Pierre Langevin - Profile on Academia.edu (original) (raw)
Papers by Pierre Langevin
![Research paper thumbnail of Cervical radiculopathy: Study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen [NCT01500044]](https://attachments.academia-assets.com/117607633/thumbnails/1.jpg)
](BMC Musculoskeletal Disorders, Jan 31, 2012
Background: Cervical radiculopathy is a common form of neck pain and has been shown to lead to se... more Background: Cervical radiculopathy is a common form of neck pain and has been shown to lead to severe disability. Clinical rehabilitation approaches for cervical radiculopathies commonly include exercise and manual therapy interventions targeting the opening of intervertebral foramen, but evidence regarding their effectiveness is scarce. The primary objective of this randomised clinical trial is to compare, in terms of pain and disability, a rehabilitation program targeting the opening of intervertebral foramen to a conventional rehabilitation program, for patients presenting acute or subacute cervical radiculopathies. The hypothesis is that the rehabilitation program targeting the opening of intervertebral foramen will be significantly more effective in reducing pain and disability than the conventional rehabilitation program. Methods/Design: This study is a double-blind (participants and evaluators blinded) randomised clinical trial that will allow the comparison of patients with a cervical radiculopathy randomly assigned to one of two groups: one group will receive a 4-week rehabilitation program targeting the opening of intervertebral foramen, and the second group will receive a 4-week conventional rehabilitation program. Thirty-six subjects with cervical radiculopathy will be recruited from participating medical and physiotherapy clinics and will be evaluated at baseline, at the end of the 4-week program and four weeks following the end of the program. The primary outcome measure will be the validated Neck Disability Index questionnaire. Secondary outcome measures will include the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, a numerical pain rating scale, cervicothoracic mobility and patients' perceived global rating of change. During the 4-week rehabilitation program, each participant will take part in eight physiotherapy treatment sessions (2 session/week) and will perform a home exercise program. A mixed-model, 2-way ANOVA will be used to analyze the effects of the rehabilitation programs. Discussion: Control trials are needed to define ideal intervention approaches in rehabilitation for this population. This randomised clinical trial will be the first study that directly compares a rehabilitation program targeting the opening of intervertebral foramen to a conventional rehabilitation program for patients with cervical radiculopathy. The results of this study may help to establish best clinical practice guidelines for this patient population.
Journal of Orthopaedic & Sports Physical Therapy, 2015
Frontiers in sports and active living, May 11, 2023
Introduction: Trunk muscle endurance (TME) tests are commonly used by clinicians to assess muscle... more Introduction: Trunk muscle endurance (TME) tests are commonly used by clinicians to assess muscle performance changes in response to rehabilitation in patients with low back pain (LBP). The aim of this study was to assess the responsiveness of three TME-tests in patients with LBP and to evaluate the relationships between changes in TME and improvement in self-reported function. Materials and Methods: Eighty-four LBP patients were evaluated at baseline and after completion of a 6-week training program. Function was assessed with the modified Oswestry Disability Index (ODI) while TME was estimated using three tests: (1) the Biering-Sørensen, (2) the side bridge endurance tests (both sides), and (3) the trunk flexor endurance test. The standardized response mean (SRM) and the minimal clinical important difference (MCID) for each TME-test, and the relationships between changes in TME and improvement in ODI were calculated. Results: SRMs were small to large for TME-tests (range: 0.43-0.82), and large for the ODI (2.85) and no clinically useful MCID was identified for the TME-tests (area under the curve below 0.70). No significant correlations were found between changes in the TME and change in ODI scores (r < 0.15; all P > 0.05). Conclusion: Our results show a weak responsiveness of TME-tests in patients with LBP. There was no association between endurance performance change and selfreported functional change. TME-tests may not be a key component of rehabilitation monitoring in patients with LBP.
