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Reynard F, Vuistiner P, Le Carré J, Léger B, Luthi F. Physical activity based on daily steps in patients with chronic musculoskeletal pain: evolution and associated factors. BMC Musculoskelet Disord 2024; 25:643. [PMID: 39143471 PMCID: PMC11323680 DOI: 10.1186/s12891-024-07766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND People with chronic musculoskeletal pain (CMSP) often have low physical activity. Various factors can influence the activity level. The aim of this study was to monitor physical activity, assessed by the number of steps per day, over time in people with CMSP and identify factors that could be associated with this activity feature. METHODS This prospective study involved people undergoing rehabilitation following an orthopedic trauma that had led to CMSP. At entry, participants completed self-reported questionnaires assessing pain, anxiety, depression, catastrophyzing, kinesiophobia, and behavioural activity patterns (avoidance, pacing and overdoing). They also underwent functional tests, assessing walking endurance and physical fitness. To determine daily step counts, participants wore an accelerometer for 1 week during rehabilitation and 3 months post-rehabilitation. The number of steps per day was compared among three time points: weekend of rehabilitation (an estimate of pre-rehabilitation activity; T1), weekdays of rehabilitation (T2), and post-rehabilitation (T3). Linear regression models were used to analyze the association between daily steps at T2 and at T3 and self-reported and performance-based parameters. RESULTS Data from 145 participants were analyzed. The mean number of steps was significantly higher during T2 than T1 and T3 (7323 [3047] vs. 4782 [2689], p < 0.001, Cohen's d = 0.769, and 4757 [2680], p < 0.001, Cohen's d = 0.693), whereas T1 and T3 results were similar (p = 0.92, Cohen's d = 0.008). Correlations of number of steps per day among time points were low (r ≤ 0.4). Multivariable regression models revealed an association between daily steps at T2 and pain interfering with walking, anxiety and overdoing behaviour. Daily steps at T3 were associated with overdoing behaviour and physical fitness. CONCLUSIONS Despite chronic pain, people in rehabilitation after an orthopedic trauma increased their physical activity if they were given incentives to do so. When these incentives disappeared, most people returned to their previous activity levels. A multimodal follow-up approach could include both therapeutic and environmental incentives to help maintain physical activity in this population.
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Keessen P, Kan KJ, ter Riet G, Visser B, Jørstad HT, Latour CHM, van Duijvenbode ICD, Scholte op Reimer WJM. The longitudinal relationship between fear of movement and physical activity after cardiac hospitalization: A cross lagged panel model. PLoS One 2024; 19:e0297672. [PMID: 38568940 PMCID: PMC10990176 DOI: 10.1371/journal.pone.0297672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/11/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Little is known about the association between fear of movement (kinesiophobia) and objectively measured physical activity (PA), the first 12 weeks after cardiac hospitalization. PURPOSE To assess the longitudinal association between kinesiophobia and objectively measured PA and to assess the factor structure of kinesiophobia. METHODS We performed a longitudinal observational study. PA was continuously measured from hospital discharge to 12 weeks using the Personal Activity Monitor. The PAM measures time spent per day in PA-intensity categories: light, moderate and heavy. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK) at four time points (hospital discharge, 3, 6 and 12 weeks). The longitudinal association between PA-intensity and kinesiophobia was studied with a random intercept cross lagged panel model (RI-CLPM). A RI-CLPM estimates effects from kinesiophobia on objectively measured PA and vice versa (cross-over effects), and autoregressive effects (e.g. kinesiophobia from one occasion to the next). RESULTS In total, 116 patients (83.6% male) with a median age of 65.5 were included in this study. On no occasion did we find an effect of kinesiophobia on PA and vice versa. Model fit for the original model was poor (X2: = 44.646 P<0.001). Best model fit was found for a model were kinesiophobia was modelled as a stable between factor (latent variable) and PA as autoregressive component (dynamic process) (X2 = 27.541 P<0.12). CONCLUSION Kinesiophobia and objectively measured PA are not associated in the first 12 weeks after hospital discharge. This study shows that kinesiophobia remained relatively stable, 12 weeks after hospital discharge, despite fluctuations in light to moderate PA-intensity.
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Affiliation(s)
- Paul Keessen
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Kees Jan Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Gerben ter Riet
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart Visser
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Harald T. Jørstad
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Corine H. M. Latour
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Ingrid C. D. van Duijvenbode
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands
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Lan Q, Fu ACL, McKay MJ, Simic M, Castrillon CM, Wei Y, Ferreira P. The association between musculoskeletal pain during pregnancy and pregnancy outcomes: A systematic review and meta-analyses. Eur J Obstet Gynecol Reprod Biol 2024; 294:180-190. [PMID: 38286038 DOI: 10.1016/j.ejogrb.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To systematically investigate the association between musculoskeletal pain during pregnancy and birth outcomes including caesarean section, newborn birthweight, newborn birth length, and gestational age at birth. METHODS Medline, Embase, Web of Science, Cinahl and Scopus were systematically searched to identify eligible studies. Odds ratios, mean differences, and confidence intervals were used to describe results. Risk of Bias was assessed using the Newcastle-Ottawa Scale for observational studies. GRADE (The Grading of Recommendation Assessment, Development, and Evaluation) was used to assess the quality of each outcome. RESULTS Seven studies were included with a total population of 85,991 participants. There is low- quality evidence that pregnant women with musculoskeletal pain had 1.59 greater odds to experience delivery by caesarean section compared to those without musculoskeletal pain ([OR] 1.59, 95 % confidence interval [CI] 1.09 to 2.31). Both newborn birth weight (Mean Difference [MD] 77.79 g, 95 % [CI] -23.09 to 178.67) and newborn birth length ([MD] 0.55 cm, 95 % [CI] -0.47 to 1.56) were not affected by musculoskeletal pain, with very low-quality and low-quality evidence, respectively. There was moderate evidence that pregnant women with musculoskeletal pain had shorter gestational age (weeks), although the effect was small and possibly not clinically relevant ([MD] -0.41, 95 % [CI] -0.41 to -0.07). CONCLUSION Pregnant women experiencing musculoskeletal pain are at greater odds of delivering their babies via caesarean than those without musculoskeletal pain, however, musculoskeletal pain during pregnancy does not appear to affect newborn birth weight, length, or gestational age at birth.
