Papers by Motti Ratmansky
Psychological injury and law, May 22, 2024
Noncredible cognitive performance among chronic pain patients garners increased clinical attentio... more Noncredible cognitive performance among chronic pain patients garners increased clinical attention. The Word Memory Test (WMT)-a well-established stand-alone validity indicator-was recently integrated with an eye tracker, and its utility was assessed using healthy simulators. The current study expands on this earlier work by assessing the utility of the eyetracker integrated WMT to detect noncredible cognitive performance in the context of chronic pain. Chronic pain outpatients were randomly assigned to either a simulation (i.e., patients simulating cognitive impairment; n = 22) or honest control (i.e., patients performing to the best of their ability; n = 23) conditions. They then completed the WMT's immediate recognition (IR) subtest while their eye movements were recorded. Simulators gazed less at relevant stimuli and gazed more at irrelevant stimuli than controls. Sensitivity levels tended to be low to moderate when maintaining specificities ≥ 90%, as customary in the field. While a previously developed scale that integrates eye movement measures using a logistic regression did not adequately differentiate the groups, conjunctive rules (i.e., the participant was required to fail both the WMT's classification scheme and the eye movement measure with the strongest discriminative capacity) were associated with higher specificities than those of the WMT's conventional classification scheme. Overall, the eye-tracker integrated WMT shows initial clinical utility for detecting noncredible cognitive performance. Decreasing costs of eye trackers and enhanced usability will hopefully encourage further research of their utility for detecting noncredible cognitive performance and integration of this novel technology with other stand-alone validity indicators.
Cogstate Brief Battery: Cognition and the feigning of cognitive impairment in chronic pain
Applied Neuropsychology: Adult, Jan 25, 2021
Chronic pain (CP) is often associated with cognitive impairment. The Cogstate Brief Battery (CBB)... more Chronic pain (CP) is often associated with cognitive impairment. The Cogstate Brief Battery (CBB), a computerized assessment battery, has been studied in several neuropsychiatric disorders but not in CP. Since feigning of cognitive impairment is common in CP, the current study aimed to assess the CBB's utility in differentiating CP patients (n = 64) from healthy participants (n = 33), as well as to assess the effect of simulating cognitive impairment by CP patients on performance in the battery. CP outpatients were randomly assigned to one of two groups: (a) Patients performing the CBB to the best of their ability. (b) Patients simulating cognitive impairment. Independent-samples t-tests indicated that three of four CBB tasks successfully differentiated CP patients from matched healthy controls. Additionally, an analysis of covariance (ANCOVA) indicated that CP patients who simulated cognitive impairment performed more poorly in all four CBB tasks, with the detection task having the strongest discrimination capacity. This is the first study to point toward the usefulness and sensitivity of the CBB for assessment of cognition and detection of feigned cognitive impairment in CP. Further studies are required to validate these preliminary findings and assess the CBB's utility in daily clinical practice.
Pain Practice, Jan 11, 2018
Background: Hemiplegic Shoulder Pain (HSP) following stroke significantly affects the individual'... more Background: Hemiplegic Shoulder Pain (HSP) following stroke significantly affects the individual's function and quality of life. The mechanism of HSP is not clearly understood, hence it is unclear why HSP resolves spontaneously or following routine care in some patients, while in others it becomes persistent. The aim was therefore, to study whether HSP is associated with deficient pain modulation. Methods: Thirty post-stroke patients; 16 with HSP and 14 without HSP, and 20 matched controls participated. Pain adaptation and conditioned pain modulation (CPM) were measured as indicators of This article is protected by copyright. All rights reserved. pain modulation, in the affected (hemiplegic) and contralateral shoulder as well as in the affected shin among post-stroke patients, and in comparable body regions among controls. Post-stroke patients also underwent functional and physical evaluation of the shoulder. Results: Pain adaptation was absent among HSP patients, in both the painful shoulder and the affected shin but existed in the two control groups. In addition, the affected shoulder and shin among the HSP group had reduced thermal sensibility compared to the contralateral regions. CPM was similar across groups. Shoulder functional and physical status was similar for the two post-stroke groups. The results suggest that HSP is associated with a lack of pain adaptation, characteristic not only of the painful shoulder but also of the affected side. Although we cannot determine whether lack of pain adaptation precede the HSP or result from it, interventions that enhance descending pain inhibition may improve management and prevent HSP chronification.
