Publications by authors named "Tasha R Stanton"

72 Publications

Assessing kinesthetic proprioceptive function of the upper limb: a novel dynamic movement reproduction task using a robotic arm.

PeerJ 2021 3;9:e11301. Epub 2021 May 3.

Experimental Health Psychology, University of Maastricht, Maastricht, Netherlands.

Background: Proprioception refers to the perception of motion and position of the body or body segments in space. A wide range of proprioceptive tests exists, although tests dynamically evaluating sensorimotor integration during upper limb movement are scarce. We introduce a novel task to evaluate kinesthetic proprioceptive function during complex upper limb movements using a robotic device. We aimed to evaluate the test-retest reliability of this newly developed Dynamic Movement Reproduction (DMR) task. Furthermore, we assessed reliability of the commonly used Joint Reposition (JR) task of the elbow, evaluated the association between both tasks, and explored the influence of visual information (viewing arm movement or not) on performance during both tasks.

Methods: During the DMR task, participants actively reproduced movement patterns while holding a handle attached to the robotic arm, with the device encoding actual position throughout movement. In the JR task, participants actively reproduced forearm positions; with the final arm position evaluated using an angle measurement tool. The difference between target movement pattern/position and reproduced movement pattern/position served as measures of accuracy. In study 1 ( = 23), pain-free participants performed both tasks at two test sessions, 24-h apart, both with and without visual information available (i.e., vision occluded using a blindfold). In study 2 ( = 64), an independent sample of pain-free participants performed the same tasks in a single session to replicate findings regarding the association between both tasks and the influence of visual information.

Results: The DMR task accuracy showed good-to-excellent test-retest reliability, while JR task reliability was poor: measurements did not remain sufficiently stable over testing days. The DMR and JR tasks were only weakly associated. Adding visual information (i.e., watching arm movement) had different performance effects on the tasks: it increased JR accuracy but decreased DMR accuracy, though only when the DMR task started with visual information available (i.e., an order effect).

Discussion: The DMR task's highly standardized protocol (i.e., largely automated), precise measurement and involvement of the entire upper limb kinetic chain (i.e., shoulder, elbow and wrist joints) make it a promising tool. Moreover, the poor association between the JR and DMR tasks indicates that they likely capture unique aspects of proprioceptive function. While the former mainly captures position sense, the latter appears to capture sensorimotor integration processes underlying kinesthesia, largely independent of position sense. Finally, our results show that the integration of visual and proprioceptive information is not straightforward: additional visual information of arm movement does not necessarily make active movement reproduction more accurate, on the contrary, when movement is complex, vision appears to make it worse.
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http://dx.doi.org/10.7717/peerj.11301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101453PMC
May 2021

Intact tactile anisotropy despite altered hand perception in complex regional pain syndrome: rethinking the role of the primary sensory cortex in tactile and perceptual dysfunction.

PeerJ 2021 3;9:e11156. Epub 2021 May 3.

Neuroscience Research Australia, NEURA, University of New South Wales, Sydney, New South Wales, Australia.

Complex Regional Pain Syndrome (CRPS) is characterised by pain, autonomic, sensory and motor abnormalities. It is associated with changes in the primary somatosensory cortex (S1 representation), reductions in tactile sensitivity (tested by two-point discrimination), and alterations in perceived hand size or shape (hand perception). The frequent co-occurrence of these three phenomena has led to the assumption that S1 changes underlie tactile sensitivity and perceptual disturbances. However, studies underpinning such a presumed relationship use tactile sensitivity paradigms that involve the processing of both non-spatial and spatial cues. Here, we used a task that evaluates anisotropy (i.e., orientation-dependency; a feature of peripheral and S1 representation) to interrogate spatial processing of tactile input in CRPS and its relation to hand perception. People with upper limb CRPS ( = 14) and controls with ( = 15) or without pain ( = 19) judged tactile distances between stimuli-pairs applied across and along the back of either hand to provide measures of tactile anisotropy. Hand perception was evaluated using a visual scaling task and questionnaires. Data were analysed with generalised estimating equations. Contrary to our hypotheses, tactile anisotropy was bilaterally preserved in CRPS, and the magnitude of anisotropic perception bias was comparable between groups. Hand perception was distorted in CRPS but not related to the magnitude of anisotropy or bias. Our results suggest against impairments in spatial processing of tactile input, and by implication S1 representation, as the cause of distorted hand perception in CRPS. Further work is warranted to elucidate the mechanisms of somatosensory dysfunction and distorted hand perception in CRPS.
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http://dx.doi.org/10.7717/peerj.11156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101475PMC
May 2021

Validation of the Bath CRPS Body Perception Disturbance Scale.

J Pain 2021 May 6. Epub 2021 May 6.

Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom; Centre for Pain Research, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom.

The Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") measures alterations in body perception. We assessed its internal consistency, known group validity, construct validity, and associations with demographic and clinical characteristics. We also evaluated changes in, and baseline predictors of B-CRPS-BPDS scores at follow-up. We included people with CRPS (N = 114) and pain-free controls (N = 69). People with CRPS obtained higher scores than pain-free controls on all B-CRPS-BPDS items, except the item on attention. Because this item also had an insufficient corrected item-total correlation, we propose a revised B-CRPS-BPDS (r-B-CRPS-BPDS) excluding this item. The internal consistency of the r-B-CRPS-BPDS was good. The r-B-CRPS-BPDS showed a large positive relationship with "motor neglect-like symptoms", indicating good construct validity. The r-B-CRPS-BPDS showed positive relationships with pain intensity, fear of movement, depression, and upper limb disability. There were no independent relationships with handedness, affected side, affected limb, disease duration, CRPS severity score, tension, anger, fatigue, confusion, and vigour. Finally, r-B-CRPS-BPDS scores did not consistently change over time. Our results demonstrate the utility of the r-B-CRPS-BPDS for measuring body perception disturbances in CRPS. PERSPECTIVE: This article evaluates the validity of the Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") in CRPS, and assesses relationships with demographic and clinical variables. The proposed revised B-CRPS-BPDS appears to be a valid measure of body perception disturbances in CRPS.
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http://dx.doi.org/10.1016/j.jpain.2021.04.007DOI Listing
May 2021

What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education.

