Factor structure and internal consistency of a Swedish version of the Pain Catastrophizing Scale

Long-Term Follow-Up of a Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion

OBJECTIVE

Long-term follow-ups of prehabilitation programs for lumbar spine surgery are lacking, and more comprehensive evaluations are needed. In the current study, we evaluated the long-term effects of a prehabilitation program compared with conventional care in relation to lumbar fusion surgery in patients with degenerative disc disease.

METHODS

Patients (n = 118) receiving lumbar fusion surgery were included in a multicenter randomized controlled trial, involving 1 university hospital and 2 spine clinics. The intervention was a person-centered prehabilitation program based on cognitive-behavioral physical therapy that targeted psychological presurgical risk factors, physical activity, and overall health. The control group received conventional preoperative care. Patient-reported outcome measures (PROMs) included assessments at 8 time-points: low back disability (primary outcome), back pain intensity, leg pain intensity, pain catastrophizing, fear of movement, anxiety and depressive mood, health-related quality of life, and patient-specific functioning. Physical activity and physical capacity were assessed at 5 time points. Linear mixed models were used to analyze the effects of the intervention.

RESULTS

There were no significant differences between groups at the 12- and 24-month follow-ups for any outcome, except for the One Leg Stand test 1 year following surgery, in favor of the control group. There were significant improvements for both groups, from baseline to the 12- and 24-month follow-ups for all physical capacity test and patient-reported outcome measures, except for leg pain and self-efficacy for exercise.

CONCLUSION

No long-term effects were found for the prehabilitation program compared to conventional care. Physical activity did not improve over time, despite significantly improved self-reported functioning and physical capacity measurements.

IMPACT

These findings have implications for the current understanding of the long-term effects of prehabilitation and suggest that future research should focus on programs promoting physical activity both before and after lumbar spine surgery to decrease the risk of long-term adverse health outcomes.

Get Back, a person-centred digital programme targeting physical activity for patients undergoing spinal stenosis surgery-a study protocol of a randomized feasibility study

BACKGROUND

Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content.

METHODS

Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be displayed graphically and data from telephone interviews will be analysed using content analysis with a descriptive manifest approach.

DISCUSSION

The results will provide information on whether Get Back in its present format is feasible and can be evaluated for effectiveness in a larger randomized controlled trial, for patients with a low physical activity level and a high fear of movement who are undergoing decompression surgery.

TRIAL REGISTRATION

Registered at ClinicalTrails.gov 04/08/2023, registration no. NCT05806593.

Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder

BACKGROUND

Movement behaviours, such as sedentary behaviour (SB) and moderate to vigorous physical activity (MVPA), are linked with multiple aspects of health and can be influenced by various pain-related psychological factors, such as fear of movement, pain catastrophising and self-efficacy for exercise. However, the relationships between these factors and postoperative SB and MVPA remain unclear in patients undergoing surgery for lumbar degenerative conditions. This study aimed to investigate the association between preoperative pain-related psychological factors and postoperative SB and MVPA in patients with low back pain (LBP) and degenerative disc disorder at 6 and 12 months after lumbar fusion surgery.

METHODS

Secondary data were collected from 118 patients (63 women and 55 men; mean age 46 years) who underwent lumbar fusion surgery in a randomised controlled trial. SB and MVPA were measured using the triaxial accelerometer ActiGraph GT3X+. Fear of movement, pain catastrophising and self-efficacy for exercise served as predictors. The association between these factors and the relative time spent in SB and MVPA 6 and 12 months after surgery was analysed via linear regression models, adjusting for potential confounders.

RESULTS

Preoperative fear of movement was significantly associated with relative time spent in SB at 6 and 12 months after surgery (β = 0.013, 95% confidence interval = 0.004 to 0.022, p = 0.007). Neither pain catastrophising nor self-efficacy for exercise showed significant associations with relative time spent in SB and MVPA at these time points.

CONCLUSIONS

Our study demonstrated that preoperative fear of movement was significantly associated with postoperative SB in patients with LBP and degenerative disc disorder. This finding underscores the potential benefits of preoperative screening for pain-related psychological factors, including fear of movement, preoperatively. Such screenings could aid in identifying patients who might benefit from targeted interventions to promote healthier postoperative movement behaviour and improved health outcomes.

