Psychological interventions designed to optimise patients' treatment expectations have proven effective in surgical populations. Since these interventions are often resource-intensive, their clinical application is limited. We aimed to optimise treatment expectations in patients undergoing elective orthopaedic surgery with a brief video-based expectation-focused intervention. Additionally, the role of violated expectations was investigated exploratively.
In a three-arm randomised clinical trial, participants (N = 125) scheduled to undergo elective orthopaedic surgery received either an expectation-focused video intervention aiming at fostering realistically positive treatment expectations, an active control video or standard medical care. The primary outcome was pain intensity. Measurements were taken at baseline as well as on postoperative days one and seven.
The intervention group reported increased treatment expectations compared to the standard medical care and the control group. No significant intervention effect on pain intensity was found. Patients indicating negative postsurgical expectation violation (feeling worse than expected) reported higher pain intensity, regardless of the study condition. No differences in pain intensity were found between patients, indicating positive or no expectation violation (feeling better or exactly as expected respectively).
Patients' treatment expectations can be optimised with a brief video-based intervention. However, the clinical relevance of this effect may be questionable. Postoperative pain intensity differed by expectation violation profiles. Avoiding a negative expectation violation might be a promising approach for expectation-focused interventions in surgical populations.
Our findings suggest that treatment expectations can be improved through a brief video-based intervention, though this did not translate into improved postoperative outcomes. These results underscore both the potential and the limitations of very brief expectation-focused approaches and can inform the refinement of such interventions.
Ger
Individuals with low back pain (LBP) have high healthcare use (HCU). It is currently unclear whether self-management supportive interventions can decrease HCU among patients with LBP. The aim of this study was to investigate changes in visits to primary care and redeemed prescriptions of analgesics after enrolment in a self-management supportive programme compared to usual care.
This quasi-experimental study included adults with LBP who enrolled in the Danish GLA:D Back programme between 2018 and 2022. GLA:D Back is a structured 10-week programme of group-based patient education and supervised exercises aiming to enhance self-management skills. HCU was obtained from national registries as the total quarterly visits to primary care (general practitioner, physiotherapists or chiropractor) or quarterly total redeemed defined daily doses (DDD) of analgesics (paracetamol, non-steroidal anti-inflammatory drugs or opioids).
We included 4205 individuals. From 2 to 14 quarters post-enrolment, the additional quarterly reduction in HCU after the programme compared to the control group was −1.1 (95% CI −1.5 to −0.8) visits to primary care and −5.3 (95% CI −9.2 to −2.2) DDDs of redeemed analgesics. Sensitivity analyses questioned the statistical significance of the reduction in analgesic use, but results for people with LBP duration > 1 year were robust for both outcomes. The largest reductions were observed in those with high HCU at baseline.
Participation in a structured self-management programme led to a sustained reduction in primary care visits and analgesic use over a 3-year period, although regression to the mean may partly explain these reductions.
This quasi-experimental study demonstrated that a structured self-management supportive programme for low back pain reduced future healthcare use, especially among individuals with long-lasting pain or high initial healthcare use. These findings suggest a potential to alter healthcare use through structured interventions to support self-management.
Patients with non-specific neck pain often develop persistent or recurrent pain and associated disability. This review investigated which physical and psychological factors predict persistent and recurrent neck pain and disability.
Five databases were searched from inception to January 31, 2025. After data extraction, the Quality in Prognosis Studies tool (QUIPS) was used for risk of bias assessment and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the certainty of evidence for each factor's predictive capability for neck disability, pain intensity and incidence.
Six prospective cohort studies were selected. Three studies were rated with high overall risk of bias and three with moderate overall risk of bias. Consistent findings supported that high pain catastrophizing and psychological distress predict persistent and recurrent pain, disability and incidence with low to moderate certainty of evidence. There was inconsistency of results or limited studies reporting association between neck flexion strength, cold pain threshold tested over the tibialis anterior, pressure pain threshold tested over the neck or tibialis anterior, conditioned pain modulation, neck extensor endurance, and temporal summation with disability. In addition, there was low certainty of evidence which showed no relationship between cervical range of motion, cold pain threshold tested over the neck and neck extensor strength with disability.
