of measurement and minimal detectable change. RESULTS: The IRD was wider when standing vs. lying at both the superior-umbilicus and umbilicus by 0.30 cm (95% CI 0.21 to 0.39) and 0.20 cm (0.11-0.30) respectively (p < 0.001). Measurements at the inferior-umbilicus were, on average, 1.6 and 2.1 cm narrower than superior-umbilicus and umbilicus sites, respectively (p < 0.001). There was high intra-rater reliability within-session (ICC3.3) and between-session (ICC3.1) at all sites measured. CONCLUSION: The IRD can be measured reliably at all sites and postures. The IRD is wider at superior-umbilicus and umbilicus when upright compared with lying. There is a difference in IRD between all sites measured.

Effect of pain neurophysiology education on physiotherapy students' understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: a randomised controlled trial.

OBJECTIVE: To investigate the effect of pain neurophysiology education (PNE) on student physiotherapists': (1) knowledge of chronic pain; (2) attitudes towards patients with chronic pain; and (3) clinical recommendations for patients with chronic pain. DESIGN: Multicentre single-blind randomised controlled trial. SETTING: One UK and one Irish university. PARTICIPANTS: Seventy-two student physiotherapists. INTERVENTION: Participants received either PNE (intervention) or a control education. Both were delivered in a 70-minute group lecture. MAIN OUTCOME MEASURES: (1) The Revised Pain Neurophysiology Quiz to assess knowledge; (2) the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS) to assess attitudes; and (3) a case vignette to assess the appropriateness of clinical recommendations. RESULTS: Post education, the PNE group had a greater increase in pain neurophysiology knowledge [mean difference 4.0 (95% confidence interval 3.2 to 4.7), P<0.01] and more improved attitudes [-17.5 (95% confidence interval -22.1 to -12.9), P<0.01] compared with the control group. Post education, students in the PNE group were more likely to make appropriate recommendations regarding work (94% vs 56%), exercise (92% vs 56%), activity (94% vs 67%) and bed rest (69% vs 33%) compared with those in the control group (P<0.05). CONCLUSION: The improvements in knowledge, attitudes and recommendations for pain management show that PNE is a potentially valuable part of the education of physiotherapy students, and could be used on a more widespread basis. There is a need to investigate whether these findings can be replicated in other healthcare professions, and how well these reported changes lead to changes in actual clinical behaviour and the clinical outcomes of patients.

Visualising coordination chemistry: fluorescence X-ray absorption near edge structure tomography.

Coordination chemistry underlies the structure/function of biological metal complexes. Contextualising this chemical information within an organism's physiology is critical for enhancing the understanding of bioinorganic chemistry but few high-fidelity probes are available. Here we develop fluorescence X-ray absorption near-edge structure tomography as a means for studying the spatial arrangement of biological coordination chemistry within intact organisms, and demonstrate the approach by mapping the distribution of cuprous and cupric complexes within Drosophila melanogaster.

The intra- and inter-observer reliability of a novel protocol for two-point discrimination in individuals with chronic low back pain.

Two-point discrimination is measured as an indicator of cortical reorganisation in musculoskeletal medicine. Nevertheless, data are lacking for the reliability of this measure in patients with non-specific chronic low back pain (NSCLBP). We aimed to quantify the intra- and inter-observer reliability of a novel protocol for measuring two-point discrimination in these patients. 35 participants (12 males, 23 females, mean age 52, SD 15 years) with NSCLBP were recruited. Three clinicians made 14 consecutive measurements of two-point discrimination with callipers. One of these clinicians repeated the assessment protocol within 7 d. During each measurement, the calliper width was widened in 5 mm increments until participants could consistently identify two points. Intra- and inter-observer agreement was quantified using mean difference, within-subject SD and limits of agreement (LOA). After using the first measurement for familiarisation, the mean of measurements 2-5 within an assessment resulted in the optimum compromise between clinic time constraints and acceptable intra-observer reliability; the within-subjects SD being 7.5 mm (LOA: 20.8 mm). Inter-observer reliability was generally poorer; requiring the mean of measurements 2-9 within an assessment for a similar within-subjects SD of 8.6 mm (LOA: 23.7 mm). It was estimated that these within-subjects SDs were small enough for a clinically-important change to be detected with a feasible sample size in future studies. The intra-observer reliability of our assessment protocol is acceptable for detecting a clinically relevant difference in two-point discrimination for future research purposes. Nevertheless, individual patient measurement variability is relatively high, especially between different clinicians.

