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Sütçü Uçmak G, Kılınç M. The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. Top Stroke Rehabil 2024:1-7. [PMID: 38529783 DOI: 10.1080/10749357.2024.2333159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Gülşah Sütçü Uçmak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Akdeniz University, Antalya, Turkey
| | - Muhammed Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Monteiro AJ, de Labra C, Losa-Iglesias ME, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H, Macedo F, López-López D, Gómez-Salgado J. The relationship of kinesiophobia in patients with lymphedema: a case-control investigation. Front Psychiatry 2024; 15:1293614. [PMID: 38445089 PMCID: PMC10912151 DOI: 10.3389/fpsyt.2024.1293614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
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.
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Affiliation(s)
- Ana Júlia Monteiro
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Carmen de Labra
- Research, Health, and Podiatry Group, Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | | | - Adriano Dias
- Epidemiology – Department of Public Health and Grade Program of Public/Collective Health, Botucatu Medical School/Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | | | - Helena Silva-Migueis
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Filipe Macedo
- Integrated Continuing Care Unit, Casa de Santa Maria, Camarate, Portugal
| | - Daniel López-López
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Colman M, Syx D, De Wandele I, Rombaut L, Wille D, Malfait Z, Meeus M, Malfait AM, Van Oosterwijck J, Malfait F. Sensory Profiling in Classical Ehlers-Danlos Syndrome: A Case-Control Study Revealing Pain Characteristics, Somatosensory Changes, and Impaired Pain Modulation. THE JOURNAL OF PAIN 2023; 24:2063-2078. [PMID: 37380025 DOI: 10.1016/j.jpain.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
Pain is one of the most important yet poorly understood complaints in heritable connective tissue disorders (HCTDs) caused by monogenic defects in extracellular matrix molecules. This is particularly the case for the Ehlers-Danlos syndrome (EDS), paradigm collagen-related disorders. This study aimed to identify the pain signature and somatosensory characteristics in the rare classical type of EDS (cEDS) caused by defects in type V or rarely type I collagen. We used static and dynamic quantitative sensory testing and validated questionnaires in 19 individuals with cEDS and 19 matched controls. Individuals with cEDS reported clinically relevant pain/discomfort (Visual Analogue Scale ≥5/10 in 32% for average pain intensity the past month) and worse health-related quality of life. An altered somatosensory profile was found in the cEDS group with higher (P = .04) detection thresholds for vibration stimuli at the lower limb, indicating hypoesthesia, reduced thermal sensitivity with more (P < .001) paradoxical thermal sensations (PTSs), and hyperalgesia with lower pain thresholds to mechanical (P < .001) stimuli at both the upper and lower limbs and cold (P = .005) stimulation at the lower limb. Using a parallel conditioned pain modulation paradigm, the cEDS group showed significantly smaller antinociceptive responses (P-value .005-.046) suggestive of impaired endogenous pain modulation. In conclusion, individuals with cEDS report chronic pain and worse health-related quality of life and present altered somatosensory perception. This study is the first to systematically investigate pain and somatosensory characteristics in a genetically defined HCTD and provides interesting insights into the possible role of the ECM in the development and persistence of pain. PERSPECTIVE: Chronic pain compromises the quality of life in individuals with cEDS. Moreover, an altered somatosensory perception was found in the cEDS group with hypoesthesia for vibration stimuli, more PTSs, hyperalgesia for pressure stimuli, and impaired pain modulation.
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Affiliation(s)
- Marlies Colman
- Center for Medical Genetics, Ghent University Hospital, Ghent, East Flanders, Belgium; Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium; Pain in Motion International Research Consortium, Belgium
| | - Delfien Syx
- Center for Medical Genetics, Ghent University Hospital, Ghent, East Flanders, Belgium; Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Inge De Wandele
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Lies Rombaut
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Deborah Wille
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Zoë Malfait
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Mira Meeus
- Pain in Motion International Research Consortium, Belgium; Spine, Head and Pain Research Unit Ghent, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Anne-Marie Malfait
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois
| | - Jessica Van Oosterwijck
- Pain in Motion International Research Consortium, Belgium; Spine, Head and Pain Research Unit Ghent, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, East Flanders, Belgium; Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
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Colman M, Syx D, de Wandele I, Rombaut L, Wilie D, Malfait Z, Meeus M, Malfait AM, Van Oosterwijck J, Malfait F. Sensory profiling in classical Ehlers-Danlos syndrome: a case-control study revealing pain characteristics, somatosensory changes, and impaired pain modulation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.24.23286404. [PMID: 36865307 PMCID: PMC9980260 DOI: 10.1101/2023.02.24.23286404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Pain is one of the most important, yet poorly understood complaints in heritable connective tissue disorders (HCTD) caused by monogenic defects in extracellular matrix molecules. This is particularly the case for Ehlers-Danlos syndromes (EDS), paradigm collagen-related disorders. This study aimed to identify the pain signature and somatosensory characteristics in the rare classical type of EDS (cEDS) caused by defects in type V or rarely type I collagen. We used static and dynamic quantitative sensory testing and validated questionnaires in 19 individuals with cEDS and 19 matched controls. Individuals with cEDS reported clinically relevant pain/discomfort (VAS ≥5/10 in 32% for average pain intensity the past month) and worse health -related quality of life. Altered sensory profile was found in the cEDS group with higher (p=0.04) detection thresholds for vibration stimuli at the lower limb indicating hypoesthesia, reduced thermal sensitivity with more (p<0.001) paradoxical thermal sensations, and hyperalgesia with lower pain thresholds to mechanical (p<0.001) stimuli at both the upper and lower limbs and to cold (p=0.005) stimulation at the lower limb. Using a parallel conditioned pain paradigm, the cEDS group showed significantly smaller antinociceptive responses (p-value between 0.005 and 0.046) suggestive of impaired endogenous central pain modulation. In conclusion, Individuals with cEDS report chronic pain and worse health-related quality of life, and present altered somatosensory perception. This study is the first to systematically investigate pain and somatosensory characteristics in a genetically defined HCTD and provides interesting insights on the possible role of the ECM in the development and persistence of pain.
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Affiliation(s)
- Marlies Colman
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Consortium
| | - Delfien Syx
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Inge de Wandele
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lies Rombaut
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Deborah Wilie
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Zoë Malfait
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Spine, Head and Pain SPINE Research Unit Ghent, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Consortium
| | - Anne-Marie Malfait
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica Van Oosterwijck
- Spine, Head and Pain SPINE Research Unit Ghent, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Consortium
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Malchrowicz-Mośko E, Nowaczyk P, Wasiewicz J, Urbaniak T, Siejak W, Rozmiarek M, Czerniak U, Demuth A, Aguirre-Betolaza AM, Castañeda-Babarro A. The level of kinesiophobia in breast cancer women undergoing surgical treatment. Front Oncol 2023; 13:1010315. [PMID: 36816937 PMCID: PMC9932589 DOI: 10.3389/fonc.2023.1010315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Lifestyle-associated factors like physical activity (PA) play an important role in cancer prevention and oncology treatment outcomes. The aim of the study is to investigate the level of kinesiophobia (fear of movement) in breast cancer (BC) patients undergoing surgical treatment depending on socio-demographic variables, lifestyle before cancer diagnosis, stage and type of BC and comorbidities. Methods We interviewed 285 women (132 patients from Greater Poland Cancer Center - age: 55.7 ± 12.4; BMI: 26.7 ± 4.7 and 153 healthy women from control group - age: 49.0 ± 15.7; BMI: 25.7 ± 4.0) using Polish adaptation of the Tampa Scale of Kinesiophobia (TSK). Results Research results show that women with BC suffer from kinesiophobia (>37 points) signi!cantly. Approximately 3/4 of the surveyed women with BC did not know the World Health Organization (WHO) recommendations regarding the weekly dose of PA for healthy people and for people with cancer. Before cancer diagnosis more than a half of women (60%) performed PA in accordance with WHO recommendations. 7% less women performed PA during oncology treatment. Almost a half of patients are not physically active during cancer treatment and 1/5 of the respondents declared that they do not know yet if they will be physically active after oncology treatment. The level of kinesiophobia in BC women with comorbidities was the same as in the group of BC women without comorbidities. However, the highest levels of fear of movement have been observed among women with BC suffering also from osteoporosis, obesity and diabetes. In general, higher levels of kinesiophobia were reported among women in less advanced stages of the disease. There were no differences in the level of kinesiophobia depending on the type of BC (hormonally dependent luminal cancers vs. other types). The level of kinesiophobia did not differ between women who were physically active before BC diagnosis and women who were not. In terms of socio- demographic variables, we found one direct association between the level of kinesiophobia (pain) with age - the greater age, the higher level of pain kinesiophobia. Discussion Research on fear of movement in female oncology requires further research (including also chemotherapy, radiotherapy, immunotherapy and hormonal therapy) and in order to effectively eliminate hypokinetic attitudes at every stage of cancer treatment.
