F BRAITHWAITE

South Australian Health and Medical Research Institute

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Tasha R. Stanton

University of South Australia

G. Lorimer Moseley

University of South Australia

Erin MacIntyre

University of South Australia

Maureen McEvoy

University of South Australia

Julie Walters

University of South Australia

J HAWKSHAW

University of Westminster

Brian W. Pulling

South Australian Health and Medical Research Institute

Marie Williams

University of South Australia

Brendan Mouatt

University of South Australia

John Farey

North Sydney Orthopaedic and Sports Medicine Centre

Cooperative Institutions

University of South Australia

University of Sydney

University of Adelaide

Flinders University

South Australian Health and Medical Research Institute

Institute for Musculoskeletal Health

The University of Notre Dame Australia

Queensland University of Technology

Universidade Cidade de São Paulo

University College London

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The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials

Pain (2024)

Monique V. Wilson F BRAITHWAITE John B. Arnold S. Crouch Emily Moore

This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling adults with chronic musculoskeletal pain (PROSPERO CRD42022356850). A systematic search (inception-January 2023) of electronic databases and grey literature was undertaken to identify relevant randomised controlled trials, with risk of bias and GRADE assessments performed on included studies. Meta-analyses used a generic, inverse-variance, random-effects model, calculating mean difference (MD) or standardised mean difference (SMD). Of 16,445 records identified, 29 records reporting on 24 studies (n = 6202 participants) were included. All evidence had unclear/high risk of bias and low-very low certainty. Peer support interventions resulted in small improvements in pain (medium-term: MD -3.48, 95% CI -6.61, -0.35; long-term: MD -1.97, 95% CI -3.53, -0.42), self-efficacy (medium-term: SMD 0.26, 95% CI 0.16, 0.36; long-term: SMD 0.21, 95% CI 0.07, 0.36), and function (long-term: SMD -0.10, 95% CI -0.19, -0.00) relative to usual care and greater self-efficacy (medium-term: SMD 0.36, 95% CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar improvement as active (health professional led) interventions bar long-term self-efficacy (MD -0.41, 95% CI -0.77, -0.05), which favoured active interventions. No point estimates reached minimal clinically important difference thresholds. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence. Despite low-very low evidence certainty, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes, suggesting that peer support may be useful as an adjunct to other treatments for musculoskeletal pain.

10.1097/j.pain.0000000000003293

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Commentary on “Effectiveness of motor imagery and action observation training on musculoskeletal pain intensity: A systematic review and meta‐analysis” by Suso‐Martí et al.

European Journal of Pain (2020)

