Timothy H. Wideman's research while affiliated with McGill University and other places
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Publications (79)
Background and introduction:
Pain is a subjective phenomenon, that is often misunderstood and invalidated. Despite recent advances in health professional training, it remains unclear how students should be taught about the subjectivity of pain. This study explored how a novel teaching activity that integrated physiotherapy students' first-hand exp...
Background:
Activity-based treatments play an integral role in managing musculoskeletal conditions including low back pain. However, while therapeutic exercise has been shown to reduce pain in such conditions, certain individuals experience a paradoxical pain increase in response to exercise. The physiological processes underlying this sensitivity...
Objective:
This project aimed to develop a Virtual Intervention for Vertebral frActures (VIVA) to implement the international recommendations for the non-pharmacological management of osteoporotic vertebral fractures (VFs), and to test its acceptability and usability.
Methods:
VIVA was developed in accordance with integrated knowledge translatio...
Purpose:
To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs).
Design and setting:
We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a...
Background:
Systemic inflammation, particularly the elevation of interleukin-6 (IL-6), plays an important role in the maintenance and progression of knee osteoarthritis. Insomnia, being highly prevalent in knee osteoarthritis, is understood to be a risk factor for systemic inflammation. The present study examined if cognitive behavioral therapy fo...
Objectives:
To determine the absolute and relative within-session test-retest reliability of pain pressure threshold (PPT) and temporal summation of pain (TSP) at the low back and the forearm in individuals with chronic low back pain (CLBP) and to test the impact of different sequences of measurements on reliability metrics.
Methods:
Twenty-eigh...
Background:
Clinical interventions aim to improve the daily-life experiences of patients. However, past research has highlighted important discrepancies between commonly used assessments (e.g., retrospective questionnaires) and patients' daily-life experiences of pain. These gaps may contribute to flawed clinical decision-making and ineffective ca...
Summary/RationaleWe identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures.Main resultsThis international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral frac...
Introduction:
Chronic pain represents a major health issue, affecting the physical and mental health of approximately one in five people worldwide. It is now widely recognized that health professionals should use interventions that meet the needs of people living with chronic pain. Therefore, physiotherapists should attend to patients' perceived n...
Objective
To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures.
Design and setting
We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective.
Pa...
Introduction:
Exercise is the most recommended treatment for chronic low back pain (CLBP) and is effective in reducing pain, but the mechanisms underlying its effects remain poorly understood. Exercise-induced hypoalgesia (EIH) may play a role and is thought to be driven by central pain modulation mechanisms. However, EIH appears to be disrupted i...
Background
A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined.
Objectives
The aim of this sys...
Background
Pain experience has a multidimensional nature. Assessment and treatment recommendations for pain conditions suggest clinicians use biopsychosocial approaches to treat pain and disability. The current pain research is overwhelmingly skewed towards the study of biological and psychological factors including interventions, whereas, cultural...
Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that spe...
Purpose
The purpose of the present study was to conduct a preliminary evaluation of the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with comorbid pain and depression.
Methods
The design of the study was a single-arm non-randomized trial. The sample consisted of 66 work-disabled individ...
Background:
The Canadian Pain Task Force recently advanced an action plan calling for improved entry-level health professional pain education. However, there is little research to inform the collaboration and coordination across stakeholders that is needed for its implementation.
Aims:
This article reports on the development of a stakeholder-gen...
This chapter defines physical therapy as a collective of non‐pharmaceutical and non‐surgical interventions. These are most commonly delivered by physical therapists/physiotherapists, but some or all may be delivered by other rehabilitation or movement‐based professionals depending on local regulatory and service delivery frameworks. Several standar...
Objective:
To estimate the effects of musculoskeletal rehabilitation interventions on movement-evoked pain and to explore the methods/protocols used to evaluate movement-evoked pain in adults with musculoskeletal pain.
Design:
Systematic review with meta-analysis.
Literature search:
Three electronic databases (PubMed, Web of Science, and Scopu...
Too often, pain is reduced to a simple symptom of illness or injury – a puzzle piece to fit into the differential diagnostic jigsaw. Pain reports that fit the emerging pathoanatomical picture are validated and treated accordingly. But many reports don’t fit this picture, and the widespread stigma associated with persistent pain is most commonly dir...
Background
National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited w...
Purpose
The purpose of the present study was to conduct a preliminary evaluation the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with co-morbid pain and depression.
Methods
The design of the study was a single arm non-randomized trial. The sample consisted of 66 work-disabled individua...
Objective
Although pain-related fear and catastrophizing are predictors of disability in low back pain (LBP), their relationship with guarded motor behavior is unclear. The aim of this meta-analysis was to determine the relationship between pain-related threat (via pain-related fear and catastrophizing) and motor behavior during functional tasks in...
