Immersive Virtual Reality for the Management of Pain in Community-Dwelling Older Adults.

Immersive virtual reality (VR) can provide a high level of engagement and distraction analgesia to address pain. However, community-based applications of this technology for older adults have not been studied. The objective of this study was to examine the applicability and effectiveness of an immersive VR intervention for pain, depression, and quality of life (QOL) in older adults. This pretest–posttest, mixed-methods design included senior center members (n = 12) with pain that interfered with daily functioning. The outcomes included the Numeric Pain Rating Scale, Patient-Reported Outcomes Measurement Information System (PROMIS®) depression scale, World Health Organization Quality of Life Scale Brief Version (WHO QOL-BREF), and open-ended questions. The VR intervention (15- to 45-min sessions, 12 sessions over 6 weeks) was well accepted with no dropouts. There was a significant decrease in pain (p =.002, d = −1.54) with no effect on depression and QOL. There were no adverse effects, and positive perceptions of VR were reported. The 6-week immersive VR intervention was applicable and effective in reducing pain intensity for community-dwelling older adults

A questionnaire to identify patellofemoral pain in the community: an exploration of measurement properties

Background Community-based studies of patellofemoral pain (PFP) need a questionnaire tool that discriminates between those with and those without the condition. To overcome these issues, we have designed a self-report questionnaire which aims to identify people with PFP in the community. Methods Study designs: comparative study and cross-sectional study. Study population: comparative study: PFP patients, soft-tissue injury patients and adults without knee problems. Cross-sectional study: adults attending a science festival. Intervention: comparative study participants completed the questionnaire at baseline and two weeks later. Cross-sectional study participants completed the questionnaire once. The optimal scoring system and threshold was explored using receiver operating characteristic curves, test-retest reliability using Cohen’s kappa and measurement error using Bland-Altman plots and standard error of measurement. Known-group validity was explored by comparing PFP prevalence between genders and age groups. Results Eighty-four participants were recruited to the comparative study. The receiver operating characteristic curves suggested limiting the questionnaire to the clinical features and knee pain map sections (AUC 0.97 95 % CI 0.94 to 1.00). This combination had high sensitivity and specificity (over 90 %). Measurement error was less than the mean difference between the groups. Test–retest reliability estimates suggest good agreement (N = 51, k = 0.74, 95 % CI 0.52–0.91). The cross-sectional study (N = 110) showed expected differences between genders and age groups but these were not statistically significant. Conclusion A shortened version of the questionnaire, based on clinical features and a knee pain map, has good measurement properties. Further work is needed to validate the questionnaire in community samples

Quality of Postoperative Pain Management after Midfacial Fracture Repair—An Outcome-oriented Study

Objectives There is a lack of literature regarding the procedure-specific quality of acute postoperative pain management after midfacial fracture repair. The purpose of the presented prospective clinical study was to evaluate postoperative pain management after surgical repair of midfacial fractures. Materials and methods Eighty-five adults were evaluated on the first postoperative day following midfacial repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. The main outcome measures were patients’ characteristics and clinical- and patient-reported outcome parameters. Results Overall, pain on the first postoperative day was moderate. A significant correlation between process and outcome parameters could be shown. Duration of surgery above the calculated median was significantly associated with higher maximum pain intensity (p = 0.017). Patients requiring opioids in the recovery room presented significantly higher pain on activity (p = 0.029) and maximum pain (p = 0.035). Sleeping impairment (p = 0.001) and mood disturbance (p = 0.008) were significantly more prevalent in patients undergoing repair of a centrolateral midfacial fracture. Conclusions QUIPS is a simple and qualified tool to evaluate the procedure specific quality of acute postoperative pain management. Pain on the first postoperative day following midfacial fracture repair seems overall to be moderate. Nearly a third of the patients showed inadequate postoperative pain management. To prevent inadequate postoperative pain management, it is necessary to establish a continued procedure-specific outcome measurement

The comparison of the effect of pharmaceutical methods and ice pack on the reliefe of perineal pain after episiotomy in patient reffering to educational health centers of Alzahra- Tabriz,2005-6.

