Robert Ferrari

University of Alberta, Edmonton, Alberta, Canada

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Publications (81)217.79 Total impact

  • Robert Ferrari, Anthony Science Russell
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    ABSTRACT: The objective of this study is to determine the prevalence of primary hyperparathyroidism in a referred sample of fibromyalgia patients. Consecutively, referred patients with confirmed fibromyalgia (FM group) had measurements of serum levels of vitamin D, alkaline phosphatase, total calcium, magnesium, phosphate, creatinine, total protein, albumin, and parathyroid hormone. The same measurements were also conducted in a group of patients with widespread pain (WP group) who did not meet the 2010 Modified ACR criteria for fibromyalgia and a group with localized musculoskeletal pain (MSK group). A case of primary hyperparathyroidism was defined as a subject whose results showed any of the following: (1) parathyroid hormone levels above 6.8 pmol/L; (2) an ionized calcium above 1.25 mmol/L; or (3) both elevated, in the presence of normal range creatinine, alkaline phosphatase, vitamin D, phosphate, and magnesium. The mean age and the proportion of subjects who met the case definition of primary hyperparathyroidism were calculated for all groups. There were 125 subjects in the FM group, 127 in the WP group, and 138 in the MSK group. The prevalence rates of primary hyperparathyroidism were 6.4, 5.5, and 6.1 %, respectively, for these groups. Comparison of these prevalence rates to published figures for general clinical and non-clinical populations reveals no differences. The prevalence of primary hyperparathyroidism in fibromyalgia patients is not different than that in other patients with WP or those with localized pain, nor is it likely different than that seen in the general population.
    Clinical rheumatology. 07/2014;
  • Robert Ferrari
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    ABSTRACT: The aim of the study was to examine the effect of a daily pain diary on recovery from acute low back sprain. Summary of background data: Pain diaries are often recommended to or used by patients suffering with acute lumbar (low back) sprain. Diaries have been shown to be associated, however, with a slower rate of recovery after whiplash (neck) injury. The effect of diary use on recovery from low back injury is unknown. Subjects with acute lumbar (low back) sprain were randomly assigned to one of the two groups: a diary group and control group. A total of 58 out of 62 initially recruited subjects were seen in follow-up 3-month post-injury, 29 in the diary group, and 29 in the control group. Data were gathered within 1 week of injury on sex, age, and Oswestry Disability Questionnaire (ODQ) scores. The diary group was asked then to keep a record of their overall pain experience, rating their pain on a scale of 1-10 on a daily basis for 4 weeks. At the outset, both groups had similar mean age, sex distribution, and mean ODQ scores. After 4 weeks of pain diary use, fewer diary group subjects reported recovery at 3 months compared with the control group (52 vs. 79 %, respectively, p < 0.05). The use of a pain diary for 4 weeks in acute lumbar sprain subjects is associated with a reduced rate of recovery.
    Rheumatology international. 07/2014;
  • Robert Ferrari
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    ABSTRACT: The objectives of this paper are to to measure levels of perceived injustice in whiplash victims and determine the relationship to recovery at 6-month post-injury. Consecutive acute whiplash patients completed the Injustice Experience Questionnaire, at presentation, and also 3- and 6-month post-injury. At each of these two follow-up points, participants were examined for recovery. Of an initial 134 participants, 130 participants were followed up at 3 months and 124 at 6 months. At the 3-month follow-up, 62 % (80/130) of participants reported recovery from their injuries. At 6 months, 80 % (99/124) reported recovery. The initial Injustice Experience Questionnaire score was low, with a mean score of 6.0 ± 1.0 (range 5–10) out of a maximum of 48. The mean score at 3-month follow-up had increased in the cohort to 7.4 ± 1.6 (range 5–11). At 6-month post-injury, the mean of the Injustice Experience Questionnaire score for the cohort who still reported lack of recovery (25/124 participants) was 15.0 ± 6.0 (range 5–31), while that for the recovered group remained low at 8.2 ± 3.9 (range 5–11). In the primary care setting, a significant proportion of whiplash patients who have not recovered by 3-month post-injury subsequently develop higher levels of perceived injustice by 6-month post-injury. The development of high levels of perceived injustice at 6-month post-injury appears to follow the development of chronic pain and a lack of recovery at 3 months and, at that point, becomes a risk factor for lack of recovery thereafter.
