Psychological factors unrelated to activity level in patients with chronic musculoskeletal pain

Kinesiophobia Predicts Physical Function and Physical Activity Levels in Chronic Pain-Free Older Adults

Advanced aging is associated with a general decline in physical function and physical activity. The current evidence suggests that pain-related fear of movement (i.e., kinesiophobia) is increased in the general older adult population and impacts physical activity levels in patients with chronic pain. However, whether kinesiophobia could impact physical activity and function in relatively healthy, chronic pain-free older adults remain unclear. Thus, the purpose of this study was to examine whether fear of movement due to pain predicted self-reported and objective levels of physical function and physical activity in healthy older adults without chronic pain. Fifty-two older adults were enrolled in this study. The participants completed the International Physical Activity Questionnaire (IPAQ) and wore an accelerometer on the hip for 7 days to measure physical activity. Measures of sedentary time, light physical activity, and moderate to vigorous physical activity were obtained from the accelerometer. Measures of physical function included the Physical Functioning subscale of the Short Form-36, Short Physical Performance Battery (SPPB), the 30-s Chair Stand test, and a maximal isometric hand-grip. The Tampa Scale of Kinesiophobia (TSK) was used to measure fear of movement or re-injury associated with pain. Potential covariates included self-reported activity-related pain and demographics. Hierarchical linear regressions were conducted to determine the relationship of kinesiophobia with levels of physical activity and physical function while controlling for activity-related pain and demographics. TSK scores did not predict self-reported physical activity on the IPAQ. However, TSK scores predicted self-reported physical function (Beta = -0.291, p = 0.015), 30-s Chair Stand test scores (Beta = -0.447, p = 0.001), measures from the SPPB (Gait speed time: Beta = 0.486, p < 0.001; Chair stand time: Beta = 0.423, p = 0.003), percentage of time spent in sedentary time (Beta = 0.420, p = 0.002) and light physical activity (Beta = -0.350, p = 0.008), and moderate to vigorous physical activity (Beta = -0.271, p = 0.044), even after controlling for significant covariates. These results suggest that greater pain-related fear of movement/re-injury is associated with lower levels of light and moderate to vigorous physical activity, greater sedentary behavior, and worse physical function in healthy, chronic pain-free older adults. These findings elucidate the potential negative impact of kinesiophobia in older adults who don't report chronic pain.

Factors associated with physical activity participation in adults with chronic cervical spine pain: a systematic review

OBJECTIVE

To determine the factors associated with physical activity participation in adults with chronic cervical spine pain.

METHODS

A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE and CINAHL from inception to June 12th, 2016. Grey literature and reference checking was also undertaken. Quantitative studies including factors related to physical activity participation in adults with chronic cervical spine pain were included. Two independent authors conducted the searches, extracted data and completed methodological quality assessment.

RESULTS

A total of seven studies met the selection criteria, however, four papers were finally included in the final review. A modified Downs and Black criteria was used to assess methodological quality, each study included was classed as moderate quality. A total of six factors were assessed against physical activity participation for people with chronic neck pain. These included: pain, fear of movement, smoking habits, socioeconomic status, gender, leisure and work time habits. A significant relationship was demonstrated between pain, leisure and work time habits and physical activity. Subjects were less likely to participate in physical activity if they were in pain. Subjects with neck pain were less likely to participate in physical activity in their leisure and work time.

CONCLUSION

This review, based on a small number of heterogeneous studies demonstrated key factors that are likely to affect physical activity in people with chronic neck pain, most notably, pain levels, leisure and work habits. This review suggests that more in-depth, high quality studies are required to fully understand the impact of chronic pain on physical activity.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42015027970.

