Research Mira Meeus

Abstract

Telerehabilitation and eHealth, albeit providing novel opportunities and advantages for rehabilitation and physiotherapy programs, still pose many challenges at societal, technological and individual levels. With this postdoc challenge we aim to recruit a candidate proficient in tackling these challenges at least at one of three levels: 1) societal: providing evidence of (cost-)effectiveness of telerehabilitation and eHealth in physiotherapy through large-scale intervention trials; 2) technological: advancing the technical level of eHealth in physiotherapy by research on technology and the inclusion of artificial intelligence (AI) for using collected patient data in clinical decision making; 3) individual: monitoring and/or alleviating barriers by researching emotions, cognitions, and behavior in different contexts to explain differences in outcome. By using innovative recruitment strategies (including triggering recruitment videos, and organization of a hackathon), MOVANT aims to recruit a high potential postdoc candidate to apply for an FWO postdoctoral fellowship and/or an MSCA-PF. The candidate will be supported by a promotor and a mentor team, consisting of several ZAP colleagues and the MOVANT research coordinator.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Gebruers Nick
• Co-promoter: Roussel Nathalie

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Introduction Chronic low back pain (CLBP) is one of the most common chronic musculoskeletal disorders worldwide, responsible for the highest levels of disability. All state-of-the-art guidelines recommend implementing exercise therapy (ET) in CLBP management. However, more research is needed to investigate specific modalities of ET and their underlying mechanisms as this can optimize treatment effects. Our research group has shown that high intensity training (HIT) can be a valuable method to improve the effect sizes of ET in persons with severely disabling CLBP (PwCLBP). By adding technology, the adherence to HIT could be increased, encouraging PwCLBP to keep performing their exercises and prolong the rehabilitation process. Methods Conform Good Clinical Practice (GCP) regulations, a double blind (outcome assessor and statistical analysis) three-armed multicenter randomized controlled trial will be conducted, in which 168 PwCLBP will be randomized into 3 groups. Patients with cLBP who present themselves at UZA/Jesse for consultation and start-up of a rehabilitation program, who meet the inclusion criteria, will be informed about this study by the physician. If they are interestes, an approval form will be issued and signed, followed by providing the informed consent form. Patients who sign and return the informed consent within 2 weeks will be contacted for possible enrolment. All 3 groups start with a biopsychosocial education program (BPS)(4 sessions), followed by ET at the hospital for 12 weeks (12x/week). Groups 1 and 2 will receive HIT training, group 3 will receive Moderate IT (MIT) training. Then, a 12-week ET program (2x/week) at home will be continued, in which group 1 will be supported by an app (TECH-HIT: technology supported). Short- (after 12 and 24 weeks of training) and long-term (6 and 18 months after cessation of training) effects of HIT are evaluated. The primary outcome measure will be functional disability, assessed by the Modified Oswestry Disability Index (MODI). Objectives The primary goal is to evaluate the short- and long-term effectiveness of a time contingent individualized HIT protocol on disability compared to moderate intensity training (MIT) as used in usual care, in persons with severely disabling CLBP. Secondary goals entail 1) evaluating short- and long-term effectiveness of HIT on psychosocial correlates, central pain processing, and physical fitness, 2) investigating additional effects of (prolonged) HIT at home, 3) investigating added value of technology through a mobile application that offers support during home training, 4) evaluating cost-effectiveness of (technology supported) HIT compared to MIT. Process evaluation This study will start recruitment in February 2024 and have an active intervention phase of three years. The end of the recruitment phase is therefore planned around January 2027. After the recruitment phase, a period of six months is reserved for final data analysis and scientific publication writing. Data analysis will be performed with JMP Pro. For the primary objective, descriptive statistics will be performed to determine the different outcome measures for each group, and finally linear multiple regression analyses will be performed to determine associations between disability and pain processing. Conclusion This project will provide valuable insights into efficacy of HIT through a high-quality clinical evaluation study in a larger spectrum of PwCLBP in a rehabilitation center setting. The added use of technology might support HIT by encouraging PwCLBP to keep performing their exercises and prolong the rehabilitation process and retain long-term positive effects.