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Affiliation(s)
- Qianwen Lan
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Allan Chak Lun Fu
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Marnee J McKay
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Milena Simic
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Carlos Mesa Castrillon
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Yuanye Wei
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, China.
| | - Paulo Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
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HajAli T, Shmaisani A, Fares Y, Abou-Abbas L. Predictors of neuropathic pain and related functional disability in sciatica patients: a cross-sectional study. Int J Neurosci 2023; 133:1338-1345. [PMID: 35603462 DOI: 10.1080/00207454.2022.2079504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the present paper was to assess neuropathic pain and its predictors among patients with sciatica. In addition, we sought to investigate the predictors of functional disability in sciatica patients with neuropathic pain. METHODS A cross-sectional study was carried out on a sample of 100 sciatica patients aged 18 years and older with a radiating pain from the lower back down to the leg below the knee. Information about socio-demographic characteristics, duration of symptoms, being treated or not, type of treatment, side of sciatica, presence of back pain, leg pain occurrence, leg pain intensity, functional disability and pain catastrophizing were collected. RESULTS Of the total patients, 57% had neuropathic pain. Multivariable analysis showed that leg pain intensity was higher in the neuropathic pain group as compared to the non-neuropathic pain group. Also, patients with left sciatica were less likely to have neuropathic pain than patients with right sciatica. Patients with neuropathic pain having high levels of pain catastrophizing and being on bed rest for at least one week were at a higher risk of developing functional disability as compared to their counterparts. CONCLUSION Low levels of pain catastrophizing and less bed rest should be considered in interventions aimed at improving the functional ability for sciatica patients with neuropathic pain.
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Affiliation(s)
- Thuraya HajAli
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Ammar Shmaisani
- Neurosurgery Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Neurosurgery Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Saulicz M, Saulicz A, Myśliwiec A, Knapik A, Rottermund J, Saulicz E. Effect of Nordic Walking Training on Physical Fitness and Self-Assessment of Health of People with Chronic Non-Specific Lower Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095720. [PMID: 37174238 PMCID: PMC10178667 DOI: 10.3390/ijerph20095720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
In order to determine the impact of a four-week cycle of Nordic Walking (NW) training on the physical fitness of people with chronic non-specific lower back pain and the impact of this form of activity on their self-assessment of health quality, the study included 80 men and women aged 29 to 63 years. The subjects were divided into two equal (40-person) groups: experimental and control. In both study groups the degree of disability in daily activities caused by back pain was assessed with the FFb-H-R questionnaire, the physical fitness was evaluated with the modified Fullerton test and the sense of health quality was assessed with the SF-36 questionnaire. The same tests were repeated after four weeks. In the experimental group NW training was applied between the two studies. During four weeks, 10 training units were carried out, and each training session lasted 60 min with a two-day break between each training. The four-week NW training resulted in a statistically significant sense of disability due to back pain (p < 0.001), significant improvement of physical fitness expressed by improvement in upper (p < 0.001) and lower (p < 0.01) body strength, upper and lower body flexibility (p < 0.001) and ability to walk a longer distance in a 6-min walk test (p < 0.001). The training participants also showed significant improvements in health quality in both physical (p < 0.001) and mental (p < 0.001) components. The four-week NW training has a positive impact on the physical fitness of men and women with chronic lower back pain. Participation in NW training also contributes to a significant reduction in the sense of disability caused by back pain and improvement in the self-assessment of health quality.
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Affiliation(s)
- Mariola Saulicz
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Aleksandra Saulicz
- School of Public Health & Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD 4059, Australia
| | - Andrzej Myśliwiec
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Andrzej Knapik
- Department of Adapted Physical Activity and Sport, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, ul. Medyków 12, 40-751 Katowice, Poland
| | - Jerzy Rottermund
- Health and Social Work, St. Elizabeth University, Namestie 1, maja 1, 811 02 Bratislava, Slovakia
| | - Edward Saulicz
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
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Courbalay A, Jobard R, Descarreaux M, Bouvard B. Direct and Indirect Relationships Between Physical Activity, Fitness Level, Kinesiophobia, and Health-Related Quality of Life in Patients with Rheumatic and Musculoskeletal Diseases: A Network Analysis. J Pain Res 2021; 14:3387-3399. [PMID: 34737633 PMCID: PMC8560166 DOI: 10.2147/jpr.s323424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/01/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Using a network analysis, the present study investigated the extent to which physical activity (PA), objective fitness level, kinesiophobia, and health-related quality of life (HRQoL) interact in patients with rheumatic and musculoskeletal diseases. The objectives were twofold: 1) to clarify the direct and indirect relationships between these variables while controlling for the shared variance between them, and 2) to establish a potential ranking of influence among them. Methods This cross-sectional design study involved patients recruited from a rheumatology unit. One hundred and twenty patients completed self-reported measures of PA, the Tampa scale of kinesiophobia and the 36-item Short-Form Health Survey, and ninety-seven of those patients performed the six-minute walking test and the thirty-second sit-to-stand test. Network analyses were conducted using bootnet and qgraph packages. Results Weekly time spent on PA, as well as physical fitness measures, were directly linked to kinesiophobia and the HRQoL physical dimension, but indirectly linked to HRQoL mental dimension through the mediation of kinesiophobia. Specifically, weekly PA time had direct relationships to physical functioning, vitality, and role limitations due to physical and emotional problems. Fitness measures had direct relationships with physical functioning, bodily pain, and mental health. The analyses did not clearly highlight one variable as the most influential in the network. Discussion The study highlights the complexities of direct and indirect biopsychosocial relationships that are at the core of patients’ daily functioning. Measurement of PA, use of a longitudinal design, and interventions are discussed.