Catastrophizing and acceptance are mediators between insomnia and pain intensity-an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions

Background

Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship.

Aims

In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators.

Methods

This study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008-2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline.

Results

In this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia-pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths.

Discussion and conclusion

This study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.

Construct validity of the Mini-BESTest in individuals with chronic pain in specialized pain care

BACKGROUND

Balance assessment scales are important clinical tests to identify balance impairments. Chronic pain (> 3 months) is associated with impaired dynamic balance; however, very few balance assessment scales are psychometrically evaluated for the population. The purpose of this study was to evaluate the construct validity and internal consistency of the Mini-BESTest for individuals with chronic pain in specialized pain care.

METHODS

In this cross-sectional study, 180 individuals with chronic pain (> 3 months) were assessed with the Mini-BESTest and included in the analyses. For construct validity, five alternative factor structures were evaluated using a confirmatory factor analysis. In addition, we tested the a priori hypotheses about convergent validity with the 10-meter walk test, and divergent validity with the Brief Pain Inventory (BPI): pain intensity, the Tampa Scale of Kinesiophobia-11 (TSK-11), and the Pain Catastrophizing Scale (PCS-SW). Internal consistency was evaluated for the model with the best fit.

RESULTS

A one-factor model with added covariance via the modification indices showed adequate fit indices. In line with our hypotheses, Mini-BESTest showed convergent validity (r_s = > 0.70) with the 10-meter walk test, and divergent validity (r_s = < 0.50) with BPI pain intensity, TSK-11, and PCS-SW. Internal consistency for the one-factor model was good (α = 0.92).

CONCLUSIONS

Our study supported the construct validity and internal consistency of the Mini-BESTest for measuring balance in individuals with chronic pain, who were referred to specialized pain care. The one-factor model showed an adequate fit. In comparison, models with subscales did not reach convergence, or showed high correlations between subscales, implying that Mini-BESTest is measuring one construct in this sample. We, therefore, propose using the total score, instead of subscale scores, for individuals with chronic pain. However, further studies are necessary to establish the reliability of the Mini-BESTest in the population.

Fear network and pain extent: Interplays among psychological constructs related to the fear-avoidance model

OBJECTIVE

Psychological constructs related to the fear-avoidance model such as fear of movement, pain catastrophizing, and affective distress have been found to be inter-related among patients with chronic pain. However, relationships of these constructs have mostly been examined using regression-based analyses. This cross-sectional study employs a novel analytical approach, network analysis, to illustrate the complex interplays among these variables as well as pain intensity and pain interference.

METHODS

This study utilized the Swedish Quality Registry for Pain Rehabilitation, including data from 10,436 participants (76.0% women; M_age = 45.0 years). Networks were analyzed separately for patients with different pain extents (i.e., numbers of pain locations) as the interplays may differ qualitatively depending on pain extent.

RESULTS

We found that patients with a larger pain extent showed a worse clinical presentation (i.e., more depression and anxiety, increased fear of movement and pain interference), and their network differed from the patients with a smaller number of pain extent in terms of how strongly key variables were interconnected. In all network models, pain interference and catastrophizing showed consistently influential roles.

CONCLUSION

Our findings highlight the interactive nature of psychological aspects of pain and how interrelated associations differ depending on pain extent. Findings are discussed based on ideas on how both fear and pain become overgeneralized.

Masticatory performance in patients with jaw muscle pain: A case control study

Introduction

Masticatory function is often impaired in patients with painful temporomandibular disorders (TMD) therefore more detailed studies on comminution and mixing ability are warranted in well-defined TMD patients with chronic myalgia. Moreover, there is a need to explore the correlation between any changes in perceived pain or fatigue in such patients and the masticatory function.

Materials and methods

Self-assessments using questionnaires regarding pain, oral health, jaw function, masticatory ability, fear of movement and psychosocial signs were answered by all the participants. A series of chewing tasks involving viscoelastic food and two-colored gum was performed. Optical imaging and analyzing was conducted. Bite force as well as characteristics of pain and fatigue were assessed.

