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Kehl C, Suter M, Johannesdottir E, Dörig M, Bangerter C, Meier ML, Schmid S. Associations between pain-related fear and lumbar movement variability during activities of daily living in patients with chronic low back pain and healthy controls. Sci Rep 2024; 14:22889. [PMID: 39358482 PMCID: PMC11447241 DOI: 10.1038/s41598-024-73430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024] Open
Abstract
Low back pain (LBP) is a global issue involving biological, psychological, and social factors. Pain-related fear has been shown to influence movement behavior, however, its association with some measures of movement behavior, such as spinal movement variability, remains inconclusive. To further investigate this, spinal kinematics during various activities of daily living (i.e., walking, running, lifting, and stair climbing) of 49 patients with chronic LBP and a group of 51 sex-, age-, and BMI-matched healthy controls were used to calculate lumbar spine movement variability which was quantified using different indices (i.e., coefficient of variation, coupling angle variability in vector coding, deviation phase of the continuous relative phase and an angle-angular velocity variability). General and task-specific pain-related fear was assessed using the Tampa Scale of Kinesiophobia and the Photograph Series of Daily Activities-Short Electronic Version, respectively. Linear regression analyses showed no significant association between movement variability and pain-related fear, however, the sample consisted of younger individuals with moderate disability and with low levels of pain and pain-related fear. In addition, the different variability indices were weakly correlated and varied greatly depending on the method used and the task performed. Therefore, comparisons between studies with different movement variability calculation methods or different activities should be treated with caution.
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Affiliation(s)
- Corinne Kehl
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Magdalena Suter
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Embla Johannesdottir
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Monika Dörig
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Bangerter
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Michael L Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
- Faculty of Medicine, University of Basel, Basel, Switzerland.
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Montgomery G, Tobias JH, Paskins Z, Khera TK, Huggins CJ, Allison SJ, Abasolo D, Clark EM, Ireland A. Daily Pain Severity but Not Vertebral Fractures Is Associated With Lower Physical Activity in Postmenopausal Women With Back Pain. J Aging Phys Act 2024; 32:428-437. [PMID: 38527456 DOI: 10.1123/japa.2023-0035] [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: 01/30/2023] [Revised: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 03/27/2024]
Abstract
Back pain lifetime incidence is 60%-70%, while 12%-20% of older women have vertebral fractures (VFs), often with back pain. We aimed to provide objective evidence, currently lacking, regarding whether back pain and VFs affect physical activity (PA). We recruited 69 women with recent back pain (age 74.5 ± 5.4 years). Low- (0.5 < g < 1.0), medium- (1.0 ≤ g < 1.5), and high-impact (g ≥ 1.5) PA and walking time were measured (100 Hz for 7 days, hip-worn accelerometer). Linear mixed-effects models assessed associations between self-reported pain and PA, and group differences (VFs from spine radiographs/no-VF) in PA. Higher daily pain was associated with reduced low (β = -0.12, 95% confidence interval, [-0.22, -0.03], p = .013) and medium-impact PA (β = -0.11, 95% confidence interval, [-0.21, -0.01], p = .041), but not high-impact PA or walking time (p > .11). VFs were not associated with PA (all p > .2). Higher daily pain levels but not VFs were associated with reduced low- and medium-impact PA, which could increase sarcopenia and falls risk in older women with back pain.
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Affiliation(s)
- Gallin Montgomery
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Zoe Paskins
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Tarnjit K Khera
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Cameron J Huggins
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, United Kingdom
| | - Sarah J Allison
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
- Department of Nutrition, Food & Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Daniel Abasolo
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, United Kingdom
| | - Emma M Clark
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
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Harvie DS, Kelly J, Kluver J, Deen M, Spitzer E, Coppieters MW. A randomized controlled pilot study examining immediate effects of embodying a virtual reality superhero in people with chronic low back pain. Disabil Rehabil Assist Technol 2024; 19:851-858. [PMID: 36256688 DOI: 10.1080/17483107.2022.2129846] [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: 01/18/2022] [Revised: 07/19/2022] [Accepted: 09/22/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE In virtual reality, avatar embodiment can spur perceptions and behaviours related the avatars' characteristics. We tested whether embodying superhero-like avatars can change self-perceptions in people with chronic low back pain (CLBP). DESIGN A non-blinded pilot randomized controlled trial. METHODS Participants were randomly allocated to embody a superhero (VR-SH, n = 20) or a neutral, non-superhero (VR-Play, n = 10) avatar. Primary outcomes related to body image (e.g., self-perceived vulnerability) and pain intensity were assessed at baseline, during exposure, immediately after and at one-week follow-up. Fear of movement, strength and patient impression of change were also recorded. RESULTS The VR-SH group reported gains in body image during (p < .001, η p 2 =0.71) and immediately after (p < .001, η p 2 =0.66) VR, whereas the VR-Play group reported small gains during VR (p = .021, η p 2 =0.46) but not immediately after (p = .076, η p 2 =0.31). Pain, strength and fear of movement did not change and there were no sustained effects at follow-up (all ps > .05). A greater proportion of people in the VR-SH group reported at least minimal improvement at follow-up (7/20 vs. 1/10). CONCLUSION A VR-SH session produced temporary positive effects on body image. Future research may consider whether larger and sustained effects can be obtained with multisession exposures or explore combined interventions. Implications for rehabilitationPhysical confidence and bodily trust can be significantly enhanced in people with chronic back pain using virtual reality.These positive body image effects may have implications for rehabilitation, such as in enhancing confidence with movementWhether a multisession intervention might produce more robust effects and changes in pain is yet to be determined.
