Multivariate Analysis of Risk Factors Predisposing to Kinesiophobia in Persons With Chronic Low Back and Neck Pain

Understanding the role of positive body image in chronic low back pain: A path-analytic model

Chronic low back pain (CLBP) is a prevalent and disabling condition that significantly affects individuals' quality of life. Recently, the cognitivebehavioral model of body image and chronic pain has emphasized the influence of body image on the course of this condition. Nevertheless, the role of positive body image constructs, such as body appreciation and appreciation of body functionality, in CLBP remains underexplored. This study examined associations between body appreciation and functionality appreciation with pain intensity and interference in individuals with CLBP, with pain catastrophizing and kinesiophobia as potential mediators. A sample of 99 Spanish adults suffering from CLBP completed self-report measures. The path-analytic model showed an acceptable fit. While body appreciation showed no significant associations, functionality appreciation was negatively associated with pain catastrophizing, which in turn was positively associated with both pain intensity and interference. Indirect associations revealed that pain catastrophizing mediated the relationships between functionality appreciation and both pain outcomes. These results suggest the potential role of functionality appreciation in relation to pain outcomes in CLBP, with pain catastrophizing mediating these associations, highlighting the need for research examining whether targeting positive body image constructs, especially functionality appreciation, in pain management interventions could influence CLBP outcomes.

Fear of movement in patients after lumbar spine fusion and an analysis of factors: a cross-sectional study

BACKGROUND

Numerous studies have confirmed the significant benefits of exercise rehabilitation in both preoperative and postoperative treatment of lumbar disc herniation. However, there is a prevalent fear or avoidance of exercise among patients with chronic low back pain prior to surgery, while research on exercise fear after lumbar fusion remains insufficient. This study aims to investigate the incidence and severity of exercise fear in patients with chronic low back pain and leg pain following lumbar fusion surgery, as well as analyze its underlying mechanism and associated risk factors.

METHODS

A cross-sectional study was conducted on patients undergoing posterior lumbar fusion for lumbar disc herniation between May 2023 and January 2024. The Tampa Motor Phobia Scale (TSK-17) was utilized to assess motor fear among participants. Additionally, clinical and imaging risk factors were analyzed through multivariate regression analysis to determine relevant influencing factors.

RESULTS

Following strict inclusion and exclusion criteria, a total of 178 patients who underwent posterior lumbar fusion were included in this study, comprising 104 males (58.4%). Kinesiophobia was defined as a TSK-17 score ≥ 37, which identified 65.2% (116/178) of the screened patients exhibiting motor phobia. Multivariate regression analysis revealed that motor phobia was strongly associated with age, higher levels of pain intensity, elevated Beck Depression Inventory (BDI) scores, lower General Self-Efficacy Scale (GSES) scores, increased number of surgical levels involved during operation, greater amount of postoperative incision drainage, higher degree of nerve root compression observed on preoperative lumbar MRI scans, as well as smaller area occupied by the paravertebral muscles in the lumbar region.

CONCLUSION

This study has identified a significantly high incidence of postoperative exercise fear in patients undergoing posterior lumbar fusion, along with potential risk factors. Therefore, it is crucial for clinicians to closely evaluate and monitor these patients in order to develop appropriate strategies for postoperative exercise rehabilitation.

The effect of kinesiophobia on clinical parameters in sacroiliac joint dysfunction: A cross-sectional study

