Hans Timmerman

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of physical prehabilitation (i.e. exercise-based interventions delivered before surgery) alone or as part of a multimodal programme compared with no exercise-based intervention, usual care, or a different intervention in people undergoing major abdominal surgery.

Background: Percutaneous cervical cordotomy (PCC) is a minimally invasive radiofrequency procedure for intractable unilateral cancer pain. Commonly performed under conscious sedation, awake PCC enables real‐time patient feedback, potentially improving targeting precision and expanding eligibility for patients in whom sedation poses risks. Method and Technique: This article presents the structured protocol for awake PCC implemented at our center, including pre‐procedural training, positioning, fluoroscopic guidance, impedance monitoring, sensory and motoric testing, lesioning strategy, and aftercare. The key principle is to create the smallest effective lesion, applied incrementally until spinothalamic tract disruption is confirmed. Discussion: In our experience, awake PCC enables precise targeting and has yielded up to 90% success in pain relief. The approach requires substantial preparation, including training for both patient and team to ensure cooperation, clear communication, and tolerance of brief intraoperative discomfort. Although these demands can be challenging, we have found awake PCC to be a safe and effective last‐resort option for patients facing devastating pain. Conclusion: This technical note provides a practical and stepwise approach to awake PCC. It may assist clinicians in adopting or refining the technique.

Background: Proprioception training is essential for restoring knee function in several medical conditions. Open kinetic chain (OKC) and closed kinetic chain (CKC) exercises are used in active movement interventions to enhance proprioception. Exergames, supported by wearable sensors, offer a solution by providing real-time feedback. Auditory feedback (AF) embedded in the serious game training has shown benefits in upper limb rehabilitation compared to visual feedback (VF) alone. However, the potential of AF in exergames that provide knee training is not known. Objective: This study presents an exergame platform aimed at enhancing knee joint proprioception through stretching and squatting exercises. The platform allows to provide feedback in 2 modes, namely, VF only and a combination of AF and VF. The AF indicates the joint position by adjusting the loudness of the sound. The VF maps the motion of the lower limb into the game space, where this information is used to control a game object. A randomized controlled trial with 14 participants compared AF to VF only. The hypothesis was that AF would improve knee joint position accuracy, enhancing neuromuscular coordination and lower limb stability. Methods: A randomized controlled trial was conducted within 14 healthy volunteers to test the exergames for knee joint motor learning using augmented feedback. All participants were required to do a pretest consisting of half and full squats and two tasks, in which participants were asked to reproduce a 45-degree knee bend and to stretch their knee fully. After that, participants played 4 rounds of each of the 2 exergames. Then the tasks of the pretest were repeated. A 1-sided Mann-Whitney U test was conducted for answering whether AF has a positive effect on the ability of participants to accurately control the knee joint angle. In addition, we calculated the muscle synergies participants used to complete the exercises. Subjective gaming experience was assessed using the Intrinsic Motivation Inventory and the User Experience Questionnaire. Results: A total of 14 participants were recruited, including 7 in the experimental group with AF, and 7 in the control group only with VF. The result of the Mann-Whitney U test demonstrated that augmented feedback improved knee joint accuracy compared to VF in both the CKC (statistics=41.0; P=.04) and OKC (statistics=42.0; P=.03) tasks. Additionally, muscle synergy analysis revealed high consistency in different muscle synergy patterns between groups across both game types. Conclusions: Augmented feedback significantly enhanced knee joint motor learning performance (reflected in the knee joint angle positioning ability) in both CKC and OKC exergame training. Consistent muscle synergy patterns across participants show that the developed exergames are suitable for knee training. Studies in patient populations are needed to establish whether the games could be used in lower limb rehabilitation. Trial Registration: ClinicalTrials.gov NCT07141290; https://clinicaltrials.gov/study/NCT07141290

