Background: Cognitive Muscular TherapyTM (CMT) is an integrated behavioural intervention developed for knee osteoarthritis. CMT teaches patients to reconceptualise the condition, integrates muscle biofeedback and aims to reduce muscle overactivity, both in response to pain and during daily activities. This nested qualitative study explored patient and physiotherapist perspectives and experiences of CMT.Methods: Five physiotherapists were trained to follow a well-defined protocol and then delivered CMT to at least two patients with knee osteoarthritis. Each patient received seven individual clinical sessions and was provided with access to online learning materials incorporating animated videos. Semi-structured interviews took place after delivery/completion of the intervention and data were analysed at the patient and physiotherapist level.Results: Five physiotherapists and five patients were interviewed. All described a process of changing beliefs throughout their engagement with CMT. A framework with three phases was developed to organise the data according to how osteoarthritis was conceptualised and how this changed throughout their interactions with CMT. Firstly, was an identification of pain beliefs to be challenged and recognition of how current beliefs can misalign with daily experiences. Secondly was a process of challenging and changing beliefs, validated through new experiences. Finally, there was an embedding of changed beliefs into self-management to continue with activities.
Conclusion:This study identified a range of psychological changes which occur during exposure to CMT. These changes enabled patients to reconceptualise their condition, develop a new understanding of their body, understand psychological processes, and make sense of their knee pain.
We have examined the structure of the lamellar phase (Lalpha) that coexists with a micellar solution (L1) for a commercial sodium alkyl benzene sulfonate (LAS) mixed with water. The surfactant is a mixture containing C10-C13 alkyl chains, having all positional isomers of the benzene sulfonate group present except the 1-isomer. Unusually for ionic surfactants, the difference in compositions between the coexisting L1 and Lalpha phases is large (L1 = approximately 20 wt % LAS; Lalpha = approximately 65 wt %). The main technique employed was X-ray diffraction, supplemented by optical microscopy and differential scanning calorimetry (DSC). At ambient temperatures, the lamellar phase gives a single diffraction pattern with the main reflection (d) at approximately 32.5 A, whatever the composition. However, above 40 degrees C, the diffraction peak becomes broader and moves to higher d values. At higher temperatures still, several distinct and different diffraction peaks are observed, differing in detail according to composition. The largest d values (approximately 42-4 A) are observed for the lowest LAS concentrations, while the largest number of separate reflections (five) occurs for samples with approximately 44-50% LAS, both at the highest temperatures. Although there are some differences in the data between heating and cooling cycles, the d values return to the original value at low temperature. There are no observable transitions in DSC, nor is there any heterogeneity in the lamellar phase observable by microscopy. The data clearly indicate that there is some lateral separation of the different LAS isomers within the bilayers, which results in the formation of local lamellar regions having different surfactant compositions. This lateral phase separation may arise from the presence of an (electrostatic) attractive interaction, which gives rise to an upper consolute loop within the lamellar phase region of a pure LAS isomer. Similar mechanisms may occur in biological membranes and could be responsible for the occurrence of membrane lipid patches.
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