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Affiliation(s)
- Anne Courbalay
- Institut de Formation en Education Physique et en Sport d'Angers (IFEPSA-UCO), APCoSS, Les Ponts de Cé, France
| | - Romane Jobard
- Institut de Formation en Education Physique et en Sport d'Angers (IFEPSA-UCO), APCoSS, Les Ponts de Cé, France
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières Québec, Trois-Rivières, Canada
| | - Béatrice Bouvard
- Univ Angers, GEROM, SFR ICAT, Angers, France.,CHU Angers, Service de Rhumatologie, Angers, France
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Ansuategui Echeita J, Dekker R, Schiphorst Preuper HR, Reneman MF. Maximal cardiopulmonary exercise test in patients with chronic low back pain: feasibility, tolerance and relation with central sensitization. An observational study. Disabil Rehabil 2021; 44:6287-6294. [PMID: 34428385 DOI: 10.1080/09638288.2021.1962991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze the feasibility of and pain-related tolerance to a maximal cardiopulmonary exercise test (CPET), and the relationship between the aerobic capacity and central sensitization (CS) in patients with chronic low back pain (CLBP). METHODS An observational study, combining a cross-sectional and a prospective 24-hour follow-up was performed. Participants underwent a maximal CPET on a cycle ergometer and were assessed with three measures of CS (CS Inventory, quantitative sensory testing and heart rate variability). Before the CPET, immediately afterwards and 24 h after, the Pain Response Questionnaire (PRQ) was filled out. The CPET was considered feasible when >80% performed maximally, and tolerable when <20% reported relevant pain increase, body reactions and additional pain medication use in the PRQ. Multiple regression analyses were applied to assess the relationship between the aerobic capacity (VO2max) and CS measures, corrected for confounders. RESULTS 74 patients with CLBP participated of which 30 were male, mean age was 40.4 years (SD: 12.4) and median VO2max was 23.9 ml/kg/min (IQR: 18.2-29.4). CPET was completed by 92%. No serious adverse events occurred. A relevant pain increase was reported in the upper legs by 40% immediately after CPET and by 28% 24 h afterwards, 27% reported body reactions after 24 h, and 22% increased pain medication use 24 h after CPET. Very weak and not significant relations (rpartial=-0.21 to 0.05; p > 0.10) were observed between aerobic capacity and CS measures. CONCLUSIONS A maximal CPET is feasible in patients with CLBP. Most, but not all, tolerated it well. CS was not related to aerobic capacity.Implications for rehabilitationMaximal CPET is feasible in patients with CLBP and well tolerated by most patients.Maximal CPET can be safely applied to assess the aerobic capacity of patients with CLBP.Aerobic capacity is unrelated to central sensitization.Outcomes of a maximal CPET and the pain response to straining activity can be used to provide valid information for the decision-making of exercise therapy.
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Affiliation(s)
- Jone Ansuategui Echeita
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Michiel Felix Reneman
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Buchmann J, Baumann N, Meng K, Semrau J, Kuhl J, Pfeifer K, Kazén M, Vogel H, Faller H. Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research. PLoS One 2021; 16:e0248875. [PMID: 33765020 PMCID: PMC7993813 DOI: 10.1371/journal.pone.0248875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Identifying pain-related response patterns and understanding functional mechanisms of symptom formation and recovery are important for improving treatment. OBJECTIVES We aimed to replicate pain-related avoidance-endurance response patterns associated with the Fear-Avoidance Model, and its extension, the Avoidance-Endurance Model, and examined their differences in secondary measures of stress, action control (i.e., dispositional action vs. state orientation), coping, and health. METHODS Latent profile analysis (LPA) was conducted on self-report data from 536 patients with chronic non-specific low back pain at the beginning of an inpatient rehabilitation program. Measures of stress (i.e., pain, life stress) and action control were analyzed as covariates regarding their influence on the formation of different pain response profiles. Measures of coping and health were examined as dependent variables. RESULTS Partially in line with our assumptions, we found three pain response profiles of distress-avoidance, eustress-endurance, and low-endurance responses that are depending on the level of perceived stress and action control. Distress-avoidance responders emerged as the most burdened, dysfunctional patient group concerning measures of stress, action control, maladaptive coping, and health. Eustress-endurance responders showed one of the highest levels of action versus state orientation, as well as the highest levels of adaptive coping and physical activity. Low-endurance responders reported lower levels of stress as well as equal levels of action versus state orientation, maladaptive coping, and health compared to eustress-endurance responders; however, equally low levels of adaptive coping and physical activity compared to distress-avoidance responders. CONCLUSIONS Apart from the partially supported assumptions of the Fear-Avoidance and Avoidance-Endurance Model, perceived stress and dispositional action versus state orientation may play a crucial role in the formation of pain-related avoidance-endurance response patterns that vary in degree of adaptiveness. Results suggest tailoring interventions based on behavioral and functional analysis of pain responses in order to more effectively improve patients quality of life.
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Affiliation(s)
- Jana Buchmann
- Department I—Psychology, University of Trier, Trier, Germany
- * E-mail: (JB); (NB)
| | - Nicola Baumann
- Department I—Psychology, University of Trier, Trier, Germany
- * E-mail: (JB); (NB)
| | - Karin Meng
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Julius Kuhl
- Department of Psychology, University of Osnabrück, Osnabrück, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Miguel Kazén
- Department of Psychology, University of Osnabrück, Osnabrück, Germany
| | - Heiner Vogel
- Section of Medical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Hermann Faller
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
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Zhaoyang R, Martire LM, Darnall BD. Daily pain catastrophizing predicts less physical activity and more sedentary behavior in older adults with osteoarthritis. Pain 2020; 161:2603-2610. [PMID: 32569091 PMCID: PMC7572728 DOI: 10.1097/j.pain.0000000000001959] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Musculoskeletal disorders such as knee osteoarthritis (OA) are the primary cause of chronic pain in older adults. Recommended self-management strategies for knee OA include staying physically active in the face of pain, but many patients avoid activities they are capable of doing. The overall purpose of this study was to examine the extent to which daily pain catastrophizing, a maladaptive coping strategy, could influence OA patients' physical activity and sedentary behavior. The current study used data from 143 older knee OA patients who completed electronic daily diaries for 22 days and wore an accelerometer to capture physical activity and sedentary behavior. At the beginning of each day, patients reported their pain catastrophizing regarding the day ahead. Results from multilevel models demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning. These findings support the mechanistic role of daily pain catastrophizing in the avoidance of physical activity for older OA patients, and suggest that effective interventions for pain catastrophizing may also reduce sedentary behavior and enhance physical activity, with longer-term benefits for pain management, physical function, and overall health.
