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1.
Pain ; 161(1): 83-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568237

RESUMO

Recent research has highlighted a need for the psychometric evaluation of instruments targeting core domains of the pain experience in chronic pain populations. In this study, the measurement properties of Short Form-36 Health Survey (SF-36),EuroQol 5-dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) were analyzed within the item response-theory framework based on data from 35,908 patients. To assess the structural validity of these instruments, the empirical representations of several conceptually substantiated latent structures were compared in a cross-validation procedure. The most structurally sound representations were selected from each questionnaire and their internal consistency reliability computed as a summary of their precision. Finally, questionnaire scores were correlated with each other to evaluate their convergent and discriminant validity. Our results supported that SF-36 is an acceptable measure of 2 independent constructs of physical and mental health. By contrast, although the approach to summarize the health-related quality of life construct of EQ-5D as a unidimensional score was valid, its low reliability rendered practical model implementation of doubtful utility. Finally, rather than being separated into 2 subscales of anxiety and depression, HADS was a valid and reliable measure of overall emotional distress. In support of convergent and discriminant validity, correlations between questionnaires showed that theoretically similar traits were highly associated, whereas unrelated traits were not. Our models can be applied to score SF-36 and HADS in chronic pain patients, but we recommend against using the EQ-5D model due to its low reliability. These results are useful for researchers and clinicians involved in chronic pain populations because questionnaires' properties determine their discriminating ability in patient status assessment.

2.
Diagn Progn Res ; 3: 5, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093575

RESUMO

Background: Many studies have been performed to identify important prognostic factors for outcomes after rehabilitation of patients with chronic pain, and there is a need to synthesize them through systematic review. In this process, it is important to assess the study quality and risk of bias. The "Quality In Prognosis Studies" (QUIPS) tool has been developed for this purpose and consists of several prompting items categorized into six domains, and each domain is judged on a three-grade scale (low, moderate or high risk of bias). The aim of the present study was to determine the interrater agreement of the risk of bias assessment in prognostic studies of patients with chronic pain using QUIPS and to elaborate on the use of this instrument. Methods: We performed a systematic review and a meta-analysis of prognostic factors for long-term outcomes after multidisciplinary rehabilitation in patients with chronic pain. Two researchers rated the risk of bias in 43 published papers in two rounds (15 and 28 papers, respectively). The interrater agreement and Cohen's quadratic weighted kappa coefficient (κ) and 95% confidence interval (95%CI) were calculated in all domains and separately for the first and second rounds. Results: The raters agreed in 61% of the domains (157 out of 258), with similar interrater agreement in the first (59%, 53/90) and second rounds (62%, 104/168). The overall weighted kappa coefficient (kappa for all domains and all papers) was weak: κ = 0.475 (95%CI = 0.358-0.601). A "minimal agreement" between the raters was found in the first round, κ = 0.323 (95%CI = 0.129-0.517), but increased to "weak agreement" in the second round, κ = 0.536 (95%CI = 0.390-0.682). Conclusion: Despite a relatively low interrater agreement, QUIPS proved to be a useful tool in assessing the risk of bias when performing a meta-analysis of prognostic studies in pain rehabilitation, since it demands of raters to discuss and investigate important aspects of study quality. Some items were particularly hard to differentiate in-between, and a learning phase was required to increase the interrater agreement. This paper highlights several aspects of the tool that should be kept in mind when rating the risk of bias in prognostic studies, and provides some suggestions on common pitfalls to avoid during this process. Trial registration: PROSPERO CRD42016025339; registered 05 February 2016.