    Clinical Rheumatology 06/2014; · 2.04 Impact Factor
  • Robert Ferrari, Anthony Science Russell
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    ABSTRACT: This is a pilot study to compare levels of perceived injustice via the Injustice Experience Questionnaire in patients with fibromyalgia or rheumatoid arthritis. Two cohorts of patients, one with fibromyalgia (FM), one with rheumatoid arthritis (RA), completed the Injustice Experience Questionnaire, a visual analogue pain scale, and the Hospital Anxiety and Depression Scale (HADS). Inferential statistics were then used to determine whether participants in the two diagnostic groups had significantly different scores on the Perceived Injustice Questionnaire. This was done univariately using t tests and after adjusting for potential confounders using ANCOVA. We also examined crude associations between the variables using Pearson correlation coefficients, then examined the adjusted association between diagnostic group and perceived injustice using multivariable linear regression. Our final models were built in a blocked fashion by initially entering diagnostic category into the model, then entering other variables simultaneously using a stepwise strategy (p-to-enter ≤.05, p-to-remove ≥.10). A total of 126 participants (64 FM, 62 RA) completed all questionnaires. The FM group had a greater percentage of female participants, more severe pain, more severe anxiety and more severe depression. In unadjusted analysis, the FM group had higher Injustice Experience Questionnaire scores. When the RA and FM group scores for the Injustice Experience Questionnaire are adjusted for pain levels, there is no statistically significant difference between groups. Adjustment for HADS anxiety and HADS depression does not significantly affect the Injustice Experience Questionnaire scores after adjustment for pain. Fibromyalgia is associated with a higher level of perceived injustice than is seen with rheumatoid arthritis. This difference appears to be associated with higher levels of pain reported by fibromyalgia patients, and therefore may not be specific to the diagnosis. Prospective studies may help to resolve this issue.
    Clinical Rheumatology 03/2014; · 2.04 Impact Factor
  • Robert Ferrari
    Seminars in arthritis and rheumatism 01/2014; · 4.72 Impact Factor
  • Robert Ferrari, Deon Louw
    Journal of Zhejiang University SCIENCE B 11/2013; 14(11):1049-53. · 1.11 Impact Factor
  • Robert Ferrari
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    ABSTRACT: The objective of this study was to compare the effect of customized foot orthotics in addition to usual care (UC) compared with UC alone for the treatment of patients with chronic low back pain after work-related injury. Sixty-two consecutive patients presenting with chronic (>3 months), nonspecific, low back pain following work-related low back injury were included in the study. A total of 30 patients in the UC group were given a 6-week exercise therapy program along with prescription analgesics. The intervention group, composed of 32 patients, received UC in addition to customized foot orthotics (orthotics group). All subjects completed the Oswestry Disability Index at the initiation of the study and at 8-week follow-up. Work disability, as defined by working at usual, preinjury job labor level, was recorded at baseline and 8-week follow-up. A total of 28 subjects in the UC group and 32 in the orthotics group completed the study. The 2 groups were well matched in terms of age, sex distribution, and duration of low back pain as well as baseline Oswestry Disability Index score. At 8 weeks, both groups had improved. The orthotics group had a lower Oswestry Disability Index than the UC group (P < .01), with a smaller proportion of the orthotics group using any form of prescribed analgesics for back pain (P < .05). The findings showed that patients in this study with chronic, nonspecific low back pain following work-related low back injury had greater improvement in short-term outcomes with orthotics and UC than with UC alone.
