Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13)

Chronic musculoskeletal pain and its association with cognitive function and sarcopenia in older adults: Characterization and change over three months

Pain, cognitive impairment, and sarcopenia share common risk factors and neurophysiological processes, but studies investigating cognition and sarcopenia in older adults with pain are scarce. This study's main aim was to compare cognition and sarcopenia between older adults with and without chronic pain. A secondary aim was to investigate predictors of cognition and sarcopenia at baseline and 3 months while adjusting for confounders. Participants (67 older adults with pain and 67 asymptomatic older adults) were assessed for sociodemographic and clinical information, pain (number of painful body sites - body chart, pain phenotype - PainDETECT, severity and disability - BPI, pain catastrophizing - PCS, and kinesiophobia - Tampa Scale), cognition (MoCA), sarcopenia (risk of sarcopenia - SARC-F, hand grip strength, and calf circumference) and physical activity (RAPA) at baseline and 3 months after. Older adults with and without pain did not differ in cognition (Mean (95% CI): Pain = 21.47 (20.60; 22.34); Asymptomatic = 21.75 (20.89; 22.61)), but older adults with pain had greater signs of sarcopenia than asymptomatic older adults, including higher risk of sarcopenia (Mean (95%CI): Pain=2.89 (2.41; 3.37); Asymptomatic=0.50 (0.32; 0.68)) and lower hand grip strength (Pain=24.01 (21.74; 26.29); Asymptomatic=27.98 (25.80; 30.16)). No between-group differences were found for calf circumference (Pain=35.03 (34.26; 35.79); Asymptomatic=34.55 (33.86; 35.24)). Pain phenotype (baseline) and kinesiophobia (3 months) contributed to poorer cognition. Kinesiophobia and catastrophizing (baseline), and pain severity (3 months) contributed to sarcopenia. Despite no differences in cognition between older adults with and without pain, pain-related variables contributed to explaining sarcopenia and cognition. PERSPECTIVE: This study compared cognition and sarcopenia between older adults with and without pain and explored the association between pain, cognition, and sarcopenia. Groups were similar for cognition, but older adults with pain showed higher signs of sarcopenia. Kinesiophobia and pain severity partially explained cognition and sarcopenia among those with pain.

The incidence and risk factors of phobic movement disorder after hip fracture internal fixation surgery

OBJECTIVE

This study aims to analyze the cumulative incidence and associated risk factors of phobic movement disorder (PMD) after hip fracture internal fixation surgery, with the goal of optimizing postoperative rehabilitation management and improving the quality of life in elderly patients.

METHODS

A total of 269 patients who underwent hip fracture internal fixation surgery at our hospital from June 2022 to June 2024 were retrospectively included. Clinical data, including age, sex, BMI, underlying diseases, psychological status, postoperative hip joint function, and self-efficacy, were collected. PMD was assessed using the Tampa Scale for Kinesiophobia (TSK), pain acceptance was evaluated using the Chronic Pain Acceptance Questionnaire (CPAQ-8), anxiety and depression status were assessed with the Hospital Anxiety and Depression Scale (HADS), hip joint function was measured using the Harris Hip Score, and self-efficacy was evaluated using the General Self-Efficacy Scale (GSE). Univariate analysis and multivariate binary logistic regression analysis were used to identify independent risk factors for PMD. The variance inflation factor (VIF) was calculated to assess multicollinearity.

RESULTS

The cumulative incidence of PMD was 34.9%. Univariate analysis revealed that BMI ≥ 30 kg/m², low pain acceptance, anxiety and depression, poor postoperative hip joint function, and low self-efficacy were significantly associated with PMD (P < 0.001). Multivariate logistic regression analysis further confirmed that BMI ≥ 30 kg/m² (OR = 4.07, 95% CI [2.39, 6.94]), low pain acceptance (OR = 4.67, 95% CI [2.69, 8.10]), anxiety and depression (OR = 4.14, 95% CI [2.44, 7.04]), poor postoperative hip joint function (OR = 10.61, 95% CI [5.67, 19.87]), and low self-efficacy (OR = 4.19, 95% CI [2.44, 7.18]) were independent risk factors for PMD. All VIF values were < 5, indicating no significant multicollinearity.

CONCLUSION

PMD is common after hip fracture internal fixation surgery and is closely associated with high BMI, low pain acceptance, anxiety and depression, poor postoperative hip joint function, and low self-efficacy. The VIF analysis showed no significant multicollinearity, indicating stable results. Comprehensive interventions targeting high-risk factors may help reduce the incidence of PMD and improve postoperative recovery.

Effects of Global Postural Re-Education Versus Specific Therapeutic Exercises on Pain, Head Posture, and Pain-Related Psychosocial Factors in Women with Chronic Nonspecific Neck Pain: A Randomized Clinical Trial

Background: The aim of this trial is to compare the effects of two types of exercises, Global Postural Re-education versus specific therapeutic exercises on pain perception, pain threshold to pressure, psychosocial factors associated with pain, and craniocervical posture in women with chronic nonspecific neck pain. Methods: This study is a randomized, parallel-group, single-blind clinical trial. Fifty-two women with chronic nonspecific neck pain (two excluded) were recruited and randomly assigned to (n = 25) Global Postural Re-education and (n = 25) specific therapeutic exercises. Interventions were carried out for 4 weeks, two sessions per week, and were combined with a daily home exercise program. Numerical Pain Rating Scale, mechanosensitivity to pressure, kinesiophobia, pain catastrophizing, and craniocervical angle were assessed in two pre-intervention assessments, one week apart, and at 2 and 4 weeks after the start of the intervention. Results: Global Postural Re-education was as effective as specific therapeutic exercises, showing improvements in all variables assessed with significant intra-group differences over time and high effect sizes (ŋp2 > 0.157 for all variables). Conclusions: Global Postural Re-education is as effective as a specific therapeutic exercise program in reducing subjective pain perception, local and remote mechanosensitivity, and short-term pain-related psychosocial factors in women with chronic nonspecific neck pain.

Treating Anxiety-Based Cognitive Distortions Pertaining to Somatic Perception for Better Chronic Pain Outcomes: A Recommendation for Better Practice in the Present Day and the Cyber Age of Medicine

Anxiety-based cognitive distortions pertaining to somatic perception (ABCD-SPs)-primarily catastrophizing, fear avoidance, and kinesiophobia-have been repeatedly linked to worsening chronic, non-cancer pain (CNCP) outcomes of increased disability, amplified pain, ineffective opioid use, and opioid misuse. Several studies have suggested that treating ABCD-SPs can improve pain outcomes, yet identification and targeting of ABCD-SPs are not part of the standard medical pain assessment and treatment plan. Utilizing a narrative review of proposed mechanisms, published patient perspectives, and study correlations connecting these cognitive distortions with CNCP outcomes, an approach for better practice in the delivery of standard medical CNCP care can be deduced and formulated into a Belief and Behavior Action Plan (BBAP) for medical clinicians treating CNCP to implement into initial and maintenance care planning. These recommendations require relatively few resources to implement and have the potential to disseminate more effective CNCP treatment on a large scale now and in the future with the new frontier of cognitive computing in medicine.

The effects of the mirror therapy on shoulder function in patients with breast cancer following surgery: a randomized controlled trial

PURPOSE

Shoulder dysfunction is one of the most bothersome questions for breast cancer survivors. Studies show that mirror therapy can improve shoulder function in patients with a limited shoulder range of motion and shoulder pain. Here, this article reports the results of a randomized controlled trial investigating the effects of the mirror therapy on shoulder function in patients with breast cancer following surgical treatments.

METHODS

Totally, 79 participants were divided to two groups receiving active range-of-motion upper limb exercise based on the mirror therapy or active range-of-motion upper limb exercise respectively for 8 weeks. Shoulder range of motion, Constant-Murley Score, Disabilities of Arm, Shoulder, and Hand Questionnaire, Tampa Scale of Kinesiophobia, Visual analog scale, and grip strength were measured at baseline (T0), 2 weeks (T1), 4 weeks (T2), and 8 weeks (T3). The effects of the intervention on shoulder function were analyzed in generalized estimation equation, from group, time, and the interactions between group and time based on the data from participants who completed at least one post-baseline observation RESULTS: At least one post-baseline observation was performed by 69 participants (n=34 mirror group, n=35 control group). 28(82.35%) participants in the mirror group adhered to the exercise compared to 30(85.71%) in the control group. Generalized estimation equation model showed group had main effects on forward flexion (Waldχ²=6.476, P=0.011), with the Cohen's d=0.54. The effects of the group on abduction, Constant-Murley Score, and Disabilities of Arm, Shoulder, and Hand Questionnaire were significant when fix the effects of the time. At 8 weeks, participants in the mirror group showed an improvement in abduction compared to the control group (P=0.005), the Cohen's d was 0.70. At 8 weeks, participants in the mirror group had a higher Constant-Murley Score than control group (P=0.009), with Cohen's effect size value of d=0.64. The mirror group showed a greater improvement on the Disability of Arm, Shoulder, and Hand Questionnaire than control group at 2 weeks, 4 weeks, and 8 weeks (P≤0.032), but with a weak effect size value of all (r≤0.32). Group had main effects on Tampa Scale of Kinesiophobia (Waldχ²=6.631, P=0.010), with the Cohen's effect size value of d=0.56.