Pain 2021 Feb 18. Epub 2021 Feb 18.

IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.

Abstract: Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by people with persistent pain who improved after a pain science education intervention. An online survey was distributed to 123 people who were treated for persistent pain with a pain science education approach; responses of participants who self-identified as "improved" were analysed. Open-ended survey questions were analysed using reflexive thematic analysis and close-ended questions were analysed for frequency of responses. Each question-type was analysed separately, before integration for complementarity. We analysed the data of 97 participants. We constructed 3 themes from the open-ended questions. Pain does not mean my body is damaged (theme 1) captured the importance of abandoning preexisting ideas that pain indicated damage. Thoughts, emotions and experiences affect pain (theme 2) captured the value of recognising multifactorial influences on pain. I can retrain my overprotective pain system (theme 3) captured the importance of conceptualising pain as a heightened protective response that could be lessened. Responses from close-ended questions confirmed that the target concepts represented by these themes are among those most valued, although divergence with the qualitative data suggests differences between patient and clinician language. These data offer patient-centred conceptualizations and language that could assist in further refining pain education interventions.
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http://dx.doi.org/10.1097/j.pain.0000000000002244DOI Listing
February 2021

Using Mediation Analysis to Understand How Treatments for Paediatric Pain Work: A Systematic Review and Recommendations for Future Research.

Children (Basel) 2021 Feb 16;8(2). Epub 2021 Feb 16.

Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK.

Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review examined studies that used mediation analysis to investigate mechanisms of interventions on pain-relevant outcomes for youth (3-18 years) with acute or chronic pain, and provides recommendations for future mediation research in this field. We searched five electronic databases for clinical trials or observational longitudinal studies that included a comparison group and conducted mediation analyses of interventions on youth and assessed pain outcomes. We found six studies ( = 635), which included a total of 53 mediation models examining how interventions affect pain-relevant outcomes for youth. Five studies were secondary analyses of randomized controlled trials of psychological interventions for chronic pain; one was a longitudinal observational study of morphine for acute pain. The pain conditions studied were irritable bowel syndrome, functional abdominal pain, juvenile fibromyalgia, mixed chronic pain, and post-operative pain. Fourteen putative mediators were tested, of which three partially mediated treatment effect; seven did not significantly mediate treatment effect and four had mixed results. Methodological and reporting limitations were common. There are substantial gaps in the field with respect to investigating, and therefore understanding, how paediatric interventions work.
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http://dx.doi.org/10.3390/children8020147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919827PMC
February 2021

Imprecise Visual Feedback About Hand Location Increases a Classically Conditioned Pain Expectancy Effect.

J Pain 2021 Jun 30;22(6):748-761. Epub 2021 Jan 30.

IIMPACT in Health, University of South Australia, Adelaide, Australia.

We tested the hypotheses that rendering sensory input about hand location imprecise increases a classically conditioned pain expectancy effect, increases generalization of the effect to novel locations and reduces extinction of the effect. Forty healthy volunteers performed movements with their right hand along predefined paths. Each path passed through 2 locations that were defined as either i) the conditioned stimulus (CS+; paired with a painful unconditioned stimulus), or ii) unpaired (CS-). During acquisition phase, participants watched their hand as they moved it. Participants were randomly allocated to an Imprecise group, for whom visual feedback of the hand was offset 30 to 50 mm from its true location, or a Precise group, for whom vision was not disrupted. In the test phase, participants moved their hands to 5 locations-the CS+, CS-, and 3 locations that lay between the 2 ("generalization stimuli"). Our primary hypothesis was supported-pain expectancy was greater at the CS+ location in the Imprecise group than in the Precise group (6.9 [SD = 1.9] vs 5.4 [SD = 2.5], P= .02). Pain expectancies generalized to novel locations similarly in both groups and there was no difference in extinction between groups. Our primary hypothesis was supported but our subsequent hypotheses were not. PERSPECTIVE: We conditioned pain expectancy at a certain location of one hand, even though most participants were unaware of the contingency. Conditioned pain expectancy was greater when sensory information about location was less precise. This adds support to the possibility that associative learning may play a role in the progression of an acute pain episode to a more generalized pain disorder.
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http://dx.doi.org/10.1016/j.jpain.2021.01.004DOI Listing
June 2021

A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: a feasibility study.

Pain Rep 2020 Sep-Oct;5(5):e830. Epub 2020 Sep 24.

Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia.

Introduction: Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit.

Objectives: To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis.

Methods: Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wrist-worn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback).

Results: Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had >75% valid wear-time. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of "physiotherapy", that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness.

Conclusions: Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.
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http://dx.doi.org/10.1097/PR9.0000000000000830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808687PMC
September 2020

Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain.

BMC Musculoskelet Disord 2021 Jan 21;22(1):98. Epub 2021 Jan 21.

Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University of South Australia, Adelaide, SA, Australia.

Background: There is evidence that people with persistent shoulder pain exhibit findings consistent with the presence of sensorimotor dysfunction. Sensorimotor impairments can manifest in a variety of ways, and further developing our understanding of sensorimotor dysfunction in shoulder pain may improve current models of care. The Fremantle Back Awareness Questionnaire (FreBAQ) has been developed to assess disturbed body perception specific to the back. The purpose of the present study was to develop a shoulder-specific self-perception questionnaire and evaluate the questionnaire in people with persistent shoulder pain.

Methods: The Fremantle Shoulder Awareness Questionnaire (FreSHAQ-J) was developed by modifying the FreBAQ. One hundred and twelve consecutive people with persistent shoulder pain completed the FreSHAQ-J. Thirty participants completed the FreSHAQ-J again two-weeks later to assess test-retest reliability. Rasch analysis was used to assess the psychometric properties of the FreSHAQ-J. Associations between FreSHAQ-J total score and clinical status was explored using correlational analysis.

