Ershela L. Sims

Pain Catastrophizing and Pain-Related Fear in Osteoarthritis Patients: Relationships to Pain and Disability

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps < or = 0.05) of variance in measures of pain (partial r(2) [pr(2)] = 0.10), psychological disability (pr(2) = 0.20), physical disability (pr(2) = 0.11), and gait velocity at normal (pr(2) = 0.04), fast (pr(2) = 0.04), and intermediate speeds (pr(2) = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr(2) = 0.07) and walking at a fast speed (pr(2) = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.

Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: A randomized controlled study

Summary Combined training in pain and weight management in overweight and obese OA patients resulted in improved pain and other outcomes compared to either training alone. ABSTRACT Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long‐term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (n = 232) were randomized to a 6‐month program of: 1) PCST + BWM; 2) PCST‐only; 3) BWM‐only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self‐efficacy, weight self‐efficacy), and body weight were collected at 4 time points (pretreatment, posttreatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST + BWM demonstrated significantly better treatment outcomes (average of all 3 posttreatment values) in terms of pain, physical disability, stiffness, activity, weight self‐efficacy, and weight when compared to the other 3 conditions (Ps < 0.05). PCST + BWM also did significantly better than at least one of the other conditions (ie, PCST‐only, BWM‐only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self‐efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long‐term benefits.

A comparison of cleat types during two football-specific tasks on FieldTurf

Objective: To examine the effect of different cleat plate configurations on plantar pressure during two tasks. Design: Thirty-six athletes ran an agility course 5 times while wearing 4 different types of Nike Vitoria cleats: (1) bladed, (2) elliptical firm ground, (3) hard ground and (4) turf. Plantar pressure data were recorded during a side cut and a cross cut using Pedar-X insoles. Setting: Controlled laboratory study Participants: No history of lower extremity injury in the past 6 months, no previous foot or ankle surgery, not currently wearing foot orthotics and play a cleated sport at least twice a week. Main outcome measurements: Total foot contact time, contact area, maximum force, peak pressure and the force-time integral (FTI) in the medial, middle and lateral regions of the forefoot were collected. A 1×4 ANOVA (α = 0.05) was performed on each dependent variable. A Bonferroni adjustment was conducted (α = 0.008). Results: In the cross cut task, statistical differences between cleats were observed in three variables: total foot peak pressure, lateral forefoot FTI, and lateral forefoot normalised maximum force. In the side cut task, statistical differences between cleats were observed in 4 variables: total foot peak pressure, the medial and middle forefoot FTI, and the medial and middle forefoot normalised maximum force. Conclusions: Significant differences in forefoot loading patterns existed between cleat types. Based on the results of this study, it might be beneficial to increase the forefoot cushioning in cleats in an attempt to decrease loading in these regions of the foot.

The Relationship of Self-Reported Pain and Functional Impairment to Gait Mechanics in Overweight and Obese Persons with Knee Osteoarthritis

OBJECTIVE To examine the degree to which 2 commonly used measures of pain and disability, the Arthritis Impact Measurement Scales (AIMS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), relate to objective gait measurements. DESIGN A descriptive study of the influence of self-reported pain and perceived functional impairment on gait mechanics in osteoarthritic adults. SETTING A university clinical research laboratory. PARTICIPANTS Overweight/obese adults with radiographic knee osteoarthritis (OA) as well as pain and disability associated with the disease (N=179). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The AIMS and WOMAC were administered to determine self-report measures of pain and disability. Speed, stride length, support time, knee angle, and peak vertical force (PVF) were determined from 3-dimensional kinematic and kinetic data collected on subjects walking at self-selected normal and fast speeds. Anthropometric data and radiographic levels of OA were also collected. RESULTS Pearson correlation analysis showed that the AIMS physical disability score was inversely correlated with speed, stride length, and knee range of motion at both speeds and PVF at the fast speed. The WOMAC function score was inversely correlated with speed and stride length at both speeds and with PVF at fast speed. The WOMAC pain score was inversely correlated with speed and PVF at the fast speed. Regression analysis revealed that the AIMS physical disability score and body mass index accounted for the greatest variation in speed at the normal speed. Overall, AIMS physical disability and WOMAC function explained a larger proportion of variance in gait mechanics than radiographic measures of OA disease severity. CONCLUSIONS Taken together, the results suggest that the AIMS physical disability and WOMAC function scores are associated with some important measures of gait impairment.

Gender differences in plantar loading during three soccer-specific tasks

Objective: Examine the effect of gender on plantar loading during three football-specific tasks. Design: Thirty-four athletes (17 men, 17 women) ran an agility course five times while wearing the Nike Vitoria hard ground cleat. Plantar loading data were recorded during a side cut, a cross-over cut and a forward acceleration task using Pedar-X insoles. Setting: Controlled laboratory study. Participants: No history of lower extremity injury in the past 6 months, no previous foot or ankle surgery, not currently wearing foot orthotics and play a cleated sport at least two times per week. Main outcome measurements: Contact area, maximum force and the force-time integral (FTI) in the medial and lateral midfoot, medial, middle and lateral forefoot as well as the hallux. A univariate ANCOVA (α = 0.05) was performed on each dependent variable (covariate was course speed). Results: Significant gender differences existed in the force and force-time integral beneath the lateral midfoot and forefoot during the cross-over cut task as well as in the middle forefoot during the side cut task with the men demonstrating an increased force. No significant differences existed in the loading on the medial side of the foot during any tasks. Conclusions: The results of this study indicate that the increase in plantar loading on the lateral portion of the midfoot and forefoot in men could be one possible explanation for the increased incidence of fifth metatarsal stress fractures in men. Gender differences in loading patterns need to be considered when comparing different movements as well as different footwear conditions.

