Akiko Okifuji's research while affiliated with University of Utah and other places

Publications (102)

Article
Background: Individuals with fibromyalgia (FM) exhibit generalized hyperalgesia to pain stimuli, and physical activity (PA) is critical to manage FM symptoms. Purpose: This study examined the relationship between exercise-induced muscle pain, symptom severity, and PA in 28 women with FM. Methods: Muscle pain rating (MPR) was assessed during 3...
Article
Background: Baseline heart rate variability (HRV) that reflects parasympathetic nervous system (PNS) activity may serve as an objective, physiological index of pain assessment, but more research is warranted to examine the link between HRV and laboratory pain responses. This study examined whether baseline HRV would predict pain responses to subse...
Article
This secondary analysis examined relationships between pain severity and interference and substance use among patients filling opioid prescriptions in Indiana and Ohio community pharmacies (n = 1,461). We likewise sought to explore the moderating role of gender in pain-substance use relations. We used patient-reported data from a cross-sectional he...
Article
Background >1 in 3 of the 9 million individuals engaged in opioid medication misuse obtain legitimate opioid prescriptions and fill these in community pharmacies, which are subsequently misused. This study is testing the efficacy of a pharmacist-led intervention—Brief Intervention-Medication Therapy Management (BI-MTM)—compared to standard medicati...
Article
The opioid epidemic continues to affect pregnant women with opioid use disorder adversely in unique and enduring ways. The onset of the coronavirus disease 2019 (COVID-19) pandemic and the necessary public health measures implemented to slow the transmission have increased barriers to care for these same women. This commentary explores the implicat...
Article
Aim: We conducted a preliminary evaluation of a newly developed, time-based visual time analog (VITA) scale for measuring pain in chronic pain patients. Materials & methods: 40 patients with chronic back pain rated their pain over four visits using numerical (pain) rating scale (NRS) and VITA assessing pain intensity by distributing the amount of t...
Article
Conditioned pain modulation (CPM) test examines central pain inhibitory processing. Aerobically-trained individuals show greater CPM. However, there is a paucity of knowledge regarding CPM among resistance exercise-trained individuals, although regular engagement in resistance exercise may lead to greater CPM via augmented blood pressure (BP) respo...
Article
Background: Opioids remain the mainstay of cancer pain management but are associated with systemic toxicity. In refractory cancer pain, intrathecal therapy (ITT) is associated with improved pain control, reduced systemic side effects, and improved survival. It has been assumed that ITT decreases systemic serum opioid levels and their associated to...
Article
Aim: Opioid consumption and addiction are increasing worldwide, yet the USA stands out for its high addiction rates and opioid-related deaths. Considering that patient characteristics are comparable across western countries, physicians' prescribing modalities may influence opioid consumption. We conducted a pilot study to examine opioid-related bel...
Article
Chronic pain is a biopsychosocial condition, and behavioral medicine has made significant contributions to the understanding of the phenomenon and optimization of therapeutic outcomes. The objective of this article is to provide future perspectives of behavioral medicine in pain management based upon recent development in the field. We will briefly...
Article
Introduction Behavioral and activity rhythms (BAR) illustrate a diurnal pattern summarized by a period of 1) quiescence/sleep, 2) morning activity increase, 3) plateau of wakeful activity, and 4) “winding down” or decreasing activity to the next quiescent/sleep period. The goal of this study was to model these clinically-relevant component of BAR i...
Article
Objective: To evaluate the safety of and long-term pain relief due to intravenous lidocaine infusion for the treatment of chronic pain in a tertiary pain management clinic. Design: Retrospective chart review. Methods: Medical records were reviewed from 233 adult chronic pain patients who underwent one to three lidocaine infusions. The initial...
Article
Objective Research shows that African American (AA) adults experience more severe and frequent pain compared to non-Hispanic White (NHW) adults. Additionally, experimental studies demonstrate that AA adults exhibit less efficient central pain inhibition compared to NHW adults, which may partially explain the racial/ethnic disparities in pain. Evide...
Article
Introduction Actigraphy is commonly used in research to provide an objective measure of sleep. Many attempts to evaluate activity using this measure have been undertaken. These tend to involve day/night activity averages which disregards the variability of the hour-by-hour data and variability. To our knowledge, there have been no attempts to aggre...