An investigation of association between chronic musculoskeletal pain and cardiovascular disease in the Health Survey for England (2008).

BACKGROUND: Chronic musculoskeletal pain (CMP) may be associated with cardiovascular disease (CVD). This study aimed to investigate the association between CMP and CVD, and the contribution of physical activity and sedentary behaviour to any association. METHODS: We performed a secondary analysis of 3332 middle-aged (45-64 years) and 2022 older (65+ years) adults included in the Health Survey for England (2008). The survey contained self-reported physical activity/sedentary behaviour data. Objectively measured physical activity/sedentary behaviour using accelerometry (Actigraph™) was also available for a subset of the middle-aged (n = 715) and older (n = 492) participants. Logistic regression examined the association between CMP and CVD adjusted for self-reported and objectively measured physical activity, sedentary behaviour and a range of other CVD risk factors. RESULTS: There was a higher prevalence of CVD in those with CMP for both the middle-aged (22.5% vs. 13.5%) and the older (46.8% vs. 28.2%) adults (p < 0.001). After adjusting for CVD risk factors, older adults with CMP were significantly more likely to have CVD {odds ratio [95% confidence interval (CI)] 1.828 (1.452, 2.300); p < 0.001}. A similar non-significant trend was shown for the middle-aged adults [odds ratio (95% CI) 1.271 (0.975, 1.656); p = 0.076]. Neither self-reported nor objectively measured physical activity (or sedentary behaviour) had any meaningful effect on the association between CMP and CVD. CONCLUSIONS: CMP is associated with an increased risk of CVD and the association is stronger in older adults. Neither physical activity nor sedentary behaviour contributed to this relationship. Longitudinal studies are warranted to better understand the relationship between CVD and CMP.

Free-living physical activity as a novel outcome measure in patients with intermittent claudication.

OBJECTIVE: To develop a method of event-based analysis that quantifies the fragmented nature of walking bouts in individuals with intermittent claudication [IC] and compare outcomes with age and gender-matched healthy controls. DESIGN: Cross-sectional. MATERIALS: The activPAL™ physical activity monitor. METHODS: 7-day physical activity patterns were compared between individuals with IC (n = 30) and controls matched for age and gender (n = 30). The ratio of the number of walking events to upright events was calculated to provide an event-based claudication index (EBCI) that represented the fragmented nature of walking bouts commonly reported in those with IC. RESULTS: Individuals with IC had a greater EBCI than age matched controls indicating a more fragmented walking pattern (5.8 ± 2.0 vs. 7.7 ± 3.1, p < 0.01). The difference between groups was more pronounced when the EBCI was calculated from upright events that included >400 steps (23.4 ± 11.3 vs. 35.8 ± 14.2, p < 0.01). CONCLUSION: The classic fragmented stop/start walking pattern universally described by individuals with IC can be quantified using the EBCI. This method of measurement potentially provides a novel method of assessing the effectiveness of clinical interventions for this patient group.

The clinical effects of Kinesio® Tex taping: A systematic review.

Kinesio(®) Tex tape (KTT) is used in a variety of clinical settings. The purpose of this study was to investigate the effect of KTT from randomized controlled trials (RCTs) in the management of clinical conditions. A systematic literature search of CINAHL; MEDLINE; OVID; AMED; SCIENCE DIRECT; PEDRO; www.internurse.com; SPORT DISCUS; BRITISH NURSING INDEX; www.kinesiotaping.co.uk; www.kinesiotaping.com; COCHRANE CENTRAL REGISTER OF CLINICAL TRIALS; and PROQUEST was performed up to April 2012. The risk of bias and quality of evidence grading was performed using the Cochrane collaboration methodology. Eight RCTs met the full inclusion/exclusion criteria. Six of these included patients with musculoskeletal conditions; one included patients with breast-cancer-related lymphedema; and one included stroke patients with muscle spasticity. Six studies included a sham or usual care tape/bandage group. There was limited to moderate evidence that KTT is no more clinically effective than sham or usual care tape/bandage. There was limited evidence from one moderate quality RCT that KTT in conjunction with physiotherapy was clinically beneficial for plantar fasciitis related pain in the short term; however, there are serious questions around the internal validity of this RCT. There currently exists insufficient evidence to support the use of KTT over other modalities in clinical practice.