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Affiliation(s)
- Daniel S Harvie
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
- Metro South Pain Rehabilitation Centre, Division of Rehabilitation, Princess Alexandra Hospital,Woolloongabba, Australia
- Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), Allied Health and Human Performance, University of South Australia, North Tce, Adelaide, Australia
| | - Joan Kelly
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Joseph Kluver
- Metro South Pain Rehabilitation Centre, Division of Rehabilitation, Princess Alexandra Hospital,Woolloongabba, Australia
| | - Michael Deen
- Metro South Pain Rehabilitation Centre, Division of Rehabilitation, Princess Alexandra Hospital,Woolloongabba, Australia
| | - Elizabeth Spitzer
- Metro South Pain Rehabilitation Centre, Division of Rehabilitation, Princess Alexandra Hospital,Woolloongabba, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Ansanello W, Dos Reis FJJ, Tozzo MC, Zatiti SCA, Meulders A, Vlaeyen JWS, de Oliveira AS. Reliability and Validity of the Avoidance of Daily Activities Photo Scale for Patients With Shoulder Pain (ADAP Shoulder Scale). Phys Ther 2023; 103:pzad101. [PMID: 37690060 DOI: 10.1093/ptj/pzad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/08/2023] [Accepted: 07/16/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE The Avoidance of Daily Activities Photo Scale for Patients With Shoulder Pain (ADAP Shoulder Scale) was developed to assess pain-related avoidance behavior during daily activities in people with shoulder pain. However, its measurement properties must be verified according to international guidelines. As such, this study investigated the following 4 measurement properties of the ADAP Shoulder Scale: reliability, measurement errors, convergent validity, and floor and ceiling effects. METHODS The sample comprised 100 individuals with chronic shoulder pain (43 men and 57 women; mean duration of symptoms of 29.7 [SD = 89.0] months; mean age of 44.9 [SD = 15.9] years). The mean test-retest reliability range was 5 days via the intraclass correlation coefficient (ICC). Measurement errors included the standard error of measurement and the minimal detectable change. Convergent validity was analyzed by applying the Pearson correlation with the Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, and Shoulder Pain and Disability Index. RESULTS The ADAP Shoulder Scale showed excellent test-retest reliability, both in all domains and in the total score [ICC(2,1) = 0.94; 95% CI = 0.92-0.96]. The standard errors of measurement for the free-movement, high-effort, and self-care domains were 8.1%, 6.0%, and 7.6%, respectively. The minimal detectable change for the total score of the ADAP Shoulder Scale was 16.0%. The total score of the ADAP Shoulder Scale was low to moderately correlated with the total scores of the Tampa Scale for Kinesiophobia (r = 0.52), Pain Catastrophizing Scale (r = 0.30), and Shoulder Pain and Disability Index (r = 0.72). No floor or ceiling effects were detected in the total score. CONCLUSION The ADAP Shoulder Scale is a reliable, valid instrument for assessing avoidance behavior in adults who have chronic shoulder pain and are not athletes. IMPACT This study provides evidence that the ADAP Shoulder Scale is appropriate for clinical and practical use in people with chronic shoulder pain.
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Affiliation(s)
- Walter Ansanello
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Felipe José Jandre Dos Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Postgraduation Program - Clinical Medicine Department of Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marcela Camargo Tozzo
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Salomão Chade Assan Zatiti
- Department of Orthopaedic Surgery, Hospital Especializado de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Ann Meulders
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Johan W S Vlaeyen
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Lotz JC, Ropella G, Anderson P, Yang Q, Hedderich MA, Bailey J, Hunt CA. An exploration of knowledge-organizing technologies to advance transdisciplinary back pain research. JOR Spine 2023; 6:e1300. [PMID: 38156063 PMCID: PMC10751978 DOI: 10.1002/jsp2.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 12/30/2023] Open
Abstract
Chronic low back pain (LBP) is influenced by a broad spectrum of patient-specific factors as codified in domains of the biopsychosocial model (BSM). Operationalizing the BSM into research and clinical care is challenging because most investigators work in silos that concentrate on only one or two BSM domains. Furthermore, the expanding, multidisciplinary nature of BSM research creates practical limitations as to how individual investigators integrate current data into their processes of generating impactful hypotheses. The rapidly advancing field of artificial intelligence (AI) is providing new tools for organizing knowledge, but the practical aspects for how AI may advance LBP research and clinical are beginning to be explored. The goals of the work presented here are to: (1) explore the current capabilities of knowledge integration technologies (large language models (LLM), similarity graphs (SGs), and knowledge graphs (KGs)) to synthesize biomedical literature and depict multimodal relationships reflected in the BSM, and; (2) highlight limitations, implementation details, and future areas of research to improve performance. We demonstrate preliminary evidence that LLMs, like GPT-3, may be useful in helping scientists analyze and distinguish cLBP publications across multiple BSM domains and determine the degree to which the literature supports or contradicts emergent hypotheses. We show that SG representations and KGs enable exploring LBP's literature in novel ways, possibly providing, trans-disciplinary perspectives or insights that are currently difficult, if not infeasible to achieve. The SG approach is automated, simple, and inexpensive to execute, and thereby may be useful for early-phase literature and narrative explorations beyond one's areas of expertise. Likewise, we show that KGs can be constructed using automated pipelines, queried to provide semantic information, and analyzed to explore trans-domain linkages. The examples presented support the feasibility for LBP-tailored AI protocols to organize knowledge and support developing and refining trans-domain hypotheses.
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Affiliation(s)
- Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | | | - Paul Anderson
- Department of Computer Science & Software EngineeringCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Qian Yang
- Department of Information ScienceCornell UniversityIthacaNew YorkUSA
| | | | - Jeannie Bailey
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - C. Anthony Hunt
- Department of Bioengineering & Therapeutic SciencesUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
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6
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Alves M, Krypotos AM, Crombez G, Vlaeyen JWS. Experimental Pain Picture System (EPPS): Development and Validation. THE JOURNAL OF PAIN 2023; 24:2052-2062. [PMID: 37356605 DOI: 10.1016/j.jpain.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/27/2023]
Abstract
Pain-related pictures are useful for studying how individuals respond to pain-related stimulation. Such pictures can occasionally be found in databases for affective pictures. However, a validated database specifically for pain-related pictures is not available yet. In 2 experiments (N = 185 and 103, respectively), we developed and validated the Experimental Pain Pictures System (EPPS). In both experiments, negative valence, arousal, and painfulness ratings were compared between neutral-, sad-, and pain-related pictures. The pain-related pictures represented both deep and superficial somatic pain. Across the 2 experiments, pain-related pictures were judged as more negative, arousing, and painful than neutral pictures and more painful than sad pictures. The final EPPS contains 50 pictures of different painful events considered moderately to highly painful by participants. The EPPS is a valuable tool for studying pain-related responses, as it gives researchers a choice among many validated pictures depicting different types of pain, increasing the comparability between studies. PERSPECTIVE: This article presents the validation of the experimental pain pictures system, which consists of a set of pain-related pictures. The experimental pain pictures system is composed of pictures depicting different types of pain. Participants rated all the pictures as being negative, arousing, and painful.
