Aerobic Exercise Training in Addition to Conventional Physiotherapy for Chronic Low Back Pain: A Randomized Controlled Trial
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Aerobic Exercise
Aerobic Exercise
Stimulus (psychology)
Aerobic capacity
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Foot (prosody)
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【背景】アレルギー性鼻炎 (AR) の重症度や症状の程度を評価する目的で, Allergic Rhinitis and its Impact on Asthma (ARIA) やわが国の鼻アレルギー診療ガイドライン (PG-MARJ) に基づく質問票が用いられている. しかし, ARIAでは患者の多くが中等症・重症と分類されてしまい, PG-MARJでは症状を1日の平均回数でスコア化しており, 正確に回数を把握するのが困難であるという問題点がある. 【目的】小児AR患者の重症度および症状の程度の評価, モニタリングのため, より簡便な方法であるvisual analog scale (VAS) の有用性を検討する. 【対象・方法】当科定期受診したAR患者を対象とし, ARIAならびにPG-MARJに基づく質問票と鼻炎症状のVASを比較検討した. また, 1~2か月後の再診時までのそれぞれの変化について検討した. 【結果】VAS値は, ARIAの分類による軽症よりも中等症/重症で有意に高値であり, 両者を識別するカットオフ値は26mmであった. また, VAS値はPG-MARJによる症状の程度と有意な正の相関を認め, さらに再診時までの鼻炎症状点数の変化量はVASの変化量との間に有意な正の相関を認めた. 【結論】小児AR患者では, VASは重症度ならびに症状の程度を簡便に評価することが可能であり, 症状のモニタリングのツールとして有用である可能性が示唆された.
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Background: There is a recognised need for a feasible continuous composite measure in routine clinical care for psoriatic arthritis (PsA). Two multidimensional composite Visual Analogue Scales (VAS) have been proposed; the 3 and 4VAS 1 , but there may be some advantages to using a numerical rating scale (NRS) over VAS in patient reported outcomes. VAS is a 100mm horizontal line, and the NRS a 21-point scale ranging from 0 to 10 in increments of 0.5. NRS are simple and faster to score, less susceptible to measurement error and may reduce the floor and ceiling effects, whereby patients avoid using the extremes of the scale. A previous study has demonstrated good agreement between VAS and NRS for the separate patient reported outcome measures in PsA, which correlate with disease severity and life impact. 2 Objectives: To test the performance of NRS, compared with VAS, in the composite 3 and 4VAS scores. Methods: Data were collected prospectively across three UK hospital trusts from 2018-2019, as part of a study assessing the use of NRS in patient reported outcome measures in PsA. 2 Patients completed the VAS and NRS for pain, arthritis, skin psoriasis, and global disease activity. The 3 VAS comprises of a physician global VAS, patient global VAS and patient skin VAS and the 4 VAS comprises of the physician global VAS, patient pain VAS, joint VAS and skin VAS. NRS and VAS versions of the patient reported measures were tested. Physician global scores were not available from the study data, therefore only the patient reported components are included. Agreement between the scales was assessed using the intraclass correlation coefficients (ICCs), with a two-way mixed absolute agreement model, and Bland-Altman plots. Spearman’s rank correlation coefficients were used to assess dependency between scale scores and clinical parameters including tender and swollen joint count, PsAID12 and HAQDI. Results: Data from 209 patients were analysed. 60.0% were male, with mean age of 51.7 years and median PsA duration of 7.0 years. Mean 3VAS score was 3.57 and the mean NRS-3VAS was 3.79, with ICC 0.98 (95% CI 0.96-0.98). Mean 4VAS was 3.71 and NRS-4VAS was 3.90 with ICC 0.98 (95% CI 0.97-0.98). Average NRS scores were slightly higher than VAS scores. The Bland-Altman plots comparing NRS and VAS for the patient-reported components of 3VAS and 4VAS are demonstrated in Figure 1. 64.1% patients reported a preference for NRS over VAS. Correlation of the 3/4VAS with PSAID, HAQ and joints counts are reported in Table 1. Visual representation of the NRS and VAS scales for 3VAS and 4VAS as histograms demonstrated that there is marginally less floor effect using NRS compared to VAS. Conclusion: There is good agreement between VAS and NRS for the patient-reported components of 3VAS and 4VAS, supporting that VAS scores are reproducible as NRS scores. Both NRS and VAS versions of the 3 and 4VAS scales correlate with disease activity and life impact. 2 There may be advantages in testing the 3/4VAS as NRS moving forward. References: [1]Tillett W et al. J Rheumatol. 2021; in press [2]Ye W et al. J Rheumatol . 2020 Dec 1:jrheum.200928. Table 1. Spearman’s correlations of the 3 and 4 VAS scores with TJC, SJC, PsAID and HAQ Patient Reported TJC SJC PsAID HAQDI without aids 3 VAS vas 0.51 0.44 0.88 0.62 4 VAS vas 0.54 0.47 0.89 0.65 3 VAS nrs 0.49 0.43 0.89 0.63 4 VAS nrs 0.53 0.46 0.92 0.67 Key: 3VAS; Patient global and skin VAS, 4 VAS: Patient pain, joint and skin VAS. 3 and 4 NRS; Numeric Rating Scale (NRS). TJC/ SJC: Tender/Swollen Joint count. PSAID: Psoriatic Arthritis Impact of Disease. HAQDI: Stanford Heath Assessment Questionnaire. Acknowledgements: Dr Day and Dr Ye contributed equally to the development of this abstract. Disclosure of Interests: Julia Day: None declared, Weiyu Ye: None declared, William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc., and UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc., and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen and UCB, Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB;, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis.