Results

In patients, the fragmented soft candy particles were less in number and had larger median of area and minimum Feret's diameter after standardized chewing compared to healthy individuals (P = 0.02). Surprisingly, the two-colored Hue-Check gum was less mixed by the healthy controls since they displayed a greater variance of the hue (P = 0.04). There were significant differences between the patients and the healthy controls in the self-assessed masticatory ability mainly regarding pain-related variables.

Conclusions

Objectively, TMD patients with chronic myalgia exhibited an impaired masticatory performance with less efficiency in comminuting soft viscoelastic food compared to the pain-free healthy control group. There was an agreement between the patients' self-assessed masticatory ability and the efficiency of their masticatory function.

The Role of Pain Catastrophizing, Emotional Intelligence, and Pain Intensity in the Quality of Life of Cancer Patients with Chronic Pain

Pain catastrophizing (PC) is a negative cognitive distortion to actual or anticipated pain. This study aims to investigate the relationship between pain catastrophizing, emotional intelligence, pain intensity, and quality of life (QoL) in cancer patients with chronic pain. Eighty-nine outpatients with chronic pain attending pain clinics and palliative care units were recruited. Participants were men (42.7%) and women (57.3%) with an average age of 56.44 years (SD = 14.82). Self-report psychological measures were completed, including a measure of emotional intelligence, a standard measure of PC, a scale assessing pain intensity, and a scale measuring QoL. The PC scale was found to assess three correlated yet different dimensions of pain catastrophizing (helplessness, magnification, and rumination). Moreover, as expected, patients with PC scale scores ≥ 30 had lower scores in functional QoL dimensions and higher scores in the fatigue, pain, and insomnia symptom dimensions. Regression analyses demonstrated that PC (B = − 0.391, p = 0.004), pain intensity (B = − 1.133, p < 0.001), and education (B = 2.915, p = 0.017) remained the only significant variables related to QoL, when controlling for demographic and clinical confounders. Regarding mediating effects, PC and pain intensity were jointly found to be significant mediators in the relationship between emotional intelligence and QoL. Results are discussed in the context of the clinical implications regarding interventions designed to improve cancer patients’ quality of life and offer new insight, understanding, and evaluation targets in the field of pain management.

A bifactor structural model of the Hungarian Pain Catastrophizing Scale and latent classes of a clinical sample

Pain catastrophizing is an exaggerated cognitive-affective response to actual or anticipated pain, usually measured by the Pain Catastrophizing Scale (PCS). Our study aimed to test the bifactor measurement model of the Hungarian PCS and to identify a catastrophizing risk group with a clinically meaningful cut-off score.

The data of 404 chronic spine-related (neck, back and low-back) pain patients (mean age: 58.61 (SD = 14.34)) were used in our cross-sectional study. Besides pain-related and demographic data, pain catastrophizing and depressive symptoms were measured with questionnaires. Confirmatory factor analyses confirmed that the bifactor model outperformed the other tested measurement models, and the general catastrophizing factor was responsible for 81.5% of the explained variance. Using latent class analysis, we found that even moderately elevated pain catastrophizing score was related to more depressive symptoms and higher perceived pain intensity, and 22 score could be used as a cut-off score. Our results support the concept of global pain catastrophizing and the validity of the Hungarian PCS. Further studies are needed to evaluate the bifactor structure of this scale and the predictive value of the proposed cut-off score.

Psychometric assessment of the Swedish version of the injustice experience questionnaire among patients with chronic pain

OBJECTIVES

The use of the Injustice Experience Questionnaire (IEQ) in psychological assessment of individuals with chronic pain is supported by research. The psychometric properties of the Swedish version, the IEQ-S, has not yet been evaluated. Hence, the aim was to investigate structural validity, and concurrent criterion validity of the IEQ-S against the Work Ability Index (WAI), the Pain Catastrophizing Scale (PCS-SW), the Patient Health Questionnaire 9-item depression module (PHQ-9), and the Generalized anxiety disorder 7-item scale (GAD-7). Internal consistency and test-retest reliability were also studied.

METHODS

Sixty-five participants, referred to a University hospital, with a pain duration over three months were consecutively sampled. They completed the IEQ-S at admission and again within six weeks. A confirmatory factor analysis was performed for the study of structural validity. Concurrent criterion validity was evaluated using Spearman's correlation coefficient. Internal consistency reliability for the full IEQ-S was calculated using the Cronbach's alpha. Test-retest reliability was calculated using an Intraclass Correlation Coefficient (ICC).