Objectives:
Many people living with musculoskeletal pain conditions experience a range of negative biopsychosocial responses to physical activity, referred to as increased sensitivity to physical activity (SPA), that may undermine successful rehabilitation. This exploratory study aims to provide the first prospective analysis of the potential prog...
Objective: Exercise may reduce pain sensitivity. This phenomenon called exercise-induced hypoalgesia is observed in different types of exercises and involves the activation of endogenous pain modulation systems. Although the effect of limb exercise on pain sensitivity has often been tested, few studies explored the impact of back exercises that are...
Objective
To determine the absolute and relative intra-rater within-session test-retest reliability of pressure pain threshold (PPT) and mechanical temporal summation of pain (TSP) at the low back and the forearm in healthy participants and to test the influence of the number and sequence of measurements on reliability metrics.
Methods
In 24 parti...
Objective
The risk constructs based on psychological risk factors (e.g. pain catastrophizing, PC) and sensitization risk factors (e.g. pressure pain threshold, PPT) are important in research and clinical practice. While most research looks at individual constructs, but doesn’t consider how different constructs might interact within the same individ...
Background:
A growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direc...
Background
Low back pain (LBP) is the leading cause of disability worldwide. The therapeutic management of patients with chronic LBP is challenging.
Objectives
The aim of this study is to evaluate the effects of heat and transcutaneous electrical nerve stimulation (TENS) combined on pain relief in participants with chronic LBP.
Methods
Fifty part...
Introduction:
The neurobiological mechanisms underlying recovery from or persistence of low back pain (LBP) remain misunderstood, limiting progress toward effective management. We have developed an innovative two-tier design to study the transition from acute to chronic LBP. The objective of the first tier is to create a provincial web-based infra...
Background:
We recently proposed the Pain and Disability Drivers Management (PDDM) model, which was designed to outline comprehensive factors driving pain and disability in low back pain (LBP). Although we have hypothesized and proposed 41 elements, which make up the model's five domains, we have yet to assess the external validity of the PDDM's e...
Objectives:
Increasing pain during physical activity is as an important, but often poorly assessed, barrier to engaging in activity-based rehabilitation among people with chronic musculoskeletal pain. Preliminary work has addressed this problem by developing new clinical measures of sensitivity to physical activity (SPA). Indices of SPA are genera...
Introduction/Aim: The Fear-Avoidance Model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain-related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysio...
Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensit...
Background
Computerized methods to analyze pain drawings (PDs) were developed and may aid to measure the pain area more precisely.
Objective
The aim of this study was to verify if examiners can reproduce the patient's PDs with acceptable reliability.
Methods
This is an intra‐rater and inter‐rater reliability study. The protocol consisted in four...
Background
The Fear‐Avoidance Model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain‐related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysiological...
Purpose: To determine the current state of pain education across physiotherapy programs in Canada.
Materials and methods: Educators that were responsible for teaching pain-related content at each of the 14 Canadian physiotherapy programs were invited to complete a cross-sectional survey. The online survey evaluated total time spent on pain educatio...
Objectives:
Pain assessment is enigmatic. Although clinicians and researchers must rely upon observations to evaluate pain, the personal experience of pain is fundamentally unobservable. This raises the question of how the inherent subjectivity of pain can and should be integrated within assessment. Current models fail to tackle key facets of this...
Background:
It has been speculated that there is an association between pain area and psychological factors in chronic musculoskeletal pain conditions; however, this relation is not well established.
Purpose:
To investigate the association between pain distribution and psychological factors in chronic musculoskeletal pain conditions.
Study desi...
Background
Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is need...
Objectives Previous research has shown that sensitivity to movement-evoked pain is associated with higher scores on self-report measures of disability in individuals who have sustained whiplash injuries. However, it remains unclear whether sensitivity to movement-evoked pain is associated with work-disability. The aim of the present study was to ex...
Purpose:
In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance.
Material and methods:
Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteo...
Background: Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice.
The objective of this perspective is to design a set of clinical descriptors for the recognition of central sensitiz...
Purpose:
This article reports on a national stakeholder workshop that focused on advancing pain education in physiotherapy programmes across Canada.
Methods:
Workshop participants included national leaders from the following stakeholder groups: people living with pain; physiotherapy students and recent graduates; pain educators; physiotherapy prog...
In the multidisciplinary fields of pain medicine and rehabilitation, advancing techniques such as functional magnetic resonance imaging (fMRI) are used to enhance our understanding of the pain experience. Given that such measures are, in some circles, expected to help us understand the brain in pain, future research in pain measurement is undeniabl...