Physical therapy, Feb 19, 2021
Objective. The purpose of this review was to compare the efficacy of motor control exercises (MCE... more Objective. The purpose of this review was to compare the efficacy of motor control exercises (MCEs) to strengthening exercises for adults with upper-or lower-extremity musculoskeletal disorders (MSKDs). Methods. Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL, and CINAHL. Randomized controlled trials were identified on the efficacy of MCEs compared to strengthening exercises for adults with upper-or lower-extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MDs) and standardized mean differences (SMDs) were calculated using random-effects inverse variance models. Results. Twenty-one randomized controlled trials (n = 1244 participants) were included. Based on moderate-quality evidence, MCEs lead to greater pain (MD = −0.41 out of 10 points; 95% CI = −0.72 to −0.10; n = 626) and disability reductions (SMD = −0.28; 95% CI = −0.43 to −0.13; n = 713) when compared to strengthening exercises in the short term; these differences are not clinically important. When excluding trials on osteoarthritis (OA) participants and evaluating only the trials involving participants with rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain, or patellofemoral pain syndrome, there is moderate quality evidence that MCEs lead to greater pain (MD = −0.74 out of 10 points; 95% CI = −1.22 to −0.26; n = 293) and disability reductions (SMD = −0.40; 95% CI = −0.61 to −0.19; n = 354) than strengthening exercises in the short term; these differences might be clinically important. Conclusions. MCEs lead to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve OA. Inclusion of new trials might modify these conclusions. Impact. These results suggest that MCEs could be prioritized over strengthening exercises for adults with the included non-OA MSKDs; however, results are unclear for OA disorders.
Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review
Pain reports, Nov 1, 2021
A higher level of pain self-efficacy has been suggested as a predictor of a better outcome in pat... more A higher level of pain self-efficacy has been suggested as a predictor of a better outcome in patients with musculoskeletal disorders. The Pain Self-Efficacy Questionnaire (PSEQ) is one of the most frequently used patient-reported outcome measures for pain self-efficacy. The purpose of this study was to conduct a systematic review that would identify, appraise, and synthetize the psychometric properties of the PSEQ. Embase, MEDLINE, and CINAHL databases were searched for publications reporting on psychometric properties of the PSEQ in populations with musculoskeletal disorders. After applying selection criteria on identified citations, 28 studies (9853 participants) were included. The methodological quality as measured with the COSMIN risk of bias tool varied from adequate to very good for most measurement properties. The results showed a weighted mean intraclass correlation coefficient of 0.86 (range: 0.75–0.93) for test–retest reliability for the original 10-item PSEQ and the minimal detectable change at 95% confidence interval was 11.52 out of 60 points. Effect size and standardized response mean values were 0.53 and 0.63, respectively, whereas the minimal clinically important difference ranged from 5.5 to 8.5 in patients with chronic low back pain. Internal consistency (Cronbach alpha) ranged from 0.79 to 0.95. The results also showed that the PSEQ has low to moderate correlations with measures of quality of life, disability, pain, pain interference, anxiety, depression, and catastrophizing. Finally, the PSEQ has been adapted and validated in 14 languages. Overall, the results demonstrate that the PSEQ has excellent validity, reliability, and responsiveness. Further high-quality studies are needed to determine responsiveness in populations other than chronic low back pain.
Assessment of exercise‐induced hypoalgesia in chronic low back pain and potential associations with psychological factors and central sensitization symptoms: A case–control study
Pain Practice, Dec 12, 2022
Physiotherapy, May 1, 2015
The Cochrane library, Sep 23, 2015
Background: Patients with neuropathic pain experience higher levels of disability and pain compar... more Background: Patients with neuropathic pain experience higher levels of disability and pain compared to non-neuropathic pain patients. It is important to identify neuropathic pain early, preferably in primary care settings, to guide treatment decisions and prevent chronicity. There is lack of evidence whether the Dutch painDETECT questionnaire) and Douleure Neuropathique en 4 questions (DN4 DLV) can adequately assess neuropathic pain in patients with neck-arm pain and back-leg pain suspected of radiculopathy. Purpose: The purpose of this study was to evaluate the diagnostic accuracy and the test-retest reliability of the PDQ DLV and DN4 DLV compared to a consensus reference test diagnosis based on the grading system in patients with neck-arm pain or back-leg pain suspected of radiculopathy. Methods: Patients with neck-arm pain and back-leg pain suspected of cervical or lumbar radiculopathy referred from primary care, were eligible for inclusion. The painDETECT and DN4 screening lists were considered as the index tests. The reference test was the expert consensus diagnosis for neuropathic pain between a medical specialist and a physiotherapist by using the international accepted grading system. Diagnostic accuracy was determined by calculating the sensitivity, specificity, positive predictive values, negative predictive values, likely hood ratio's and diagnostic odds ratio's. Test-retest reliability for the index tests was assessed using intraclass correlation coefficients. Results: A total of 180 patients were included. Fifty-nine patients (33%) had neuropathic pain according to the reference test. Both the pain-DETECT and DN4 had moderate sensitivity of respectively 75% (95% CI: 61.6-85.0) and 76% (95% CI: 63.4-86.4) and poor specificity of respectively 51% (95% CI: 42.0-60.4) and 42% (95% CI: 33.2-51.5). A negative score on both screening lists increased the sensitivity up to 83% (95% CI: 71.0-91.6). Conclusion: Both the painDETECT) and the DN4 screening lists are not suitable in primary care to rule in or rule out neuropathic pain in patients with suspected cervical or lumbar radiculopathy. A combination of both screening lists seems to be somewhat better to rule out a neuropathic pain component, however the percentage false negative test-scores is still about 20%. Implications: The use of both the PDQ (DLV) and the DN4 (DLV) in patients with suspected radiculopathy in a primary care setting should not be recommended yet.