Researcher(s)

• Promoter: Roussel Nathalie
• Co-promoter: Meeus Mira

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

The current state-of-the art advocates for a biopsychosocial rehabilitation approach for persistent pain after breast cancer treatment. Within this approach pain science education is combined with promotion of an active lifestyle based on self-regulation techniques. We argue for testing an innovative eHealth self-management support program for this purpose. The assumption is that this delivery mode reduces barriers to pain self-management support, through bringing timely support near to people, creating a safe environment as opposed to hospital settings, providing a multidimensional support model taking into account the biopsychosocial needs of patients, and lowering costs. This program can provide patients with the knowledge, proactive, cognitive and self-management skills to master their situation and journey towards less pain and pain-related disability and participation in normal life again. Therefore, the general aim of the proposed project is to investigate the effectiveness of an eHealth self-management support program for pain-related disability (I) in breast cancer survivors with persistent pain (P). The program makes use of an innovative chatbot format for delivering pain science education and motivating and monitoring physical activity. The eHealth program is automated and personalized using comprehensive decision-tree-based algorithms in order to promote pain self-management support. The primary scientific objective of the study is to determine the effectiveness of this eHealth self-management support program for persistent pain after breast cancer treatment compared to 1) usual care (i.e. superiority of the eHealth self-management support program) (C1) and 2) a comprehensive pain rehabilitation program delivered face-to-face in a physical therapy setting (i.e. non-inferiority of the eHealth self-management support program) (C2) on pain-related disability (O).

Researcher(s)

• Promoter: De Groef An
• Co-promoter: Meeus Mira
• Co-promoter: van Olmen Josefien
• Co-promoter: Wens Johan
• Co-promoter: Willem Lander

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Upper limb (UL) dysfunctions after breast cancer treatment are complex and multifactorial. Increasing proof of concept is available for local soft tissues problems as underlying mechanism of UL dysfunctions during and after breast cancer treatment. These problems include structural changes (tissue composition, thickness and volume) and altered mechanical properties (tissue stiffness and impaired gliding). The challenge is to properly assess these properties to get a true understanding of their contribution to UL dysfunctions. Up to know, only (subjective) methods with limited validity were used. Also, longitudinal assessments of all properties together are lacking. Therefore, a comprehensive set of innovative, high-quality and objective ultrasound techniques for assessment of both structural and mechanical properties will be developed and adopted. More specific, the research objectives are 1) developing and testing a comprehensive assessment protocol for the quantification (i.e. severity) of soft tissue properties with ultrasound techniques; 2) exploring the clinical relevance of ultrasound findings by comparing them with other clinical outcomes and 3) determining the value of soft tissue properties (evaluated with ultrasound) as a diagnostic and prognostic biomarker for UL dysfunctions up to one year post-breast cancer surgery. With these insights, tailoring currently available and/or new therapies to the exact underlying mechanism(s) of UL dysfunctions will improve.

Researcher(s)

• Promoter: Meeus Mira
• Fellow: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Up to 40% of women experience chronic pain after treatment for breast cancer, and this pain is often very disabling. However, chronic pain after breast cancer remains under-recognised and under-treated. An effective and patient-tailored approach of (chronic) pain after breast cancer indeed requires a thorough knowledge and evaluation of the pain. In daily clinical practice, however, guidelines for a comprehensive diagnosis of pain in cancer patients and survivors are lacking. Further research in this topic is crucial for an efficient, preventive as well as curative, approach of pain after breast cancer. Besides the high prevalence and the important impact of pain in this population, the breast cancer population is also an ideal population to study chronic pain and its natural time course in different stages, since most patients start pain-free, but almost half of them end up with chronic pain. Therefore, this study aims to map biomarkers (both predictive, prognostic and diagnostic) for chronic pain after breast cancer treatment. We will study possible biopsychosocial biomarkers in relation to (chronic) pain and monitor their temporal changes from the moment of diagnosis until 1 year after surgery. The potential biomarkers are situated within the medical imaging of the brain, measurements of pain sensitivity and psychological variables.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Total knee replacement (TKR) surgery is the most common surgical treatment for knee osteoarthritis (OA) worldwide. Despite a good outcome for the majority of patients, approximately 20% of patients experience chronic pain after surgery. Therefore, it is desirable and useful to define predictive factors for this postoperative chronic pain. It is hypothesized that the presence of altered central pain processing (CPP) may be a determinant of chronic pain after TKR surgery. Besides altered CPP, metabolic disorders such as obesity and diabetes might also contribute to postoperative chronic pain. Both disorders are risk factors for developing knee OA in the first place, but their relationship with postoperative chronic pain is not yet clear. In addition, the association between altered CPP on the one hand and obesity and diabetes on the other hand needs to be examined. Given the prediction that the incidence of TKR will increase in the future, prevention of chronic postoperative pain is of tremendous importance. Therefore, the aim of this research proposal is to unravel the contribution of preoperative altered CPP, obesity and diabetes to chronic postoperative pain after TKR surgery.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel
• Fellow: Vervullens Sophie