Introduction: perineal pain is the most common women's problems in postpartum period. This problem has been found in %94 of the women who became episiotomy and it caused undesirable complications on mothers' physical and emotional health state and their relationship with their infants. Objective: Comparing the effects of Acetaminophen tablets, Diclofenac Suppositories & Ice packs on the relief of perineal pain after episiotomy. Material and methods: This research is a randomized clinical trial in which 180 primiparous women with mediolateral episiotomy were selected and divided randomly into three groups (tablets, suppositories, and icepacks). After beginning of post – episiotomy pain, the intensity of pain determined before and after intervention using numerical rating scale, in the first group, 50 mg Diclofenac suppositories (at maximal 3 doses until the pain relieved) and in the other group 325 mg Acetaminophen tablets (at maximal 4 doses until the pain relieved) and in the third group ice packs (based on the patients' need) were described. The data have been analyzed with descriptive statistical methods and non – parametric tests, frequent measurement (Friedman), kruskall – wallis, wilcoxon using statistical software spss.14/win. Results: The result of this research showed that the perineal pain decreased significantly in all groups, that is, the effect of ice packs was more than the diclofenac suppositories and the effect of diclofenac suppositories was more than acetaminophen tablets. Discussion: Encouraging patients and health care workers to use non-pharmaceutical methods and lessen drug interference with the motivation of decreasing side effects of drugs and saving time and expenses seem necessary

Penatalaksanaan Fisioterapi Pada Kasus Low Back Pain (LBPp) Akibat Scoliosis Dengan Modalitas Micro Wave Diathermy (MWD), Core Stabilitation Di RSUD Salatiga

Background: Low Back Pain is a clinical syndrome characterized by the major symptoms of pain or feeling unwell lower spine area . Modality given in these conditions Micro Wave Diathermy ( MWD ) and Core Stabilization. Objective: To determine the effect of Micro Wave Diathermy ( MWD ) and core stabilization in reducing pain due to LBP , to determine the effect of Core Stabilization in the increased range of motion ( LGS ) on condition of LBP due to scoliosis . Methods: Physiotherapy methods used in the case that the modalities MWD and Core Stabilization . The evaluation was done by the method of measurement of pain ( VDS ) , the measurement of LGS ( tape measure ) . Results: After 6 times of therapy showed a decrease in tenderness T1 : not so heavily into T6 : mild , pain motion T1 : really heavy into T6 : not so heavy ; increase range of motion trunk , flexi T1 : 12 cm to T6 : 15 cm , T1 extension : 7 cm to T6 : 7 cm , lateral flexion right- T1 : 11 cm to T6 : 11 cm , left lateral flexion T1 : 9 cm to T6 : 9 cm . Conclusion: In that case the modalities MWD and Core Stabilization exercise can reduce pain and improve range of motion

Symptom Domain Groups of the Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations and Re-hospitalizations in Cirrhosis

Background Patient-Reported Outcomes Measurement Information System (PROMIS) tools can identify health-related quality of life (HRQOL) domains that could differentially affect disease progression. Cirrhotics are highly prone to hospitalizations and re-hospitalizations, but the current clinical prognostic models may be insufficient, and thus studying the contribution of individual HRQOL domains could improve prognostication. Aim Analyze the impact of individual HRQOL PROMIS domains in predicting time to all non-elective hospitalizations and re-hospitalizations in cirrhosis. Methods Outpatient cirrhotics were administered PROMIS computerized tools. The first non-elective hospitalization and subsequent re-hospitalizations after enrollment were recorded. Individual PROMIS domains significantly contributing toward these outcomes were generated using principal component analysis. Factor analysis revealed three major PROMIS domain groups: daily function (fatigue, physical function, social roles/activities and sleep issues), mood (anxiety, anger, and depression), and pain (pain behavior/impact) accounted for 77% of the variability. Cox proportional hazards regression modeling was used for these groups to evaluate time to first hospitalization and re-hospitalization. Results A total of 286 patients [57 years, MELD 13, 67% men, 40% hepatic encephalopathy (HE)] were enrolled. Patients were followed at 6-month (mth) intervals for a median of 38 mths (IQR 22–47), during which 31% were hospitalized [median IQR mths 12.5 (3–27)] and 12% were re-hospitalized [10.5 mths (3–28)]. Time to first hospitalization was predicted by HE, HR 1.5 (CI 1.01–2.5, p = 0.04) and daily function PROMIS group HR 1.4 (CI 1.1–1.8, p = 0.01), independently. In contrast, the pain PROMIS group were predictive of the time to re-hospitalization HR 1.6 (CI 1.1–2.3, p = 0.03) as was HE, HR 2.1 (CI 1.1–4.3, p = 0.03). Conclusions Daily function and pain HRQOL domain groups using PROMIS tools independently predict hospitalizations and re-hospitalizations in cirrhotic patients

The Comparison of the effect of pharmaceutical and non pharmaceutical methods on the reliefe of perineal pain after episiotomy in patients reffering to educating health center of ALZAHRA-Tabriz, 2005-6.