Moving from the clinic to telehealth during the COVID-19 pandemic – a pilot clinical trial comparing in-clinic rehabilitation versus telerehabilitation for persisting symptoms following a mild Traumatic brain injury
Disability and Rehabilitation
Manual Therapy, Sep 1, 2016
Background: Patients with neuropathic pain experience higher levels of disability and pain compar... more Background: Patients with neuropathic pain experience higher levels of disability and pain compared to non-neuropathic pain patients. It is important to identify neuropathic pain early, preferably in primary care settings, to guide treatment decisions and prevent chronicity. There is lack of evidence whether the Dutch painDETECT questionnaire) and Douleure Neuropathique en 4 questions (DN4 DLV) can adequately assess neuropathic pain in patients with neck-arm pain and back-leg pain suspected of radiculopathy. Purpose: The purpose of this study was to evaluate the diagnostic accuracy and the test-retest reliability of the PDQ DLV and DN4 DLV compared to a consensus reference test diagnosis based on the grading system in patients with neck-arm pain or back-leg pain suspected of radiculopathy. Methods: Patients with neck-arm pain and back-leg pain suspected of cervical or lumbar radiculopathy referred from primary care, were eligible for inclusion. The painDETECT and DN4 screening lists were considered as the index tests. The reference test was the expert consensus diagnosis for neuropathic pain between a medical specialist and a physiotherapist by using the international accepted grading system. Diagnostic accuracy was determined by calculating the sensitivity, specificity, positive predictive values, negative predictive values, likely hood ratio's and diagnostic odds ratio's. Test-retest reliability for the index tests was assessed using intraclass correlation coefficients. Results: A total of 180 patients were included. Fifty-nine patients (33%) had neuropathic pain according to the reference test. Both the pain-DETECT and DN4 had moderate sensitivity of respectively 75% (95% CI: 61.6-85.0) and 76% (95% CI: 63.4-86.4) and poor specificity of respectively 51% (95% CI: 42.0-60.4) and 42% (95% CI: 33.2-51.5). A negative score on both screening lists increased the sensitivity up to 83% (95% CI: 71.0-91.6). Conclusion: Both the painDETECT) and the DN4 screening lists are not suitable in primary care to rule in or rule out neuropathic pain in patients with suspected cervical or lumbar radiculopathy. A combination of both screening lists seems to be somewhat better to rule out a neuropathic pain component, however the percentage false negative test-scores is still about 20%. Implications: The use of both the PDQ (DLV) and the DN4 (DLV) in patients with suspected radiculopathy in a primary care setting should not be recommended yet.
Assessment of exercise‐induced hypoalgesia in chronic low back pain and potential associations with psychological factors and central sensitization symptoms: A case–control study
Pain Practice
Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury
Orthopaedic Journal of Sports Medicine
Background: The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity o... more Background: The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity of symptoms after a concussion/mild traumatic brain injury. However, its responsiveness to monitor clinical recovery has yet to be determined. Purpose: To evaluate the responsiveness of the PCSS to change and longitudinal validity in patients with persistent postconcussive symptoms as well as to explore the responsiveness of other clinical outcome measures to monitor recovery of physical symptoms in patients with persistent postconcussive symptoms. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with persistent symptoms after a concussion (N = 109) were evaluated using self-reported questionnaires at baseline and after a 6-week rehabilitation program. The program consisted of an individualized symptom-limited aerobic exercise program combined with education. Questionnaires included the PCSS, Neck Disability Index (NDI), Headache Disability Inventory (HDI), ...
Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review
PAIN Reports, 2021
The Pain Self-Efficacy Questionnaire has excellent validity, reliability, and responsiveness. Fur... more The Pain Self-Efficacy Questionnaire has excellent validity, reliability, and responsiveness. Further high-quality studies are needed to determine responsiveness in populations other than chronic low back pain.
Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury: A Randomised Clinical Trial
Journal of Neurotrauma, 2022
The objective of this study was to compare the effects of a cervicovestibular rehabilitation prog... more The objective of this study was to compare the effects of a cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to a SLAE program alone in adults with persistent symptoms following mild traumatic brain injury (mTBI) on severity of symptoms and other indicators of clinical recovery. In this single-blind, parallel-group randomised clinical trial, 60 adults with persistent symptoms following mTBI were randomly assigned to: 1) a 6-week SLAE program or 2) a 6-week cervicovestibular rehabilitation program combined with SLAE program. All participants took part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), time to return to function, and physical cervical and vestibular measures. Nonparametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes. For PCSS, NPRS, NDI, HDI, DHI and return to function, there were no group-by-time interactions at any time-points follow-up (p>0.05); clinically significant time effects were however observed (p0.05). There were group-by-time interactions at weeks 6 and 12 for vestibulo-ocular reflex (p0.003) and the cranio-vertebral mobility (p0.001) measures in favor of the cervicovestibular rehabilitation group. The study indicates that a cervicovestibular rehabilitation program combined with SLAE was not superior to a SLAE program alone in term of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function. Keywords: mild traumatic brain injury, rehabilitation, neck pain, dizziness, headache.
Additional file 1: of Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain
Illustrations of the exercises included in the multi-station program. (DOCX 923 kb)
Botulinum toxin injection therapy for neck pain: A systematic review
F1000Research, 2010
Physical Therapy, 2021
Objective The purpose of this review was to compare the efficacy of motor control exercises (MCE)... more Objective The purpose of this review was to compare the efficacy of motor control exercises (MCE) to strengthening exercises for adults with upper or lower extremity musculoskeletal disorders (MSKDs). Methods Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. Randomized controlled trials (RCTs) were identified on the efficacy of MCE compared to strengthening exercises for adults with upper or lower extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance models. Results Twenty-one RCTs (n = 1244 participants) were included. Based on moderate quality evidence, MCE leads to greater pain (MD = −0.41 out of 10 points; 95% CI = −0.72 to −0.10; n = 626) and disability reductions (SMD = −0.28; 95% CI = −0.43 to −0.13; n = 713) ...
Region-specific Exercises vs General Exercises in the Management of Spinal and Peripheral Musculoskeletal Disorders: A Systematic Review With Meta-analyses of Randomized Controlled Trials
Archives of Physical Medicine and Rehabilitation, 2021
OBJECTIVE To compare the efficacy of region-specific exercises to general exercises approaches fo... more OBJECTIVE To compare the efficacy of region-specific exercises to general exercises approaches for adults with spinal or peripheral musculoskeletal disorders (MSKDs). DESIGN Systematic review with meta-analyses. Mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance modeling. DATA SOURCES Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized control trials (RCTs) on the efficacy of region-specific exercises compared to general exercises approaches for adults with various MSKDs. RESULTS Eighteen RCTs (n=1,719) were included. Cohorts were composed of participants with chronic neck (n=313) or low back disorders (n=1,096) and knee OA (n=310). Based on low quality evidence in the short-term and very low quality in the mid- and long-term, there were no statistically significant differences between region-specific and general exercises in terms of pain and disability reductions for adults with spinal disorders or knee OA. Secondary analyses for pain reduction in the short-term for neck or low back disorders did not report any statistically significant differences according to very low to low quality of evidence. CONCLUSIONS The difference in treatment effect remains uncertain between region-specific and general exercises approaches. Based on very low to low quality evidence, there appear to have no differences between both types of exercise approaches for pain reduction or disability for adults with spinal disorders. Future trials may change the current conclusions. More evidence is needed for region-specific exercises compared to general exercises for other peripheral MSKDs including knee OA.
Medicine & Science in Sports & Exercise, 2020
Many scientific studies, especially in the biomedical sciences, generate data measured simultaneo... more Many scientific studies, especially in the biomedical sciences, generate data measured simultaneously over a multitude of units, over a period of time, and under different conditions or combinations of factors. Often, an important question of interest asked relates to which units behave similarly under different conditions, but measuring the variation over time complicates the analysis significantly. In this article we address such a problem arising from a gene expression study relating to bone aging, and develop a Bayesian statistical method that can simultaneously detect and uncover signals on three levels within such data: factorial, longitudinal, and transcriptional. Our model framework considers both cluster and time-point-specific parameters and these parameters uniquely determine the shapes of the temporal gene expression profiles, allowing the discovery and characterization of latent gene clusters based on similar underlying biological mechanisms. Our methodology was successfully applied to discover transcriptional networks in a microarray data set comparing the transcriptomic changes that occurred during bone aging in male and female mice expressing one or both copies of the bromodomain (Brd2) gene, a transcriptional regulator which exhibits an age-dependent sex-linked bone loss phenotype.