    Journal of manipulative and physiological therapeutics 07/2013; · 1.06 Impact Factor
  • Robert Ferrari, Anthony S Russell
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    ABSTRACT: To determine the specificity and sensitivity of the Modified 2010 American College of Rheumatology (ACR) Diagnostic Criteria for Fibromyalgia (given as a self-administered questionnaire) in clinical practice. A cohort of patients with widespread pain, referred by primary care physicians to rheumatologists, completed the questionnaire for the Modified ACR 2010 criteria. Prior to completion of the questionnaire, patients were diagnosed by at least 1 rheumatologist as either having fibromyalgia (FM) or not having FM, using the rheumatologist's clinical assessment as the gold standard for diagnosis of FM. The Modified ACR 2010 criteria were then applied to determine whether a diagnosis of FM was satisfied by the criteria. Sensitivity and specificity were determined, using the rheumatologist's clinical assessment as the gold standard. A score ≥ 12 on the Modified ACR 2010 criteria questionnaire was also tested as the criterion to satisfy a diagnosis of FM, and subsequently to determine sensitivity and specificity. We examined the effect of using a cutoff score ≥ 13, as previous research indicated that this may be a more useful cutoff value. A total of 451 subjects completed the questionnaire: 174 with an a priori diagnosis of FM by a rheumatologist and 277 with widespread pain who did not have an a priori clinical diagnosis of FM by a rheumatologist. The Modified ACR 2010 criteria were satisfied by 90.2% of patients with an a priori diagnosis of FM, and by 10.5% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, sensitivity and specificity are 90.2% and 89.5%, respectively, using the Modified ACR 2010 criteria. A score ≥ 12 on the Modified ACR 2010 criteria was observed in 97.4% of patients with an a priori diagnosis of FM, and 14.8% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, the sensitivity and specificity are 97.4% and 85.2%, respectively, using a cutoff score ≥ 12. Using a score of ≥ 13, however, the sensitivity was 93.1% and the specificity was 91.7%. The Modified ACR 2010 criteria questionnaire can be used in primary care as a tool to assist physicians in the diagnosis of FM with high specificity and sensitivity. Calculating the total score on a Modified ACR 2010 criteria questionnaire, and setting the value of ≥ 13 as the cutoff for a diagnosis of FM appears to be the most effective approach. The Modified ACR 2010 criteria may reduce the need for rheumatology referral simply for the diagnosis of FM.
    The Journal of Rheumatology 07/2013; · 3.26 Impact Factor
  • Robert Ferrari
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    ABSTRACT: The purpose of this study was to compare reported disability due to chronic low back pain following a motor vehicle collision between groups of those using customized foot orthotics and those not using orthotics. Sixty-six consecutive patients referred from primary care medical physicians for the complaint of chronic (> 3 months) low back pain following a motor vehicle collision were included. Thirty patients received "usual care" that included prescription of an exercise therapy program in addition to analgesics. Thirty-four patients received the same therapy along with customized foot orthotics. All patients completed the Oswestry Disability Index at the initiation of the study and at 8-week follow-up. The number of participants using any type of prescription analgesic for their back pain at baseline and at 8 weeks was also recorded. All patients completed treatment, and the baseline and 8-week questionnaires. Both treatment groups were well matched in terms of age, sex distribution, and duration of low back pain, as well as baseline Oswestry Disability Index score. At 8 weeks, although both groups had improved, the group that used orthotics had a lower Oswestry Disability Index than the usual care group (P < .05), with a smaller proportion of the orthotics group using any form of prescribed analgesics for back pain (P < .05). In this study, patients with chronic low back pain following a motor vehicle collision who used orthotics in addition to usual care had improved short-term outcomes compared with usual care alone.
    Journal of chiropractic medicine 03/2013; 12(1):15-9.
