Combining a psychological intervention with physiotherapy: A systematic review to determine the effect on physical function and quality of life for adults with chronic pain

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Background: Chronic pain affects approximately 28 million people in the UK. It does not always respond to conventional curative treatments and can have a devastating impact on an individual’s ability to function and perform life roles in the way they would like. Psychological approaches to pain management have been advocated for over 40 years, but it is unclear whether the addition of such approaches to physiotherapy increases treatment effectiveness. Objectives: To systematically review the literature to determine whether the addition of psychological approaches to physiotherapy is more effective in improving physical functioning and quality of life than physiotherapy alone. Methods: An electronic database search focused on randomised controlled trials comparing a physiotherapy intervention for chronic pain with a matched intervention with an additional psychological therapy component. All eligible studies were independently reviewed by two researchers and the strength of evidence and results evaluated. A meta-analysis was conducted on post-test mean data for physical functioning. Results: Eight studies were identified for inclusion. Meta-analysis of the data showed combined treatments to be superior in modifying functional outcomes (standardised mean difference −1.12 95% confidence intervals −1.94 to −0.31). This was echoed in the narrative review of the quality of life evidence. Study quality was variable and thus the findings should be interpreted with caution. Conclusions: There is evidence that combining physiotherapy and psychological approaches improves physical function in chronic pain in comparison with physiotherapy alone. Further examination of this field is required to inform changes in practice and to develop treatment methods

Immediate replacement of fishing with dairying by the earliest farmers of the NE Atlantic archipelagos

The appearance of farming, from its inception in the Near East around 12 000 years ago, finally reached the northwestern extremes of Europe by the fourth millennium BC or shortly thereafter. Various models have been invoked to explain the Neolithization of northern Europe; however, resolving these different scenarios has proved problematic due to poor faunal preservation and the lack of specificity achievable for commonly applied proxies. Here, we present new multi-proxy evidence, which qualitatively and quantitatively maps subsistence change in the northeast Atlantic archipelagos from the Late Mesolithic into the Neolithic and beyond. A model involving significant retention of hunter–gatherer–fisher influences was tested against one of the dominant adoptions of farming using a novel suite of lipid biomarkers, including dihydroxy fatty acids, ω-(o-alkylphenyl)alkanoic acids and stable carbon isotope signatures of individual fatty acids preserved in cooking vessels. These new findings, together with archaeozoological and human skeletal collagen bulk stable carbon isotope proxies, unequivocally confirm rejection of marine resources by early farmers coinciding with the adoption of intensive dairy farming. This pattern of Neolithization contrasts markedly to that occurring contemporaneously in the Baltic, suggesting that geographically distinct ecological and cultural influences dictated the evolution of subsistence practices at this critical phase of European prehistory

Adaptive latitudinal variation in Common Blackbird Turdus merula nest characteristics

Nest construction is taxonomically widespread, yet our understanding of adaptive intraspecific variation in nest design remains poor. Nest characteristics are expected to vary adaptively in response to predictable variation in spring temperatures over large spatial scales, yet such variation in nest design remains largely overlooked, particularly amongst open-cup-nesting birds. Here, we systematically examined the effects of latitudinal variation in spring temperatures and precipitation on the morphology, volume, composition, and insulatory properties of open-cup-nesting Common Blackbirds’ Turdus merula nests to test the hypothesis that birds living in cooler environments at more northerly latitudes would build better insulated nests than conspecifics living in warmer environments at more southerly latitudes. As spring temperatures increased with decreasing latitude, the external diameter of nests decreased. However, as nest wall thickness also decreased, there was no variation in the diameter of the internal nest cups. Only the mass of dry grasses within nests decreased with warmer temperatures at lower latitudes. The insulatory properties of nests declined with warmer temperatures at lower latitudes and nests containing greater amounts of dry grasses had higher insulatory properties. The insulatory properties of nests decreased with warmer temperatures at lower latitudes, via changes in morphology (wall thickness) and composition (dry grasses). Meanwhile, spring precipitation did not vary with latitude, and none of the nest characteristics varied with spring precipitation. This suggests that Common Blackbirds nesting at higher latitudes were building nests with thicker walls in order to counteract the cooler temperatures. We have provided evidence that the nest construction behavior of open-cup-nesting birds systematically varies in response to large-scale spatial variation in spring temperatures

Radiolabelling of Corynebacterium parvum and its distribution in mice.