Take a walk in the park? A cross-over pilot trial comparing brisk walking in two different environments: park and urban.

OBJECTIVE: The objective of the present study is to investigate whether differences exist between a 30 minute brisk walk taken in two different environments in order to determine which environment best facilitates current physical activity guidelines: park or urban. METHODS: In this randomised cross-over pilot study, participants performed a self-timed 30 minute brisk walk in two different environments, park and urban, in Glasgow, Scotland (October 2009 to January 2010). Cadence, recorded using the activPAL™ activity monitor, was used to measure intensity. Outcome measures were: mean cadence; moderate-to-vigorous physical activity time accumulated in bouts lasting ≥ 10 min; number of walking breaks; and duration. RESULTS: A convenience sample of 40 healthy adults was recruited: 16 males, 24 females, mean age 22.9 (5.5) years. The mean cadence for the whole walk was higher in the park: 119.3 (8.3) vs. 110.9 (8.9) steps/min. Participants accumulated more moderate-to-vigorous physical activity in ≥ 10 minute bouts during park walks: 25.5 (9.6) [median (interquartile range)] vs. 14.0 (20.3) min. There was no difference in self-timed duration between locations. CONCLUSION: Participants accumulated more moderate-to-vigorous physical activity in bouts ≥ 10 min in duration on park walks due to the lack of interruptions in walking. Hence the park environment better facilitated the achievement of current physical activity guidelines. Further research involving a larger, more heterogeneous sample is recommended.

A multi-technique investigation of copper and zinc distribution, speciation and potential bioavailability in biosolids.

The use of biosolids in agriculture continues to be debated, largely in relation to their metal contents. Our knowledge regarding the speciation and bioavailability of biosolids metals is still far from complete. In this study, a multi-technique approach was used to investigate copper and zinc speciation and partitioning in one contemporary and two historical biosolids used extensively in previous research and field trials. Using wet chemistry and synchrotron spectroscopy techniques it was shown that copper/zinc speciation in the biosolids was largely equivalent despite the biosolids being derived from different countries over a 50 year period. Furthermore, copper speciation was consistently dominated by sorption to organic matter whereas Zn partitioned mainly to iron oxides. These data suggest that the results of historical field trials are still relevant for modern biosolids and that further risk assessment studies should concentrate particularly on Cu as this metal is associated with the mineralisable biosolids fraction.

Trends in hard X-ray fluorescence mapping: environmental applications in the age of fast detectors.

Environmental samples are extremely diverse but share a tendency for heterogeneity and complexity. This heterogeneity poses methodological challenges when investigating biogeochemical processes. In recent years, the development of analytical tools capable of probing element distribution and speciation at the microscale have allowed this challenge to be addressed. Of these available tools, laterally resolved synchrotron techniques such as X-ray fluorescence mapping are key methods for the in situ investigation of micronutrients and inorganic contaminants in environmental samples. This article demonstrates how recent advances in X-ray fluorescence detector technology are bringing new possibilities to environmental research. Fast detectors are helping to circumvent major issues such as X-ray beam damage of hydrated samples, as dwell times during scanning are reduced. They are also helping to reduce temporal beamtime requirements, making particularly time-consuming techniques such as micro X-ray fluorescence (µXRF) tomography increasingly feasible. This article focuses on µXRF mapping of nutrients and metalloids in environmental samples, and suggests that the current divide between mapping and speciation techniques will be increasingly blurred by the development of combined approaches.

An electromyographical study to investigate the effects of patellar taping on the vastus medialis/vastus lateralis ratio in asymptomatic participants.

It is commonly theorised that patellofemoral pain syndrome (PFPS) is caused by maltracking due to vastus medialis (VM) weakness relative to the vastus lateralis (VL). Despite this being a controversial theory, patellar taping is a commonly used technique that purports to correct this muscle imbalance by increasing the VM/VL ratio. The effects of different forms of taping on vasti muscle activity are still not known. The objective of this study was to investigate the effects of three different types of patellar taping on the VM/VL ratio in asymptomatic university students. Each participant performed a set of four single-legged squats under four separate taping conditions: A) medial, B) lateral, C) neutral, and D) no-tape. The condition sequence was randomised. The main outcome measure was the normalised VM/VL ratio, assessed by using surface electromyography. Secondary outcome measures were the normalised EMG activity of the VM and the VL. A convenience sample of 24 (17 females) students (22 +/- 10 years, M +/- SD) completed this study. The lateral taping condition produced small but significantly greater VM/VL ratios than the medial (p = 0.007) and neutral (p = 0.007) but not the no-tape (p = 0.123) condition. There were no significant differences between the medial, neutral, and no-tape conditions. These results question whether patellar taping can impart a clinically significant effect on the VM/VL ratio. The results of this study cannot be directly extrapolated to a patient population, and further research in the PFPS population is required before clinical recommendations can be made.