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Total knee replacement (TKR) surgery is the most common surgical treatment for knee osteoarthritis (OA) worldwide. Despite a good outcome for the majority of patients, approximately 20% of patients experience chronic pain after surgery. Therefore, it is desirable and useful to define predictive factors for this postoperative chronic pain. It is hypothesized that the presence of altered central pain processing (CPP) may be a determinant of chronic pain after TKR surgery. Besides altered CPP, metabolic disorders such as obesity and diabetes might also contribute to postoperative chronic pain. Both disorders are risk factors for developing knee OA in the first place, but their relationship with postoperative chronic pain is not yet clear. In addition, the association between altered CPP on the one hand and obesity and diabetes on the other hand needs to be examined. Due to their shared relation with low grade inflammation, there might exist an undiscovered link between these conditions. Given the prediction that the incidence of TKR will increase in the future, prevention of chronic postoperative pain is of tremendous importance. Therefore, the aim of this research proposal is to unravel the contribution of preoperative altered CPP, obesity and diabetes to chronic postoperative pain after TKR surgery.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel
• Fellow: Meert Lotte

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Lymphedema is a chronic, debilitating disorder characterized by abnormal tissue swelling, adipose deposition and/or tissue fibrosis. Advances in oncologic treatment have led to an ever-increasing number of cancer survivors over time. As a result, morbidities related to the treatment (such as lymphedema) are likely to increase too. In the scientific community there is a large discrepancy in the reporting of incidence and prevalence data of lower limb lymphedema (LLL), because of a lack of valid and standardized measurement tools. It is unknown, at present, which measurement methods are the most accurate to use for screening, diagnosing or evaluating LLL in clinical practice. Consequently, at this moment there is an urgent need to validate the currently limited guidelines regarding screening, diagnosing (including severity grading) and evaluating unilateral and bilateral LLL and make them more concrete and unambiguous. To meet these needs, and to encourage an international uniformity regarding the management of LLL, the proposed project aims at developing a screening, diagnostic and evaluation set for patients with unilateral or bilateral LLL that can be used in clinical practice, based on directly edema-related measurement tools. Importantly, these sets need to be used in addition to questionnaires assessing problems or limitations in mental, social and general daily functioning as well as quality of life, in order to be able to outline a holistic treatment approach.

Researcher(s)

• Promoter: Meeus Mira
• Fellow: De Vrieze Tessa

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Hemophilia is a genetic disorder characterized by recurrent bleedings in synovial joints. Thanks to tremendous scientific progress, patients with hemophilia (PwH) have a life expectancy that is comparable to the general population. However, the majority of adult PwH suffer from extremely intense and invalidating joint pain. Although the complexity of joint pain has been studied in other chronic joint pain conditions, there is an immense lack of studies examining pain in PwH. Current studies have not sufficiently focused on pain as primary outcome and thus lack valid and thorough assessments of prevalence and extent of pain, life impact and nociceptive processing. Moreover, pain is not yet studied within a biopsychosocial perspective and the role of beliefs, emotions and behavior is thus unexplored. Especially interactions between pain and beliefs, emotions and behavior are wasteland, since longitudinal studies are necessary to explore the bidirectional relations. Therefore the main aim of the current proposal is to gain more insights in joint pain in PwH enabling us to move towards an adequate pain management within this patient population. As the majority of studies in other chronic joint pain conditions has shown that the biopsychosocial perspective is crucial in pain management, we will use a consensus-based set of outcome measures that should be evaluated in patients with chronic joint pain. The primary objective is to examine pain characteristics (prevalence, intensity and extent) and life impact of pain (impact on physical functioning and quality of life) using validated outcome measures in an unselected and representative sample of adult PwH. As secondary objective we want to assess peripheral and central nociceptive processing in PwH, and examine the relationship with joint status to gain more insight in the pathophysiology of joint pain in PwH. The third objective is to record fluctuations and interrelations in pain intensity, intake of medication and physical activity to gain more insight in the relation between pain intensity and pain behavior in PwH. We will examine whether beliefs and emotions are predictive of pain behavior. The insights gathered with the current research proposal will lead to more comprehensive biopsychosocial pain assessments of PwH both in further research and in clinical practice. These ameliorated assessments unravelling contributors to chronic pain in this populations, will serve as base to steer interventions for the management of joint pain, accounting for nociceptive processing profiles and specific beliefs, emotions and behavior. We expect that proper pain management strategies will be more effective and less costly, resulting in enhanced quality of life and increased social participation for PwH.

