Lateral epicondylalgia (LE), commonly referred to as tennis elbow, is a musculoskeletal condition characterized by pain and sensorimotor dysfunction. In some individuals with chronic uni-lateral LE, sensorimotor symptoms develop on the unaffected side despite no evidence of tissue da-mage. Altered interhemispheric inhibition (IHI) is one mechanism that could underpin this phenomenon. The aim of this cross-sectional study was to examine IHI between the primary motor cortices (M1) in individuals with chronic LE and healthy controls. In 20 individuals with chronic LE and 20 healthy par-ticipants, transcranial magnetic stimulation was used to assess 1) short and long-latency IHI from the affected (corresponding to the injured side) to the unaffected M1 and 2) corticomotor excitability of the affected and unaffected M1. Sensorimotor function was evaluated bilaterally at the extensor carpi ra-dialis brevis muscle using pressure pain threshold, grip strength, 2-point discrimination, and temporal summation tests. Short-and long-latency IHI from the affected to the unaffected M1 and corticomotor excitability of the affected and unaffected M1 were not altered in individuals with LE compared with healthy participants. No differences in sensorimotor function were observed for the affected or un-affected extensor carpi radialis brevis muscles when individuals with LE were compared with healthy participants. IHI is not altered in individuals with chronic LE. Further studies are required to determine the mechanisms that underpin the development of bilateral sensorimotor symptoms in unilateral LE. Perspective: IHI is unaltered from the affected M1 (corresponding to the painful muscle) to unaffected M1 in individuals with LE compared to healthy controls. The absence of bilateral sensorimotor dysfunction and low pain severity in this cohort of individuals with LE may explain this finding.(R) 2023 Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc

The aim of the current study was to determine whether gait control (muscle synergies) or gait stability (margin of stability (MoS)) were different between younger and older adults when walking on level or downhill slopes. Further, it sought to determine associations between either age or physical activity with muscle synergy widths. Ten healthy younger (28.1 ± 8.0 years) and ten healthy older (69.5 ± 6.3 years) adults walked at their preferred walking speed on a treadmill at different slopes (0˚, − 4˚ and − 8˚). Muscle synergies were extracted using non-negative matrix factorisation and compared between groups and walking slopes. Correlations between the full width at half maximum (FWHM) of the synergies’ activations and weekly recreational physical activity minutes and age were also determined. Younger and older adults both walked with similar muscle synergies across all tested slopes, with 4 synergies accounting for > 85

Background: The STarT Back Screening Tool (SBT) is recommended to provide risk-stratified care in low back pain (LBP), yet its predictive value is moderate for disability and low for pain severity. Assessment of human assumed central sensitisation (HACS) in conjunction with the SBT may improve its predictive accuracy. Objectives: To examine whether assessment of HACS in acute LBP improves the predictive accuracy of the SBT for LBP recovery at six months in people with acute non-specific LBP. Design: A prospective longitudinal study. Method: Data were drawn from the UPWaRD study. One hundred and twenty people with acute non-specific LBP were recruited from the community. Baseline measures included SBT risk status, nociceptive flexor withdrawal reflex, pressure and heat pain thresholds and conditioned pain modulation. Primary outcome was the presence of LBP (pain numeric rating scale >= 1 and Roland Morris Disability Questionnaire score >= 3) at six-month follow-up. Regression coefficients were penalised using the least absolute shrinkage and selection operator technique to select predictor variables. Internal validation was performed using ten-fold cross-validation. Results/findings: SBT risk status alone did not predict the presence of LBP at six months (area under receiver operating characteristic curve [AUC] = 0.58). Adding measures of HACS to the SBT did not improve discrimination for whether LBP was present at six months (AUC = 0.59). Conclusions: This study confirmed the suboptimal predictive accuracy of the SBT, administered during acute LBP, for LBP recovery at six months. Assessment of HACS in acute LBP does not improve the predictive accuracy of the SBT.