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Affiliation(s)
- Ewa Malchrowicz-Mośko
- Department of Kinesiology, Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Piotr Nowaczyk
- Breast Surgical Oncology Department, Breast Cancer Unit, Greater Poland Cancer Center, Poznan, Poland
| | - Janusz Wasiewicz
- Breast Surgical Oncology Department, Breast Cancer Unit, Greater Poland Cancer Center, Poznan, Poland
| | - Tomasz Urbaniak
- Breast Surgical Oncology Department, Breast Cancer Unit, Greater Poland Cancer Center, Poznan, Poland
| | - Wojciech Siejak
- Breast Surgical Oncology Department, Breast Cancer Unit, Greater Poland Cancer Center, Poznan, Poland
| | - Mateusz Rozmiarek
- Department of Kinesiology, Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Urszula Czerniak
- Department of Kinesiology, Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Anna Demuth
- Department of Kinesiology, Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
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Validity and reliability of the Tampa Kinesiophobia-Fatigue Scale in patients with multiple sclerosis. Ir J Med Sci 2023; 192:285-290. [PMID: 35094232 DOI: 10.1007/s11845-021-02902-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Kinesiophobia can be a barrier for physical activity in patients with multiple sclerosis (PwMS) and it can develop as a result of fear and avoidance reactions due to fatigue. However, there is no valid and reliable scale available to assess kinesiophobia due to fatigue in PwMS. AIMS To investigate the test-retest reliability and construct validity of the Tampa Scale of Kinesiophobia-Fatigue (TSK-F) in PwMS. METHODS Eighty-seven PwMS were included in the study. In addition to TSK-F, the following measurements were used for construct validity: Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS), 6-Minute Walking Test (6MWT), International Physical Activity Questionnaire (IPAQ), Beck Depression Inventory (BDI), Multiple Sclerosis Quality of Life Scale-54 (MSQoL-54). TSK-F was administered twice (3-7 days apart) to measure test-retest reliability. RESULTS The intraclass correlation coefficient of the TSK-F was 0.867. It had a weak correlation with the IPAQ and EDSS, moderate correlation with the MSQoL-54 and 6MWT, and strong correlation with the BDI, FSS, and FIS (respectively, rho - 0.345, rho 0.365, rho 0.544, rho - 0.449, rho 0.690, rho 0.602, rho 0.650). The scale had good performance to discriminate the disease severity with the area under the curve (AUC) value 0.730. CONCLUSIONS TSK-F has excellent reliability and moderate-to-good validity in evaluating kinesiophobia and the scale may be a useful outcome measurement for assessment of kinesiophobia due to fatigue in PwMS.
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Sadeghi-Yarandi M, Ghasemi M, Ghanjal A, Sepandi M, Soltanzadeh A. The Prediction of Chronicity in Patients With Acute and Subacute Nonspecific Low Back Pain and Associated Risk Factors: A Case-Control Study. Pain Manag Nurs 2022; 23:838-847. [PMID: 35177310 DOI: 10.1016/j.pmn.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/03/2022] [Accepted: 01/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic low back pain is one of the most common musculoskeletal disorders in different countries. AIMS This study aimed to predict the chronicity of nonspecific acute and nonspecific low back pain (LBP) and related risk factors among cases referred to physiotherapy clinics. DESIGN A case-control and cross-sectional study. SETTINGS Two physiotherapy centers in Tehran, Iran. PARTICIPANTS This study included 502 patients with acute, subacute and chronic LBP. METHOD This study included 502 patients with acute, subacute and chronic LBP. Data were obtained using the Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophic Scale, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire, and Numerical Pain Rating Scale. Data analysis was performed by applying independent sample t test, χ2, and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was used for path analysis. RESULTS It was found that some demographic parameters (i.e., weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters (i.e., fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e., health responsibility, physical activity, and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and subacute LBP (p < .05). CONCLUSIONS Personal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and subacute nonspecific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and subacute into chronic LBP has particular importance.
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Affiliation(s)
- Mohsen Sadeghi-Yarandi
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghasemi
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Ali Ghanjal
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mojtaba Sepandi
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ahmad Soltanzadeh
- Department of Occupational Safety and Health Engineering, Health Faculty, Qom University of Medical Sciences, Qom, Iran
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Malchrowicz-Mośko E. Kinesiophobia among Breast Cancer Survivors One Year after Hospital Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14565. [PMID: 36361442 PMCID: PMC9655552 DOI: 10.3390/ijerph192114565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Breast cancer (BC) is one of the most dangerous health problems affecting women. Lifestyle-associated determinants like physical activity (PA) play an important role in BC treatment outcomes. Studies suggest that oncology patients are insufficiently physically active. One of the potential barriers is kinesiophobia-fear of movement due to expected pain and fatigue. The aim of this cross-sectional study is to investigate the level of kinesiophobia among women one year after BC hospital treatment depending on socio-demographic variables, stage and type of BC, lifestyle, and comorbidities. Polish women after BC (n = 138, age 46.5 ± 9.2, BMI 24.6 ± 4.0) participated in the study and the Tampa Scale of Kinesiophobia (TSK) questionnaire was used in the diagnostic survey. The study results show that women suffer from kinesiophobia after BC. Moreover, every third woman (32.6%) does not practice sport regularly one year after BC treatment. The lifestyle before BC diagnosis impacts the level of kinesiophobia after treatment-women who were not physically active before BC diagnosis declared higher levels than previously active women. The study result shows that a high level of kinesiophobia correlates with a low level of PA among women after BC. Women with obesity and diabetes also declared higher levels of kinesiophobia than women without comorbidities. The type and stage of BC have no influence on the level of kinesiophobia; however, in terms of socio-demographic variables, a direct association between kinesiophobia and age has been found-the greater the age, the higher the level of kinesiophobia. Further research on fear of movement in oncology is required in order to effectively eliminate hypokinetic attitudes in every type of female and male cancer.
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Affiliation(s)
- Ewa Malchrowicz-Mośko
- Department of Kinesiology, Faculty of Sport Sciences, Poznan University of Physical Education, 61-871 Poznan, Poland
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Zhang X, Zhao Q, Wang M, Yang M, Fan X. Fear of movement and its associated psychosocial factors in heart failure patients: A cross-sectional study. Eur J Cardiovasc Nurs 2022; 22:273-281. [PMID: 35989416 DOI: 10.1093/eurjcn/zvac075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
AIMS Fear of movement is a significant obstacle to daily activities, which may lead to adverse outcomes in patients with heart failure. This study aimed to examine the prevalence of fear of movement and to identify psychosocial factors associated with fear of movement in heart failure patients. METHODS AND RESULTS In this cross-sectional study, a total of 305 heart failure patients were recruited from three cardiovascular units of a university hospital. Self-reported questionnaires were used to measure fear of movement, cardiac anxiety, depressive symptoms, subjective social status, education, monthly income, and employment status. The results showed that 178 (58.4%) patients were accompanied with fear of movement. Hierarchical linear regression analysis showed that scores for cardiac anxiety (β=0.254, p < 0.001) and depressive symptoms (β=0.308, p < 0.001), as well as being employed (β=0.186, p < 0.001) were positively associated with fear of movement score, while the score for subjective social status (β=-0.101, p = 0.038) was negatively associated with fear of movement score. The four independent variables accounted for 30.3% of the variance in fear of movement. CONCLUSIONS Fear of movement is common in patients with heart failure. Cardiac anxiety, depressive symptoms, subjective social status, and employment status were associated with patients' fear of movement. This indicates that measures should be taken to screen and manage patients' fear of movement. Furthermore, alleviating cardiac anxiety and depressive symptoms may be important to consider in relieving fear of movement in heart failure patients, especially for those who are employed and with low subjective social status.
