Perceived body distortion rather than actual body distortion is associated with chronic low back pain in adults with cerebral palsy: A preliminary investigation

Objectives: The aim of the present study was to investigate whether distorted body perception is a feature of the low back pain experience in people with Cerebral Palsy (CP) and whether any distortions noted are confounded by the presence of motor and postural impairments commonly seen in CP. Methods: Forty‐five individuals participated in this study: fifteen adults with CP with LBP (CP_Pain group), fifteen adults with CP without LBP (CP_noPain group), and fifteen age‐matched adults with LBP but no CP (Pain group). Body perception was evaluated using the Fremantle Back Awareness Questionnaire (FreBAQ) and by assessing two‐point discrimination (TPD) thresholds over the low back. A comprehensive assessment of motor function was also undertaken in the CP population and postural function was assessed in all three groups. Results: Significant differences between the three groups were found for FreBAQ scores (p \u3c 0.0001). The TPD threshold in the low back of the CP_Pain group was significantly larger than that of the CP_noPain group (p = 0.01), though we found no difference between the CP_noPain group and the Pain group (p = 0.21). We found no difference in motor or postural function between the two CP groups. Discussion: The present results suggest that body image is disrupted in people with CP who experience low back pain. The disruptions in perception were similar to those seen in people with LBP and no CP suggesting the distortions maybe more related to the presence of pain than the presence of CP. This article is protected by copyright. All rights reserved

Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis-generating study

Background: The purpose of this investigation was to undertake a hypothesis generating study to identify candidate variables that characterize people with knee osteoarthritis who are most likely to experience a positive response to exercise. Methods: One hundred and fifty participants with knee osteoarthritis participated in this observational, longitudinal study. All participants received a standard exercise intervention that consisted of 20-min sessions two to three times a week for three months. The classification and regression tree methodology (CART) was used to develop prediction of positive clinical outcome. Positive pain and disability outcomes (dependent variables) were defined as an improvement in pain intensity by \u3e50% or an improvement of five or more on the Oxford knee score, respectively. The predictor variables considered included age, sex, body mass index, knee osteoarthritis severity (Kellgren/Lawrence grade), pain duration, use of medication, range of knee motion, pain catastrophizing, self-efficacy and knee self-perception. Results: Fifty-five participants (36.6%) were classified as responders for pain intensity and 36.6% were classified as responders for disability. The CART model identified impairments in knee self-perception and knee osteoarthritis severity as the discriminators for pain intensity reduction following exercise. No variables predicted reduction of disability level following exercise. Conclusions: Such findings suggest that both body perception and osteoarthritis severity may play a role in treatment outcome with exercise. It also raises the possibility that those with higher levels of disrupted body perception may need additional treatment targeted at restoring body perception prior to undertaking exercise. Significance: Regardless age, sex, body mass index, pain duration, use of medication, knee range of motion, pain catastrophizing and self-efficacy, participants with knee osteoarthritis who report low levels of body perception disruption (a FreKAQ score ≦ 17) and minimal structural changes (KL grade I) demonstrate significantly better outcomes from exercise therapy than other participants

Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis

The aim of this study was to explore the existence of subgroups in a cohort of people with knee osteoarthritis (OA) based upon data from multiple pain-related variables and to profile identified clusters according to levels of pain intensity and knee-related disability. Three hundred and three people with knee OA were recruited. Latent profile analysis was used to confirm the optimal number of knee OA subgroups. Body mass index, radiographic knee OA severity, pain catastrophizing, pain related self-efficacy, and knee specific self-perception, were incorporated into the model. Cluster, demographic and clinical variables were compared between the resulting classes. Four distinct classes were identified. Cluster 1 (28.7%) represented early radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 2 (18.8%) showed advanced radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 3 (34.3%) represented various levels of radiographic OA, and the lowest pain intensity, disability and cognitive and perceptual dysfunction. Cluster 4 (18.1%) represented various levels of radiographic OA, the highest disability and cognitive and perceptual dysfunction. Considering cognitive factors and disturbed body perception may help to explain the phenomenon of the discrepancy between the knee-related disability and the severity of radiographic knee OA