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Affiliation(s)
- Maryna Alves
- Research Group Health Psychology, KU Leuven, Leuven, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Angelos-Miltiadis Krypotos
- Research Group Health Psychology, KU Leuven, Leuven, Belgium; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium; Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
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7
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Quirk DA, Chung J, Schiller G, Cherin JM, Arens P, Sherman DA, Zeligson ER, Dalton DM, Awad LN, Walsh CJ. Reducing Back Exertion and Improving Confidence of Individuals with Low Back Pain with a Back Exosuit: A Feasibility Study for Use in BACPAC. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S175-S186. [PMID: 36794907 PMCID: PMC10403307 DOI: 10.1093/pm/pnad003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Low back pain (LBP) is hallmarked by activity limitations, especially for tasks involving bending. Back exosuit technology reduces low back discomfort and improves self-efficacy of individuals with LBP during bending and lifting tasks. However, the biomechanical efficacy of these devices in individuals with LBP is unknown. This study sought to determine biomechanical and perceptual effects of a soft active back exosuit designed to assist individuals with LBP sagittal plane bending. To understand patient-reported usability and use cases for this device. METHODS Fifteen individuals with LBP performed two experimental lifting blocks once with and without an exosuit. Trunk biomechanics were measured by muscle activation amplitudes, and whole-body kinematics and kinetics. To evaluate device perception, participants rated task effort, low back discomfort, and their level of concern completing daily activities. RESULTS The back exosuit reduced peak back extensor: moments by 9%, and muscle amplitudes by 16% when lifting. There were no changes in abdominal co-activation and small reductions maximum trunk flexion compared to lifting without an exosuit. Participants reported lower task effort, back discomfort, and concern about bending and lifting with an exosuit compared to without. CONCLUSIONS This study demonstrates a back exosuit not only imparts perceptual benefits of reduced task effort, discomfort, and increased confidence in individuals with LBP but that it achieves these benefits through measurable biomechanical reductions in back extensor effort. The combined effect of these benefits implies back exosuits might be a potential therapeutic aid to augment physical therapy, exercises, or daily activities.
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Affiliation(s)
- D Adam Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, United States
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, United States
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States
| | - Gregory Schiller
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, United States
| | - Philipp Arens
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, United States
| | - David A Sherman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, United States
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Emma R Zeligson
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Diane M Dalton
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Lou N Awad
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, United States
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States
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Tissot LPM, Evans DW, Kirby E, Liew BXW. Tampa Scale of Kinesiophobia may underestimate task-specific fear of movement in people with and without low back pain. Pain Rep 2023; 8:e1081. [PMID: 37293339 PMCID: PMC10247215 DOI: 10.1097/pr9.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction The Tampa Scale of Kinesiophobia (TSK) is commonly used to assess fear of movement (FoM) in people with low back pain (LBP). However, the TSK does not provide a task-specific measure of FoM, whereas image-based or video-based methods may do so. Objectives To compare the magnitude of FoM when assessed using 3 methods (TSK-11, image of lifting, video of lifting) in 3 groups of people: current LBP (LBP), recovered LBP (rLBP), and asymptomatic controls (control). Methods Fifty-one participants completed the TSK-11 and rated their FoM when viewing images and videos depicting people lifting objects. Low back pain and rLBP participants also completed the Oswestry Disability Index (ODI). Linear mixed models were used to estimate the effects of methods (TSK-11, image, video) and group (control, LBP, rLBP). Linear regression models were used to assess associations between the methods on ODI after adjusting for group. Finally, a linear mixed model was used to understand the effects of method (image, video) and load (light, heavy) on fear. Results In all groups, viewing images (P = 0.009) and videos (P = 0.038) elicited greater FoM than that captured by the TSK-11. Only the TSK-11 was significantly associated with the ODI (P < 0.001). Finally, there was a significant main effect of load on fear (P < 0.001). Conclusion Fear of specific movements (eg, lifting) may be better measured using task-specific measures, such as images and videos, than by task-generic questionnaires, such as the TSK-11. Being more strongly associated with the ODI, the TSK-11 still plays an important role in understanding the impact of FoM on disability.
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Affiliation(s)
- Liam-Pierre Mathieu Tissot
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - David William Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Edward Kirby
- Musculoskeletal Physiotherapy, Essex Partnership University NHS Foundation Trust, Runwell, Wickford, United Kingdom
| | - Bernard Xian Wei Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
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De Baets L, Meulders A, Van Damme S, Caneiro JP, Matheve T. Understanding Discrepancies in a Person's Fear of Movement and Avoidance Behavior: A Guide for Musculoskeletal Rehabilitation Clinicians Who Support People With Chronic Musculoskeletal Pain. J Orthop Sports Phys Ther 2023; 53:307–316. [PMID: 36884314 DOI: 10.2519/jospt.2023.11420] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND: Generic self-report measures do not reflect the complexity of a person's pain-related behavior. Since variations in a person's fear of movement and avoidance behavior may arise from contextual and motivational factors, a person-centered evaluation is required-addressing the cognitions, emotions, motivation, and actual behavior of the person. CLINICAL QUESTION: Most musculoskeletal rehabilitation clinicians will recognize that different people with chronic pain have very different patterns of fear and avoidance behavior. However, an important remaining question for clinicians is "How can I identify and reconcile discrepancies in fear of movement and avoidance behavior observed in the same person, and adapt my management accordingly?" KEY RESULTS: We frame a clinical case of a patient with persistent low back pain to illustrate the key pieces of information that clinicians may consider in a person-centered evaluation (ie, patient interview, self-report measures, and behavioral assessment) when working with patients to manage fear of movement and avoidance behavior. CLINICAL APPLICATION: Understanding the discrepancies in a person's fear of movement and avoidance behavior is essential for musculoskeletal rehabilitation clinicians, as they work in partnership with patients to guide tailored approaches to changing behaviors. J Orthop Sports Phys Ther 2023;53(5):1-10. Epub: 9 March 2023. doi:10.2519/jospt.2023.11420.
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10
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The Relationship Between Pain-Related Psychological Factors and Maximal Physical Performance in Low Back Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2022; 23:2036-2051. [PMID: 36057387 DOI: 10.1016/j.jpain.2022.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 01/04/2023]
Abstract
Theoretical frameworks explain how pain-related psychological factors may influence the physical performance. In this systematic review and meta-analysis, we evaluated the evidence regarding the relationship between the pain-related psychological factors and the maximal physical performance in patients with low back pain (LBP). Pubmed, Embase, CINAHL and Web of Science databases were searched from inception to May 2022. Cross-sectional or longitudinal studies reporting cross-sectional measures of association between at least one pain-related psychological factor and a quantitatively measured outcome of maximal physical performance in patients with LBP were eligible for inclusion. Thirty-eight studies (n = 2,490; 27 cross-sectional studies, n = 1,647 (66%); 11 longitudinal studies, n = 843 (34%)) were included, with 92% of participants (n = 2,284) having chronic LBP. Results showed that pain-related fear, pain catastrophizing, and anticipated pain were consistently and negatively associated with the maximal physical performance in chronic LBP, whereas pain-self efficacy showed positive correlations. Overall, magnitudes of absolute pooled r-values were small (r ≤ 0.25), except for anticipated pain, which was moderately associated with maximal physical performance (r = -0.34 to -0.37). Subanalyses and sensitivity analyses yielded similar pooled correlation coefficients. Certainty of evidence using the GRADE recommendations was very low to moderate for pain-related fear, and very low to low for the other pain-related psychological factors. Prospero registration: CRD42021227486. PERSPECTIVE: Overall, small pooled correlation coefficients were shown between pain-related psychological factors and maximal physical performance in chronic LBP. Certainty of evidence was very low to low for all pain-related psychological factors other than pain-related fear. Future studies taking into account limitations of the current literature may therefore change these conclusions.