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Affiliation(s)
- Xiuting Zhang
- Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qiuge Zhao
- Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mei Wang
- Master Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mei Yang
- Master Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuzhen Fan
- Professor and Associate Dean, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
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Adamowicz JL, Vélez-Bermúdez M, Thomas EB. Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis. J Psychosom Res 2022; 159:110951. [PMID: 35665612 PMCID: PMC9629285 DOI: 10.1016/j.jpsychores.2022.110951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease. METHODS PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve. RESULTS The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18-0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis. CONCLUSION Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population.
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Affiliation(s)
| | - Miriam Vélez-Bermúdez
- University of Iowa, Department of Psychological and Brain Sciences, United States of America.
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11
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Effects of fatigue and kinesiophobia on functional capacity, physical activity and quality of life in Parkinson's disease. Int J Rehabil Res 2021; 44:65-68. [PMID: 33290306 DOI: 10.1097/mrr.0000000000000449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to investigate the effects of fatigue and fatigue-related kinesiophobia on functional capacity, physical activity and quality of life in patients with Parkinson's disease. Twenty patients with Parkinson's disease were included in the study. The fatigue severity was assessed by the Fatigue Severity Scale, kinesiophobia by the Tampa Kinesiophobia Scale, functional capacity with the Six-Minute Walk Test, and quality of life was evaluated by the Parkinson's Disease Questionnaire. In addition, the physical activity level of each patient, such as the number of steps, active energy expenditure and total energy expenditure, were recorded for one week with an activity monitor mounted on the patients' arms. The mean age of the patients (10 female/10 male) was 69.85 ± 9.38. According to the multiple regression analysis, a significant correlation was found between fatigue with 6-min walking test score (P = 0.039) and number of steps (P = 0.030). Also, a significant correlation was found between kinesiophobia with total energy expenditure (P = 0.013) and quality of life (P = 0.042). While fatigue was a significant determinant for functional capacity and number of steps, kinesiophobia was a significant determinant for total energy expenditure and quality of life. Fatigue and kinesiophobia are emphasized less compared to other findings in Parkinson's disease. However, fatigue and kinesiophobia symptoms negatively affect the functional capacity, physical activity and quality of life of patients. The results of this study revealed the need to evaluate fatigue and kinesiophobia, and the need to use physiotherapy and rehabilitation interventions to reduce these symptoms.
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Hughes AM, Hirsch CR, Nikolaus S, Chalder T, Knoop H, Moss-Morris R. Cross-Cultural Study of Information Processing Biases in Chronic Fatigue Syndrome: Comparison of Dutch and UK Chronic Fatigue Patients. Int J Behav Med 2018; 25:49-54. [PMID: 28836119 PMCID: PMC5803280 DOI: 10.1007/s12529-017-9682-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose This study aims to replicate a UK study, with a Dutch sample to explore whether attention and interpretation biases and general attentional control deficits in chronic fatigue syndrome (CFS) are similar across populations and cultures. Method Thirty eight Dutch CFS participants were compared to 52 CFS and 51 healthy participants recruited from the UK. Participants completed self-report measures of symptoms, functioning, and mood, as well as three experimental tasks (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) versus neutral words, (ii) interpretive bias task measuring positive versus somatic interpretations of ambiguous information, and (iii) the Attention Network Test measuring general attentional control. Results Compared to controls, Dutch and UK participants with CFS showed a significant attentional bias for illness-related words and were significantly more likely to interpret ambiguous information in a somatic way. These effects were not moderated by attentional control. There were no significant differences between the Dutch and UK CFS groups on attentional bias, interpretation bias, or attentional control scores. Conclusion This study replicated the main findings of the UK study, with a Dutch CFS population, indicating that across these two cultures, people with CFS demonstrate biases in how somatic information is attended to and interpreted. These illness-specific biases appear to be unrelated to general attentional control deficits.
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Affiliation(s)
- Alicia M Hughes
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colette R Hirsch
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephanie Nikolaus
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hans Knoop
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Cheshire A, Ridge D, Clark L, White P. Guided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions. Disabil Rehabil 2018; 42:368-377. [DOI: 10.1080/09638288.2018.1499822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Anna Cheshire
- College of Arts and Liberal Sciences, University of Westminster, London, UK
| | - Damien Ridge
- College of Arts and Liberal Sciences, University of Westminster, London, UK
| | - Lucy Clark
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Bart’s and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Peter White
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Bart’s and the London School of Medicine and Dentistry, Queen Mary University, London, UK
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Vardar-Yagli N, Calik-Kutukcu E, Saglam M, Inal-Ince D, Arikan H, Coplu L. The relationship between fear of movement, pain and fatigue severity, dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease. Disabil Rehabil 2018; 41:2159-2163. [PMID: 29631469 DOI: 10.1080/09638288.2018.1459886] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: Dyspnea, sedentary lifestyle, and comorbid diseases may reduce the desire to engage in physical movement in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess levels of kinesiophobia among stable COPD patients and evaluate the relationship between kinesiophobia and pain and fatigue severity, dyspnea level, and comorbidities in this patient group. Material and Methods: Thirty-one patients with moderate/severe COPD and thirty-one age- and sex-matched healthy controls participated in the study. All participants were assessed using Visual Analog Scale for pain severity, Fatigue Severity Scale, modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia. Results: Ninety-three percent of the patients with COPD had a high degree of kinesiophobia (Tampa Scale of Kinesiophobia score >37). The modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia scores of patients with COPD was significantly higher than those of healthy subjects (p < 0.001). Tampa Scale of Kinesiophobia score was significantly associated with modified Medical Research Council Dyspnea Scale score (r = 0.676, p < 0.001), Charlson Comorbidity Index score (r = 0.746, p < 0.001) and fatigue severity level (r = 0.524, p = 0.005). Conclusion: Most moderate/severe COPD patients express fear of movement. Kinesiophobia is strongly associated with dyspnea perception, fatigue severity, multisystemic comorbidities in COPD. Further studies are needed to determine the effects of kinesiophobia on the success of pulmonary rehabilitation. Implications for rehabilitation Most of moderate-to-severe chronic obstructive pulmonary disease patients have fear of movement. Increase fear of movement in moderate-severe chronic obstructive pulmonary disease is associated with increased dyspnea perception and fatigue severity and multisystemic comorbidities.
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Affiliation(s)
- Naciye Vardar-Yagli
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Ebru Calik-Kutukcu
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Melda Saglam
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Deniz Inal-Ince
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Hulya Arikan
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Lutfi Coplu
- b Faculty of Medicine, Department of Chest Diseases , Hacettepe University , Ankara , Turkey
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15
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Lenaert B, Boddez Y, Vlaeyen JW, van Heugten CM. Learning to feel tired: A learning trajectory towards chronic fatigue. Behav Res Ther 2018; 100:54-66. [DOI: 10.1016/j.brat.2017.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
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16
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Clark LV, Buckland M, Murphy G, Taylor N, Vleck V, Mein C, Wozniak E, Smuk M, White PD. Cytokine responses to exercise and activity in patients with chronic fatigue syndrome: case-control study. Clin Exp Immunol 2017; 190:360-371. [PMID: 28779554 DOI: 10.1111/cei.13023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/08/2023] Open
Abstract
Chronic fatigue syndrome (CFS) is characterized by fatigue after exertion. A systematic review suggested that transforming growth factor (TGF)-β concentrations are often elevated in cases of CFS when compared to healthy controls. This study attempted to replicate this finding and investigate whether post-exertional symptoms were associated with altered cytokine protein concentrations and their RNA in CFS patients. Twenty-four patients fulfilling Centers for Disease Control criteria for CFS, but with no comorbid psychiatric disorders, were recruited from two CFS clinics in London, UK. Twenty-one healthy, sedentary controls were matched by gender, age and other variables. Circulating proteins and RNA were measured for TGF-β, tumour necrosis factor (TNF), interleukin (IL)-8, IL-6 and IL-1β. We measured six further cytokine protein concentrations (IL-2, IL-4, IL-5, IL-10, IL-12p70, and interferon (IFN)-γ). Measures were taken at rest, and before and after both commuting and aerobic exercise. CFS cases had higher TGF-β protein levels compared to controls at rest (median (quartiles) = 43·9 (19·2, 61·8) versus 18·9 (16·1, 30·0) ng/ml) (P = 0·003), and consistently so over a 9-day period. However, this was a spurious finding due to variation between different assay batches. There were no differences between groups in changes to TGF-β protein concentrations after either commuting or exercise. All other cytokine protein and RNA levels were similar between cases and controls. Post-exertional symptoms and perceived effort were not associated with any increased cytokines. We were unable to replicate previously found elevations in circulating cytokine concentrations, suggesting that elevated circulating cytokines are not important in the pathophysiology of CFS.
