Papers by Guillaume Léonard
Canadian Journal Of Pain, 2020
Pain reports, Mar 1, 2022
Introduction: Numerous definitions of acute low back pain (aLBP) exist. The use of different defi... more Introduction: Numerous definitions of acute low back pain (aLBP) exist. The use of different definitions results in variability in reported prevalence or incidence, conflicting data regarding factors associated with the transition to chronic LBP (cLBP), and hampers comparability among studies. Objective: Here, we compare the impact of 3 aLBP definitions on the number of aLBP cases and participants' characteristics and explore the distribution of participants across definitions. Methods: A sample of 1264 participants from the Quebec Low Back Pain Study was included. Three definitions of aLBP were used: (1) not meeting the National Institutes of Health (NIH) cLBP definition (“nonchronic”), (2) pain beginning <3 months ago (“acute”), and (3) pain beginning <3 months with a preceding LBP-free period (“new episode”). Results: There were 847, 842, and 489 aLBP cases meeting the criteria for the 3 definitions, respectively. Participants included in the “nonchronic” had lower pain interference, greater physical function scores, and fewer participants reporting >5 years of pain than in the other definitions. Half the participants meeting the “acute” definition and one-third of participants meeting the “new episode” definition were also classified as cLBP based on the NIH definition. Conclusions: Our results highlight the importance of the definition used for aLBP. Different definitions influence the sample size and clinical profiles (group's characteristics). We recommended that cohort studies examining the transition from aLBP to cLBP ensure that the definitions selected are mutually exclusive (ie, participants included [aLBP] differ from the expected outcome [cLBP]).
Clinical Interventions in Aging, Feb 1, 2018
Purpose: Placebo analgesia refers to a perceived reduction in pain intensity following the admini... more Purpose: Placebo analgesia refers to a perceived reduction in pain intensity following the administration of a simulated or otherwise medically ineffective treatment. Previous studies have shown that many factors can influence the magnitude of placebo analgesia. However, few investigations have examined the effect of age on placebo analgesia, and none have done it in the context of electrotherapeutic interventions. The objective of this study is to compare the placebo response induced by sham transcutaneous electrical nerve stimulation (TENS) between young and older individuals, using an experimental heat-pain paradigm. Patients and methods: Twenty-two young (21-39 years) and 22 older (58-76 years) healthy adults participated in this comparative study. Experimental heat pain was evoked with a thermode (2-min stimulation at a constant individually adjusted temperature) applied on the lumbar region. Participants were asked to evaluate the intensity of their pain using a computerized visual analog scale. Experimental pain was induced before and after an unconditioned placebo intervention (placebo TENS) applied for 25 min. Results: In young individuals, no significant pain reductions were noted, whereas in older individuals, a statistically significant pain reduction was observed after the placebo stimulation (P,0.01). Between-group analyses revealed that placebo analgesia was greater in older individuals (40% pain reduction) compared with young individuals (15% pain reduction) (P,0.05). However, sham TENS increased heat-pain thresholds in the young group (P,0.01), but not in the older group (P=0.43). Our results indicate that placebo analgesia is influenced by age, with older individuals showing larger placebo analgesia than young adults. Although these results should be confirmed in clinical pain populations, the current observations bear potentially important consequences for the design of future placebo-controlled trials and for healthcare professionals working with elderly patients.
