Effects of exercise/physical activity on fear of movement in people with spine-related pain: a systematic review

Expectations about the benefit of exercise, not surgery, are associated with future pain and physical function in patients with non-specific low back pain

Beliefs can affect perceived harms and benefits of a treatment. The purpose of this study was to assess the relationship between beliefs about exercise and surgery effectiveness and pain interference and physical function in patients with non-specific low back pain. This was a cohort of 629 pooled clinical trial participants receiving non-pharmacological pain management. Participants either agreed (somewhat or completely) or disagreed that surgery would be beneficial or that exercise would make their symptoms worse. Those that agreed were categorized as having high expectations about the treatment. The influence of high expectations on short-term (6-week) and long-term (6-month) PROMIS Pain Interference scores was modeled with generalized linear (Gaussian) models. In a subset of 510 patients, the same analysis was conducted using PROMIS Physical function scores. The cohort was 28.8% female, mean(SD) age of 33.4(8.3) years and 83.1% active-duty. In all 67.1% had low expectations of exercise and 11.0% had high expecations of surgery. High expectations for surgery were not a significant predictor of pain interference or physical function. High expectations for exercise predicted lower pain interference (ß=-2.146, 95CI -3.366, -0.926; P<0.001) and higher physical function (ß=1.807, 95CI 0.586, 3.027; P=0.004) at 6 weeks and 6 months. High expectations for exercise were uncommon (about 33%) but associated with better outcomes out to six months. One in 10 patients had high expectations for surgery but this was not associated with outcomes. A better understanding of treatment expectations may present opportunities to improve engagement and education strategies for patients with low back pain. PERSPECTIVE: The results of this study show that exercise expectations predict outcomes for those that get exercise, but expectations about treatment in general may not be as helpful as asking specifically about a given treatment. These finding can potentially help clinicians better understand how to improve patient engagement and education strategies.

Pain, Physical Activity, Kinesiophobia, Balance and Fall Risk in Patients with Diabetic Neuropathy

PURPOSE

In this study, we aimed to investigate the risk of balance disorders and falls in patients with diabetic neuropathic pain and the associated kinesiophobia and physical limitation.

METHODS

This study was designed as a cross-sectional descriptive study and was conducted with 250 patients seen in Family Medicine outpatient clinics between February and March 2023. The Tampa Kinesiophobia Scale (TSK) was used to measure the patients' fear of movement/reinjury, the International Fall Efficacy Scale (FES-I) was used to measure the level of fear of falling, the Berg Balance Scale (BBS) was used to assess balance status, and the International Physical Activity Questionnaire (IPAQ) was used to assess all activities during the day. Patients were divided into three groups according to pain patterns: Neuropathic pain (N = 74), nociceptive/mechanical pain (N = 96), and control group (no pain) (N = 90). In statistical analyses, p < .05 was considered significant.

RESULTS

The mean age was 62.56 ± 9.81 years in the neuropathic pain group, 62.47 ± 11.67 years in the nociceptive/mechanical pain group, and 60.87 ± 10.99 years in the control group. Overall, 60% of the participants were women. In intergroup analyses, there were significant differences between the groups in terms of TSK (p = .012), FES-I (p < .001), IPAQ (p < .001), and BBS (p < .001). The neuropathic pain group had the lowest BBS scores. When comparing the neuropathic pain group to the control group, TSK was significantly higher (p = .009).

CONCLUSIONS

Patients with neuropathic pain due to diabetes mellitus are more likely to have increased balance impairment, leading to decreased physical activity and an increased risk of falls.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Influence of kinesiophobia on lumbar position sense in patients with chronic low back pain-a case-control study

BackgroundChronic lower back pain condition (CLBP) was reported with a significantly higher disability levels and fear-avoidance beliefs than their asymptomatic counterparts. However, the anecdotal evidence is there to support whether kinesiophobia had impacted the level of lumbar position sense among CLBP. The aim of the study was to analyze the relation between kinesiophobia, and lumbar position sense in patients with CLBP and asymptomatic individual.MethodsThis is part of a major case-control study proceeded with 200 patients with CLBP and 400 controls. Kinesiophobia, and lumbar position sense were assessed with Tampa Scale for Kinesiophobia, and lumbar re-positioning test, respectively. Functional ability was measured with a patient- specific Functional Scale in patients with CLBP. Regression models was administered to explore the complex relation between kinesiophobia, and lumbar position sense.ResultsKinesiophobia was reported high among patients with CLBP (30%) than in controls (11%) with the mean difference of 6.49 ± 0.52, d = 1.07 and lumbar position sense (0.09) were positively correlated with kinesiophobia.Discussion and conclusionAlthough a higher rate of kinesiophobia was reported among patients with CLBP when compared to controls, majority of cases with CLBP did not report Kinesiophobia. Further, Kinesiophobia was found to influence lumbar position sense among patients with CLBP.ClinicalTrials.gov Identifier: NCT05079893 Registered on 14/10/2021.

Executive functioning is associated to everyday interference of pain in patients with chronic pain

Dysfunction in executive functions is common among patients with chronic pain. However, the relationships between executive functioning and pain management have not been extensively studied. In this study, 189 outpatients (160 women, 29 men; mean age 33.15) with chronic pain underwent an extensive neuropsychological assessment, including several tests of executive functions. In addition, all participants completed self-assessment questionnaires regarding pain and interference of pain in everyday life. After adjusting for effects of age, education, and depression, several aspects of executive functioning were significantly associated with self-assessed everyday interference of pain (rs = 0.13-0.22, all ps < 0.05). This indicates that lower performance on tests of executive functioning was significantly associated with a higher degree of pain interference and a lower degree of life control. Pain characteristics such as pain intensity, pain duration, and pain spreading were not associated with executive functioning. These results suggest that preserved executive functions are related to better coping with pain, but not directly to the pain itself, in patients with chronic pain. Depression was also associated with self-management of pain, indicating that patients with lower executive functioning in combination with depression may need special attention during rehabilitation.

The Impact of Spine Injuries on Amateur Athletes: An Exploratory Analysis of Sport-Related Patient-Reported Outcomes

INTRODUCTION

There is a lack of information on return to sport and patient-reported outcome measures (PROMs) in amateur athletes after isolated spine injuries.

METHODS

A single-center cohort study in amateur athletes aged 18 to 60 with isolated spine injuries; clinical data collection and follow-up via telephone interview and standardized PROMs (Short-Form 36, Oswestry and Neck Disability Index, Tampa Scale of Kinesiophobia, Hospital Anxiety and Depression Scale, Pain Visual Analog Scale). Bivariate analyses of potential influencing factors on PROMs were conducted using the Wilcoxon Signed-Rank Test. p-values < 0.05 were considered statistically significant.

RESULTS

Out of the 80 included participants, 78% (n = 62) were active in sport at follow-up. PROMs were slightly worse than those described for the age-adjusted general population. There were consistent associations of better PROMs with having reached the subjective preinjury level of performance in sport, while injury severity and surgical or conservative therapy did not show consistent associations with PROMs.

CONCLUSION

Most amateur athletes resume their sports activity after a spine injury. Better outcomes are associated with individuals' resumption of sport and subjective level of performance, while injury severity and surgical or conservative therapy do not show consistent associations with PROMs, highlighting the importance of patient education, rehabilitation, and encouragement.

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

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

Introduction

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

Methods

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

Results

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

Conclusions

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