RESULTS

The median total score (0-48, where high scores indicate high levels of injustice) at admission (test 1) was 27.0 (n=64), 25th percentile=15.3, 75th percentile=37.8, range=3-48 points. A one-factor model was supported with item-loadings between 0.67-0.92. Spearman's correlation coefficient between the IEQ-S and the WAI (n=56) was r _S =-0.46; the PCS-SW (n=63) was r _S =0.68, the PHQ-9 (n=64) was r _S =0.50 and the GAD-7 (n=64) was r _S =0.57, p<0.01. Cronbach's alpha was 0.94 (n=64). The ICC was 0.80 (n=55), with a 95% confidence interval, ranging between 0.69-0.88.

CONCLUSIONS

Our study supported structural validity and concurrent criterion validity of the IEQ-S against other measures of psychological constructs and work ability. It also supported the internal consistency reliability of the IEQ-S and the test-retest reliability with a retest interval up to six weeks, was good. These findings support the use of the IEQ-S as an adjunct tool to assess appraisals of injustice in patients with chronic pain who are referred to tertiary care in Sweden. The added value might be identification of those who are at risk for slow or no improvement in their pain condition over time, and sick-leave, but this has to be confirmed in future studies.

ETHICAL COMMITTEE NUMBER

EPN Uppsala D-No 2016-376.

Tapering of prescribed opioids in patients with long-term non-malignant pain (TOPIO)-efficacy and effects on pain, pain cognitions, and quality of life: a study protocol for a randomized controlled clinical trial with a 12-month follow-up

Background

Opioids are still widely prescribed to long-term pain patients although they are no longer recommended for long-term treatments due to poor evidence for long-term efficacy, risks of serious side effects, and the possibility of inducing opioid hyperalgesia. In a Cochrane study from 2017, the authors identified an urgent need for more randomized controlled trials investigating the efficiency and effects of opioid tapering.

The study aimed to assess (1) the efficiency of a structured intervention in causing stable reductions of opioid consumption in a population with long-term non-malignant pain and (2) effects on pain, pain cognitions, physical and mental health, quality of life, and functioning in response to opioid tapering.

Methods

The study is a randomized controlled trial. The sample size was set to a total of 140 individuals after estimation of power and dropout. Participants will be recruited from a population with long-term non-malignant pain who will be randomly allocated to (1) the start of tapering immediately or (2) the control group who return to usual care and will commence tapering of opioids 4 months later. A 12-month follow-up is included.

When all follow-ups are closed, data from the Swedish drug register of the National Board of Health and Welfare will be collected and individual mean daily opioid dose in morphine equivalents will be calculated at three time points: baseline, 4 months, and 12 months after the start of the intervention. At the same time points, participants fill out the following questionnaires: Numeric Pain Rating Scale (NPRS), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Hospital Anxiety and Depression Scale (HADS), and RAND-36. At baseline and follow-up, a clinical assessment of opioid use disorder is performed.

Discussion

A better understanding of the efficiency and effects of opioid tapering could possibly facilitate attempts to taper opioid treatments, which might prove beneficial for both the individual and society.

Trial registration

ClinicalTrials.gov NCT03485430. Retrospectively registered on 26 March 2018, first release date. “Tapering of Long-term Opioid Therapy in Chronic Pain Population. RCT with 12 Months Follow up (TOPIO).” First patient in trial 22 March 2018.

A Network Analysis of Clinical Variables in Chronic Pain: A Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

BACKGROUND

Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective.

METHODS

In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain.

RESULTS

We found that Acceptance, Pain Interference, and Depression were key, "central," variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders.

CONCLUSIONS

This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.

Predicting pain: differential pain thresholds during self-induced, externally induced, and imagined self-induced pressure pain

Supplemental Digital Content is Available in the Text.

Imagining pressure pain to be self-induced led to increased pressure pain thresholds. Such sensory attenuation of pain was also seen in actual self-induced pressure.