CONCLUSIONS

Mirror therapy improved shoulder flexion, abduction, shoulder function in daily life, and arm function and symptom of the affected shoulder in patients with breast cancer following surgical treatment, while decreasing fear of movement/(re)injury. Mirror configuration needs to be improved in further research to increase its feasibility.

IMPLICATIONS FOR CANCER SURVIVORS

Breast cancer survivors can try mirror therapy as a practical and effective method in shoulder rehabilitation for a promotion on effects.

TRIAL REGISTRATION

ClinicalTrial.gov Identifier: ChiCTR2000033080.

Implementation of back to living well, a community-based program for the tertiary prevention of low back pain: a study protocol

BACKGROUND

The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives.

METHODS

This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application.

DISCUSSION

The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354.

Associations between pain intensity, pain sensitivity, demographics, psychological factors, disability, physical activity, pain phenotype and COVID-19 history in low back pain: An observational study

BACKGROUND AND PURPOSE

Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self-reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID-19 and pain intensity and sensitivity in patients with chronic non-specific low back pain (LBP).

METHODS

This was a cross-sectional secondary analysis with 83 participants with chronic non-specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used.

RESULTS

The model for pain intensity explained 34% of its variance (Adjusted R2 = -0.343, p < 0.001), with depression and anxiety (p = 0.008) and disability (p = 0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2 = 0.344, p < 0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p < 0.05) and 15% of the variance at a distant body site (Adjusted R2 = 0.148, p = 0.018) with sex and BMI reaching statistical significance (p < 0.05).

DISCUSSION

This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI.

Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation

INTRODUCTION

The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention.

MATERIALS AND METHODS

This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences.

RESULTS

The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant.

CONCLUSION

Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation

Introduction

Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia.

Methods

A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13).

Results

Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild.

Conclusions

Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.

The relationship between kinesiophobia severity and clinical parameters in patients with mechanical low back pain

BACKGROUND

Low back pain is an important widespread health problem that can occur at any age, causing serious socioeconomic losses.

OBJECTIVE

The objective of this study is to investigate the relationship between kinesiophobia severity and pain severity, depression, and quality of life in patients with mechanical low back pain.

METHODS

The study sample consisted of 155 patients, of whom 72 were female and 83 were male, aged between 18 and 75 years with mechanical low back pain. Quality of life was assessed with the 36-Item Short Form Health Survey (SF-36), pain intensity with the Visual Analogue Scale (VAS), kinesiophobia with the Tampa Kinesiophobia Scale (TKS), and depression with the Beck Depression Inventory (BDI). Patients were divided into the low (TKS ⩽ 37) and high kinesiophobia (TKS > 37) groups according to the scores they obtained from TKS.

RESULTS

VAS-pain severity and BDI scores were significantly higher in the high kinesiophobia group than in the low kinesiophobia group (p< 0.001). On the other hand, the SF-36 subscale scores were significantly higher in the low kinesiophobia group than in the high kinesiophobia group (p< 0.001). The TKS scores were moderately correlated with VAS-pain severity (r= 0.470; p< 0.001) and BDI scores (r= 0.584; p< 0.001) in the positive direction, and strongly correlated with all sub-parameters of quality of life in the negative direction (p< 0.001).

CONCLUSION

The results indicated that the severity of kinesiophobia in patients with non-inflammatory low back pain is associated with pain severity, depression, and poor quality of life.

Translation and examination of construct validity of the Danish version of the Tampa Scale for Kinesiophobia

OBJECTIVES

This study investigates the construct validity of the Danish Tampa Scale for Kinesiophobia (TSK).

METHODS

The English 17-item scale was translated into Danish adhering to WHO's guidelines. The construct validity of the TSK was examined in a random general population sample of 4,884 18- to 72-year olds with pain within the past 4 weeks. Examination of construct validity adhered to the COSMIN checklist. Structural validity was examined by splitting the sample and conducting exploratory factor analysis on one half and confirmatory factor analysis on the other half. Convergent validity was examined through associations with self-report measures and objective physical performance tests. Reference scores for the TSK were calculated.

RESULTS

After translation, all respondents felt confident that they understood the meaning of the items. All but one found the questionnaire acceptable. The exploratory factor analysis suggested that a 1-factor 13-item version without 4 reversed items resulted in the most consistent fit across subgroups of gender, age, and severe pain report. Five different models of the TSK were tested in the confirmatory factor analysis. While none were excellent fits, both one- and two-factor models of the TSK-13 and TSK-11 were acceptable. Two-factor models marginally outperformed one-factor models on goodness of fit. There was no association between TSK scores and muscular fitness or self-reported physical activity. Cardiorespiratory fitness, self-perceived physical fitness, and self-efficacy had weak correlations with TSK scores. Scores showed modest associations with self-report measures of anxiety, illness worry, pain interference, and daily limitations.

CONCLUSIONS

Based on an overall consideration of results, we recommend using the TSK-13 as a one-dimensional construct for both research and clinical purposes pending further examinations of the TSK in clinical samples. TSK scores from the present study can serve as a standard of reference for levels of Kinesiophobia in the general population.

A single session of action observation therapy versus observing a natural landscape in adults with chronic neck pain - a randomized controlled trial

BACKGROUND

Action observation (AO) has emerged as a potential neurorehabilitation therapy for patients with neck pain (NP), but evidence of its effectiveness is scarce. This study aims to assess the effect of a single session of AO when compared to observing a natural landscape on NP intensity, fear of movement, fear-avoidance beliefs, neck muscles' strength, pressure pain threshold, and tactile acuity.

METHODS

Sixty participants with NP were randomly allocated to the AO group (n = 30) or control group (n = 30). Both groups watched an 11-minute video: the AO group watched a video of a person matched for age and sex performing neck exercises, while the control group watched a video of natural landscapes. Neck pain intensity, fear of movement, fear-avoidance beliefs, tactile acuity, pressure pain thresholds, and neck muscle strength were assessed both at baseline and post-intervention. General linear models of repeated measures (ANCOVA of two factors) were used to explore between-group differences at post-intervention.

RESULTS

There was a significant main effect of time for pain intensity (p = 0.02; η2p = 0.09; within-group mean change and 95% CI: AO=-1.44 (-2.28, -0.59); control=-1.90 (-2.74, -1.06), but no time versus group interaction (p = 0.46). A time versus group significant interaction was found for one out of the six measurement sites of two-point discrimination and the neck flexors strength (p < 0.05) favoring the control group. No other statistically significant differences were found for the remaining variables).

CONCLUSIONS

Results suggest a similar acute benefit for both a single session of AO and observing natural landscapes for promoting hypoalgesia, but no impact on kinesiophobia, fear-avoidance beliefs, or pressure pain thresholds. Also, AO had no positive effect on two-point discrimination and muscle strength. Further research is needed, with longer interventions.

TRIAL REGISTRATION

Clinialtrials.gov (NCT05078489).

Get Your Head in the Game: A Replicated Single-Case Experimental Design Evaluating the Effect of a Novel Virtual Reality Intervention in People With Chronic Low Back Pain

Chronic low back pain (CLBP) is a leading cause of disability worldwide. Contemporary treatment of CLBP is suboptimal, with small-moderate effect sizes and high relapse rates. Virtual reality (VR) is an increasingly accessible technology that can improve adherence to exercise programs through gamification. Using VR to facilitate exercise adherence and enjoyment may improve the clinical outcomes. This study aimed to evaluate the effects of a gamified VR graded activity intervention in people with CLBP, using commercially available and bespoke VR programs. A sequentially replicated, multiple-baseline, randomized AB single-case experimental design was undertaken in 10 people with CLBP. Outcomes were assessed daily and included pain intensity (primary) and pain catastrophizing, pain-related fear, and anxiety/worry (secondary). The effect of the intervention on the primary outcome was evaluated using a multilevel-model, nonparametric randomization test. The VR graded activity intervention resulted in a significant reduction in pain intensity (effect estimate = -1.0, standard error = .27, P < .0011) with 4 participants achieving ≥30% pain reduction (minimum important change). There was a significant effect of the intervention on pain catastrophizing but not pain-related fear or anxiety/worry measures. These findings provide preliminary support for a VR graded activity program to reduce pain in people with CLBP. PERSPECTIVE: This novel, VR graded activity intervention reduced pain intensity and catastrophizing in people with CLBP. The intervention also had high adherence and enjoyment. Given that this intervention involved 2 freely available VR programs, it can be easily translated into clinical practice.

