Robert Ferrari

University of Alberta, Edmonton, Alberta, Canada

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Publications (110)284.12 Total impact

  • Robert Ferrari

    No preview · Article · Dec 2015
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    Robert Ferrari

    Preview · Article · Jun 2015 · Journal of General Internal Medicine
  • Robert Ferrari
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    ABSTRACT: The objective of this study was to evaluate the Canadian Rheumatology Association Choosing Wisely recommendation concerning anti-nuclear antibody (ANA) testing. Patients with joint pain/stiffness/swelling were assessed to determine if ANA testing was indicated. An a priori threshold was set before ANA testing would be considered. Those who did not have ANA testing ordered were followed for 1 year to determine if any of them went on to have a diagnosis of systemic lupus erythematosus (SLE) or other connective tissue disease. A parallel study was conducted with a similar a priori threshold for the use of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody testing in the diagnosis of rheumatoid arthritis (RA), and again, patients were followed for 1 year. A total of 866 subjects were examined, 509 females (58.8 %) and 357 males (41.2 %). The mean age of the group was 47.5 ± 16.8 years. The mean duration of symptoms was 12.0 ± 5.6 weeks. Of the 866 subjects, 68 met an a priori threshold for ordering ANA, RF, and anti-CCP testing. Of these 68, there was a newly diagnosed case of SLE, 4 newly diagnosed cases of RA, and 3 cases of polymyalgia rheumatica. The remaining 798 subjects were followed for approximately 1 year and none developed evidence of SLE, RA, or other connective tissue disease. In the evaluation of non-specific musculoskeletal symptoms, setting an a priori threshold for ordering serology in keeping with the spirit of the Canadian Rheumatology Association Choosing Wisely recommendation for antibody testing results in a very low risk of missing a case of systemic lupus erythematosus or rheumatoid arthritis.
    No preview · Article · Jun 2015 · Clinical Rheumatology
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    Robert Ferrari

    Preview · Article · Apr 2015
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    Robert Ferrari

    Preview · Article · Mar 2015
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    Robert Ferrari
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    ABSTRACT: Objective To measure the 1-year incidence of fibromyalgia in a cohort of acute whiplash-injured participants. Methods Consecutive acute patients with whiplash were assessed via the 2010 Modified American College of Rheumatology (ACR) criteria for fibromyalgia at 3 months, 6 months and 1 year postinjury. At each of these follow-up points, participants were also examined for recovery from whiplash injury. Results Of an initial 268 participants, data on recovery was available for 264 participants during the 1-year follow-up period. At the 3-month follow-up, 62% (167/268) of participants reported recovery from their whiplash injuries. At 6 months, 76% (203/268) reported recovery, and at 1 year 82% (216/264) reported recovery. At 3 and 6 months follow-up none of the participants met the 2010 Modified ACR Criteria for fibromyalgia, but fibromyalgia criteria were met for 2 (of 264) seen at the 1-year follow-up, yielding a 1-year incidence of 0.8% (95% CI 0.1% to 3.0%). Conclusions In the primary care setting, a significant proportion of patients with whiplash recover from whiplash injury at 1 year, and the incidence of fibromyalgia after acute whiplash injury is very low. The impression that fibromyalgia is common after whiplash injury may be due to the failure to exclude precollision fibromyalgia cases or due to referral bias of non-recovered patients.
    Preview · Article · Feb 2015
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    Robert Ferrari · Anthony Science Russell
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    ABSTRACT: Objectives. To compare the mysteriousness scores of the Pain Beliefs and Perceptions Inventory in fibromyalgia. Methods. Two cohorts of patients, one with fibromyalgia (FM) and one with rheumatoid arthritis (RA), completed the Mystery Scale component of the Pain Beliefs and Perceptions Inventory to determine whether subjects in the two diagnostic groups had significantly different scores on the Mystery Scale. Results. A total of 126 subjects (64 FM, 62 RA) completed all questionnaires. The FM group had a greater percentage of female subjects, more severe pain, more severe anxiety, more severe depression, and a higher perceived injustice score. When the RA and FM group scores for the Mystery Scale were adjusted for age, sex, pain severity, HADS scores, and perceived injustice scores, the FM group still had a higher Mystery Scale score. Discussion. Fibromyalgia is associated with a higher level of perception of mysteriousness in the Pain Beliefs and Perceptions Inventory than is seen with rheumatoid arthritis. This difference appears to be independent of levels of pain, depression, anxiety, and perceived injustice. This sense of mysteriousness may reflect a lack of understanding of pain in fibromyalgia as previously reported and may be an area to be addressed in therapy.
    Preview · Article · Dec 2014 · International Journal of Rheumatology
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    Robert Ferrari · Lewis Klar