Results: The FreSHAQ-J has acceptable category order, unidimensionality, no misfitting items, and excellent test-retest reliability. The FreSHAQ-J was moderately correlated with disability and pain catastrophization.

Conclusions: The FreSHAQ-J fits the Rasch measurement model well and is suitable for use with people with shoulder pain. Given the relationship between the FreSHAQ-J score and clinical status, change in body perception may be worth assessing when managing patients with shoulder pain.
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http://dx.doi.org/10.1186/s12891-021-03944-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819341PMC
January 2021

Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis-generating study.

Eur J Pain 2021 02 20;25(2):485-496. Epub 2020 Nov 20.

The Doctoral Course of Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.

Background: The purpose of this investigation was to undertake a hypothesis-generating study to identify candidate variables that characterize people with knee osteoarthritis who are most likely to experience a positive response to exercise.

Methods: One hundred and fifty participants with knee osteoarthritis participated in this observational, longitudinal study. All participants received a standard exercise intervention that consisted of 20-min sessions two to three times a week for three months. The classification and regression tree methodology (CART) was used to develop prediction of positive clinical outcome. Positive pain and disability outcomes (dependent variables) were defined as an improvement in pain intensity by >50% or an improvement of five or more on the Oxford knee score, respectively. The predictor variables considered included age, sex, body mass index, knee osteoarthritis severity (Kellgren/Lawrence grade), pain duration, use of medication, range of knee motion, pain catastrophizing, self-efficacy and knee self-perception.

Results: Fifty-five participants (36.6%) were classified as responders for pain intensity and 36.6% were classified as responders for disability. The CART model identified impairments in knee self-perception and knee osteoarthritis severity as the discriminators for pain intensity reduction following exercise. No variables predicted reduction of disability level following exercise.

Conclusions: Such findings suggest that both body perception and osteoarthritis severity may play a role in treatment outcome with exercise. It also raises the possibility that those with higher levels of disrupted body perception may need additional treatment targeted at restoring body perception prior to undertaking exercise.

Significance: Regardless age, sex, body mass index, pain duration, use of medication, knee range of motion, pain catastrophizing and self-efficacy, participants with knee osteoarthritis who report low levels of body perception disruption (a FreKAQ score ≦ 17) and minimal structural changes (KL grade I) demonstrate significantly better outcomes from exercise therapy than other participants.
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http://dx.doi.org/10.1002/ejp.1687DOI Listing
February 2021

Prevalence and incidence of phantom limb pain, phantom limb sensations and telescoping in amputees: A systematic rapid review.

Eur J Pain 2021 01 28;25(1):23-38. Epub 2020 Sep 28.

IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.

Background And Objective: This systematic, rapid review aimed to critically appraise and synthesize the recent literature (2014-2019) evaluating the incidence and prevalence of post-amputation phantom limb pain (PLP) and sensation (PLS).

Databases And Data Treatment: Five databases (Medline, Embase, Emcare, PsychInfo, Web of Science) and Google Scholar were searched, with two independent reviewers completing eligibility screening, risk of bias assessment and data extraction.

Results: The search identified 1,350 studies with 12 cross-sectional and 3 prospective studies included. Studies evaluated traumatic (n = 5), atraumatic (n = 4), and combined traumatic/atraumatic (n = 6) amputee populations, ranging from 1 month to 33 years post-amputation. Study heterogeneity prevented data pooling. The majority of studies had a high risk of bias, primarily due to limited generalizability. Three studies evaluated PLP incidence, ranging from 2.2% (atraumatic; 1 month) to 41% (combined; 3 months) and 82% (combined; 12 months). Only one study evaluated PLS/telescoping incidence. Across contrasting populations, PLP point prevalence was between 6.7%-88.1%, 1 to 3-month period prevalence was between 49%-93.5%, and lifetime prevalence was high at 76%-87%. Point prevalence of PLS was 32.4%-90%, period prevalence was 65% (1 month) and 56.9% (3 months), and lifetime prevalence was 87%. Telescoping was less prevalent, highest among traumatic amputees (24.6%) within a 1-month prevalence period. Variations in population type (e.g. amputation characteristics) and incidence and prevalence measures likely influence the large variability seen here.

Conclusions: This review found that lifetime prevalence was the highest, with most individuals experiencing some type of phantom phenomena at some point post-amputation.

Significance: This systematic rapid review provides a reference for clinicians to make informed prognosis estimates of phantom phenomena for patients undergoing amputation. Results show that most amputees will experience phantom limb pain (PLP) and phantom limb sensations (PLS): high PLP incidence 1-year post-amputation (82%); high lifetime prevalence for PLP (76%-87%) and PLS (87%). Approximately 25% of amputees will experience telescoping. Consideration of individual patient characteristics (cause, amputation site, pre-amputation pain) is pertinent given their likely contribution to incidence/prevalence of phantom phenomena.
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http://dx.doi.org/10.1002/ejp.1657DOI Listing
January 2021

The RESOLVE Trial for people with chronic low back pain: statistical analysis plan.

Braz J Phys Ther 2021 Jan-Feb;25(1):103-111. Epub 2020 Jun 18.

Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia.

Background: Statistical analysis plans describe the planned data management and analysis for clinical trials. This supports transparent reporting and interpretation of clinical trial results. This paper reports the statistical analysis plan for the RESOLVE clinical trial. The RESOLVE trial assigned participants with chronic low back pain to graded sensory-motor precision training or sham-control.

Results: We report the planned data management and analysis for the primary and secondary outcomes. The primary outcome is pain intensity at 18-weeks post randomization. We will use mixed-effects models to analyze the primary and secondary outcomes by intention-to-treat. We will report adverse effects in full. We also describe analyses if there is non-adherence to the interventions, data management procedures, and our planned reporting of results.

Conclusion: This statistical analysis plan will minimize the potential for bias in the analysis and reporting of results from the RESOLVE trial.

Trial Registration: ACTRN12615000610538 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619).
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http://dx.doi.org/10.1016/j.bjpt.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817870PMC
April 2021

Study protocol for a 9-month randomised controlled trial assessing the effects of almonds versus carbohydrate-rich snack foods on weight loss and weight maintenance.

