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- Nijs, Jo, et al.
(författare)
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Central sensitisation in chronic pain conditions : latest discoveries and their potential for precision medicine
- 2021
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Ingår i: The Lancet Rheumatology. - : Elsevier. - 2665-9913. ; 3:5, s. E383-E392
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Forskningsöversikt (refereegranskat)abstract
- Chronic pain is a leading cause of disability globally and associated with enormous health-care costs. The discrepancy between the extent of tissue damage and the magnitude of pain, disability, and associated symptoms represents a diagnostic challenge for rheumatology specialists. Central sensitisation, defined as an amplification of neural signalling within the CNS that elicits pain hypersensitivity, has been investigated as a reason for this discrepancy. Features of central sensitisation have been documented in various pain conditions common in rheumatology practice, including fibromyalgia, osteoarthritis, rheumatoid arthritis, Ehlers-Danlos syndrome, upper extremity tendinopathies, headache, and spinal pain. Within individual pain conditions, there is substantial variation among patients in terms of presence and magnitude of central sensitisation, stressing the importance of individual assessment. Central sensitisation predicts poor treatment outcomes in multiple patient populations. The available evidence supports various pharmacological and non-pharmacological strategies to reduce central sensitisation and to improve patient outcomes in several conditions commonly seen in rheumatology practice. These data open up new treatment perspectives, with the possibility for precision pain medicine treatment according to pain phenotyping as a logical next step. With this view, studies suggest the possibility of matching non-pharmacological approaches, or medications, or both to the central sensitisation pain
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- Nijs, Jo, et al.
(författare)
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Nociceptive, neuropathic, or nociplastic low back pain? : The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations
- 2024
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Ingår i: The Lancet Rheumatology. - : Elsevier. - 2665-9913. ; 6:3, s. e178-e188
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Tidskriftsartikel (refereegranskat)abstract
- The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.
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- Rossettini, Giacomo, et al.
(författare)
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Digital Entry-Level Education in Physiotherapy : a Commentary to Inform Post-COVID-19 Future Directions
- 2021
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Ingår i: Medical Science Educator. - : Springer Science and Business Media LLC. - 2156-8650. ; 31:6, s. 2071-2083
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Tidskriftsartikel (refereegranskat)abstract
- Currently, the coronavirus disease 2019 (COVID-19) severely influences physiotherapy education which is based mostly on face-to-face teaching. Thus, educators have been compelled to adapt their pedagogical approaches moving to digital education. In this commentary, we debate on digital education highlighting its effectiveness, the users’ perspectives, and its weakness in the context of physiotherapy teaching aimed at informing post-COVID-19 future directions in this educational field. Existing evidence on digital education produced before COVID-19 supports its implementation into entry-level physiotherapy education. However, some challenges (e.g. social inequality and evaluation of students) threaten its applicability in post-COVID-19 era, calling educators to take appropriate actions.
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- Strong, Andrew, 1983-
(författare)
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Knee function, knee proprioception and related brain activity following anterior cruciate ligament injury
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Injury of the anterior cruciate ligament (ACL) may have negative effects on the short- and long-term function and proprioception of the knee joint. However, existing tests of knee function are often sports-related and less relevant for assessment in the very long term and there remains no ‘gold standard’ test of knee proprioception. A growing body of research also suggests neuroplasticity post-ACL injury, but brain response to lower limb proprioception tasks is not established and nor is the potentially related impact of ACL injury. Developing standardised, reliable and valid tests of knee function and proprioception including brain imaging may target rehabilitation interventions more efficiently.Methods: Paper I assesses knee function ~23 years after ACL injury. One ACL-injured group treated with physiotherapy only (ACLD) and one with additional reconstruction (ACLR) were compared to asymptomatic controls for performance and knee kinematics of the One-leg rise (OLR) test. Paper II is a published protocol for Paper III, which is a systematic review and meta-analysis of the psychometric properties (PMPs) of knee joint position sense (JPS) tests among individuals with ACL injury. Paper IV describes the development of one weight-bearing (WB) and one non-weight-bearing (NWB) knee JPS test using motion capture. Test-retest reliability is assessed and errors are compared between an active ACLR group (~23 months after reconstruction) and two asymptomatic groups of different activity levels. Paper V characterises brain response to a knee JPS test using simultaneous functional magnetic resonance imaging and motion capture among individuals ~2 years after ACL reconstruction and controls.Results: ACLD performed significantly fewer repetitions of the OLR with both legs compared to controls and displayed significantly greater knee abduction than ACLR and controls. Meta-analyses found sufficient validity for existing knee JPS tests, particularly those of passive movements, by showing that ACL-injured knees produce significantly greater absolute errors than contralateral asymptomatic knees and those of controls. However, the tests were found not to be responsiveness to intervention and the remaining PMPs, such as reliability, require more evidence to better determine their quality. The novel knee JPS tests of paper IV showed mixed reliability but were better for the WB compared to the NWB test and when absolute rather than variable error was the outcome measure. Post-hoc comparisons revealed significantly greater errors for less-active controls compared to the ACLR group. For Paper V, the knee JPS test recruited brain regions such as the parietal cortex, precentral gyrus and insula. Greater knee JPS errors were correlated with greater activation in the insula, as well as the anterior and middle cingula. The ACLR group showed significantly greater response compared to controls for mainly the precuneus, but only at the uncorrected level.Conclusions: Knee function may be negatively affected more than two decades after ACL injury based on performance and knee kinematics of the OLR test, which offers a clinician-friendly assessment tool of lower limb function but requires further investigation. Existing knee JPS tests seem to discriminate ACL-injured from asymptomatic knees. Passive tests produce greater differences, but current methods are diverse and often poorly reported, complicating recommendation of specific tests for research or clinics. The novel WB and NWB knee JPS tests should be developed for improved reliability, but their outcomes demonstrate the importance of considering activity level when comparing knee JPS between groups, which is rarely done. Brain regions recruited during our knee JPS test have previously been associated with, e.g. sensorimotor processes, interoception and body schema, confirming proprioceptive demands of the task. Correlations between knee JPS errors and response in the insula and cingula suggest they have an important role during such tasks. Subtle differences in brain response between ACLR and CTRL warrant further investigation.
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