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Racial Differences in Movement-Related Appraisals and Pain Behaviors among Adults with Chronic Low Back Pain

Kissi, Ama; Vorensky, Mark; Sturgeon, John A; Vervoort, Tine; van Alboom, Ischa; Guck, Adam; Perera, Robert A; Rao, Smita; Trost, Zina
Research documents racial disparities in chronic low back pain (CLBP). Few studies have examined racial disparities in movement-related appraisals and no studies have examined anticipatory appraisals prior to or pain behaviors during functional activities among individuals with CLBP. This cross-sectional study examined racial differences in anticipatory appraisals of pain, concerns about harm, and anxiety, appraisals of pain and anxiety during movement, and observed pain behaviors during three activities of daily living (supine-to-standing bed task, sitting-to-standing chair task, floor-to-waist lifting task) in a sample (N = 126) of non-Hispanic Black (31.0%), Hispanic (30.2%), and non-Hispanic White (38.9%) individuals with CLBP. Hispanic participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed and chair tasks compared to non-Hispanic White participants. Hispanic participants reported more pain during the bed task and more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed task and more pre-movement anxiety prior to the chair task compared to non-Hispanic White participants. Non-Hispanic Black participants reported more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants were observed to have significantly more verbalizations of pain during the bed task compared to non-Hispanic White participants. Current findings identify racial disparities in important cognitive-behavioral and fear-avoidance mechanisms of pain. Results indicate a need to revisit traditional theoretical and treatment models in CLBP, ensuring racial disparities in pain cognitions are considered. PERSPECTIVE: This study examined racial disparities in anticipatory and movement-related appraisals, and pain behaviors during activities of daily living among Non-Hispanic Black, Non-Hispanic White, and Hispanic individuals with CLBP. Racial disparities identified in the current study have potentially important theoretical implications surrounding cognitive-behavioral and fear-avoidance mechanisms of pain.
PMID: 38065466
ISSN: 1528-8447
CID: 5591592

Effect of integrated exercise therapy and psychosocial interventions on self-efficacy in patients with chronic low back pain: A systematic review

Vorensky, Mark; Murray, Tyler; McGovern, Andrew F; Patel, Yera Y; Rao, Smita; Batavia, Mitchell
OBJECTIVE:Investigate if integrated exercise and psychosocial (EP) interventions effect self-efficacy to manage pain and self-efficacy for physical functioning compared to alternate interventions, usual care, waitlists and attention controls for individuals with chronic low back pain (CLBP). METHODS:MEDLINE, Embase, CINAHL, Web of Science, PsychINFO, PEDro, and Cochrane Library were searched. Included randomized controlled trials utilized an EP intervention for CLBP and measured self-efficacy. Independent reviewers screened abstracts, reviewed full-texts, extracted data, and assessed risk of bias. GRADE, synthesis without meta-analysis, and ranges of effects (Hedges' g) were used. RESULTS:2207 Participants were included (22-studies). EP interventions positively effected self-efficacy to manage pain short-term compared to usual care (range of effects: -0.02, 0.94) and controls (range of effects: 0.69, 0.80) and intermediately compared to usual care (range of effects: 0.11, 0.29); however, no differences were found when compared to alternate interventions. EP interventions positively effected self-efficacy for physical functioning short-term compared to alternate interventions (range of effects: 0.57, 0.71), usual care (range of effects: -0.15, 0.94), and controls (range of effects: 0.31, 0.56), and intermediately compared to alternate interventions (1-study, effect: 0.57) and controls (1-study, effect: 0.56). Conclusions were limited by low to very low-quality-evidence often from risk of bias, imprecision, and clinical/statistical heterogeneity. CONCLUSIONS:EP interventions may be more effective short-term for self-efficacy to manage pain than usual care and waitlists, but not alternate interventions. EP interventions may be effective for self-efficacy for physical functioning at short- and intermediate-term compared to alternate interventions, usual care, waitlist and attention controls. Considerations for future research include methods for blinding and measurement of self-efficacy for physical functioning.
PMID: 36610335
ISSN: 1879-1360
CID: 5410202

Non-parametric Functional Muscle Network as a Robust Biomarker of Fatigue

O'Keeffe, Rory; Shirazi, Seyed Yahya; Yang, Jinghui; Mehrdad, Sarmad; Rao, Smita; Atashzar, S Farokh
Characterization of fatigue using surface electromyography (sEMG) data has been motivated for rehabilitation and injury-preventative technologies. Current sEMG-based models of fatigue are limited due to (a) linear and parametric assumptions, (b) lack of a holistic neurophysiological view, and (c) complex and heterogeneous responses. This paper proposes and validates a data-driven non-parametric functional muscle network analysis to reliably characterize fatigue-related changes in synergistic muscle coordination and distribution of neural drive at the peripheral level. The proposed approach was tested on data collected in this study from the lower extremities of 26 asymptomatic volunteers (13 subjects were assigned to the fatigue intervention group, and 13 age/gender-matched subjects were assigned to the control group). Volitional fatigue was induced in the intervention group by moderate-intensity unilateral leg press exercises. The proposed non-parametric functional muscle network demonstrated a consistent decrease in connectivity after the fatigue intervention, as indicated by network degree, weighted clustering coefficient (WCC), and global efficiency. The graph metrics displayed consistent and significant decreases at the group level, individual subject level, and individual muscle level. For the first time, this paper proposed a non-parametric functional muscle network and highlighted the corresponding potential as a sensitive biomarker of fatigue with superior performance to conventional spectrotemporal measures.
PMID: 37022022
ISSN: 2168-2208
CID: 5495972