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Affiliation(s)
- Ruixue Zhaoyang
- Center for Healthy Aging, The Pennsylvania State University, State College, PA, United States
| | - Lynn M. Martire
- Center for Healthy Aging, The Pennsylvania State University, State College, PA, United States
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, United States
| | - Beth D. Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, Palo Alto, CA, United States
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Sousa Filho LF, Barbosa Santos MM, Teles CV, da Silva Lima H, De Farias Neto JP, Da Silva Júnior WM. The Influence of Clinical, Functional, and Psychosocial Factors on Walking Time in Individuals With Chronic Low Back Pain. J Manipulative Physiol Ther 2020; 43:331-338. [PMID: 32703612 DOI: 10.1016/j.jmpt.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether clinical, functional, and psychosocial factors are associated with walking time in patients with chronic low back pain. METHODS This study included patients aged ≥18 years with low back pain for at least 3 months who visited our outpatient clinic between October 2017 and February 2018. We used the following scales/questionnaires: International Physical Activity Questionnaire for self-reported walking time, Numerical Pain Rating Scale for pain intensity, self-report assessing symptom duration, Roland Morris Disability Questionnaire for disability, Patient-Specific Functional Scale for function, Pain Catastrophizing Scale for pain catastrophizing, and screening questions to assess depression and anxiety. Odds ratios (ORs) with their respective 95% CIs were obtained using logistic regression analysis. RESULTS Neither clinical nor functional factors were associated with the total walking time. Among psychosocial factors, only anxiety showed a negative association with the total walking time (OR 0.23, 95% CI 0.06-0.82)-an association that persisted even after adjusting for confounders (OR 0.15, 95% CI 0.03-0.77). CONCLUSION Anxiety was shown to be associated with the total walking time in patients with CLBP. No clinical or functional factors seem to be associated with walking in this study sample.
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Affiliation(s)
- Luis Fernando Sousa Filho
- Graduate Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | | | - Calistene Vieira Teles
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
| | - Heliadja da Silva Lima
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
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Verbrugghe J, Agten A, Stevens S, Eijnde BO, Vandenabeele F, Roussel N, De Baets L, Timmermans A. Disability, kinesiophobia, perceived stress, and pain are not associated with trunk muscle strength or aerobic capacity in chronic nonspecific low back pain. Phys Ther Sport 2020; 43:77-83. [PMID: 32126515 DOI: 10.1016/j.ptsp.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate to which extent disability, psychological and pain-related factors are associated with the outcomes of an isometric trunk muscle strength test and a cardiopulmonary exercise test in persons with chronic nonspecific low back pain (CNSLBP). DESIGN Cross-sectional study. SETTING REVAL Rehabilitation Research Center (Hasselt, Belgium). PARTICIPANTS Persons with CNSLBP. MAIN OUTCOME MEASURES Questionnaires concerning disability, patient specific functioning, kinesiophobia, perceived stress, pain intensity, and central sensitization were recorded. Outcomes of an isometric trunk strength test (maximum back and abdominal torque) and cardiopulmonary exercise test (VO2max) were assessed. Multivariate linear regression models determined factors explaining outcome variance. RESULTS Data of 101 persons (39 males, mean age: 44.2y (SD = 9.6)) was assessed. Neither disability, nor psychological, nor pain-related factors were associated with the assessments. Variance in back muscle strength (R2 = 0.44, F = p < 0.01), abdominal muscle strength (R2 = 0.68, F = p < 0.01), and aerobic capacity (R2 = 0.76, F = p < 0.01) could only be explained through the included demographics covariates (age, gender, weight). CONCLUSION This study highlighted the lack of biopsychosocial factors in explaining variance in outcomes of abdominal and back strength, and aerobic capacity in persons with CNSLBP with characteristics as depicted in the current sample. This information supports the valid interpretation of the outcomes of these assessments.
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Affiliation(s)
- Jonas Verbrugghe
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Anouk Agten
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Sjoerd Stevens
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Bert O Eijnde
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Frank Vandenabeele
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Liesbet De Baets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Coyle PC, Schrack JA, Hicks GE. Pain Energy Model of Mobility Limitation in the Older Adult. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:1559-1569. [PMID: 28531299 PMCID: PMC6084583 DOI: 10.1093/pm/pnx089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Chronic pain is prevalent, costly, and disabling among older adults. Although mobility decline is inevitable with aging, it is clear, from current evidence, that older adults with chronic pain experience a greater rate of functional mobility decline than their pain-free peers. Past studies suggest that pain expedites the age-related decline in functional mobility; however, the pathways through which pain affects mobility remain unclear. Gerontological experts hypothesize that the age-related decline in mobility may be driven by alterations in energy expenditure; these concepts are outlined in a model known as the Energetic Pathway of Mobility Loss. Pain may play a critical role in this process through a pathway of energetic inefficiency, physical inactivity, and decreased capacity. Purpose The purposes of this article are to 1) summarize the current literature that supports the Energetic Pathway of Mobility Loss model and 2) propose a new framework, known as the Pain Energy Model, to clarify how the disablement process may be amplified among older adults with painful conditions. Conclusion This new framework is designed to generate new clinical research and to suggest new clinical implications for older adults with painful conditions by identifying key steps and potential treatment targets in the pathway to functional mobility decline.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Jennifer A Schrack
- Johns Hopkins Bloomberg School of Public Health, Center on Aging and Health, Baltimore, Maryland
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware
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Carvalho FA, Maher CG, Franco MR, Morelhão PK, Oliveira CB, Silva FG, Pinto RZ. Fear of Movement Is Not Associated With Objective and Subjective Physical Activity Levels in Chronic Nonspecific Low Back Pain. Arch Phys Med Rehabil 2016; 98:96-104. [PMID: 27713076 DOI: 10.1016/j.apmr.2016.09.115] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/12/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the association of physical activity measures, derived with an accelerometer and a self-reported questionnaire, with fear of movement in patients with chronic nonspecific low back pain (LBP) and to investigate the association between disability and fear of movement in this population. DESIGN Cross-sectional study. SETTING Outpatient physical therapy university clinics. PARTICIPANTS Patients (N=119) presenting with nonspecific LBP of >3 months' duration. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical activity levels measured objectively with an accelerometer (ie, counts per minute, time spent in moderate-to-vigorous and light physical activity per day, number of steps per day, and number of 10-minute bouts of moderate-to-vigorous physical activity per day) and subjectively with a self-reported questionnaire (Baecke Physical Activity Questionnaire); fear of movement (Tampa Scale of Kinesiophobia); pain (11-point numerical rating scale); disability (Roland Morris Disability Questionnaire); and depression (Beck Depression Inventory). The associations were examined with correlational, univariate, and multivariable linear regression analyses. RESULTS None of the objective physical activity measures were associated with fear of movement. The apparent association of self-reported physical activity levels with fear of movement (correlational analyses: r=-.18; P<.05; univariate regression analyses: β=-.04; 95% confidence interval [CI], -.07 to -.01; P=.04) was not confirmed in multivariable analyses. Fear of movement was consistently associated with disability in both correlational (r=.42; P<.01) and multivariable (β=.21; 95% CI, .11-.31; P<.001) analyses. CONCLUSIONS Our data support one aspect of the fear-avoidance model-that higher fear of movement is associated with more disability-but not the aspect of the model linking fear of movement with inactivity.