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11
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Meinke A, Maschio C, Meier ML, Karlen W, Swanenburg J. The association of fear of movement and postural sway in people with low back pain. Front Psychol 2022; 13:1006034. [PMID: 36467232 PMCID: PMC9716132 DOI: 10.3389/fpsyg.2022.1006034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/28/2022] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Fear of movement is thought to interfere with the recovery from low back pain (LBP). To date, the relationship between fear of movement and postural balance has not been adequately elucidated. Recent findings suggest that more specific fears need to be assessed and put in relation to a specific movement task. We propose that the fear to bend the trunk in a certain direction is distinctly related to the amount of postural sway in different directions. Therefore, our aim was to investigate whether fear of movement in general and fear of bending the trunk in a certain plane is related to postural sway. METHODS Data was collected from participants with LBP during two assessments ~3 weeks apart. Postural sway was measured with a force-platform during quiet standing with the eyes closed. Fear of movement was assessed with an abbreviated version of the Tampa Scale of Kinesiophobia (TSK-11) and custom items referring to fear of bending the trunk in the sagittal and the frontal plane. RESULTS Based on data from 25 participants, fear of bending the trunk in the frontal plane was positively related to displacement in the sagittal and frontal plane and to velocity in the frontal plane (χ 2 = 4.35, p = 0.04; χ 2 = 8.15, p = 0.004; χ 2 = 9.79, p = 0.002). Fear of bending the trunk in the sagittal plane was not associated with any direction specific measure of sway. A positive relation of the TSK-11 with velocity of the frontal plane (χ 2 = 7.14, p = 0.008) was found, but no association with undirected measures of sway. DISCUSSION Fear of bending the trunk in the frontal plane may be especially relevant to postural sway under the investigated stance conditions. It is possible that fear of bending the trunk in the frontal plane could interfere with balance control at the hip, shifting the weight from side to side to control balance. CONCLUSION For the first time the directional relationship of fear of movement and postural sway was studied. Fear of bending the trunk in the frontal plane was positively associated with several measures of postural sway.
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Affiliation(s)
- Anita Meinke
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Cinzia Maschio
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Michael L Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Institute of Biomedical Engineering, University of Ulm, Ulm, Germany
| | - Jaap Swanenburg
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
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12
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Liew BXW, Syrett J, Freeman P, Evans DW. Pain-related fear of movement dynamics in individuals with and without low back pain participating in weightlifting and/or powerlifting training. PLoS One 2022; 17:e0276983. [PMID: 36302048 PMCID: PMC9612576 DOI: 10.1371/journal.pone.0276983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Pain-free adults in the general population have been shown to possess unhelpful beliefs that certain movements and postures are harmful to the spine, potentially reinforcing fear-avoidance behaviour. Whether such beliefs occur in individuals undertaking regular powerlifting (PL) and Olympic weightlifting (OWL) training is unclear. METHODS In a cross-sectional study design, 67 individuals who participate in OWL and PL training completed an online survey. Demographic characteristics, training history, and self-reported perceptions of harm, on the 40-item Photograph Series of Daily Activities shortened electronic version (PHODA-SeV), were collected. After removing collinear variables, 13 items were entered into a network analysis, in which the adjusted correlations between items, and the centrality indices of each item (i.e., the degree of connection with other symptoms in the network) were quantified. RESULTS Twenty-one (31.3%) participants had LBP symptoms. The pairwise correlations with the greatest magnitudes were between images of 'leg stretch' and 'jumping' (0.32 [95%CI 0.08 to 0.45]) and two images depicting ironing (0.32 [95%CI 0.05 to 0.54]) respectively. The three most Central (connected) items were 'stair ascend', 'walking with groceries', and 'mopping with spine flexion'. CONCLUSIONS For individuals training in OWL and PL, images reflecting walking, rather than those depicting high spinal flexion angle, had greater connectivity to other activity items. In addition, the strongest correlations were not between items reflecting high spinal flexion angle. Future studies that investigate the relationship between different intensities of OWL and PL training and the dynamics of pain-related fear are warranted.
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Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Josce Syrett
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Paul Freeman
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - David W. Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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13
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Liechti M, von Arx M, Eichelberger P, Bangerter C, Meier ML, Schmid S. Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task. J Electromyogr Kinesiol 2022; 65:102678. [DOI: 10.1016/j.jelekin.2022.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022] Open
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14
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Schmid S, Bangerter C, Schweinhardt P, Meier ML. Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics. FRONTIERS IN PAIN RESEARCH 2022; 2:715219. [PMID: 35295522 PMCID: PMC8915772 DOI: 10.3389/fpain.2021.715219] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Persistent low back pain (LBP) is a major health issue, and its treatment remains challenging due to a lack of pathophysiological understanding. A better understanding of LBP pathophysiology has been recognized as a research priority, however research on contributing mechanisms to LBP is often limited by siloed research within different disciplines. Novel cross-disciplinary approaches are necessary to fill important knowledge gaps in LBP research. This becomes particularly apparent when considering new theories about a potential role of changes in movement behavior (motor control) in the development and persistence of LBP. First evidence points toward the existence of different motor control strategy phenotypes, which are suggested to have pain-provoking effects in some individuals driven by interactions between neuroplastic, psychological and biomechanical factors. Yet, these phenotypes and their role in LBP need further validation, which can be systematically tested using an appropriate cross-disciplinary approach. Therefore, we propose a novel approach, connecting methods from neuroscience and biomechanics research including state-of-the-art optical motion capture, musculoskeletal modeling, functional magnetic resonance imaging and assessments of psychological factors. Ultimately, this cross-disciplinary approach might lead to the identification of different motor control strategy phenotypes with the potential to translate into clinical research for better treatment options.
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Affiliation(s)
- Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Bangerter
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Integrative Spinal Research, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Alan Edwards Center for Research on Pain, McGill University, Montreal, QC, Canada
| | - Michael L Meier
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Integrative Spinal Research, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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15
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Bontinck J, den Hollander M, Kaas AL, De Jong JR, Timmers I. Individual Patterns and Temporal Trajectories of Changes in Fear and Pain during Exposure In Vivo: A Multiple Single-Case Experimental Design in Patients with Chronic Pain. J Clin Med 2022; 11:1360. [PMID: 35268453 PMCID: PMC8911417 DOI: 10.3390/jcm11051360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Exposure in vivo (EXP) is an effective treatment to reduce pain-related fear and disability in chronic pain populations. Yet, it remains unclear how reductions in fear and pain relate to each other. This single-case experimental design study attempted to identify patterns in the individual responses to EXP and to unravel temporal trajectories of fear and pain. Daily diaries were completed before, during and after EXP. Multilevel modelling analyses were performed to evaluate the overall effect. Temporal effects were scrutinized by individual regression analyses and determination of the time to reach a minimal clinically important difference. Furthermore, individual graphs were visually inspected for potential patterns. Twenty patients with chronic low back pain and complex regional pain syndrome type I were included. On a group level, both fear and pain were reduced following EXP. Individually, fear was significantly reduced in 65% of the patients, while pain in only 20%. A decrease in fear was seen mostly in the first weeks, while pain levels reduced later or remained unchanged. Daily measurements provided rich data on temporal trajectories of reductions in fear and pain. Overall, reductions in fear preceded pain relief and seemed to be essential to achieve pain reductions.