Corynebacterium parvum was labelled by growing live bacteria in the presence of [3H]thymidine. The bacteria were killed by formalin, washed thoroughly and resuspended at a concentration of 7 mg dry weight/ml. An activity of 1-6 X 10(5) ct/min/0-1 ml was obtained. The biological properties (inhibition of tumour growth and hepatosplenomegaly) of the labelled C. parvum were compared with those of commercially available vaccine, and were found to be similar. Labelled C. parvum was injected i.v., i.p., or s.c. into normal C57BL mice and the localization of activity determined at 4 h and 1,3,7 and 14 days after injection. After i.v. or i.p. injection, highest counts were recorded in the liver. Moderate activity was found in the spleen, lungs and small gut. After s.c. injection, the majority of radioactive label was detected at the site of injection and little found in other tissues. The distribution of injected C. parvum was also studied in mice bearing Lewis tumour, and was found to be similar to that in normal mice. Moderate amounts of labelled C. parvum were recovered from tumour. There appeared to be no relationship between the antitumour effect of C. parvum given by a particular route of injection and the concentration of C. parvum recovered from the tumour

Development of a physical activity programme for people with recently diagnosed rheumatoid arthritis

Background People with rheumatoid arthritis (RA) are less physically active (PA) than the general population and lower PA levels are associated with work disability, reduced physical function and co-morbidities. This suggests an urgent need to identify programmes that effectively promote sustainable PA to improve physical function in RA.Objectives The purpose of this research was to seek patient's views in relation to a range of potential PA programmes.Methods Focus groups were carried out with adults with RA with participants purposefully sampled to reflect a range of age and gender. Prior to commencing the research a draft interview guide was reviewed by the study Patient Research Partner and a pilot interview conducted. The interview guide was designed to explore PA support needs and experiences since diagnosis as well as motivators and facilitators to support engagement in PA. Each focus group was subsequently provided with information regarding potential PA programmes and invited to comment upon their suitability for people with a recent diagnosis of RA. Focus groups were audio recorded, transcribed and anonymised. Ethics approval for the study was obtained. Written informed consent was obtained from all participants. Thematic analysis was used to identify the main themes across the groups. Emerging themes were verified through discussion and a coding framework based on these themes developed. Themes and sub-themes were subsequently reviewed and the interpretation and analysis discussed and agreed.Results Three focus groups were conducted with 19 patients in total (15 female, 4 male); mean age (SD) 60 (±10) years; mean time (SD) since diagnosis 44 (±34) months. There was strong support for a PA programme with four key themes garnered from the focus groups:Recruitment and adherence included programme endorsement from peers and PA endorsement from health professionals; the need for support to overcome barriers to PA, such as pain and fatigue; and prompts such as text messages to improve adherence.Programme scheduling included timing with most suggesting six to 12 months following diagnosis, once a stable drug regime was established; afternoon sessions were preferred; views on frequency of sessions and duration of the programme were disparate.Programme content included support for education on relaxation and coping strategies, medication, flare, fatigue and pain; supervised exercise sessions; home exercise training; and expert physiotherapy input. Goal setting received mixed opinions with emphasis on the need to be patient-led.Programme delivery suggested group sessions were preferred by most, but not all; individual sessions in addition to the group were positively received; telephone support polarised opinion; but an accessible location was an agreed priority.Conclusions Participants supported development of a PA programme delivered at an accessible location, by physiotherapists within six to 12 months of diagnosis. Mixed views relating to delivery suggests a flexible approach may need to be developed.Disclosure of Interest None declare

Testing a Grassroots Citizen Science Venture Using Open Design, “the Bee Lab Project”

