Comparative Techniques of Acupuncture and Dry Needling Intersecting with Trigger Point Physiology and Diagnostics: A Cross-Discipline Narrative Review.

Background: Pain management is a great burden on society; therefore, cost-effective and nonaddictive treatments for pain are urgently required. Needling of painful spots has been applied in acupuncture along with dry needling

Predicting and reasoning about replicability using structured groups.

This paper explores judgements about the replicability of social and behavioural sciences research and what drives those judgements. Using a mixed methods approach, it draws on qualitative and quantitative data elicited from groups using a structured approach called the IDEA protocol ('investigate', 'discuss', 'estimate' and 'aggregate'). Five groups of five people with relevant domain expertise evaluated 25 research claims that were subject to at least one replication study. Participants assessed the probability that each of the 25 research claims would replicate (i.e. that a replication study would find a statistically significant result in the same direction as the original study) and described the reasoning behind those judgements. We quantitatively analysed possible correlates of predictive accuracy, including self-rated expertise and updating of judgements after feedback and discussion. We qualitatively analysed the reasoning data to explore the cues, heuristics and patterns of reasoning used by participants. Participants achieved 84% classification accuracy in predicting replicability. Those who engaged in a greater breadth of reasoning provided more accurate replicability judgements. Some reasons were more commonly invoked by more accurate participants, such as 'effect size' and 'reputation' (e.g. of the field of research). There was also some evidence of a relationship between statistical literacy and accuracy.

Predicting reliability through structured expert elicitation with the repliCATS (Collaborative Assessments for Trustworthy Science) process.

As replications of individual studies are resource intensive, techniques for predicting the replicability are required. We introduce the repliCATS (Collaborative Assessments for Trustworthy Science) process, a new method for eliciting expert predictions about the replicability of research. This process is a structured expert elicitation approach based on a modified Delphi technique applied to the evaluation of research claims in social and behavioural sciences. The utility of processes to predict replicability is their capacity to test scientific claims without the costs of full replication. Experimental data supports the validity of this process, with a validation study producing a classification accuracy of 84% and an Area Under the Curve of 0.94, meeting or exceeding the accuracy of other techniques used to predict replicability. The repliCATS process provides other benefits. It is highly scalable, able to be deployed for both rapid assessment of small numbers of claims, and assessment of high volumes of claims over an extended period through an online elicitation platform, having been used to assess 3000 research claims over an 18 month period. It is available to be implemented in a range of ways and we describe one such implementation. An important advantage of the repliCATS process is that it collects qualitative data that has the potential to provide insight in understanding the limits of generalizability of scientific claims. The primary limitation of the repliCATS process is its reliance on human-derived predictions with consequent costs in terms of participant fatigue although careful design can minimise these costs. The repliCATS process has potential applications in alternative peer review and in the allocation of effort for replication studies.

Comparison of the Effects of a Pharmaceutical Industry Decision Guide and Decision Aids on Patient Choice to Intensify Therapy in Rheumatoid Arthritis.

OBJECTIVE: To compare the effects a pharmaceutical industry decision guide and International Patient Decision Aids Standard (IPDAS) compliant patient decision aids (PtDA) on patient medication beliefs and choice to intensify therapy. METHODS: Rheumatoid arthritis (RA) patients, who had never taken etanercept (Enbrel), took part in a mail survey. They were presented with a hypothetical decision scenario where they were asked to consider adding etanercept to their current regimen. Each patient was randomized to review 1 of 3 forms of an etanercept-specific decision support: a long PtDA (LONG DA), a short PtDA (SHORT DA), or the manufacturer's Enbrel decision guide (Pharm Booklet). RESULTS: We had 402 RA patients participate in the study (response rate, 52%). Of the patients randomized to the Pharm Booklet, 30.6% elected to initiate etanercept. Only 14.6% and 14.0% of patients who reviewed the LONG DA or SHORT DA choose to take etanercept (χ2 = 15.7; P < 0.001). Patients who reviewed the LONG DA or SHORT DA had a greater increase in knowledge about etanercept than those who reviewed the Pharm Booklet. There was no difference in decisional conflict among the groups. A logistic regression model explained 44.2% (R2 = 0.442) of patient choice to intensify therapy by initiating etanercept. The strongest predictor of choice to intensify therapy were beliefs about etanercept's ability to improve symptoms (OR = 2.56, 96%CI [1.71, 3.80]), and its use by others like the respondent (OR = 2.24, 95%CI [1.49, 3.35]). Mediation analysis confirmed the presence of a partial mediating effect of decision support on patients' intent to take etanercept (OR = 0.59, 95%CI [0.39, 0.89]). CONCLUSIONS: Patients supported by the Pharm Booklet were twice as likely to choose to intensify therapy. The Pharm Booklet's effects are partially mediated through persuasive communication techniques that influence patients' beliefs that symptoms will improve, and increase social normative beliefs, rather than by increasing the relevant knowledge, clarifying patient values about positive or negative treatment outcomes, or increasing their self-efficacy.