The validation of a novel activity monitor in the measurement of posture and motion during everyday activities.

BACKGROUND: Accurate measurement of physical activity patterns can be used to identify sedentary behaviour and may facilitate interventions aimed at reducing inactivity. OBJECTIVE: To evaluate the activPAL physical activity monitor as a measure of posture and motion in everyday activities using observational analysis as the criterion standard. METHODS: Wearing three activPAL monitors, 10 healthy participants performed a range of randomly assigned everyday tasks incorporating walking, standing and sitting. Each trial was captured on a digital camera and the recordings were synchronised with the activPAL. The time spent in different postures was visually classified and this was compared with the activPAL output. RESULTS: Intraclass correlation coefficients (ICC 2,1) for interdevice reliability ranged from 0.79 to 0.99. Using the Bland and Altman method, the mean percentage difference between the activPAL monitor and observation for total time spent sitting was 0.19% (limits of agreement -0.68% to 1.06%) and for total time spent upright was -0.27% (limits of agreement -1.38% to 0.84%). The mean difference for total time spent standing was 1.4% (limits of agreement -6.2% to 9.1%) and for total time spent walking was -2.0% (limits of agreement -16.1% to 12.1%). A second-by-second analysis between observer and monitor found an overall agreement of 95.9%. CONCLUSION: The activPAL activity monitor is a valid and reliable measure of posture and motion during everyday physical activities.

The validity and reliability of a novel activity monitor as a measure of walking.

BACKGROUND: The accurate measurement of physical activity is crucial to understanding the relationship between physical activity and disease prevention and treatment. OBJECTIVE: The primary purpose of this study was to investigate the validity and reliability of the activPAL physical activity monitor in measuring step number and cadence. METHODS: The ability of the activPAL monitor to measure step number and cadence in 20 healthy adults (age 34.5+/-6.9 years; BMI 26.8+/-4.8 (mean+/-SD)) was evaluated against video observation. Concurrently, the accuracy of two commonly used pedometers, the Yamax Digi-Walker SW-200 and the Omron HJ-109-E, was compared to observation for measuring step number. Participants walked on a treadmill at five different speeds (0.90, 1.12, 1.33, 1.56, and 1.78 m/s) and outdoors at three self selected speeds (slow, normal, and fast). RESULTS: At all speeds, inter device reliability was excellent for the activPAL (ICC (2,1)> or =0.99) for both step number and cadence. The absolute percentage error for the activPAL was <1.11% for step number and cadence regardless of walking speed. The accuracy of the pedometers was adversely affected by slow walking speeds. CONCLUSION: The activPAL monitor is a valid and reliable measure of walking in healthy adults. Its accuracy is not influenced by walking speed. The activPAL may be a useful device in sports medicine.

Mutagenicity of 1,2-dichloroethane and 1,2-dibromoethane in two human lymphoblastoid cell lines.

1,2-Dichloroethane (DCE) and 1,2-dibromoethane (DBE) were tested for the ability to induce gene mutations in two human lymphoblastoid cell lines, designated AHH-1 and TK6. Both chemicals were 'direct-acting' mutagens in both cell lines. DBE was essentially equally mutagenic in TK6 cells and AHH-1 cells. In contrast, DCE was 25-fold more mutagenic in the AHH-1 cell line than in the TK6 cell line. This differential sensitivity between AHH-1 cells and TK6 cells was related to the levels of glutathione S-transferase activity in these two cell lines.

New characteristics of Mycobacterium haemophilum.

The first isolation of Mycobacterium haemophilum in Victoria was from 8-month-old leg lesions in an immunosuppressed renal transplant patient. Characteristics of the isolate that had not been described previously for M. haemophilum included growth enhancement by carbon dioxide, a temperature optimum that was lower than previously reported, and the surprisingly slow growth of the primary isolate.