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    ABSTRACT: OBJECTIVE:: Coping is shown to affect outcomes in chronic pain patients; however, few studies have examined the role of coping in the course of recovery in whiplash-associated disorders (WAD). The purpose of this study was to determine the predictive value of coping style for 2 key aspects of WAD recovery, reductions in neck pain, and in disability. METHODS:: A population-based prospective cohort study design was used to study 2986 adults with traffic-related WAD. Participants were assessed at baseline, 6 weeks, and 4, 8, and 12 months postinjury. Coping was measured at 6 weeks using the Pain Management Inventory, and neck pain recovery was assessed at each subsequent follow-up, using a 100 mm visual analogue scale (VAS). Disability was assessed at each follow-up using the Pain Disability Index (PDI). Pain recovery was defined as a VAS score of 0 to 10; disability recovery was defined as a PDI score of 0 to 4. Data analysis used multivariable Cox proportional hazards models. RESULTS:: Those using high versus low levels of passive coping at 6 weeks postinjury experienced 28% slower pain recovery and 43% slower disability recovery. Adjusted hazard rate ratios for pain recovery and disability recovery were 0.72 (95% CI, 0.59-0.88) and 0.57 (95% CI, 0.41-0.78), respectively. Active coping was not associated with recovery of neck pain or disability. CONCLUSIONS:: Passive coping style predicts neck pain and self-assessed disability recovery. It may be beneficial to assess and improve coping style early in WAD.
    The Clinical journal of pain 02/2013; · 3.01 Impact Factor
  • Robert Ferrari
    The Lancet 12/2012; · 39.06 Impact Factor
  • Robert Ferrari
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    ABSTRACT: The purpose of this study was to quantify the degree to which fibromyalgia patients perceive the cause of their pain to be inexplicable or difficult to understand. The author developed two simple Likert scales, Understand Pain Scale and Explain Pain Scale, which ask the subject to indicate the degree to which they are able to, respectively, understand the cause of their pain and to explain the cause of their pain to others. A total of 104 subjects who met the 1990 American College of Rheumatology Diagnostic Criteria for fibromyalgia (FM group), and 272 subjects with widespread pain who did not meet these criteria (non-FM group) completed these two instruments. On the Understand Pain Scale, 67.3 % of FM subjects endorsed either the item "understand very little about the cause of my pain (the reason I have pain)" or "cannot understand at all the cause of my pain (the reason I have pain)". By comparison, 16.2 % of the non-FM group with widespread pain endorsed either of these Understand Pain Scale items. On the Explain Scale, 84.6 % of fibromyalgia subjects endorsed either the item "can very little or not very often explain the cause of my pain (the reason I have pain) to others" or "cannot at all explain the cause of my pain (the reason I have pain) to others". In contrast, 21.7 % of non-FM group subjects with widespread pain endorsed either of the aforementioned items. Compared to other patients with chronic, widespread pain, fibromyalgia patients report a much greater degree of difficulty in understanding the cause of their pain and explaining the cause of their pain to others. This phenomenon may reflect the narrative of "inexplicability" in fibromyalgia patients that distinguishes them from other widespread pain populations.
    Clinical Rheumatology 07/2012; 31(10):1455-61. · 2.04 Impact Factor
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    Robert Ferrari
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    ABSTRACT: Background Central sensitization has been associated with chronic pain in whiplash patients.Methods Consecutive whiplash patients were assessed at 3 months post-whiplash injury with the brachial plexus provocation test (BPPT) as a sign of central sensitization. Self-reported recovery was assessed by the response to the question ‘Do you feel you have recovered fully from your accident injuries?’ResultsSixty-nine subjects (32 males, 37 females, age 37.5 ± 13.0 years (mean ± SD), range 18–71) were included. Of these, 34 reported a lack of recovery, and 35 reported recovery at 3 months post-injury. The mean BPPT elbow extension (from 180°) was 41.5 ± 23.0°, and the mean VAS score for the BPPT was 2.2 ± 1.2 (out of 10). Those who reported recovery had a mean BPPT elbow extension angle of 25.1 ± 15.8 while those who did not report recovery had a mean BPPT angle of 58.4 ± 15.9 (P < 0.05). The visual analogue scale (VAS) score for recovered subjects was 1.8 ± 1.1 and 2.7 ± 1.1 (P < 0.05) for non-recovered. There was a moderate correlation between self-reported recovery and BPPT elbow extension angle (−0.44) and a lower correlation between self-reported recovery and VAS score (−0.30).Conclusion Self-reported recovery correlates well with a lower likelihood of signs of central sensitization.