Archives of Physical Medicine and Rehabilitation, Jun 1, 2016
This article has been accepted for publication and undergone full peer review but has not been th... more This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record.
Research Square (Research Square), Mar 1, 2023
Background. We aimed to examine the e ciency of xed daily dose enoxaparin (40 mg) thromboprophyla... more Background. We aimed to examine the e ciency of xed daily dose enoxaparin (40 mg) thromboprophylaxis strategy for patients undergoing inpatient rehabilitation. Methods. This was an observational, prospective, cohort study that included 63 hospitalized patients undergoing rehabilitative treatment following sub-acute ischemic stroke (SAIS) or spinal cord injury (SCI), with an indication for thromboprophylaxis. Anti-Xa level measured three hours post-drug administration (following three consecutive days of enoxaparin treatment or more) was utilised to assess in vivo enoxaparin activity. An anti-Xa level between 0.2-0.5 U/ml was considered evidence of effective antithrombotic activity. Results. We found sub-prophylactic levels of anti-Xa (< 0.2 U/ml) in 19% (12/63). Results were within the recommended prophylactic range (0.2-0.5 U/ml) in 73% (46/63) and were supra-prophylactic (> 0.5 U/ml) in 7.9% (5/63) of patients. Anti-Xa levels were found to inversely correlate with patients' weight and renal function as de ned by creatinine clearance (CrCl) (p < 0.05). Conclusions. Our study con rmed that a one-size-ts-all approach for venous thromboembolism (VTE) prophylaxis may be inadequate for rehabilitation patient populations. The e cacy of xed-dose enoxaparin prophylaxis is limited and may be in uenced by renal function and weight. This study suggests that anti-Xa studies and prophylactic enoxaparin dose adjustments should be considered in certain patients, such as those who are underweight, overweight and or have suboptimal renal function. Trial Registration. No. NCT103593291, registered August 2018. Clinicians should be aware that xed dose enoxaparin prophylaxis will only provide adequate therapeutic response for a proportion of rehabilitation patient patients. The e cacy of xed-dose enoxaparin prophylaxis is limited and may be in uenced by renal function and weight. A personalized approach to VTE prophylaxis that includes anit-Xa studies and prophylactic dose adjustments should be considered in certain patients, such as those who are underweight, overweight and or have suboptimal renal function. More studies are required to investigate the interaction of weight and creatinine in order to establish VTE prophylactic dosing guidelines for speci c rehabilitation populations.
Israel Journal of Health Policy Research, Mar 31, 2017
Background: Patient non-attendance is an expensive and persistent problem worldwide with rates be... more Background: Patient non-attendance is an expensive and persistent problem worldwide with rates between 5-39% reported in the literature. The objective of the study was to assess whether there is a higher incidence of non-attendance in a hospital-based pain clinic during the period of the Jewish High Holidays (Rosh-Hashanah to Sukkot) and whether this is further compounded by other factors, such as demographic characteristics and previous visits to the clinic. Methods: Records were taken from the Lowenstein Rehabilitation Hospital appointment scheduling system. Data was gathered from two time-periods: High-Holidays and Control for each year, over a total of 6 years 2008-2013. Non-attendance was analyzed by period, by age, by gender and by previous visits to the clinic. Results: In the entire population studied (666 distinct records), the non-attendance rate was higher during the High-Holidays as compared to the Control period (32 vs. 24.1%; p = 0.030). Non-attendance rates were significantly higher during the Holidays among repeating patients (28.6 vs. 14.8%; p = 0.002) and among women (34.6 vs. 20.7%; p = 0.004). Discussion: Our data suggest that non-attendance is elevated during the High-Holidays in specific groups of patients, namely, repeating patients and women. Despite no direct inquiry into the reasons for non-attendance, we speculate that the elevated well-being and familial support during the holidays contribute to the patients' ability to cope with persistent pain and possibly directly reduce the amount of pain, leading to patients missing their pain clinic appointments. Conclusion: Our results, provided they can be corroborated by larger-scale studies, can assist in scheduling policy adjustments such as avoidance of appointments during the High-holidays for specific patient populations and more rigorous reminder efforts during these times of the year that may lead to reduction in overall non-attendance rates in the pain clinic. Further, our data provide an impetus for further studies of non-attendance patterns among pain clinic patients, in order to acquire a better understanding of the reasons for non-attendance and develop strategies to reduce it and thus contribute to the continuous improvement of the Israeli health systems as well as others worldwide.