Introduction: perineal pain is the most common women's problems in postpartum period. This problem has been found in %94 of the women who became episiotomy and it caused undesirable complications on mothers' physical and emotional health state and their relationship with their infants. Objective: Comparing the effects of Acetaminophen tablets, Diclofenac Suppositories & Ice packs on the relief of perineal pain after episiotomy. Material and methods: This research is a randomized clinical trial in which 180 primiparous women with mediolateral episiotomy were selected and divided randomly into three groups (tablets, suppositories, and icepacks). After beginning of post – episiotomy pain, the intensity of pain determined before and after intervention using numerical rating scale, in the first group, 50 mg Diclofenac suppositories (at maximal 3 doses until the pain relieved) and in the other group 325 mg Acetaminophen tablets (at maximal 4 doses until the pain relieved) and in the third group ice packs (based on the patients' need) were described. The data have been analyzed with descriptive statistical methods and non – parametric tests, frequent measurement (Friedman), kruskall – wallis, wilcoxon using statistical software spss.14/win. Results: The result of this research showed that the perineal pain decreased significantly in all groups, that is, the effect of ice packs was more than the diclofenac suppositories and the effect of diclofenac suppositories was more than acetaminophen tablets. Discussion: Encouraging patients and health care workers to use non-pharmaceutical methods and lessen drug interference with the motivation of decreasing side effects of drugs and saving time and expenses seem necessary

Comparative responsiveness of pain outcome measures among primary care patients with musculoskeletal pain

BACKGROUND: Comparative responsiveness data are needed to inform choices about pain outcome measures. OBJECTIVES: To compare responsiveness of pain intensity, pain-related function, and composite measures, using data from a randomized trial and observational study. RESEARCH DESIGN: Analysis of responsiveness. SUBJECTS: A total of 427 adults with persistent back, hip, or knee pain were recruited from primary care. METHODS: Participants completed Brief Pain Inventory, Chronic Pain Grade (CPG), Roland disability, SF-36 bodily pain, and pain global rating of change measures. We used the global rating as the anchor for standardized response mean and receiver operating characteristic curve analyses. We used the distribution-based standard error of measurement to estimate minimally important change. To assess responsiveness to the trial intervention, we evaluated standardized effect size statistics stratified by trial arm. RESULTS: All measures were responsive to global improvement and all had fair-to-good accuracy in discriminating between participants with and without improvement. SF bodily pain was less responsive than other measures in several analyses. The 3-item PEG was similarly responsive to full Brief Pain Inventory scales. CPG and SF bodily pain were less responsive to the trial intervention and did not perform well among participants with hip/knee pain. Agreement between anchor and distribution-based methods was modest. CONCLUSIONS: If a brief measure is desired, the 3-item PEG is more responsive than the SF bodily pain scale. CPG and SF bodily pain scales may be relatively poor choices for trial outcome assessment. Both anchor and distribution-based methods should be considered when determining clinically important change

Measures of upper limb function for people with neck pain: A systematic review of measurement and practical properties (protocol)

Background Upper limb disability is a common musculoskeletal condition frequently associated with neck pain. Recent literature has reported the need to utilise validated upper limb outcome measures in the assessment and management of patients with neck pain. However, there is a lack of clear guidance about the suitability of available measures, which may impede utilisation. This review will identify all available measures of upper limb function developed for use in neck pain patients and evaluate their measurement and practical properties in order to identify those measures that are most appropriate for use in clinical practice and research. Methods/design This review will be performed in two phases. Phase one will identify all measures used to assess upper limb function for patients with neck pain. Phase two will identify all available studies of the measurement and practical properties of identified instrument. The COnsensusbased Standards for selection of health Measurement INstrument (COSMIN) will be used to evaluate the methodological quality of the included studies. To ensure methodological rigour, the findings of this review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline.Discussion Optimal management of patients with neck pain should incorporate upper limb rehabilitation. The findings of this study will assist clinicians who seek to utilise suitable and accurate measures to assess upper limb function for a patient with neck pain. In addition, the findings of this study may suggest new research directions to support the development of upper limb outcome measures for patients with neck pain