BackgroundSacroiliac joint dysfunction (SJD) is often recognized as a contributing factor to chronic low back pain. Nevertheless, studies evaluating the connection between SJD and kinesiophobia are currently lacking.ObjectiveIt aims to examine the occurrence of kinesiophobia and its impact on emotional well-being, spinal flexibility, disability, quality of life and pain in individuals with SJD.MethodsThe study assessed the occurrence of kinesiophobia and its clinical effects in 55 patients with SJD. The Tampa Scale of Kinesiophobia (TSK) was utilized to measure kinesiophobia. Clinical parameters were evaluated using Oswestry Disability Index (ODI), 36-Item Short Form Survey (SF-36), Hospital Anxiety and Depression Scale (HADS), finger-to-floor distance test (FTF), Visual Analogue Scale (VAS) and the modified Schober Test (MST).ResultsParticipants were grouped based on their TSK scores. SJD symptom duration was longer in patients with kinesiophobia compared to those without (p = 0.002) and a positive relationship was identified between symptom duration and TSK scores (p < 0.001). Higher mean VAS score (p = 0.047), ODI (p = 0.003) and HADS-Depression sub-scores (p = 0.024) were determined in kinesiophobic group. Although HADS-Anxiety sub-scores were higher in the kinesiophobic group, these scores did not exceed the cut-off value in both groups. A significant association was identified between ODI and TSK scores (ρ=0.467 p = 0.002), and between FTF distance and TSK scores in the kinesiophobic group (ρ=0.307 p = 0.046).ConclusionKinesiophobia has the potential to elevate the risk of developing chronic pain. Therefore, identifying kinesiophobia in individuals with SJD and incorporating it into treatment strategies may enhance rehabilitation outcomes.

The association of previous and current non-chronic low back pain with daily physical activity in middle- and older-aged adults

BACKGROUND

Low back pain (LBP) is a leading cause of years lived with disability. However, the association of non-chronic LBP with levels of daily physical activity (PA) remains poorly explored. This study investigated the association between previous and current non-chronic LBP with daily PA and compliance with PA recommendations in middle and older-aged adults.

METHODS

This is a cross-sectional analysis including volunteers from the Baltimore Longitudinal Study of Aging who answered questions about LBP and wore an Actiheart accelerometer for 7days. Generalized linear models and logistic models were used and adjusted for potential confounders.

RESULTS

662 volunteers were included (50.8% women, 68.1% white), aged 68.0 (± 11.4) years. Previous non-chronic LBP was reported by 240 (36.3%) participants with mean pain intensity of 3.5 ± 2.0 (ranging from 0 to 10). Current non-chronic LBP was reported by 5.7% (n = 38) with mean pain intensity of 4.1 ± 2.3. Participants reporting current non-chronic LBP had lower levels of total (β -0.18, 95% CI -0.34 to -0.02) and vigorous (β -0.29, 95% CI -0.56 to -0.007) daily PA and lower odds of meeting PA recommendations (OR 0.20, 95% CI 0.05 to 0.92) compared to those reporting no LBP. No association was observed for LBP intensity. Conversely, previous non-chronic LBP showed no statistically significant association with daily PA levels.

CONCLUSION

The presence of current non-chronic LBP seems to be negatively associated with PA levels driven mainly by lower engagement in vigorous PA. No association was observed for pain intensity.

The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke

BACKGROUND

Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear.

OBJECTIVES

This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke.

METHODS

The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods.

RESULTS

The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05).

CONCLUSIONS

The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.

The link between childhood physical activity enjoyment and adult kinesiophobia in individuals with chronic low back pain

BACKGROUND

This study aimed to investigate the relationship between childhood physical activity enjoyment and current kinesiophobia among individuals with chronic low back pain (CLBP), considering the mediating influence of adult physical activity.

METHODS

We recruited 648 adults (474 males, 174 females) with CLBP through an online platform. Of these, 99.1% (n = 642) were aged 18-60 years, and 0.9% (n = 6) were older than 60 years. Childhood physical activity enjoyment was retrospectively assessed using a single-item question to gauge participants' enjoyment during primary school. Kinesiophobia was measured with the 11-item Tampa Scale for Kinesiophobia (TSK-11), and physical activity was assessed focusing on walking, moderate, and vigorous physical activities. Age, sex, education, and income served as control variables in the analysis.

RESULTS

A significant negative association was found between childhood physical activity enjoyment and adult kinesiophobia. Additionally, childhood physical activity enjoyment was positively associated with adult physical activity across the three types of physical activities. In the adjusted mediation model, walking was identified as the only statistically significant partial mediator.

