Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain

Turkish adaptation, validity and reliability study of the cognitive behavior questionnaire in non-specific chronic low back pain:: CBQNSCLBP Turkish Version Validity and Reliability

BackgroundChronic low back pain (CLBP) is a complex condition with significant physical, psychological, and social impacts. The Cognitive Behavior Questionnaire for Nonspecific Chronic Low Back Pain (CBQ-NSCLBP) was developed to assess cognitive-behavioral factors.ObjectiveThe aim of this study was to translate the CBQ-NSCLBP into Turkish (CBQ-NSCLBP-Tr), evaluate its psychometric properties, and also to assess the clinicometric properties of the instrument, including its validity, reliability, and effectiveness in assessing cognitive-behavioral factors in Turkish-speaking individuals with chronic low back pain.MethodsA total of 120 participants with CLBP aged 18-65 years were recruited. Construct validity was evaluated by correlating CBQ-NSCLBP-Tr scores with established measures, including the Oswestry Disability Index(ODI), Fear Avoidance Beliefs Questionnaire(FABQ), Tampa Kinesiophobia Scale(TKS), Back Pain Attitudes Questionnaire(Back-PAQ), Beck Anxiety Inventory(BAI), and Beck Depression Inventory(BDI). Test-retest reliability was assessed using the intraclass correlation coefficient(ICC), and internal consistency was determined using Cronbach's alpha.ResultsThe CBQ-NSCLBP-Tr demonstrated excellent reliability (ICC = 0.89) and strong internal consistency significant correlations with established measures, such as the Oswestry Disability Index (ODI, r = 0.44) and Fear Avoidance Beliefs Questionnaire (FABQ, r = 0.48). According to these results, the CBQ-NSCLBP-Tr is a reliable instrument for evaluating cognitive-behavioral variables affecting chronic low back pain in Turkish-speaking individuals.ConclusionsThe CBQ-NSCLBP-Tr is a reliable and valid instrument for assessing cognitive-behavioral factors in Turkish-speaking CLBP populations. It captures critical psychological dimensions influencing pain perception and disability, complementing existing measures.

Effectiveness of movement representation techniques in non-specific shoulder pain: a systematic review and meta-analysis

This systematic review and meta-analysis aims to assess the effects of movement representation techniques (MRT) on pain, range of motion, functional outcomes, and pain-related fear in patients with non-specific shoulder pain (NSSP). A literature search conducted in PubMed, PEDro, EBSCO, Scopus, Cochrane Library, ScienceDirect, and gray literature on April 31, 2023. We selected seven randomized controlled trials based on the PICOS framework. Incomplete data or non-NSSP excluded. Study quality was assessed using the PEDro scale (mean score = 6.43), and certainty of evidence was evaluated with the GRADE approach. MRT demonstrated a large effect size for pain reduction (high heterogeneity, I2 = 85.2%, Hedges'g = 1.324, 95% CI = 0.388-2.260, P = 0.006), functional improvement (moderate heterogeneity, I2 = 70.82%, Hedges'g = 1.263, 95% CI = 0.622-1.904, P < 0.001), and reduction of pain-related fear (moderate heterogeneity, I2 = 70.86%, Hedges'g = 0.968, 95% CI = 0.221-1.716, P < 0.001). MRT also showed significant benefits for range of motion, particularly in flexion (low heterogeneity, I2 = 26.38%, Hedges'g = 0.683), abduction (low heterogeneity, I2 = 33.27%, Hedges'g = 0.756), and external rotation (low heterogeneity, I2 = 48.33%, Hedges'g = 0.542) (P < 0.001 for all), while no significant effect was found for internal rotation (P > 0.05). No publication bias was detected. While limited evidence and methodological concerns necessitate further research, MRT appears to positively impact pain, range of motion, functional outcomes, and pain-related fear in NSSP patients.

Association of demographics, lumbar active range of motion and disability in chronic low back: a baseline data analysis of a randomized controlled trial from Pakistan

BACKGROUND

The disability and significant economic costs accredited to Low back pain (LBP) are likely to rise which is an essential problem in low and middle-income countries like Pakistan. The associated factors of LBP are age, sex, and race including physical activity, high spinal load, lifting, bending, and twisting occupations. The literature highlighted there is substantial differences in associated factors of LBP within available studies in developing countries. The objective is to investigate the association of demographic factors and lumbar range of motion with disability in patients with chronic low back.