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Affiliation(s)
- Jente Bontinck
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium;
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Marlies den Hollander
- Department of Rehabilitation Medicine, Maastricht University, 6211 LK Maastricht, The Netherlands; (M.d.H.); (J.R.D.J.)
- Adelante Centre of Expertise in Rehabilitation and Audiology, 6430 AB Hoensbroek, The Netherlands
| | - Amanda L. Kaas
- Department of Cognitive Neuroscience, Maastricht University, 6229 EV Maastricht, The Netherlands;
| | - Jeroen R. De Jong
- Department of Rehabilitation Medicine, Maastricht University, 6211 LK Maastricht, The Netherlands; (M.d.H.); (J.R.D.J.)
- Intergrin Academy for Specialized Healthcare, 6167 AC Geleen, The Netherlands
| | - Inge Timmers
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Department of Rehabilitation Medicine, Maastricht University, 6211 LK Maastricht, The Netherlands; (M.d.H.); (J.R.D.J.)
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16
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Masuy R, Bamelis L, Bogaerts K, Depreitere B, De Smedt K, Ceuppens J, Lenaert B, Lonneville S, Peuskens D, Van Lerbeirghe J, Van Schaeybroeck P, Vorlat P, Zijlstra S, Meulders A, Vlaeyen JWS. Generalization of fear of movement-related pain and avoidance behavior as predictors of work resumption after back surgery: a study protocol for a prospective study (WABS). BMC Psychol 2022; 10:39. [PMID: 35193697 PMCID: PMC8862001 DOI: 10.1186/s40359-022-00736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies indicated that about 20% of the individuals undergoing back surgery are unable to return to work 3 months to 1 year after surgery. The specific factors that predict individual trajectories in postoperative pain, recovery, and work resumption are largely unknown. The aim of this study is to identify modifiable predictors of work resumption after back surgery. Methods In this multisite, prospective, longitudinal study, 300 individuals with radicular pain undergoing a lumbar decompression will be followed until 1-year post-surgery. Prior to surgery, participants will perform a computer task to assess fear of movement-related pain, avoidance behavior, and their generalization to novel situations. Before and immediately after surgery, participants will additionally complete questionnaires to assess fear of movement-related pain, avoidance behavior, optimism, expectancies towards recovery and work resumption, and the duration and severity of the pain. Six weeks, 3 months, 6 months, and 12 months after surgery, they will again complete questionnaires to assess sustainable work resumption, pain severity, disability, and quality of life. The primary hypothesis is that (generalization of) fear of movement-related pain and avoidance behavior will negatively affect sustainable work resumption after back surgery. Second, we hypothesize that (generalization of) fear of movement-related pain and avoidance behavior, negative expectancies towards recovery and work resumption, longer pain duration, and more severe pain before the surgery will negatively affect work resumption, pain severity, disability, and quality of life after back surgery. In contrast, optimism and positive expectancies towards recovery and work resumption are expected to predict more favorable work resumption, better quality of life, and lower levels of pain severity and disability after back surgery. Discussion With the results of this research, we hope to contribute to the development of strategies for early identification of risk factors and appropriate guidance and interventions before and after back surgery. Trial registration The study was preregistered on ClinicalTrials.gov: NCT04747860 on February 9, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00736-5.
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Affiliation(s)
- Rini Masuy
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.
| | - Lotte Bamelis
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Centre for Translational Psychological Research TRACE, Genk, Belgium.,Department of Psychology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Katleen Bogaerts
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Kris De Smedt
- Department of Neurosurgery, GasthuisZusters Antwerpen, Wilrijk, Belgium
| | | | - Bert Lenaert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Sarah Lonneville
- Department of Neurosurgery, Centre Hospitalier de Wallonie picarde, Tournai, Belgium
| | - Dieter Peuskens
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Neurosurgery, Noorderhart Mariaziekenhuis, Pelt, Belgium
| | | | - Patrick Van Schaeybroeck
- Department of Neurosurgery, Imeldaziekenhuis, Bonheiden, Belgium.,Department of Neurosurgery, Regional Hospital Sacred Heart Tienen, Tienen, Belgium
| | - Peter Vorlat
- Department of Orthopedics, Noorderhart Mariaziekenhuis, Pelt, Belgium
| | | | - Ann Meulders
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
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17
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den Hollander M, Smeets RJEM, van Meulenbroek T, van Laake-Geelen CCM, Baadjou VA, Timmers I. Exposure in Vivo as a Treatment Approach to Target Pain-Related Fear: Theory and New Insights From Research and Clinical Practice. Phys Ther 2022; 102:6515749. [PMID: 35084025 DOI: 10.1093/ptj/pzab270] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/21/2021] [Accepted: 11/07/2021] [Indexed: 01/07/2023]
Abstract
UNLABELLED Pain-related fear (PRF) can be a significant factor contributing to the development and maintenance of pain-related disability in individuals with persistent pain. One treatment approach to target PRF and related avoidance behavior is exposure in vivo (EXP). EXP has a long history in the field of anxiety, a field that is constantly evolving. This Perspective outlines recent theoretical advancements and how they apply to EXP for PRF, including suggestions for how to optimize inhibitory learning during EXP; reviews mechanistic work from neuroimaging supporting the targeting of PRF in people with chronic pain; and focuses on clinical applications of EXP for PRF, as EXP is moving into new directions regarding who is receiving EXP (eg, EXP in chronic secondary pain) and how treatment is provided (EXP in primary care with a crucial role for physical therapists). Considerations are provided regarding challenges, remaining questions, and promising future perspectives. IMPACT For patients with chronic pain who have elevated pain-related fear (PRF), exposure is the treatment of choice. This Perspective highlights the inhibitory learning approach, summarizes mechanistic work from experimental psychology and neuroimaging regarding PRF in chronic pain, and describes possible clinical applications of EXP in chronic secondary pain as well as in primary care.