CONCLUSION

The findings highlight the long-term protective role of childhood physical activity enjoyment against the development of kinesiophobia in adulthood. Walking, in particular, holds unique therapeutic potential, emphasizing the importance of fostering physical activity enjoyment early in life for sustained physical activity and reduced risk of kinesiophobia among CLBP patients.

Effect of kinesiophobia on postoperative rehabilitation outcomes in patients with cervical spondylotic myelopathy: a cross-sectional study

OBJECTIVE

This study aims to investigate the occurrence of postoperative kinesiophobia in patients with CSM and compare the postoperative recovery of patients with and without kinesiophobia to understand its influence on clinical outcomes in CSM.

METHODS

Between November 2020 and November 2022, surgical treatment was performed in the neurosurgical wards of 2 Grade III Class A general public hospitals in the Fujian Province. The demographic and disease data of the patients were collected, and patients were divided into a kinesiophobia group and non-kinesiophobia group according to the Tampa kinesiophobia Scale (TSK). The cervical dysfunction index, cervical Japanese Orthopaedic Association (JOA) rating, self-anxiety rating, and activity of daily living rating scales were collected three months postoperatively. The influence of postoperative kinesiophobia on early rehabilitation was also analysed.

RESULTS

A total of 122 patients were an average age of (55.2 ± 10.3) years included in this study. The average score of kinesophobia after surgery was 41.2 ± 4.5, with an incidence of 75.4%. Multivariate logistic regression analysis showed that age (OR = 1.105, 95% CI = 1.014-1.204), neck disability index (NDI) (OR = 1.268, 95% CI = 1.108-1.451), diabetes mellitus (OR = 0.026, 95% CI = 0.001-0.477), and Japanese Orthopaedic Association (JOA) score (OR = 0.698, 95% CI = 0.526-0.927) were associated with the occurren.

CONCLUSION

Doctors should be aware of kinesiophobia in patients with CSM. Education regarding kinesiophobia, strategies to avoid it, and treatment strategies using a multidisciplinary approach can improve recovery outcomes.

Assessment of kinesiophobia levels in patients with musculoskeletal pathologies: A demographic, physical, and clinical perspective

INTRODUCTION

Kinesiophobia is a crucial factor influencing the rehabilitation process for individuals with musculoskeletal pathologies. Assessing kinesiophobia levels is crucial for personalized interventions.

AIM

The aim of this study is to investigate the level of kinesiophobia in individuals with musculoskeletal pathology based on the pathology areas, demographic, physical, and clinical characteristics.

METHODS

A total of 210 participants with musculoskeletal pathologies were included in the study. All participants were assessed using a sociodemographic information form for demographic and physical characteristics, the Tampa Kinesiophobia Scale for kinesiophobia level, and the McGill-Melzack Pain Questionnaire for pain location and intensity.

RESULTS

There was no statistically significant difference observed in kinesiophobia level between patients in terms of pathology location and sex. However, a significant difference in kinesiophobia levels was found among patients based on the acute and chronic duration of the disease (p = 0.00), previous treatment history (p = 0.04), and exercise engagement (p = 0.00). When kinesiophobia levels were examined according to educational status, a significant difference was found between the primary education group and the undergraduate and above group (p = 0.00).

CONCLUSIONS

According to the results of this study, kinesiophobia levels appear to be independent of pathology location and sex, but vary based on educational level, exercise habits, pain duration and history of previous treatment. Considering these findings, it is essential to take into account these factors in treatment programs in clinical practice and to provide support in exercise and physical activity training to individuals who have previously received treatment and individuals with low education levels.

Prevalence and influencing factors of kinesiophobia in older patients with primary osteoporosis: A cross-sectional survey

AIM

To explore the prevalence of kinesiophobia in older patients with primary osteoporosis and analyze its influencing factors.