Despite chronic low back pain (LBP) being considered a biopsychosocial condition for diagnosis and management, few studies have investigated neurobiological risk factors thought to underpin the transition from acute to chronic LBP. The aim of this research is to describe the methodology, compare baseline characteristics between acute LBP participants and pain-free controls, and compare LBP participants with or without completed follow-up. One hundred and twenty individuals experiencing acute LBP and 57 pain-free controls were recruited to participate in the Understanding persistent Pain Where it ResiDes (UPWaRD) study. Neurobiological, psychological, and sociodemographic data were collected at baseline, and at 3 and 6 months. Ninety-five participants (79%) provided outcome data at 3-month follow-up and 96 participants (80%) at 6 months. Compared to controls, LBP participants in the UPWaRD cohort were older, had a higher BMI, a higher prevalence of comorbidities, and higher medication usage. Higher depression, anxiety and stress, lower pain self-efficacy, and higher pain catastrophising during acute LBP were correlated with higher 6-month pain and disability. This cohort provides novel and significant opportunities to increase understanding of neurobiological risk factors of LBP. Future findings endeavour to provide new targets for treatment and prevention of chronic LBP. Additional priorities include exploring epigenetic and proteomic biomarkers of poor LBP outcome.

Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N = 120) participated in a prospective cohort study with 6-month follow-up. Candidate predictors were selected from the neurobiological (eg, sensorimotor cortical excitability assessed by sensory and motor-evoked potentials and brain-derived neurotrophic factor genotype), psychological (eg, depression and anxiety), symptom-related (eg, LBP history), and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with the presence of LBP at 6 months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress, and pain catastrophizing were the strongest predictors (R-2 = 0.47) of pain intensity at 6 months. Older age and higher pain catastrophizing were the strongest predictors (R-2 = 0.30) of disability at 6 months. When the LBP outcome was dichotomised, sensory cortex and corticomotor excitability, brain-derived neurotrophic factor genotype, depression and anxiety, LBP history and baseline pain intensity, discriminated between those who did and did not report LBP at 6 months (C-statistic 0.91). This study identifies novel risk factors for the development of future LBP. Neurobiological risk factors, when added to a multivariable linear regression model, explained a further 15% of the variance in the 6-month pain intensity.

Background Fall accidents in older adults are associated with reduced quality of life, personal health issues, and earlier deaths. Previous studies have found that both physical and cognitive parameters influence the risk of falling in older adults. During the COVID-19 pandemic lockdown (2020-2021) in Denmark, web-based training was the safest option for training, although its effectiveness was uncertain. Objective The purpose of this stratified, block randomized trial was to examine the effect of two types of web-based and in-person training—salsa dance and regular fitness circuit—in two training groups in comparison with a control group. Methods A total of 78 older adults (9 male and 69 female; mean age 70.4, SD 4.4 years; mean height 165.2, SD 6.8 cm; and mean weight 65.7, SD 11.9 kg) completed the 6-months training period: dance (n=25), fitness (n=23), and control group (n=30). Accidental falls were registered during the follow-up test. Participants in the two training groups were assigned to 1-hour training sessions twice a week for 6 months. Prior to the pandemic, training was administered by a skilled instructor at an activity center in the municipality or a dance studio. Following the pandemic, dance training was administered through a web-based meeting platform, whereas fitness training was guided by a video. Adherence to the training was collected weekly. Participants in the control group were encouraged to continue their everyday life. Results Both intervention groups had fewer accidental falls during the 6 months intervention compared with the control group (control group: 9 falls; dance: 4 falls, fitness: 0 falls; chi-square: P<.05). In total, adherence to fitness training was 72.6%, and it was 86.9% for dance. However, adherence to the web-based dance training was 95% (342 dance training hours of possible 360 dance training hours). Conclusions A combination of a 6-months web-based and in-person training (for dance and fitness) reduced the number of accidental falls in older adults. Trial Registration ClinicalTrials.gov NCT03683849; https://clinicaltrials.gov/ct2/show/NCT03683849

ABSTRACT BACKGROUND Determining the mechanistic causes of complex biopsychosocial health conditions such as low back pain (LBP) is challenging, and research is scarce. Cross-sectional studies demonstrate altered excitability and organisation of the primary somatosensory and primary motor cortex in people with acute and chronic LBP, however, no study has explored these mechanisms longitudinally or attempted to draw causal inferences. METHODS Prospective, longitudinal, cohort study including 120 people with an acute episode of LBP. Sensory evoked potential area measurements were used to assess primary and secondary somatosensory cortex excitability. Transcranial magnetic stimulation derived map volume was used to assess corticomotor excitability. Directed acyclic graphs identified variables potentially confounding the exposure-outcome relationship. The effect of acute-stage sensorimotor cortex excitability on six-month LBP outcome was estimated using multivariable regression modelling, with adjusted and unadjusted estimates reported. Sensitivity analyses were performed to explore the effect of unmeasured confounding and missing data. RESULTS Lower primary (OR = 2.08, 95% CI = 1.22 to 3.57) and secondary (OR = 2.56, 95% CI = 1.37 to 4.76) somatosensory cortex excitability in the acute stage of LBP increased the odds of developing chronic pain at six-month follow-up. This finding was robust to confounder adjustment and unmeasured confounding (E-Value = 2.24 & 2.58, respectively). Corticomotor excitability in the acute stage of LBP was associated with higher pain intensity at 6-month follow-up (B = −0.15, 95% CI: −0.28 to −0.02) but this association did not remain after confounder adjustment. CONCLUSION These data provide the first evidence that low somatosensory cortex excitability in the acute stage of LBP is a cause of chronic pain. Interventions designed to increase somatosensory cortex excitability in acute LBP may be relevant to the prevention of chronic pain.