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Affiliation(s)
- Marlies den Hollander
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,CIR Revalidatie, location Eindhoven, the Netherlands
| | - Thijs van Meulenbroek
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Charlotte C M van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Vera A Baadjou
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Inge Timmers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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18
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Ansanello W, Dos Reis FJJ, Tozzo MC, Zatiti SCA, Meulders A, Vlaeyen JWS, de Oliveira AS. Development of the Avoidance Daily Activities Photo Scale for Patients With Shoulder Pain. Phys Ther 2022; 102:6448018. [PMID: 34935976 DOI: 10.1093/ptj/pzab268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/30/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this study was to develop the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale) to measure shoulder pain-related avoidance behavior in patients with shoulder pain and evaluate and report the structural validity and internal consistency of the scale. METHODS Potential daily activities involving the shoulder were selected from the activities and participation domain of the International Classification of Functioning, Disability and Health. The selected activities were presented to an expert panel, health care professionals, and patients with shoulder pain with the question "How much do you think it is important to ask patients with shoulder pain about this activity?" Activities attaining a content validity index (CVI) ≥ 0.8 were represented using a digitally colored photograph. Activity photographs were evaluated by health care professionals and patients with shoulder pain. Photographs with a CVI ≥ 0.8 were included in the scale. To evaluate structural validity and internal consistency of the scale, exploratory factor analysis was performed to determine the presence of any scale domain. Cronbach alpha was calculated to indicate the internal consistency of each domain. RESULTS Of the 107 preselected activities, 21 attained a CVI ≥ 0.8. Eighteen photographs (CVI ≥ 0.8) were included in the scale after being analyzed by 120 health care professionals and 50 patients with shoulder pain. Exploratory factor analysis (N = 156) showed that the ADAP Shoulder Scale consists of 3 domains: free movement, high effort, and self-care. The internal consistencies of the domains were 0.92, 0.89, and 0.92, respectively. CONCLUSION The ADAP Shoulder Scale included 15 photographs distributed in 3 domains. All domains had a high internal consistency. The scale is easily applicable, well understood, and relevant for shoulder pain. IMPACT The ADAP Shoulder Scale can be used to rate shoulder pain-related avoidance behaviors.
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Affiliation(s)
- Walter Ansanello
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Marcela Camargo Tozzo
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Salomão Chade Assan Zatiti
- Department of Orthopaedic Surgery, Hospital Especializado de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Ann Meulders
- Department of Medical, Clinical and Experimental Psychology, University of Maastricht, Maastricht, the Netherlands
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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19
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Ippersiel P, Teoli A, Wideman TH, Preuss RA, Robbins SM. The Relationship Between Pain-Related Threat and Motor Behavior in Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:6478879. [PMID: 34939120 DOI: 10.1093/ptj/pzab274] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although pain-related fear and catastrophizing are predictors of disability in low back pain (LBP), their relationship with guarded motor behavior is unclear. The aim of this meta-analysis was to determine the relationship between pain-related threat (via pain-related fear and catastrophizing) and motor behavior during functional tasks in adults with LBP. METHODS This review followed PRISMA guidelines. MEDLINE, Embase, PsychINFO, and CINAHL databases were searched to April 2021. Included studies measured the association between pain-related fear or pain catastrophizing and motor behavior (spinal range of motion, trunk coordination and variability, muscle activity) during movement in adults with nonspecific LBP. Studies were excluded if participants were postsurgery or diagnosed with specific LBP. Two independent reviewers extracted all data. The Newcastle-Ottawa Scale was used to assess for risk of bias. Correlation coefficients were pooled using the random-effects model. RESULTS Reduced spinal range of motion during flexion tasks was weakly related to pain-related fear (15 studies, r = -0.21, 95% CI = -0.31 to -0.11) and pain catastrophizing (7 studies, r = -0.24, 95% CI = -0.38 to -0.087). Pain-related fear was unrelated to spinal extension (3 studies, r = -0.16, 95% CI = -0.33 to 0.026). Greater trunk extensor muscle activity during bending was moderately related to pain-related fear (2 studies, r = -0.40, 95% CI = -0.55 to -0.23). Pain catastrophizing, but not fear, was related to higher trunk activity during gait (2 studies, r = 0.25, 95% CI = 0.063 to 0.42). Methodological differences and missing data limited robust syntheses of studies examining muscle activity, so these findings should be interpreted carefully. CONCLUSION This study found a weak to moderate relationship between pain-related threat and guarded motor behavior during flexion-based tasks, but not consistently during other movements. IMPACT These findings provide a jumping-off point for future clinical research to explore the advantages of integrated treatment strategies that target both psychological and motor behavior processes compared with traditional approaches.
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Affiliation(s)
- Patrick Ippersiel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Anthony Teoli
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Richard A Preuss
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Shawn M Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
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20
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Chen D, Zhang H, Kavitha PT, Loy FL, Ng SH, Wang C, Phua KS, Tjan SY, Yang SY, Guan C. Scalp EEG-based Pain Detection using Convolutional Neural Network. IEEE Trans Neural Syst Rehabil Eng 2022; 30:274-285. [PMID: 35089860 DOI: 10.1109/tnsre.2022.3147673] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pain is an integrative phenomenon coupled with dynamic interactions between sensory and contextual processes in the brain, often associated with detectable neurophysiological changes. Recent advances in brain activity recording tools and machine learning technologies have intrigued research and development of neurocomputing techniques for objective and neurophysiology-based pain detection. This paper proposes a pain detection framework based on Electroencephalogram (EEG) and deep convolutional neural networks (CNN). The feasibility of CNN is investigated for distinguishing induced pain state from resting state in the recruitment of 10 chronic back pain patients. The experimental study recorded EEG signals in two phases: 1. movement stimulation (MS), where induces back pain by executing predefined movement tasks; 2. video stimulation (VS), where induces back pain perception by watching a set of video clips. A multi-layer CNN classifies the EEG segments during the resting state and the pain state. The novel approach offers high and robust performance and hence is significant in building a powerful pain detection algorithm. The area under the receiver operating characteristic curve (AUC) of our approach is 0.83±0.09 and 0.81±0.15, in MS and VS, respectively, higher than the state-of-the-art approaches. The sub-brain-areas are also analyzed, to examine distinct brain topographies relevant for pain detection. The results indicate that MS-induced pain tends to evoke a generalized brain area, while the evoked area is relatively partial under VS-induced pain. This work may provide a new solution for researchers and clinical practitioners on pain detection.
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21
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Im SC, Cho HY, Lee JH, Kim K. Analysis of the Effect of Wearing Extensible and Non-Extensible Lumbar Belts on Biomechanical Factors of the Sit-to-Stand Movement and Pain-Related Psychological Factors Affecting Office Workers with Low Back Pain. Healthcare (Basel) 2021; 9:healthcare9111601. [PMID: 34828646 PMCID: PMC8624328 DOI: 10.3390/healthcare9111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the effects of wearing extensible and non-extensible lumbar belt (LB) on biomechanical factors of the sit-to-stand (STD) movement and pain-related psychological factors affecting office workers with low back pain. Among 30 office workers, 15 with low back pain (LBP) were assigned to the experimental group and 15 healthy adults were assigned to the control group. The participants performed STD movement in random order of three different conditions: without LB (Condition 1), with extensible LB (Condition 2), and with non-extensible LB (Condition 3). Biomechanical variables of STD movement in each condition were measured using a three-dimensional motion analysis system and force plate. Pain-related psychological factors were measured only in the experimental group. Among the biomechanical factors of STD movement, an interaction effect was found in the maximum anterior pelvic tilt angle and total-phase range of motion of the trunk (p < 0.05). Pain intensity, pain-related anxiety, and pain catastrophizing were decreased in the conditions with lumbar belts (Conditions 2 and 3) compared to the condition without LB (Condition 1) (p < 0.05). Extensible and non-extensible lumbar belts engender biomechanically beneficial effects during STD movement in both office workers with LBP and healthy office workers. Further, pain intensity, pain-related anxiety, and pain catastrophizing were decreased in office workers with LBP. Therefore, both types of extensible lumbar belts may be helpful in the daily life of patients with LBP and office workers.