During self-induced pain, a copy of the motor information from the body's own movement may help predict the painful sensation and cause downregulation of pain. This phenomenon, called sensory attenuation, enables the distinction between self-produced stimuli vs stimuli produced by others. Sensory attenuation has been shown to occur also during imagined self-produced movements, but this has not been investigated for painful sensations. In the current study, the pressure pain thresholds of 40 healthy participants aged 18 to 35 years were assessed when pain was induced by the experimenter (other), by themselves (self), or by the experimenter while imagining the pressure to be self-induced (imagery). The pressure pain was induced on the participants left lower thigh (quadriceps femoris) using a handheld algometer. Significant differences were found between all conditions: other and self (P < 0.001), other and imagery (P < 0.001), and self and imagery (P = 0.004). The mean pressure pain threshold for other was 521.49 kPa (SE = 38.48), for self 729.57 kPa (SE = 32.32), and for imagery 618.88 kPa (SE = 26.67). Thus, sensory attenuation did occur both in the self condition and the imagery condition. The results of this study may have clinical relevance for understanding the mechanisms involved in the elevated pain thresholds seen in patients with self-injury behavior and the low pain thresholds seen in patients with chronic pain conditions. Imagery of sensory attenuation might also be used to alleviate the pain experience for patients undergoing procedural pain.

Cross-cultural adaptation of the Pain Catastrophizing Scale in Greek clinical population

Background:

Catastrophizing is an important psychological construct in mediating the behavioral response toward pain.

Objective:

The purpose of this study is to examine the psychometric properties of the Pain Catastrophizing Scale (PCS) in Greek clinical population.

Methods:

The scale was administered in 376 patients with chronic cervical and lumbar pain. Test–retest reliability, internal consistency (Cronbach α) and concurrent validity were assessed. Exploratory (EFA) and Confirmatory Factor Analysis (CFA) were used to test the factorial validity of the hypothesized three factor structure.

Results:

The PCS factors suggested high levels of test–retest reliability, whereas Cronbachs’ α values were acceptable. The EFA yielded a three-factor solution and indicated a marginal fit to the data. CFA procedures indicated a rather acceptable fit to the data. The concurrent validity of the instrument was confirmed.

Conclusion:

PCS seems to be a reliable and valid instrument in Greek patients with chronic cervical and lumbar pain.

Development of the Hausa version of the Pain Catastrophizing Scale: translation, cross-cultural adaptation and psychometric evaluation in mixed urban and rural patients with chronic low back pain

Background

Catastrophizing has been recognized as an important contributor to chronicity in individuals with chronic pain syndromes including low back pain (LBP). The Pain Catastrophizing Scale (PCS) is perhaps the most widely used tool to evaluate the degree of pain catastrophizing. However, its use is limited in Hausa-speaking countries due to the lack of a validated translated version.

Objective

To translate and cross-culturally adapt the PCS into Hausa (Hausa-PCS), and evaluate its psychometric properties in mixed urban and rural patients with chronic LBP.

Methods

The PCS was translated and cross-culturally adapted into Hausa in accordance with established guidelines. To evaluate its psychometric properties, a consecutive sample of 200 patients with chronic LBP was recruited from urban and rural Nigerian hospitals. Validity was evaluated by exploring content validity, factorial structure (confirmatory factor analysis [CFA]), construct validity (Spearman’s rho for a priori hypotheses) and known-groups validity. Reliability was evaluated by calculating internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement with 95% confidence interval (LOA_95%).

Results

The Hausa-PCS was comprehensible with good content validity. The CFA confirmed a 3-factor structure similar to the original English version. The concurrent validity was supported as 83% (5/6) of the a priori hypotheses were confirmed. Known-groups comparison showed that the questionnaire was unable to differentiate between male and female or urban and rural patients (p > 0.05). Internal consistency and ICC were adequate for the Hausa-PCS total score (α = 0.84; ICC = 0.90) and the subscale helplessness (α = 0.78; ICC = 0.89) but for the subscales rumination (α = 0.69; ICC = 0.68) and magnification (α = 0.41; ICC = 0.43). The LOA_95% for the Hausa-PCS total score was between − 8.10 and + 9.75, with SEM and MDC of 3.47 and 9.62 respectively.