Clinical Interventions in Aging, Dec 1, 2018
Pain, Jun 2, 2022
The National Institutes of Health (NIH) minimum dataset for chronic low back pain (CLBP) was deve... more The National Institutes of Health (NIH) minimum dataset for chronic low back pain (CLBP) was developed in response to the challenge of standardizing measurements across studies. Although reference values are critical in research on CLBP to identify individuals and communities at risk of poor outcomes such as disability, no reference values have been published for the Quebec (Canada) context. This study was aimed to (1) provide reference values for the Canadian version of the NIH minimum dataset among individuals with CLBP in Quebec, both overall and stratified by gender, age, and pain impact stratification (PIS) subgroups, and (2) assess the internal consistency of the minimum data set domains (pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS score). We included 2847 individuals living with CLBP who completed the baseline web survey of the Quebec Low Back Pain Study (age: 44.0 ± 11.2 years, 48.1% women) and were recruited through social media and healthcare settings. The mean score was 6.1 ± 1.8 for pain intensity. Pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS scores were 12.9 ± 4.1, 14.4 ± 3.9, 9.8 ± 4.4, 13.0 ± 3.6, and 26.4 ± 6.6, respectively. Emotional distress or depression showed floor effects. Good-to-excellent internal consistency was found overall and by language, gender, and age subgroups for all domains (alpha: 0.81-0.93) and poor-to-excellent internal consistency for PIS subgroups (alpha: 0.59-0.91). This study presents reference values and recommendations for using the Canadian version of the NIH minimum dataset for CLBP that can be useful for researchers and clinicians.
Journal of Electromyography and Kinesiology, Dec 1, 2022
La presence de douleur chronique et l’insensibilite apparente a la douleur aigue constituent deux... more La presence de douleur chronique et l’insensibilite apparente a la douleur aigue constituent deux phenomenes opposes mais frequemment observes en psychiatrie ; dependant, bien sur, du type de desordre concerne. L’existence d’une telle dualite nous interpelle quant a la pertinence d’etudier les phenomenes douloureux chez les patients souffrant de troubles psychiatriques. En fait, une meilleure comprehension de la perception de la douleur chez cette population devrait servir a bonifier la semiologie des traumatismes psychiques et a promouvoir une meilleure appreciation de leurs etiologies neurobiologiques. Le chapitre qui suit est divise en fonction des desordres cliniques qui sont le plus frequemment associes aux desordres douloureux. Nos interpretations sont issues des recueils scientifiques deja publies et se basent sur les donnees probantes les plus recentes. Quant a notre classification des desordres cliniques, elle se base sur la taxonomie multiaxiale decrite dans le Manuel diagnostique et statistique des troubles mentaux (4e edition revisee (DSM IV-TR)
BMJ Open, Mar 1, 2021
Repetitive transcranial magnetic stimulation alone and in combination with motor control exercise... more Repetitive transcranial magnetic stimulation alone and in combination with motor control exercise for the treatment of individuals with chronic non-specific low back pain (ExTraStim trial): study protocol for a randomised controlled trial.
European journal of public health, Sep 1, 2020
Innovation in Aging, Jun 30, 2017
Work-a Journal of Prevention Assessment & Rehabilitation, Jun 13, 2023
BACKGROUND: Low back pain (LBP) is a prevalent condition frequently leading to disability. Resear... more BACKGROUND: Low back pain (LBP) is a prevalent condition frequently leading to disability. Research suggests that self-management (SM) programs for chronic LBP should include strategies to promote sustainable return to work. OBJECTIVES: This study aimed to 1) validate and prioritize the essential content elements of a SM program in light of the needs of workplace representatives, and 2) identify the main facilitators and barriers to be considered when developing and implementing a SM program delivered via information and communication technologies (ICT). METHODS: A sequential qualitative design was used. We recruited workplace representatives and potential future users of SM programs (union representatives and employers) and collected data through focus groups and nominal group techniques to validate the relevance of the different elements included into 3 broad categories (Understand, Learn, Apply), as well as to highlight potential barriers and facilitators. RESULTS: Eleven participants took part in this study. The content elements proposed in the scientific literature for SM programs were found to align with potential future users’ needs, with participants ranking the same elements as those proposed in the literature as the most important across all categories. Although some barriers were identified, workplace representatives believed that ICT offer an appropriate strategy for delivering individualized SM programs to injured workers who have returned to work. CONCLUSION: Our study suggests that the elements identified in the scientific literature as essential components of SM programs designed to ensure a sustainable return to work for people with LBP are in line with the needs of future users.