BMJ Open 2020 07 19;10(7):e036542. Epub 2020 Jul 19.

Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia

Introduction: Epidemiological studies indicate an inverse association between nut consumption and body mass index (BMI). However, clinical trials evaluating the effects of nut consumption compared with a nut-free diet on adiposity have reported mixed findings with some studies reporting greater weight loss and others reporting no weight change. This paper describes the rationale and detailed protocol for a randomised controlled trial assessing whether the inclusion of almonds or carbohydrate-rich snacks in an otherwise nut-free energy-restricted diet will promote weight loss during 3 months of energy restriction and limit weight regain during 6 months of weight maintenance.

Methods And Analysis: One hundred and thirty-four adults aged 25-65 years with a BMI of 27.5-34.9 kg/m will be recruited and randomly allocated to either the almond-enriched diet (AED) (15% energy from almonds) or a nut-free control diet (NFD) (15% energy from carbohydrate-rich snack foods). Study snack foods will be provided. Weight loss will be achieved through a 30% energy restriction over 3 months, and weight maintenance will be encouraged for 6 months by increasing overall energy intake by ~120-180 kcal/day (~500-750kJ/day) as required. Food will be self-selected, based on recommendations from the study dietitian. Body composition, resting energy expenditure, total daily energy expenditure (via doubly labelled water), physical activity, appetite regulation, cardiometabolic health, gut microbiome, liver health, inflammatory factors, eating behaviours, mood and personality, functional mobility and pain, quality of life and sleep patterns will be measured throughout the 9-month trial. The effects of intervention on the outcome measures over time will be analysed using random effects mixed models, with treatment (AED or NFD) and time (baseline, 3 months and 9 months) being the between and within factors, respectively in the analysis.

Ethics And Dissemination: Ethics approval was obtained from the University of South Australia Human Research Ethics Committee (201436). Results from this trial will be disseminated through publication in peer-reviewed journals, national and international presentations.

Trial Registration Number: Australian New Zealand Clinical Trials Registry (ACTRN12618001861246).
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http://dx.doi.org/10.1136/bmjopen-2019-036542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371143PMC
July 2020

The effect of multisensory illusions on pain and perceived burning sensations in patients with Burning Mouth Syndrome: A proof-of-concept study.

J Oral Pathol Med 2020 Jul 28;49(6):505-513. Epub 2020 Jun 28.

Innovation, Implementation and Clinical Translation (IIMPACT), University of South Australia, Adelaide, SA, Australia.

Background: Burning mouth syndrome (BMS) is a chronic pain disorder affecting the oral cavity. Previous work has shown promising analgesic results of bodily illusions in other chronic pain conditions. The aim of this proof-of-concept, pilot study was to investigate whether bodily illusions reduce pain in BMS patients.

Methods: Nine participants diagnosed with BMS underwent bodily illusions using a MIRAGE-mediated reality system. All participants completed four conditions and performed standardised movements of the tongue. First, a baseline condition was performed while the tongue was viewed at normal size and colour. Then, three conditions were performed in random order: resizing shrink, colour-based (blue tongue) and incongruent movement illusions. During each condition, participants rated overall pain intensity and the intensity of burning pain/sensation on the tongue.

Results: There was no difference in overall pain intensity ratings between conditions. However, a significant effect of condition was found for burning pain/sensation of the tongue. The colour illusion significantly reduced burning pain compared with baseline (MD = -12.8, 95% CI -20.7 to -4.8), corresponding to an average pain reduction of 32%. Exploratory analyses showed the colour illusion also significantly reduced pain compared with the shrink illusion (MD = -11.7, 95% CI -22.2 to -1.1).

Conclusion: Using visual illusions to change tongue colour to blue resulted in significant reductions in burning pain/sensations in BMS patients for the duration of the illusion. This proof-of-concept study suggests that BMS patients may benefit from bodily illusions, and supports additional research using larger samples and more comprehensive control conditions.
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http://dx.doi.org/10.1111/jop.13065DOI Listing
July 2020

Implicit motor imagery performance is impaired in people with chronic, but not acute, neck pain.

PeerJ 2020 14;8:e8553. Epub 2020 Feb 14.

IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.

Background: People with chronic neck pain have impaired proprioception (i.e., sense of neck position). It is unclear whether this impairment involves disruptions to the proprioceptive representation in the brain, peripheral factors, or both. Implicit motor imagery tasks, namely left/right judgements of body parts, assess the integrity of the proprioceptive represention. Previous studies evaluating left/right neck judgements in people with neck pain are conflicting. We conducted a large online study to comprehensively address whether people with neck pain have altered implicit motor imagery performance.

Methods: People with and without neck pain completed online left/right judgement tasks followed by a left/right judgement task (control). Participants judged whether the person in the image had their head rotated to their left or right side (neck task) or whether the image was of a left hand or a right hand (hand task). Participants were grouped on neck pain status (no pain; <3 months-acute; ≥3 months-chronic) and pain location (none, left-sided, right-sided, bilateral). Outcomes included accuracy (primary) and response time (RT; secondary). Our hypotheses-that (i) chronic neck pain is associated with disrupted performance for neck images and (ii) the disruption is dependent on the side of usual pain, were tested with separate ANOVAs.

Results: A total of 1,404 participants were recruited: 105 reported acute neck pain and 161 reported chronic neck pain. When grouped on neck pain status, people with chronic neck pain were less accurate than people without neck pain ( = 0.001) for left/right neck judgements, but those with acute neck pain did not differ from those without neck pain ( = 0.14) or with chronic neck pain ( = 0.28). Accuracy of left/right hand judgements did not differ between groups ( = 0.58). RTs did not differ between groups for any comparison. When grouped on neck pain location, people were faster and more accurate at identifying right-turning neck images than left-turning neck images, regardless of history or location of pain ( < 0.001 for both); people with no pain were more accurate and faster than people with bilateral neck pain ( = 0.001, = 0.015) and were faster than those with left-sided neck pain ( = 0.021); people with right-sided neck pain were more accurate than people with bilateral neck pain ( = 0.018). Lastly, there was a significant interaction between neck image and side of neck pain: people with right-sided neck pain were more accurate at identifying right-sided neck turning images than people with left-sided neck pain ( = 0.008), but no different for left-sided neck turning images ( = 0.62).

