Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment : a systematic review incorporating an indirect-comparisons meta-analysis

Aim: To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment. Design: Systematic review and indirect-comparisons meta-analysis. Data sources: Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. Eligibility criteria for selecting studies: Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment. Study appraisal and synthesis: Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis. Results: We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardised mean difference (SMD) of −0.77 (95% Credible Interval (CrI) −1.22 to −0.31), while massage (−0.78; −1.55 to −0.01), cognitive–behavioural therapy combined with physical activity (combined CBT, −0.72; −1.34 to −0.09), combined aerobic and resistance training (−0.67; −1.01 to −0.34), resistance training (−0.53; −1.02 to −0.03), aerobic (−0.53; −0.80 to −0.26) and yoga (−0.51; −1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (−0.68; −0.93 to −0.43). Combined aerobic and resistance training (−0.50; −0.66 to −0.34), combined CBT (−0.45; −0.70 to −0.21), Tai-Chi (−0.45; −0.84 to −0.06), CBT (−0.42; −0.58 to −0.25), resistance training (−0.35; −0.62 to −0.08) and aerobic (−0.33; −0.51 to −0.16) showed all small-to-moderate SMDs. Conclusions: Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF

Psychometric properties of the German Version of the Pediatric Evaluation of Disability Inventory (PEDI-G) : A factor analysis

Background: Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children`s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure. Aim: To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment. Material and Methods: An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale. Results: 262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child`s ability to perform activities of daily living. Conclusion: The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland

Language errors in pain medicine: An umbrella review

The goal of this article is to systematically explore the main biomedical databases to see if a significant part of the reviews published since the last IASP definition revision (Raja et al., 2020) are presenting errors in language, either by using nociceptive shortcuts conflating both terms – pain and nociception –, or by conceptualising pain as a “thing”

Language errors in pain medicine: An umbrella review

Errors in language are common in pain medicine, but the extent of such errors has not been systematically measured. This pre-registered umbrella review explored Embase, PubMed, Medline and CINAHL and seeks to quantify the prevalence of language errors in review articles since the last IASP definition revision. Inclusion criteria comprised any type of review with a primary focus on providing neurophysiological insights into human nociception and/or pain within a pathological context, written in English and published in a peer-reviewed journal. Exclusion criteria involved articles published before the latest IASP definition revision, after May 2023, or listed on Beall's list. Statistical analyses employed Fisher exact tests for error proportions, while contrasted negative binomial models were applied for error counts. Out of 5,470 articles screened, 48 review articles met the inclusion criteria, each revealing at least one language error category. Years of publication were not associated with the presence of language errors or language error counts. Despite limitations like a limited number of studies, outlier, terminology ambiguity, an exclusive focus on human studies, and no risk of bias evaluation, this umbrella review shows a robust methodology and transparency with online available material. Considering our findings, urgent action is needed to regulate the use of misnomers in pain medicine and improve pain related terminology. Perspective: This umbrella review explored the main biomedical databases to see how many review articles contained language errors. Our findings underscore the imperative for prompt action in regulating pain medicine terminology. Pre-registration: This umbrella review was pre-registered on OSF registries (https://doi.org/10.17605/osf.io/kau8m). Online material: https://osf.io/kdweg/ Keywords: Umbrella review - Language errors - Pain - Nociception – Terminolog

Physiotherapists’ ability to identify psychological factors and their self-reported competence to manage chronic low back pain

Background: In the management of chronic low back pain (LBP), identifying and managing more patients who are at high risk and who have psychological barriers to recovery is important yet difficult. Objective: The objective of this study was to test physical therapists' ability to allocate patients into risk stratification groups, test correlations between therapists' assessments of psychological factors and patient questionnaires, and explore relationships between psychological factors and therapists' self-reported competence to manage patients with chronic LBP. Design: This was a pragmatic, observational study. Methods: Patients completed the STarT Back Tool (SBT, for risk stratification), the Four-Dimensional Symptom Questionnaire (distress, depression, anxiety), and the Tampa Scale of Kinesiophobia (kinesiophobia) prior to the intake session. After this session, physical therapists estimated patient prognostic risk using the 3 SBT categories and rated patient psychological factors using a 0-to-10 scale. Finally, therapists reported their self-reported competence to manage the patient. Intraclass and Spearman rank correlations tested correlations between therapists' intuitive assessments and patient questionnaires. A linear-mixed model explored relationships between psychological factors and therapists' self-reported competence. Results: Forty-nine patients were managed by 20 therapists. Therapists accurately estimated SBT risk allocation in only 41% of patients. Correlations between therapist perceptions and patient questionnaires were moderate for distress (r = 0.602) and fair for depression (r = 0.304) and anxiety (r = 0.327). There was no correlation for kinesiophobia (r = -0.007). Patient distress was identified as a negative predictor of therapists' self-reported competence. Limitations: This was a cross-sectional study, conducted in only 1 center. Conclusions: Physical therapists were not very accurate at allocating patients into risk stratification groups or identifying psychological factors. Therapists' self-reported competence in managing patients was lowest when patients reported higher distress.status: accepte

Validation of the 7-item knee replacement patient education questionnaire (KR-PEQ-7), based on the 16-item knee osteoarthritis patient education questionnaire (KOPEQ)