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Affiliation(s)
- L V Clark
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, London, UK
| | - M Buckland
- UCL Centre for Immunodeficiency, Royal Free London NHS Foundation Trust, London, UK
| | - G Murphy
- UCL Centre for Immunodeficiency, Royal Free London NHS Foundation Trust, London, UK
| | - N Taylor
- UCL Centre for Immunodeficiency, Royal Free London NHS Foundation Trust, London, UK
| | - V Vleck
- CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - C Mein
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - E Wozniak
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Smuk
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, London, UK
| | - P D White
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, London, UK
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The interface between chronic fatigue syndrome and depression: A psychobiological and neurophysiological conundrum. Neurophysiol Clin 2017; 47:123-129. [DOI: 10.1016/j.neucli.2017.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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18
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Roche R, Taylor RR. Coping and Occupational Participation in Chronic Fatigue Syndrome. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920502500205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Existing studies have shown that individuals with chronic fatigue syndrome demonstrate functional impairment in several domains related to occupational participation. Researchers have not yet explored whether coping styles may be associated with occupational participation in individuals with this condition. The aim of this study was to examine the effects of coping styles on occupational participation among adults with chronic fatigue syndrome. The authors hypothesized that occupational participation would be associated with coping strategies oriented toward information seeking and maintaining activity, and that this relationship would endure despite individual differences in illness severity. The study used a cross-sectional design to describe the associations between coping and occupational participation for 47 individuals diagnosed as having chronic fatigue syndrome. Findings from linear regression analysis revealed that the coping style of maintaining activity was positively associated with occupational participation, whereas illness accommodation was negatively associated. Implications of the findings for continued research and clinical practice in occupational therapy are discussed.
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Clark LV, McCrone P, Ridge D, Cheshire A, Vergara-Williamson M, Pesola F, White PD. Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study. JMIR Res Protoc 2016; 5:e70. [PMID: 27278762 PMCID: PMC4917732 DOI: 10.2196/resprot.5395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/29/2015] [Accepted: 01/03/2016] [Indexed: 11/13/2022] Open
Abstract
Background Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability. Objective While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested. Methods This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened. Results The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon. Conclusions This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice. Trial Registration International Standard Randomized Controlled Trial Number (ISRTCTN): 22975026; http://www.isrctn.com/ISRCTN22975026 (Archived by WebCite at http://www.webcitation.org/6gBK00CUX)
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Affiliation(s)
- Lucy V Clark
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
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20
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Explaining fatigue in multiple sclerosis: cross-validation of a biopsychosocial model. J Behav Med 2016; 39:815-22. [PMID: 27236455 DOI: 10.1007/s10865-016-9749-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Fatigue is a common and disabling symptom in patients with multiple sclerosis (MS), but its pathogenesis is still poorly understood and consequently evidence-based treatment options are limited. Bol et al. (J Behav Med 33(5):355-363, 2010) suggested a new model, which explains fatigue in MS from a biopsychosocial perspective, including cognitive-behavioral factors. For purposes of generalization to clinical practice, cross-validation of this model in another sample of 218 patients with MS was performed using structural equation modeling. Path analysis indicated a close and adequate global fit (RMSEA = 0.053 and CFI = 0.992). The cross-validated model indicates a significant role for disease severity, depression and a fear-avoidance cycle in explaining MS-related fatigue. Modifiable factors, such as depression and catastrophizing thoughts, propose targets for treatment options. Our findings are in line with recent evidence for the effectiveness of a new generation of cognitive behavioral therapy, including acceptance and mindfulness-based interventions, and provide a theoretical framework for treating fatigue in MS.
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21
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Understanding Muscle Dysfunction in Chronic Fatigue Syndrome. J Aging Res 2016; 2016:2497348. [PMID: 26998359 PMCID: PMC4779819 DOI: 10.1155/2016/2497348] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/12/2015] [Accepted: 01/13/2016] [Indexed: 12/11/2022] Open
Abstract
Introduction. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating disorder of unknown aetiology, characterised by severe disabling fatigue in the absence of alternative diagnosis. Historically, there has been a tendency to draw psychological explanations for the origin of fatigue; however, this model is at odds with findings that fatigue and accompanying symptoms may be explained by central and peripheral pathophysiological mechanisms, including effects of the immune, oxidative, mitochondrial, and neuronal pathways. For example, patient descriptions of their fatigue regularly cite difficulty in maintaining muscle activity due to perceived lack of energy. This narrative review examined the literature for evidence of biochemical dysfunction in CFS/ME at the skeletal muscle level. Methods. Literature was examined following searches of PUB MED, MEDLINE, and Google Scholar, using key words such as CFS/ME, immune, autoimmune, mitochondria, muscle, and acidosis. Results. Studies show evidence for skeletal muscle biochemical abnormality in CFS/ME patients, particularly in relation to bioenergetic dysfunction. Discussion. Bioenergetic muscle dysfunction is evident in CFS/ME, with a tendency towards an overutilisation of the lactate dehydrogenase pathway following low-level exercise, in addition to slowed acid clearance after exercise. Potentially, these abnormalities may lead to the perception of severe fatigue in CFS/ME.
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Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain and Fatigue. Phys Ther 2015; 95:1274-86. [PMID: 25908522 PMCID: PMC4556956 DOI: 10.2522/ptj.20140405] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Therapists frequently advise the use of activity pacing as a coping strategy to manage long-term conditions (eg, chronic low back pain, chronic widespread pain, chronic fatigue syndrome/myalgic encephalomyelitis). However, activity pacing has not been clearly operationalized, and there is a paucity of empirical evidence regarding pacing. This paucity of evidence may be partly due to the absence of a widely used pacing scale. To address the limitations of existing pacing scales, the 38-item Activity Pacing Questionnaire (APQ-38) was previously developed using the Delphi technique. OBJECTIVE The aims of this study were: (1) to explore the psychometric properties of the APQ-38, (2) to identify underlying pacing themes, and (3) to assess the reliability and validity of the scale. DESIGN This was a cross-sectional questionnaire study. METHODS Three hundred eleven adult patients with chronic pain or fatigue participated, of whom 69 completed the test-retest analysis. Data obtained for the APQ-38 were analyzed using exploratory factor analysis, internal and test-retest reliability, and validity against 2 existing pacing subscales and validated measures of pain, fatigue, anxiety, depression, avoidance, and mental and physical function. RESULTS Following factor analysis, 12 items were removed from the APQ-38, and 5 themes of pacing were identified in the resulting 26-item Activity Pacing Questionnaire (APQ-26): activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance. These themes demonstrated satisfactory internal consistency (Cronbach α=.72-.92), test-retest reliability (intraclass correlation coefficient=.50-.78, P≤.001), and construct validity. Activity adjustment, activity progression, and activity acceptance correlated with worsened symptoms; activity consistency correlated with improved symptoms; and activity planning correlated with both improved and worsened symptoms. LIMITATIONS Data were collected from self-report questionnaires only. CONCLUSIONS Developed to be widely used across a heterogeneous group of patients with chronic pain or fatigue, the APQ-26 is multifaceted and demonstrates reliability and validity. Further study will explore the effects of pacing on patients' symptoms to guide therapists toward advising pacing themes with empirical benefits.