BMC Sports Science, Medicine and Rehabilitation, 2019
Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25%... more Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activatio...
BMC Musculoskeletal Disorders, Jan 31, 2012
Background: Cervical radiculopathy is a common form of neck pain and has been shown to lead to se... more Background: Cervical radiculopathy is a common form of neck pain and has been shown to lead to severe disability. Clinical rehabilitation approaches for cervical radiculopathies commonly include exercise and manual therapy interventions targeting the opening of intervertebral foramen, but evidence regarding their effectiveness is scarce. The primary objective of this randomised clinical trial is to compare, in terms of pain and disability, a rehabilitation program targeting the opening of intervertebral foramen to a conventional rehabilitation program, for patients presenting acute or subacute cervical radiculopathies. The hypothesis is that the rehabilitation program targeting the opening of intervertebral foramen will be significantly more effective in reducing pain and disability than the conventional rehabilitation program. Methods/Design: This study is a double-blind (participants and evaluators blinded) randomised clinical trial that will allow the comparison of patients with a cervical radiculopathy randomly assigned to one of two groups: one group will receive a 4-week rehabilitation program targeting the opening of intervertebral foramen, and the second group will receive a 4-week conventional rehabilitation program. Thirty-six subjects with cervical radiculopathy will be recruited from participating medical and physiotherapy clinics and will be evaluated at baseline, at the end of the 4-week program and four weeks following the end of the program. The primary outcome measure will be the validated Neck Disability Index questionnaire. Secondary outcome measures will include the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, a numerical pain rating scale, cervicothoracic mobility and patients' perceived global rating of change. During the 4-week rehabilitation program, each participant will take part in eight physiotherapy treatment sessions (2 session/week) and will perform a home exercise program. A mixed-model, 2-way ANOVA will be used to analyze the effects of the rehabilitation programs. Discussion: Control trials are needed to define ideal intervention approaches in rehabilitation for this population. This randomised clinical trial will be the first study that directly compares a rehabilitation program targeting the opening of intervertebral foramen to a conventional rehabilitation program for patients with cervical radiculopathy. The results of this study may help to establish best clinical practice guidelines for this patient population.
Journal of Orthopaedic & Sports Physical Therapy, 2015
Frontiers in sports and active living, May 11, 2023
Introduction: Trunk muscle endurance (TME) tests are commonly used by clinicians to assess muscle... more Introduction: Trunk muscle endurance (TME) tests are commonly used by clinicians to assess muscle performance changes in response to rehabilitation in patients with low back pain (LBP). The aim of this study was to assess the responsiveness of three TME-tests in patients with LBP and to evaluate the relationships between changes in TME and improvement in self-reported function. Materials and Methods: Eighty-four LBP patients were evaluated at baseline and after completion of a 6-week training program. Function was assessed with the modified Oswestry Disability Index (ODI) while TME was estimated using three tests: (1) the Biering-Sørensen, (2) the side bridge endurance tests (both sides), and (3) the trunk flexor endurance test. The standardized response mean (SRM) and the minimal clinical important difference (MCID) for each TME-test, and the relationships between changes in TME and improvement in ODI were calculated. Results: SRMs were small to large for TME-tests (range: 0.43-0.82), and large for the ODI (2.85) and no clinically useful MCID was identified for the TME-tests (area under the curve below 0.70). No significant correlations were found between changes in the TME and change in ODI scores (r < 0.15; all P > 0.05). Conclusion: Our results show a weak responsiveness of TME-tests in patients with LBP. There was no association between endurance performance change and selfreported functional change. TME-tests may not be a key component of rehabilitation monitoring in patients with LBP.
Physical therapy, Feb 19, 2021
Objective. The purpose of this review was to compare the efficacy of motor control exercises (MCE... more Objective. The purpose of this review was to compare the efficacy of motor control exercises (MCEs) to strengthening exercises for adults with upper-or lower-extremity musculoskeletal disorders (MSKDs). Methods. Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL, and CINAHL. Randomized controlled trials were identified on the efficacy of MCEs compared to strengthening exercises for adults with upper-or lower-extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MDs) and standardized mean differences (SMDs) were calculated using random-effects inverse variance models. Results. Twenty-one randomized controlled trials (n = 1244 participants) were included. Based on moderate-quality evidence, MCEs lead to greater pain (MD = −0.41 out of 10 points; 95% CI = −0.72 to −0.10; n = 626) and disability reductions (SMD = −0.28; 95% CI = −0.43 to −0.13; n = 713) when compared to strengthening exercises in the short term; these differences are not clinically important. When excluding trials on osteoarthritis (OA) participants and evaluating only the trials involving participants with rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain, or patellofemoral pain syndrome, there is moderate quality evidence that MCEs lead to greater pain (MD = −0.74 out of 10 points; 95% CI = −1.22 to −0.26; n = 293) and disability reductions (SMD = −0.40; 95% CI = −0.61 to −0.19; n = 354) than strengthening exercises in the short term; these differences might be clinically important. Conclusions. MCEs lead to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve OA. Inclusion of new trials might modify these conclusions. Impact. These results suggest that MCEs could be prioritized over strengthening exercises for adults with the included non-OA MSKDs; however, results are unclear for OA disorders.
Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review
Pain reports, Nov 1, 2021
A higher level of pain self-efficacy has been suggested as a predictor of a better outcome in pat... more A higher level of pain self-efficacy has been suggested as a predictor of a better outcome in patients with musculoskeletal disorders. The Pain Self-Efficacy Questionnaire (PSEQ) is one of the most frequently used patient-reported outcome measures for pain self-efficacy. The purpose of this study was to conduct a systematic review that would identify, appraise, and synthetize the psychometric properties of the PSEQ. Embase, MEDLINE, and CINAHL databases were searched for publications reporting on psychometric properties of the PSEQ in populations with musculoskeletal disorders. After applying selection criteria on identified citations, 28 studies (9853 participants) were included. The methodological quality as measured with the COSMIN risk of bias tool varied from adequate to very good for most measurement properties. The results showed a weighted mean intraclass correlation coefficient of 0.86 (range: 0.75–0.93) for test–retest reliability for the original 10-item PSEQ and the minimal detectable change at 95% confidence interval was 11.52 out of 60 points. Effect size and standardized response mean values were 0.53 and 0.63, respectively, whereas the minimal clinically important difference ranged from 5.5 to 8.5 in patients with chronic low back pain. Internal consistency (Cronbach alpha) ranged from 0.79 to 0.95. The results also showed that the PSEQ has low to moderate correlations with measures of quality of life, disability, pain, pain interference, anxiety, depression, and catastrophizing. Finally, the PSEQ has been adapted and validated in 14 languages. Overall, the results demonstrate that the PSEQ has excellent validity, reliability, and responsiveness. Further high-quality studies are needed to determine responsiveness in populations other than chronic low back pain.
Assessment of exercise‐induced hypoalgesia in chronic low back pain and potential associations with psychological factors and central sensitization symptoms: A case–control study
Pain Practice, Dec 12, 2022
Physiotherapy, May 1, 2015
The Cochrane library, Sep 23, 2015
Background: Patients with neuropathic pain experience higher levels of disability and pain compar... more Background: Patients with neuropathic pain experience higher levels of disability and pain compared to non-neuropathic pain patients. It is important to identify neuropathic pain early, preferably in primary care settings, to guide treatment decisions and prevent chronicity. There is lack of evidence whether the Dutch painDETECT questionnaire) and Douleure Neuropathique en 4 questions (DN4 DLV) can adequately assess neuropathic pain in patients with neck-arm pain and back-leg pain suspected of radiculopathy. Purpose: The purpose of this study was to evaluate the diagnostic accuracy and the test-retest reliability of the PDQ DLV and DN4 DLV compared to a consensus reference test diagnosis based on the grading system in patients with neck-arm pain or back-leg pain suspected of radiculopathy. Methods: Patients with neck-arm pain and back-leg pain suspected of cervical or lumbar radiculopathy referred from primary care, were eligible for inclusion. The painDETECT and DN4 screening lists were considered as the index tests. The reference test was the expert consensus diagnosis for neuropathic pain between a medical specialist and a physiotherapist by using the international accepted grading system. Diagnostic accuracy was determined by calculating the sensitivity, specificity, positive predictive values, negative predictive values, likely hood ratio's and diagnostic odds ratio's. Test-retest reliability for the index tests was assessed using intraclass correlation coefficients. Results: A total of 180 patients were included. Fifty-nine patients (33%) had neuropathic pain according to the reference test. Both the pain-DETECT and DN4 had moderate sensitivity of respectively 75% (95% CI: 61.6-85.0) and 76% (95% CI: 63.4-86.4) and poor specificity of respectively 51% (95% CI: 42.0-60.4) and 42% (95% CI: 33.2-51.5). A negative score on both screening lists increased the sensitivity up to 83% (95% CI: 71.0-91.6). Conclusion: Both the painDETECT) and the DN4 screening lists are not suitable in primary care to rule in or rule out neuropathic pain in patients with suspected cervical or lumbar radiculopathy. A combination of both screening lists seems to be somewhat better to rule out a neuropathic pain component, however the percentage false negative test-scores is still about 20%. Implications: The use of both the PDQ (DLV) and the DN4 (DLV) in patients with suspected radiculopathy in a primary care setting should not be recommended yet.