Pain intensity and pain sensitivity are not increased by a single session of high-intensity interval aerobic exercise in individuals with chronic low back pain: A randomized and controlled trial

BACKGROUND

Evidence on the acute impact of high-intensity interval aerobic exercise on pain is scarce. This type of exercise might be perceived as increasing pain intensity and pain sensitivity negatively impacting adherence. More evidence on the acute effects of high-intensity interval aerobic exercise in individuals with low back pain (LBP) is needed.

OBJECTIVES

To compare the acute effects of a single session of high-intensity interval aerobic exercise, continuous moderate-intensity aerobic exercise, and no exercise on pain intensity and pain sensitivity in patients with chronic non-specific LBP.

DESIGN

Randomized controlled trial with three arms.

METHOD

Participants were randomly assigned to one of three groups (i) continuous moderate-intensity aerobic exercise, ii) high-intensity interval aerobic exercise, and iii) no intervention. Measures of pain intensity and pressure pain threshold (PPT) at the lower back and at a distant body site (upper limb) were taken before and after 15 min of exercise.

RESULTS

Sixty-nine participants were randomized. A significant main effect of time was found for pain intensity (p = 0.011; η2p = 0.095) and for PPT at the lower back (p < 0.001; η2p = 0.280), but not a time versus group interaction (p > 0.05). For PPT at the upper limb, no main effect of time or interaction was found (p > 0.5).

CONCLUSIONS

Fifteen minutes of high-intensity interval aerobic exercise does not increase pain intensity or pain sensitivity compared to both moderate-intensity continuous aerobic exercise and no exercise, suggesting that high-intensity interval aerobic exercise can be used in clinical practice and patients reassured that it is unlikely to increase pain.

The effect of in-bed turning and mobilization training given to patients who undergo lumbar disk surgery on postoperative first mobility level: A single-blind, randomized controlled trial

OBJECTIVE

This study was conducted to investigate the effects of mobilization and in-bed turning training given through the role-playing technique to patients to undergo lumbar disk surgery on the patient's pain, strain and dependence level during the first postoperative mobilization (turning, sitting, standing and walking).

METHODS

Patients who would undergo a lumbar disk hernia surgery were recruited from a neurosurgery clinic in Turkey. Patients who met inclusion criteria and agreed to participate (n = 40) in the study were randomly assigned to an intervention group (in-bed turning and mobilization training simulated with the role-playing technique, n = 19) and a control group (usual clinical care, n = 21). The outcome of the study was patient mobility and observer mobility scale scores.

RESULTS

Postoperative scores obtained from the patient mobility and observer mobility scale were lower in the intervention group than the scores of the control group, and the difference between the groups was found statistically significant (p < 0.05). The anxiety levels of the intervention group before (38.00 ± 6.59, p < 0.001) and after mobilization (31.63 ± 4.57, p = 0.032) were significantly lower.

CONCLUSION

The findings indicate training improves patient care outcomes for first postoperative mobility. It is recommended that structured training for in-bed turning and mobilization should be integrated into routine clinical care in the preoperative period for patients to undergo lumbar disk hernia surgery.

PRACTICE IMPLICATIONS

Preoperative training increases the patient's willingness to be mobilized and decreases the anxiety level and perceived pain and strain.

Preoperative and Postoperative Kinesiophobia Influences Postoperative Outcome Measures Following Anterior Cruciate Ligament Reconstruction: A Prospective Study

The anterior cruciate ligament (ACL) is the most injured ligament of the knee, and the treatment of choice is usually ACL reconstruction. Kinesiophobia refers to an irrational and paralyzing fear of movement caused by the feeling of being prone to injury or reinjury. The aim of the present study is to evaluate the relationship between preoperative and postoperative kinesiophobia with postoperative outcomes of ACL-R evaluated through SF-36, ACL-RSI, KOOS, and OKS scores. Included patients all underwent ACL reconstruction. The preoperative TSK-13 questionnaire and six-month postoperative TSK-13, ACL-RSI, SF-36, KOOS, and OKS questionnaires were assessed in included patients. Normal distribution was assessed using the Shapiro-Wilk test. The study included 50 patients who filled out the questionnaires at the 6-month postoperative follow-up. Correlations between preoperative TSK-13 and postoperative outcome measures revealed a low-moderate negative correlation between preoperative TSK-13 and SF-36 PCS at 6-month follow-up. Correlations between postoperative TSK-13 and postoperative outcome measures revealed a high negative correlation between preoperative TSK-13 and ACL-RSI, KOOS Symptoms, KOOS Pain, KOOS ADL, and OKS at 6-month follow-up. Preoperative and postoperative kinesiophobia were found to influence postoperative ACL-R outcomes negatively, more specifically an increase in kinesiophobia showed a statistically significant correlation with worse postoperative SF-36 PCS scores in patients.

The prognostic value of fear-avoidance beliefs on postoperative pain and dysfunction for lumbar degenerative disk disease: a meta-analysis

The study aimed to explore the prognostic value of fear-avoidance beliefs (FABs) on postoperative pain and back-specific function for patients with lumbar degenerative disk disease (LDDD). FABs have been proven to be a predictorof pain and disability for patients with low back pain. However, whether FABs are a predictor of surgical outcomes for LDDD is a matter of debate. PubMed, Cochrane library, EMBASE, and EBSCO were searched for eligible cohort studies or secondary analyses of randomized controlled trials. Fixed-effect meta-analysis models were used to estimate odds ratios (OR) because of absent or low heterogeneity ( I ² < 50%). Subgroup analyses were conducted according to different follow-up durations. Forest plots were used for graphical representation. Six studies with a total of 829 participants were included in the meta-analyses. Risk of bias was high for three studies and moderate for the other three studies. For patients with LDDD, meta-analyses showed that FABs were a predictor of postoperative pain intensity [OR 2.88; 95% confidence interval (CI), 2.76-3.00] and back-specific function (OR 3.13; 95% CI, 3.02-3.24). Patients with FABs are less likely to report improvement in pain (OR 2.56; 95% CI, 1.73-3.86) and function (OR 2.81; 95% CI, 2.57-3.07). In conclusion, FABs were a predictor of postoperative pain and back-specific function for patients with LDDD. This prognostic value is sustained for a long period after surgery (>12 months). Clinicians are advised to initiate targeted interventions for patients with FABs at different stages after surgery. Due to the limited number and low quality of included studies, the results of this meta-analysis should be interpreted with caution.

The Interaction Between Psychosocial Factors and Exercise-Induced Hypoalgesia in Pain-Free Nurses

Purpose

This cross-sectional study aimed to investigate whether psychosocial factors were predictive for exercise-induced hypoalgesia (EIH) in pain-free adults.

Methods

A sample of 38 pain-free nurses with a mean (SD) age of 26 (6) years were included in this study. Participants completed psychosocial questionnaires prior to physical tests. Pressure pain threshold (PPT) was assessed bilaterally at the calves (local), lower back (semi-local) and forearm (remote) before and immediately after a maximal graded cycling exercise test. Separate linear mixed effects models were used to determine change in PPT before and after cycling exercise (EIH). Multiple linear regression for all psychosocial variables and best subset regression was used to identify predictors of EIH at all locations.

Results

The relative mean increase in PPT at the forearm, lumbar, calf, and globally (all sites pooled) was 6.0% (p<0.001), 10.1% (p<0.001), 13.9% (p<0.001), and 10.2% (p=0.013), respectively. Separate best subset multiple linear regression models at the forearm (predictors; Multidimensional Scale of Perceived Social Support (MSPSS) total), lumbar (predictors; MSPSS total, Pain Catastrophizing Scale (PCS) total, Depression Anxiety Stress Scale (DASS) depression), calf (predictors; MSPSS friends, PCS total), and global (predictors; MSPSS friends, PCS total) accounted for 7.5% (p=0.053), 13% (p=0.052), 24% (p=0.003), and 17% (p=0.015) of the variance, respectively.

Conclusion

These findings confirm that cycling exercise produced EIH in young nurses and provided preliminary evidence to support the interaction between perceived social support, pain catastrophizing and EIH. Further investigation is required to better understand psychological and social factors that mediate EIH on a larger sample of adults at high risk of developing chronic musculoskeletal pain.