Bilateral deficits in sensorimotor function have been observed in unilateral musculoskeletal pain conditions. Altered interhemispheric inhibition (IHI) between primary sensory cortices (S1s) is one mechanism that could explain this phenomenon. However, IHI between S1s in response to acute muscle pain, and the relationship between IHI and pressure pain sensitivity in the unaffected limb have not been examined. In 21 healthy individuals, IHI was assessed using somatosensory evoked potentials in response to paired median nerve electrical stimulation at: 1) baseline; 2) immediately following pain resolution; and 3) at 30-minutes follow-up. Acute muscle pain was induced by injection of hypertonic saline into the right abductor pollicis brevis (APB) muscle. Pressure pain thresholds were assessed at the right and left APB muscles before and 30minutes after pain resolution. Compared to baseline, IHI from the affected to unaffected S1 was unaltered in response to acute muscle pain immediately following pain resolution, or at 30minutes follow-up. Pressure pain thresholds were reduced over the right (P = .001) and left (P = .001) APB muscles at 30-minutes follow-up. These findings suggest IHI between S1s is unaffected by acute, short-lasting muscle pain, despite the development of increased sensitivity to pressure in the unaffected APB muscle. Perspective: IHI from the affected S1 (contralateral to the side of pain) to unaffected S1 is unaltered following the resolution of acute muscle pain. This finding suggests that IHI between S1s may not be relevant in the development of bilateral sensorimotor symptoms in unilateral pain conditions. (c) 2022 by United States Association for the Study of Pain, Inc.

Introduction Approximately one in three of all older adults fall each year, with wide ranging physical, psychosocial and healthcare-related consequences. Exercise-based interventions are the cornerstone for falls prevention programmes, yet these are not consistently provided, do not routinely address all components of the balance system and are often not well attended. The HOLOBalance system provides an evidence-based balance training programme delivered to patients in their home environment using a novel technological approach including an augmented reality virtual physiotherapist, exergames and a remote monitoring system. The aims of this proof-of-concept study are to (1) determine the safety, acceptability and feasibility of providing HOLOBalance to community dwelling older adults at risk for falls and (2) provide data to support sample size estimates for a future trial. Methods A single (assessor) blinded pilot randomised controlled proof of concept study. 120 participants will be randomised to receive an 8-week home exercise programme consisting of either: (1) HOLOBalance or (2) The OTAGO Home Exercise Programme. Participants will be required to complete their exercise programme independently under the supervision of a physiotherapist. Participants will have weekly telephone contact with their physiotherapist, and will receive home visits at weeks 0, 3 and 6. Outcome measures of safety, acceptability and feasibility, clinical measures of balance function, disability, balance confidence and cognitive function will be assessed before and immediately after the 8 week intervention. Acceptability and feasibility will be explored using descriptive statistics, and trends for effectiveness will be explored using general linear model analysis of variance. Ethics and dissemination This study has received institutional ethical approvals in Germany (reference: 265/19), Greece (reference: 9769/24-6-2019) and the UK (reference: 19/LO/1908). Findings from this study will be submitted for peer-reviewed publications. Trial registration number NCT04053829 . Protocol version V.2, 20 January 2020

BACKGROUND:Unintentional falls among older adults are of primary importance due to their impact on quality of life. Falling accounts for 95% of hip fractures, leading to an approximately six times increased risk of death within the first 3 months. Furthermore, physical and cognitive parameters are risk factors for falls. The purpose of this study is to examine the effect of a 6-month salsa dance training intervention, compared with regular fitness circuit training and a control group.METHODS:This study will include 180 older adults: 90 healthy patients and 90 patients with osteoporosis. Participants will be allocated randomly in either of the groups, stratified according to age. Training groups will receive 2 weekly 1-hour training sessions, continuously through 6 months. Participants will be tested at baseline and 6 and 18 months post baseline. Primary outcome will be number of falls and secondary outcomes include bone mineral density, body composition, pain evaluation, weekly physical activity, single-task and dual-task gait patterns, balance, Fullerton Functional Fitness Test and assessment of the mini-BESTest.DISCUSSION:This study will investigate the effects of a specially designed dance training programme (Dancing Against falls iN Community-dwElling older adults (DANCE)) to reduce the risk of falling among older adults. The study will investigate the effect against an active and passive comparator, resulting in the possibility to state, if DANCE training should be an alternative to traditional training.TRIAL REGISTRATION NUMBER:NCT03683849.