Article
Introduction CBT-I has been shown to improve both sleep and pain in chronic pain patients. The mechanisms by which CBT-I improves pain are poorly understood. While studies have shown that increase in physical activity is associated with positive outcomes, the impact of CBT-I on activity has been largely unexplored. In the present analysis, the asso...
Chapter
Chronic pain is a complex phenomenon that has biomedical, psychosocial, and physiological elements that interact with one another. Engagement in self-management of pain is critical and approaches to enhance engagement must address all integral components. The authors discuss approaches such as Motivation Enhancement Treatment (MET) and Implementati...
Article
The primary aim of this study was to evaluate activity rhythms in fibromyalgia syndrome (FMS) and their association with FMS-related symptoms. We hypothesized that stronger and more consistent activity rhythms would be associated with reduced symptom severity and presentation in FMS. 292 patients with FMS (Mean age = 45.1±11.1; 272 females) provide...
Article
Chronic pain is difficult to treat successfully. The Jack of satisfactory outcomes from the traditional medical, pharmacological, and surgical approaches was an impetus to the development of specialty treatment facilities-Multidisciplinary Pain Centers (MPCs). With health care costs continuing to rise, the clinical efficacy, cost-benefits, and cost...
Chapter
Chronic pain is one of the most common and debilitating physical conditions in our society. It adversely influences a range of life domains of people living with pain. One of the most common comorbid conditions is depression. In this chapter, we review the epidemiology and discuss the relationship between pain and depression. It seems that the pain...
Article
Fibromyalgia syndrome is a chronic pain disorder and defies definitively efficacious therapy. In this review, we summarize the results from the early treatment research as well as recent research evaluating the pharmacological, interventional and nonpharmacological therapies. We further discuss future directions of fibromyalgia syndrome management;...
Chapter
Chronic pain is one of the most common and debilitating physical conditions in our society. It adversely influences a range of life domains of people living with pain. One of the most common comorbid conditions is depression. In this chapter, we review the epidemiology and discuss the relationship between pain and depression. It seems that the pain...
Article
Chronic pain is a prevalent and disabling problem. It is a complex, multifactorial disorder that requires a comprehensive biopsychosocial conceptualization. In this paper we provide an update on research implicating the importance of the behavioral and cognitive factors in chronic pain. In addition to the significant co-variations among self-report...
Article
Full-text available
Obesity and pain present serious public health concerns in our society. Evidence strongly suggests that comorbid obesity is common in chronic pain conditions, and pain complaints are common in obese individuals. In this paper, we review the association between obesity and pain in the general population as well as chronic pain patients. We also revi...
Article
To determine if independent candidate genes can be grouped into meaningful biological factors and if these factors are associated with the diagnosis of chronic fatigue syndrome (CFS) and fibromyalgia (FMS) while controlling for co-morbid depression, sex, and age. We included leukocyte mRNA gene expression from a total of 261 individuals including h...
Article
Although data exist for the efficacy of intrathecal therapy (ITT), there are no prospective data on patient-controlled intrathecal analgesia (PCIA) in refractory cancer pain. This study examines the effect of PCIA on cancer symptom scores, patient satisfaction, and analgesic efficacy with an emphasis on breakthrough pain (BTP). Ninety-eight patient...
Chapter
Chronic widespread pain (CWP) is defined as musculoskeletal pain in multiple locations that represents generalized body pain. Fibromyalgia syndrome (FMS) is a subset of CWP, characterized with CWP, hyperalgesia, and a host of other functional and mood disturbances, such as fatigue, poor sleep, cognitive problems, depression, and anxiety (Wolfe et a...
Article
Fibromyalgia syndrome (FMS) is a common chronic musculoskeletal pain disorder of unknown etiology and characterized by generalized body pain, hyperalgesia, and other functional and emotional comorbidities. Despite extensive research, no treatment modality is effective for all FMS patients. In this paper, we briefly review the history of FMS and dia...
Article
Chronic pain is a biopsychosocial phenomenon. Management of patients with chronic pain can be complicated by the web of multiple contributing and interacting factors. Assessment of chronic pain requires a comprehensive approach including medical, physical, and psychological evaluations of patients. In this chapter, we briefly describe the historica...
Article
Problematic sleep is one of the most common comorbidities for chronic pain patients. The association between pain and sleep has long been recognized but the nature of the relationship is not well understood. The current consensus is that the relationship is likely bidirectional, both reciprocally influencing one another. In this review, we discuss...