The Bee Lab project applies Citizen Science and Open Design to beekeeping, enabling participants to construct monitoring devices gathering reciprocal data, motivating participants and third parties. The presented approach uses design workshops to provide insight into the design of kits, user motivations, promoting reciprocal interests and address community problems. This paper signposts issues and opportunities in the process of designing Citizen Science tools for communities using Open Design to solve individual problems, including: downloadable design for social/local change, laypeople creating technology and repairable kits

First light for avian embryos: eggshell thickness and pigmentation mediate variation in development and UV exposure in wild bird eggs

Article first published online: 29 JUL 20141. The avian embryo's development is influenced by both the amount and the wavelength of the light that passes through the eggshell. Commercial poultry breeders use light of specific wavelengths to accelerate embryonic growth, yet the effects of the variably patterned eggshells of wild bird species on light transmission and embryonic development remain largely unexplored. 2. Here, we provide the first comparative phylogenetic analysis of light transmission, through a diverse range of bird eggshells (74 British breeding species), in relation to the eggshell's thickness, permeability, pigment concentration and surface reflectance spectrum (colour). 3. The percentage of light transmitted through the eggshell was measured in the spectral range 250–700 nm. Our quantitative analyses confirm anecdotal reports that eggshells filter the light of the externally coloured shell. Specifically, we detected a positive relationship between surface eggshell reflectance (‘brightness’) and the percentage of light transmitted through the eggshell, and this relationship was strongest at wavelengths in the human-visible blue-green region of the spectra (c. 435 nm). 4. We show that less light passes through thicker eggshells with greater total pigment concentrations. By contrast, permeability (measured as water vapour conductance) did not covary significantly with light transmission. Eggs of closed-nesting species let more light pass through, compared with open nesters. 5. We postulate that greater light transmission is required to assist embryonic development under low light exposure. Importantly, this result provides an ecological explanation for the repeated evolution of immaculate, white- or pale-coloured eggshells in species nesting in enclosed spaces. 6. Finally, we detected correlative support for the solar radiation hypothesis, in that eggshells of bird species with a longer incubation period let significantly less of the potentially harmful, ultraviolet (UV) light pass through the eggshell. In summary, we demonstrate suites of avian eggshell properties, including eggshell structure and pigmentation, which are consistent with an evolutionary pressure to both enhance and protect embryonic development.Golo Maurer, Steven J. Portugal, Mark E. Hauber, Ivan Mikšík, Douglas G. D. Russell and Phillip Casse

Chemical evidence of dairying by hunter-gatherers in the highlands of Lesotho in the late first millennium AD

The recovery of Early Iron Age artefacts and domestic animal remains from hunter-gatherer contexts at Likoaeng, Lesotho, has been argued to indicate contact between highland hunter-gatherers and Early Iron Age agropastoralist communities settled in lowland areas of southeastern Africa during the second half of the first millennium ad. However, disagreement between archaeozoological studies and ancient DNA means that the possibility that those hunter-gatherers kept livestock themselves remains controversial. Here we report analyses of pottery-absorbed organic residues from two hunter-gatherer sites and one agriculturalist site in highland Lesotho to reconstruct prehistoric subsistence practices. Our results demonstrate the exploitation of secondary products from domestic livestock by hunter-gatherers in Lesotho, directly dated to the seventh century ad at Likoaeng and the tenth century ad at the nearby site of Sehonghong. The data provide compelling evidence for the keeping of livestock by hunter-gatherer groups and their probable incorporation as ancillary resources into their subsistence strategies

Repeatability of plantar pressure assessment during barefoot walking in people with stroke

Stroke-related changes in foot structure and function affect balance and mobility and quantifying foot function following stroke could offer clinically useful information to inform rehabilitation. The aim of this work was to explore the feasibility of undertaking plantar pressure assessment during barefoot walking in people with stroke, and evaluate the repeatability of the assessment protocol and regional footprint analysis as a measure of dynamic foot characteristics