    Preview · Article · Oct 2014
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    Robert Ferrari
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    ABSTRACT: To determine the test–retest repeatability of the Injury Severity Perception (ISP) score in participants with acute whiplash-associated disorders.Methods Consecutive patients with whiplash-associated disorder, presenting in the acute stage to a primary care center, were asked to complete the ISP score. ISP was measured with a numerical rating scale that ranged from 0 to 10, on which subjects were asked to rate how severe (in terms of damage) they thought their injury was. The anchors were labeled ‘‘no damage’’ (0) and ‘‘severe, and maybe permanent damage” (10). The ISP questionnaire was administered to the participants at the time of recruitment and again 7 days later. Repeatability was evaluated by calculating percentage agreement and Cohen kappa statistic between the two time points of measurement.ResultsA total of 94 subjects (34 males, 60 females, mean age 40.6 ± 10.0 years, range 19–60years) were included. The mean ISP score was 4.9 ± 1.7 (range 2–9 out of 10) at the time of recruitment and 5.1 ± 2.1 (range 2–9 out of 10) 7 days later. The percentage agreement between the two repeat measures of the ISP was 86% and the kappa coefficient was 0.79.Conclusions This study suggests that the test–retest repeatability for the ISP is high and that it is thus likely to have a low risk of classification bias in prognostic studies. The ISP likely has adequate reliability for use in epidemiological research of whiplash-associated disorders.
    Preview · Article · Oct 2014 · Journal of Sport and Health Science
  • Robert Ferrari