Conclusion

The Hausa-PCS was successfully developed and psychometrically adequate in terms of factorial structure, construct validity, internal consistency and test–retest reliability when applied in mixed urban and rural patients with chronic LBP. However, the internal consistency and reliability coefficients (ICC) for the individual subscales are inadequate. Thus, we support the use of the total score when evaluating pain catastrophizing for clinical or research purposes.

Anhedonia to Gentle Touch in Fibromyalgia: Normal Sensory Processing but Abnormal Evaluation

Social touch is important for interpersonal interaction. Gentle touch and slow brushing are typically perceived as pleasant, the degree of pleasantness is linked to the activity of the C-tactile (CT) fibers, a class of unmyelinated nerves in the skin. The inability to experience pleasure in general is called anhedonia, a common phenomenon in the chronic pain condition fibromyalgia. Here, we studied the perception and cortical processing of gentle touch in a well-characterized cohort of fibromyalgia. Patients and controls participated in functional brain imaging while receiving tactile stimuli (brushing) on the forearm. They were asked to provide ratings of pleasantness of the tactile stimulus and ongoing pain. We found high distress, pain catastrophizing, and insomnia, and a low perceived state of health in fibromyalgia. Further, patients rated both slow (CT-optimal) and fast (CT-suboptimal) brushing as less pleasant than healthy participants. While there was no difference in brain activity during touch, patients showed deactivation in the right posterior insula (contralateral to the stimulated arm) during pleasantness rating and activation during pain rating. The opposite pattern was observed in healthy participants. Voxel-based morphometry analysis revealed reduced grey matter density in patients, in the bilateral hippocampus and anterior insula. Our results suggest anhedonia to gentle touch in fibromyalgia with intact early-stage sensory processing but dysfunctional evaluative processing. These findings contribute to our understanding of the mechanisms underlying anhedonia in fibromyalgia.

A Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion Surgery: A Randomized Controlled Trial

BACKGROUND

Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery.

OBJECTIVE

The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease.

DESIGN

This study was a randomized controlled trial.

SETTING

The study took place at 2 private spine clinics and 1 university hospital.

PATIENTS

We prospectively enrolled 118 patients scheduled for lumbar fusion surgery.

INTERVENTION

The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care.

MEASUREMENTS

The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome.

RESULTS

No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect ("Group × Time") was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up.

LIMITATIONS

The participants' preoperative level of disability was lower than normative values, which suggests selection bias.

CONCLUSIONS

Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.

One-minute stair climbing, 50-foot walk, and timed up-and-go were responsive measures for patients with chronic low back pain undergoing lumbar fusion surgery

Background

Physical capacity tasks are useful tools to assess functioning in patients with low back pain (LBP), but evidence is scarce regarding the responsiveness (ability to detect change over time) and minimal important change (MIC). The aim was to investigate the responsiveness and MIC of 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go in patients with chronic LBP undergoing lumbar fusion surgery.

Methods

In this clinimetric study, 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes were included. All patients performed the physical capacity tasks 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go 8–12 weeks before and six months after surgery. Responsiveness was evaluated by testing five a priori responsiveness hypotheses. The hypotheses concerned the area under the receiver operating characteristics (ROC) curve and correlations (Spearman’s rho) between the change scores of the physical capacity tasks, the Oswestry Disability Index 2.0 (ODI), and back pain intensity measured with visual analog scale (VAS). At least 80% of the hypotheses would have to be confirmed for adequate responsiveness. Absolute and relative MICs for improvement were determined by the optimal cut-off point of the ROC curve based on the classification of improved and unchanged patients according to construct-specific global perceived effect (GPE) scales.

Results

One-minute stair climbing, 50-ft walk and timed up-and-go displayed adequate responsiveness (≥ 80% of hypotheses confirmed), while 5-min walk did not (40% of hypotheses confirmed). The absolute MICs for improvement were 45.5 m for 5-min walk, 20.0 steps for 1-min stair climbing, − 0.6 s for 50-ft walk, and − 1.3 s for timed up-and-go.

Conclusions

The results of responsiveness for 1-min stair climbing, 50-ft walk, and timed up-and-go implies that these have the ability to detect changes in physical capacity over time in patients with chronic LBP who have undergone lumbar fusion surgery.