Background The aim of this study was to investigate the content validity including item reduction, construct validity and internal consistency of the existing 16-item Knee Osteoarthritis Patient Education Questionnaire. Former research had indicated that a reduction of items was necessary. Participants were patients with severe knee osteoarthritis who, prior to undergoing a knee replacement operation, participated routinely in a preoperative educational intervention. Methods A mixed method design was used. The first step was directed at the reduction in the number of items on the 16-item Knee Osteoarthritis Patient Education Questionnaire. Based on a priori hypotheses, this was followed by a cross-sectional validation study, performed to compare the resulting 7-item Knee Replacement Patient Education Questionnaire to a patient-testing Interview Protocol that was tailored to the same patient educational material. Additionally, the revised questionnaire was correlated with both the Short Test of Functional Health Literacy and the Mini-Mental State Examination score. Results A relatively high internal consistency was found for the 7-item Knee Replacement Patient Education Questionnaire, with a Cronbach's alpha of 0.84 (SE: 0.036). Explanatory factor analysis showed no evidence against a one-factor model, with the first and second eigenvalues being 3.8 and 0.31, respectively. Bayesian Estimation of the correlation between the 7-item Knee Replacement Patient Education Questionnaire and the Interview Protocol was 0.78 (mode) (95% HPD 0.58-0.89). Conclusions The 7-item Knee Replacement Patient Education Questionnaire shows good psychometric properties and could provide valuable support to health professionals. It can provide valid feedback on how patients waiting for a knee replacement operation experience an applied patient education intervention. Further investigation is needed to assess the applicability of the 7-item Knee Replacement Patient Education Questionnaire to larger samples in different hospitals and countries

Comparison of clinical vignettes and standardized patients as measures of physiotherapists’ activity and work recommendations in patients with non-specific low back pain

Abstract Objective: To validate clinical vignettes as measure of physiotherapists’ activity and work recommendations given to patients with non-specific low back pain. Design:Validation study comparing two methodsfor measuring aspects of health providers’ clinical management: clinical vignettes and unannounced visits of standardized patients (the gold standard). Setting:Outpatient physiotherapy clinics Subjects:Physiotherapists (N = 59)who consented to see unannounced standardized patients in their clinical practice. Main measures: Clinical vignettes were used to initially measure physiotherapists’ self-reported activity and work recommendations. Subsequently, actors performing as standardized patients visited physiotherapists in their clinical practice and rated the advice given by the physiotherapist regarding activity and work. Twenty-three standardized patients were randomly scheduled to physiotherapists.Physiotherapists were blinded towards the standardized patients. To test whether standardized patients were detected, physiotherapists reported if they suspected that theyhad treated an actor. Results: The 23 standardized patients visited 22 different physiotherapists.Physiotherapistsdetected12of 23 unannouncedstandardized patients (detection rate: 52%).Theestimated agreement betweenthe two measureswas poor, for both activity and work recommendations(weighted kappa: 0.29 resp. -0.21). Conclusion:The poor concordance between clinical vignettes and standardized patients indicates the potentially limited validity of clinical vignettes as measure of health providers’ activity and work recommendations in low back pain practice.status: publishe

Construct validity of change scores of the Chair Stand Test versus Timed Up and Go Test, KOOS questionnaire and the isometric muscle strength test in patients with severe knee osteoarthritis undergoing total knee replacement

Introduction: The Chair Stand Test (CST) is a frequently used performance-based test in clinical studies involving individuals with knee osteoarthritis and demonstrates good reliability. Aim: To assess the construct validity of change scores of the CST compared to three other measures in patients before and after total knee replacement surgery. Methods: The construct validity of change scores of the CST compared to the Timed Up and Go (TUG) test, the Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS, subscale ADL) and the isometric muscle strength test of the knee extensors (IMS sum) was measured 1-2 week before and 3 months after surgery. Results: Change (%) CST = -4.45, TUG = -2.08, KOOS ADL = 43.90, IMS sum = -13.24. Correlations CST–TUG = 0.56 (95% confidence interval (CI) 0.29, 0.74), CST–KOOS = -0.31 (95% CI -0.57, 0.01), CST–IMS sum = -0.11 (95% CI -0.42, 0.22). Comparison of pairwise correlations: CST–KOOS versus CST–TUG (p < 0.0004), CST–TUG versus CST–IMS sum (p < 0.0068), CST–KOOS versus CST–IMS sum (p < 0.3100). Conclusion: For patients undergoing TKR, the CST might not be an ideal measure to assess change between pre-surgery and 3 months post-surgery. Construct validity of change scores was close to zero but the result might have been influenced by the relatively small homogeneous sample size and the chosen timespan of measurement. We ordered pairwise correlations based on the strength of correlation between the different instruments, which to our knowledge has never been done before

Associations between alliance, physiotherapists? confidence in managing the patient and patient-reported distress in chronic low back pain practice

status: publishe

Psychometric Properties of a Standardized Observation Protocol to Quantify Pediatric Physical Therapy Actions

Purpose: Pediatric physical therapy (PPT) is characterized by heterogeneity. This blurs the evaluation of effective components of PPT. The Groningen Observation Protocol (GOP) was developed to quantify contents of PPT. This study assesses the reliability and completeness of the GOP. Methods: Sixty infant PPT sessions were video-taped. Two random samples of 10 videos were used to determine interrater and intrarater reliability using interclass correlation coefficients (ICCs) with 95% confidence intervals. Completeness of GOP 2.0 was based on 60 videos. Results: Interrater reliability of quantifying PPT actions was excellent (ICC, 0.75-1.0) in 71% and sufficient to good (ICC, 0.4-0.74) in 24% of PPT actions. Intrarater reliability was excellent in 94% and sufficient to good in 6% of PPT actions. Completeness was good for greater than 90% of PPT actions. Conclusions: GOP 2.0 has good reliability and completeness. After appropriate training, it is a useful tool to quantify PPT for children with developmental disorders