Article
Background: Uncertainty about potentially painful events affects how pain is experienced. Individuals with fibromyalgia (FM) often exhibit anxiety and catastrophic thoughts regarding pain and difficulties dealing with pain uncertainty. Objectives: The effects of pain uncertainty in predictably high odds (HO), predictably low odds (LO), and even...
Article
Full-text available
Anxiety disorders are the most prevalent type of mental disorder, and they frequently co-occur with various medical conditions, including chronic pain. Anxiety disorders are associated with higher health care costs, and comorbid chronic pain and anxiety disorder leads to worse outcomes. Despite their prevalence, anxiety disorders often go unrecogni...
Article
Sleep disturbance is one of the most common comorbid problems for chronic pain patients. The association between the two phenomena has long been recognized, but the nature of the relationship is not well-understood. Many agree that the relationship is likely bidirectional. In this review, we focus on one side of the relationship: whether and how di...
Article
The objective of this study was to evaluate past suicidal attempt, history of self-harm, and current suicidal ideation in chronic pain patients. Based upon the review of 260 psychological evaluation reports at a university-based multidisciplinary pain center, we found that 25% reported at least one suicidal attempt or self-harming incident. Current...
Article
Unlabelled: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder characterized by generalized pain, chronic fatigue, sleep disturbance, and a range of other symptoms having no definitive pathology. Consequently, patient evaluations rely on self-report. Ecological Momentary Assessment (EMA) allows frequent real-time collection of...
Article
To evaluate the concordance between the subjective and objective methods of sleep assessment in patients with fibromyalgia syndrome (FMS) and to delineate factors associated with discrepancy between the 2 sleep assessment methods. Seventy-five patients with FMS completed a 7-day home assessment protocol. They wore an actigraphic device at all times...
Article
Unlabelled: Fibromyalgia syndrome (FMS) is a prevalent and disabling chronic pain disorder. Past research suggests that obesity is a common comorbidity and may be related to the severity of FMS. The main objective of the present study was to evaluate the relationships between FMS and obesity in the multiple FMS-related domains: hyperalgesia, sympt...
Article
Fibromyalgia syndrome is a chronic, musculoskeletal pain disorder that is characterized by diffuse body pain and heightened hyperalgesia. It is typically associated with a range of functional and psychological disturbances, such as chronic fatigue, non-restorative sleep, cognitive slowness, headaches, functional bowel disorder, paresthesia, stiffne...
Article
Pain is a complex, idiosyncratic experience. When pain is the primary complaint for seeking medical attention, understanding of multiple factors is essential in guiding successful treatment. Behavioral medicine, a branch of psychology, has been an integral part of interdisciplinary/multidisciplinay care of pain patients. In this article, we provide...
Article
The aim of this study was to investigate the associations between obesity and fibromyalgia syndrome (FMS). This study was conducted at the University of Utah Pain Management and Research Center, Salt Lake City, Utah. Thirty-eight FMS patients were included in this study. Neuroendocrine indices (catecholamines, cortisol, C-reactive protein [CRP], an...
Article
Pain is a complex, idiosyncratic experience. When pain is the primary complaint for seeking medical attention, understanding of multiple factors is essential in guiding successful treatment. Behavioral medicine, a branch of psychology, has been an integral part of interdisciplinary/multidisciplinay care of pain patients. In this article, we provide...
Article
Unlabelled: Fibromyalgia syndrome (FMS) is more prevalent in women than in men. The skewed sex distribution in the prevalence has prompted questions of if and how sex hormones may be involved in the pathophysiology of FMS. In this study, we evaluated the levels of sex hormones and pain sensitivity at different phases of a menstrual cycle in regula...
Article
Unlabelled: Chronic pain is one of the most prevalent and costly problems in the United States today. Traditional medical treatments for it, though, have not been consistently efficacious or cost-effective. In contrast, more recent comprehensive pain programs (CPPs) have been shown to be both therapeutically efficacious and cost-effective. The pre...
Chapter
IntroductionConceptualizations of Chronic PainPsychology of PainIntegrative ModelsCognitive-Behavioral Model for the Treatment of Chronic PainHomogeneity vs. Heterogeneity of Pain PopulationsIdentification of Subgroups of PatientsEmpirically Derived Classification of Pain PatientsPotential of Customizing TreatmentDual-Diagnostic ApproachConcluding...