Scientometrics, Jun 15, 2016
A journal's impact factor (IF) may be boosted by increasing self-citations. We aimed to determine... more A journal's impact factor (IF) may be boosted by increasing self-citations. We aimed to determine the self-citation rate (SCR) of pediatric journals registered in the Journal Citations Report (JCR), to evaluate the impact of SCR upon the IF and to determine the effect of the SCR of a journal on its IF. We found 117 journals categorized as pediatric journals by the JCR (as of 2013). The median and range of SCR, IF and corrected IF (IF without self-citations) were 9 % (0-30 %), 1.54 (0-6.35) and 1.37 (0-5.87) respectively. No differences were found between general and subspecialty journals in terms of SCR, IF or corrected IF. Spearman's ranked correlation showed that IF was significantly and inversely correlated with SCR (r = -0.28, P = 0.002; R 2 = 0.08). There was a significant difference between IF and corrected IF among all journals (1.74 ± 1.04 vs 1.59 ± 0.98, P \ 0.001). Self-citation is relatively rare in pediatric journals.
Additive Analgesic Effect of Transcranial Direct Current Stimulation Together with Mirror Therapy for the Treatment of Phantom Pain
Pain Medicine, Nov 29, 2020
Objective Current analgesic treatments for phantom pain are not optimal. One well-accepted yet li... more Objective Current analgesic treatments for phantom pain are not optimal. One well-accepted yet limited nonpharmacological option is mirror therapy, which is thought to counterbalance abnormal plasticity. Transcranial direct current stimulation (tDCS) is an emerging approach believed to affect the membrane potential and activity threshold of cortical neurons. tDCS analgesic effectiveness, however, is mild and short, rendering it a noneffective stand-alone treatment. This study aimed to assess if a combination of mirror therapy with tDCS results in a superior analgesic effect as compared with mirror therapy alone in patients suffering from phantom pain due to recent amputation. Design Following ethical approval, eligible patients provided informed consent and were randomly assigned to a study treatment group that continued for 2 weeks (once daily): 1) mirror therapy; 2) mirror therapy and sham tDCS; or 3) mirror therapy and tDCS. Assessments were done before treatment; at the end of treatment weeks 1 and 2; and at 1 week, 1 month, and 3 months following treatment. The primary outcome measure was pain intensity. Secondary measures were derived from the Short Form McGill Pain Questionnaire and the Brief Pain Inventory. Results Thirty patients were recruited, and 29 patients completed the study. Three months following treatment, pain intensity was significantly (P&lt;0.001) reduced in the combined treatment group (reduction of 5.4±3.3 points) compared with the other study arms (mirror therapy, 1.2±1.1; mirror therapy and sham tDCS, 2.7±3.2). All secondary outcome results were in line with these findings. Conclusions Combining tDCS with mirror therapy results in a robust long-lasting analgesic effect. These encouraging findings may contribute to the understanding of the underlying mechanisms of phantom pain.
Consistency of inconsistency in long‐COVID‐19 pain symptoms persistency: A systematic review and meta‐analysis
Pain Practice
IntroductionIndividuals recovering from acute COVID‐19 episodes may continue to suffer from vario... more IntroductionIndividuals recovering from acute COVID‐19 episodes may continue to suffer from various ongoing symptoms, collectively referred to as Long‐COVID. Long‐term pain symptoms are amongst the most common and clinically significant symptoms to be reported for this post‐COVID‐19 syndrome.ObjectivesThis systematic review and meta‐analysis aimed to evaluate the proportions of persisting pain symptoms experienced by individuals past the acute phase of COVID‐19 and to identify their associated functional consequences and inflammatory correlates.MethodsTwo online databases were systematically searched from their inception until 31 March 2022. We searched primary research articles in English, which evaluated individuals after laboratory‐confirmed COVID‐19 acute phase resolution and specifically reported on pain symptoms and their inflammatory and/or functional outcomes.ResultsOf the 611 identified articles, 26 were included, used for data extraction, and assessed for their methodologi...
