Factors contributing to disability in a chronic low back pain population: A comprehensive analysis using continuous ambulatory monitoring

Disability in chronic low back pain patients has been established as a function of variables across three areas: pain, cognitive-behavioral variables, and social variables. New technology has improved the ability to accurately measure physical activity, a significant component of disability, through the use of actigraphy for real-time ambulatory monitoring. The current study assessed between and within patient changes in physical activity as a function of current pain, anticipated pain, pain sensitivity, depression, pain anxiety, catastrophizing, and significant others\u27 responses. Time-series and ordinary least squares regression analyses of 20 participants revealed that patients change their physical activity based on both their current experience of pain and their anticipation of future pain. Additionally, patients differ in amount of activity based on their sensitivity to pain, fear of pain, and receiving solicitous responses to their pain from a significant other. The results support the fear-avoidance model of pain through multiple findings: (1) some patients escape from current pain by decreasing activity; (2) some patients avoid future pain by engaging in low levels of activity when they anticipate their pain could worsen; (3) patients with higher sensitivity to pain engage in less physical activity; (4) patients who endorse more beliefs that their pain is harmful engage in less physical activity; and (5) patients whose significant others are overly responsive to the pain and inadvertently reinforce beliefs that pain is harmful also engage in less activity. However, a strength of this study was the ability to simultaneously analyze a wide variety of theoretically-based predictors. Results of this comprehensive analysis revealed that variables from the Social Model accounted for a statistically significant amount of the variance in physical activity. These results are particularly meaningful given that increase in physical activity is a core component of many treatments for chronic low back pain. By better understanding the variables that impact physical activity in low back pain patients, clinicians can more accurately assess patients and intervene more effectively

A comparison of the relationship between depression, perceived disability, and physical performance in persons with chronic pain

This study examined the relationships between self‐report of depressive symptoms, perceived disability, and physical performance among 267 persons with chronic pain. Prior research has reported a relationship between depression and disability using self‐report measures. However, self‐report instruments may be prone to biases associated with depression as depressed persons with pain may have an exaggerated negative view of their level of function. In addition, we examined whether the relationship between depression and functional activity was mediated by physiologic effort (as measured by heart rate). The results indicated that self‐report of depressive symptoms (using the Center for Epidemiological Studies‐Depression Scale (CES‐D)) was significantly correlated with self‐report of disability on the Quebec Back Pain Disability Scale (QBPDS) and physical performance on the Progressive Isoinertial Lifting Evaluation (PILE). Regression analyses revealed that depression assessed by the CES‐D significantly contributed to the prediction of QBPDS scores and PILE performance even when controlling for age, gender, site of pain, and pain intensity. The magnitude of the relationships between depression and self‐report and functional activity were similar, suggesting that a self‐report bias associated with depression is not responsible for an observed relationship between depression and disability. Physiologic effort partially mediated the relationship between depression and physical performance. The findings further highlight the importance of depression in the experience of chronic pain.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90095/1/j.ejpain.2007.11.003.pd

Reply to Rob Smeets’ letter to the editor regarding the article “A comparison of the relationship between depression, perceived disability, and physical performance in persons with chronic pain” (2008)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90330/1/j.ejpain.2008.08.007.pd

Cannabinoid use among Americans with MS : Current trends and gaps in knowledge

Acknowledgements: The National Multiple Sclerosis Society (NMSS) provided participant recruitment support. The Michigan Institute for Clinical & Health Research (MICHR:NIH award number UL1TR002240) provided participant recruitment support through UMHealthResearch.org. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or NMSS. The investigators thank Shubha Kulkarni for her assistance with data collection.Peer reviewedPublisher PD

The validity, responsiveness, and score interpretation of the PROMISnq Physical Function – Multiple Sclerosis 15a short form in multiple sclerosis

© 2022 Published by Elsevier B.V.Background A valid, sensitive patient-reported outcome (PRO) measure of physical function (PF) for people with multiple sclerosis (MS) would have substantial value in routine care and clinical research. We now describe development of the PROMISnq Short Form v2.0 PF – Multiple Sclerosis 15a [PROMISnq PF(MS)15a] for assessing PF in relapsing and progressive MS. Also, the validity, reliability, and responsiveness of the PROMISnq PF(MS)15a is evaluated, minimal important difference (MID) thresholds for score change estimated and a score interpretation guide developed. Methods A mixed-methods sequential design was employed. Relevant PF concepts were elicited through semi-structured interviews with people with relapsing MS, and then mapped to the PROMIS PF item bank. Measurement experts integrated results from interviews with people with MS and input from a panel of neurologists to generate a draft short form. Relevance and comprehensiveness of the draft short form were assessed in cognitive debriefing interviews with people with relapsing or progressive MS. Subsequently, item reduction and evaluation of psychometric properties were performed in two observational studies: a cross-sectional study in the US (n = 296), and a 96-week longitudinal study in the UK MS Register cohort (n = 558). The main outcomes and measures are estimates of: known-groups validity, convergent validity, reliability, responsiveness; MID for worsening. Results Factor analyses supported the unidimensionality of the newly derived 15-item short form. Cronbach's alpha (≥ 0.97) and intraclass correlation coefficient (≥ 0.97) of test-retest scores (5–27 days) indicated strong reliability. Convergent validity was demonstrated by moderate-to-strong correlations with scores on related PRO measures. Scores discriminated among patient groups classified by levels of physical health and other criteria. Score changes of 2.3–2.7 points are proposed as MID criteria for minimal worsening in PF. Conclusion PROMISnq PF(MS)15a demonstrated reliability, validity and sensitivity to change. Input from patients and clinicians ensured the content is comprehensive and relevant for people with MS.Peer reviewe

The Future of American Sentencing: A National Roundtable on Blakely

In the wake of the dramatic Supreme Court decision in Blakely v. Washington, Stanford Law School convened an assembly of the most eminent academic and professional sentencing experts in the country to jointly assess the meaning of the decision and its implications for federal and state sentencing reform. The event took place on October 8 and 9, just a few months after Blakely came down and the very week that the Supreme Court heard the arguments in United States v. Booker and United States v. Fanfan, the cases that will test Blakely\u27s application to the Federal Sentencing Guidelines. Thus the Roundtable offered these experts an intellectual breathing space at a crucial point in American criminal law. The event was built around six sessions, with shifting panels of participants doing brief presentations on the subject of the session, and with others then joining in the discussion. We are pleased that FSR is able to publish this version of the proceedings of the event-a condensed and edited transcript of the sessions