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Affiliation(s)
- Flávia A Carvalho
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Chris G Maher
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Marcia R Franco
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Priscila K Morelhão
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Crystian B Oliveira
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Fernanda G Silva
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Rafael Z Pinto
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil; Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
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Felício DC, Pereira DS, de Queiroz BZ, da Silva JP, Leopoldino AAO, Pereira LSM. Kinesiophobia is not associated with disability in elderly women with acute low back pain: Back Complaints in the Elders (BACE) Brazil study results. Spine J 2016; 16:619-25. [PMID: 26780753 DOI: 10.1016/j.spinee.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/01/2015] [Accepted: 01/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The study of low back pain (LBP) is complex, and the physical and psychological aspects, including kinesiophobia, should be considered. Several studies have investigated the relationship between kinesiophobia and functionality in patients with chronic LBP. However, to the best of the authors' knowledge, no studies have investigated the association between kinesiophobia and self-reported assessments of disability and physical performance in elderly patients with acute LBP. PURPOSE The study aimed to investigate the association between kinesiophobia and self-reported and physical performance measures among the elderly with acute LBP. DESIGN This was an observational, cross-sectional, ancillary study of the Back Complaints in the Elders study, a longitudinal observational epidemiologic research project by an international consortium involving Brazil, the Netherlands, and Australia. PATIENT SAMPLE Sample selection was carried out by convenience. The study included women from the community aged 60 years old and older who presented with a new episode of LBP. Volunteers with severe diseases, as well as visual, hearing, and mobility losses, or cognitive dysfunction, were excluded. Four hundred fifty nine elderly women (mean age: 69.0±6.1 years) were included. OUTCOME MEASURES Kinesiophobia was evaluated by Fear Avoidance Beliefs Questionnaire (FABQ), subscale FABQ-Phys. Functionality was investigated by the Roland-Morris Questionnaire and the gait speed test. METHODS Statistical analysis was performed using hierarchical linear regression model. Statistical significance was established at the level of .05. RESULTS The additional predictive value because of the inclusion of the FABQ-Phys was 0.1%, using the Roland-Morris score, and 0.2% for the gait speed test. CONCLUSIONS This was the first study to investigate the association between the FABQ-Phys and functionality in elderly patients with acute LBP. The results provide preliminary evidence that kinesiophobia assessed by the FABQ-Phys cannot be generalized to disability.
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Affiliation(s)
- Diogo C Felício
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil; Universidade Federal de Juiz de Fora, São Pedro, 36036-900 Juiz de Fora, MG, Brazil.
| | - Daniele S Pereira
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Barbara Z de Queiroz
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Juscelio P da Silva
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Amanda A O Leopoldino
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Leani S M Pereira
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
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A Functional Magnetic Resonance Imaging Study to Investigate the Utility of a Picture Imagination Task in Investigating Neural Responses in Patients with Chronic Musculoskeletal Pain to Daily Physical Activity Photographs. PLoS One 2015; 10:e0141133. [PMID: 26496709 PMCID: PMC4619796 DOI: 10.1371/journal.pone.0141133] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022] Open
Abstract
Pain-related anxiety and fear are associated with increased difficulties in attention, increased awareness of pain, impaired disengagement from pain, and can moderate the effects of attentional coping attempts. Accurately assessing the direct impact of pain-related anxiety and fear on pain behavior has proved difficult. Studies have demonstrated no or limited influence of pain-related fear and anxiety on behavior but this may be due to inherent problems with the scales used. Neuroimaging has improved the understanding of neural processes underlying the factors that influence pain perception. This study aimed to establish if a Picture and Imagination Task (PIT), largely developed from the Photographs of Daily Activity (PHODA) assessment tool, could help explore how people living with chronic pain process information about daily activities. Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) was used to compare brain responses in patients with chronic musculoskeletal pain (CMSKP) (n = 15) and healthy controls (n = 15). Subjects were asked to imagine how they would feel mentally and physically if asked to perform daily activities illustrated in PIT. The results found that a number of regions involved in pain processing saw increased BOLD activation in patients compared with controls when undertaking the task and included the insula, anterior cingulate cortex, thalamus and inferior and superior parietal cortices. Similarly, increased BOLD responses in patients compared to controls in the frontal pole, paracingulate and the supplementary motor cortex may be suggestive of a memory component to the responses The amygdala, orbitofrontal cortex, substantia nigra/ventral tegmentum, putamen, thalamus, pallidum, inferior parietal (supramarginal and angular gyrus) and cingulate cortex were also seen to have greater differences in BOLD signal changes in patients compared with controls and many of these regions are also associated with general phobic responses. Therefore, we suggest that PIT is a useful task to explore pain- and movement-related anxiety and fear in fMRI studies. Regions in the Default Mode Network remained active or were less deactivated during the PIT task in patients with CMSKP compared to healthy controls supporting the contention that the DMN is abnormal in patients with CMSKP.
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Carvalho AR, Ribeiro Bertor WR, Briani RV, Zanini GM, Silva LI, Andrade A, Peyré-Tartaruga LA. Effect of Nonspecific Chronic Low Back Pain on Walking Economy: An Observational Study. J Mot Behav 2015; 48:218-26. [PMID: 26403060 DOI: 10.1080/00222895.2015.1079162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The authors investigated the effects of chronic low back pain (LBP) and walking speed (WS) on metabolic power and cost of transport (CT). Subjects with chronic nonspecific LBP (LBP group [LG]; n = 9) and healthy (control group [CG]; n = 9) were included. The test battery was divided into 3 blocks according to WS as follows: preferred self-selected speed (PS), and lower and higher than the PS. In each block, the volunteers walked 5 min, during which oxygen consumption was measured. Although without differences between groups, the LG had CT lower in slower speeds than in faster speeds. Walking speed affected CT only in the LG, which the group had the greatest walking economy at slower speeds.