Background. We aimed to examine the efficiency of fixed daily dose enoxaparin (40 mg) thromboprop... more Background. We aimed to examine the efficiency of fixed daily dose enoxaparin (40 mg) thromboprophylaxis strategy for patients undergoing inpatient rehabilitation. Methods. This was an observational, prospective, cohort study that included 63 hospitalized patients undergoing rehabilitative treatment following sub-acute ischemic stroke (SAIS) or spinal cord injury (SCI), with an indication for thromboprophylaxis. Anti-Xa level measured three hours post-drug administration (following three consecutive days of enoxaparin treatment or more) was utilised to assess in vivo enoxaparin activity. An anti-Xa level between 0.2–0.5 U/ml was considered evidence of effective antithrombotic activity. Results. We found sub-prophylactic levels of anti-Xa (< 0.2 U/ml) in 19% (12/63). Results were within the recommended prophylactic range (0.2–0.5 U/ml) in 73% (46/63) and were supra-prophylactic (> 0.5 U/ml) in 7.9% (5/63) of patients. Anti-Xa levels were found to inversely correlate with patien...
Cogstate Brief Battery: Cognition and the feigning of cognitive impairment in chronic pain
Applied Neuropsychology: Adult
Chronic pain (CP) is often associated with cognitive impairment. The Cogstate Brief Battery (CBB)... more Chronic pain (CP) is often associated with cognitive impairment. The Cogstate Brief Battery (CBB), a computerized assessment battery, has been studied in several neuropsychiatric disorders but not in CP. Since feigning of cognitive impairment is common in CP, the current study aimed to assess the CBB's utility in differentiating CP patients (n = 64) from healthy participants (n = 33), as well as to assess the effect of simulating cognitive impairment by CP patients on performance in the battery. CP outpatients were randomly assigned to one of two groups: (a) Patients performing the CBB to the best of their ability. (b) Patients simulating cognitive impairment. Independent-samples t-tests indicated that three of four CBB tasks successfully differentiated CP patients from matched healthy controls. Additionally, an analysis of covariance (ANCOVA) indicated that CP patients who simulated cognitive impairment performed more poorly in all four CBB tasks, with the detection task having the strongest discrimination capacity. This is the first study to point toward the usefulness and sensitivity of the CBB for assessment of cognition and detection of feigned cognitive impairment in CP. Further studies are required to validate these preliminary findings and assess the CBB's utility in daily clinical practice.
Additive Analgesic Effect of Transcranial Direct Current Stimulation Together with Mirror Therapy for the Treatment of Phantom Pain
Pain Medicine, 2020
Objective Current analgesic treatments for phantom pain are not optimal. One well-accepted yet li... more Objective Current analgesic treatments for phantom pain are not optimal. One well-accepted yet limited nonpharmacological option is mirror therapy, which is thought to counterbalance abnormal plasticity. Transcranial direct current stimulation (tDCS) is an emerging approach believed to affect the membrane potential and activity threshold of cortical neurons. tDCS analgesic effectiveness, however, is mild and short, rendering it a noneffective stand-alone treatment. This study aimed to assess if a combination of mirror therapy with tDCS results in a superior analgesic effect as compared with mirror therapy alone in patients suffering from phantom pain due to recent amputation. Design Following ethical approval, eligible patients provided informed consent and were randomly assigned to a study treatment group that continued for 2 weeks (once daily): 1) mirror therapy; 2) mirror therapy and sham tDCS; or 3) mirror therapy and tDCS. Assessments were done before treatment; at the end of t...
Journal of Stroke and Cerebrovascular Diseases, 2019
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Papers by Motti Ratmansky