Sarah B. Wallwork F BRAITHWAITE

This journal recently published a paper by Suso-Martí et al., entitled “Effectiveness of motor imagery and action observation training on musculoskeletal pain intensity: A systematic review and meta-analysis” (2020). Motor imagery training and action observation training are rehabilitation approaches that involve imagining oneself executing a particular action, and watching actions that are performed by others, respectively. Both are thought to activate similar neural substrates that are responsible for the actual execution of an action (Eaves, Riach, Holmes, & Wright, 2016). Motor imagery and action observation have been used to enhance motor skill performance in several groups—including athletes and musicians who require highly accurate and precise movement for professional performances, and a similar approach has been employed during rehabilitation with variable outcomes in people after stroke, spinal cord injury and persistent pain. In the pain neuroscience field, there is now reasonable evidence indicating that there are disruptions to the neural representation of a painful body part in people with persistent pain. That is, sensorimotor representations of the body in the brain appear to be different in people with persistent pain, and rehabilitation approaches that target these representations have gained traction for the treatment of persistent pain. Motor imagery and action observation are motor simulation paradigms that are thought to influence neural representations for movement (i.e. the distributed and complex neuronal networks associated with movement planning and execution) and excitability of the motor cortex. There is also limited evidence that people with pain have alterations to motor cortex maps—although this area has had some conflicting views and more robust functional magnetic resonance imaging studies are warranted. Given the growth and development of literature in this area, the meta-analysis by Suso-Martí et al., is topical and synthesizes the literature for both researchers and clinicians on the progress in this field. It is important to place such review findings into the scope of the larger field of treatment focussed on targeting sensorimotor representations in chronic pain. It was interesting to note that this review did not include any studies involving implicit motor imagery, nor mirror therapy (a form of action observation training)—and it is unclear why they have taken this stance in their review. Explicit and implicit motor imagery techniques likely engage different mechanisms and thus, have distinct influences on the sensorimotor representations. Thus, without considering the breadth of motor-focussed techniques, the implications for the treatment of chronic pain may not be comprehensive. For example, mirror therapy has been shown to be an important part of training when paired with motor imagery within graded motor imagery, a treatment programme that has shown some promise to alleviate some chronic pain disorders. Another interesting feature of the current review was the decision to exclude randomised controlled trials that compared the treatments to placebo in isolation. Given that placebo-controlled trials would provide good evidence for the authors' stated aim—to assess the effects of motor imagery and action observation on musculoskeletal pain—this exclusion has probably obscured the outcome by omitting data that would have been more revealing of the specific effects of these techniques. Previous reviews, including a recent meta-analysis by Thieme, Morkisch, Rietz, Dohle, and Borgetto (2016), have been limited to evaluating the effect of techniques that target movement representations (including motor imagery and action observation) on clinical outcomes in those with limb pain. In contrast, this review broadly aimed to evaluate the evidence for such techniques on musculoskeletal pain of any site. We note that there were methodological discrepancies between these two reviews. A notable difference was in the studies that were or were not included in the meta-analysis—which raises some methodological concerns about the repeatability and robustness of one or both of these papers. The Thieme review also took a broader approach and included measures of disability and quality of life, whereas the Suso-Martí review only collected measures of pain intensity. Interestingly, to assess risk of bias, the Thieme paper used the PEDro Scale and Suso-Martí used the Cochrane Handbook—but the two had some contrasting views on the level of bias of similarly included studies in their respective reviews, which cannot be explained by different tool use. Such findings bring into question the repeatability of quality assessments. Overall, the meta-analysis by Suso-Martí is an important addition to the literature that extends past work in this field, but limitations exist in the clinical conclusions made given their narrowed scope, which includes exclusion of placebo-controlled trials. We also note the variable nature of study quality assessments across reviews, which is concerning given their rank in the top tier of evidence with the lowest level of bias.

Motor Imagery

Premotor cortex

10.1002/ejp.1571

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Does who I am and what I feel determine what I see (or say)? A meta-analytic systematic review exploring the influence of real and perceived bodily state on spatial perception of the external environment

PeerJ (2022)

Erin MacIntyre F BRAITHWAITE Brendan Mouatt Dianne Wilson Tasha R. Stanton

Background Bodily state is theorised to play a role in perceptual scaling of the environment, whereby low bodily capacity shifts visuospatial perception, with distances appearing farther and hills steeper, and the opposite seen for high bodily capacity. This may play a protective role, where perceptual scaling discourages engaging with the environment when capacity is low. Methodology Our protocol was pre-registered via Open Science Framework ( https://osf.io/6zya5/ ) with all amendments to the protocol tracked. We performed a systematic review and meta-analysis examining the role of bodily state/capacity on spatial perception measures of the environment. Databases (Medline, PsychINFO, Scopus, Embase, and Emcare) and grey literature were searched systematically, inclusive to 26/8/21. All studies were assessed using a customised Risk of Bias form. Standard mean differences and 95% CIs were calculated via meta-analysis using a random-effects model. Results A total of 8,034 studies were identified from the systematic search. Of these, 68 experiments (3,195 participants) met eligibility and were included in the review. These were grouped into the following categories: fatigue; pain; age; embodiment; body size/body paty size; glucose levels; fitness; and interoception, and interoceptive accuracy. We found low level evidence (limited studies, high risk of bias) for the effect of bodily state on spatial perception. There was consistent evidence that both glucose manipulations and age influence spatial perception of distances and hills in a hypothesised direction (lower capacity associated with increased distance and hill steepness). Mixed evidence exists for the influence of external loads, embodiment, body/body-part size manipulations, pain, and interoceptive accuracy. Evidence for fitness and/or fatigue influencing spatial perception was conflicting; notably, methodological flaws with fitness and fatigue paradigms and heterogenous spatial perception measures may underlie null/conflicting results. Conclusion We found limited evidence for bodily state influencing spatial perception of the environment. That all studies had high risk of bias makes conclusions about reported effects reflecting actual perceptual shifts ( vs merely reflecting experimental demands or error due to inadequate study design) pre-emptive. Rigorous evaluation is needed to determine whether reported effects reflect more than bias ( e.g ., experimental demands, inadequate blinding). Future work using reliable measures of spatial perception, comprehensive evaluation of relevant confounders, and methodologically robust (and experimentally confirmed) bodily state experimental paradigms is warranted.