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Nijrolder I, Leone SS, van der Horst HE. Explaining fatigue: an examination of patient causal attributions and their (in)congruence with family doctors' initial causal attributions. Eur J Gen Pract 2015; 21:164-9. [PMID: 26134092 DOI: 10.3109/13814788.2015.1055556] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND General practitioners (GPs) and patients can have different ideas about the causes of fatigue, which may hinder management of fatigue. OBJECTIVE To investigate the causal attributions of patients and their GPs for fatigue, their level of agreement, and the association between patients' attributions, and fatigue characteristics and other illness perceptions. METHODS Baseline data, collected between 2004 and 2006, of a prospective cohort study among 642 adult patients presenting to Dutch primary care practices (n = 147) with a main symptom of fatigue, were used. Patient causal attributions and illness perceptions were measured using the revised illness perception questionnaire (fatigue version). GP causal attributions were measured with an open question included in the form that was completed at the end of the patient's visit. Fatigue severity was measured using the checklist individual strength. RESULTS Psychosocial causes were among the most often reported causal attributions by both patients and GPs. In 33% of 519 cases, the GP had no idea about the cause whereas the patient did. Overall, the agreement between the first reported causal attribution of patients and GPs was low. Qualitative differences in the labelling of causes were also found. Type of attribution (physical vs psychosocial/psychological) was associated with duration of fatigue (40 vs 25 months), and personal control (score 17.4 vs. 18.9). CONCLUSION Most patients and GPs had ideas about the causes of fatigue, but differences were found in the first reported causes and the labelling of causes. The findings may provide leads for optimizing communication about fatigue.
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Affiliation(s)
- Iris Nijrolder
- a Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , the Netherlands
| | - Stephanie S Leone
- b Department of Public Mental Health , Netherlands Institute of Mental Health and Addiction , Utrecht , the Netherlands
| | - Henriette E van der Horst
- a Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , the Netherlands
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Bourke JH, Langford RM, White PD. The common link between functional somatic syndromes may be central sensitisation. J Psychosom Res 2015; 78:228-36. [PMID: 25598410 DOI: 10.1016/j.jpsychores.2015.01.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/23/2014] [Accepted: 01/04/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Functional somatic syndromes are common and disabling conditions that all include chronic pain, and which may be related to central nervous system sensitisation. Here, we address the concept of central sensitisation as a physiological basis for the functional somatic syndromes. METHODS A narrative review of the current literature on central sensitisation and physiological studies in the functional somatic syndromes. RESULTS Central sensitisation may be a common neurophysiological process that is able to explain non-painful as well as painful symptoms in these disorders. Furthermore, central sensitisation may represent an endophenotypic vulnerability to the development of these syndromes that potentially explains why they cluster together. CONCLUSIONS Further research is needed to verify these findings, including prospective studies and the standardisation of combined methods of investigation in the study of central sensitisation in functional somatic syndromes. In turn, this may lead to new explanatory mechanisms and treatments being evaluated. Our conclusions add to the debate over the nomenclature of these syndromes but importantly also provide an explanation for our patients.
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Affiliation(s)
- Julius H Bourke
- Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University London, UK.
| | - Richard M Langford
- Pain and Anaesthesia Research Centre, St. Bartholomew's Hospital, London EC1A 7BE, UK
| | - Peter D White
- Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University London, UK
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Band R, Wearden A, Barrowclough C. Patient Outcomes in Association With Significant Other Responses to Chronic Fatigue Syndrome: A Systematic Review of the Literature. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015; 22:29-46. [PMID: 26617440 PMCID: PMC4654336 DOI: 10.1111/cpsp.12093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 04/06/2014] [Accepted: 05/15/2014] [Indexed: 01/08/2023]
Abstract
Social processes have been suggested as important in the maintenance of chronic fatigue syndrome (also known as myalgic encephalomyelitis; CFS/ME), but the specific role of close interpersonal relationships remains unclear. We reviewed 14 articles investigating significant other responses to close others with CFS/ME and the relationships between these responses and patient outcomes. Significant other beliefs attributing patient responsibility for the onset and ongoing symptoms of CFS/ME were associated with increased patient distress. Increased symptom severity, disability, and distress were also associated with both solicitous and negative significant other responses. Specific aspects of dyadic relationship quality, including high Expressed Emotion, were identified as important. We propose extending current theoretical models of CFS/ME to include two potential perpetuating interpersonal processes; the evidence reviewed suggests that the development of significant other-focused interventions may also be beneficial.
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Affiliation(s)
- Rebecca Band
- School of Psychological Sciences & Manchester Centre for Health Psychology, University of Manchester
| | - Alison Wearden
- School of Psychological Sciences & Manchester Centre for Health Psychology, University of Manchester
| | - Christine Barrowclough
- School of Psychological Sciences & Manchester Centre for Health Psychology, University of Manchester
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Gray matter volumes in patients with chronic fatigue syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:380615. [PMID: 25792998 PMCID: PMC4352504 DOI: 10.1155/2015/380615] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/26/2014] [Indexed: 11/17/2022]
Abstract
Chronic fatigue syndrome (CFS) is a debilitating and complex disorder characterized by profound fatigue with uncertain pathologic mechanism. Neuroimage may be an important key to unveil the central nervous system (CNS) mechanism in CFS. Although most of the studies found gray matter (GM) volumes reduced in some brain regions in CFS, there are many factors that could affect GM volumes in CFS, including chronic pain, stress, psychiatric disorder, physical activity, and insomnia, which may bias the results. In this paper, through reviewing recent literatures, we discussed these interferential factors, which overlap with the symptoms of CFS.
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Stahl D, Rimes KA, Chalder T. Mechanisms of change underlying the efficacy of cognitive behaviour therapy for chronic fatigue syndrome in a specialist clinic: a mediation analysis. Psychol Med 2014; 44:1331-1344. [PMID: 23931831 DOI: 10.1017/s0033291713002006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several randomized controlled trials (RCTs) have shown that cognitive behavioural psychotherapy (CBT) is an efficacious treatment for chronic fatigue syndrome (CFS). However, little is known about the mechanisms by which the treatment has its effect. The aim of this study was to investigate potential mechanisms of change underlying the efficacy of CBT for CFS. We applied path analysis and introduce novel model comparison approaches to assess a theoretical CBT model that suggests that fearful cognitions will mediate the relationship between avoidance behaviour and illness outcomes (fatigue and social adjustment). METHOD Data from 389 patients with CFS who received CBT in a specialist service in the UK were collected at baseline, at discharge from treatment, and at 3-, 6- and 12-month follow-ups. Path analyses were used to assess possible mediating effects. Model selection using information criteria was used to compare support for competing mediational models. RESULTS Path analyses were consistent with the hypothesized model in which fear avoidance beliefs at the 3-month follow-up partially mediate the relationship between avoidance behaviour at discharge and fatigue and social adjustment respectively at 6 months. CONCLUSIONS The results strengthen the validity of a theoretical model of CBT by confirming the role of cognitive and behavioural factors in CFS.
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Affiliation(s)
- D Stahl
- Department of Biostatistics, Institute of Psychiatry, King's College London, UK
| | - K A Rimes
- Department of Psychology, University of Bath, UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
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Koho P, Aho S, Kautiainen H, Pohjolainen T, Hurri H. Test-retest reliability and comparability of paper and computer questionnaires for the Finnish version of the Tampa Scale of Kinesiophobia. Physiotherapy 2014; 100:356-62. [PMID: 24679373 DOI: 10.1016/j.physio.2013.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To estimate the internal consistency, test-retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients' personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied. DESIGN Test-retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days. PARTICIPANTS The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour. RESULTS The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test-retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods. CONCLUSION Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test-retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.