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Affiliation(s)
- Sang-Cheol Im
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Korea; (S.-C.I.); (H.-Y.C.)
| | - Ho-Young Cho
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Korea; (S.-C.I.); (H.-Y.C.)
| | - Jae-Hong Lee
- Department of Physical Therapy, Daegu Health College, Daegu 41453, Korea;
| | - Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Korea; (S.-C.I.); (H.-Y.C.)
- Correspondence: ; Tel.: +82-53-850-4351
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22
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Meinke A, Peters R, Knols R, Karlen W, Swanenburg J. Exergaming Using Postural Feedback From Wearable Sensors and Exercise Therapy to Improve Postural Balance in People With Nonspecific Low Back Pain: Protocol for a Factorial Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e26982. [PMID: 34435954 PMCID: PMC8430828 DOI: 10.2196/26982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/22/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023] Open
Abstract
Background Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP. Objective This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP. Methods The study was an assessor-blinded 2×2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter’s bow task. Physical activity was recorded using an activity tracker and the participants’ mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet. Results The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check. Conclusions Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions. International Registered Report Identifier (IRRID) DERR1-10.2196/26982
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Affiliation(s)
- Anita Meinke
- Mobile Health Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Rick Peters
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Ruud Knols
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.,Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Walter Karlen
- Mobile Health Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Jaap Swanenburg
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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23
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Bandeira PM, Reis FJJ, Muniz FDN, Chaves ACS, Fernandes O, Arruda-Sanchez T. Heart Rate Variability and Pain Sensitivity in Chronic Low Back Pain Patients Exposed to Passive Viewing of Photographs of Daily Activities. Clin J Pain 2021; 37:591-597. [PMID: 34108363 DOI: 10.1097/ajp.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Investigation if emotional reactivity by measuring heart rate variability (HRV) and pressure pain sensitivity during a passive visualization task in participants with chronic low back pain (CLBP). MATERIALS AND METHODS This case-control study was composed of 47 participants with CLBP and 47 asymptomatic participants. Both groups were submitted to a passive visualization task using 27 pictures from PHODA (Photograph Series of Daily Activities). HRV frequency domains were measured before, during, and after the task. Pressure pain threshold and pain intensity were also measured before and after the task. RESULTS The adjusted mean difference was statistically significant for HRV frequency domains during the visualization task, including low frequency [-5.92; 95% confidence interval (CI)=-9.60 to -2.23], high frequency (-0.71; 95% CI=-1.02 to -0.39), and low-frequency/high-frequency ratio (8.82; 95% CI=5.19 to 12.45). Pressure pain threshold decreased after the task in the CLBP group in all body sites, and pain intensity increased (-0.8; 95% CI=-1.16 to -0.39). DISCUSSION Aversive environmental stimuli, such as visual cues, may generate defensive physiological reactions. HRV can provide a measure that reflects the perceptions of threat and safety in the environment. Participants with CLBP presented changes in sympathovagal balance during passive visualization of pictures of daily activities, higher pain sensitivity, and high pain intensity when they were exposed to a passive visualization task using pictures of daily living that may arouse fears of harm.
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Affiliation(s)
| | - Felipe J J Reis
- Postgraduate Program in Medicine (Cardiology)
- Department of Physical Therapy, Federal Institute of Rio de Janeiro (IFRJ)
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Fernanda D N Muniz
- Department of Physical Therapy, Federal Institute of Rio de Janeiro (IFRJ)
| | | | - Orlando Fernandes
- Laboratory of Neuroimaging and Psychophysiology, Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ)
- Postgraduate Program in Medicine (Radiology), Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Tiago Arruda-Sanchez
- Postgraduate Program in Medicine (Cardiology)
- Laboratory of Neuroimaging and Psychophysiology, Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ)
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24
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Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory. THE JOURNAL OF PAIN 2021; 22:1315-1327. [PMID: 34029684 DOI: 10.1016/j.jpain.2021.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 01/04/2023]
Abstract
Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure protocols in chronic primary pain, and provide recommendations on how to optimize them. We propose several adaptations that are expected to strengthen inhibitory learning and/or retrieval of the extinction memory, thus likely decreasing relapse. We summarize the limited, but emerging experimental data in the pain domain, and draw parallels with experimental evidence in the anxiety literature. Our reflections and suggestions pertain to the use of the fear hierarchy, reassurance, positive psychology interventions, exposure with a range of stimuli and within different contexts, and the use of safety behaviors during treatment, as well as associating the fear-inducing stimuli with novel outcomes. In addition, we reflect on the importance of specifically tackling (the return of) pain-related avoidance behavior with techniques such as disentangling fear from avoidance and reinforcing approach behaviors. Finally, we discuss challenges in the clinical application of exposure to improve functioning in chronic primary pain and possible avenues for future research. Perspectives: Inspired by recent advances in learning theory and its applications on the treatment of anxiety disorders, we reflect on the delivery of exposure treatment for chronic primary pain and propose strategies to improve its long-term outcomes.
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25
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Behavioral Test (BAT-Back): Preliminary Evidence for a Successful Predictor of Treatment Outcome After Exposure Treatment for Chronic Low Back Pain. Clin J Pain 2021; 37:265-269. [PMID: 33555697 DOI: 10.1097/ajp.0000000000000920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although several questionnaires assessing fear of movement exist, it is still a challenge to identify individuals who might benefit more from exposure for chronic pain than from other psychological approaches and vice versa. Psychological approaches to chronic pain cannot advance toward the often called-for "tailored approaches" because of limited knowledge about treatment predictors. Our aim was to evaluate the additional predictive value of avoidance behavior based on behavioral observation. METHODS This study examined pretreatment self-report and behavioral measures as predictors of treatment outcome for n=43 patients experiencing disabling chronic low back pain, who took part in a randomized controlled trial in which they received 10 to 15 sessions of exposure treatment. Only patients with elevated fear avoidance based on self-report measures were included. Data were analyzed using regression analyses and classification and regression trees. RESULTS Regression analyses showed that higher avoidance behavior at pretreatment as measured by the Behavioral Avoidance Test-Back Pain (BAT-Back) significantly predicted reduction in global disability (with a small to medium effect), but not in specific disability. Self-report measures failed to predict treatment success for both outcome measures. Classification and regression trees divide subgroups who might benefit from exposure treatment through a BAT-Back score of >22 for Pain Disability Index. DISCUSSION There is some preliminary evidence that pretreatment avoidance behavior might be an indicator for reduction in global disability after exposure treatments in patients experiencing disabling chronic low back pain and elevated fear avoidance. We identified preliminary cutoff scores that need further investigation.