3.
BMC Health Serv Res ; 19(1): 130, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30791905

RESUMO

BACKGROUND: Health risk assessment (HRAs) are commonly used by occupational health services (OHS) to aid workplaces in keeping their employees healthy, but for unknown reasons, many employees choose not to participate in the HRAs. The aim of the study was to explore whether demographic, lifestyle and health-related factors in employees are associated with non-participation in initial and repeated HRAs. METHODS: In an OHS-based health project, 2022 municipal employees were asked to participate in three repeated HRAs. Multiple logistic regression analyses were used so as to determine associations between non-participating and demographic, lifestyle and health-related factors (e.g. biomarkers). RESULTS: Among the employees who were asked to participate in the health project, more than half did not participate in any HRA and among those who did, more than one third did not participate in repeated HRAs. Young age, male sex and being employed in the Technical department or Health and Social Care department in comparison with being employed in the department for Childcare and Education were factors significantly associated with non-participation in the initial HRA. These factors, together with being on sick leave and having unhealthy dietary habits, were factors associated with non-participation in repeated HRAs. CONCLUSIONS: Among the non-participators in initial HRAs and in repeated HRAs younger men and those already related to ill-health were overrepresented. This implicates that health care providers to a higher extent should focus on "those most needed" and that employers should be more engaged in results of repeated HRA's. Future studies should focus on modifiable variables that could make the HRAs more attractive and inclusive.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde , Indicadores Básicos de Saúde , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Engajamento no Trabalho , Adulto , Idoso , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
BMJ Open ; 8(5): e018471, 2018 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-29730615

RESUMO

INTRODUCTION: Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA. METHODS AND ANALYSIS: This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment. ETHICS AND DISSEMINATION: This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: NCT02024126; Pre-results.


Assuntos
Terapia por Exercício/métodos , Osteoartrite do Joelho/reabilitação , Dor/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Análise Multivariada , Noruega , Medição da Dor/métodos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Suécia , Resultado do Tratamento
5.
Syst Rev ; 6(1): 199, 2017 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-29020989

RESUMO

BACKGROUND: Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain. METHODS: We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation. DISCUSSION: The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016025339.


Assuntos
Dor Crônica/psicologia , Dor Musculoesquelética/reabilitação , Prognóstico , Qualidade de Vida , Resultado do Tratamento , Assistência à Saúde/métodos , Humanos , Retorno ao Trabalho , Revisões Sistemáticas como Assunto
6.
BMJ Open ; 7(7): e016006, 2017 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-28729320

RESUMO

OBJECTIVE: High-performance marine craft personnel (HPMCP) are regularly exposed to vibration and repeated shock (VRS) levels exceeding maximum limitations stated by international legislation. Whereas such exposure reportedly is detrimental to health and performance, the epidemiological data necessary to link these adverse effects causally to VRS are not available in the scientific literature, and no suitable tools for acquiring such data exist. This study therefore constructed a questionnaire for longitudinal investigations in HPMCP. METHODS: A consensus panel defined content domains, identified relevant items and outlined a questionnaire. The relevance and simplicity of the questionnaire's content were then systematically assessed by expert raters in three consecutive stages, each followed by revisions. An item-level content validity index (I-CVI) was computed as the proportion of experts rating an item as relevant and simple, and a scale-level content validity index (S-CVI/Ave) as the average I-CVI across items. The thresholds for acceptable content validity were 0.78 and 0.90, respectively. Finally, a dynamic web version of the questionnaire was constructed and pilot tested over a 1-month period during a marine exercise in a study population sample of eight subjects, while accelerometers simultaneously quantified VRS exposure. RESULTS: Content domains were defined as work exposure, musculoskeletal pain and human performance, and items were selected to reflect these constructs. Ratings from nine experts yielded S-CVI/Ave of 0.97 and 1.00 for relevance and simplicity, respectively, and the pilot test suggested that responses were sensitive to change in acceleration and that the questionnaire, following some adjustments, was feasible for its intended purpose. CONCLUSIONS: A dynamic web-based questionnaire for longitudinal survey of key variables in HPMCP was constructed. Expert ratings supported that the questionnaire content is relevant, simple and sufficiently comprehensive, and the pilot test suggested that the questionnaire is feasible for longitudinal measurements in the study population.


Assuntos
Dor Musculoesquelética/fisiopatologia , Doenças Profissionais/fisiopatologia , Navios , Inquéritos e Questionários , Desempenho Profissional , Adulto , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Humanos , Internet , Estudos Longitudinais , Masculino , Dor Musculoesquelética/etiologia , Exposição Ocupacional/efeitos adversos , Reprodutibilidade dos Testes , Suécia
7.
Disabil Rehabil ; 34(2): 136-44, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21957887