METHODS

A baseline data analysis was performed as an analytical cross-sectional study among 150 patients with chronic low back in a randomized controlled trial with a duration from March 2020 and January 2021. After recording demographics, Modified-Modified Schober's test was used to measure lumbar flexion and extension and Oswestry disability index for disability. After the descriptive analysis the continuous variables, age and pain were analyzed with Spearman's correlation. Variables that were significant in bivariate analysis were then fitted in a multivariable linear regression. The Kruskal-Wallis test was used to analyze variations of disability in gender, marital status, work status, education level, and duration of pain. The p-value of 0.05 was significant.

RESULTS

The results showed a significant correlation between age and pain in sitting (rh=-0.189, p = 0.021 and rh = 0.788, p < 0.001) with the disability but no significant effects of age and pain in sitting (B=-0.124, p = 0.212 and B = 1.128, p = 0.082) on disability were found. The decrease in lumbar flexion and extension was found to increase disability (B=-6.018 and - 4.032 respectively with p < 0.001). Female gender (x2(1) = 15.477, p = < 0.001) and unmarried marital status (x2(1) = 4.539, p = 0.033) had more disability than male gender and married marital status, respectively. There was a significance between groups of the duration of pain regarding disability (x2 (2) = 70.905, p < 0.001). Age, education level, and work status showed no significance (p > 0.05).

CONCLUSIONS

The female gender and unmarried marital status are associated with functional disability. Decreased lumbar range of motion accompanies more disability, while age, education level, and work status do not effect on disability.

Exploring Interactions Between Sex, Pain Characteristics, Disability, and Quality of Life in People With Chronic Spinal Pain: A Structural Equation Model

In people with nonspecific chronic spinal pain (nCSP), disability and quality of life are associated with clinical, cognitive, psychophysical, and demographic variables. However, evidence regarding the interactions between these variables is only limited to this population. Therefore, this study aims to explore path models explaining the multivariate contributions of such variables to disability and quality of life in people with nCSP. This secondary analysis uses baseline data from a randomized controlled trial including 120 participants with nCSP. Structural equation modeling was used to explore path models for the Pain Disability Index (PDI), the Short Form 36-item physical (SF-36 PC), and mental (SF-36 MC) component scores. All models included sex, pain catastrophizing, kinesiophobia, hypervigilance, and pain intensity. Additionally, the PDI and SF-36 PC models included pressure pain thresholds (PPTs) at the dominant pain site (ie, neck or low back). Significant associations were found between sex, pain cognitions, pain intensity, and PPTs. Only pain catastrophizing significantly directly influenced the PDI (P ≤ .001) and SF-36 MC (P = .014), while the direct effects on the SF-36 PC from kinesiophobia (P = .008) and pain intensity (P = .006) were also significant. However, only the combined effect of all pain cognitions on the SF-36 PC was mediated by pain intensity (P = .019). Our findings indicate that patients' pain-related cognitions have an adverse effect on their physical health-related quality of life via a negative influence on their pain intensity in people with nCSP. PERSPECTIVE: This secondary analysis details a network analysis confirming significant interactions between sex, pain cognitions, pain intensity, and PPTs in relation to disability and health-related quality of life in people with chronic spinal pain. Moreover, its findings establish the importance of pain cognitions and pain intensity for these outcomes. TRIALS REGISTRATION: Clinicaltrials.gov (NCT02098005).

Effects of Pain Beliefs on Postoperative Pain and Analgesic Consumption in Spine Surgery Patients

ABSTRACT

PURPOSE: This study evaluates the impact of pain belief on postoperative pain and analgesic consumption in patients undergoing spine surgery. METHODS: This descriptive and cross-sectional study was conducted on 71 patients undergoing spine surgery, who were admitted to the neurosurgery department of a university hospital between January 2021 and April 2022. Descriptive information form, Pain Beliefs Questionnaire, visual analog scale, pain evaluation form, and verbal category scale were used for data collection. RESULTS: Participant mean age was 53 years, and 40.8% underwent spinal disc surgery. A total of 60.2% of the participants experienced moderate postoperative pain, and severe pain was noted during the second postoperative hour, after rest and coughing, which decreased significantly during consecutive hours. Besides, 70.4% of the participants expressed that the level of pain decreased, 43.7% had pain as they expected, 69.0% had intermittent pain, and 53.5% experienced pain at the surgical site. The mean scores obtained from the Organic and Psychological Beliefs subscales of the Pain Beliefs Questionnaire were 4.25 and 4.21, respectively. There was a statistically significant relationship between the Psychological Beliefs and visual analog scale scores after coughing measured in the postoperative 24th and 36th hours. There was also a significant relationship between organic beliefs and working status. There was no statistically significant relationship between analgesic consumption and pain belief. CONCLUSION: Patients undergoing spine surgery experienced moderate pain and had a relatively high level of pain beliefs. Regular evaluation of pain levels and beliefs is required for effective pain management.