Study Design Cross-sectional cohort. Background Knee osteoarthritis (OA) is a leading cause of pain and mobility restriction. Past research has advocated the use of brief functional tasks to evaluate these restrictions, such as the 6-Minute-Walk (6MW) and Timed-Up-and-Go (TUG) tests. Typically, only task performance (i.e. walking distance, completi...
. Chronic or persistent pain and disability following noncatastrophic “musculoskeletal” (MSK) trauma is a pervasive public health problem. Recent intervention trials have provided little evidence of benefit from several specific treatments for preventing chronic problems. Such findings may appear to argue against formal targeted intervention for MS...
Chronic pain negatively impacts health, well-being, and social participation. Effective rehabilitation often hinges on long-term changes in pain-related perceptions and behaviors. However, there are important gaps in understanding how patients perceive these changes. The present pilot study addresses this gap by using qualitative and quantitative m...
Unlabelled:
This study examined the degree to which measures of spontaneous and movement-evoked pain accounted for shared or unique variance in functional disability associated with whiplash injury. The study also addressed the role of fear of movement as a mediator or moderator of the relation between different indices of pain and functional disa...
Recent findings suggest that certain individuals with musculoskeletal pain conditions have increased Sensitivity to Physical Activity (SPA) and respond to activities of stable intensity with increasingly severe pain. This study aimed to determine the degree to which individuals with knee OA show heightened SPA in response to a standardized walking...
This study sought to determine whether repetition-induced summation of activity-related pain (RISP) could be demonstrated in healthy individuals in response to experimentally induced musculoskeletal pain. This study also assessed the effects of transcutaneous electrical nerve stimulation on RISP. The relation between the index of RISP and psycholog...
Objectives:
Pain catastrophizing has emerged as a significant risk factor for problematic recovery after musculoskeletal injury. As such, there has been an increased focus on interventions that target patients' levels of catastrophizing. However, it is not presently clear how clinicians might best interpret scores on catastrophizing before and aft...
Purpose:
The aim of the present study was to investigate the factors that influence the change in pain catastrophizing during the course of a physical therapy intervention for musculoskeletal injury.
Methods:
187 clients enrolled in a 7-week physical therapy intervention were divided into four mutually exclusive groups on the basis of a pre-trea...
Objectives:
To evaluate the properties of the Pain Catastrophizing Scale (PCS) from a Rasch paradigm.
Methods:
A secondary analysis of 235 patients with work-related pain conditions was performed using the Rasch methodology. Unidimensionality, item fit, location independence, differential item functioning, response option structure, and linearit...
Back pain is a leading cause of disability. Previous research suggests that modifiable risk factors influence recovery from back pain, and practice guidelines recommend integrating such factors within primary care management. Toward this goal, a brief, multidimensional questionnaire, the STarT Back Tool, was designed to facilitate risk assessment b...
Study design:
Prospective cohort.
Objectives:
(1) To determine the trajectory of depressive symptoms over the course of physical therapy, (2) to identify variables that best predict the resolution of depressive symptoms, and (3) to explore the relationship between recovery from depressive symptoms and long-term outcomes.
Background:
Twenty-fiv...
In the present study, participants (ie, observers) watched video sequences of patients with chronic back pain performing a physically demanding lifting task. Participants were asked to make judgments about patients' levels of pain and readiness to work. For each patient, observers were also asked to make judgments about personality traits relevant...
Psychosocial variables such as fear of movement, depression, and pain catastrophizing have been shown to be important prognostic factors for a wide range of pain-related outcomes. The potential for a cumulative relationship between different elevated psychosocial factors and problematic recovery following physical therapy has not been fully explore...
The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after whiplash injury.
This article focuses on two psychological variables that have been shown to impact on recovery trajectories after whiplash injury; namely pain catastrophizing and perceived i...
Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, we assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes. We acquired MRI scans from chronic low back pain (CLBP) patients before (n = 18) and 6 months after (spine surgery...
SUMMARY Over the past two decades increasingly compelling research has identified pain catastrophizing as an important psychological risk factor for a wide range of pain-related outcomes. In response to this literature, there have been calls for the clinical use of catastrophizing as a prognostic indicator of problematic recovery, and for the devel...
The fear avoidance model of pain (FAM) conceptualizes pain catastrophizing as the cognitive antecedent of pain-related fear, and pain-related fear as the emotional antecedent of depression and disability. The FAM is essentially one of mediation whereby pain-related fear becomes the process by which depression or disability ensue. However, emerging...
Chronic pain is one of the most common reasons for the use of complementary and alternative medicine (CAM). There are a great many such treatments available, almost all of which are paid for directly by the patient, and for which there may be little or no scientific rationale or clinical evidence of safety and efficacy. In this chapter, a framework...