Conclusions: There is evidence of impaired implicit motor imagery performance in people with chronic neck pain, which may suggest disruptions to proprioceptive representation of the neck. These disruptions seem specific to the neck (performance on hand images intact) but non-specific to the exact location of neck pain.
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http://dx.doi.org/10.7717/peerj.8553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025709PMC
February 2020

The Influence of Auditory Cues on Bodily and Movement Perception.

Front Psychol 2019 17;10:3001. Epub 2020 Jan 17.

Crossmodal Research Laboratory, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.

The sounds that result from our movement and that mark the outcome of our actions typically convey useful information concerning the state of our body and its movement, as well as providing pertinent information about the stimuli with which we are interacting. Here we review the rapidly growing literature investigating the influence of non-veridical auditory cues (i.e., inaccurate in terms of their context, timing, and/or spectral distribution) on multisensory body and action perception, and on motor behavior. Inaccurate auditory cues provide a unique opportunity to study cross-modal processes: the ability to detect the impact of each sense when they provide a slightly different message is greater. Additionally, given that similar cross-modal processes likely occur regardless of the accuracy or inaccuracy of sensory input, studying incongruent interactions are likely to also help us predict interactions between congruent inputs. The available research convincingly demonstrates that perceptions of the body, of movement, and of surface contact features (e.g., roughness) are influenced by the addition of non-veridical auditory cues. Moreover, auditory cues impact both motor behavior and emotional valence, the latter showing that sounds that are highly incongruent with the performed movement induce feelings of unpleasantness (perhaps associated with lower processing fluency). Such findings are relevant to the design of auditory cues associated with product interaction, and the use of auditory cues in sport performance and therapeutic situations given the impact on motor behavior.
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http://dx.doi.org/10.3389/fpsyg.2019.03001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978806PMC
January 2020

The effect of knee resizing illusions on pain and swelling in symptomatic knee osteoarthritis: a case report.

Pain Rep 2019 Nov-Dec;4(6):e795. Epub 2019 Nov 21.

IIMPACT in Health, The University of South Australia, Adelaide, South Australia, Australia.

Introduction: Resizing illusions that manipulate perceived body size are analgesic in some chronic pain conditions. Little is known whether such illusions may also alter other physiological features, such as swelling.

Objectives: To determine the effects of a knee resizing illusion on knee pain and swelling in symptomatic osteoarthritis.

Methods: This case study was extracted from a larger study evaluating the analgesic effects of resizing illusions in people with knee osteoarthritis. A mediated reality system (alters real-time video) was used to provide resizing "stretch" and "shrink" illusions of the knee. Knee pain intensity (0-100 numerical rating scale) was measured before and after illusion and after sustained (3 minutes) and repeated (n = 10) illusions. In this case study, knee swelling (leg circumference below, at, and above the knee) was also measured.

Results: The 55-year-old male participant reported a long history of episodic knee pain and swelling that was subsequently diagnosed as severe osteoarthritis in 2013. In the first testing session, the participant experienced an increase in pain with the shrink illusion and a decrease in pain with stretch illusion. A noticeable increase in knee swelling was also observed. Thus, in sessions 2/3, swelling was also assessed. The stretch illusion decreased pain to the largest extent, but resulted in increased knee swelling. Repeated and sustained stretch illusions had cumulative analgesic effects but resulted in cumulative increases in swelling. While the shrink illusion increased pain, sustained (∼10 minutes) visual minification of the entire knee and leg reduced both pain and swelling.

Conclusion: Our case report suggests that both pain and swelling may be modifiable by altering body-relevant sensory input in symptomatic knee osteoarthritis.
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http://dx.doi.org/10.1097/PR9.0000000000000795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903346PMC
November 2019

What is the effect of bodily illusions on corticomotoneuronal excitability? A systematic review.

PLoS One 2019 15;14(8):e0219754. Epub 2019 Aug 15.

BodyinMind Research Group, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.

Background: This systematic review aimed to summarise and critically appraise the evidence for the effect of bodily illusions on corticomotoneuronal excitability.

Methods: Five databases were searched, with two independent reviewers completing study inclusion, risk of bias, transcranial magnetic stimulation (TMS) reporting quality, and data extraction. Included studies evaluated the effect of an illusion that altered perception of the body (and/or its movement) on excitability of motor circuitry in healthy, adult, human participants. Studies were required to: use TMS to measure excitability and/or inhibition; report quantitative outcomes (e.g., motor evoked potentials); compare the illusion to a control or active comparison condition; evaluate that an illusion had occurred (e.g., measured illusion strength/presence).

Results: Of 2,257 studies identified, 11 studies (14 experiments) were included, evaluating kinaesthetic illusions (n = 5), a rubber hand illusion (RHI) paradigm (n = 5), and a missing limb illusion (n = 1). Kinaesthetic illusions (induced via vision/tendon vibration) increased corticomotoneuronal excitability. Conflicting effects were found for traditional, visuotactile RHIs of a static hand. However, embodying a hand and then observing it move ("self-action") resulted in decreased corticomotoneuronal excitability and increased silent period duration (a measure of Gamma-Aminobutynic acid [GABA]B-mediated intracortical inhibition in motor cortex), with the opposite occurring (increased excitability, decreased inhibition) when the fake hand was not embodied prior to observing movement ("other-action"). Visuomotor illusions manipulating agency had conflicting results, but in the lower risk study, illusory agency over movement resulted in a relative decrease in corticomotoneuronal excitability. Last, an illusion of a missing limb reduced corticomotoneuronal excitability.