Influence of patient characteristics on perceived risks and willingness to take a proposed anti-rheumatic drug.

BACKGROUND: The causes of the underutilization of disease modifying anti-rheumatic drugs (DMARDS) for rheumatoid arthritis (RA) are not fully known, but may in part, relate to individual patient factors including risk perception. Our objective was to identify the determinants of risk perception (RP) in RA patients and predictors of their willingness to take a proposed DMARD (DMARD willingness). METHODS: A cross-sectional mail survey of RA patients in a community rheumatology practice. Patients were presented a hypothetical decision scenario where they were asked to consider switching DMARDs. They evaluated how risky the proposed medication was and how likely they would be to take it. RESULTS: The completed sample included 1009 RA patients. The overall survey response rate was 71%. PATIENT CHARACTERISTICS: age 61.6 years (range 18-93), 75% female, minority 6.5%, low or marginal health literacy 8.8%, depression 15.0%, duration RA 13.1 years (range 0.5 - 68). Regression models demonstrated that health literacy, independent of low educational achievement or other demographic (including race), was a common predictor of both RP and DMARD willingness. There was partial mediation of the effects of HL on DMARD willingness through RP. Depression and happiness had no significant effect on RP or DMARD willingness. RP was influenced by negative RA disease and treatment experience, while DMARD willingness was affected mainly by perceived disease control. CONCLUSIONS: Risk aversion may be the result of potentially recognizable and correctable cognitive defect. Heightened clinician awareness, formal screening for low health literacy or cognitive impairment in high-risk populations, may identify patients could benefit from additional decision support.

Patient decision-making related to antirheumatic drugs in rheumatoid arthritis: the importance of patient trust of physician.

OBJECTIVE: To explore how rheumatoid arthritis (RA) antirheumatic drug-specific knowledge and numeric literacy, patient trust in physician, and demographic and disease-related factors relate to the confidence of patient decision-making related to disease modifying antirheumatic drugs (DMARD). METHODS: Data were analyzed from 628 randomly selected patients with RA receiving care in community rheumatology practices, who responded to a multicenter, cross-sectional mail survey. We used multiple regression models to predict patient confidence in DMARD decision-making related to their most recently initiated DMARD. RESULTS: Significant positive correlation was found between confidence in DMARD decision and trust in physician, DMARD-specific knowledge, and disease duration, but not risk-related numeric literacy, sex, or education. Negative correlations were found with disease severity and current bother with DMARD side effects. A multiple linear regression model of confidence in DMARD decision had an overall R = 0.788, R2 = 0.620 (p < 0.001). The 4 dependent variables contributing significantly to the model were female sex, Medicaid insurance status, satisfaction with RA disease control, and trust in physician, with standardized beta = 0.077, -0.089, 0.147, and 0.687, respectively. CONCLUSION: In this sample of community patients with RA, the patient trust in physician had substantially greater effect on confidence in DMARD decision than DMARD-specific knowledge, disease-related factors, or demographic characteristics.

Physiological and psychological responses to a 12-week BodyBalance training programme.

BodyBalance is a popular mind-body program practised at numerous leisure centres throughout the western world that makes many unsubstantiated claims as to the benefits of participation. This study examines physiological and psychological responses in adults, aged (mean+/-S.D.) 43.9+/-10.9 years, to a 12-week 'BodyBalance' exercise program. An exercise intervention group (n=17) undertook three 1-h classes, each week for 12 consecutive weeks while the control group (n=17) attended three 90-min 'health lectures'. ANCOVA demonstrated significant differences between the control and exercise groups in body mass, skinfold measures, total girth circumference from six sites, maximal isometric back strength, five measures of flexibility and state anxiety. Post-hoc tests on the experimental group data showed body fat decreased significantly by 1.10+/-1.02% (t=4.44; P<0.01), girth by 4.40+/-5.80cm (t=3.13; P<0.01) and back strength increased by 17.12+/-15.39kgf (t=-4.59; P<0.01). Flexibility was also significantly enhanced with performance of the modified sit-and-reach test increasing by 5.90+/-2.56cm (t=-9.50; P<0.01), hip flexion by 9.84+/-8.41 degrees (t=-4.82; P<0.01), hip extension by 7.65+/-4.48 degrees (t=-7.04; P<0.01), hip abduction by 10.00+/-4.91 degrees (t=-8.40; P<0.01) and lateral trunk flexion by 3.06+/-5.72 degrees (t=-2.21; P<0.05). Finally, state-anxiety (STAI) was significantly reduced intra-class at weeks 1, 6 and 12 by 9.24+/-9.46 (t=4.02; P<0.01), 6.59+/-6.26 (t=4.34; P<0.01) and 7.18+/-5.50 (t=5.38; P<0.01), respectively. The findings of this study suggest mind-body exercise programs like BodyBalance could significantly benefit state-anxiety as well as strength, flexibility, and anthropometry around the trunk.