Burden of disease and impact on quality of life in chronic back pain - a comparative cross-sectional study of 150 axial spondyloarthritis and 150 orthopedic back pain patients

Objective

Chronic back pain (CBP) constitutes one of the most common complaints in primary care and a leading cause of disability worldwide. CBP may be of mechanical or inflammatory character and may lead to functional impairment and reduced quality of life. In this study, we aimed to assess and compare burden of disease, functional capacity, quality of life and depressive symptoms in axial spondyloarthritis (axSpA) patients with orthopedic chronic back pain patients (OBP). We further aimed to identify factors associated with quality of life.

Methods

Cross-sectional survey of a cohort of 300 CBP patients including 150 patients from a University Hospital Orthopedic Back Pain Outpatient Clinic with OBP and 150 patients with confirmed axSpA from a University Hospital Rheumatology Outpatient Clinic. Questionnaire-based assessment of pain character (Inflammatory Back Pain, MAIL-Scale), functional status (FFbH, BASFI), quality of life (WHOQOL-Bref) and depressive symptoms (Phq9) and retrospective medical chart analysis.

Results

Both, OBP and axSpA patients reported on average intermediate pain levels of mostly mixed pain character. Both groups demonstrated a reduced health-related quality of life and the presence of depressive symptoms. However, axSpA patients reported a significantly better subjective quality of life, more satisfaction with their health status and better functional capacity compared to OBP patients (all p < 0.001). In a multivariate regression model, depressive symptoms, mechanical back pain, pain level and age were negative predictors of subjective quality of life, whereas functional capacity was a positive predictor.

Conclusion

Chronic back pain was associated with a high morbidity and reduced quality of life regardless of pain character. We identified multiple factors associated with reduced quality of life. Awareness and addressing of these factors may help to overcome unmet needs and improve quality of life for these patients.

Experiencing COMFORT: Perceptions of Virtually-delivered Nonpharmacologic Therapies in Adults Prescribed Opioids for Chronic Pain

BACKGROUND

An opioid task force within an urban public health district sought to increase access to, and utilization of, non-opioid, nonpharmacologic alternatives for pain management.

AIMS

The COMFORT (Community-engaged Options to Maximize and Facilitate Opioid ReducTion) study was designed to provide virtual multidimensional integrated nonpharmacologic therapies via a cloud-based videoconferencing platform over six weeks to adults with chronic pain who were prescribed an opioid to investigate measurable health improvements.

METHODS

A qualitative descriptive analysis explored participants' experiences of a novel pain management intervention. A total of 19 participants consented to participate in the study and 15 completed six virtual consultations with either yoga, massage, chiropractic, or physical therapists. Semi-structured exit interviews were conducted, and data analyzed using content analysis.

RESULTS

Five main themes were identified, including unmet pain needs, self-care practices, incentive for participation, perception of a virtual environment, and benefits of the intervention. All participants reported at least minor benefits, with about half reporting improvement in pain levels, and some were able to reduce their opioid use. A virtual environment posed challenges for a few participants who found it more difficult to engage with than in-person therapy; others found the platform easy to navigate.

CONCLUSIONS

Participants with chronic pain were open and willing to try a novel way to access nonpharmacologic consultations to address unmet pain needs. Virtual consultations with pain management experts may increase access to, and utilization of, complementary and integrative treatment modalities.

Spanish version of the pain beliefs questionnaire: Translation, cross-cultural adaptation, validation, and psychometric properties in a working population

BACKGROUND

Chronic musculoskeletal pain is a major health problem and a common cause of disability in the workplace. Beliefs related to musculoskeletal pain may influence its onset and perpetuation. Consequently, tools designed to identify potentially harmful beliefs are needed. However, the Pain Beliefs Questionnaire (PBQ) is not available for individuals speaking European-Spanish.

OBJECTIVES

To translate and culturally adapt the original English version of the PBQ into European-Spanish and evaluate its psychometric properties among Spanish workers with and without chronic musculoskeletal pain.

DESIGN

Study on measurement properties.