Less is more: reliability and measurement error for three versions of the Tampa Scale of Kinesiophobia (TSK-11, TSK-13, and TSK-17) in patients with high-impact chronic pain

OBJECTIVES

The Tampa Scale of Kinesiophobia (TSK) is a valid and reliable tool to assess somatic focus and activity avoidance in patients. Currently, the test-retest reliability and measurement error for the Danish version is unknown. The aim of the study was to determine standard error of measurement (SEM) and smallest detectable change (SDC) for three Danish lengths of the TSK in patients with chronic pain.

METHODS

Waiting-list patients (n = 77) completed the TSK-17 twice from home with a test interval between 7 and 14 days. Based on COSMIN recommendations, the test-retest reliability was estimated using intraclass correlation coefficient (ICC2,1), and measurement error in terms of standard error of measurement (SEMagreement) and SDC95% were calculated.

RESULTS

All three versions showed good test-retest reliability with ICC2,1-values (CI95%) of 0.86(0.79-0.91), 0.88(0.82-0.92) and 0.87(0.81-0.92) for the TSK-17, TSK-13, and TSK-11. The SEM-values were 3.08, 2.42 and 2.10 respectively and SDC95%-values were 8.53, 6.71 and 5.82.

CONCLUSIONS

The Danish versions of TSK-11, TSK-13 and TSK-17 showed good to excellent test-retest reliability. SEM and SDC95% values in patients with chronic pain are reported. The TSK-11 did not show systematic bias between test and retest and may be preferred to minimize responder burden.

The quality of physiotherapy and rehabilitation program and the effect of telerehabilitation on patients with knee osteoarthritis

OBJECTIVE

To compare the effects of telerehabilitation vs home-based exercise programs for knee osteoarthritis (KOA).

METHOD

Patients diagnosed with moderate/mild KOA were enrolled in the study and randomized into two groups. The patients in the telerehabilitation group did their exercises via video conference simultaneously, accompanied by a physiotherapist, while the patients in the control group were given a brochure showing how to do the exercises and explaining how to do each exercise. Patients completed 30-s chair stand test (30 CST), Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Rating Scale (NRS), International Physical Activity Questionnaire Short Form (IPAQ-SF), Hospital Anxiety and Depression Scale (HADS), TAMPA Kinesiophobia Scale (TKS), Fatigue Severity Scale (FSS) twice before and after 8-week treatment, and Quality Indicators Questionnaire for Physiotherapy Management of Hip and Knee Osteoarthritis (QUIPA) and Exercise Adherence Rating Scale (EARS) after treatment only. Moreover, the number of painkillers that patients used in the last 15 days was recorded before and after treatment, and patient satisfaction with treatment was questioned after treatment.

RESULTS

Forty-eight patients were included in the study. The mean age of patients was 55.83 ± 6.93 years, and 43 (89.6%) patients were women. No significant differences were determined between groups in terms of baseline characteristics. After the 8-week follow-up, telerehabilitation group demonstrated better 30 CST, IPAQ-SF, KOOS, QUIPA, treatment satisfaction, and total and C subscale of EARS scores increment and greater NRS, HADS, TKS, and FSS score reduction than the control group. It was determined that there was a statistically significant difference between the telerehabilitation and control groups for all of the specified parameters; however, no statistically significant difference was found for the B subscale of EARS.

CONCLUSION

This study indicated that telerehabilitation is superior to self-management. Moreover, through this innovative and population specific web-based approach for KOA, a vast number of patients who have internet access could be reached. Thus, patients with KOA received effective treatment.

A Feasibility Study of Pain Neuroscience Education and Exercise for Community-Dwelling Older Adults With Chronic Pain

BACKGROUND AND PURPOSE

Pain prevalence in older adults is high and greatly impacts their functioning. The primary aim of this study was to determine the feasibility of an intervention consisting of pain neuroscience education (PNE) plus exercise for community-dwelling older adults attending primary care, by assessing recruitment rates (inclusion, refusal, and exclusion rates), adverse events, and acceptability of the intervention. Secondary aims were to establish suitable procedures for delivering the intervention and assess the feasibility of data collection for psychosocial and physical functioning.

METHODS

A mixed-methods feasibility study with 2 groups was conducted. One group received 8 weekly 75-minute sessions of PNE plus exercise (PNE+E) and the other received usual care (UC), which consisted of appointments with the general practitioner. Inclusion, refusal, exclusion, and retention rates, dropouts, and adverse events were assessed. The Brief Pain Inventory, the Pain Catastrophizing Scale, the Tampa Scale, the Geriatric Depression Scale, the World Health Organization Disability Assessment Schedule, the 4-meter walk gait speed test and the 5 times sit-to-stand tests were used for assessment. A focus group interview was conducted with participants from the PNE+E group. Descriptive statistics were used for quantitative data and thematic analysis for qualitative data.

RESULTS AND DISCUSSION

Of 61 participants recruited, 33 (PNE+E = 22; UC = 11) entered the study, and 24 completed the intervention (PNE+E = 15; UC = 9). The inclusion rate was 54%, the refusal rate was 21%, the exclusion rate was 35%, the dropout rate was 32% in the PNE+E and 18% in the UC, and the retention rate was 68% in the PNE+E group and 82% in the UC group. No adverse events were reported and the intervention was well accepted by participants. Data collection for the clinical outcomes was feasible and results suggested higher improvements in the PNE+E group than in the UC group.

CONCLUSION

PNE+E is possible to implement, safe, and well accepted by community-dwelling older adults independent of their education level. This study informs future studies on practical and methodological strategies that should be considered when designing a PNE+E intervention for older adults, such as adapting the language of the PNE to participants, using relatable metaphors, and encouraging written and exercise homework.

Factors associated with self-rated difficulty to descend stairs in persons with knee osteoarthritis

BACKGROUND

Difficulty descending stairs is common in persons with knee osteoarthritis (OA). Clinically, it is important to know if and how this is explained by objectively measured difficulty to descend stairs, muscle weakness, pain, fear of movement, or knee joint status.

OBJECTIVE

To identify the potential of these factors to explain self-reported difficulty descending stairs.

DESIGN

Cross sectional, case-control.

SETTING

Hospital outpatient and physiotherapy clinic.

PARTICIPANTS

Twenty-eight men and women with knee OA (age 62.2 SD 5.9 years) and 31 controls (age 50.0 SD 8.5 years).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Using multivariate statistics, group comparisons were made for lower extremity kinematics (incorporating hip, knee, and ankle angles) and stance time in stair descent and lower extremity muscle strength. Then, a stepwise linear regression analysis was performed within the OA group to explain self-reported difficulties in stair descent where pain, kinesiophobia, radiographic signs, and outcomes that differed from controls for stair-descent kinematics and muscle strength were independent variables.

RESULTS

Multivariate statistics showed that the OA group displayed different all-over lower extremity kinematics (F_8,42 = 2.44 p = .029, η²  = 0.32) and a longer stance time (F_3,50 = 6.46; p = .001, η²  = 0.28) in stair descent and lower muscle strength (F_7,47 = 2.39; p = .035, η²  = 0.26) compared to controls. Regression analysis within the OA group to explain self-rated difficulties to descend stairs showed that the strongest association with kinesiophobia (ß = 0.607, p = .001) that combined with pain last week and radiographic signs explained almost 100% (ß = 0.972). Stair descent kinematics and strength variables that differed between groups did not explain self-rated difficulties to descend stairs.

CONCLUSION

Kinesiophobia and pain rather than stair-descent kinematics and reduced muscle-strength explained self-rated difficulties in stair descent in the OA group.

Psychometric properties of the Persian version of the pain anxiety symptom scale (PASS-20) in chronic non-specific neck pain patients

OBJECTIVES

Pain-related anxiety has been linked to avoidance behaviour, maintenance of pain and disability. A valid and reliable tool is required to evaluate pain-related anxiety among Persian speaking adults with chronic non-specific neck pain (CNSNP). This study aimed to evaluate psychometric properties of the Persian pain anxiety symptom scale-20 (PASS-20) according to the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist in Iranian adults with CNSNP.

METHODS

198 individuals with CNSNP completed the PASS-20. The factorial structure (confirmatory factor analysis (CFA), exploratory factor analysis (EFA)), test-retest reliability (intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC)), internal consistency (Cronbach's alpha), and construct validity (convergent and known-group validity) were assessed. The correlation between PASS-20 with pain catastrophizing scale (PCS), Tampa Scale for Kinesiophobia (TSK), neck disability index (NDI), Beck Depression Inventory (BDI), visual analog scale (VAS) (Spearman's rank correlation) were examined. Known-group validity of PASS-20 was evaluated by comparing the difference between the PASS-20 scores of the known groups based on level of disability, pain intensity and gender using non-parametric tests.