METHODS

A cross-sectional survey was conducted among 221 older patients with primary osteoporosis in a general hospital in Kunming, China. Data were collected through a sociodemographic-clinical questionnaire, Tampa Scale for Kinesiophobia-11 (TSK-11), Global Pain Scale (GPS), Five Facets Mindfulness Questionnaire-Short Form (FFMQ-SF), and Hospital Anxiety and Depression Scale (HADS). SPSS 27.0 software was utilized for univariate and binary logistic regression analyses.

RESULTS

The findings revealed that the prevalence of kinesiophobia in this study was 57.01 %. Age, history of fractures, chronic obstructive pulmonary disease (COPD), lumbar disc herniation, chronic pain, mindfulness, anxiety, and depression were identified as significant influencing factors of kinesiophobia in the binary logistic regression analyses.

CONCLUSION

Healthcare professionals should be attentive to occurrence of kinesiophobia. Timely measures should be implemented to improve pain, anxiety and depression, and employ mindfulness interventions to mitigate kinesiophobia.

Kinesiophobia and associated variables in patients with heart failure

AIMS

Patients with heart failure (HF) can exhibit kinesiophobia, an excessive, debilitating, and irrational fear of movement. This study aimed to enhance the understanding of kinesiophobia in patients with HF by analysing associations with the following variables: musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, frailty, sex, and age.

METHODS AND RESULTS

In this cross-sectional study, 107 participants were included, with ages ranging from 28 to 97 years (57% men, mean age 73.18 ± 12.68 years). Multiple regression analyses were performed with all variables, including polynomial regressions for variables with a non-linear relationship. Kinesiophobia was significantly correlated (P < 0.01) with musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, and being at risk of frailty, while age and sex were not statistically significant. Frailty disability and musculoskeletal pain intensity were variables linearly associated with kinesiophobia, while quality of sleep and disability had a non-linear relationship with kinesiophobia.

CONCLUSION

Kinesiophobia needs to be evaluated and better understood in patients with HF to improve physical activity and exercise adherence. This study found that musculoskeletal pain intensity, quality of sleep, disability, and frailty risk have a significant association with kinesiophobia in patients with HF. Our results suggest multi-dimensional associations of kinesiophobia in patients with HF, which require further examination and understanding.

Fear of Movement in People With CRPS: A Psychometric Evaluation of the Tampa Scale-11 for Kinesiophobia

BACKGROUND

People with complex regional pain syndrome (CRPS) commonly report a fear of movement that can worsen symptoms and increase disability. The Tampa Scale of Kinesiophobia (TSK) is used to evaluate fear of movement and (re)injury, but findings have been inconsistent in different populations.

OBJECTIVE

To evaluate the psychometric properties of the Persian version of TSK-11 in individuals with upper limb CRPS. Specifically, to determine whether the factor structure aligns with the original 2-factor model, consisting of "activity avoidance" and "somatic focus."

MATERIALS AND METHODS

People with CRPS (n=142, mean age=42, 54% female) completed the TSK. The psychometric testing included internal consistency, test-retest reliability (intraclass correlation coefficient), and convergent construct validity. Confirmatory and exploratory factor analyses were performed to evaluate the structural validity.

RESULTS

The TSK-11 showed acceptable internal consistency (Cronbach alpha 0.93) and excellent test-retest reliability (intraclass correlation coefficient=0.93, 95% CI: 0.92-0.94). The Standard Error of Measurement and Minimal Detectable Change were 4.3 and 11.7, respectively. The results also demonstrated excellent criterion validity ( r =0.81). Confirmatory factor analysis demonstrated that the original 2-factor model did not fit. Exploratory factor analysis derived a 2-factor solution with different items. The factor structure accounted for 64.91% of the variance, and the internal consistency of the factors was acceptable (>0.90). Expert consensus suggested naming these 2 factors as fear avoidance and magnification and helplessness.

DISCUSSION

The TSK-11 demonstrates excellent retest reliability in people with CRPS. The original 2-factor structure was not confirmed, and a new 2-factor structure of the TSK-11 was proposed consisting of subscales for Fear Avoidance Beliefs and Magnification/Helplessness. Given the overlap between these constructs and the construct of pain catastrophizing, further study is needed to clarify both measures' content validity and relative uniqueness.