Validation of the Japanese version of the Central Sensitization Inventory in patients with musculoskeletal disorders

Many musculoskeletal pain conditions are characterized by hypersensitivity, which is induced by central sensitization (CS). A questionnaire, the Central Sensitization Inventory (CSI), was recently developed to help clinicians identify patients whose presenting symptoms may be related to central sensitivity syndrome (CSS). The aims of the present study were to examine criterion validity and construct validity of the Japanese version of the CSI (CSI-J), and to investigate prevalence rates of CS severity levels in patients with musculoskeletal disorders.Translation of the CSI into Japanese was conducted using a forward-backward method. Two hundred and ninety patients with musculoskeletal pain disorders completed the resultant CSI-J. A subset of the patients (n = 158) completed the CSI-J again one week later. The relationships between CSI and clinical symptoms, EuroQol 5-dimension (EQ-5D) and Brief Pain Inventory (BPI), were examined for criterion validity. EQ-5D assesses Health-related QOL and BPI measures pain intensity and pain interference. The psychometric properties were evaluated with analyses of construct validity, factor structure and internal consistency, and subsequently investigate the prevalence rates of CS severity levels.The CSI-J demonstrated high internal consistency (Cronbach's α = 0.89) and test-retest reliability was excellent value (ICC = 0.85). The CSI-J was significantly correlated with EQ-5D (r = -0.44), pain intensity (r = 0.42), and pain interference (r = 0.48) (p < 0.01 for all). Ten percent of the participants were above the cutoff "40". The exploratory factor analysis resulted in 5-factor model.This study reported that the CSI-J was a useful and psychometrically sound tool to assess CSS in Japanese patients with musculoskeletal disorders. The finding of the prevalence rates of CS severity levels in patients with musculoskeletal disorders may help clinicians to decide strategy of treatment

Development and psychometric properties of short form of central sensitization inventory in participants with musculoskeletal pain: A cross-sectional study

<div><p>Background</p><p>The central sensitization inventory (CSI) comprises 25 items and is commonly used to measure somatic and emotional symptoms related to central sensitization symptoms. CSI was developed as an easy-to-administer screening instrument for patients at high risk of developing central sensitization in whom it was essential to quickly evaluate the condition. The purpose of the present study was to develop a short form of CSI and evaluate its psychometric properties using a contemporary approach called Rasch analysis.</p><p>Methods</p><p>A total of 505 patients with musculoskeletal disorders were recruited in this study. The CSI, pain intensity, pain interference, and the health-related quality of life (QOL) were evaluated for each participant. The original CSI items were consecutively analyzed using the Rasch model. Successive Rasch analyses were performed until a final set of items satisfied the model fit requirements. We also analyzed the psychometric properties of the original and short forms of CSI.</p><p>Results</p><p>Four consecutive Rasch analyses identified the removable items. Finally, the shortest questionnaire obtained that maintained the correct psychometric properties based on the Rasch model contained only 9 items (CSI-9). Rasch analysis showed that the CSI-9 had acceptable internal consistency, exhibited unidimensionality, had no notable differential item functioning, and was functional on the category rating scale.</p><p>Conclusions</p><p>The nine-item short form of CSI has acceptable psychometric properties and is suitable for use for patients with musculoskeletal pain. Thus, the CSI-9 can be used as a brief instrument to evaluate central sensitization.</p></div

Central sensitization inventory.

<p>C0, never; C1, rarely; C2, sometimes; C3, often; C4, always). a = CSI-25, b = CSI-9.</p

Exploratory factor analyses using ESEM.

<p>Exploratory factor analyses using ESEM.</p

Item characteristic curves for the best (Item 2) and worst (Item 23) ordered items in CSI-9.

<p>Item characteristic curves for the best (Item 2) and worst (Item 23) ordered items in CSI-9.</p

Demographic information.

<p>Demographic information.</p