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Affiliation(s)
- Alberito Rodrigo Carvalho
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil.,d Educação Física, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
| | - Welds Rodrigo Ribeiro Bertor
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil
| | | | - Gabriela Matté Zanini
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil
| | - Lígia Inez Silva
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil
| | - Alexandro Andrade
- c Educação Física, Universidade Estadual de Santa Catarina , Florianópolis , Brazil
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Cho YK, Kim DY, Jung SY, Seong JH. Synergistic effect of a rehabilitation program and treadmill exercise on pain and dysfunction in patients with chronic low back pain. J Phys Ther Sci 2015; 27:1187-90. [PMID: 25995585 PMCID: PMC4434006 DOI: 10.1589/jpts.27.1187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study examined the influence of treadmill exercise added to a low
back pain rehabilitation program on low back extensor strength, pain, and dysfunction in
chronic low back pain patients. [Subjects and Methods] Twenty men aged 22–36 years with
chronic low back pain were randomly divided into experimental and control groups of 10
patients each. Both groups underwent a low back pain rehabilitation program lasting 30 min
each, thrice/week for 8 weeks. The experimental group was prescribed an additional 30 min
of treadmill exercise without a slope at a speed of 3.0–3.5 km/h, at which patients could
walk comfortably. Low back extensor strength was tested using the Medx lumbar extension
machine, pain level was tested, using the visual analog scale, and dysfunction was tested,
using the Oswestry Low Back Pain Disability Questionnaire. [Results] Changes in low back
extensor strength by angle showed significant interaction effects between measurement time
and group at 12°, 24°, and 36°. The results of the visual analog scale and Oswestry
Questionnaire showed a decreasing trend after the experiment in both groups. However,
there was no interaction effect of the additional treadmill exercise in the experimental
group. [Conclusion] The combination of a low back pain rehabilitation program and
treadmill exercise has a synergistic effect, to some extent, on the improvement of low
back extensor strength and should be considered for treatment and rehabilitation of low
back pain patients.
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Affiliation(s)
- Young-Ki Cho
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of
| | | | - Sun-Young Jung
- Department of Sports Healthcare, Inje University, Republic of Korea
| | - Jun-Hyuk Seong
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of
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Geha P, deAraujo I, Green B, Small DM. Decreased food pleasure and disrupted satiety signals in chronic low back pain. Pain 2014; 155:712-722. [DOI: 10.1016/j.pain.2013.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 01/22/2023]
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Demoulin C, Huijnen IPJ, Somville PR, Grosdent S, Salamun I, Crielaard JM, Vanderthommen M, Volders S. Relationship between different measures of pain-related fear and physical capacity of the spine in patients with chronic low back pain. Spine J 2013; 13:1039-47. [PMID: 23623193 DOI: 10.1016/j.spinee.2013.02.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 12/17/2012] [Accepted: 02/18/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It has been controversially stated that pain-related fear is a more important determining factor for disability in chronic low back pain (CLBP) than pain or physical impairment in itself. So far, the relationship between psychological and physiological determinants of chronic pain, that is, pain-related fear and physiological abilities, remains unclear. PURPOSE To evaluate whether pain-related fear assessed by different tools (both task specific and non task specific) is related to physical capacity measured by specific spine tests and, secondarily, to explore the relationship between different pain-related fear assessment tools. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE Fifty patients with CLBP (50% women; meanage [standard deviationage]: 44.2 [9.5 years]). OUTCOME MEASURES Physical capacity by means of three specific spine tests, that is, the finger-floor distance test (flexibility), a maximal isometric strength test of trunk extensor muscles (strength), and the Sorensen test (endurance). Pain-related fear by means of self-report measures, that is, the Tampa Scale for Kinesiophobia (TSK), the Photograph Series of Daily Activities (PHODA), and a fear visual analog scale (FVAS) tailored to the spine tests. METHODS Participants were asked to complete the TSK and PHODA and to perform the three spine tests. Right before performing each of the spine tests, an FVAS was filled out. Linear regression analyses controlling for gender and age were performed to study the association between the pain-related fear measurements and the results of the spine tests. To investigate the relationship between the pain-related fear measurements, correlation tests were performed. RESULTS The linear regression analyses revealed that neither the TSK and PHODA scores nor the FVAS scores were significantly related to the physical capacity measurements. The correlational tests showed no significant correlation between the PHODA, TSK, and FVAS scores. CONCLUSIONS The present study shows that neither the task-specific tool (FVAS) nor the non task-specific questionnaires (TSK and PHODA) were significantly correlated to the spine tests in patients with CLBP. This is contrary to earlier evidence according to which physical capacity is inversely related to the level of pain-related fear, and it suggests that one should not draw conclusions about physical capacity based on pain-related fear scores. Furthermore, the different assessment tools for pain-related fear were surprisingly not correlated with each other.
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Affiliation(s)
- Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, ISEPK BAT B21, Sart-Tilman, 4000 Liège, Belgium; Department of Physical Medicine and Rehabilitation, Liège University Hospital, Sart Tilman, 4000 Liège, Belgium.
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Huijnen IPJ, Verbunt JA, Wittink HM, Smeets RJEM. Physical performance measurement in chronic low back pain: measuring physical capacity or pain-related behaviour? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.830643] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wideman TH, Asmundson GGJ, Smeets RJEM, Zautra AJ, Simmonds MJ, Sullivan MJL, Haythornthwaite JA, Edwards RR. Rethinking the fear avoidance model: toward a multidimensional framework of pain-related disability. Pain 2013; 154:2262-2265. [PMID: 23748115 DOI: 10.1016/j.pain.2013.06.005] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/03/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Timothy H Wideman
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA Department of Psychology, University of Regina, Regina, Saskatchewan, Canada Department of Rehabilitation, Maastricht University, Maastricht, The Netherlands Department of Psychology, Arizona State University, Phoenix, AZ, USA Department of Physical Therapy, University of Texas, Health Sciences Center, San Antonio, TX, USA Department of Psychology, McGill University, Montreal, Quebec, Canada Department of Anaesthesia, Harvard School of Medicine, Boston, MA, USA
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Hendrick P, Milosavljevic S, Hale L, Hurley DA, McDonough SM, Herbison P, Baxter GD. Does a patient's physical activity predict recovery from an episode of acute low back pain? A prospective cohort study. BMC Musculoskelet Disord 2013; 14:126. [PMID: 23560880 PMCID: PMC3626659 DOI: 10.1186/1471-2474-14-126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 04/02/2013] [Indexed: 11/14/2022] Open
Abstract
Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain. Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population. This prospective cohort study recruited 101 consenting patients with sub-acute LBP (< 6 weeks) who completed the Roland Morris Disability Questionnaire (RMDQ), the Visual Analogue Scale, and resumption of full ‘normal’ activity question (Y/N), at baseline and 3 months. Physical activity was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall questionnaire. Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ (p > 0.05) or RMDQ change (p > 0.05) over 3 months. A self-report of a return to full ‘normal’ activities was significantly associated with greater RMDQ change score at 3 months (p < 0.001). Paired t-tests found no significant change in activity levels measured with the RT3 (p = 0.57) or the recall questionnaire (p = 0.38) from baseline to 3 months. Conclusions These results question the predictive role of physical activity in LBP recovery, and the assumption that activity levels change as LBP symptoms resolve. The importance of a patient’s perception of activity limitation in recovery from acute LBP was also highlighted. Trial registration Clinical Trial Registration Number, ACTRN12609000282280
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Affiliation(s)
- Paul Hendrick
- Division of Physiotherapy Education, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK.