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Affiliation(s)
- P Koho
- ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland; ORTON Orthopaedic Hospital, ORTON Foundation, Helsinki, Finland.
| | - S Aho
- ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland
| | - H Kautiainen
- ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland; Unit of Family Practice, Central Finland Central Hospital, Jyväskylä, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - T Pohjolainen
- ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland
| | - H Hurri
- ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland
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Allostatic overload in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Med Hypotheses 2013; 81:506-8. [PMID: 23850395 DOI: 10.1016/j.mehy.2013.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/06/2013] [Accepted: 06/21/2013] [Indexed: 12/19/2022]
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterised by diverse symptoms such as fatigue, pain, sleep disturbance and autonomic dysfunction. There remains to be a singular biomarker identified for this illness, hence numerous theories about its development and perpetuation have been posited in the literature. This brief report presents the model of 'allostasis' as a framework for understanding ME/CFS, specifically the notion that the physiological mechanisms employed in the body to deal with stress termed here as 'allostatic states' (e.g. elevation of inflammatory cytokines), may in and of themselves contribute to the perpetuation of the disorder. This theoretical assertion has important consequences for the understanding of ME/CFS and treatment; rather than searching for a singular pathogen responsible for this condition, ME/CFS can be conceptualised as a maladaptive stress disorder and interventions aimed at addressing the allostatic states may be incorporated into current symptom management programmes.
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Buchser E, Paraschiv-Ionescu A, Durrer A, Depierraz B, Aminian K, Najafi B, Rutschmann B. Improved physical activity in patients treated for chronic pain by spinal cord stimulation. Neuromodulation 2013; 8:40-8. [PMID: 22151382 DOI: 10.1111/j.1094-7159.2005.05219.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to objectively assess the physical activity of daily living in chronic pain patients treated with spinal cord stimulation (SCS). Changes in pain and spontaneous physical activity following SCS were evaluated under real life conditions. Five series of measurements were performed before the implant (baseline) and at one, three, six, and 12 months after the implantation of an SCS system. Compared to baseline values, physical activity increased consistently during the entire follow-up period. The time spent walking and standing was statistically increased after six months (p < 0.01) and the time spent lying decreased significantly (p < 0.001) at the same time. The average total walking distance increased up to 389% at 12 months, reaching statistical significance (p < 0.05) after three months. The stride length and the speed increased (p < 0.01) at all times. We conclude that the reduction in pain intensity due to SCS is associated with a progressive and sustained improvement in physical activity. j.
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Affiliation(s)
- Eric Buchser
- Anesthesia and Pain Management Services, Center for Neuromodulation EHC, Hospital of Morges, Morges; Anesthesia Department, University Hospital, CHUV, Lausanne; School of Engineering, Laboratory of Movement Analysis and Measurement, Swiss Federal Institute of Technology, Lausanne, Switzerland
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Strahler J, Fischer S, Nater UM, Ehlert U, Gaab J. Norepinephrine and epinephrine responses to physiological and pharmacological stimulation in chronic fatigue syndrome. Biol Psychol 2013; 94:160-6. [PMID: 23770415 DOI: 10.1016/j.biopsycho.2013.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 11/30/2022]
Abstract
Chronic fatigue syndrome (CFS) is characterized by fatigue lasting 6 months or longer. CFS has been associated with a disturbed (re-)activity of the autonomic nervous system. However, the sympathetic adrenomedulla (SAM) remains under-examined in CFS. To investigate SAM reactivity, we implemented a submaximal cycle ergometry (ERGO) and a pharmacological test (Insulin Tolerance Test, ITT) in 21 CFS patients and 20 age-, sex-, and BMI-matched controls. Plasma norepinephrine and epinephrine were collected once before and twice after the tests (+10/+20, and +30 min). Lower baseline levels and attenuated responses of epinephrine to the ERGO were found in CFS patients compared to controls, while the groups did not differ in their responses to the ITT. To conclude, we found evidence of altered sympathetic-neural and SAM reactivity in CFS. Exercise stress revealed a subtle catecholaminergic hyporeactivity in CFS patients. It is conceivable that inadequate catecholaminergic responses to physical exertion might contribute to CFS symptoms.
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Affiliation(s)
- Jana Strahler
- Clinical Biopsychology, Department of Psychology, University of Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany.
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Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice. Clin Rheumatol 2013; 32:1121-9. [DOI: 10.1007/s10067-013-2277-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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The neuropsychiatric and neuropsychological features of chronic fatigue syndrome: revisiting the enigma. Curr Psychiatry Rep 2013; 15:353. [PMID: 23440559 DOI: 10.1007/s11920-013-0353-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this article is to provide a comprehensive and updated review of the key neuropsychiatric and neuropsychological complaints associated with chronic fatigue syndrome (CFS). Neuropsychiatric and neuropsychological difficulties are common in CFS and are linked primarily to disorders of mood, affect and behaviour. The neuropsychiatric complaint most frequently encountered amongst CFS patients is depression and in particular major depressive disorder (MDD). Despite decades of research, the precise aetiological relationship between CFS and MDD remains poorly understood. This has resulted in the development of a number of interesting and polarised hypotheses regarding the aetiological nature of CFS. Recent scientific advances have however begun to unravel a number of interesting inflammatory and immunological explanations that suggest CFS and MDD are distinct yet interrelated conditions. The possibility that the overlap between CFS and MDD might be explained in terms of shared oxidative and nitrosative (IO&NS) pathways is an area of intense research interest and is reviewed in detail in this article. The overlap between CFS and MDD is further differentiated by variations in HPA axis activity between the two disorders. Important immunological differences between MDD and CFS are also reviewed with particular emphasis on antiviral RNase L pathways in CFS. In addition to the presence of neuropsychiatric complaints, CFS is also associated with neuropsychological symptoms such as impaired attention, memory and reaction time. The key neuropsychological problems reported by CFS patients are also included in the review in an effort to understand the significance of cognitive impairment in CFS.
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Suárez A, Guillamó E, Roig T, Blázquez A, Alegre J, Bermúdez J, Ventura JL, García-Quintana AM, Comella A, Segura R, Javierre C. Nitric oxide metabolite production during exercise in chronic fatigue syndrome: a case-control study. J Womens Health (Larchmt) 2012; 19:1073-7. [PMID: 20469961 DOI: 10.1089/jwh.2008.1255] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a disabling illness of unknown etiology that is characterized by fatigue associated with a reduced ability to work, lasting for more than 6 months, and accompanied by a specific set of symptoms. The diagnosis remains difficult because of the absence of laboratory tests and is, therefore, made largely on the basis of the symptoms reported by the patient. The aim of this study was to analyze differences in blood nitrate levels in CFS patients and a matched control group after a physical exercise test. METHODS Forty-four consecutive female patients with CFS and 25 healthy women performed an exercise test using a cycle ergometer with monitoring of cardiopulmonary response. Blood samples were obtained for biochemical analyses of glucose, lactate, and nitrates at the beginning (under resting conditions) and after the maximal and supramaximal tests. RESULTS Plasma nitrates differed between the groups, with higher values in the CFS group (F = 6.93, p = 0.003). Nitrate concentration increased in relation to workload and reached higher values in the CFS group, the maximum difference with respect to the control group being 295% (t = 4.88, p < 0.001). CONCLUSIONS The main result of the present study is that nitric oxide (NO) metabolites (nitrates) showed a much higher increase after a maximal physical test in CFS patients than in a group of matched subjects. This combination (exercise plus NO response evaluation) may be useful in the assessment of CFS.