SEX DIFFERENCES IN BIOMECHANICS ASSOCIATED WITH KNEE OSTEOARTHRITIS

Osteoarthritis of the knee is seen more frequently in females than males. However, few studies have examined the interplay of gender, gait mechanics, pain, and disability in persons with osteoarthritis. This study examines the influence of anthropometrics, radiographic disease severity, pain, and disability on gender differences in gait mechanics in patients with knee osteoarthritis. Gait mechanics for 26 men and 30 women were collected using 3-D kinematics and kinetics. Women had a significantly lower knee adduction moment than men and a significantly higher stride frequency. Within female subjects, variations in gait mechanics were primarily explained by weight, BMI, pain, and disability. In males, variations in gait mechanics were primarily explained by age and disability.

An interactive method for teaching anatomy of the human eye for medical students in ophthalmology clinical rotations.

Much research has shown the benefits of additional anatomical learning and dissection beyond the first year of medical school human gross anatomy, all the way through postgraduate medical training. We have developed an interactive method for teaching eye and orbit anatomy to medical students in their ophthalmology rotation at Duke University School of Medicine. We provide review lectures on the detailed anatomy of the adult human eye and orbit as well as the developmental anatomy of the eye. These lectures are followed by a demonstration of the anatomy of the orbit using conventional frontal and superior exposures on a prosected human cadaver. The anatomy is projected onto a large LCD screen using a mounted overhead camera. Following a brief lecture on clinically relevant anatomy, each student then dissects a fresh porcine (pig) eye under low magnification using a dissecting microscope. These dissections serve to identify structures extrinsic to the eyeball, including extraocular muscle attachments, small vessels, optic nerve stalk, and fascial sheath of the eyeball (Tenons fascia). Dissection then shifts to the internal anatomy of the eyeball. The size and anatomy of the porcine eye is comparable with that of the human and the dissection provides students with a valuable hands‐on learning opportunity that is otherwise not available in embalmed human cadavers. Students and clinical faculty feedback reveal high levels of satisfaction with the presentation of anatomy and its scheduling early during the ophthalmology clerkship. Anat Sci Educ 2:173–178, 2009.

Racial differences in gait mechanics associated with knee osteoarthritis

Background and aims: This study examines racial differences in gait mechanics in persons with knee osteoarthritis and the influence of anthropometrics, educational level, radiographic disease severity (rOA), and self-report measures of pain and disability on racial differences in gait. Methods: One hundred seventy five (64 black and 111 white) adults with radiographie knee OA were tested. 3-D kinematic and kinetic data were collected while subjects walked at two self-selected speeds (normal and fast). Anthropometrie data, radiographie level of OA, and self-report measures of pain and disability were also collected. Gait patterns were compared across groups and within groups. Results: Black and white subjects did not differ significantly in radiographie OA. However, blacks walked significantly more slowly when asked to walk fast. At the normal speed, blacks had a smaller knee range of motion and loading rate than whites. Blacks also took longer to reach their peak maximum ground reaction force than whites. Within black subjects variations in gait mechanics were primarily explained by BMI, rOA, self-reported psychological disability, and pain self-efficacy. In white subjects, variations in gait mechanics were primarily explained by weight, age, velocity, psychological disability, and self-efficacy. Conclusions: Blacks in this study had a pattern of gait mechanics generally associated with high levels of osteoarthritis, though they did not differ significantly in rOA from whites. The variability in gait patterns exhibited by blacks was most strongly related to variance in walking speed, anthropometries, and perceived physical ability. Taken together, these results suggest that race is an important factor that must be considered in the treatment and study of osteoarthritis.

The Relationship Between Gait Mechanics and Radiographic Disease Severity in Knee Osteoarthritis

Osteoarthritis (OA) is a multifactorial degenerative joint disease affecting more than 10% of adults over the age of 55 (Baliunas et al., 2002; Miyazaki et al., 2002). Radiographic indications of OA can be found in at least one joint in most people over 65; with prevalence rates as high as 80% in people over the age of 75, depending on the joint (Helmick et al., 2008; Lawrence et al., 2008; Lawrence et al., 1998; Sangha, 2000). Systematic autopsy studies reveal near universal pathological signs of OA in people over age 65 (Sangha, 2000). It is the most prevalent type of arthritis (Lawrence et al., 2008) and the knee is one of the most commonly affected joints. Symptomatic knee OA affects 4.3M adults over age 60 (Dillon et al., 2006). Moreover, OA of the knee is particularly debilitating in terms of normal locomotor activity and as such has devastating physical and psychological effects (Maly et al., 2006; Nebel et al., 2009). Characterized by pain and lack of mobility, osteoarthritis of the knee may have a profound influence on gait patterns. Among the most commonly reported differences are slower walking speeds, shortened step lengths, larger double support times (the period of time in the gait cycle when both feet are in contact with the ground), as well as decreased hip range of motion and knee range of motion angles as compared to a non-arthritic population (AlZahrani & Bakheit, 2002; Andriacchi et al., 1977; Baliunas et al., 2002; Brinkmann & Perry, 1985; Kaufman et al., 2001; Messier et al., 2005a; Messier et al., 1992). Patients also exhibit decreased knee angular velocity (Messier, 1994; Messier et al., 1992), a change compensated for by increased hip angular velocity (Messier, 1994). In addition, patients with knee OA have been shown to demonstrate both altered ground reaction forces and increased dynamic