Conclusion: While evidence for the effect of bodily illusions on corticomotoneuronal excitability was limited (only 14 experiments) and had a high risk of bias, kinaesthetic illusions and illusions of embodying a hand (and seeing it move), had consistent effects. Future investigations into the role of embodiment and the illusion strength on corticomotoneuronal excitability and inhibition are warranted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219754PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695177PMC
March 2020

Does readiness to change influence pain-related outcomes after an educational intervention for people with chronic pain? A pragmatic, preliminary study.

Physiother Theory Pract 2021 May 3;37(5):608-619. Epub 2019 Jul 3.

Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.

: There is a strong association between chronic pain and unhelpful pain cognitions. Educating patients on pain neuroscience has been shown to reduce pain catastrophization, kinesiophobia, and self-perceived disability. This study investigated whether a group-based pain neuroscience education (PNE) session influenced pain-related outcomes, and whether readiness to change moderated these outcomes.: In a pragmatic pre-post-intervention study using a convenience sample, adults with chronic pain participated in one, 90-120 minute PNE session. Pain-related outcomes (i.e. pain catastrophization, kinesiophobia, disability, and pain neuroscience knowledge) and the Pain Stage of Change Questionnaire (PSOCQ) were assessed at baseline and immediately post-intervention. Paired t-tests evaluated pre-post changes in outcomes, and linear regression examined the impact of PSOCQ score changes on PNE-induced changes in clinical outcomes.: Sixty-five participants were recruited. All outcomes showed positive intervention effects ( < .01). Relationships between changes in PSOCQ subscale scores and change in post-intervention pain-related outcomes were found; 'Pre-Contemplation' was positively associated with pain catastrophization ( = .01), and 'Action' was negatively associated with kinesiophobia ( = .03).: Consistent with previous research, there were improvements in outcomes associated with chronic pain after PNE. Some of these improvements were predicted by changes in PSOCQ scores, however, these findings are preliminary and require further investigation using controlled research designs.
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http://dx.doi.org/10.1080/09593985.2019.1636436DOI Listing
May 2021

Pain Education for Adolescents and Young Adults Living Beyond Cancer: An Interdisciplinary Meeting Report.

J Adolesc Young Adult Oncol 2019 10 31;8(5):529-533. Epub 2019 May 31.

School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.

Pain is an understudied and undertreated consequence of cancer survival. Pain education is now a recommended treatment approach for persistent non-cancer pain, yet it has not been well applied to the context of adolescent and young adult (AYA) cancer survival. In March 2018, an interdisciplinary meeting was held in Adelaide, South Australia to set a research agenda for pain education in AYA cancer survivors. We identified that AYAs with persistent pain and those with heightened pain-related fear have the potential to benefit from pain education. We identified a number of unique challenges of engaging AYA survivors in pain education, and point towards future research directions.
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http://dx.doi.org/10.1089/jayao.2019.0047DOI Listing
October 2019

Motor imagery in high-functioning individuals with chronic anterior cruciate ligament deficiency: A cross-sectional study.

Knee 2019 Jun 21;26(3):545-554. Epub 2019 Mar 21.

Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.

Background: There is increasing evidence that motor imagery performance (MIP) is impaired in conditions that have a component of movement dysfunction. However, MIP has not been investigated in people with chronic anterior cruciate ligament (ACL) deficiency who experience limited disability and function at high levels.

Hypothesis: This study had three objectives: (1) to assess implicit MIP in individuals with a chronic ACL deficient (ACLD) knee compared with healthy controls (i.e., intact anterior cruciate ligament); (2) to determine if the location of ACL deficiency affects MIP (dominant versus non-dominant leg); and (3) to determine if impairment in MIP is specific to the side (injured versus non-injured) of ACL deficiency.

Methods: Forty-five participants with chronic ACLD knee and 44 healthy controls completed a left/right judgement task of pictured knees using the "Recognise" app to evaluate implicit MIP. Accuracy and reaction time of judgements were compared between groups. Additionally, within the chronic ACLD knee group, we made comparisons between the dominant ACLD knee and non-dominant ACLD knee subgroups and between the injured knee and the non-injured knee of the ACLD group.

Results: There were no differences in implicit MIP between the ACLD knee and the control group, the non-injured knee versus injured knee of the ACLD knee group, or the dominant ACLD knee versus non-dominant ACLD knee subgroups.

Conclusion: Implicit MIP is not disrupted in high functioning individuals with chronic ACLD knee.
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http://dx.doi.org/10.1016/j.knee.2019.02.011DOI Listing
June 2019

Differential influence of habitual third-person vision of a body part on mental rotation of images of hands and feet.

Exp Brain Res 2019 May 14;237(5):1325-1337. Epub 2019 Mar 14.

School of Health Sciences, University of South Australia, G.P.O. Box 2471, Adelaide, SA, 5001, Australia.

Left/right judgement (LRJ) tasks involve determining the laterality of presented hand or feet images. Allocentric images (third-person perspective; 3PP) take longer to identify than egocentric images (first-person perspective; 1PP), supporting that implicit motor imagery (IMI)-mentally manoeuvring one's body to match the shown posture-is used. While numerous cognitive processes are involved during LRJs, it remains unclear whether features of the individual (e.g., visual exposure, experience, task-dependent use) influence the type of recognition strategy used during LRJs (IMI versus non-IMI). To investigate whether an individual's routine visual exposure to hands/feet in 3PP disrupts the typical perspective-reaction time (RT) relationship in LRJs, hand therapists, podiatrists, and healthy controls completed online LRJ tasks of hand and feet images. A group-specific reduction in RT for only allocentric images would represent a switch to non-IMI strategies. The results show that routine visual exposure to feet in 3PP (podiatrists) results in quicker RTs only for allocentric images of feet, suggesting a switch from IMI to non-IMI (e.g., visual object-based recognition) strategies. In contrast, routine visual exposure to hands in 3PP (hand therapists) does not alter RT for allocentric images, suggesting maintenance of IMI. However, hand therapists have quicker RTs (vs other groups) for egocentric hand images, supporting enhanced sensorimotor processing for the hand, consistent with task-dependent use (precise hand use). Higher accuracy in health professionals (vs control) on both tasks supports enhanced body schema. Combined, this suggests that 3PP visual exposure to body parts and task-dependent use contribute to LRJ performance/recognition strategy.
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http://dx.doi.org/10.1007/s00221-019-05512-3DOI Listing
May 2019

Mass media campaigns are needed to counter misconceptions about back pain and promote higher value care.