RESULTS

The CFA showed almost the best fit with the original version. The subscales and total score demonstrated good internal consistency (Cronbach's α: 0.70-0.92) and high test-retest reliability (ICC: 0.94-0.97). PASS-20 had significant moderate correlations with PCS, TSK, NDI, VAS and a significant low correlation with BDI. Regarding known-group validity, the total score of Persian PASS-20 was higher in CNSNP with higher levels of pain and disability and in the female gender.

CONCLUSIONS

The Persian PASS-20 has acceptable psychometric properties in adults with CNSNP. The results of the factor analysis supported the four-factor structure comparable to the original version.

ETHICAL COMMITTEE NUMBER

921672004.

Kinesiophobia and its association with treatment choice in individuals with idiopathic scoliosis

BACKGROUND

Previous studies have reported increased kinesiophobia in adults with degenerative scoliosis or adolescents who have undergone spinal surgery. However, little is known about the phenomenon of kinesiophobia among adolescents with idiopathic scoliosis (IS).

OBJECTIVES

The aim of this study was to investigate levels of kinesiophobia and its association with treatment choice in IS.

METHODS

The study included 98 IS patients with a mean age of 14 years and 20 healthy controls. Participants with IS were divided into groups based on treatment conditions, as follows: (1) untreated (n= 33); (2) treated with exercise (n= 32); and (3) treated with a brace (n= 33). Kinesiophobia was measured using the Tampa Scale for Kinesiophobia (TSK). Comparisons were made between four groups.

RESULTS

Untreated participants with IS were found to have greater kinesiophobia than healthy controls (p< 0.001). Participants treated with a brace (p= 0.046) and exercise (p= 0.064) had similar kinesiophobia levels as the healthy control group.

CONCLUSIONS

Kinesiophobia was found to be higher in adolescents with IS compared to healthy peers. Brace or exercise treatment both had a positive impact on kinesiophobia. These findings should be considered when organizing rehabilitation programs to achieve the best results for adolescents with IS.

A Mixed Comparison of Interventions for Kinesiophobia in Individuals With Musculoskeletal Pain: Systematic Review and Network Meta-Analysis

Objective

This systematic review aims to make a mixed comparison of interventions for kinesiophobia and individuals with musculoskeletal pain.

Methods

A comprehensive search strategy was conducted in the database of PubMed, MEDLINE, and Web of Science with the inclusion criteria: (1) randomized controlled design; (2) patients with musculoskeletal pain as participants; (3) treatments protocols of kinesiophobia as interventions or comparisons; (4) the score of Tampa Scale Kinesiophobia (TSK) as outcome measures. A network meta-analysis was used to synthesize the data after checking the model consistency. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Assessment Tool.

Results

Thirty-one studies were included in this review after a comprehensive search strategy with a low risk of bias and good consistency. According to the results of the network meta-analysis, a multi-modal treatment protocol had the highest probability to become the best choice in dealing with kinesiophobia caused by musculoskeletal pain, whereas psychological treatment protocols also showed a potentially positive effect on musculoskeletal pain-induced kinesiophobia.

Conclusion

Multi-modal protocols could be recommended as the preferred option when dealing with kinesiophobia caused by musculoskeletal pain. However, it is still worth mentioning that there are also potentially positive therapeutic effects of psychological interventions. Since the concept of kinesiophobia is based on the fear-avoidance model, the psychological mechanism should be paid enough attention to during treatment.

Registration Number

CRD42021286450.

Evaluation of Kinesiophobia in Survivors of Major Burn Injury

Kinesiophobia, the fear of movement and re-injury, has not been described in burn injury survivors. Physical activity is a key component of burn rehabilitation programs. Yet, not all burn survivors exercise at the recommended level. This is an exploratory study examining the association of the demographics and injury characteristics of burn survivors with a fear of movement. The subjective fear of movement was measured using the Tampa Scale for Kinesiophobia (TSK). The TSK score was compared between several demographics and injury characteristics by performing the independent sample t-test. Sixty-six percent of subjects in our study (n=35), reported high levels of kinesiophobia (score 37 or above). The mean scores of the TSK were greater in males (40.7), non-White (43.0), Hispanic/Latino (41.1), age greater than 50 years (42.3), and total body surface area (TBSA) burn of >15% compared to females (36.9), White (38.5), non-Hispanic/Latino (39.3), age 50 years or less (38.1), and TBSA 15% or less (39.4) respectively. However, with the exception of time post injury, none of the mean differences were statistically significant. Subjects who had sustained a burn injury more than 12 months ago showed higher levels of kinesiophobia than the subjects who were injured within 12 months with a mean difference of 7.35 (p=.01). Thus, this study highlights the importance of (i) continued, long-term follow up for burn survivors, and (ii) appropriate educational and treatment interventions to address any underlying existing, new, or emerging medical issues that may contribute to the fear or avoidance of movement.

The association between work-related physical and psychosocial factors and musculoskeletal disorders in healthcare workers: Moderating role of fear of movement

Objectives

Knowledge is lacking on the interaction between fear of movement (FOM) and work‐related physical and psychosocial factors in the development and persistence of musculoskeletal disorders (MSDs).

Methods

In this cross‐sectional study, 305 healthcare workers from several Belgian hospitals filled out a questionnaire including sociodemographic factors, work‐related factors (social support, autonomy at work, workload, and physical job demands), FOM, and MSDs for different body regions during the past year. Path analysis was performed to investigate (1) the association between the work‐related factors, FOM and MSDs, and (2) the moderating role of FOM on the association between the work‐related factors and MSDs among healthcare workers.

Results

Complaints were most frequently located at the neck–shoulder region (79.5%) and lower back (72.4%). Physical job demands (odds ratio [OR] 2.38 and 95% confidence interval [CI] 1.52–3.74), autonomy at work (OR 1.64 CI [1.07–2.49]) and FOM (OR 1.07 CI [1.01–1.14] and OR 1.12 CI [1.06–1.19]) were positively associated with MSDs. Healthcare workers who experienced high social support at work (OR 0.61 CI [0.39–0.94]) were less likely to have MSDs. Fear of movement interacted negatively with workload (OR 0.92 CI [0.87–0.97]) and autonomy at work (OR 0.94 CI [0.88–1.00]) on MSDs.

Conclusions

Work‐related physical and psychosocial factors as well as FOM are related to MSDs in healthcare workers. FOM is an important moderator of this relationship and should be assessed in healthcare workers in addition to work‐related physical and psychosocial factors to prevent or address MSDs.

The Relationship of Kinesiophobia with Pain and Quality of Life in Idiopathic Scoliosis

STUDY DESIGN

Prospective, multi-centric, cross-sectional study.

OBJECTIVE

To analyze the construct validity of the Tampa Scale of Kinesiophobia (TSK) in a cohort of patients with adolescent idiopathic scoliosis (AIS).

SUMMARY OF THE BACKGROUND DATA

Back pain is not uncommon in AIS. The fear of movement (kinesiophobia) in response to pain is related to back pain. TSK psychometric properties in AIS patients have not been properly analyzed.

METHODS

Patients with AIS and no prior spine surgery were prospectively included. They fulfilled the Spanish version of the TSK-11 questionnaire, a pain intensity numerical rating scale (NRS), refined SRS-22 (SRS-22r), the Hospital Anxiety and Depression Scale (HADS), and item 7 of the Core Outcome Measurement Index (COMI). The sample was split into two groups for the statistical analysis: adolescents and young adults. Cronbach alpha was used to assess internal consistency. Discriminant and concurrent validity were obtained by computing Pearson correlation coefficients between the TSK score and several criterion measures.

RESULTS

A total of 275 patients were included-198 adolescents (mean age of 14.6 yrs) and 77 young adults (mean age of 26.9 yrs). The Cobb of largest curve means were 44.9° and 48.9°, respectively. In the adolescent group, the TSK mean (±SD) was 21.5 (±5.93), with a floor effect of 2.5%. In the adult group, the TSK mean was 24.2 (±6.63), with a floor effect of 3.9%. The ceiling effect was 0% in both groups. Cronbach alphas for the adolescent and adult groups were 0.76 and 0.79, respectively. No correlation was found in any group between the TSK score and the curve magnitude or pattern (Lenke classification). The TSK was significantly correlated with HAD depression and SRS-22r in both groups. However, these correlations were weaker in adolescents. In adults, the TSK also significantly correlates with NRS and work/school absenteeism.

CONCLUSION

The Spanish version of TSK-11 is a reliable and valid instrument to analyze kinesiophobia in AIS. However, the weak correlation between kinesiophobia and pain intensity, disability, and emotional condition in adolescents requires further study.Level of Evidence: 4.

Role of psychosocial factors on the effect of physical activity on physical function in patients after lumbar spine surgery

Background

The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery.