Pain catastrophizing and psychological distress were identified as predictors of persistent and recurrent neck pain, disability and incidence. Further studies are needed to confirm findings of an association between physical factors with future neck pain and disability.
This review provides evidence to support the addition of early assessment of pain catastrophizing and psychological distress to identify patients that are more susceptible to persistent and recurrent neck pain. When warranted, psychological interventions targeting maladaptive beliefs, pain-related anxiety and catastrophizing may be required to minimize persistent and recurrent neck pain and disability.
Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This study investigated whether impaired CPM is seen in pain-free individuals and determined associations with attachment.
A CPM test paradigm was used to determine the differences in the measures of pain across attachment anxiety and avoidance dimensions in pain-free females in a neutral social context. First, static (heat pain threshold, heat pain tolerance, and cold pain intensity) and dynamic (cumulative pain load) measures of pain were explored.
One hundred and three females were recruited (median [IQR] age: 21 [20–23] years). We found no associations between attachment dimensions and static measures of pain (ps > 0.05). Higher attachment anxiety, but not avoidance, was associated with an increase in pain intensity over time (Estimate [95% CI] = 0.15 [0.06–0.25], p-value = 0.002), and increased average test stimulus pain intensity rating both before (Estimate [95% CI] = 0.15 [0.07–0.23], p-value < 0.001) and during (Estimate [95% CI] = 0.36 [0.23–0.48], p-value < 0.001) conditioning. In the 78% (80/103) who completed the full CPM procedure, there was no association between CPM effect and attachment anxiety (Estimate [95% CI] = −3.79 [−8.62 to 1.03], p = 0.122) or avoidance (Estimate [95% CI] = 0.25 [−4.88 to 5.38], p = 0.923). Effective CPM was seen in 90% (72/80).
Impaired CPM was not seen in pain-free individuals suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.
Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This is the first study to investigate a link between attachment and experimental pain using a conditioned pain modulation (CPM) paradigm in a neutral social context. Impaired CPM was not seen in pain-free individuals, suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.
The purpose of this systematic review was to identify and evaluate the quality of cross-cultural adaptations of the six core outcome measures (NRS, SF-12, PROMIS, ODI, RMDQ and VAS) for low back pain (LBP) and assess their psychometric properties.
Medline, EMBASE, Emcare and CINAHL databases were searched from inception to August 2024. Eligible studies included those assessing core LBP outcome measures in adults with LBP. The COSMIN checklist was used to assess the quality of cross-cultural adaptations and evaluate the psychometric properties. Additionally, the COSMIN risk of bias tool and GRADE approach were employed to assess study quality and provide levels of evidence.
A total of 82 studies were included. Among them, 35 studies examined the cross-cultural adaptations of the ODI, 25 for the RMDQ, 4 for PROMIS, 1 for SF-12 and 2 for NRS/VAS. The quality of cross-cultural adaptations was generally poor or fair due to inadequate reporting of pre-testing processes and small sample sizes. Most psychometric properties were rated as having an inadequate risk of bias, with evidence quality ranging from very low to low.
This review highlights that the cross-cultural adaptations of the five core LBP outcome measures have generally been conducted with low quality. To improve the adaptation process, studies should employ larger sample sizes and standardised pre-testing procedures. Additional research is needed to explore a broader range of psychometric properties of cross-cultural adaptations, ensuring better validity, reliability and comparability across adapted versions.
Improving the quality of cross-cultural adaptations of LBP outcome measures is crucial to ensuring that assessments are culturally relevant and accurate across diverse populations, leading to better-informed clinical decisions and equitable care for patients with LBP globally.
CRD42023413077
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：