The primary purpose of this study was to analyze the sequential relationships proposed by the fear-avoidance model of pain [Vlaeyen JWS et al. The role of fear of movement/(re)injury in pain disability. J Occup Rehab 1995;5:235-52]. Specifically, this study evaluated whether early change in catastrophizing predicted late change in fear of movement,...
Citations
... Notably, exercise regimens have been reported to decrease the use of analgesics and improve quality of life in some, but not all, studies [39,58]. Complete and long bedrest should be avoided, and patients should resume physical activity as quickly as possible [59]. In patients with the so-called vertebral fracture cascade, i.e., an increased risk of subsequent VFx after an initial VFx [60], weight-bearing and muscle-strengthening exercises, with caution to avoid undue stress on the back, are advised [37]. ...
... 11 However, patient apprehension or surgeon fear of VF during postoperative exercise limits widespread implementation. [12][13][14] The aim of this systematic review and meta-analysis was to examine the evidence for and against postoperative exercise following vertebral augmentation for osteoporotic VFs to guide future practice. ...
... 6 Potential alteration in these brain areas could explain the lower efficacy of pain modulation in participants with CLBP measured through psychophysical paradigms, such as conditioned pain modulation (CPM) 7 or exercise-induced hypoalgesia (EIH). [8][9][10] Indeed, EIH and CPM involve pain modulation systems, such as the opioidergic system, which are known to produce antinociceptive effects. [11][12][13][14][15] CPM represents the decrease in pain sensitivity after a painful stimulus on a remote body part (eg, the cold pressor task-cold water immersion of a limb as conditioning stimulus). ...
... 4,5 Movementevoked pain is typically more severe than pain at rest in patients with rotator cuff-related shoulder pain (RCRSP), 6 which is the most common diagnosis of shoulder pain, [7][8][9] and seems to be mediated by peripheral and central sensitization mechanisms and psychological factors. 3,4,[10][11][12] Repetitive movement tasks are recommended for movementevoked pain assessment. 4,13,14 However, pain intensity may be exacerbated by repeated movement of the shoulder. ...
... Fourth, current results should not be extrapolated to other cultures or to the general population with lateral epicondylalgia. Thus, multicentric studies across diverse cultures are needed to examine the validity of our results (Reis et al., 2022). Finally, the lack of a control group could also be considered a limitation of the study; however, it should be considered that scores of CSI and S-LANSS in a control group would be relatively small. ...
... Several investigators have suggested that Acceptance and Commitment Therapy might be of benefit in modifying perceptions of injustice [9,10,58]. There are also indications that risk-targeted behavioural activation might be effective in reducing perceptions of injustice [59,60]. ...
... Studies of mimetic proprioception and respectively of reciprocal inhibition of facial muscles up till now did not attract many researchers . Probably, the reason is that this object is rather challenging to study on animal models, and that disruptions of facial movements after peripheral neuropathies of facial nerve, although represent a huge aesthetic problem for the patients, do not nevertheless present any immediate danger to general health or to life of such patients [7] . This article is aimed at giving a start to the study of this issue and attracting attention of researchers to the necessity of deeper and more detailed studies of mechanisms of mimetic proprioception, as well as of the problems related to disruption of natural mimetic patterns in patients Клинические особенности нарушения реципрокного торможения лицевых мышц-антагонистов как обоснование для применения программ реабилитации пациентов с давним невосстановленным параличом Белла а. пашов 1 , и. Жарова 2 резюме. ...
... Recent research has investigated the effect of several therapies on people experiencing MEP: exercise, transcutaneous electrical nerve stimulation (TENS), kinesiology taping, continuous and pulsed ultrasound, manual therapy, and medications. 30,31 One systematic review found moderate evidence for exercise therapy and low evidence for TENS in providing a beneficial treatment effect for MEP. 30 While multifaceted pain treatment is a recommended best practice, it is not consistently applied and could benefit from implementation science investigations and consensus-developed nursing order sets for MEP management. ...
... In the studies that do report differences in erector spinae reaction time, they are typically delayed [18,19]. Although these data appear to suggest some compromise in the activation of back muscles (which implies suboptimal control) [12], there are also data that suggest excessive recruitment of back muscles in response to experimental pain [44] and in individuals with chronic back pain during functional tasks [12,45], especially in those with unhelpful beliefs [46,47]. Increased activation appears to more consistently involve the more superficial erector spinae than deep (e.g., multifidus) muscles [12]. ...
... In this aspect, it is important to clarify a fundamental distinction between essential percepts: pain and suffering as closely interconnected entities, albeit not synonymous [119]. Suffering can occur independently of pain, just as pain can be experienced without implicit suffering. ...