Validation of the French Version of the "Patterns of Activity Measure" in Patients with Chronic Musculoskeletal Pain

Background. The “Patterns of Activity Measure” (POAM-P) is a self-administered questionnaire that assesses “avoidance”, “pacing” and “overdoing” activity patterns in chronic pain patients. Objectives. To adapt the POAM-P to French (“POAM-P/F”) and test its validity and reliability in Chronic Musculo-Skeletal Pain patients (CMSP). Methods. We followed the recommended procedure for translation of questionnaires. Five hundred and ninety five inpatients, admitted to a tertiary rehab center in the French-speaking part of Switzerland for chronic pain after orthopedic trauma, were included (sex ratio M/F = 4.36, mean age 43 ± 12). Face, content and criterion validities, internal consistency and reliability were assessed. Data included: TAMPA Scale for Kinesiophobia (TSK), Chronic Pain Coping Inventory (CPCI), Pain Catastrophizing Scale (PCS), Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS). Results. Face and content validities were checked during the translation process. Correlations between POAM-P/F-avoidance and TSK, POAM-P/F-pacing and CPCI-pacing, POAM-P/F-overdoing and CPCI-task persistence were highly significant (r > 0.3, p < 10⁻²). The three subscales demonstrated excellent homogeneity (Cronbach's alpha coefficients > 0.8) and test-retest reliability (Intraclass Correlation Coefficients > 0.8). They correlated very differently with the other scales. Discussion and Conclusion. The three POAM-P/F subscales clearly assess different behaviors in CMSP. The POAM-P/F is a suitable questionnaire for classifying French speaking CMSP into avoiders, pacers or overdoers.

Effect of experimental anterior temporalis muscle pain on jaw movements

To test the hypotheses that experimental noxious stimulation of the anterior temporalis muscle results in significant decreases in jaw movement amplitude and velocity, and there are significant correlations between scores of mood or pain-related cognitions and amplitude and velocity. The jaw movements of 14 asymptomatic participants were recorded during standardised open/close jaw movements and free and standardised chewing tasks. Tonic infusion of hypertonic saline into the right anterior temporalis muscle maintained pain intensity between 40 and 60 mm on a 100-mm visual analogue scale. Tasks were performed in a single session in the following sequence: baseline condition, test 1 condition (during hypertonic or isotonic saline infusion), test 2 condition (during saline infusion) (10-min rest between conditions). Participants completed the Depression, Anxiety and Stress Scale (DASS-21) and the Pain Catastrophizing Scale (PCS). Amplitude and velocity of opening and closing were compared between conditions with a repeated-measures analysis of variance (anova), and Spearman's rank correlation coefficient explored correlations; statistical significance: P < 0·05. For any of the three tasks, there were no significant differences in kinematic variables between any condition and no significant correlations between DASS-21 or PCS scores and kinematic variables during hypertonic saline infusion. The absence of a significant reduction in velocity or amplitude of open/close or chewing jaw movements during experimental temporalis muscle pain is not consistent with the Pain Adaptation Model proposing decreases in kinematic measures in pain. The lack of significant correlations between psychological variables and measures of jaw movement may reflect the low scores reported by our study sample.

Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship

BACKGROUND

Promoting physical activity is key to the management of chronic pain, but little is understood about the factors facilitating an individual's engagement in physical activity on a day-to-day basis. This study examined the within-person effect of sleep on next day physical activity in patients with chronic pain and insomnia.

METHODS

119 chronic pain patients monitored their sleep and physical activity for a week in their usual sleeping and living environment. Physical activity was measured using actigraphy to provide a mean activity score each hour. Sleep was estimated with actigraphy and an electronic diary, providing an objective and subjective index of sleep efficiency (A-SE, SE) and a sleep quality rating (SQ). The individual and relative roles of these sleep parameters, as well as morning ratings of pain and mood, in predicting subsequent physical activity were examined in multilevel models that took into account variations in relationships at the 'Day' and 'Participant' levels.

RESULTS

Of the 5 plausible predictors SQ was the only significant within-person predictor of subsequent physical activity, such that nights of higher sleep quality were followed by days of more physical activity, from noon to 11 pm. The temporal association was not explained by potential confounders such as morning pain, mood or effects of the circadian rhythm.

CONCLUSIONS

In the absence of interventions, chronic pain patients spontaneously engaged in more physical activity following a better night of sleep. Improving nighttime sleep may well be a novel avenue for promoting daytime physical activity in patients with chronic pain.