Correlates of musculoskeletal pain and kinesiophobia in older adults with heart failure: A structural equation model

The study aimed to study the influence of musculoskeletal pain on kinesiophobia in patients with heart failure. This cross-sectional study recruited 107 heart failure patients aged 73.18±12.68 years (57% men) from an outpatient setting. Participants self-reported pain using the Musculoskeletal System Assessment Inventory and the Cornell Musculoskeletal Discomfort Questionnaire. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia-11. About 62% reported musculoskeletal pain, with knees (16.8%) and lower back (12.%) being the most painful locations. About 31% reported moderate levels and 24% indicated high levels of kinesiophobia. There were positive and significant associations between the indicators of pain and kinesiophobia. Results showed an adequate structural equation model fit to the data with musculoskeletal pain factors explaining 22.09% of the variance in kinesiophobia. Assessment of kinesiophobia in patients with heart failure with musculoskeletal pain is essential to improve self-care and overall quality of life.

Health literacy, pain-related interference and pain-related distress of patients with musculoskeletal pain

The present study aimed to compare pain-related interference and pain-related distress in patients with musculoskeletal pain and differing levels of health literacy. A cross-sectional study was conducted among 243 patients with chronic musculoskeletal pain. Short Test of Functional Health Literacy in Adults classified the level of health literacy. Outcome measures included pain-related interference (pain intensity and functional limitation) and pain-related distress (psychosocial factors). Analysis of variance methods were used. One hundred twenty-three (50.62%) participants were classified as adequate, 24 (9.88%) as marginal and 96 (39.50%) as inadequate health literacy. Patients with inadequate health literacy had higher values of pain severity compared to the other groups, when controlled for age. The group adequate health literacy showed less kinesiophobia compared to their counterparts. Functional limitations and other psychosocial factors were similar among groups. Pain severity and kinesiophobia had disadvantageous findings in participants with inadequate health literacy. Still, the results of pain severity must be approached cautiously because the differences were observed when controlled for age solely.

The impact of neck pain on gait health: a systematic review and meta-analysis

BACKGROUND

Evidence exists demonstrating the negative impacts of chronic musculoskeletal pain on key measures of gait. Despite neck pain being the second most common musculoskeletal pain condition, there is a paucity of evidence exploring the impacts of neck pain specifically on these outcomes. The aims of this work were to systematically review the current evidence of the associations between chronic neck pain and measures of gait health and to conduct meta-analysis for quantitative assessment of the effect sizes under different walking conditions.

METHODS

Systematic review was conducted following PRISMA guidelines. Databases searched included MEDLINE, Embase, Web of Science, CINAHL, and PEDro. Eligible study designs included observational studies consisting of an exposure group with chronic neck pain and control group without chronic neck pain and primary outcomes relating to gait health. For outcomes amenable to meta-analysis, a random-effects model was used to derive summary estimates of Hedge's g depicted graphically with forest plots. Other gait outcomes were narratively summarized. Risk of bias was also assessed.

RESULTS

The original search yielded 1918 articles; 12 met final eligibility criteria including 10 cross-sectional studies. Outcomes were grouped first by the five domains of gait: pace, rhythm, asymmetry, variability, and postural control; and second by the tested walking conditions. Meta-analyses for gait speed revealed large effect-sizes indicating that individuals with chronic neck pain had slower measures of gait and lower measures of cadence. Gait outcomes that were narratively summarized supported these findings.

CONCLUSION

The quantitative and qualitative findings of this systematic review and meta-analysis suggest a negative impact of CNNP on measures of gait health, particularly gait speed, under various walking conditions. However, broad interpretation of these results should be cautious. Testing gait under dual task conditions may be particularly sensitive to the impact of CNNP, and future work is needed to better understand how pain disrupts this important functionality of the locomotor system. Additionally, consideration should be made to assess measures of variability and investigate these relationships in the older adult population.