Chapter
Fibromyalgia syndrome (FMS) is a chronic, musculoskeletal pain disorder, characterized by diffuse pain and a lowered pain threshold at certain anatomical points (“tender points”). FMS may be accompanied by other pain, and functional comobidity factors, and mood disturbance. Most commonly, patients complain of chronic fatigue, diffuse tenderness and...
Article
Chronic pain is a prevalent and debilitating condition and can become quite recalcitrant. Poor outcomes from traditional medical, pharmacological, and surgical approaches have been an impetus to development of comprehensive pain programs (CPPs) in which pain specialists from multiple disciplines provide treatment for patients. With health-care cost...
Chapter
This chapter reviews the major unidimensional perspectives on chronic pain (i.e., biomedical, psychogenic, operant, and motivational) and describes the inadequacies of each. The authors review the important contributions of cognitive, affective, and environmental factors and the principles of learning to the maintenance and exacerbation of pain and...
Article
Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal pain disorder characterized by diffuse pain and associated psychophysiological symptoms. Despite extensive research in the past 3 decades, the etiology and pathophysiology of FMS and effective treatment approaches are yet to be delineated. Recently, it has been suggested that FMS may be rel...
Article
Research has demonstrated the importance of psychological factors in coping, quality of life, and disability in chronic pain. Furthermore, the contributions of psychology in the effectiveness of treatment of chronic pain patients have received empirical support. The authors describe a biopsychosocial model of chronic pain and provide an update on r...
Article
Fibromyalgia syndrome (FMS) is a generalized musculoskeletal pain disorder with multiple functional and psychological problems. Despite extensive efforts during the last 30 years to uncover the etiology, the mechanisms underlying FMS remain elusive. Similarly, no single treatment has proven to be universally effective for FMS. FMS is considered to...
Article
Traumatic events can result in a set of symptoms including nightmares, recurrent and intrusive recollections, avoidance of thoughts or activities associated with the traumatic event, and symptoms of increased arousal such as insomnia and hypervigilance. These posttraumatic stress disorder (PTSD)-like symptoms are frequently observed in persons with...
Article
Chronic diffuse pain and hyperalgesia are two cardinal features of pain in fibromyalgia syndrome (FMS). Advancement in understanding the pathophysiology and treatment efficacy often depends on pain that is defined and measured. Pain is a subjective phenomenon that we can measure only by indirect methods. In this article, we provide methodological g...
Article
To examine the relationship between fibromyalgia syndrome (FM) and depression by determining the set of factors that differentiate FM patients with and without depressive disorders. A sample of 69 patients with FM underwent a standardized tender point examination and a semistructured psychological interview and completed a set of self-report invent...
Article
The Multidimensional Pain Inventory (MPI) has been used widely to assess the psychosocial adaptation in chronic pain patients. The MPI can also be used to classify patients into one of three primary subgroups. However, studies have reported that anywhere from 3% to 30% of patients are unclassifiable, mostly attributable to an excessive number of mi...
Article
Research suggests that dysregulated pain modulation may play an important role in recurrent headaches and fibromyalgia syndrome (FMS). The primary objective of this study was to investigate algesic responses in localized cervical and pericranial regions (ie, headache-specific areas) and distal locations (ie, trochanter and gluteal) in patients with...
Article
The literature suggests that the sex of patients is an important factor in understanding how they are treated by health care professionals and how they adapt to their symptoms. In two groups of patients with chronic pain (n = 428 non-cancer (Study 1) and n = 143 cancer-related (Study 2)), men and women were compared on medications prescribed, treat...
Article
The study was designed to assess the frequency and intensity of patients' anger directed toward various potential targets and how intensity of anger toward different targets was related to the chronic pain experience. Ninety-six chronic pain patients who were referred for a comprehensive evaluation completed questionnaires to assess their levels of...
Article
The study was designed to assess the frequency and intensity of patients' anger directed toward various potential targets and how intensity of anger toward different targets was related to the chronic pain experience. Ninety-six chronic pain patients who were referred for a comprehensive evaluation completed questionnaires to assess their levels of...
Article
A common assumption about pain is that it always results from the presence of underlying organic pathology. In the absence of objective pathology, an individual's report of pain may be ascribed to psychological causes. There is a wide variation in patient's experience of pain and organic factors alone cannot explain individual differences in patien...