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Handrakis JP, Friel K, Hoeffner F, Akinkunle O, Genova V, Isakov E, Mathew J, Vitulli F. Key Characteristics of Low Back Pain and Disability in College-Aged Adults: A Pilot Study. Arch Phys Med Rehabil 2012; 93:1217-24. [DOI: 10.1016/j.apmr.2012.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 02/11/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
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Ledoux E, Dubois JD, Descarreaux M. Physical and psychosocial predictors of functional trunk capacity in older adults with and without low back pain. J Manipulative Physiol Ther 2012; 35:338-45. [PMID: 22608282 DOI: 10.1016/j.jmpt.2012.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/02/2012] [Accepted: 01/12/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the physical and psychosocial predictors of functional trunk capacity in a group of healthy elderly individuals and a group of elderly patients with chronic low back pain (LBP). METHODS The study was done in Canada and included 61 community-dwelling elderly individuals (29 patients with nonspecific chronic LBP and 32 healthy participants) who performed maximal trunk endurance and force tasks. Participants completed various psychologic and functional questionnaires. Sequential linear regression analyses were performed with functional capacity results (endurance and force) as dependent variables and questionnaire scores as independent variables. RESULTS Endurance time and peak force were significantly lower in patients compared with healthy elderly individuals (all P values < .001), whereas pain-related fear of movement, pain catastrophizing, and depression levels were higher in patients than their healthy counterpart (all P values < .001). After adjusting for physical activity and disability levels (R(2) = 33.7%-50.5% in patients; R(2) = 0.1%-5.7% in healthy individuals), none of the psychologic questionnaire could explain variations observed in functional capacity in patients (R(2) changes, 4.8%-6.7%) and in healthy participants (R(2) changes, 5.2%-10.6%). CONCLUSION Patients showed diminished functional capacity compared with healthy participants. Moreover, physical activity levels represent the most important predictors of functional capacity in elderly patients with LBP.
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Affiliation(s)
- Elizabeth Ledoux
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Thorell E, Kristiansson P. Pregnancy related back pain, is it related to aerobic fitness? A longitudinal cohort study. BMC Pregnancy Childbirth 2012; 12:30. [PMID: 22510295 PMCID: PMC3353851 DOI: 10.1186/1471-2393-12-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/17/2012] [Indexed: 11/30/2022] Open
Abstract
Background Low back pain with onset during pregnancy is common and approximately one out of three women have disabling pain. The pathogenesis of the pain condition is uncertain and there is no information on the role of physical fitness. Whether poorer physical conditioning is a cause or effect of back pain is also disputed and information from prospective studies needed. Methods A cohort of pregnant women, recruited from maternal health care centers in central Sweden, were examined regarding estimated peak oxygen uptake by cycle ergometer test in early pregnancy, reported physical activity prior to pregnancy, basic characteristics, back pain during pregnancy and back pain postpartum. Results Back pain during the current pregnancy was reported by nearly 80% of the women. At the postpartum appointment this prevalence was 40%. No association was displayed between estimated peak oxygen uptake and incidence of back pain during and after pregnancy, adjusted for physical activity, back pain before present pregnancy, previous deliveries, age and weight. A significant inverse association was found between estimated peak oxygen uptake and back pain intensity during pregnancy and a direct association post partum, in a fully adjusted multiple linear regression analysis. Conclusions Estimated peak oxygen uptake and reported physical activity in early pregnancy displayed no influence on the onset of subsequent back pain during or after pregnancy, where the time sequence support the hypothesis that poorer physical deconditioning is not a cause but a consequence of the back pain condition. The mechanism for the attenuating effect of increased oxygen uptake on back pain intensity is uncertain.
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Affiliation(s)
- Eva Thorell
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine unit, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden
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Griffin D, Harmon D, Kennedy N. Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature. Physiotherapy 2012; 98:13-23. [DOI: 10.1016/j.physio.2011.04.350] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 04/23/2011] [Indexed: 11/29/2022]
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Tuzer V, Bulut SD, Bastug B, Kayalar G, Göka E, Beştepe E. Causal attributions and alexithymia in female patients with fibromyalgia or chronic low back pain. Nord J Psychiatry 2011; 65:138-44. [PMID: 20874000 DOI: 10.3109/08039488.2010.522596] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Our general objective was to assess the psychological symptoms and the types of causal attributions linked to the symptoms among women chronic pain. METHODS 70 fibromyalgia (FM) patients, 56 chronic low back pain (CLBP) patients and 72 healthy controls were assessed within a general hospital setting, using the Toronto Alexithymia Scale, Brief Symptom Inventory and Symptom Interpretation Questionnaire. Three-way analysis of variance and chi-square tests were used for inter-group comparisons, followed by multivariate correlation, covariate analysis and linear regression. RESULTS Alexithymia, somatization, depression, anxiety and hostility scores were significantly higher in FM patients relative to CLBP patients and healthy controls (P < 0.05). Alexithymia was linked to psychological attributions in FM patients and to somatic attributions in CLBP patients. Psychological attributions, the number of symptoms and difficulty in describing emotions were related to increased anxiety in FM patients. Depression, anxiety and somatization were significantly increased in subjects with high alexithymia scores in the FM group. There was no difference between groups regarding causal attributions. CONCLUSIONS Causal attributions do not seem to have distinctive features between functional somatic syndromes like FM and CLBP, though differences might exist between groups as to the effects of coexisting psychological distress symptoms like anxiety and depression.