Ceiling effect
Patient-reported outcome
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The aim of this study was to evaluate differences in pain scores with different visual analog scale (VAS) presentations and to compare those differences with a numeric rating scale. We also asked the patients for preference of the different methods.Prior to the trial, we performed power calculations to estimate a preferred sample size, and 62 postoperative patients supplied a complete set of data to the study. Inclusion criteria were newly operated patients within the first 5 days after surgery. Every patient included was with 1-minute intervals and presented with one of the following 100-mm VAS lines: VAS horizontal with or without stop lines at the endings, or VAS vertical with or without stop lines. They also completed a numeric rating scale (NRS).We did not find differences in pain scores between the four VAS measures. The NRS had slightly higher pain scores than VAS, especially at low levels of pain. Patients preferred the NRS as compared to the VAS, and when choosing between the four different VAS presentations, they preferred the horizontal VAS with stop lines at the ends.For daily clinical practice for guiding postoperative analgesic treatment, the NRS seems to be a good option measuring pain reliably with good patient understanding and acceptance. For pain research, where there may be more time to explain the method and when a scale with more data points may be preferred, a VAS horizontal including stop lines at the ends can be recommended.
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Objective There is disagreement as to whether percutaneous laser disc decompression (PLDD) is effective. This may be attributed to incorrect patient selection because of the need of additional criteria. This study is investigating whether initial visual analog scale (VAS) score has an effect on outcomes of cervical PLDD and whether it could be a patient selection criterion. Material and Methods: Cervical PLDD patients were divided into 3 groups according to initial VAS scores as Group-I (VAS:3-5), Group-IIa (VAS:6-7) and Group-IIb (VAS:8-9). Datas analyzed retrospectively and compared with the VAS scores during 12-month follow-up. Relationship between initial VAS scores and success of procedure was investigated. Patient satisfaction was also evaluated according to Odom criteria. Results: In sum, 79.16 % of the patients were satisfied from the procedure. However, the satisfaction rate was 96.15% in Group-I, 76.47 % in Group-IIa, and 0.0 % in Group-IIb. The mean initial VAS scores of patients who were satisfied with the procedure was 5.08 but 7.30 of dissatisfied ones. Number of affected discs and patient age have no effect on the results. Conclusion: Initial VAS scores are directly correlated with patient outcomes. Patients with higher than initial VAS scores of 5, must be rejected for the procedure.
Discectomy
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Background The visual analog scale is widely used in research studies, but its connection with clinical experience outside the research setting and the best way to administer the VAS forms are not well established. This study defines changes in dosing of intravenous patient-controlled analgesia as a clinically relevant outcome and compares it with VAS measures of postoperative pain. Methods Visual analog scale measurements were obtained from 150 patients on the morning after intraabdominal surgery. On the same afternoon, 50 of the patients provided a VAS score on the same form used in the morning, 50 on a new form, and 50 were not asked for a second VAS measurement. Results Visual analog scale values and changes in value were similar for patients who were given a new VAS form in the afternoon and those who used the form that showed the morning value. The proportions of patients requesting additional analgesia were 4, 43, and 80%, corresponding to afternoon VAS scores of 30 or less, 31-70, and greater than 70, respectively. Change from morning VAS score had no apparent influence on patient-controlled analgesic dosing for patients with afternoon values of 30 or less or greater than 70, but changes in VAS scores of at least 10 did discriminate among patients whose afternoon values were between 31 and 70. Conclusions When pain is an outcome measure in research studies, grouping final VAS scores into a small number of categories provides greater clinical relevance for comparisons than using the full spectrum of measured values or changes in value. Seeing an earlier VAS form has no apparent influence on later values.
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Contrary results have been reported from studies comparing horizontal and vertical orientations of the visual analogue scale (VAS) in non-dental pain states. The vertical orientation of the VAS has been used in our department for several years while the horizontal orientation is the most commonly used in other acute pain models. The present study investigated whether a horizontally oriented VAS is as sensitive as a vertically oriented VAS in the assessment of present pain after oral surgery. Seventy-four patients recorded their pain intensity hourly and half-hourly 15 times during 11 hours after surgery on a horizontal and on a vertical 100 mm VAS. Slightly lower mean and median values were observed at 2/3 of the observation time points for the vertical VAS compared to the horizontal VAS. The results from the two scales were compared with analysis of variance for repeated measures. No significant differences between the horizontal and the vertical VAS-values were found (p = 0.099). Distributions (Kolmogorov-Smirnov test) and dispersions of data were also similar with the two orientations of the VAS. This study shows that a vertically oriented VAS is equally sensitive as a horizontally oriented VAS in assessing present pain intensity after oral surgery.
Intensity
Vertical orientation
Repeated measures design
Acute Pain
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Objectives:
To evaluate the possible value of the perfusion index (PI) as a tool for pain assessment.Methods:
This prospective, observational study was performed with 89 patients underwent surgery with general anesthesia. The patients with visual analog scale (VAS)>3 were grouped as M1, and patients with VAS≤3 and performed morphine were grouped as M2. After surgery patients with VAS>3 were given 2mg morphine. Patients with VAS>3 were given increments of intravenous morphine (2 mg) at 20 minute intervals until VAS<3. The correlation and difference between PI and VAS score values were evaluated before and after analgesic administration.Results:
Significant changes were found in both PI values and VAS scores between M1 and M2 groups (2.80±0.77, 3.97±0.94, p<0.001; 6.60±1.20, 2.74±0.46, p<0.001) Despite no correlation was found between PI values and VAS scores of M1 and M2 groups, weak negative correlation was detected between differences in PI values and VAS scores among groups (r=-0.255, p=0.016).Conclusion:
Perfusion index is a parameter that can be used in the assessment of postoperative pain and responses to analgesics.Cite
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