Methods

We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition. Physical activity was measured using a triaxial accelerometer (Actigraph GT3X) at 6-weeks (6wk), 6-months (6M), 12-months (12M) and 24-months (24M) following spine surgery. Physical function (computerized adaptive test domain version of Patient-Reported Outcomes Measurement Information System) and psychosocial factors (pain self-efficacy, depression and fear of movement) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) techniques were utilized to analyze data, and results are represented as standardized regression weights (SRW). Overall SRW were computed across five imputed datasets to account for missing data. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed [(SRW for effect of activity on psychosocial factor X SRW for effect of psychosocial factor on function) ÷ SRW for effect of activity on function]. Each SEM model was tested for model fit by assessing established fit indexes.

Results

The overall effect of steps per day on physical function (SRW ranged from 0.08 to 0.19, p<0.05) was stronger compared to the overall effect of physical function on steps per day (SRW ranged from non-existent to 0.14, p<0.01 to 0.3). The effect of steps per day on physical function and function on steps per day remained consistent after accounting for psychosocial factors in each of the mediation models. Depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of steps per day at 6wk on physical function at 12M, respectively. Pain self-efficacy was not a statistically significant mediator.

Conclusions

The findings of this study suggest that the relationship between physical activity and physical function is stronger than the relationship of function to activity. However, future research is needed to examine whether promoting physical activity during the early postoperative period may result in improvement of long-term physical function. Since depression and fear of movement had a very small mediating effect, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04622-w.

Effects of Global Postural Reeducation versus Specific Therapeutic Neck Exercises on Pain, Disability, Postural Control, and Neuromuscular Efficiency in Women with Chronic Nonspecific Neck Pain: Study Protocol for a Randomized, Parallel, Clinical Trial

Background: Chronic nonspecific neck pain is the most frequent form of neck pain. It is more prevalent in women, and a costly public health issue. It is commonly associated with biomechanical, functional, proprioceptive, and postural impairments. The aim of this trial is to compare the effects of global postural exercises versus specific therapeutic exercises on neck pain, disability, mobility, pressure pain threshold, kinesiophobia, pain catastrophizing, postural control, and neuromuscular efficiency in women with chronic nonspecific neck pain. Methods and analysis: This study is a randomized, parallel-group and single blinded clinical trial. Sixty-two women with nonspecific chronic neck pain were recruited from the community of Guarda, Portugal, and randomly assigned to one of two intervention groups: (1) global postural reeducation (GPR group), (2) specific therapeutic exercises (STE group). The intervention was carried out over 4 weeks, with two sessions per week (eight sessions), and applied by a physiotherapist and paired with a daily individual at-home-exercise program. Primary outcomes are neck pain intensity and disability (Numerical Pain Rating Scale, Neck Disability Index). Secondary outcomes are cervical mobility and pressure pain threshold (CROM, algometry), attitude to pain (kinesiophobia, pain catastrophizing), standing postural control (Center of Pressure (COP) displacements), and neuromuscular efficiency (electromyography). There are four points of evaluation where the outcomes were assessed twice before the intervention, 1 week apart, and the two post-intervention assessments will be carried out after four and eight sessions. The objective was to increase scientific knowledge of different exercise modalities, such as global postural reeducation, in musculoskeletal disorders. Trial registration: ClínicalTrials.gov (NCT04402463), prospectively registered (data 22 May 2020).

Who makes it all the way? Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT

PURPOSE

To compare sociodemographic, health- and exercise-related characteristics of participants vs. decliners, and completers vs. drop-outs, in an exercise intervention trial during cancer treatment.

METHODS

Patients with newly diagnosed breast, prostate, or colorectal cancer were invited to participate in a 6-month exercise intervention. Background data for all respondents (n = 2051) were collected at baseline by questionnaire and medical records. Additional data were collected using an extended questionnaire, physical activity monitors, and fitness testing for trial participants (n = 577). Moreover, a sub-group of decliners (n = 436) consented to additional data collection by an extended questionnaire . Data were analyzed for between-group differences using independent t-tests and chi²-tests.

RESULTS

Trial participants were younger (59 ± 12yrs vs. 64 ± 11yrs, p < .001), more likely to be women (80% vs. 75%, p = .012), and scheduled for chemotherapy treatment (54% vs. 34%, p < .001), compared to decliners (n = 1391). A greater proportion had university education (60% vs 40%, p < .001), reported higher anxiety and fatigue, higher exercise self-efficacy and outcome expectations, and less kinesiophobia at baseline compared to decliners. A greater proportion of trial participants were classified as 'not physically active' at baseline; however, within the group who participated, being "physically active" at baseline was associated with trial completion. Completers (n = 410) also reported less kinesiophobia than drop-outs (n = 167).

CONCLUSION

The recruitment procedures used in comprehensive oncology exercise trials should specifically address barriers for participation among men, patients without university education and older patients. Individualized efforts should be made to enroll patients with low exercise self-efficacy and low outcome expectations of exercise. To retain participants in an ongoing exercise intervention, extra support may be needed for patients with kinesiophobia and those lacking health-enhancing exercise habits at baseline.

Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain-Results from a Preliminary Study

OBJECTIVE

To describe differences between patients with chronic, non-cancer pain (CNCP) who were successfully able to cease full mu agonist chronic opioid analgesic therapy (COAT), and those who exhibited refractory COAT reliance, among those who participated in a multidisciplinary program designed for COAT cessation.

DESIGN

A retrospective review of electronic medical records (EMR) data was organized for preliminary analysis.

SETTING

A multicenter private practice specializing in CNCP, which received patient referrals from the surrounding geographical area of primary and specialty care offices in Northern California.

SUBJECTS

Data from 109 patients with CNCP who participated in a multidisciplinary program to cease COAT between the dates of October 2017 to December 2019 were examined.

METHODS

EMR data, pre-COAT cessation, of oral morphine milligram equivalence (MME) and validated questionnaire responses assessing anxiety and fear-based beliefs and behavior, as well as opioid misuse, were extracted and compared between those who successfully ceased COAT and those who did not.

RESULTS

Patients who were unsuccessful at COAT cessation reported significantly higher Fear Avoidance Beliefs Questionnaire (FAB) scores. No significant differences were found based on incoming MME amounts, Current Opioid Misuse Measure (COMM) or Tampa Scale of Kinesiophobia (TSK) scores. Pain Catastrophizing Scale (PCS) scores showed a split pattern with unclear significance.

CONCLUSIONS

Results suggest that fear avoidance beliefs and behavior, as measured by the FAB, play a significant role in refractory COAT reliance for patients with CNCP.

Functional Ability Classification Based on Moderate and Severe Kinesophobia and Demoralization Scores in Degenerative Spine Patients

STUDY DESIGN

A prospective cohort study.

OBJECTIVE

To assess the relationship of fear avoidance and demoralization on gait and balance and determine a threshold score for the Tampa Scale for Kinesophobia (TSK) and the Demoralization Scale (DS) that identifies spine patients with gait and balance dysfunction amplified by underlying psychological factors.

SUMMARY OF BACKGROUND DATA

Fear avoidance and demoralization are crucial components of mental health that impact the outcomes in spine surgery. However, interpreting their effect on patient function remains challenging. Further establishing this correlation and identifying a threshold of severity can aid in identifying patients in whom a portion of their altered gait and balance may be amplified by underlying psychologic distress.

METHODS

Four hundred five symptomatic spine patients were given the TSK and DS questionnaires. Patient's gait and balance were tested with a human motion capture system. A TSK score of 41 and a DS score of 30 were chosen as thresholds to classify moderate versus severe dysfunction based on literature and statistical analysis.

RESULTS

Higher TSK and DS scores were correlated with worse walking speed (P < 0.001), longer stride time (P = 0.001), decreased stride length (P < 0.048), and wider step width (<0.001) during gait as well as increased sway across planes (P = 0.001) during standing balance. When classified by TSK scores >41, patients with more severe fear avoidance had slower walking speed (P < 0.001), longer stride time (P = 0.001), shorter stride length (P = 0.004), increased step width (P < 0.001), and increased sway (P = 0.001) compared with their lower scoring counterparts. Similarly, patients with DS > 30 had slower walking speed (P = 0.012), longer stride time (P = 0.022), and increased sway (P = 0.003) compared with their lower scoring counterparts.

CONCLUSION

This study demonstrates that fear avoidance and demoralization directly correlate with worsening gait and balance. Furthermore, patients with TSK > 41 and DS > 30 have more underlying psychological factors that contribute to significantly worse function compared with lower scoring peers. Understanding this relationship and using these guidelines can help identify and treat patients whose gait dysfunction may be amplified by psychologic distress.Level of Evidence: 3.