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Affiliation(s)
- Verda Tuzer
- Numune Training and Research Hospital, First Psychiatry Clinic, Ankara, Turkey.
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Vincent HK, Omli MR, Day T, Hodges M, Vincent KR, George SZ. Fear of Movement, Quality of Life, and Self-Reported Disability in Obese Patients with Chronic Lumbar Pain. PAIN MEDICINE 2011; 12:154-64. [DOI: 10.1111/j.1526-4637.2010.01011.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hendrick P, Milosavljevic S, Hale L, Hurley DA, McDonough S, Ryan B, Baxter GD. The relationship between physical activity and low back pain outcomes: a systematic review of observational studies. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:464-74. [PMID: 21053026 DOI: 10.1007/s00586-010-1616-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 10/01/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
Abstract
Although clinical guidelines advocate exercise and activity in the management of non-specific low back pain (NSLBP), the link between levels of physical activity and outcomes is unclear. This systematic review investigated the relationships between free living activity levels after onset of low back pain (LBP) and measures of pain, and disability in patients with NSLBP. Cohort and cross-sectional studies were located using OVID, CINAHL, Medline, AMED, Embase, Biomed, PubMed-National Library of Medicine, Proquest and Cochrane Databases, and hand searches of reference lists. Studies were included if a statistical relationship was investigated between measures of free living physical activity (PA) in subjects with LBP and LBP outcome measures. Twelve studies (seven cohort and five cross-sectional) were included. One prospective study reported a statistically significant relationship between increased leisure time activity and improved LBP outcomes, and one cross-sectional study found that lower levels of sporting activity were associated with higher levels of pain and disability. All other studies (n = 10) found no relationship between measures of activity levels and either pain or disability. Heterogeneity of study designs, particularly in terms of activity measurement, made comparisons between studies difficult. These data suggest that the activity levels of patients with NSLBP are neither associated with, nor predictive of, disability or pain levels. Validated activity measurement in prospective research is required to better evaluate the relationships between PA and LBP.
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Affiliation(s)
- Paul Hendrick
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
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Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine (Phila Pa 1976) 2010; 35:E1178-86. [PMID: 20881658 DOI: 10.1097/brs.0b013e3181e53334] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An experimental and comparative study of chronic low back pain (CLBP) patients and healthy controls. OBJECTIVE To use a motivation-independent electromyography (EMG) based test of back muscle capacity to determine whether back muscle deconditioning is present in CLBP patients and whether it is related to pain-related psychological variables. SUMMARY OF BACKGROUND DATA The verification of the deconditioning syndrome in CLBP patients might be biased by the use of performance-based measures to assess physical fitness, especially in patients having fear of injury. Also, the use of lumbar-specific measures of physical fitness, such as back muscle strength and endurance, might be more sensitive to physical deconditioning than more general assessments such as aerobic capacity. METHODS A time-limited submaximal fatigue test was performed by 27 nonspecific CLBP subjects (14 men) who had not had any surgery, and 31 healthy controls (17 men) while surface EMG signals were collected from back muscles. Motivation-independent EMG indices, which are sensitive to muscle fatigue or to activation patterns, were then computed and entered as input into previously developed regression equations to predict endurance (PTend) and strength (PStrength). Between-group comparisons were completed with patients divided in subgroups based on a median split of pain intensity, fear of movement, or pain catastrophizing scores. RESULTS Differences between healthy and CLBP subgroups were mainly observed when patients were divided using pain catastrophizing scores (PCS). High-PCS patients showed significantly lower PTend than low-PCS patients. Various EMG indices showed comparable results to PTend. However, some of them also pointed out that the PCS-low patients were more fatigue-resistant and showed different activation patterns comparatively to healthy subjects. CONCLUSION These results suggest that physical deconditioning that is specific to back muscle capacity was present in a subgroup of patients while the opposite was observed in another subgroup, pain catastrophizing being related to this outcome. These findings support previous theoretical models of pain/disability.
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Cause or effect? Deconditioning and chronic low back pain. Pain 2010; 149:428-430. [DOI: 10.1016/j.pain.2010.01.020] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/24/2010] [Accepted: 01/26/2010] [Indexed: 11/20/2022]
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Hendrick P, Te Wake AM, Tikkisetty AS, Wulff L, Yap C, Milosavljevic S. The effectiveness of walking as an intervention for low back pain: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1613-20. [PMID: 20414688 DOI: 10.1007/s00586-010-1412-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/08/2010] [Accepted: 04/11/2010] [Indexed: 11/29/2022]
Abstract
As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low-moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP.
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Affiliation(s)
- P Hendrick
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand
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Smeets RJ, Soest MV. The usability of a modified Astrand bicycle test to assess the aerobic capacity in patients with musculoskeletal pain and healthy controls. Disabil Rehabil 2010; 31:1988-95. [PMID: 19874077 DOI: 10.3109/09638280902874162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to assess the usability of a modified Astrand bicycle test in subjects with musculoskeletal pain disorder (MSPD) and healthy controls. METHODS In a random cross-over design, 31 subjects with a MSPD who have been referred to rehabilitation medicine and 33 healthy subjects matched for age, gender, height and body weight, performed an Astrand bicycle test and a modified test with a time interval of 7 days. Drop-out rates, VO2max values (in mL/kg lean body mass (LBM) min(-1)), intraclass correlation coefficients (ICCs) and critical difference (Bland-Altman plots) for both tests within each group of subjects were compared. RESULTS The drop-out rate in both tests for the MSPD group was comparable, and mainly caused by pain, fatigue or breathlessness. Compared with the modified version, the Astrand test showed higher VO2max-scores: 4.83 mL/kg LBM min(-1) (9.96%) in the MSPD group and 3.5 mL/kg LBM min(-1) (5.57%) in the healthy group. ICCs were 0.79 and 0.87 and the limits of agreement were 8.5 mL/kg LBM min(-1) (15.9%) and 10.2 mL/kg LBM min(-1) (18.1%), respectively. CONCLUSION The usability of the modified test is acceptable, as well as in healthy individuals as subjects suffering from MSPD being referred to rehabilitation medicine. However, a slight under estimation of VO2max with the modified test has to be taken into account.
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Affiliation(s)
- Rob Johannes Smeets
- Rehabilitation Foundation Limburg, Knowledge Centre, Hoensbroek 6430 AB, The Netherlands.
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