BACKGROUND Proprioception training is essential for restoring knee function in several medical conditions. Open kinetic chain (OKC) and closed kinetic chain (CKC) exercises are used in active movement interventions to enhance proprioception. Exergames, supported by wearable sensors, offer a solution by providing real-time feedback. Auditory feedback (AF) embedded in the serious game training has shown benefits in upper limb rehabilitation compared to visual feedback (VF) alone. However, the potential of AF in exergames that provide knee training is not known. OBJECTIVE This study presents an exergame platform aimed at enhancing knee joint proprioception through stretching and squatting exercises. The platform allows to provide feedback in 2 modes, namely, VF only and a combination of AF and VF. The AF indicates the joint position by adjusting the loudness of the sound. The VF maps the motion of the lower limb into the game space, where this information is used to control a game object. A randomized controlled trial with 14 participants compared AF to VF only. The hypothesis was that AF would improve knee joint position accuracy, enhancing neuromuscular coordination and lower limb stability. METHODS A randomized controlled trial was conducted within 14 healthy volunteers to test the exergames for knee joint motor learning using augmented feedback. All participants were required to do a pretest consisting of half and full squats and two tasks, in which participants were asked to reproduce a 45-degree knee bend and to stretch their knee fully. After that, participants played 4 rounds of each of the 2 exergames. Then the tasks of the pretest were repeated. A 1-sided Mann-Whitney U test was conducted for answering whether AF has a positive effect on the ability of participants to accurately control the knee joint angle. In addition, we calculated the muscle synergies participants used to complete the exercises. Subjective gaming experience was assessed using the Intrinsic Motivation Inventory and the User Experience Questionnaire. RESULTS A total of 14 participants were recruited, including 7 in the experimental group with AF, and 7 in the control group only with VF. The result of the Mann-Whitney U test demonstrated that augmented feedback improved knee joint accuracy compared to VF in both the CKC (statistics=41.0; P=.04) and OKC (statistics=42.0; P=.03) tasks. Additionally, muscle synergy analysis revealed high consistency in different muscle synergy patterns between groups across both game types. CONCLUSIONS Augmented feedback significantly enhanced knee joint motor learning performance (reflected in the knee joint angle positioning ability) in both CKC and OKC exergame training. Consistent muscle synergy patterns across participants show that the developed exergames are suitable for knee training. Studies in patient populations are needed to establish whether the games could be used in lower limb rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT07141290; https://clinicaltrials.gov/study/NCT07141290

Background In many patients with axial spondyloarthritis (axSpA), pain persists despite anti-inflammatory medication. Quantitative sensory testing (QST) indirectly assesses altered somatosensory function, though its clinical practicality is limited. The Central Sensitisation Inventory (CSI) could be an alternative in the initial assessment of central sensitisation (CS). This study aimed to investigate the value of the CSI in evaluating CS in patients with axSpA by (1) assessing somatosensory function related to CS with QST and (2) exploring associations between CSI, QST, patient and disease characteristics and pain-related psychosocial factors. Methods Consecutive outpatients from the Groningen Leeuwarden AxSpA cohort underwent QST, including pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). Participants completed questionnaires assessing CS (CSI), illness perception (Revised Illness Perception Questionnaire, IPQ-R), pain-related worrying (Pain Catastrophising Scale, PCS), fatigue (Modified Fatigue Impact Scale, MFIS), anxiety/depression (Hospital Anxiety and Depression Scale, HADS) and coping. QST measurements were stratified for CSI≥40. Results 201 patients with axSpA were included; 63% male, 64% radiographic axSpA, median symptom duration 12 years (IQR 5–24), mean Axial Spondyloarthritis Disease Activity Score 2.1±1.0. Patients with CSI≥40 had significantly lower PPTs and higher TS than CSIConclusion In this large cross-sectional study in patients with axSpA, the CSI appears as a useful initial CS assessment questionnaire. When CSI scores indicate CS, considering pain-related psychosocial factors is important. These results emphasise the need for a biopsychosocial approach to manage chronic pain in patients with axSpA.

Background: Sex is an important factor influencing the development and treatment of chronic pain, but the extent of its influence is still unclear. Other demographic factors as well as nonpharmacological interventions might influence pain sensitivity differently in men and women. Objective: In this study, we aimed to investigate the influence of sex and other demographic, lifestyle, behavioral, clinical, and environmental factors on pain sensitivity in the Dutch population. Different films were used to investigate how they would impact pain sensitivity and what influence sex and other variables have on the effect of this simple intervention. Methods: We performed a study consisting of 2 parts: (1) a cross-sectional research to investigate pain sensitivity differences between men and women and the influence of other demographic variables on the pain sensitivity in a Dutch cohort and (2) an internet intervention study to determine whether a short film could skew pain sensitivity. Results: All respondents filled in a web-based demographic questionnaire and were randomized into 4 groups. The control group filled in the Pain Sensitivity Questionnaire without watching a preliminary film. A cross-sectional analysis was performed in the control group (n=1746). The other 3 groups watched short films: one group watched a film with scenes of nature (n=2650), another group watched a film on laughing people (n=2735), and the last group watched a film on physically painful events (n=2708). Immediately after the film viewing, participants were directed to the Pain Sensitivity Questionnaire to measure their pain sensitivity. The Pain Sensitivity Questionnaire score was stated as a mean per question on the numeric rating scale from 0-1. The cross-sectional study revealed no significant differences between men and women but showed male-female differences in the Pain Sensitivity Questionnaire when specific background factors were present. Watching a short film had a positive impact on the pain sensitivity of the respondents who had chronic pain, with a higher effect observed in female respondents. Conclusions: Scientists performing pain research need to account for factors that can influence the outcome of their study and be aware that these factors can be sex-dependent, and pain sensitivity should be analyzed accordingly. Even relatively small interventions such as watching a film can impact pain sensitivity, especially in respondents with current chronic pain. This effect can vary as well when different background factors are present. Our findings warrant further explorations of the possibilities that simple interventions bring for patients in personalized medicine. Trial Registration: Landelijk Trial Register NTR-new NL8182; https://onderzoekmetmensen.nl/en/trial/29537