Highland dance: heart-rate and blood lactate differences between competition and class.

PURPOSE: This study looked at the physiological effects of performance in Highland-dance competition to consider whether the traditional methods used during class and rehearsal provide an appropriate training stimulus toward this performance. METHODS: Nine championship standard, female Highland dancers (age 14.2 +/- 1.47 years) had their heart rate and blood lactate concentrations measured before and after 3 dances during a championship competition. Heart rate was also measured during the same 3 dances in rehearsal and during class. RESULTS: Repeated-measures analysis of variance showed significant differences in predance lactate concentrations between the first dance (Highland Fling, 1.4 +/- 0.3 mM/L), the second dance (Sword dance, 2.3 +/- 0.8 mM/L), and the third dance (Sean Truibhas, 3.5 +/- 1.8 mM/L; F2,16 = 11.72, P < .01. This, coupled with a significant rise in lactate concentration during the dances (F1,8 = 76.75, P < .001), resulted in a final postdance lactate concentration of 7.3 +/- 2.96 mM/L. Heart-rate data during competition, rehearsal, and class (195.0 +/- 6.5, 172.6 +/- 5.4, and 151.9 +/- 7.4 beats/min, respectively) showed significant differences between all 3 (F2,16 = 107.1, P < .001); these are comparable to research on other dance forms. CONCLUSIONS: Given the disparity between the anaerobic predominance of competition and the aerobic predominance during class, it is suggested that the class does not provide an appropriate training stimulus as preparation for competitive performance in Highland dance.

Bone mineral density and turnover in non-corticosteroid treated African American children with juvenile rheumatoid arthritis.

OBJECTIVE: To determine bone mineral content (BMC), bone mineral density (BMD), Z scores, and markers of bone turnover in African American children with juvenile rheumatoid arthritis (JRA). METHODS: Eight children with JRA with no prior exposure to corticosteroids were evaluated. Lumbar spine (L1-L4) and total body and total hip BMC and BMD were determined using dual x-ray absorptiometry (DXA), and Z scores (BMD) were calculated. Serum samples of markers of bone turnover including pyridinoline (PYR), N-terminal propeptide of type I procollagen (P1NP), osteocalcin (OC), and bone-specific alkaline phosphatase (BSAP) were measured. RESULTS: The mean Z score (BMD) at the lumbar spine (L1-L4) in patients with JRA was -1.2+/-0.8. Z scores for total body and total hip were within 1 standard deviation of normal compared with healthy historical controls matched for age, sex, and race. CONCLUSION: BMD was normal for chronological age (defined as Z score >or= 2.0) in African American children with JRA who had not previously been treated with corticosteroids. Further studies are needed on the effects of JRA on skeletal health in African American children.

Oxygen uptake during modern dance class, rehearsal, and performance.

The aim of the present study was to examine whether the workload, expressed in oxygen uptake and heart rate, during dance class and rehearsal prepared the dancer for performance. Previous research on the demands of class and performance has been affected by equipment limitations and could only provide limited insight into the physiological demands placed on the dancer. The present study noted that dance performance had significantly greater mean oxygen uptake and heart rate than noted in both class and rehearsal (p < 0.05). Further analysis noted that, during class and rehearsal, heart rates were rarely within the aerobic training zone (60-90%HRmax, where HRmax is the maximum heart rate). Dance performance placed a greater demand on the aerobic and anaerobic glycolytic energy systems than seen during class and rehearsal, which placed a greater emphasis on the adenosine triphosphate-creatine phosphate system. Practical implications suggest the need to supplement training within dance companies to overcome this deficit in training demand.