10.7717/peerj.13383

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DISCUSSION. THE RESISTANCES TO RAILWAY TRAINS AT DIFFERENT VELOCITIES.

Minutes of the Proceedings of the Institution of Civil Engineers (1846)

W. David Harding Jeffery S. Russell Edward J. Woods J SAMUDA SIR J RENNIE

Keywords RAILWAYS, TRAINS, RESISTANCE, VELOCITY, SPEED, EXPERIMENTS, FRICTION, GRADIENTS, WATER, EVAPORATION, ATMOSPHERIC, FORMULAE, WHEELS, RAILS, AIR, TRACTION, STEAM... Show All

10.1680/imotp.1846.24326

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Erratum: An Extension Study Using Hypnotic Suggestion as an Adjunct to Intravenous Sedation

American Journal of Clinical Hypnosis (2020)

Brian W. Pulling F BRAITHWAITE Mark P. Jensen G. Lorimer Moseley Edward Mackey

"Erratum: An Extension Study Using Hypnotic Suggestion as an Adjunct to Intravenous Sedation." American Journal of Clinical Hypnosis, 62(4), pp. 427–428

Adjunct

Intravenous sedation

10.1080/00029157.2020.1713630

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DISCUSSION. ON THE MANAGEMENT OF ENGINE FURNACES, WITH A VIEW TO THE PREVENTION OF THE WASTE AND NUISANCE FROM SMOKE.

Minutes of the Proceedings of the Institution of Civil Engineers (1854)

C W WILLIAMS G F WILSON J G MARSHALL J HAWKSHAW F BRAITHWAITE

Keywords COMBUSTION, FURNACES, GAS, PREVENTION, SMOKE, AIR, STOKING, COAL, MACHINES, APPARATUS, MACHINERY, MECHANICAL, BOILERS, POLLUTION, CONSUMPTION, FUEL, ENGINES... Show All

Nuisance

Pulverized coal-fired boiler

10.1680/imotp.1854.23953

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Transcutaneous auricular vagus nerve stimulation modifies cortical excitability in middle‐aged and older adults

Psychophysiology (2024)

Ashraf N. H. Gerges Lynton Graetz Susan Hillier Jeric Uy Taya Hamilton

Abstract There is a growing interest in the clinical application of transcutaneous auricular vagus nerve stimulation (taVNS). However, its effect on cortical excitability, and whether this is modulated by stimulation duration, remains unclear. We evaluated whether taVNS can modify excitability in the primary motor cortex (M1) in middle‐aged and older adults and whether the stimulation duration moderates this effect. In addition, we evaluated the blinding efficacy of a commonly reported sham method. In a double‐blinded randomized cross‐over sham‐controlled study, 23 healthy adults (mean age 59.91 ± 6.87 years) received three conditions: active taVNS for 30 and 60 min and sham for 30 min. Single and paired‐pulse transcranial magnetic stimulation was delivered over the right M1 to evaluate motor‐evoked potentials. Adverse events, heart rate and blood pressure measures were evaluated. Participant blinding effectiveness was assessed via guesses about group allocation. There was an increase in short‐interval intracortical inhibition ( F = 7.006, p = .002) and a decrease in short‐interval intracortical facilitation ( F = 4.602, p = .014) after 60 min of taVNS, but not 30 min, compared to sham. taVNS was tolerable and safe. Heart rate and blood pressure were not modified by taVNS ( p > .05). Overall, 96% of participants detected active stimulation and 22% detected sham stimulation. taVNS modifies cortical excitability in M1 and its effect depends on stimulation duration in middle‐aged and older adults. taVNS increased GABA A ergic inhibition and decreased glutamatergic activity. Sham taVNS protocol is credible but there is an imbalance in beliefs about group allocation.

Blinding

Vagus Nerve Stimulation

Silent period

10.1111/psyp.14584

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Citations (2)

Reliability and validity of a mobile tablet for assessing left/right judgements

Musculoskeletal Science and Practice (2019)

Lindy Williams F BRAITHWAITE Hayley B. Leake Michelle N. McDonnell Daniela Peto

Validity

10.1016/j.msksp.2019.01.010

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