Asymmetries in Two-Dimensional Trunk and Knee Kinematics During a Single-Leg Drop Landing Post Anterior Cruciate Ligament Reconstruction

Vorensky, Mark; Peredo, Daniel; Colon, Wil; Rao, Smita; Kakar, Rumit Singh
ISSN: 2157-7277
CID: 5441192

High Level Mobility Training in Ambulatory Patients with Acquired Non-Progressive Central Neurological Injury: a Feasibility Study

Gallo, Estelle; Yao, Lanqiu; Tarpey, Thaddeus; Cepeda, Jaime; Connors, Katie Ann; Kedzierska, Iwona; Rao, Smita
The purpose of this study was to test the feasibility and safety of High-Level Mobility (HLM) training on adults with Acquired Brain Injury (ABI). Our hypotheses were that HLM training would be feasible and safe. This study was a pilot randomized control trial with a Simple Skill Group (SSG) and a Complex Skill Group (CSG). Both groups received 12 sessions over 8 weeks and completed 4 testing sessions over 16 weeks. The SSG focused on locomotion, while CSG focused on the acquisition of running. Feasibility was assessed in terms of process, resources, management, and scientific metrics, including safety. Among the 41 participants meeting inclusion criteria, 28 consented (CSG, n = 13, SSG, n = 15), 20 completed the assigned protocol and 8 withdrew (CSG n = 4, SSG n = 4). Adherence rate to assigned protocol was 100%. There were two Adverse Events (AEs), 1 over 142 SSG sessions and 1 over 120 CSG sessions. The AE Odd Ratio (OR) (CSG:SSG) was 1.18 (95% CI: 0.07, 19.15). The data support our hypotheses that HLM training is feasible and safe on ambulatory adults with ABI.
PMID: 35138211
ISSN: 1362-301x
CID: 5156422

Lower extremity MRI following 10-week supervised exercise intervention in patients with diabetic peripheral neuropathy

Brown, Ryan; Sharafi, Azadeh; Slade, Jill M; Convit, Antonio; Davis, Nathan; Baete, Steven; Milton, Heather; Mroczek, Kenneth J; Kluding, Patricia M; Regatte, Ravinder R; Parasoglou, Prodromos; Rao, Smita
INTRODUCTION/BACKGROUND:The purpose of this study was to characterize using MRI the effects of a 10-week supervised exercise program on lower extremity skeletal muscle composition, nerve microarchitecture, and metabolic function in individuals with diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS/METHODS:) and once following intervention to measure relaxation times (T1, T1ρ, and T2), phosphocreatine recovery, fat fraction, and diffusion parameters. RESULTS:and postintervention MRI metrics were: calf adipose infiltration -2.6%±6.4%, GM T1ρ -4.1%±7.7%, GM T2 -3.5%±6.4%, and gastrocnemius lateral T2 -4.6±7.4%. Insignificant changes were observed in gastrocnemius phosphocreatine recovery rate constant (p>0.3) and tibial nerve fractional anisotropy (p>0.6) and apparent diffusion coefficient (p>0.4). CONCLUSIONS:The 10-week supervised exercise intervention program successfully reduced adiposity and altered resting tissue properties in the lower leg in DPN. Gastrocnemius mitochondrial oxidative capacity and tibial nerve microarchitecture changes were not observed, either due to lack of response to therapy or to lack of measurement sensitivity.
PMID: 34518157
ISSN: 2052-4897
CID: 5012272

Simultaneous T1 , T2 , and T1ρ relaxation mapping of the lower leg muscle with MR fingerprinting

Sharafi, Azadeh; Medina, Katherine; Zibetti, Marcelo W V; Rao, Smita; Cloos, Martijn A; Brown, Ryan; Regatte, Ravinder R
PURPOSE/OBJECTIVE: METHODS:measured using TB-SL MRF in Bloch simulations, model agar phantoms, and in vivo experiments to those with a self-compensated spin-lock preparation module (SC-SL). The TB-SL MRF repeatability was evaluated in maps acquired in the lower leg skeletal muscle of 12 diabetic peripheral neuropathy patients, scanned two times each during visits separated by about 30 days. RESULTS:= 31.7 ± 3.2 ms in skeletal muscle across patients. Bland-Altman analysis demonstrated low bias between TB-SL and SC-SL MRF and between TB-SL MRF maps acquired in two visits. The coefficient of variation was less than 3% for all measurements. CONCLUSION/CONCLUSIONS:
PMID: 33554369
ISSN: 1522-2594
CID: 4799722