Article
Outcome studies evaluating psychological treatments for pain vary in nature and intensity. Overall, however, treatment programs that include psychological interventions have been shown to be effective in treating postoperative pain, noncardiac chest pain, fibromyalgia syndrome, and chronic back pain. Cost analyses of the treatments indicate not onl...
Article
To evaluate differential treatment responses among 3 empirically derived, psychosocial subgroups of patients with fibromyalgia syndrome to a standard interdisciplinary treatment program. Patients were classified into 1 of 3 psychosocial groups on the basis of their responses to the Multidimensional Pain Inventory. Forty-eight patients completed a 6...
Article
Objectives. To evaluate differential treatment responses among 3 empirically derived, psychosocial subgroups of patients with fibromyalgia syndrome to a standard interdisciplinary treatment program. Method. Patients were classified into 1 of 3 psychosocial groups on the basis of their responses to the Multidimensional Pain Inventory. Forty-eight pa...
Article
Objectives. The primary purposes of the study were to: evaluate the treatment efficacy of an outpatient, interdisciplinary treatment program for fibromyalgia syndrome (FMS); examine whether treatment gains would be sustained for 6 months following the treatment; assess whether improvements were clinically significant; and delineate the factors asso...
Article
Chronic pain is difficult to treat successfully. The lack of satisfactory outcome from the traditional medical, pharmacological and surgical approaches was an impetus to the development of specialty treatment facilities—multidisciplinary pain centers (MPCs). With health-care costs continuing to rise, the clinical efficacy and cost-effectiveness of...
Article
The present study compared the adaptation of cancer pain patients and chronic non-cancer pain patients. Differences between samples of cancer pain patients with and without metastatic disease were also examined. Cancer pain patients reported comparable levels of pain severity to non-cancer chronic pain patients; however, pain due to cancer was asso...
Article
To evaluate the contribution of pain severity, physical pathology, demographic factors, initiators of symptoms, affective distress, behavioral expressions of pain, and functional activity levels in physicians' decisions to prescribe opioid medication for chronic noncancer pain patients. Patients were examined by a physician and physical therapist,...
Article
Chronic pain is difficult to treat successfully. The lack of satisfactory outcomes from the traditional medical, pharmacological, and surgical approaches was an impetus to the development of specialty treatment facilities - Multidisciplinary Pain Centers (MPCs). With health care costs continuing to rise, the clinical efficacy, cost-benefits, and co...
Article
Behavioral manifestations of pain, distress, and suffering have been characterized as pain behaviors. Although acquisition and maintenance of pain behaviors have been considered to occur through reinforcement contingencies, empirical evidence suggests that pain behavior is better understood as a multidimensional entity. The present study was design...
Article
To (a) develop a standardized tender point examination protocol [Manual Tender Point Survey (MTPS)] as a diagnostic procedure to evaluate the tender point (TP) criterion for fibromyalgia syndrome (FM) and (b) determine a threshold point for positive TP. A standardized MTPS consisted of standardized components including (a) location of the survey si...
Article
The purpose of the study was to investigate the differences between two types of onset (post-traumatic versus idiopathic) in pain, disability, and psychological distress in patients with fibromyalgia syndrome (FS). Forty-six FS patients with post-traumatic onset and 46 FM patients with idiopathic onset, who were matched in age and pain duration, we...
Article
The primary purposes of the present study were to investigate the roles of physical findings, financial compensation, and types of pain onset (i.e., trauma vs. insidious onset) on adaptation by chronic pain patients. Comparisons between patients who were receiving or seeking compensation and those who were not revealed that, despite comparable degr...
Article
To investigate (1) whether patients with fibromyalgia (FM) could be subgrouped on the basis of psychosocial and behavioral responses to pain, and (2) the relationships among pain severity, perceived disability, and observed physical functioning, as measured by cervical spinal mobility. 117 patients with FM received a comprehensive examination, unde...
Article
Chronic pain adversely affects individuals' physical as well as emotional well-being. A cognitive-behavioral model has been proposed to explain the role of cognitive appraisal variables in mediating the development of emotional distress following pain of long duration. There is little evidence linking the prevalence of depression in chronic pain pa...