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Affiliation(s)
- Andrea Suárez
- Department of Physiological Sciences II, Medical School, University of Barcelona, L'Hospitalet, Barcelona, Spain
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Van Cauwenbergh D, De Kooning M, Ickmans K, Nijs J. How to exercise people with chronic fatigue syndrome: evidence-based practice guidelines. Eur J Clin Invest 2012; 42:1136-44. [PMID: 22725992 DOI: 10.1111/j.1365-2362.2012.02701.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the large number of studies emphasizing the effectiveness of graded exercise therapy (GET) and cognitive behavioural therapy (CBT) for people with chronic fatigue syndrome (CFS), clinicians are left wondering how exactly to apply exercise therapy to their patients with CFS. The aim of this literature review is to identify the appropriate exercise modalities (i.e. exercise duration, mode, number of treatment sessions, session length, duration of treatment, exercise intensity and whether or not to apply home exercise program) for people with CFS. MATERIALS AND METHODS All studies that were identified through electronic databases (PubMed and PEDro) were assessed for methodological quality by using selection criteria (Delphi score). RESULTS In this literature review, 12 studies fulfilled all study requirements. One study had a low methodological quality. The parameters used in the GET and CBT interventions were divided into subgroups: (i) time or symptom contingent, (ii) exercise frequency and (iii) exercise modality. CONCLUSION The lack of uniformity in outcome measures and CFS diagnostic criteria make it difficult to compare the findings across studies. Based on the available evidence, exercise therapy for people with CFS should be aerobic and must comprise of 10-11 sessions spread over a period of 4-5 months. A time-contingent approach is preferred over a symptom-contingent way of exercising. In addition, people with CFS can perform home exercises five times a week with an initial duration of 5-15 min per exercise session. The exercise duration can be gradually increased up to 30 min.
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Affiliation(s)
- Deborah Van Cauwenbergh
- Chronic Pain and Chronic Fatigue Research Group (CHROPIVER), Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
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Ryan S, Räisänen U. "The brain is such a delicate thing": an exploration of fear and seizures among young people with epilepsy. Chronic Illn 2012; 8:214-24. [PMID: 22615484 DOI: 10.1177/1742395312449666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Epilepsy is a condition where pathology, diverse manifestations and attached social understandings contribute to an emotional experience unlike many other chronic conditions. The emotional dimension to epilepsy has been little considered in existing research. OBJECTIVES To explore the emotional experience of young people with epilepsy. METHODS A qualitative study involving in-depth interviews with 37 young people diagnosed with epilepsy. RESULTS Fear emerged as the key emotion and this largely related to the experience, or anticipated experience, of seizure activity. Three key features of fear and epilepsy emerged through the analysis; harm, temporality and action. The fear experienced was not only external, relating to immediate injury, but also internal in terms of potential damage to the brain. The embodied nature of epilepsy can, therefore, present a threat to conceptions of the self. Underlying this internal dimension of fear is an understanding of the brain as central to the sense of self. CONCLUSIONS The experience of epilepsy does not only involve fear of physical harm but also fear of a loss of self. We conclude that there are broader (alternative) readings of the experience of epilepsy that are often overlooked.
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Affiliation(s)
- Sara Ryan
- Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
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Influence of Symptom Expectancies on Stair-Climbing Performance in Chronic Fatigue Syndrome: Effect of Study Context. Int J Behav Med 2012; 20:213-8. [DOI: 10.1007/s12529-012-9253-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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VanNess JM, Stevens SR, Bateman L, Stiles TL, Snell CR. Postexertional malaise in women with chronic fatigue syndrome. J Womens Health (Larchmt) 2012; 19:239-44. [PMID: 20095909 DOI: 10.1089/jwh.2009.1507] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Postexertional malaise (PEM) is a defining characteristic of chronic fatigue syndrome (CFS) that remains a source of some controversy. The purpose of this study was to explore the effects of an exercise challenge on CFS symptoms from a patient perspective. METHODS This study included 25 female CFS patients and 23 age-matched sedentary controls. All participants underwent a maximal cardiopulmonary exercise test. Subjects completed a health and well-being survey (SF-36) 7 days postexercise. Subjects also provided, approximately 7 days after testing, written answers to open-ended questions pertaining to physical and cognitive responses to the test and length of recovery. SF-36 data were compared using multivariate analyses. Written questionnaire responses were used to determine recovery time as well as number and type of symptoms experienced. RESULTS Written questionnaires revealed that within 24 hours of the test, 85% of controls indicated full recovery, in contrast to 0 CFS patients. The remaining 15% of controls recovered within 48 hours of the test. In contrast, only 1 CFS patient recovered within 48 hours. Symptoms reported after the exercise test included fatigue, light-headedness, muscular/joint pain, cognitive dysfunction, headache, nausea, physical weakness, trembling/instability, insomnia, and sore throat/glands. A significant multivariate effect for the SF-36 responses (p < 0.001) indicated lower functioning among the CFS patients, which was most pronounced for items measuring physiological function. CONCLUSIONS The results of this study suggest that PEM is both a real and an incapacitating condition for women with CFS and that their responses to exercise are distinctively different from those of sedentary controls.
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Affiliation(s)
- J Mark VanNess
- Pacific Fatigue Laboratory, University of the Pacific, Stockton, California 95211, USA.
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Velthuis MJ, Peeters PH, Gijsen BC, van den Berg JP, Koppejan-Rensenbrink RA, Vlaeyen JW, May AM. Role of fear of movement in cancer survivors participating in a rehabilitation program: a longitudinal cohort study. Arch Phys Med Rehabil 2012; 93:332-8. [PMID: 22289246 DOI: 10.1016/j.apmr.2011.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 07/23/2011] [Accepted: 08/14/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the relationship between fear of movement and perceived global health status and the role of rehabilitation with graded activity in cancer survivors. DESIGN Longitudinal cohort study. SETTING Rehabilitation centers. PARTICIPANTS Cancer survivors (N=1236). INTERVENTION Twelve-week graded activity rehabilitation program. MAIN OUTCOME MEASURES Fear of movement (Modified Tampa Scale for Kinesiophobia-Fatigue), fatigue (Functional Assessment of Cancer Therapy-Fatigue), and perceived global health status (European Organisation Research and Treatment of Cancer Quality of Life Questionnaire C30) were measured at baseline and after rehabilitation. We performed multiple linear regression analyses to examine the association between fear of movement and perceived global health status at baseline. Differences between baseline and postintervention scores were assessed with a paired t test and effect sizes (ESs). Hierarchical multiple regression analyses were used to investigate whether changes in fear of movement were associated with perceived global health status. RESULTS Fear of movement was associated with perceived global health status prior to rehabilitation (P=.001). Only participants with high scores on baseline fear of movement showed a considerable decrease in fear of movement after rehabilitation (ES=-.69; 95% confidence interval [CI], -.80 to -.57); the reduction was largest for fears because of a somatic focus (ES=-.57; 95% CI, -.68 to -.45). Changes in fear of movement because of a somatic focus were related to perceived global health status postintervention (P=.001). CONCLUSIONS Fear of movement is associated with the perceived global health status of cancer survivors. Fear of movement decreases after rehabilitation with graded activity in high scorers on baseline fear of movement.
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Role of psychological aspects in both chronic pain and in daily functioning in chronic fatigue syndrome: a prospective longitudinal study. Clin Rheumatol 2012; 31:921-9. [DOI: 10.1007/s10067-012-1946-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 11/16/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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Nijs J, Meeus M, Heins M, Knoop H, Moorkens G, Bleijenberg G. Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study. Disabil Rehabil 2012; 34:1299-305. [PMID: 22324510 DOI: 10.3109/09638288.2011.641661] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Kinesiophobia and catastrophizing are frequent among people with chronic fatigue syndrome (CFS). This study was aimed at examining (1) whether kinesiophobia, anticipated symptoms and fatigue catastrophizing are related to stair climbing performance in people with CFS; and (2) whether kinesiophobia and fatigue catastrophizing are related to daily physical activity in CFS. METHOD Patients with CFS filled in a set of questionnaires, performed a physical demanding task (two floors stair of climbing and descending) with pre-test and post-test heart rate monitoring and immediate post-stair climbing symptom assessment. Real-time activity monitoring was used between the baseline and second assessment day (7 days later). RESULTS Kinesiophobia and fatigue catastrophizing were strongly related (ρ = 0.62 and 0.67, respectively) to poorer stair climbing performance (i.e. more time required to complete the threatening activity). Kinesiophobia and fatigue catastrophizing were unrelated to the amount of physical activity on the first day following stair climbing or during the seven subsequent days. CONCLUSION These findings underscore the importance of kinesiophobia and fatigue catastrophizing for performing physical demanding tasks in everyday life of people with CFS, but refute a cardinal role for kinesiophobia and fatigue catastrophizing in determining daily physical activity level in these patients.