METHODS

A translation and cultural adaptation process was based on a forward-backward translation process. One hundred fifty-one active workers were included. Participants completed the PBQ (composed of the organic and psychological subscales), the Pain Catastrophizing Scale (PCS), and the Hospital Anxiety and Depression Scale (HADS). Finally, thirty participants completed the PBQ again two weeks later for test-retest reliability.

RESULTS

The PBQ showed adequate internal consistency (Cronbach's alpha: 0.72-0.73), good item response stability (weighted Kappa: 0.65-0.90), and reliability (Intraclass Correlation Coefficient: 0.72-0.80). A positive correlation was found between the PCS and the organic subscale (r = 0.403). However, no significant correlations were found between the HADS and the PBQ subscales. Workers with chronic musculoskeletal pain showed greater scores in the organic subscale and lower scores in the psychological subscale than workers without pain.

CONCLUSION

The Spanish version of the PBQ was linguistically accurate and acceptable for use by workers with and without musculoskeletal pain.

Exploring the role of respiratory intervention as an effective adjunct tool in the management of chronic low back pain: A scoping systematic review

BACKGROUND

Individuals with chronic low back pain (CLBP) are usually prescribed manual therapy and exercise programs. Respiratory exercise interventions are also recommended by some researchers for CLBP. However, the evidence for the relative effectiveness of these treatments is limited, and the question of which sort of intervention is most suited remains unanswered.

OBJECTIVE

This systematic review aims to evaluate the effectiveness of respiratory interventions in CLBP.

METHODS

A systematic search was performed using databases: PubMed, Web of Science, PEDro, Cochrane Library, and Science Direct. The review was registered in PROSPERO (CRD42021233739).

RESULTS

Seven studies met the inclusion criteria. Out of these, one was of poor, three were of fair, and three were of good qualities. A total of 293 subjects were included in seven studies, the mean age of subjects ranged from 21 to 53 years. The largest effect size was reported for pain (d = 1.5) and maximum inspiratory pressure (d = 1.38). No detrimental effects were reported for any of the intervention programs.

CONCLUSIONS

Since most of the research has been done on pain and MIP, and both of these parameters have revealed significant changes with large effect size, therefore it can be concluded that respiratory interventions improve pain and MIP in CLBP. Owing to the limited number of studies available, a definitive outcome could not be documented for other parameters. Thus, further research is needed to provide a more robust piece of evidence and understanding.

Validation of the international classification of functioning, disability, and health (ICF) core sets for musculoskeletal conditions in a primary health care setting from physiotherapists' perspective using the Delphi method

PURPOSE

To analyze the possibilities of using ICF core sets for musculoskeletal conditions in primary care physiotherapy units of the Health Service of "Castilla y León" (Spain).

METHODS

A three-round Delphi study was conducted by physiotherapists working in a primary care setting. The data obtained were linked to second-level ICF categories and their relevance was assessed by the participants. The most relevant categories were compared with those present in the existing ICF core sets for musculoskeletal conditions.

RESULTS

Eighty-four physiotherapists participated in the survey. The consensus was reached for 45 ICF categories and 5 personal factors after the survey. Thirty-five of these categories were present in the Comprehensive Core Set for post-acute Musculoskeletal Conditions. In addition, 35 categories present in the core set were not considered relevant from the participants' perspective.

CONCLUSIONS

Physiotherapists mainly considered movement-related categories as relevant. The ICF core set for post-acute musculoskeletal conditions comprises many of these categories and can therefore be taken as a basis for the adoption of ICF in the clinical context.

RELEVANCE

Primary care physiotherapists should be aware of the advantages of using ICF in their clinical settings.Implications for RehabilitationThis study shows which body functions and structures, activities and participation, environmental factors, and personal characteristics are relevant from primary care physiotherapists' perspective assessing persons with musculoskeletal conditions.The Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions includes most of the categories identified in this study, but they need to be refined to fully represent the primary care physiotherapists' perspective.The results of this study support the use of the Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions as a basis for operationalizing ICF in this clinical setting.

Determinants of quality of life in individuals with chronic low back pain: a systematic review

OBJECTIVE

Chronic low back pain (CLBP) is a prominent medical condition that can affect an individual at some point in their life time which could lead to poor quality of life (QOL). Low back pain has affected approximately 577 million individuals globally by 2017. The aim of the current systematic review is to synthesise the existing evidence on the factors influencing the QOL in individuals with CLBP and to identify strategies to improve their QOL.

METHOD

PubMed, ScienceDirect, PsychNet and Google Scholar were used to extract studies reporting quantitative relationships between QOL and its possible determinants in individuals having CLBP and the intervention strategies to improve QOL.

