Abstract
Objective
Multidimensional aspects of pain have raised awareness about cognitive appraisals, such as perceived injustice (PI) and pain catastrophizing (PC). It has been demonstrated that ...they play an important role in patients’ pain experience. However, the mediating effect of these appraisals has not been investigated in breast cancer survivors (BCS), nor have they been related to fatigue and sleep.
Methods
Cross-sectional data from 128 BCS were analysed by structural path analysis with the aim to examine the mediating effect of PI and PC in the relationship of pain on fatigue and sleep.
Results
The indirect mediating effects of PI on fatigue (CSI*PI = 0.21; P < .01 and VAS*PI = 1.19; P < .01) and sleep (CSI*PI = 0.31; P < .01 and VAS*PI = 1.74; P < .01) were found significant for both pain measures (Central Sensitization Inventory CSI and Visual Analogue Scale VAS). PC, on the other hand, only mediated the relationship between pain measured by VAS and fatigue (VAS*PC = 0.80; P = .03). Positive associations were found, indicating that higher pain levels are positively correlated with PI and PC, which go hand in hand with higher levels of fatigue and sleep problems.
Conclusions
PI is an important mediator in the relationship of pain on fatigue and sleep, while PC is a mediator on fatigue after cancer treatment. These findings highlight that both appraisals are understudied and open new perspectives regarding treatment strategies in BCS.
Background
Headache is identified as a common post‐COVID sequela experienced by COVID‐19 survivors. The aim of this pooled analysis was to synthesize the prevalence of post‐COVID headache in ...hospitalized and non‐hospitalized patients recovering from SARS‐CoV‐2 infection.
Methods
MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers, were searched up to 31 May 2021. Studies or preprints providing data on post‐COVID headache were included. The methodological quality of the studies was assessed using the Newcastle‐Ottawa Scale. Random effects models were used for meta‐analytical pooled prevalence of post‐COVID headache. Data synthesis was categorized at hospital admission/symptoms' onset, and at 30, 60, 90, and ≥180 days afterwards.
Results
From 9573 studies identified, 28 peer‐reviewed studies and 7 preprints were included. The sample was 28,438 COVID‐19 survivors (12,307 females; mean age: 46.6, SD: 17.45 years). The methodological quality was high in 45% of the studies. The overall prevalence of post‐COVID headache was 47.1% (95% CI 35.8–58.6) at onset or hospital admission, 10.2% (95% CI 5.4–18.5) at 30 days, 16.5% (95% CI 5.6–39.7) at 60 days, 10.6% (95% CI 4.7–22.3) at 90 days, and 8.4% (95% CI 4.6–14.8) at ≥180 days after onset/hospital discharge. Headache as a symptom at the acute phase was more prevalent in non‐hospitalized (57.97%) than in hospitalized (31.11%) patients. Time trend analysis showed a decreased prevalence from the acute symptoms’ onset to all post‐COVID follow‐up periods which was maintained afterwards.
Conclusion
This meta‐analysis found that the prevalence of post‐COVID headache ranged from 8% to 15% during the first 6 months after SARS‐CoV‐2 infection.
Headache is a common acute symptom of COVID‐19 and also a common post‐COVID‐19 symptom. The prevalence of post‐COVID headache ranged from 8% to 15% during the first 6 months after SARS‐CoV‐2 infection.
Objective
This study looked at differences in the presence of headache as an onset symptom of coronavirus disease 2019 (COVID‐19) and as a post‐COVID‐19 symptom in individuals previously hospitalized ...owing to infection with the Wuhan, Alpha, or Delta variants of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).
Background
Headache can be present in up to 50% of individuals during the acute phase of SARS‐CoV‐2 infection and in 10% of subjects during the post‐COVID‐19 phase. There are no data on differences in the occurrence of headache in the acute‐ and post‐COVID‐19 phase according to the SARS‐CoV‐2 variants.
Methods
A cross‐sectional cohort study was conducted. Unvaccinated subjects previously hospitalized for COVID‐19 caused by the Wuhan (n = 201), Alpha (n = 211), or Delta (n = 202) SARS‐CoV‐2 variants were scheduled for a telephone interview 6 months after hospital discharge. Hospitalization data were collected from hospital medical records.
Results
The presence of headache as a COVID‐19 onset symptom at hospitalization was higher in subjects with the Delta variant (66/202, 32.7%) than in those infected with the Wuhan (42/201, 20.9%; odds ratio OR 1.83, 95% confidence interval CI 1.17–2.88) or Alpha (25/211, 11.8%; OR 3.61, 95% CI, 2.16–6.01) variants. The prevalence of post‐COVID‐19 headache 6 months after hospital discharge was higher in individuals infected with the Delta variant (26/202, 12.9%) than in those infected with the Wuhan (11/201, 5.5%; OR 2.52, 95% CI 1.22–5.31) or Alpha (eight of 211, 3.8%; OR 3.74, 95% CI 1.65–8.49) variants. The presence of headache as a COVID‐19 onset symptom was associated with post‐COVID‐19 headache in subjects infected with the Wuhan (OR 7.75, 95% CI 2.15–27.93) and Delta variants (OR 2.78, 95% CI 1.20–6.42) but not with the Alpha variant (OR 2.60, 95% CI 0.49–13.69).
Conclusion
Headache was a common symptom in both the acute‐ and post‐COVID‐19 phase in subjects infected with the Wuhan, Alpha, and Delta variants but mostly in those infected with the Delta variant.
Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle ...instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211 ; P = 0 . 008 ; SPORTS: F = 13.943 ; P < 0 . 001 ) and for pain ( F = 44.420 ; P < 0 . 001 ): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.
The SARS‐CoV‐2 VIrus PERsistence (VIPER) study investigated the presence of long‐lasting SARS‐CoV‐2 RNA in plasma, stool, urine, and nasopharyngeal samples in COVID‐19 survivors. The presence of ...SARS‐CoV‐2 RNA reverse transcription polymerase chain reactions (RT‐PCR) were analyzed within plasma, stool, urine, and nasopharyngeal swab samples in COVID‐19 survivors with post‐COVID symptoms and a comparison group of COVID‐19 survivors without post‐COVID symptoms matched by age, sex, body mass index and vaccination status. Participants self‐reported the presence of any post‐COVID symptom (defined as a symptom that started no later than 3 months after the initial infection). Fifty‐seven (57.9% women, age: 51.1, standard deviation SD: 10.4 years) previously hospitalized COVID‐19 survivors with post‐COVID symptoms and 55 (56.4% women, age: 50.0, SD: 12.8 years) matched individuals who had a past SARS‐CoV‐2 infection without post‐COVID symptoms were evaluated 27 (SD 7.5) and 26 (SD 8.7) months after hospital discharge, respectively. The presence of SARS‐CoV‐2 RNA was identified in three nasopharyngeal samples of patients with post‐COVID symptoms (5.2%) but not in plasma, stool, or urine samples. Thus, SARS‐CoV‐2 RNA was not identified in any sample of survivors without post‐COVID symptoms. The most prevalent post‐COVID symptoms consisted of fatigue (93%), dyspnea, and pain (both, 87.7%). This study did not find SARS‐CoV‐2 RNA in plasma, stool, or urine samples, 2 years after the infection. A prevalence of 5.2% of SARS‐CoV‐2 RNA in nasopharyngeal samples, suggesting a potential active or recent reinfection, was found in patients with post‐COVID symptoms. These results do not support the association between SARS‐CoV‐2 RNA in plasma, stool, urine, or nasopharyngeal swab samples and post‐COVID symptomatology in the recruited population.
Abstract
Objective
The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for ...prescribing exercise to patients with migraine.
Methods
This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index ≥ 0.7 was obtained.
Results
The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients’ exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions.
Conclusion
From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients’ preferences and psychological considerations, level of physical activity, and possible adverse effects.
Impact
The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients’ psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.
Background
Previous evidence showed altered lumbar multifidus (LM) activation in populations with chronic nonspecific low back pain (LBP). We aimed to investigate the test–retest and inter‐examiner ...reliability of ultrasound imaging (US) for assessing LM thickness at rest and activation during the active straight leg raise test (ASLR) and the association between thickness changes with clinical outcomes.
Methods
Fifty‐two patients with LBP and two examiners (one experienced and one novice) participated in this study. A total of 18 B‐mode images at L4–L5 or L5–S1 level (both sides, 3 at rest and 6 during ASLR) were collected. For assessing test–retest reliability, the experienced examiner repeated the procedure after 7 days. Intraclass correlation coefficients (ICC), standard error of measurements (SEM) and minimal detectable changes (MDC) were calculated.
Results
Inter‐examiner agreement was good to excellent (ICC3,2 = 0.71–0.92) and test–retest reliability was excellent (ICC3,1 = 0.91–0.98). Mean average of multiple measurements improved the agreement. Greater LM thickness at rest (p < .05) and greater thickness change after 3 s (p < .01) and 10 s (homolateral side, p < .01; contralateral side, p < .05) were associated with less pain intensity.
Conclusions
US is a reliable method to assess the LM thickness at rest and contracted during the ASLR in patients with LBP. The measurement at 3 s after maintaining ASLR, as well as the use of the mean of three measurements, has been shown to be the most reliable method for measuring LM muscle thickness during ASLR.
Background
Although most common adverse events associated with dry needling can be considered minor, serious adverse events including induced pneumothorax cannot be excluded, and safety instructions ...for reducing the risk of pleura puncture are needed.
Objective
To investigate if anthropometric features can predict the rhomboid major muscle and pleura depth in a sample of healthy subjects to avoid the risk of pneumothorax during dry needling.
Methods
A diagnostic study was conducted on 59 healthy subjects (52.5% male) involving a total of 236 measurements (both sides in maximum inspiration and expiration), to calculate the accuracy of a prediction model for both pleura and rhomboid depth, as assessed with ultrasound imaging, based on sex, age, height, weight, body mass index (BMI), breathing and chest circumference. A correlation matrix and a multiple linear regression analyses were used to detect those variables contributing significantly to the variance in both locations.
Results
Men showed greater height, weight, BMI, thorax circumference and skin‐to‐rhomboid, rhomboid‐to‐pleura and skin‐to‐pleura distances (P < .001). Sex, BMI, and thorax circumference explained 51.5% of the variance of the rhomboid (P < .001) and 69.7% of pleura (P < .001) depth limit. In general, inserting a maximum length of 19 mm is recommended to reach the deep limit of rhomboid major decreasing the risk of passing through the pleura.
Conclusion
This study identified that gender, BMI and thorax circumference can predict both rhomboid and pleura depth, as assessed with ultrasonography, in healthy subjects. Our findings could assist clinicians in the needle length election in avoiding the risk of induced pneumothorax during dry needling.
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