The Mediation Effect of Pain on the Relationship between Kinesiophobia and Lumbar Joint Position Sense in Chronic Low Back Pain Individuals: A Cross-Sectional Study

(1) Background: Fear of movement (kinesiophobia) and impaired lumbar joint position sense (LJPS) play a vital role in developing and maintaining non-specific chronic low back pain (CLBP). However, how kinesiophobia impacts LJPS is still being determined. The aims of this study are to (1) assess the correlation between kinesiophobia and LJPS in individuals with chronic low back pain; (2) compare LJPS between individuals with CLBP and those who are asymptomatic; and (3) evaluate if pain can mediate the relationship between kinesiophobia and LJPS in CLBP individuals. (2) Methods: Eighty-three individuals (mean age = 48.9 ± 7.5 years) with a diagnosis of CLBP and 95 asymptomatic individuals (mean age = 49.4 ± 7.0 years) were recruited into this cross-sectional study. Fear of movement in CLBP individuals was assessed using the Tampa Scale for Kinesiophobia (TSK). LJPS was determined using the active target repositioning technique using a dual-digital inclinometer. LJPS was evaluated in lumbar flexion, extension, and side-bending left and right directions, and the repositioning accuracy was determined in degrees using a dual digital inclinometer. (3) Results: Kinesiophobia showed a significant (p < 0.001) moderate positive correlation with LJPS (flexion: r = 0.51, extension: r = 0.41, side-bending left: r = 0.37 and side-bending right: r = 0.34). LJPS errors were larger in CLBP individuals compared to asymptomatic individuals (p < 0.05). Mediation analyses showed that pain significantly mediated the relationship between kinesiophobia and LJPS (p < 0.05) in CLBP individuals. (4) Conclusions: Kinesiophobia and LJPS were positively associated. LJPS is impaired in CLBP individuals compared to asymptomatic individuals. Pain may mediate adverse effects on LJPS. These factors must be taken into account when assessing and developing treatment plans for those with CLBP.

Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis: A Cross-Sectional Study

The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.

Biopsychosocial Approach in Identifying Risk Factors of Kinesiophobia in Persons with Subacromial Pain Syndrome and Developing a Clinical Prediction Tool

Introduction

Although the negative effects of kinesiophobia on functional status in subacromial pain syndrome (SAPS) patients are clearly demonstrated, no study examines the risk factors of kinesiophobia in individuals with SAPS from a biopsychosocial perspective. The present study aims to determine the risk factors of kinesiophobia in individuals with SAPS using a biopsychosocial approach. This study also aims to explore the compounding effects of multiple associative risk factors by developing a clinical prediction tool to identify SAPS patients at higher risk for kinesiophobia.

Materials and methods

This cross-sectional study included 549 patients who were diagnosed with SAPS. The Tampa-Scale of Kinesiophobia (TSK) was used to assess kinesiophobia. Visual analog scale (VAS), The Shoulder Pain and Disability Index (SPADI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the presence of metabolic syndrome, using any non-steroidal anti-inflammatory drugs, Pain Catastrophizing Scale (PCS), Illness Perception Questionnaire-revised (IPQ-R), Hospital Anxiety and Depression Scale (HADS), behavioral pattern of the patient, sociodemographic characteristics, and treatment expectancy were outcome measures.

Results

Thirteen significant risk factors of having kinesiophobia were: VASat rest (≥ 5.2), VASduring activity (≥ 7.1), DASH (≥ 72.1), presence of metabolic syndrome, PCShelplessness (≥ 16.1), IPQ-Rpersonal control (≤ 17.1), IPQ-Rtreatment control (≤ 16.3), HADSdepression (≥ 7.9), avoidance behavior type, being female, educational level (≤ high school), average hours of sleep (≤ 6.8), and treatment expectancy (≤ 6.6). The presence of seven or more risk factors increased the probability of having high level of kinesiophobia from 34.3 to 51%.

Conclusions

It seems necessary to address these factors, increase awareness of health practitioners and individuals.

Level of evidence

Level IV.