Researcher(s)

• Promoter: Roussel Nathalie
• Co-promoter: Meeus Mira
• Fellow: Foubert Anthe

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

In addition to fatigue, pain is the most common frequent persistent symptom in cancer survivors. Pain following cancer leads to poor quality of life and impaired daily functioning. Identifying the origin or mechanism of the pain is a critical step in clinical decision-making. Awareness on the presence of so called central sensitisation pain in cancer survivors has increased past decades. In this case pain can be explained by enhanced processing of nociception (sensitization) within the peripheral and/or central nervous system and by altered pain modulation. Central sensitization pain relies on different mechanisms than typical nociceptive and neuropathic pain and therefore warrants a different treatment strategy. Unfortunately, up to now, no validated tool for the identification of central sensitization pain in daily clinical practice is available. Therefore, the aim of the proposed project is to develop a tool for the identification of central sensitisation pain in cancer survivors with persistent pain several months after finishing treatment. First, the tool will be developed and validated in a cohort of cancer survivors with persistent pain recruited in a hospital setting. Second, pilot testing to prepare a large-scale validation study in a non-hospital setting will be performed. The present project will be an important step in improving pain management in cancer survivors with persistent pain.

Researcher(s)

• Promoter: Meeus Mira
• Fellow: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Even though a Total Knee Replacement (TKR) is an effective surgical treatment for end-stage knee osteoarthritis (KOA) and the majority of patients report substantial pain relief and functional improvement following this surgical procedure, literature shows that 20-40% of patients are dissatisfied with the postsurgical outcome. Given the high costs related to TKR surgery and the substantial number of patients who do not meet the level of improvement after surgery, the decision to implant a TKR should be very well-considered. It is crucial to improve our understanding of the mechanisms contributing to persisting pain and disability following TKR. There is growing body of research suggesting that in a subgroup of patients with KOA the clinical picture is dominated by sensitization of central nervous system pain pathways (i.e. central sensitization) rather than by structural dysfunctions causing nociceptive pain. Briefly, this means that the pain is to a considerable degree due to hypersensitivity of the central nervous system, rather than being just caused by structural joint damage. Therefore, with our current ongoing study (funded BOF-DOCPRO4 project initiated November 1st 2017) we aim to understand the role of central pain processing in addition to structural and functional impairments related to KOA to predict unsatisfactory outcome (in terms of pain, symptoms, physical performance and QOL) after a TKR in patients with KOA. However, within the context of recent research developments in OA and recent suggestions proposed in international literature, we would like to upgrade our current research project and add a few measurements. In very recent systematic reviews, several OA phenotypes have been proposed, which are in part in line with the aims of our current ongoing study. However, we additionally want to investigate to what extent metabolic and inflammatory factors are related to the clinical expression of OA and are contributing to prognosis and treatment response. Moreover, in literature, different phenotypes are hypothesised and it is also plausible that the proposed phenotypes are not complete distinct entities and that interactions may exist. Therefore, we want to upgrade our research study and add some measurements to investigate the role of different OA characteristics, namely structural joint damage, inflammatory and metabolic factors and pain processing factors, in the clinical expression of KOA before and after a TKR. Moreover, we aim to unravel the interrelationship between these factors and to determine different phenotypes in relation to the outcome and prognosis after TKR, since these phenotypes may be particularly important for tailored treatment. In order to reach these objectives, a longitudinal prospective study will be performed, with specific data collection presurgical (T0) and 6 months (T1) and 1 year (T2) postsurgical. The strength of our current research study (including the proposal to upgrade the project and to add measurements) is that we will examine all putative prognostic factors on the basis of the biopsychosocial model. Besides several psychological factors (cognitive emotional modulation), we assess biomechanical factors (i.e. structural impairments, such as radiographic severity of OA, and functional impairments such as muscle weakness and proprioceptive deficits) and metabolic and inflammatory factors, and examine the role of altered central pain processing. We want to define OA phenotypes that are easy interpretable and possibly related to the outcome and prognosis after TKR.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

In addition to fatigue, pain is the most frequent and persistent symptom following breast cancer and breast cancer treatment. Despite the effectiveness of different physical therapy modalities, such as manual techniques, passive mobilizations and exercises, many patients still experience pain and subsequent difficulties in daily functioning at short and long term. Past decades, the awareness on the important role of educational interventions in the management of pain in general has increased. Educational interventions aim at explaining and improving the knowledge, control and attitude of the patient regarding his/her pain complaint. However, these educational interventions are often restricted to more biomedical pain management instructions and general advice on physical activity and analgesics (= traditional biomedical education). Only recently, increased knowledge on pain mechanisms led to a more modern educational approach. This modern approach is suited to explain more complex issues associated with pain and takes into account many more factors related to pain. To our knowledge, only one controlled trial investigated the effectiveness of a modern educational intervention in the early stage of breast cancer treatment. The results were very promising for shoulder function. However, only short-term effects were examined, no randomization was performed and no pain-related and socio-economic outcomes were evaluated. Therefore, the aim of the proposed project is to investigate the effectiveness of a similar modern educational program, in addition to standard physical therapy care, in the early treatment phase of breast cancer in comparison with traditional biomedical education. A randomized controlled trial will be performed with a long-term follow up period. The primary outcome parameters are pain intensity and pain-related disability. Secondary outcomes are other dimensions of pain, physical and mental functioning, return to work and health-care related costs.