RESULTS

10,851 studies were initially identified and twenty-six studies which met the inclusion criteria were selected for the review. 21 studies reported relationship between QOL and potential determinants and five studies assessed the influence of interventions on QOL. Determinants were classified as kinesiophobia, fear avoidance belief, or pain belief; occupation-related factors; pain and disability; activity; personal factors including age, gender, employment status; and other psychological factors including anxiety, quality of sleep, and health locus of control. Intervention strategies including MBSR, Pilates method and Back School Programme improved QOL in individuals with CLBP.

CONCLUSION

Psychosocial factors as well as the physical status of the individual contributed to the QOL in individuals having CLBP.

The effect of kinesiophobia in older people with acute low back pain: longitudinal data from Back Complaints in the Elders (BACE)

This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients' beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

The Effect of Virtual Reality Training on Anticipatory Postural Adjustments in Patients with Chronic Nonspecific Low Back Pain: A Preliminary Study

Objectives

This study is aimed at exploring the effects of virtual reality (VR) training on postural control, measured by anticipatory and compensatory postural adjustments (APAs and CPAs, respectively), in patients with chronic nonspecific low back pain (CNLBP) and the potential neuromuscular mechanism of VR training.

Methods

Thirty-four patients were recruited and randomly assigned to the VR group (n = 11), the motor control exercise group (MCE, n = 12) and the control group (CG, n = 11). The VR group received VR training using Kinect Xbox 360 systems and magnetic therapy. Besides magnetic therapy, the participants in the MCE group performed real-time ultrasound-guided abdominal drawing-in maneuver (ADIM) and four-point kneeling exercise. The CG only received magnetic therapy. Surface muscle electromyography (sEMG) was used to record the muscle activities of transverse abdominis (TrA), multifidus (MF), lateral gastrocnemius (LG), and tibialis anterior (TA) during ball-hitting tasks. The muscle activation time and integrals of the electromyography activities (IEMGs) during the APA and CPA stages were calculated and used in the data analysis. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores were also recorded.

Results

A significant interaction effect of time × group was observed on the activation time of TrA (p = 0.018) and MF (p = 0.037). The post-intervention activation time of the TrA was earlier in the VR group (p = 0.029). In contrast, the post-intervention activation time of the MF was significantly delayed in the VR group (p = 0.001). The IEMGs of TrA (p = 0.002) and TA (p = 0.007) during CPA1 significantly decreased only in the VR group after the intervention. The VAS scores of three group participants showed significant decreases after intervention (p < 0.001).

Conclusions

Patients with CNLBP showed reciprocal muscle activation patterns of the TrA and MF muscles after VR training. VR training may be a potential intervention for enhancing the APAs of the patients with CNLBP.

A comparison of the effects of fire needle and routine acupuncture for myofascitis: A protocol for systematic review and meta-analysis

BACKGROUND

Myofascitis is a common disease in clinic. The main cause of the disease is aseptic inflammation of local muscles and connective tissues such as myofascial, which can be manifested as paralysis, distension, and other discomfort, local muscle stiffness, spasm or palpable strain-like nodules. Chinese medicine ascribes it to "bi disease" and "Arthralgia disease," while Western medicine believes that the disease is mainly due to local muscle and fascia edema and exudation caused by trauma or long-term strain, forcing nerves to jam and producing pain and other abnormal feelings. Although the disease is not life-threatening, the pain and distension caused by local inflammatory stimuli can affect the patient's daily life and sleep quality. The purpose of this systematic review is to evaluate the efficacy of fire needle vs routine acupuncture in the treatment of myofascitis.

METHODS

Randomized controlled trials (RCTS) of fire needle vs routine acupuncture for myofascial inflammation will be comprehensively searched from inception to September 2020 on PubMed, Embase, Cochrane Library, China Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), and Wanfang. Additionally, RCT registered sites, including http://www.ClinicalTrials.gov and http://www.chictr.org.cn, also will be the search. Visual analogue scale (VAS) was used to score the pain before and after treatment. The primary outcome will be to compare the difference in pain scores between the 2 interventions. Two independent authors filtered the literature in the above database, extracted the data, and cross-checked it.

RESULTS

This study will offer a reasonable comprehensive evidence for the treatment of myofascitis with fire needle.

CONCLUSION

The conclusion of this study will provide evidence to judge the effectiveness of fire needle on myofascitis.

REGISTRATION NUMBER

INPLASY202080034.