Frontiers in Aging Neuroscience, Nov 27, 2018
Background: Transcranial magnetic stimulation (TMS) is a non-invasive technique that can be used ... more Background: Transcranial magnetic stimulation (TMS) is a non-invasive technique that can be used to evaluate cortical function and corticospinal pathway in normal and pathological aging. Yet, the metrologic properties of TMS-related measurements is still limited in the aging population. Objectives: The aim of this cross-sectional study was to document the reliability and smallest detectable change of TMS measurements among community-dwelling seniors. A secondary objective was to test if TMS measurements differ between elders based on lifestyle, medical and socio-demographic factors. Methods: Motor evoked potentials (MEPs) elicited by single-pulse TMS were recorded in the first dorsal interosseous (FDI) in 26 elderly individuals (mean age = 70 ± 3.8 years). Resting motor threshold (rMT), MEP amplitudes and contralateral silent period (cSP) were measured on two separate occasions (1-week interval), and the standard error of the measurement (SEM eas), intraclass correlation coefficient (ICC), and smallest detectable change in an individual (SDC indv) were calculated. Lifestyle, medical and socio-demographic factors were collected using questionnaires. TMS-related outcomes were compared using independent sample t-test based on the presence of chronic health diseases, chronic medication intake, obesity, history of smoking, physical activity levels, gender, and level of education. Results: rMT and cSP measures were the most reliable outcomes, with the lowest SEM eas and highest ICCs, whereas MEP amplitude-related measures were less reliable. SDC indv levels were generally high, even for rMT (7.29 %MSO) and cSP (43.16-50.84 ms) measures. Although not systematically significant, results pointed toward a higher corticospinal excitability in elderly individuals who were regularly active, who had no chronic medical conditions and who did not take any medication.
Quality of Life Research, Apr 1, 2023
Purpose A significant number of people will experience prolonged symptoms after COVID-19 infectio... more Purpose A significant number of people will experience prolonged symptoms after COVID-19 infection that will greatly impact functional capacity and quality of life. The aim of this study was to identify trajectories of health-related quality of life (HRQOL) and their predictors among adults diagnosed with COVID-19. Methods This is a retrospective analysis of an ongoing prospective cohort study (BQC-19) including adults (≥18y) recruited from April 2020 to March 2022. Our primary outcome is HRQOL using the EQ-5D-5L scale. Sociodemographic, acute disease severity, vaccination status, fatigue, and functional status at onset of the disease were considered as potential predictors. The latent class mixed model was used to identify the trajectories over an 18-month period in the cohort as a whole, as well as in the inpatient and outpatient subgroups. Multivariable and univariable regressions models were undertaken to detect predictors of decline. Results 2163 participants were included. Thirteen percent of the outpatient subgroup (2 classes) and 28% in the inpatient subgroup (3 classes) experienced a more significant decline in HRQOL over time than the rest of the participants. Among all patients, age, sex, disease severity and fatigue, measured on the first assessment visit or on the first day after hospital admission (multivariable models), were identified as the most important predictors of HRQOL decline. Each unit increase in the SARC-F and CFS scores increase the likelihood of belonging to the declining trajectory (univariable models). Conclusion Although to different degrees, similar factors explain the decline in HRQOL over time among the overall population, people who have been hospitalized or not. Clinical functional capacity scales could help to determine the risk of HRQOL decline.