RESUMO

PURPOSE: The aim of this cohort study was to identify early predictive factors for a poor outcome of disability and pain 12- and 36-months after an intervention in patients with recurrent low-back pain, currently at work. METHOD: Seventy-one patients with recurrent low-back pain, all at work, seeking care in a primary health care setting were included. Predictive indicators including demographic data and health-related variables were derived from questionnaires pre- and post intervention over eight weeks. The dependent outcome variables were perceived disability and present pain at 12- and 36-months. RESULTS: Multivariate regression analyses show that early data on poor self-efficacy for physical activity, greater disability, and higher level of pain-ratings emerged as independent predictors of a poor outcome of disability at 12 and 36 months. Higher ratings of pain and poor self-efficacy appeared again as independent predictors of a poor outcome of pain at the 12-month follow-up. Pain frequency ratings predicted a poor outcome of pain at 36 months. CONCLUSIONS: Our results suggest that ratings of poor self-efficacy for physical activity, greater disability, and pain-ratings, are the most consistent independent predictors of long-term poor outcome of disability and pain. This indicates the importance of screening for such factors to optimize the management of low-back pain. However, larger studies in similar patient populations are needed to confirm these results.


Assuntos
Terapia por Exercício , Dor Lombar/terapia , Adolescente , Adulto , Doença Crônica , Estudos de Coortes , Terapia por Exercício/métodos , Feminino , Seguimentos , Previsões , Humanos , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prognóstico , Análise de Regressão , Fatores de Risco , Autoeficácia , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
8.
Physiother Theory Pract ; 26(4): 281-7, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20397863

RESUMO

The primary aim was to determine the intra- and interexaminer reliability of measurements of isometric wrist extension force obtained with the Nicholas Manual Muscle Tester (NMMT) in a "break test." A secondary aim was to use NMMT measurements to describe the relation between electromyographic (EMG) activity and force produced in wrist extensors at different levels of contraction strain. Two examiners tested 51 healthy subjects (aged 19-46) in a test-retest approach with 6-7 days between the tests. Eleven subjects from this sample were also recruited for the study investigating the relation between EMG and force in the wrist extensor. Intraexaminer reliability was excellent for both examiners (ICC 0.944 and 0.902). The results also showed excellent interexaminer reliability (ICC 0.925) and relatively low CV% and S(diff). The EMG-force relation in wrist extensor muscles was strong (r = 0.985). The excellent test-retest stability indicates that measurements of isometric wrist extension force obtained with NMMT are appropriate for clinical evaluation as well as for further studies of wrist isometric extensor muscle strength. The tests indicated that the relation between force produced and levels of EMG activity in wrist extensor muscles is approximately linear.


Assuntos
Dinamômetro de Força Muscular , Amplitude de Movimento Articular , Articulação do Punho/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Adulto Jovem
9.
J Electromyogr Kinesiol ; 18(4): 538-49, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17329125

RESUMO

There is recognition that neck pain is a significant clinical problem in military aviation. In the present trial, the objectives were to explore neck motor function and pain-related fear in pilots with differing progression of neck pain. Seventy-two military helicopter pilots were enrolled: 20 had acute ongoing neck pain, 27 had subacute pain, and 25 were pain-free controls. Neck-flexor electromyography activity (root-mean-square) during staged active craniocervical flexion, median power frequency during sustained neck-flexor contraction, cervical range of motion, rating of perceived exertion after sustained flexor contraction, and rated fear-avoidance beliefs about physical activity were estimated. Main effects emerged for flexor activity, fear-avoidance and range of motion, but not for median frequency variables or perceived exertion. Post hoc testing showed that, compared to controls, both pain groups had greater flexor activity at higher stages of craniocervical flexion while the acute group had higher fear-avoidance and less range of motion in axial rotation and flexion-extension, all P<0.01. Discriminant regression revealed a sensitivity/specificity of 87%/71% (neck-pain/controls), with the flexor activity superior. The results indicate that altered neuromotor synergies are present at different progressions of pain. The tracing of such aberrant activity and fear-avoidance beliefs is suggested in future screening and neck intervention research.


Assuntos
Medicina Aeroespacial , Aeronaves , Medo/psicologia , Atividade Motora/fisiologia , Cervicalgia/fisiopatologia , Cervicalgia/psicologia , Pescoço/fisiopatologia , Adulto , Progressão da Doença , Eletromiografia , Humanos , Amplitude de Movimento Articular , Adulto Jovem
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