Researcher(s)

• Promoter: Meeus Mira

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Even though a Total Knee Replacement (TKR) is an effective surgical treatment for end-stage knee osteoarthritis (KOA) and the majority of patients report substantial pain relief and functional improvement following this surgical procedure, literature shows that 20-40% of patients are dissatisfied with the postsurgical outcome. Similar to other chronic pain conditions, there is growing body of research suggesting that in a subgroup of patients with KOA the clinical picture is dominated by sensitization of central nervous system pain pathways (i.e. central sensitization) rather than by structural dysfunctions causing nociceptive pain. Briefly, this means that the pain is to a considerable degree due to hypersensitivity of the central nervous system, rather than being just caused by structural joint damage. Therefore, it is not surprising that surgical interventions such as TKRs do not guarantee pain reduction and functional recovery, as the pain goes beyond the joint. Given the high costs related to TKR surgery and the substantial number of patients who do not meet the level of improvement after surgery, the decision to implant a TKR should be very well-considered. It is crucial to improve our understanding of the mechanisms contributing to persisting pain and disability following TKR and it emphasizes the need for further research on the role of altered central pain processing in patients with end stage KOA awaiting TKR surgery. This research proposal has two main objectives: 1) to unravel to which extent central pain processing and structural and functional impairments contribute to the clinical expression of KOA (pain, symptoms, physical performance and quality of life) in patients with end-stage KOA before (at baseline) and 6 months after primary TKR surgery. 2) to unravel which factors are predictive for an unsatisfactory outcome (in terms of pain, symptoms, physical performance and quality of life) 6 months and 1 year after a primary TKR. In order to reach these objectives, a longitudinal prospective study will be performed, with specific data collection presurgical (T0) and 6 months (T1) and 1 year (T2) postsurgical. This study allows identification of prognostic factors for unsatisfactory outcome in KOA patients after a primary TKR. Previous longitudinal studies investigating predictors of poor outcome after TKR, mainly focused on structural and functional factors related to the knee joint, while central pain processing was left unnoticed. Other studies mainly focused on psychological factors as potential predictors of poor outcome. The strength of the recent proposal is that we will examine all putative prognostic factors on the basis of the biopsychosocial model. Besides several psychological factors (cognitive emotional modulation), we assess biomechanical factors (i.e. structural impairments, such as radiographic severity of OA, and functional impairments such as muscle weakness and proprioceptive deficits) and examine the role of altered central pain processing measured in four ways (Pressure Pain Thresholds, Conditioned Pain Modulation, tactile acuity, Central Sensitization Inventory questionnaire). In this study, it is hypothesized that in patients with altered central pain processing an unsatisfactory effect of TKR surgery on KOA pain, symptoms, physical performance and quality of life can be expected, as there is no clear relation between peripheral input and perceived pain. It is possible that in this subgroup interventions aiming to desensitize the central nervous system might be more beneficial. In future interventional research, it can be clarified whether new interventions, such as cognitive-behavioral therapy or therapeutic pain neuroscience education, whether or not in combination with surgery, are useful. These new interventions target different aspects such as the central nervous system in contrast to therapeutic modalities that are only directed to structural knee joint pathology.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel
• Fellow: Meert Lotte

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Factors predicting poor outcome in knee osteoarthritis patients following total knee joint replacement (TKR) surgery will be investigated, with focus on the role of pain due to neuroplasticity (i.e. hyperexcitability of the central nervous system). This will increase insight in the success rate and reasons behind the highly varying satisfaction after TKR and may help in future decision making regarding need for and timing of TKR, as well as the needs for pre- and postsurgical rehabilitation.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

The following study proposal concerns a prospective longitudinal study design in order to assess central sensitization and metabolic characteristics relative to the patients' pain, mobility and functioning in patients with adhesive capsulitis of the shoulder.

Researcher(s)

• Promoter: Struyf Filip
• Co-promoter: Meeus Mira

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project