Br J Sports Med 2019 Oct 30;53(20):1261-1262. Epub 2018 Oct 30.

Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

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http://dx.doi.org/10.1136/bjsports-2018-099691DOI Listing
October 2019

Embodying the illusion of a strong, fit back in people with chronic low back pain. A pilot proof-of-concept study.

Musculoskelet Sci Pract 2019 02 23;39:178-183. Epub 2018 Jul 23.

Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Neuroscience Research Australia, Sydney, NSW, Australia.

Objective: This proof-of-concept pilot study aimed to investigate if a visual illusion that altered the size and muscularity of the back could be embodied and alter perception of the back.

Methods: The back visual illusions were created using the MIRAGE multisensory illusion system. Participants watched real-time footage of a modified version of their own back from behind. Participants undertook one experimental condition, in which the image portrayed a muscled, fit-looking back (Strong), and two control conditions (Reshaped and Normal) during a lifting task. Embodiment, back perception as well as pain intensity and beliefs about the back during lifting were assessed.

Results: Two participants with low back pain were recruited for this study: one with altered body perception and negative back beliefs (Participant A) and one with normal perception and beliefs (Participant B). Participant A embodied the Strong condition and pain and fear were less and both perceived strength and confidence were more than for the Normal or the Reshaped condition. Participant B did not embody the Strong condition and reported similar levels of pain, fear strength and confidence across all three conditions.

Discussion: An illusion that makes the back look strong successfully induced embodiment of a visually modified back during a lifting task in a low back pain patient with altered body perception. Both participants tolerated the illusion, there were no adverse effects, and we gained preliminary evidence that the approach may have therapeutic potential.
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http://dx.doi.org/10.1016/j.msksp.2018.07.002DOI Listing
February 2019

Illusory resizing of the painful knee is analgesic in symptomatic knee osteoarthritis.

PeerJ 2018 17;6:e5206. Epub 2018 Jul 17.

School of Psychology, University of Nottingham, Nottingham, United Kingdom.

Background: Experimental and clinical evidence support a link between body representations and pain. This proof-of-concept study in people with painful knee osteoarthritis (OA) aimed to determine if: (i) visuotactile illusions that manipulate perceived knee size are analgesic; (ii) cumulative analgesic effects occur with sustained or repeated illusions.

Methods: Participants with knee OA underwent eight conditions (order randomised): stretch and shrink visuotactile (congruent) illusions and corresponding visual, tactile and incongruent control conditions. Knee pain intensity (0-100 numerical rating scale; 0 = no pain at all and 100 = worst pain imaginable) was assessed pre- and post-condition. Condition (visuotactile illusion vs control) × Time (pre-/post-condition) repeated measure ANOVAs evaluated the effect on pain. In each participant, the most beneficial illusion was sustained for 3 min and was repeated 10 times (each during two sessions); paired -tests compared pain at time 0 and 180s (sustained) and between illusion 1 and illusion 10 (repeated).

Results: Visuotactile illusions decreased pain by an average of 7.8 points (95% CI [2.0-13.5]) which corresponds to a 25% reduction in pain, but the tactile only and visual only control conditions did not (Condition × Time interaction:  = 0.028). Visuotactile illusions did not differ from incongruent control conditions where the same visual manipulation occurred, but did differ when only the same tactile input was applied. Sustained illusions prolonged analgesia, but did not increase it. Repeated illusions increased the analgesic effect with an average pain decrease of 20 points (95% CI [6.9-33.1])-corresponding to a 40% pain reduction.

Discussion: Visuotactile illusions are analgesic in people with knee OA. Our results suggest that visual input plays a critical role in pain relief, but that analgesia requires multisensory input. That visual and tactile input is needed for analgesia, supports multisensory modulation processes as a possible explanatory mechanism. Further research exploring the neural underpinnings of these visuotactile illusions is needed. For potential clinical applications, future research using a greater dosage in larger samples is warranted.
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http://dx.doi.org/10.7717/peerj.5206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054060PMC
July 2018

A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care.

Physiother Theory Pract 2020 Jan 11;36(1):142-156. Epub 2018 Jun 11.

School of Health Sciences, University of South Australia, Adelaide, South Australia.

: To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. : Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. s: A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout,  = 0.007; BT vs. washout,  = 0.029) and left/right judgment accuracy (usual care vs. washout;  = 0.006). : Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.
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http://dx.doi.org/10.1080/09593985.2018.1482391DOI Listing
January 2020

Feeling stiffness in the back: a protective perceptual inference in chronic back pain.

Sci Rep 2017 08 29;7(1):9681. Epub 2017 Aug 29.

Department of Physical Therapy, Faculty of Rehabilitation Medicine, The University of Alberta, Edmonton, Alberta, Canada.

Does feeling back stiffness actually reflect having a stiff back? This research interrogates the long-held question of what informs our subjective experiences of bodily state. We propose a new hypothesis: feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back. This has far-reaching implications for treatment of pain/stiffness but also for our understanding of bodily feelings. Over three experiments, we challenge the prevailing view by showing that feeling stiff does not relate to objective spinal measures of stiffness and objective back stiffness does not differ between those who report feeling stiff and those who do not. Rather, those who report feeling stiff exhibit self-protective responses: they significantly overestimate force applied to their spine, yet are better at detecting changes in this force than those who do not report feeling stiff. This perceptual error can be manipulated: providing auditory input in synchrony to forces applied to the spine modulates prediction accuracy in both groups, without altering actual stiffness, demonstrating that feeling stiff is a multisensory perceptual inference consistent with protection. Together, this presents a compelling argument against the prevailing view that feeling stiff is an isomorphic marker of the biomechanical characteristics of the back.
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http://dx.doi.org/10.1038/s41598-017-09429-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5575135PMC
August 2017

An exploration into the cortical reorganisation of the healthy hand in upper-limb complex regional pain syndrome.

