The Efficacy, Acceptability and Safety of Acceptance and Commitment Therapy for Fibromyalgia – A Systematic Review and Meta-analysis

BACKGROUND: Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility, and has been found to be beneficial in treating chronic pain, however, there are few studies evaluating its efficacy in treating FM.AIM: This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia.METHODS: PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. RESULTS: Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD -1.05, 95% CI -2.02, -0.09) and follow-up (SMD -1.43, 95% CI -2.17, -0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain, and disability. Fatigue also improved, with a large negative effect. CONCLUSIONS: The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies. <br/

Effectiveness of Remotely Delivered Motivational Conversations on Health Outcomes in Patients Living with Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

Objective: to evaluate the efficacy of remotely delivered motivational conversations on health outcomes in musculoskeletal populations. Methods: four electronic databases (inception-March 2022) were searched and combined with grey literature. Randomised control trials (RCTs) evaluating the effect of remotely delivered motivational conversation-based interventions within musculoskeletal populations, using valid measures of pain, disability, quality of life (QoL), or self-efficacy were included. Overall quality was assessed using GRADE criteria. Meta-analyses were performed using random effects models with pooled effect sizes expressed as standardised mean differences (±95%CIs). Results: twelve RCTs were included. Meta-analyses revealed very-low to moderate quality evidence that remote interventions have a positive effect on pain and disability both immediately post intervention and at long-term follow-up compared to control, and have a positive effect on self-efficacy immediately post intervention. There was no effect on QoL immediately post intervention or at long-term follow up. Conclusion: remotely delivered motivation-based conversational interventions have a positive effect on pain, disability, and self-efficacy but not on QoL.Practice Implications: motivational conversations, delivered remotely, may be effective in improving some health-related outcomes in MSK populations. However, higher quality evidence is needed to determine optimal intervention durations, and dosing frequencies using sufficient sample sizes and follow-up time frames.<br/

Dual positive and negative regulation of GPCR signaling by GTP hydrolysis

G protein-coupled receptors (GPCRs) regulate a variety of intracellular pathways through their ability to promote the binding of GTP to heterotrimeric G proteins. Regulator of G protein signaling (RGS) proteins increase the intrinsic GTPase activity of G-subunits and are widely regarded as negative regulators of G protein signaling. Using yeast we demonstrate that GTP hydrolysis is not only required for desensitization, but is essential for achieving a high maximal (saturated level) response. Thus RGS-mediated GTP hydrolysis acts as both a negative (low stimulation) and positive (high stimulation) regulator of signaling. To account for this we generated a new kinetic model of the G protein cycle where GGTP enters an inactive GTP-bound state following effector activation. Furthermore, in vivo and in silico experimentation demonstrates that maximum signaling output first increases and then decreases with RGS concentration. This unimodal, non-monotone dependence on RGS concentration is novel. Analysis of the kinetic model has revealed a dynamic network motif that shows precisely how inclusion of the inactive GTP-bound state for the G produces this unimodal relationship

Exploring professional circus artists’ experience of performance-related injury and management

AIMS: Circus is a physically demanding profession, but injury and help-seeking rates tend to be low. This qualitative interview study explored the perceptions and beliefs about injury and help-seeking of circus artists. METHODS: Ten professional circus artists (5 males, 5 females; mean age 33 yrs, range 27-42) were enrolled. Individual, semi-structured interviews were conducted until data saturation of themes was reached. Data were analysed thematically. FINDINGS: Four themes were identified: 1) the injured artist; 2) professionalism; 3) circus life; and 4) artists' experience of healthcare. Most participants described the circus as central to their lives, and injuries had wide-ranging psychosocial consequences. Injury adversely affected participants' mood and threatened their identity. Situational and personal factors (e.g., the belief that pain was normal) pushed participants to use adaptive strategies to perform when injured. Continuous touring and financial constraints affected help-seeking. Easy access to healthcare was rare and participants often self-managed injuries. Experiences of healthcare varied, and participants desired flexible and accessible approaches to prevention and injury management. A modified version of the integrated model of psychological response to injury and rehabilitation process and the concept of identity provided a framework to understand participants. CONCLUSION: Injuries had extensive negative consequences. Work schedules, financial factors, employer support, the artist's perception of the importance of the show, and the relationship between circus and identity influenced injury management and help-seeking. Injury prevention and management strategies could be optimised by developing centres of expertise, online resources, and better regulations of the profession