In this study, we propose a dynamic Bayesian network (DBN)-based approach to behavioral modelling of community dwelling older adults at risk for falls during the daily sessions of a hologram-enabled vestibular rehabilitation therapy programme. The component of human behavior being modelled is the level of frustration experienced by the user at each exercise, as it is assessed by the NASA Task Load Index. Herein, we present the topology of the DBN and test its inference performance on real-patient data.

Rehabilitation programs play an important role in improving the quality of life of patients with balance disorders. Such programs are usually executed in a home environment, due to lack of resources. This procedure usually results in poorly performed exercises or even complete drop outs from the programs, as the patients lack guidance and motivation. This paper introduces a novel system for managing balance disorders in a home environment using a virtual coach for guidance, instruction, and inducement. The proposed system comprises sensing devices, augmented reality technology, and intelligent inference agents, which capture, recognize, and evaluate a patient's performance during the execution of exercises. More specifically, this work presents a home-based motion capture and assessment module, which utilizes a sensory platform to recognize an exercise performed by a patient and assess it. The sensory platform comprises IMU sensors (Mbientlab MMR© 9axis), pressure insoles (Moticon©), and a depth RGB camera (Intel D415©). This module is designed to deliver messages both during the performance of the exercise, delivering personalized notifications and alerts to the patient, and after the end of the exercise, scoring the overall performance of the patient. A set of proof of concept validation studies has been deployed, aiming to assess the accuracy of the different components for the sub-modules of the motion capture and assessment module. More specifically, Euler angle calculation algorithm in 2D (R2 = 0.99) and in 3D (R2 = 0.82 in yaw plane and R2 = 0.91 for the pitch plane), as well as head turns speed (R2 = 0.96), showed good correlation between the calculated and ground truth values provided by experts' annotations. The posture assessment algorithm resulted to accuracy = 0.83, while the gait metrics were validated against two well-established gait analysis systems (R2 = 0.78 for double support, R2 = 0.71 for single support, R2 = 0.80 for step time, R2 = 0.75 for stride time (WinTrack©), R2 = 0.82 for cadence, and R2 = 0.79 for stride time (RehaGait©). Validation results provided evidence that the proposed system can accurately capture and assess a physiotherapy exercise within the balance disorders context, thus providing a robust basis for the virtual coaching ecosystem and thereby improve a patient's commitment to rehabilitation programs while enhancing the quality of the performed exercises. In summary, virtual coaching can improve the quality of the home-based rehabilitation programs as long as it is combined with accurate motion capture and assessment modules, which provides to the virtual coach the capacity to tailor the interaction with the patient and deliver personalized experience.

An increased risk of falling is associated with changes in gait while dual-tasking. The degree to which gait stability is altered during walking is influenced by an individual’s cognitive and postural capacity, and the difficulty of the presented tasks. However, it is unknown how greater walking task difficulty affects gait stability in younger and older adults when dual-tasking. The purpose of the current study was to determine the effect of walking task difficulty on gait stability in younger and older adults while performing a difficult audiospatial task. Ten younger [mean (SD) age 30.8 (6.6) years; 5 women] and 10 older [66.8 (5.7) years; 6 women] healthy adults walked on a treadmill at their preferred walking speed [younger 4.8 (0.4) ms−1, older 4.5 (0.5) ms−1) on either a level, or downhill slope both with and without responding to an audiospatial task. Step width, step width SD and mediolateral centre of mass displacement were calculated to determine changes in gait, and response time and accuracy were calculated to determine secondary task performance. Results indicated that older adults displayed a consistently greater step width (p ≤ 0.015) and maintained their mediolateral centre of mass displacement (p > 0.05) while walking downhill and responding to the audiospatial task, compared to downhill walking only. In contrast, younger adults maintained a regular step width during both level and downhill dual-tasking compared to level and downhill walking only (p > 0.05), however displayed a lower mediolateral centre of mass displacement during level dual-task walking compared to level walking only (p = 0.013). When the difficulty of the walking task was greater, older adults increased their step width, which increased their stability.