    No preview · Article · Oct 2014 · Seminars in arthritis and rheumatism
  • Robert Ferrari
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    ABSTRACT: Background: The effect of expectation of recovery on the recovery rate of whiplash patients in the primary care setting is not known. Methods: Whiplash patients were assessed in a primary care setting within 1 week of their collision for their expectations of recovery and were re-examined 3 months later for recovery. Results: Initial expectations of recovery predicted recovery. According to adjusted odds ratios, subjects who expected 'to get better slowly' had a recovery rate that was nearly 1.9 times that of subjects with poor recovery expectations. Subjects who expected 'to get better soon' had a recovery rate that was 2.6 times greater than either of those with poor recovery expectations. Discussion: In the primary care setting, asking patients with whiplash about their expectations of recovery is a useful predictor of their outcome.
    No preview · Article · Aug 2014 · Australian family physician
  • 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.
    No preview · Article · Jul 2014 · Clinical Rheumatology
  • Robert Ferrari
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    ABSTRACT: Unlabelled: 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.
    No preview · Article · Jul 2014 · Rheumatology International
  • 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.
    No preview · Article · Jun 2014 · Clinical Rheumatology
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    Robert Ferrari
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    ABSTRACT: Current Canadian osteoporosis guidelines recommend routine bone density screening of men at age 65. The purpose of this study is to determine the prevalence of osteoporosis in men aged 65-75 in after application of screening guidelines. All males aged 65-75 years who attended a large primary care clinic were advised of the 2010 Canadian osteoporosis guidelines and advised to obtain a bone density scan at or after their 65th birthday. Those who did not have a bone density scan since their 65th birthday were advised to obtain a scan, unless there was obvious reason not to do so (i.e. known osteoporosis). A record of the results for each patient were kept and tallied to determine the prevalence of osteoporosis. Osteoporosis was defined as a T-score of ≤ -2.5 in either the hip or lumbar spine. Of 574 male subjects in this clinic, between the ages of 65-75, 557 had a bone density scan, either already having done so at the time of being informed of the guidelines or obtaining a scan in the subsequent year after being informed of the guidelines. The prevalence of osteoporosis was 1.6 % (9/557, 95 % confidence interval 0.8-3.1 %) in this sample. The average age of subjects with osteoporosis was 70.5 ± 1.4 years (range 68-75). None of the subjects under 68 years of age were found to have osteoporosis. The prevalence of osteoporosis in unselected male cohorts aged 65 may be too low to justify the routine bone density screening recommended in the 2010 Canadian osteoporosis guidelines.
    Preview · Article · Apr 2014 · Clinical Rheumatology
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    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.
    Preview · Article · Mar 2014 · Clinical Rheumatology
  • Robert Ferrari
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    ABSTRACT: There is a lack of studies of foot orthosis use in the common condition of anserine bursitis. The aim of this study was to determine the proportion of subjects reporting recovery from anserine bursitis with prescribed custom-made foot orthoses in addition to local corticosteroid injection versus corticosteroid injection alone. Sixty-nine consecutive patients presenting with symptoms and findings compatible with a case definition for anserine bursitis were included in this study. A total of 35 subjects were prescribed a local corticosteroid injection into the anserine bursa under fluoroscopic guidance (control group), and 34 subjects were equally prescribed a fluoroscopically guided local corticosteroid injection with the addition of custom-made foot orthoses (orthoses group). All subjects completed the Oswestry Disability Index at baseline, and the number of subjects using prescribed analgesics for their knee pain was recorded at baseline and at follow-up of 8 weeks and 4 months. The subjects were asked at each follow-up if they felt that they had recovered from their knee pain. A total of 33 subjects in each group completed the study at 8 weeks, and 32 subjects in each group completed the 4-month follow-up. At 8 weeks, 55% reported recovery in the control group and 76% reported recovery in the orthoses group. The number of subjects who reported recovery at 4 months, however, was markedly different between the groups, with only 41% reporting recovery in the control group and 88% reporting recovery in the orthoses group. The addition of custom-made foot orthoses to local corticosteroid injection seems to improve the short- and long-term outcome with fewer recurrences. What is already known on this subject: 1) Anserine bursitis is a common condition. 2) There are no studies to date of foot orthosis use in the treatment approach. What this study adds: 1) This is the first controlled trial of custom-made foot orthoses in anserine bursitis, a common knee disorder. 2) Custom-made orthoses, when added to usual care for anserine bursitis, increase the likelihood of recovery at 8 weeks and 4 months. How it might impact on clinical practice in the near future: The addition of custom-made foot orthoses may increase the recovery rate from anserine bursitis.
    No preview · Article · Jan 2014 · JPO Journal of Prosthetics and Orthotics
  • Robert Ferrari · Deon Louw

    No preview · Article · Nov 2013 · Journal of Zhejiang University SCIENCE B
  • 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.
    No preview · Article · Jul 2013 · Journal of manipulative and physiological therapeutics
  • 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.
    No preview · Article · Jul 2013 · The Journal of Rheumatology

Publication Stats

1k Citations
284.12 Total Impact Points

Institutions

  • 1998-2015
    • University of Alberta
      • • Department of Medicine
      • • Department of Physical Therapy
      Edmonton, Alberta, Canada
  • 2009
    • Uppsala University
      • Department of Medical Sciences
      Uppsala, Uppsala, Sweden
  • 1999-2000
    • Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών
      Pátra, West Greece, Greece