    Journal of Sport and Health Science. 05/2012; 1(1):61–64.
  • Robert Ferrari
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    ABSTRACT: Customized foot orthotics are widely prescribed for patients with chronic, non-specific low back pain and lower limb pain, but there are few trials demonstrating effectiveness, and none for fibromyalgia. A total of 67 consecutive patients presenting with chronic, widespread pain, who met the 1990 American College of Rheumatology criteria for fibromyalgia, were included in the study. A total of 32 subjects were prescribed a spinal exercise therapy program along with analgesics. These subjects formed the Control group. A second group, comprised of 35 subjects, received the same therapy, along with customized foot orthotics (Orthotics group). All subjects completed the Revised Fibromyalgia Impact Questionnaire (FIQR) at the initiation of the study and at 8 weeks follow-up. The number of subjects using any type of prescription analgesic or other medication for chronic pain at baseline and at 8 weeks was also recorded. A total of 30 subjects in the Control group and 33 in the Orthotics group completed the study. All subjects completed the baseline and 8-week FIQR. The two groups were well matched in terms of age (45.3 ± 11.5 years in the Orthotics group vs. 47.2 ± 8.7 years in the cohort Control), medication use, duration of pain (6.5 ± 4.3 years in the Orthotics group vs. 6.2 ± 3.4 years in the cohort Control group), as well as baseline FIQR scores (55.2 ± 11.0 in the Orthotics group vs. 56.3 ± 12.2 in the cohort Control group). At 8 weeks, the Orthotics group had a greater reduction in the FIQR score than the cohort Control group (reduction of 9.9 ± 5.9 vs. 4.3 ± 4.4, respectively), and this was mainly due to changes in the 'function' domain of the FIQR (reduction of 19.6 ± 9.4 in the Orthotics group vs. 8.1 ± 4.3 in the cohort Control group). As part of a complex intervention, in a cohort-controlled trial of primary care patients with fibromyalgia, the addition of custom-made foot orthotics to usual care appears to improve functioning in the short term.
    Clinical Rheumatology 03/2012; 31(7):1041-5. · 2.04 Impact Factor
  • Robert Ferrari, Anthony Science Russell
    The Journal of Rheumatology 03/2012; 39(3):655; author reply 656-7. · 3.26 Impact Factor
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    ABSTRACT: To determine the timeliness of consultation and initiation of disease-modifying antirheumatic drugs (DMARD) in patients with rheumatoid arthritis (RA) referred to rheumatologists. The first part of the study was a review of the charts of 151 patients with RA followed by 3 rheumatologists. The outcome measure was the interval between symptom onset and consultation with a rheumatologist. The second part of the study involved a chart review of 4 family physician practices in a small urban center in order to determine the accuracy of diagnostic coding (International Classification of Diseases; ICD-9) of RA, as well as the proportion of patients with RA seen by a rheumatologist. Finally, a survey was sent to primary care physicians at a group of walk-in clinics to determine what percentage of their patients with RA were referred to a rheumatologist and, concerning referral patterns, how likely it is they would refer a confirmed or suspected RA patient to a rheumatologist. Patients with RA referred to rheumatologists in this sample were seen by a rheumatologist at a mean of 9.8 months (median 5 mo, range 0-129 mo) after symptom onset, and mean 1.2 months (median 4.0 mo, range 0-8 mo) after being referred by their primary care physician. All referred patients with confirmed RA were started on DMARD within 1 week of initial consultation. Primary care physicians would refer suspected RA patients 99.5% of the time (median 100, range 90-100%), and 87.6% (median 90, range 50-100%) of patients with confirmed RA would have seen a rheumatologist at least once. A chart review showed that, in a select group of family physicians, 70.9% (22/31) of patients coded as RA per the ICD-9 did indeed have RA and all had seen a rheumatologist for their condition. In Northern Alberta, patients with RA are seen and started on DMARD therapy in a timely fashion. Most of the delay is at the primary care level, suggesting a need for improved education of patients and primary care physicians rather than a formal triage system.