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Affiliation(s)
- Jo Nijs
- Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
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Meeus M, van Eupen I, van Baarle E, De Boeck V, Luyckx A, Kos D, Nijs J. Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study. Arch Phys Med Rehabil 2011; 92:1820-6. [PMID: 22032215 DOI: 10.1016/j.apmr.2011.06.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/20/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the activity pattern of patients with chronic fatigue syndrome (CFS) with healthy sedentary subjects and examine the relationship between the different parameters of performed activity (registered by an accelerometer device) and symptom severity and fluctuation (registered by questionnaires) in patients with CFS. DESIGN Case-control study. Participants were asked to wear an accelerometer device on the nondominant hand for 6 consecutive days. Every morning, afternoon, and evening patients scored the intensity of their pain, fatigue, and concentration difficulties on a visual analog scale. SETTING Patients were recruited from a specialized chronic fatigue clinic in the university hospital, where all subjects were invited for 2 appointments (for questionnaire and accelerometer adjustments). In between, activity data were collected in the subject's normal home environment. PARTICIPANTS Female patients (n=67) with CFS and female age-matched healthy sedentary controls. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Accelerometry (average activity counts, peak activity counts, ratio peak/average, minutes spent per activity category) and symptom severity (intensity of pain, fatigue, and concentration difficulties). RESULTS Patients with CFS were less active, spent more time sedentary, and less time lightly active (P<.05). The course of the activity level during the registration period (P interaction>.05), peak activity, and the staggering of activities (ratio peak/average) on 1 day were not different between groups (P>.05). Negative correlations (-.242 varying to -.307) were observed for sedentary activity and the ratio with symptom severity and variation on the same and the next day. Light, moderate, and vigorous, as well as the average activity and the peak activity, were positively correlated (.242 varying to .421) with symptom severity and variation. CONCLUSIONS The more patients with CFS are sedentary and the better activity is dispersed, the fewer symptoms and variations they experience on the same and next day. Inversely, more symptoms and variability is experienced when patients were more active that day or the previous day. The direction of these relations cannot be determined in a cross-sectional study and requires further study.
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Affiliation(s)
- Mira Meeus
- Division of Musculoskeletal Physiotherapy, Department of Health Sciences, Artesis University College Antwerp, Belgium
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Poppe C, Crombez G, Hanoulle I, Vogelaers D, Petrovic M. Mental quality of life in chronic fatigue is associated with an accommodative coping style and neuroticism: a path analysis. Qual Life Res 2011; 21:1337-45. [DOI: 10.1007/s11136-011-0048-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2011] [Indexed: 10/15/2022]
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Nijs J, Aelbrecht S, Meeus M, Van Oosterwijck J, Zinzen E, Clarys P. Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome. Disabil Rehabil 2011; 33:1493-500. [DOI: 10.3109/09638288.2010.541543] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Velthuis MJ, Van den Bussche E, May AM, Gijsen BCM, Nijs S, Vlaeyen JWS. Fear of movement in cancer survivors: validation of the Modified Tampa Scale of Kinesiophobia-Fatigue. Psychooncology 2011; 21:762-70. [DOI: 10.1002/pon.1971] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 02/24/2011] [Accepted: 03/08/2011] [Indexed: 11/12/2022]
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Larun L, Malterud K. Finding the right balance of physical activity: a focus group study about experiences among patients with chronic fatigue syndrome. PATIENT EDUCATION AND COUNSELING 2011; 83:222-226. [PMID: 20580520 DOI: 10.1016/j.pec.2010.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 05/19/2010] [Accepted: 05/30/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To explore contexts of experiences of physical activity perceived as beneficial or harmful for CFS patients. METHODS A qualitative study with empirical data from two focus groups with purposive sampling. Mean age was 50, two of ten participants were male, and social demographics varied. Participants were invited to share stories of good as well as bad experiences concerning physical activity. Data were analysed with systematic text condensation. RESULTS Participants were not averse to physical activity, but specific preconditions would determine how the activity was perceived. Physical activity was experienced as helpful and enjoyable, especially related to leisure activities where flexible and individual adaptation was feasible. Non-customized activity may precipitate set-backs giving patients the impression of losing control and being betrayed by their bodies. Strategies to review energy usage in daily life could adjust expectations, diminish stress load and assist in approaching a more appropriate priority and balance. CONCLUSION Self-management, body awareness and physical activity of choice combined with facilitation and advice from health care professionals is essential to achieve a positive outcome. PRACTICE IMPLICATIONS Exercise programmes should be adapted, paced, and self-managed in accordance with personal preferences and activity levels to be beneficial and empowering for CFS patients.
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Affiliation(s)
- Lillebeth Larun
- Research Unit for General Practice, Uni Research, Bergen, Norway.
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Friedberg F. Chronic fatigue syndrome, fibromyalgia, and related illnesses: a clinical model of assessment and intervention. J Clin Psychol 2010; 66:641-65. [PMID: 20186721 DOI: 10.1002/jclp.20676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A clinically informative behavioral literature on chronic fatigue syndrome (CFS) and fibromyalgia (FM) has emerged over the past decade. The purpose of this article is to (a) define these conditions and their less severe counterparts, i.e., unexplained chronic fatigue (UCF) and chronic widespread pain; (b) briefly review the behavioral theory and intervention literature on CFS and FM; and (c) describe a user-friendly clinical model of assessment and intervention for these illnesses. The assessments described will facilitate understanding of the somewhat unusual and puzzling somatic presentations that characterize these patients. Using an individualized cognitive-behavioral approach the mental health clinician can offer significant help to these often stigmatized and medically underserved patients.
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Affiliation(s)
- Fred Friedberg
- Putnam Hall/South Campus, Stony Brook University, Stony Brook, NY 11794-8790, USA.
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Visscher CM, Ohrbach R, van Wijk AJ, Wilkosz M, Naeije M. The Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD). Pain 2010; 150:492-500. [DOI: 10.1016/j.pain.2010.06.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 05/27/2010] [Accepted: 06/03/2010] [Indexed: 12/19/2022]
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Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education: A Double-Blind Randomized Controlled Trial. Arch Phys Med Rehabil 2010; 91:1153-9. [DOI: 10.1016/j.apmr.2010.04.020] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/22/2010] [Accepted: 04/22/2010] [Indexed: 12/15/2022]
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Bol Y, Duits AA, Lousberg R, Hupperts RMM, Lacroix MHP, Verhey FRJ, Vlaeyen JWS. Fatigue and physical disability in patients with multiple sclerosis: a structural equation modeling approach. J Behav Med 2010; 33:355-63. [PMID: 20508981 PMCID: PMC2931636 DOI: 10.1007/s10865-010-9266-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 05/04/2010] [Indexed: 11/29/2022]
Abstract
Although fatigue is one of the most common and disabling symptoms in patients with multiple sclerosis (MS), its pathogenesis is still poorly understood and it is difficult to treat. The aim of the current study was to test the assumptions of a cognitive-behavioral model that explains fatigue and physical disability in MS patients, by comparing this approach with a more traditional biomedical approach. Structural equation modeling was applied to a sample of 262 MS patients. Neither the cognitive-behavioral, nor the biomedical model showed an adequate fit of our data. The modification indices supported an integration of both models, which showed a better fit than those of the separate models. This final model, is notable for at least three features: (1) fatigue is associated with depression and physical disability, (2) physical disability is associated with disease severity and fatigue-related fear and avoidance behavior, and (3) catastrophic interpretations about fatigue, fueled by depression, mediated the relationship between fatigue and fatigue-related fear and avoidance behavior. Our results suggest that an integrated approach, including the modification of catastrophic thoughts about fatigue, would be beneficial in the treatment of fatigue in MS patients.
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Affiliation(s)
- Yvonne Bol
- Department of Medical Psychology and Psychiatry, Orbis Medical Centre, PO Box 5500, 6130 MB Sittard, The Netherlands.
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