In this study, we propose a dynamic Bayesian network (DBN)-based approach to behavioral modelling of community dwelling older adults at risk for falls during the daily sessions of a hologram-enabled vestibular rehabilitation therapy programme. The component of human behavior being modelled is the level of frustration experienced by the user at each exercise, as it is assessed by the NASA Task Load Index. Herein, we present the topology of the DBN and test its inference performance on real-patient data. Clinical Relevance— Precise behavioral modelling will provide an indicator for tailoring the rehabilitation programme to each individual’s personal psychological needs.

BACKGROUND: One-third of individuals with acute lowback pain (LBP) experience recurrent symptoms within 12 months but the underlying mechanisms are unclear. One explanation is that individuals experiencing recurrent LBP develop altered central pain processing that predisposes to symptom recurrence. We compared central pain processing between individuals experiencing their first episode of acute LBP, recurrent acute LBP, and pain-free controls. METHODS: A cross-sectional study was conducted to evaluate central pain processing in 11 individuals experiencing their first episode of acute LBP, 11 individuals with recurrent acute LBP, and 11 pain-free controls. Outcome measures included pain and disability, pressure and heat pain thresholds (PPTs and HPTs), nociceptive flexor withdraw reflex (NFR) and conditioned pain modulation (CPM). RESULTS: The NFR latency was shorter in individuals experiencing their first episode of acute LBP when compared with pain-free controls (p = 0.01). Descending inhibitory pain control measured by CPM was less efficient in both acute LBP groups when compared with pain-free controls. HPTs and PPTs did not differ between people with and without acute LBP. There were no differences between the two LBP groups for any outcome measure. CONCLUSIONS: These data demonstrate altered central pain processing in the acute stage of LBP. However, the degree of impairment did not differ between individuals with a first episode vs. recurrent acute LBP. These findings suggest that altered central pain processing in acute LBP is not related to a previous history of LBP.

The etiologic role of work-related psychological stress in the development of musculoskeletal pain disorders (MDs) has been systematically investigated. Less clear, however, is the role of perceived stress and life stressors. This review aimed to assess the evidence for an etiologic role of perceived stress and life stressors in the development of chronic MDs. Database searches were conducted to identify prospective longitudinal studies that assessed perceived stress and life stressors in individuals without, or in the first 6 weeks of, musculoskeletal pain. The primary outcome was the development of a chronic MD. Methodologic quality was investigated using an adapted version of the Quality Assessment Tool for Observational Cohort studies and Cross-Sectional studies, and the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. Seven studies were included representing data from 6 independent cohorts. There was some evidence to support the etiologic role of perceived stress and life stressors in the development of arthritis (low quality) and chronic spinal pain (low quality). The limited number of studies, the poor quality of the evidence, and the heterogeneity of stress measures used across studies suggest that further high quality prospective studies are required to clarify the role of perceived stress and life stressors in the development of chronic MDs. PROSPERO: CRD42017059949 PERSPECTIVE: This review summarizes and critically appraises the evidence for the etiologic role of perceived stress and life stressors in the development of chronic MDs. The limited number of studies, the low quality of the evidence, and the heterogeneity across studies suggest that further research is needed on perceived stress and life stressors in MDs.

Introduction Low back pain (LBP) is the leading cause of disability worldwide, with prevalence doubling in the past 14 years. To date, prognostic screening tools display poor discrimination and offer no net benefit of screening over and above a ‘treat all’ approach. Characteristics of the primary sensory (S1) and motor (M1) cortices may predict the development of chronic LBP, yet the prognostic potential of these variables remains unknown. The Understanding persistent Pain Where it ResiDes (UPWaRD) study aims to determine whether sensorimotor cortex activity, an individual’s capacity for plasticity and psychosocial factors in the acute stage of pain, predict LBP outcome at 6 months. This paper describes the methods and analysis plan for the development of the prediction model. Methods and analysis The study uses a multicentre prospective longitudinal cohort design with 6-month follow-up. 120 participants, aged 18 years or older, experiencing an acute episode of LBP (less than 6 weeks duration) will be included. Primary outcomes are pain and disability. Ethics and dissemination Ethical approval has been obtained from Western Sydney University Human Research Ethics Committee (H10465) and from Neuroscience Research Australia (SSA: 16/002). Dissemination will occur through presentations at national and international conferences and publications in international peer-reviewed journals. Trial registration number ACTRN12619000002189; Pre-results.