Citations

... Pandemic-related stress and mood disruption have been linked to worse pain intensity and pain-related impaired functioning [1][2][3][4] which in turn can contribute to increased opioid use and high-risk concomitant benzodiazepine use. 5 Cross-sectional survey studies found respondents with chronic pain and post-surgical pain perceived worsening pain severity and worsening pain interference early in the COVID-19 pandemic. 1,3 In some cases, this perception was correlated with worsening mood, sleep problems, worries about the future, and feelings of insecurity. ...
... Regarding pregnant women with opioid use disorder (OUD), who are known for a reduced recourse to prenatal care and worse outcomes in terms of cooccurring mental illness [20], White et al. point out that COVID 19 pandemic represented an additional danger for these women because of the increased risk of overdose and a limited possibility of communication with the experts [51]. The issue of communication with clinicians is relevant, because many patients are not comfortable talking wearing a mask [51]. ...
... Visual Analogue Scale (VAS) for pain, Modified Harris Hip Score (mHHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score (HOS)-Activity Daily Life (HOS-ADL), and Hip Outcome Score-Sport Specific Subscale (HOS-SSS) were administered to each patient before surgical treatment at 6 months, 1 year, and every following year after surgery [1,13,18,21]. ...
... pain stimulus applied to a distant part of the body. Applying this method, a recent study could not detect changes in conditioned pain modulation when comparing resistance exercisers to healthy controls 27 . Finally, our results are in line with a study applying a more refined methodology including some QST measures that could show that prolonged muscular activation (contraction) of the sternocleidomastoid muscle did not alter cold detection or mechanical thresholds 28 . ...
... Likewise, other studies showed that spinal anaesthesia in combination with propofol sedation resulted in decreased intraoperative blood loss, a shorter PACU stay and lower pain scores in the PACU when compared to a general anaesthesia without regional anaesthesia (Salonia et al. 2006;Sved et al. 2005). A possible explanation would be that intrathecal opioids could have an additive pain reducing effect which has been proven for patients with cancer pain (Brogan et al. 2020). In contrast, our findings showed a higher need for postoperative intravenous opioid administration in the PACU in the SPA group, with comparable blood loss and pain scores. ...
... Finally, cultural differences may also be present in the way healthcare providers manage pain. 43,44 The current study is unique due to its large study population, the multinational data collection in a highly standardized manner, and combining patient reports on pain and related symptoms with perioperative data. We focused on four frequently performed surgical procedures, both soft tissue (laparoscopic cholecystectomy) and bone surgery (hip and knee replacements and spinal surgery). ...
... 13 Overall, these psychosocial factors are demonstrated to modulate pain perception and affect the outcome of the treatments and patients' QoL. 11,16,17 Notwithstanding, considering only the individual features is insufficient to understand the CP experience and its consequences on health status and QoL. In line with the biopsychosocial paradigm, 18,19 in which health status has been defined as the result of interconnection between physical, psychological, and social dimensions, many factors might contribute to defining the CP experience and QoL in cancer patients, including the family context and personal relations. ...
... The high response in the group of patients with myofascial pain syndromes is remarkable, and data to compare the efficacy of systemic lidocaine in this group are not available. In some studies, myofascial pain syndromes are mentioned as a separate group, but either the group size is very small (n=5 44 ) or sufficient data on the effect are missing. 41 Two studies using lidocaine 5% patches for treating myofascial pain syndromes found beneficial results, but the question is whether the mechanism is the same as with systemic lidocaine treatment. ...
... Perhaps this finding suggests that reports of pain are experienced differently than the impact of pain; other research has found that white adolescents also report more pain than those of color [34]. Findings from experimentally induced pain studies examining conditioned pain modulation, an identified risk factor of chronic pain, demonstrated that when engaging in similar levels of physical activity as their white peers, African American/Black and Latinx young adults exhibited the same conditioned pain responses [59,60]. These studies conjecture that if groups are similar in physical activity, they may share a similar risk to pain implying that physical activity may positively regulate pain processing among these groups [59,60]. ...
... Most commonly, parametric models such as the mathematical cosinor algorithms and Fourier decompositions have been applied to actigraphic data to delineate BAR parameters [5,39]. While most commonly used, cosinor methods have often been criticized for poor model fit ( Figure 2) and for the lack of clinical relevance [36,38,40,41]. A glaring example of poor fit is provided by Satlin et al. [41], who used the cosinor approach and reported a "circadian correlation" as a measure of goodness-offit of 0.27 in older adults with Alzheimer's disease (AD) and 0.49 in the healthy controls. ...