Simultaneous T-1, T-2, and T-1 rho relaxation mapping of the lower leg muscle with MR fingerprinting

Sharafi, Azadeh; Medina, Katherine; Zibetti, Marcelo W. V.; Rao, Smita; Cloos, Martijn A.; Brown, Ryan; Regatte, Ravinder R.
ISSN: 0740-3194
CID: 4821202

Interlimb Asymmetries & Correlations to Athlete Self-Perceptions 9-12 Months Post Anterior Cruciate Ligament Reconstruction [Meeting Abstract]

Vorensky, M; Peredo, D; Colon, W; Rao, S; Kakar, R S
Research Objectives: To compare interlimb asymmetries of athletes post anterior cruciate ligament reconstruction (ACLR) to healthy athletes during return to sport (RTS) testing. Secondary objectives investigated correlations between interlimb asymmetries and survey-scores of self-confidence, perceived risk, and injury-emotions (ACL-RSI). Understanding interlimb differences and athlete psychology may help prevent reinjury.
Design(s): Cross-sectional.
Setting(s): Hospital-based orthopedic/sports clinic.
Participant(s): 12 Athletes, 9-12months post-ACLR (6 female; 25.4+/-5.8y/o) and 21 healthy athletes (10 female; 27.9+/-3.5y/o) were recruited. Participants reported moderate/high activity-level (IPAQ). Athletes post-ACLR were painfree and cleared for RTS testing.
Intervention(s): N/A.
Main Outcome Measure(s): Testing included: single-leg drop-landing (30cm), knee isokinetic testing (Biodex, 60degree/sec), and single-leg hop tests (single/triple/crossover distance, 6m-timed). Single-leg landing interlimb differences in peak knee flexion (PKF), frontal plane projection angle (FPPA), peak forward/lateral trunk flexion were calculated (2-dimensional analysis, 100Hz). Peak torque and hop test limb symmetry indices (LSIs) were computed (post-ACLR:100*Surgical/Non-surgical; healthy:100*Non-dominant/Dominant). MANOVA (p < 0.05) compared outcomes between groups. Pearson correlations (r) were calculated between tests and ACL-RSI.
Result(s): Significantly greater interlimb differences between groups in single-leg landing PKF (p=0.01) were observed post-ACLR (9.2+/-8.2degree; healthy:1.0+/-8.7degree). FPPA was greater (p=0.005) in post-ACLR non-surgical limbs (11.1+/-8.7degree; healthy dominant limbs:3.7+/-5.4degree) and nearly significant (p=0.06) in post-ACLR surgical limbs (8.6+/-5.5degree; healthy non-dominant limbs:4.5+/-6.1degree). For peak torque LSI, knee extension was lower (p=0.003) post-ACLR (82.8+/-16.8%; healthy:98.2+/-10.6%) and knee flexion was higher (p=0.006) post-ACLR (106.7+/-17.2%; healthy:93.5+/-8.3%). ACL-RSI was significantly lower (p < 0.0001) post-ACLR (71.3+/-12.7%; healthy:95.0+/-8.5%). ACL-RSI negatively correlated to PKF interlimb differences (r=-0.53) and positively correlated to crossover-hop (r=0.53) and peak extension torque LSIs (r=0.60).
Conclusion(s): Interlimb asymmetries in strength and knee mechanics present 9-12months post-ACLR and can be biomarkers to evaluate RTS readiness. Given the relationships between strength, kinematics, and ACL-RSI, clinicians should consider connections between athlete self-perceptions and performance. Author(s) Disclosures: None. Keywords: Anterior Cruciate Ligament Reconstruction, Physical Functional Performance, Psychology, Sports, Physical Therapy Specialty, Muscle Strength
ISSN: 1532-821x
CID: 4699192

Reliability of a New Clinical Gait Assessment Scale for Children with Idiopathic Toe Walking Gait - A Pilot Study

Ali, Eglal; Len, Anna; Ling, Wen; Rao, Smita
Aims: Children with idiopathic toe walking (ITW) gait are increasingly referred to physical therapists. The purpose of this study was to evaluate the intra-rater and inter-rater reliability of the Clinical Gait Assessment Scale (CGAS), a newly developed observational rating scale.Methods: Four raters evaluated videos of four children. Foot, arm and head/trunk movement was scored as children walked over four surfaces. Intra-class correlation coefficients (ICC), model (3,k) were calculated to determine intra-rater and inter-rater reliability of each dependent variable.Results: The key findings of this study indicate robust intra- and inter-rater reliability, particularly of the foot (Inter-rater reliability, ICC (3,2)=0.9) and head and trunk (Inter-rater reliability, ICC (3,2)=1.0) subsections. Arm movements were more challenging to rate and showed moderate reliability (Inter-rater reliability, ICC (3,2)=0.7). Highest total impairment score; the highest value occurred while walking on the obstacle course (38 ± 29).Conclusions: Overall, the CGAS showed adequate/acceptable reliability across different surfaces (linoleum, textured surface, narrow base, obstacle), however the obstacle surface was most challenging surface to the rater.
PMID: 32249655
ISSN: 1541-3144
CID: 4395332