Back to living well: community-based management of low back pain: a feasibility study

BACKGROUND

Low back pain (LBP) is a long-term health condition with an unpredictable pattern of symptomatic episodes, remission, and recurrence. Recently published systematic reviews suggest that exercise is the most effective intervention for preventing recurrences of LBP in persons that have recovered. Similar programs may also be effective in preventing flare-ups in persistent LBP. The aim of this study was to test the feasibility of the Back to Living Well program (Physical activity + Education + Self-management) developed to prevent recurrence or flare-ups of LBP. The study evaluated feasibility in terms of recruitment rate, adherence, satisfaction with the exercise and education sessions, and the data collection procedures. We also aimed to evaluate barriers and facilitators to the engagement in the program.

METHODS

Seventeen participants with non-specific LBP recently discharged from care from physiotherapy, chiropractors or physician care (< 3 months) were referred to the study by health care providers or community advertisements between December 2018 and February 2019. Participants underwent a 12-week (1 session/week) individualized, group-based exercise in the community and 4 sessions (30 min each) of education. All participants completed an action plan weekly for 12 weeks and wore an activity monitor for 6 months. All participants responded to weekly pain measures and completed study questionnaires at baseline, 3- and 6-months. Feasibility outcomes included recruitment, attrition rates and satisfaction. At the end of the intervention, participants completed an end-of-program survey.

RESULTS

Twenty-nine participants were screened for eligibility; 20 were deemed eligible, while 17 were included over a 2-month period meeting our feasibility targets. In total, 16 completed follow-up study questionnaires at 3 months, and 15 completed the 6-month follow-up. Fourteen participants responded to weekly messages, while 3 participants reported not having a mobile device or Internet access. In total, 15 participants responded to our end-of-program survey. Average age was 54.9 (11.7); 9 were female (53%), and the mean duration of LBP was 62.9 (69.7) months. All satisfaction responses in relation to the exercise program, education program and data collection procedures reached our threshold of 70% out of 100%. Reported barriers to engagement in the program included fear of injury, lack of motivation and travel. Facilitators included proximity to home, low cost, flexible schedule and friendly location.

CONCLUSION

The results show the program is feasible in terms of recruitment, low attrition, and patient satisfaction. Participants highlighted the excellent, relevant education program and the positive, personalized exercise. Future studies should evaluate the effectiveness of this intervention within a fully powered randomized controlled trial.

TRIAL REGISTRATION

NCT03328689.

Which Exercise for Low Back Pain? (WELBack) trial predicting response to exercise treatments for patients with low back pain: a validation randomised controlled trial protocol

INTRODUCTION

Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on individual factors, then the effects of treatment could be greater. A recently published study provided evidence of better outcomes when patients are matched to the appropriate exercise type. The study demonstrated that a 15-item questionnaire, the Lumbar Spine Instability Questionnaire (LSIQ), could identify patients who responded best to one of the two exercise approaches for LBP (motor control and graded activity). The primary aim of the current study isill be to evaluate whether preidentified baseline characteristics, including the LSIQ, can modify the response to two of the most common exercise therapies for non-specific LBP. Secondary aims include an economic evaluations with a cost-effectiveness analysis.

METHODS AND ANALYSIS

Participants (n=414) will be recruited by primary care professionals and randomised (1:1) to receive motor control exercises or graded activity. Participants will undergo 12 sessions of exercise therapy over an 8-week period. The primary outcome will be physical function at 2 months using the Oswestry Disability Index. Secondary outcomes will be pain intensity, function and quality of life measured at 2, 6 and 12 months. Potential effect modifiers will be the LSIQ, self-efficacy, coping strategies, kinesiophobia and measures of nociceptive pain and central sensitisation. We will construct linear mixed models with terms for participants (fixed), treatment group, predictor (potential effect modifier), treatment group×predictor (potential effect modifier), physiotherapists, treatment group×physiotherapists and baseline score for the dependent variable.

ETHICS AND DISSEMINATION

This study received ethics approval from the Hamilton Integrate Research Ethics Board. Results will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04283409.

Cone of economy classification: evolution, concept of stability, severity level, and correlation to patient-reported outcome scores

STUDY DESIGN

A prospective cohort study OBJECTIVE: To determine a classification system for cone of economy (CoE) measurements that defines clinically significant changes in altered balance and to assess if the CoE measurements directly impacts patients reported outcome measures (PROMs). Preoperative functional data is a crucial component of determining patient disability and prognosis. The CoE has been theorized to be the foundation of biomechanical changes that leads to increased energy expenditure and disability in spine patients. PROMs have been developed to quantify the level of debilitation in spine patients but have various limitations.

METHODS

A total of 423 symptomatic adult patients with spine pathology completed a series of PROMs preoperatively including VAS, ODI, Tampa Scale for Kinesiophobia (TSK), Fear and Avoidance Beliefs Questionnaire (FABQ), and Demoralization (DS). Functional balance was tested in this group using a full-body reflective marker set to measure head and center of mass (CoM) sway.

RESULTS

PROMs scores were correlated with the magnitude of the CoE measurements. Patients were separated by the following proposed classification: CoM coronal sway > 1.5 cm, CoM sagittal sway > 3.0 cm, CoM total sway > 30.0 cm, head coronal sway > 3.0 cm, head sagittal sway > 6.0 cm, and head total sway > 60.0 cm. Significant differences were noted in the ODI (< 0.001), FABQ physical activity (< 0.001-0.009), DS (< 0.001-0.023), and TSK (< 0.001-0.032) across almost all planes of motion for both CoM and head sway. The ODI was most sensitive to the difference between groups across CoM and head sway planes with a mean ODI of 47.5-49.5 (p < 0.001) in the severe group versus 36.6-39.3 (p < 0.001) in the moderate group.

CONCLUSIONS

By classifying CoE measurements by the cutoffs proposed, clinically significant alterations in balance can be quantified. Furthermore, this study demonstrates that across spinal pathology, higher magnitude CoE and range of sway measurements correlate with worsening PROMs. The Haddas' CoE classification system in this study helps to identify patients that may benefit from surgery and guide their postoperative prognosis.

Bouncing back after lumbar spine surgery: early postoperative resilience is associated with 12-month physical function, pain interference, social participation, and disability

BACKGROUND CONTEXT

Positive psychosocial factors early after surgery, such as resilience and self-efficacy, may be important characteristics for informing individualized postoperative care.

PURPOSE

To examine the association of early postoperative resilience and self-efficacy on 12-month physical function, pain interference, social participation, disability, pain intensity, and physical activity after lumbar spine surgery.

STUDY DESIGN/SETTING

Pooled secondary analysis of prospectively collected trial data from two academic medical centers.

PATIENT SAMPLE

Two hundred and forty-eight patients who underwent laminectomy with or without fusion for a degenerative lumbar condition.

OUTCOME MEASURES

Physical function, pain inference, and social participation (ability to participate in social roles and activities) were measured using the Patient Reported Outcomes Measurement Information System. The Oswestry Disability Index, Numeric Rating Scale, and accelerometer activity counts were used to measure disability, pain intensity, and physical activity, respectively.

METHODS

Participants completed validated outcome questionnaires at 6 weeks (baseline) and 12 months after surgery. Baseline positive psychosocial factors included resilience (Brief Resilience Scale) and self-efficacy (Pain Self-Efficacy Questionnaire). Multivariable linear regression analyses were used to assess the associations between early postoperative psychosocial factors and 12-month outcomes adjusting for age, sex, study site, randomized group, fusion status, fear of movement (Tampa Scale for Kinesiophobia), and outcome score at baseline. This study was funded by Patient-Centered Outcomes Research Institute and Foundation for Physical Therapy Research. There are no conflicts of interest.

RESULTS

Resilience at 6 weeks after surgery was associated with 12-month physical function (unstandardized beta=1.85 [95% confidence interval [CI]: 0.29; 3.40]), pain interference (unstandardized beta=-1.80 [95% CI: -3.48; -0.12]), social participation (unstandardized beta=2.69 [95% CI: 0.97; 4.41]), and disability (unstandardized beta=-3.03 [95% CI: -6.04; -0.02]). Self-efficacy was associated with 12-month disability (unstandardized beta=-0.21 [95% CI: -0.37; -0.04].

CONCLUSIONS

Postoperative resilience and pain self-efficacy were associated with improved 12-month patient-reported outcomes after spine surgery. Future work should consider how early postoperative screening for positive psychosocial characteristics can enhance risk stratification and targeted rehabilitation management in patients undergoing spine surgery.