The KOMPACT-P study: Knee Osteoarthritis Management with Physiotherapy informed by Acceptance and Commitment Therapy—Pilot study protocol

Introduction: Incidence of total knee arthroplasty (TKA) is projected to rise 276% in 2030, and psychological distress affects up to 42% of people with knee osteoarthritis undergoing TKA, with demonstrated detrimental effects on postoperative outcomes. Few studies have assessed psychological treatment in people awaiting TKA, and these have been psychologist-delivered treatments. No evidence exists regarding psychologically-informed interventions delivered by health professionals currently embedded in TKA clinical pathways. The primary aim of this pilot study is to explore the safety, acceptability and feasibility of the Knee Osteoarthritis Management with Physiotherapy informed by Acceptance and Commitment Therapy (KOMPACT) approach in people awaiting TKA. Methods and analysis: 51 community-dwelling adults scheduled for a primary TKA at two hospitals will be recruited to this pilot, mixed-methods, prospective randomised controlled trial with assessor blinding. Participants will be randomised in a 1:2 ratio to either usual care (education class) or usual care plus KOMPACT (2 hours 20 min of preoperative physiotherapy informed by Acceptance and Commitment Therapy). Our primary outcome measures are safety (length of stay, complications and psychological health after KOMPACT), acceptability (treatment credibility and qualitative data) and feasibility (recruitment, retention and intervention fidelity) of the KOMPACT approach. Secondary outcomes include health service outcomes, patient-reported physical and psychological outcomes, and physical performance measures. Quantitative data collection was conducted at baseline, 1–2 weeks before TKA, 6 weeks after TKA and 6 months after TKA. Qualitative data collection is 1–2 weeks before TKA. Data analysis will take a quantitative-led approach with triangulation after thematic analysis of the qualitative data. Ethics and dissemination: This study has full ethics approval (HREC/18/WMEAD/440). Results from this study will be published in peer-reviewed journals and presented at local and international conferences. Trial registration number: Australia New Zealand Clinical Trials Registry (ACTRN12618001867280p)

Adaptation and validation of the Nigerian Igbo Multidimensional Scale of Perceived Social Support in patients with chronic low back pain

Social support may be important in the perpetuation of symptoms in chronic low back pain (CLBP). The multidimensional scale of perceived social support (MSPSS) is one of the best measures of social support with applicability in Africa. The aims of this study were to translate, culturally adapt, test-retest, and assess cross-sectional psychometric properties of the Igbo-MSPSS. Methods: Forward and backward translation of the MSPSS was done by clinicians and non-clinician translators and evaluated by a specialist review committee. The adapted measure was piloted amongst twelve adults with CLBP in rural Nigeria. Cronbach's alpha and McDonald's omega coefficient were used for investigating internal consistency. Intra-class correlation coefficient (ICC: two-way random effects model, average of raters' measurements, absolute definition of agreement) reflecting both the degree of correlation and agreement between measurements was used for the statistical investigation of test-retest reliability. Criterion validity of the adapted measure was investigated with the eleven-point box scale, back performance scale, Roland Morris Disability Questionnaire, and World Health Organisation Disability Assessment Schedule amongst 200 people with CLBP in rural Nigeria using Spearman's correlation analyses. Exploratory factor analyses conducted using Kaiser criterion and parallel analysis as methods for determining dimensionality were used to determine the structural validity of the adapted measure amongst the same sample of 200 rural dwellers. Results: Igbo-MSPSS had excellent internal consistency (0.88) and ICC of 0.82. There were moderate correlations with measures associated with the social support construct. The same item-factor pattern in the three-dimensional structure (with Kaiser criterion) as in the original measure and a two-dimensional structure (with parallel analysis) were produced. Conclusions: Igbo-MSPSS is a measure of social support with some evidence of validity and reliability and can be used clinically or for research. Future studies are required to confirm its validity and reliability

Treatment fidelity in the Camden Weight Loss (CAMWEL) intervention assessed from recordings of advisor-participant consultations.