BMC Health Services Research, Jul 31, 2019
Background: Organizational readiness is a factor known to influence the predisposition of individ... more Background: Organizational readiness is a factor known to influence the predisposition of individuals within an organization to change. Based on Weiner's organizational theory, the "Organizational Readiness for Implementing Change" (ORIC) questionnaire was developed and validated to measure organizational readiness in healthcare contexts. However, no such tools allow French-speaking organizations to measure this concept. The objectives of this study were to (1) conduct a French cultural adaptation of the ORIC questionnaire, and (2) initiate the study of its psychometric properties. Methods: (1) Cross-cultural adaptation and translation processes were first conducted with the methodologies of Beaton, Vallerand and Massoubre. (2) Subsequently, internal consistency was documented by calculating Cronbach's alpha and inter-item and item-to-scale correlations. The study of construct validity was initiated with a confirmatory factor analysis. Results: A French 10-item scale named the Réceptivité organisationnelle à l'implantation d'un changement (ROIC) was developed and pretested by 125 occupational therapists working in Quebec homecare services. Cronbach's alpha values for the 2 item subscales show satisfactory internal consistency (Commitment: α = 0.84 and Efficacy: α = 0.86). Inter-item correlations revealed that the ROIC's items are moderately related to each other while item-to-total scale correlations pinpoint items that accounts for variance and influence internal consistency. Confirmatory factor analysis allowed the initiation of a substantial documentation of ROIC's model fit with the original version (CFI = 0.89, TLI = 0.85, SRMR = 0.08, and RMSEA = 0.12). Conclusions: The ROIC is a new theory-based and translated questionnaire that can be used to rigorously document the organizational readiness of French organizations. The ROIC has the potential to support members of different organizations in the identification of subsequent efforts for the implementation of a change.
Journal of Bodywork and Movement Therapies, Jul 1, 2012
To update evidence-based clinical practice guidelines (EBCPG) on massage therapy compared to cont... more To update evidence-based clinical practice guidelines (EBCPG) on massage therapy compared to control or other treatment for adults (>18 years) suffering from acute, sub-acute and chronic low back pain (LBP). Methods: A literature search was performed for relevant articles between January 1, 1948 and December 31, 2010. Eligibility criteria were then applied focussing on participants, interventions, controls, and outcomes, as well as methodological quality. Recommendations based on this evidence were then assigned a grade (A, B, C, Cþ, D, Dþ, DÀ) based on their strength. Results: A total of 100 recommendations were formulated from 11 eligible articles, including 37 positive recommendations (25 grade A and 12 grade Cþ) and 63 neutral recommendations (49 grade C, 12 grade D, and 2 grade Dþ). Discussion: These guidelines indicate that massage therapy is effective at providing pain relief and improving functional status. Conclusion: The Ottawa Panel was able to demonstrate that massage interventions are effective to provide short term improvement of sub-acute and chronic LBP symptoms and decreasing disability at immediate post treatment and short term relief when massage therapy is combined with therapeutic exercise and education.
Journal of Pain Research, Mar 1, 2020
Purpose: Complex regional pain syndrome (CRPS) is a rare neuropathic pain condition characterized... more Purpose: Complex regional pain syndrome (CRPS) is a rare neuropathic pain condition characterized by sensory, motor and autonomic alterations. Previous investigations have shown that transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) can alleviate pain in various populations, and that a combination of these treatments could provide greater hypoalgesic effects. In the present case report, we describe the effect of tDCS and TENS treatment on pain intensity and unpleasantness in a patient suffering from chronic CRPS. Results: The patient was a 37-year-old woman, suffering from left lower limb CRPS (type I) for more than 5 years. Despite medication (pregabalin, tapentadol, duloxetine), rehabilitation treatments (sensorimotor retraining, graded motor imagery) and spinal cord stimulation (SCS), the participant reported moderate to severe pain. Treatments of tDCS alone (performed with SCS turned off during tDCS application, 1 session/day, for 5 consecutive days) did not significantly decrease pain. Combining tDCS with TENS (SCS temporarily turned off during tDCS, 1 session/day, for 5 consecutive days) slightly reduced pain intensity and unpleasantness. Discussion: Our results suggest that combining tDCS and TENS could be a therapeutic strategy worth investigating further to relieve pain in chronic CRPS patients. Future studies should examine the efficacy of combined tDCS and TENS treatments in CRPS patients, and other chronic pain conditions, with special attention to the cumulative and long-term effects and its effect on function and quality of life.