Effect of Multi-Modal Therapies for Kinesiophobia Caused by Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to identify the effect of multi-modal therapies that combined physical and psychological therapies for kinesiophobia caused by musculoskeletal disorders compared with uni-modal therapy of only phycological therapy or psychological therapy. The search terms and their logical connector were as following: (1) “kinesiophobia” at the title or abstract; and (2) “randomized” OR “randomized” at title or abstract; not (3) ”design” OR “protocol” at the title. They were typed into the databases of Medline (EBSCO), PubMed, and Ovid, following the different input rules of these databases. The eligibility criteria were: (1) Adults with musculoskeletal disorders or illness as patients; (2) Multi-modal therapies combined physical and psychological therapy as interventions; (3) Uni-modal therapy of only physical or psychological therapy as a comparison; (4) The scores of the 17-items version of the Tampa Scale of Kinesiophobia as the outcome; (5) Randomized controlled trials as study design. As a result, 12 studies were included with a statistically significant polled effect of 6.99 (95% CI 4.59 to 9.38). Despite a large heterogeneity within studies, multi-modal therapies might be more effective in reducing kinesiophobia than the unimodal of only physical or psychological therapy both in the total and subdivision analysis. The effect might decrease with age. What’s more, this review’s mathematical methods were feasible by taking test-retest reliability of the Tampa Scale of Kinesiophobia into consideration.

Factors related to fear of movement after acute cardiac hospitalization

Background

Fear of movement (kinesiophobia) after an acute cardiac hospitalization (ACH) is associated with reduced physical activity (PA) and non-adherence to cardiac rehabilitation (CR).

Purpose

To investigate which factors are related to kinesiophobia after an ACH, and to investigate the support needs of patients in relation to PA and the uptake of CR.

Methods

Patients were included 2–3 weeks after hospital discharge for ACH. The level of kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-NL Heart). A score of > 28 points is defined as ‘high levels of kinesiophobia’ (HighKin) and ≤ 28 as ‘low levels of kinesiophobia’ (LowKin). Patients were invited to participate in a semi-structured interview with the fear avoidance model (FAM) as theoretical framework. Interviews continued until data-saturation was reached. All interviews were analyzed with an inductive content analysis.

Results

Data-saturation was reached after 16 participants (median age 65) were included in this study after an ACH. HighKin were diagnosed in seven patients. HighKin were related to: (1) disrupted healthcare process, (2) negative beliefs and attitudes concerning PA. LowKin were related to: (1) understanding the necessity of PA, (2) experiencing social support. Patients formulated ‘tailored information and support from a health care provider’ as most important need after hospital discharge.

Conclusion

This study adds to the knowledge of factors related to kinesiophobia and its influence on PA and the uptake of CR. These findings should be further validated in future studies and can be used to develop early interventions to prevent or treat kinesiophobia and stimulate the uptake of CR.

The Japanese version of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale has acceptable validity and reliability

PURPOSE

The anterior cruciate ligament-return to sports after injury (ACL-RSI) scale assesses the psychological impact of returning to sports (also referred to as psychological readiness) after ACL reconstruction. The aim of this study was to evaluate important measurement properties of the Japanese version of ACL-RSI scale.

METHODS

Ninety-three participants who underwent ACL reconstruction filled out the Japanese version of ACL-RSI scale, the Tampa scale for kinesiophobia (TSK), the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF), and Knee injury and Osteoarthritis Outcome Score (KOOS). To assess test re-test reliability, 50 of the 93 participants re-answered the Japanese version of ACL-RSI scale within 10 days. Floor and ceiling effects, internal consistency, construct validity, and reliability of the Japanese version of ACL-RSI scale were analysed.

RESULTS

There were no floor and ceiling effects. The Japanese version of ACL-RSI scale showed good internal consistency (Cronbach's alpha = 0.912). It was positively correlated with total points of IKDC-SKF and the Lysholm score, and with the all sub-categories of the KOOS, and it was negatively correlated with the TSK. Reliability of the Japanese version of ACL-RSI scale was satisfactory.

CONCLUSION

The Japanese version of ACL-RSI scale has acceptable measurement properties. It can be a useful for evaluation of psychological readiness for return to sports in Japanese athletes who undergo primary ACL reconstruction. Information provided by the Japanese version of the ACL-RSI scale may also help to identify athletes who find return to sport a challenge, and guide conversations regarding treatment and rehabilitation plans.

LEVEL OF EVIDENCE

II.

Effect of information and exercise programmes after lumbar disc surgery: A randomized controlled trial

OBJECTIVE

The aim of this study was to compare two physiotherapy interventions following lumber disc surgery regarding effect on pain, functioning and fear of movement.

METHODS

This study is a prospective randomized controlled study. When admitted to hospital for first time lumbar disc surgery, the participants were randomized to one of two post-operative intervention groups: one group received information only and the other exercise in combination with information. Outcomes were collected at baseline, 6-8 weeks and 12-months post-surgery. The primary outcome was to record changes in back/hip pain and leg pain. Secondary outcomes were evaluation of changes in function, fear-avoidance beliefs and kinesiophobia.

RESULTS

Seventy patients completed the study and were included in the analysis, of which 37 were randomized to the group receiving information only and the remaining 33 receiving both exercise and information. For primary outcomes, at 12 months postoperatively, the group receiving both exercise and information had significantly lower leg pain compared with those receiving only information (p < .033). For secondary outcomes, at 12 months postoperatively, a significant difference (p < .027) was detected for function, which favoured those that received both exercise and information. There was no significant difference in the results for the other secondary outcomes. Both groups showed clinically important changes in relation to pain and function from baseline to 12 months. The effect of treatment showed a statistically significant difference in favour of exercise and information, but the difference was not clinically relevant.

CONCLUSION

Exercise in combination with information reduced leg pain and improved function, which was statistically more evident over a period of time. Postoperative physiotherapy after lumbar disc surgery could include exercises in addition to information, but perhaps not for all patients, as both groups improved, and the difference between the two groups was not clinically relevant.

Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care

BACKGROUND

Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties.

METHODS

This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach's α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI).

RESULTS

This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414.

CONCLUSION

This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.

Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care

BACKGROUND

Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties.

METHODS

This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach's α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI).

RESULTS

This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414.

CONCLUSION

This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.

Chronic Pain Patients' Kinesiophobia and Catastrophizing are Associated with Activity Intensity at Different Times of the Day

Purpose

To examine the relationship between baseline kinesiophobia and baseline pain catastrophizing with the 4-day average activity intensity at different times of the day while accounting for different wake and sleep-onset times in chronic pain patients.

Methods

Twenty-one participants suffering from idiopathic chronic pain completed baseline questionnaires about kinesiophobia, catastrophizing, disability, depression, and pain. We measured the participants' activity using accelerometers and calculated activity intensity in the morning, afternoon, and evening. We performed a 2-way repeated measures ANOVA to compare activity levels at different times of the day, and multiple linear regressions.

Results

Baseline kinesiophobia was significantly associated with 4-day average evening light activity and sedentary activity at all time periods while baseline catastrophizing was significantly associated with increased 4-day average light activity in the evening and more moderate to vigorous activity in the morning. Our participants engaged in more light activity on average than sedentary activity, and very little moderate-vigorous activity. Participants were most active in the afternoon.

Conclusion

Baseline kinesiophobia and baseline catastrophizing were not associated with the 4-day average total daily activity; however, they were associated with 4-day average activity intensities at different times throughout the day. Segmenting daily activity into morning, afternoon, evening may influence the relationship between daily activity, and kinesiophobia and pain catastrophizing. Individuals with chronic pain are less sedentary than previously thought which may affect future interventions.

Safety and feasibility of an early telephone-supported home exercise program after anterior cervical discectomy and fusion: a case series

Objective: To describe the safety, feasibility, and preliminary outcomes of an early telephone-supported home exercise program (HEP) performed within the first 6 weeks after anterior cervical discectomy and fusion (ACDF) surgery.Methods: Eight patients (mean ± SD age = 53.4 ± 14.9 years, 5 females) were enrolled in this case series. Immediately after surgery, patients began a 6-week HEP including daily walking, deep breathing, distraction techniques, and cervical and upper body exercises. The HEP was supported by weekly telephone calls by a physical therapist. Safety for performing early exercise was examined with radiographic imaging at 6 months. Adverse events were assessed through weekly calls with a physical therapist. HEP adherence and acceptability data were obtained by patient self-report. Clinical measures were assessed preoperatively, at 6 weeks and at 6 months, and included the Neck Disability Index, Numeric Rating Scale for pain, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, and accelerometry for physical activity.Results: Early radiographic imaging showed no signs of nonunion at 6 months. There were no reports of serious adverse events. At 6 months, all patients reported clinically significant changes in pain catastrophizing. Seven (88%) patients had clinically significant changes in disability and arm pain, six (75%) patients for neck pain and pain self-efficacy, and five (53%) patients for fear of movement. Only three (43%) of seven patients showed increased physical activity at 6 months.Conclusion: Based on this small case series, an early telephone-supported HEP appears safe for patients, feasible to implement, and promising for clinical benefits.