Tactile acuity training for patients with chronic low back pain: a pilot randomised controlled trial

BACKGROUND: Chronic pain can disrupt the cortical representation of a painful body part. This disruption may play a role in maintaining the individual’s pain. Tactile acuity training has been used to normalise cortical representation and reduce pain in certain pain conditions. However, there is little evidence for the effectiveness of this intervention for chronic low back pain (CLBP). The primary aim of this study was to inform the development of a fully powered randomised controlled trial (RCT) by providing preliminary data on the effect of tactile acuity training on pain and function in individuals with CLBP. The secondary aim was to obtain qualitative feedback about the intervention. METHODS: In this mixed-methods pilot RCT 15 individuals were randomised to either an intervention (tactile acuity training) or a placebo group (sham tactile acuity training). All participants received 3 sessions of acuity training (intervention or sham) from a physiotherapist and were requested to undertake daily acuity home training facilitated by an informal carer (friend/relative). All participants also received usual care physiotherapy. The primary outcome measures were pain (0-100visual analogue scale (VAS)) and function (Roland Morris Disability Questionnaire (RMDQ)). Participants and their informal carers were invited to a focus group to provide feedback on the intervention. RESULTS: The placebo group improved by the greatest magnitude for both outcome measures, but there was no statistically significant difference (Mean difference (95%CI), p-value) between groups for change in pain (25.6 (-0.7 to 51.9), p = 0.056) or function (2.2 (-1.6 to 6.0), p = 0.237). Comparing the number of individuals achieving a minimally clinically significant improvement, the placebo group had better outcomes for pain with all participants achieving ≥30% improvement compared to only a third of the intervention group (6/6 vs. 3/9, p = 0.036). Qualitatively, participants reported that needing an informal carer was a considerable barrier to the home training component of the study. CONCLUSIONS: This pilot RCT found tactile acuity training to be no more effective than sham tactile acuity training for function and less effective for pain in individuals with CLBP. That the intervention could not be self-applied was a considerable barrier to its use. TRIAL REGISTRATION: ISRCTN: ISRCTN9811808

50 Myths and Lies That Threaten America\u27s Public Schools : The Real Crisis in Education

Two of the most respected voices in education and a team of young education scholars identify 50 myths and lies that threaten America\u27s public schools. With hard-hitting information and a touch of comic relief, Berliner, Glass, and their Associates separate fact from fiction in this comprehensive look at modern education reform. They explain how the mythical failure of public education has been created and perpetuated in large part by political and economic interests that stand to gain from its destruction. They also expose a rapidly expanding variety of organizations and media that intentionally misrepresent facts. Many of these organizations suggest that their goal is unbiased service in the public interest when, in fact, they represent narrow political and financial interests. Where appropriate, the authors name the promoters of these deceptions and point out how they are served by encouraging false beliefs.This provocative book features short essays on important topics to provide every elected representative, school administrator, school board member, teacher, parent, and concerned citizen with much food for thought, as well as reliable knowledge from authoritative sources

Mechanisms of motivation–cognition interaction: challenges and opportunities

Recent years have seen a rejuvenation of interest in studies of motivation–cognition interactions arising from many different areas of psychology and neuroscience. The present issue of Cognitive, Affective, & Behavioral Neuroscience provides a sampling of some of the latest research from a number of these different areas. In this introductory article, we provide an overview of the current state of the field, in terms of key research developments and candidate neural mechanisms receiving focused investigation as potential sources of motivation–cognition interaction. However, our primary goal is conceptual: to highlight the distinct perspectives taken by different research areas, in terms of how motivation is defined, the relevant dimensions and dissociations that are emphasized, and the theoretical questions being targeted. Together, these distinctions present both challenges and opportunities for efforts aiming toward a more unified and cross-disciplinary approach. We identify a set of pressing research questions calling for this sort of cross-disciplinary approach, with the explicit goal of encouraging integrative and collaborative investigations directed toward them.Psycholog