    The Journal of Rheumatology 02/2012; 39(4):707-11. · 3.26 Impact Factor
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    R Ferrari
    Journal of neurology, neurosurgery, and psychiatry 07/2011; 82(7):826. · 4.87 Impact Factor
  • Robert Ferrari, Anthony S Russell
    Arthritis care & research. 06/2011; 63(10):1495-6.
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    Robert Ferrari, Deon Louw
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    ABSTRACT: Expectations and beliefs are important predictors of outcome following minor head injury. In this paper, the primary purpose is to develop a simple symptom expectation questionnaire for minor head injury for use in future research studies. An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for minor head injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter (a subject who expected at least one of these symptoms would remain chronic following minor head injury). A total of six of the 56 items were found to be discriminatory, and these were tested in additional subject groups against the original questionnaire. From the original database of 179 subjects completing a 56-item symptom expectation checklist, 135 expected that at least one of the 56 symptoms would be chronic following minor head injury. The 135 expecters, however, all chose at least one of six items: headache, anxious or worried, depressed, difficulty concentrating, dizziness, and neck pain. Using these six items, in two new groups of subjects, all those who endorsed one of the 56 symptoms as likely to be chronic following minor head injury (expecters) could also be identified on the 6-item checklist. A shortened (6-item) symptom expectation checklist of commonly reported symptoms following minor head injury (headache, anxious or worried, depressed, difficulty concentrating, dizziness, and neck pain) correctly identifies subjects who expect that at least one symptom will be chronic following minor head injury (i.e., an expecter).
    Journal of Zhejiang University SCIENCE B 06/2011; 12(6):499-502. · 1.11 Impact Factor
  • Robert Ferrari, Deon Louw
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    ABSTRACT: The objective of the study was to determine the odds ratio for compliance with referral to an active treatment program according to coping style in a cohort of acute whiplash-injured subjects. Sixty whiplash patients were assessed within 1 week of their collision for their coping styles and were then questioned 3 weeks later to determine if they had complied with a referral for an active treatment program. Coping style was assessed with the Vanderbilt Pain Management Inventory. Adjusting for age, gender, and initial whiplash disability questionnaire scores, the odds ratio for compliance with therapy for subjects who had a low active/high passive coping style was 0.15 (P=0.03) (95% CI, 0.03-0.86) relative to all other coping style patterns, whose odds ratios did not differ from each other. As a secondary outcome, the odds ratio for reporting prescription medication use for subjects who had a low active/high passive coping style was 6.7 (P=0.038) (95% CI, 1.1-40.4). Those whiplash patients who have a low active/high passive coping style are less likely to attend an active exercise-based rehabilitation program and more likely to use prescription medications in the first 3 weeks following injury. Coping style may affect recovery from whiplash injury through issues of compliance with active therapy and increased reliance on prescription medications.
    Clinical Rheumatology 04/2011; 30(9):1221-5. · 2.04 Impact Factor

Publication Stats

455 Citations
217.79 Total Impact Points

Institutions

  • 2002–2014
    • University of Alberta
      • • Department of Medicine
      • • Department of Physical Therapy
      Edmonton, Alberta, Canada
  • 2009
    • The University of Western Ontario
      • Department of Medicine
      London, Ontario, Canada
  • 2003
    • University of Toronto
      Toronto, Ontario, Canada