Innovation in Aging, Jun 30, 2017
We examined culture change practices within the same U.S. nursing homes (NHs) in 2009/10 and 2016... more We examined culture change practices within the same U.S. nursing homes (NHs) in 2009/10 and 2016. The proportion of NHs engaged in at least some culture change practices remained steady (87.2% vs. 87.7%). We calculated changes in scores across three domains using items measured at both time points (homelike physical environment, staff empowerment, and resident-centered/directed care). Cronbach alphas ranged from 0.40 to 0.65. For NHs with domain scores at both time points, more than half scored as high or higher at Time 2 on staff empowerment and resident care (58% and 70%, respectively) while only 37% scored as high or higher on physical environment (p values <.01). We recalculated domain scores at Time 2 using the expanded set of survey items. Scores correlated well with the original versions and Cronbach alphas improved (range 0.63 to 0.78). Compared to T1 measures, on average NHs improved across all three domains.
Annals of physical and rehabilitation medicine, Jul 1, 2018
Introduction/Background Placebo analgesia refers to a perceived reduction in pain following the a... more Introduction/Background Placebo analgesia refers to a perceived reduction in pain following the administration of a simulated or otherwise medically ineffective treatment. Previous studies have shown that many factors can influence placebo analgesia. However, few investigations have examined the effect of age on placebo analgesia, and none have done it in the context of rehabilitation interventions. The objective of this study was to compare the placebo response induced by sham transcutaneous electrical nerve stimulation (TENS) between young and older individuals, using an experimental heat-pain paradigm. Material and method Twenty-two young (21–39 years) and 22 older (58–76 years) healthy adults participated in this comparative study. Experimental heat-pain was evoked with a thermode (2-min stimulation at a constant, individually adjusted temperature) applied on the lumbar region. Participants were asked to evaluate the intensity of their pain using a computerized visual analog scale. Experimental pain was induced before and after an unconditioned placebo intervention (sham TENS). Results In young individuals, no significant pain reductions were noted, whereas in older individuals, a statistically significant pain reduction was observed after the placebo stimulation (P Conclusion Our results indicate that placebo analgesia is influenced by age, with older individuals showing higher placebo analgesia than young adults. Although these results should be confirmed in clinical pain populations, the current observations bear important consequences for the design of future placebo-controlled trials in rehabilitation and for healthcare professionals.
Innovation in Aging, Jun 30, 2017
Background: Male centenarians are generally under-represented in centenarian studies. The United ... more Background: Male centenarians are generally under-represented in centenarian studies. The United States Veteran cohort has the largest known male centenarians of any nation. Here we study Veteran centenarians' incidence of Heart Failure and its impact on survival. Methods and Results: retrospective longitudinal cohort study of elderly U.S. Veterans. Subjects are communitydwelling, born between 1910 and 1915, who survived to at least age 80. The study included 31,109 octogenarians, 52,419 nonagenarians, and 3,351 centenarians. Kaplan-Meier method was used to estimate the cumulative incidence of heart failure within age groups. Incidence rates were compared using log-rank test. Cox proportional-hazards model was used to estimate unadjusted hazard ratios. Veteran centenarians were 97.0% male, 88.0% white, and 31.8% widowed. 87.5% served in World War II, 63.9% had no service related disability. Significant differences in HF incidence rates were observed. By age 89, incidence of HF for octogenarians was 19.3%, v. 3.3% for nonagenarians and 0.4% for centenarians By age 99 incidence of HF for nonagenarians increased to 15.8% and 3.3% for centenarians. Differences in incidence rate remained significant across age groups (P =<.0001). The Hazard Ratio for heart failure incidence among octogenarians and nonagenarians compared with centenarians is HR 36.54 CI 95% (29.90-44.66) and 5.37 CI 95% (4.42-6.52), respectively. Conclusion: In a large cohort of predominantly male U.S. Veterans, compared with octogenarians and nonagenarians, centenarians had the lowest incidence of heart failure after age 80, demonstrating compression of morbidity and extension of health-span in this unique group of survivors.
Uploads
Papers by Guillaume Léonard