An investigation of the relationship between cutaneous allodynia and kinesiophobia, gastrointestinal system symptom severity, physical activity and disability in individuals with migraine

Background

To investigate the relationship between cutaneous allodynia (CA) and kinesiophobia, gastrointestinal system (GIS) symptom severity, physical activity, and disability, and to determine whether CA, pain, and disability were influencing factors for kinesiophobia, GIS symptoms, and physical activity in individuals with migraine.

Methods

The study included 144 individuals with migraine. CA, kinesiophobia, GIS symptoms, physical activity level, and migraine-related disability were evaluated with the Allodynia Symptom Checklist, the Tampa Kinesiophobia Scale (TKS), the Gastrointestinal Symptom Rating Scale (GSRS), the International Physical Activity Questionnaire-7, and the Migraine Disability Assessment Scale (MIDAS), respectively.

Results

The CA severity was only associated with TKS (r = 0.515; P < 0.001), GSRS-total (r = 0.336; P < 0.001), GSRS-abdominal pain (r = 0.323; P < 0.001), GSRS-indigestion (r = 0.257; P = 0.002), GSRS-constipation (r = 0.371; P < 0.001), and MIDAS scores (r = 0.178; P = 0.033). Attack frequency (P = 0.015), attack duration (P = 0.035) and presence of CA (P < 0.001) were risk factors for kinesiophobia. Attack frequency (P = 0.027) and presence of CA (P = 0.004) were risk factors for GIS symptoms.

Conclusions

There was a relationship between the CA and kinesiophobia, GIS symptoms, and disability. CA and attack frequency were found to be risk factors for kinesiophobia and GIS symptoms. Migraine patients with CA should be assessed in terms of kinesiophobia, GIS, and disability. Lifestyle changes such as exercise and dietary changes and/or pharmacological treatment options for CA may increase success in migraine management.

Depressive Symptoms Associated With Musculoskeletal Pain in Inactive Adults During COVID-19 Quarantine

BACKGROUND

Depression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level.

AIM

To describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels.

DESIGN

Cross-sectional study.

METHODS

This research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872; 58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants' level of physical activity.

RESULTS

Depressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain.

CONCLUSION

During the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants.

Construct Validity and Reliability of the Japanese Version of the Lumbar Stiffness Disability Index

STUDY DESIGN

Outcome study to determine the construct validity and reliability of the Japanese version of the Lumbar Stiffness Disability Index.

OBJECTIVE

The aim of this study was to evaluate the psychometric measurement properties of the Japanese version of the Lumbar Stiffness Disability Index (J-LSDI) following lumbar spinal surgery in order to assess its construct validity and reliability.

SUMMARY OF BACKGROUND DATA

The LSDI was designed and validated as a tool to assess functional impacts of lumbar spine stiffness and diminished spinal flexibility. A Japanese version has been developed, but its construct validity and reliability have not been evaluated.

METHODS

A Pearson correlation coefficient was calculated using flexion and extension range of motion, Oswestry Disability Index (ODI) and Tampa Scale for Kinesiophobia (TSK) as external standards to evaluate construct validity. An intraclass correlation coefficient (ICC) and a Bland-Altman analysis were used to evaluate test-retest reliability.

RESULTS

A total of 244 patients following lumbar spinal surgery participated in the study. Fifty one of the 244 patients participated in the reliability study. The ICC of the J-LSDI for test-retest reliability was 0.89 (95% confidence interval, 0.79-0.93). There was no systematic error found in the results of the Bland-Altman analysis. One hundred ninety-three of the 244 patients participated in the validity study. There were significant correlations between the J-LSDI and trunk flexion range of motion (r = -0.66), extension (r = -0.51), ODI (r = 0.62), and TSK (r = 0.38).

CONCLUSION

The construct validity and reliability of the Japanese version of the LSDI were confirmed. The J-LSDI can be used to evaluate lumbar stiffness and associated disability in Japanese patients following lumbar spinal surgery.Level of Evidence: 2.