Moving from the clinic to telehealth during the COVID-19 pandemic – a pilot clinical trial comparing in-clinic rehabilitation versus telerehabilitation for persisting symptoms following a mild Traumatic brain injury
Disability and Rehabilitation
Manual Therapy, Sep 1, 2016
Background: Patients with neuropathic pain experience higher levels of disability and pain compar... more Background: Patients with neuropathic pain experience higher levels of disability and pain compared to non-neuropathic pain patients. It is important to identify neuropathic pain early, preferably in primary care settings, to guide treatment decisions and prevent chronicity. There is lack of evidence whether the Dutch painDETECT questionnaire) and Douleure Neuropathique en 4 questions (DN4 DLV) can adequately assess neuropathic pain in patients with neck-arm pain and back-leg pain suspected of radiculopathy. Purpose: The purpose of this study was to evaluate the diagnostic accuracy and the test-retest reliability of the PDQ DLV and DN4 DLV compared to a consensus reference test diagnosis based on the grading system in patients with neck-arm pain or back-leg pain suspected of radiculopathy. Methods: Patients with neck-arm pain and back-leg pain suspected of cervical or lumbar radiculopathy referred from primary care, were eligible for inclusion. The painDETECT and DN4 screening lists were considered as the index tests. The reference test was the expert consensus diagnosis for neuropathic pain between a medical specialist and a physiotherapist by using the international accepted grading system. Diagnostic accuracy was determined by calculating the sensitivity, specificity, positive predictive values, negative predictive values, likely hood ratio's and diagnostic odds ratio's. Test-retest reliability for the index tests was assessed using intraclass correlation coefficients. Results: A total of 180 patients were included. Fifty-nine patients (33%) had neuropathic pain according to the reference test. Both the pain-DETECT and DN4 had moderate sensitivity of respectively 75% (95% CI: 61.6-85.0) and 76% (95% CI: 63.4-86.4) and poor specificity of respectively 51% (95% CI: 42.0-60.4) and 42% (95% CI: 33.2-51.5). A negative score on both screening lists increased the sensitivity up to 83% (95% CI: 71.0-91.6). Conclusion: Both the painDETECT) and the DN4 screening lists are not suitable in primary care to rule in or rule out neuropathic pain in patients with suspected cervical or lumbar radiculopathy. A combination of both screening lists seems to be somewhat better to rule out a neuropathic pain component, however the percentage false negative test-scores is still about 20%. Implications: The use of both the PDQ (DLV) and the DN4 (DLV) in patients with suspected radiculopathy in a primary care setting should not be recommended yet.
Assessment of exercise‐induced hypoalgesia in chronic low back pain and potential associations with psychological factors and central sensitization symptoms: A case–control study
Pain Practice
Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury
Orthopaedic Journal of Sports Medicine
Background: The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity o... more Background: The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity of symptoms after a concussion/mild traumatic brain injury. However, its responsiveness to monitor clinical recovery has yet to be determined. Purpose: To evaluate the responsiveness of the PCSS to change and longitudinal validity in patients with persistent postconcussive symptoms as well as to explore the responsiveness of other clinical outcome measures to monitor recovery of physical symptoms in patients with persistent postconcussive symptoms. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with persistent symptoms after a concussion (N = 109) were evaluated using self-reported questionnaires at baseline and after a 6-week rehabilitation program. The program consisted of an individualized symptom-limited aerobic exercise program combined with education. Questionnaires included the PCSS, Neck Disability Index (NDI), Headache Disability Inventory (HDI), ...
Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review
PAIN Reports, 2021
The Pain Self-Efficacy Questionnaire has excellent validity, reliability, and responsiveness. Fur... more The Pain Self-Efficacy Questionnaire has excellent validity, reliability, and responsiveness. Further high-quality studies are needed to determine responsiveness in populations other than chronic low back pain.
Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury: A Randomised Clinical Trial
Journal of Neurotrauma, 2022
The objective of this study was to compare the effects of a cervicovestibular rehabilitation prog... more The objective of this study was to compare the effects of a cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to a SLAE program alone in adults with persistent symptoms following mild traumatic brain injury (mTBI) on severity of symptoms and other indicators of clinical recovery. In this single-blind, parallel-group randomised clinical trial, 60 adults with persistent symptoms following mTBI were randomly assigned to: 1) a 6-week SLAE program or 2) a 6-week cervicovestibular rehabilitation program combined with SLAE program. All participants took part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), time to return to function, and physical cervical and vestibular measures. Nonparametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes. For PCSS, NPRS, NDI, HDI, DHI and return to function, there were no group-by-time interactions at any time-points follow-up (p>0.05); clinically significant time effects were however observed (p0.05). There were group-by-time interactions at weeks 6 and 12 for vestibulo-ocular reflex (p0.003) and the cranio-vertebral mobility (p0.001) measures in favor of the cervicovestibular rehabilitation group. The study indicates that a cervicovestibular rehabilitation program combined with SLAE was not superior to a SLAE program alone in term of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function. Keywords: mild traumatic brain injury, rehabilitation, neck pain, dizziness, headache.
Additional file 1: of Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain
Illustrations of the exercises included in the multi-station program. (DOCX 923 kb)
Botulinum toxin injection therapy for neck pain: A systematic review
F1000Research, 2010
Physical Therapy, 2021
Objective The purpose of this review was to compare the efficacy of motor control exercises (MCE)... more Objective The purpose of this review was to compare the efficacy of motor control exercises (MCE) to strengthening exercises for adults with upper or lower extremity musculoskeletal disorders (MSKDs). Methods Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. Randomized controlled trials (RCTs) were identified on the efficacy of MCE compared to strengthening exercises for adults with upper or lower extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance models. Results Twenty-one RCTs (n = 1244 participants) were included. Based on moderate quality evidence, MCE leads to greater pain (MD = −0.41 out of 10 points; 95% CI = −0.72 to −0.10; n = 626) and disability reductions (SMD = −0.28; 95% CI = −0.43 to −0.13; n = 713) ...
Region-specific Exercises vs General Exercises in the Management of Spinal and Peripheral Musculoskeletal Disorders: A Systematic Review With Meta-analyses of Randomized Controlled Trials
Archives of Physical Medicine and Rehabilitation, 2021
OBJECTIVE To compare the efficacy of region-specific exercises to general exercises approaches fo... more OBJECTIVE To compare the efficacy of region-specific exercises to general exercises approaches for adults with spinal or peripheral musculoskeletal disorders (MSKDs). DESIGN Systematic review with meta-analyses. Mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance modeling. DATA SOURCES Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized control trials (RCTs) on the efficacy of region-specific exercises compared to general exercises approaches for adults with various MSKDs. RESULTS Eighteen RCTs (n=1,719) were included. Cohorts were composed of participants with chronic neck (n=313) or low back disorders (n=1,096) and knee OA (n=310). Based on low quality evidence in the short-term and very low quality in the mid- and long-term, there were no statistically significant differences between region-specific and general exercises in terms of pain and disability reductions for adults with spinal disorders or knee OA. Secondary analyses for pain reduction in the short-term for neck or low back disorders did not report any statistically significant differences according to very low to low quality of evidence. CONCLUSIONS The difference in treatment effect remains uncertain between region-specific and general exercises approaches. Based on very low to low quality evidence, there appear to have no differences between both types of exercise approaches for pain reduction or disability for adults with spinal disorders. Future trials may change the current conclusions. More evidence is needed for region-specific exercises compared to general exercises for other peripheral MSKDs including knee OA.
Medicine & Science in Sports & Exercise, 2020
Many scientific studies, especially in the biomedical sciences, generate data measured simultaneo... more Many scientific studies, especially in the biomedical sciences, generate data measured simultaneously over a multitude of units, over a period of time, and under different conditions or combinations of factors. Often, an important question of interest asked relates to which units behave similarly under different conditions, but measuring the variation over time complicates the analysis significantly. In this article we address such a problem arising from a gene expression study relating to bone aging, and develop a Bayesian statistical method that can simultaneously detect and uncover signals on three levels within such data: factorial, longitudinal, and transcriptional. Our model framework considers both cluster and time-point-specific parameters and these parameters uniquely determine the shapes of the temporal gene expression profiles, allowing the discovery and characterization of latent gene clusters based on similar underlying biological mechanisms. Our methodology was successfully applied to discover transcriptional networks in a microarray data set comparing the transcriptomic changes that occurred during bone aging in male and female mice expressing one or both copies of the bromodomain (Brd2) gene, a transcriptional regulator which exhibits an age-dependent sex-linked bone loss phenotype.
BMC Sports Science, Medicine and Rehabilitation, 2019
Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25%... more Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activatio...