BACKGROUND: Variations in the delivery of content and process can alter the effectiveness of complex interventions. This study examined the fidelity of a weight loss intervention (Camden Weight Loss) from recorded consultations by assessing advisors' delivery of content, use of motivational interviewing approach and therapeutic alliance. METHODS: A process evaluation was conducted of advisor-participant consultations in a 12-month randomised controlled trial of an intervention for adult volunteers with a body mass index categorised as overweight or obese. A convenience sample of 22 consultations (12% of 191 participants) recorded at the intervention mid-point were available for analysis. Consultations were independently rated by two observers independent of intervention or study delivery, using: a fidelity scale, the Motivational Interviewing Treatment Integrity Scale and the Primary Care Therapy Process Rating Scale. Raters were blind to participants' responses to the intervention and weight outcomes. Half the participants (N = 11) achieved significant weight loss (≥ 5% of baseline weight). RESULTS: A mean of 41% of prescribed content was delivered, with a range covered per session of 8-98%, falling below the 100% content expected per session. Tasks included most frequently were: taking weight and waist measurements (98%), scheduling next appointment (86%), review of general progress (85%) and reviewing weight change (84%). Individual items most frequently addressed were 'giving encouragement' and 'showing appreciation of participant's efforts' (95 and 88% respectively). Consultation length (mean 19 min, range 9-30) was shorter than the 30-min allocation. Quantity of content correlated with consultation length (p < 0.01). Advisors' use of motivational interviewing was rated at 'beginner proficiency' for Global Clinician Rating, Reflection to Question Ratio and Percent Open Questions. Therapeutic alliance scores were moderate. Affective aspects were rated highly (e.g. supportive encouragement, involvement and warmth). CONCLUSIONS: Intervention fidelity varied in both content and process, emphasising the importance of ongoing fidelity checks in a complex intervention. Advisors focused on certain practical aspects of the intervention and providing an encouraging interpersonal climate. This concurs with other research findings, which have revealed the value participants in a weight loss intervention place on an empathic advisor-participant relationship. CLINICAL TRIALS REGISTRATION: Registered with Clinicaltrials.gov, number NCT00891943, on 1 May 2009

Gynaecological cylindroma in association with CYLD gene mutation.

Cylindroma is a benign adnexal tumour that occurs as a solitary pink-red coloured nodule and is usually found on the scalp or neck. There have been few cases reported of these lesions being found on the genitalia. They can be found in single or in multiple form, with the latter usually inherited in an autosomal dominant pattern. CYLD lysine 63 deubiquitinase (CYLD) cutaneous syndrome, also known as Brooke-Spiegler syndrome, is a genetic condition characterized by the growth of multiple benign adnexal skin tumours. The most common tumours are cylindromas, spiradenomas and trichoepitheliomas. The cause of this syndrome can be attributed to mutations in the CYLD tumour suppressor gene. If both copies of this gene are mutated, the cell undergoes uncontrolled cell proliferation and division resulting in the formation of a tumour. Here, we present an unusual case of a female patient presenting with a large cylindroma over the mons pubis

Exploring needs, barriers to, and facilitators of rehabilitation exercise following revision hip replacement - a grounded theory study

Purpose: Evidence on rehabilitation after revision total hip replacement (THR) is inadequate and development of rehabilitation interventions is warranted. Even so, little is known about patients’ experiences with revision THR rehabilitation. This study aimed to explore patients' rehabilitation exercise experiences after revision THR.Materials and methods: Using constructivist grounded theory, we conducted semi-structured qualitative interviews with twelve patients with completed or almost completed rehabilitation exercise after revision THR. Data collection and analysis were a constant comparative process conducted in three phases; initial, focused, and theoretical.Findings: From the data, we generated a substantial theory of the participant’s circumstances and ability to integrate rehabilitation exercise into their everyday life after revision THR. Four categories were constructed based on patients’ experiences in different contexts: hesitance, fear avoidance, self-commitment, and fidelity.Conclusions: This study highlighted that patients’ expectations, past experiences, attitudes, trusts, engagement, and circumstances interact to influence engagement and adherence to rehabilitation exercise and described four categories relating to the integration of THR rehabilitation exercise into their everyday life. Clinicians should be aware of and account for these categories during rehabilitation exercise. Tailored individual rehabilitation exercise interventions and clinician approaches to optimize commitment and adherence are needed among patients with revision THR