Scand J Pain 2016 10 2;13:18-24. Epub 2016 Jul 2.

Neuroscience Research Australia, Sydney, NSW 2031, Australia.

Background And Aims: Recent evidence demonstrated that complex regional pain syndrome (CRPS) is associated with a larger than normal somatosensory (S1) representation of the healthy hand. The most intuitive mechanism for this apparent enlargement is increased, i.e. compensatory, use of the healthy hand. We investigated whether enlargement of the S1 representation of the healthy hand is associated with compensatory use in response to CRPS. Specifically, we were interested in whether the size of the S1 representation of the healthy hand is associated with the severity of functional impairment of the CRPS-affected hand. We were also interested in whether CRPS duration might be positively associated with the size of the representation of the healthy hand in S1.

Methods: Using functional magnetic resonance imaging (fMRI) data from our previous investigation, the size of the S1 representation of the healthy hand in CRPS patients (n=12) was standardised to that of a healthy control sample (n=10), according to hand dominance. Responses to questionnaires on hand function, overall function and self-efficacy were used to gather information on hand use in participants. Multiple regression analyses investigated whether the S1 representation was associated with compensatory use. We inferred compensatory use with the interaction between reported use of the CRPS-affected hand and (a) reported overall function, and (b) self-efficacy. We tested the correlation between pain duration and the size of the S1 representation of the healthy hand with Spearman's rho.

Results: The relationship between the size of the S1 representation of the healthy hand and the interaction between use of the affected hand and overall function was small and non-significant (β=-5.488×10, 95% C.I. -0.001, 0.001). The relationship between the size of the S1 representation of the healthy hand and the interaction between use of the affected hand and self-efficacy was also small and non-significant (β=-6.027×10, 95% C.I. -0.001, 0.001). The S1 enlargement of the healthy hand was not associated with pain duration (Spearman's rho=-0.14, p=0.67).

Conclusion: Our exploration did not yield evidence of any relationship between the size of the healthy hand representation in S1 and the severity of functional impairment of the CRPS-affected hand, relative to overall hand use or to self-efficacy. There was also no evidence of an association between the size of the healthy hand representation in S1 and pain duration. The enlarged S1 representation of the healthy hand does not relate to self-reported function and impairment in CRPS.

Implications: While this study had a hypothesis-generating nature and the sample was small, there were no trends to suggest compensatory use as the mechanism underlying the apparent enlargement of the healthy hand in S1. Further studies are needed to investigate the possibility that inter-hemispheric differences seen in S1 in CRPS may be present prior to the development of the disorder.
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http://dx.doi.org/10.1016/j.sjpain.2016.06.004DOI Listing
October 2016

Development and psychometric properties of knee-specific body-perception questionnaire in people with knee osteoarthritis: The Fremantle Knee Awareness Questionnaire.

PLoS One 2017 26;12(6):e0179225. Epub 2017 Jun 26.

Sansom Institute for Health Research, University of South Australia, SA, Australia.

Background: Recent systematic reviews have demonstrated that pain associated with knee osteoarthritis (OA) is a complex phenomenon that involves various contributors. People with knee OA exhibit symptoms of impaired body-perception, including reduced tactile acuity, impairments in limb laterality recognition, and degraded proprioceptive acuity. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body-perception specific to the back in people with chronic low back pain. The aim of this study was to develop and assess the psychometric properties of a knee-specific version of the FreBAQ-J (FreKAQ-J), determine whether people with knee pain experience perceptual impairments and investigate the relationship between disturbed self-perception and clinical status.

Methods: Sixty-five people with knee OA completed the FreKAQ-J. A subset of the participants completed the FreKAQ-J again two-weeks later. Rasch analysis was used to assess item order, targeting, category ordering, unidimensionality, person fit, internal consistency, and differential item functioning. Validity was investigated by examining the relationship between the FreKAQ-J and clinical valuables.

Results: The FreKAQ-J had acceptable internal consistency, unidimensionality, good test-retest reliability, and was functional on the category rating scale. The FreKAQ-J was significantly correlated with pain in motion, disability, pain-related catastrophizing, fear of movement, and anxiety symptomatology.

Conclusions: We developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA. Altered body perception may be worth evaluating when managing people with knee OA.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179225PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484477PMC
September 2017

Validation of the Japanese Version of the Fremantle Back Awareness Questionnaire in Patients with Low Back Pain.

Pain Pract 2018 02 29;18(2):170-179. Epub 2017 May 29.

Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.

Background: There is a growing interest in the role of disturbed body perception in people with persistent pain problems such as chronic low back pain (CLBP). A questionnaire, the Fremantle Back Awareness Questionnaire (FreBAQ), was recently developed as a simple and quick way of assessing disturbed perceptual awareness of the back in people with CLBP and appears to have acceptable psychometric properties. The aim of the present study was to develop a Japanese version of the FreBAQ (FreBAQ-J) and evaluate its psychometric properties in a sample of Japanese people with low back pain (LBP).

Methods: Translation of the FreBAQ into Japanese was conducted using a forward-backward method. One hundred participants with LBP completed the resultant FreBAQ-J. A subset of the participants completed the FreBAQ-J again 2 weeks later. Validity was investigated by examining the relationship between the FreBAQ-J and clinical valuables. Rasch analysis was used to assess targeting, category ordering, unidimensionality, person fit, internal consistency, and differential item functioning.

Results: The FreBAQ-J was significantly correlated with pain in motion, disability, pain-related catastrophizing, fear of movement, and anxiety symptomatology. The FreBAQ-J had acceptable internal consistency, a minor departure from unidimensionality, and good test-retest reliability, and was functional on the category rating scale.

Conclusions: The FreBAQ-J has acceptable psychometric properties and is suitable for use in people with LBP. Participants with high levels of disturbed body perception are well targeted by the scale. The functioning of one item (item 8) was poor. Further study is warranted to confirm if this item should be excluded.
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http://dx.doi.org/10.1111/papr.12586DOI Listing
February 2018