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26
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Wijenberg M, Rauwenhoff J, Stapert S, Verbunt J, van Heugten C. Do fear and catastrophizing about mental activities relate to fear-avoidance behavior in a community sample? An experimental study. J Clin Exp Neuropsychol 2021; 43:66-77. [PMID: 33567961 DOI: 10.1080/13803395.2021.1874881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Healthy people often experience headache, cognitive failures, or mental fatigue. Some people even experience these symptoms on a level comparable to patients with mild spectrum brain injuries. In these individuals, the fear-avoidance model explains symptoms as a consequence of catastrophizing and fear-avoidance toward mental activities. This experimental study investigated in healthy adults whether fear-avoidance and catastrophizing about mental activities are related to fear-avoidance behavior (i.e., behavioral avoidance of mental activities) according to the fear-avoidance model.Method: A randomized crossover within-subject design was used with two measurements and 80 participants. Participants were exposed to three demanding cognitive tasks and their simplified counterparts. Post-concussion symptoms, catastrophizing, fear-avoidance, behavioral avoidance (time spent working on cognitive tasks), exposure to mental activity, depression, heart rate, and state-trait anxiety were assessed.Results: Significant correlations between the variables of the fear-avoidance model were found. Furthermore, catastrophizers spent less time on difficult tasks compared to easy tasks. Both catastrophizing and female sex predicted time spent on difficult tasks, whereas only female sex predicted time spent on easy tasks.Conclusions: This study found that, according to the fear-avoidance model, catastrophizing is related to behavioral avoidance of cognitively challenging tasks in a community sample.
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Affiliation(s)
- Melloney Wijenberg
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, The Netherlands
| | - Johanne Rauwenhoff
- Limburg Brain Injury Centre, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sven Stapert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Jeanine Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Caroline van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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27
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van Erp RMA, Huijnen IPJ, Köke AJA, Verbunt JA, Smeets RJEM. Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1840627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Reni M. A. van Erp
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ivan P. J. Huijnen
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Albère J. A. Köke
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Faculty of Health, Department of Physiotherapy, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jeanine A. Verbunt
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rob J. E. M. Smeets
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- CIR Revalidatie location Eindhoven, Eindhoven, The Netherlands
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28
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The Association Between Fear of Movement, Pain Catastrophizing, Pain Anxiety, and Protective Motor Behavior in Persons With Peripheral Joint Conditions of a Musculoskeletal Origin: A Systematic Review. Am J Phys Med Rehabil 2020; 99:941-949. [PMID: 32349043 DOI: 10.1097/phm.0000000000001455] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of the study was to investigate alterations in motor behavior related to pain-related beliefs in persons with peripheral joint conditions. DESIGN This is a systematic review. RESULTS Our database search (PubMed, Web of Science, Embase, PsycINFO) identified 7390 articles (until September 2019), and nine articles (344 participants) were selected based on the eligibility criteria for selecting studies, i.e., studies in adults with primary peripheral joint conditions, assessing the influence of fear of movement, catastrophizing or anxiety on motor behavior in terms of kinematics, kinetics, and muscle activity during active movements.In the acute stage after knee or radius surgery, more catastrophizing and fear were associated with less active joint motion in the operated and adjacent joints. In knee patients in the chronic stage after surgery, increased hip adduction and knee valgus were linked to increased fear of movement during the performance of challenging tasks. Similar results were found in persons with nonsurgical chronic knee pain. During gait, no relation between lower limb kinematics and fear of movement was observed. CONCLUSIONS Kinematic alterations appear in tandem with pain-related perceptions in acute stages after surgery. Altered kinematics influenced by pain-related beliefs are also seen in persons with chronic nonsurgical and surgical knee pain, when challenging tasks are performed.
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29
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Horgan D, Purtill H, Ryan E, O’Sullivan K. The impact of manual handling training on beliefs regarding low back pain. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1815837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Diarmuid Horgan
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Eva Ryan
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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30
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Hennessy RW, Rumble D, Christian M, Brown DA, Trost Z. A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design. JMIR Serious Games 2020; 8:e17799. [PMID: 32773381 PMCID: PMC7445609 DOI: 10.2196/17799] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP. OBJECTIVE This study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities. METHODS We recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up. RESULTS The 12 participants who completed the study period assigned higher avoidance (P=.002), expected pain (P=.002), and expected concern (P=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; P=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (P=.20) nor pain-related fear (P=.58) changed significantly across sessions. CONCLUSIONS The GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely.
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Affiliation(s)
- Rebecca White Hennessy
- PhD Program in Rehabilitation Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Deanna Rumble
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - David A Brown
- School of Health Professions, University of Texas Medical Branch, Galveston, TX, United States
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
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31
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Biggs EE, Meulders A, Kaas AL, Goebel R, Vlaeyen JWS. The acquisition and generalization of fear of touch. Scand J Pain 2020; 20:809-819. [PMID: 32712594 DOI: 10.1515/sjpain-2019-0177] [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: 12/06/2019] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
Abstract
Objectives Contemporary fear-avoidance models of chronic pain posit that fear of pain, and overgeneralization of fear to non-threatening stimuli is a potential pathway to chronic pain. While increasing experimental evidence supports this hypothesis, a comprehensive investigation requires testing in multiple modalities due to the diversity of symptomatology among individuals with chronic pain. In the present study we used an established tactile fear conditioning paradigm as an experimental model of allodynia and spontaneous pain fluctuations, to investigate whether stimulus generalization occurs resulting in fear of touch spreading to new locations. Methods In our paradigm, innocuous touch is presented either paired (predictable context) or unpaired (unpredictable context) with a painful electrocutaneous stimulus (pain-US). In the predictable context, vibrotactile stimulation to the index or little finger was paired with the pain-US (CS+), whilst stimulation of the other finger was never paired with pain (CS-). In the unpredictable context, vibrotactile stimulation to the index and little fingers of the opposite hand (CS1 and CS2) was unpaired with pain, but pain-USs occurred unpredictable during the intertrial interval. During the subsequent generalization phase, we tested the spreading of conditioned responses (self-reported fear of touch and pain expectancy) to the (middle and ring) fingers between the CS+ and CS-, and between the CS1 and CS2. Results Differential fear acquisition was evident in the predictable context from increased self-reported pain expectancy and self-reported fear for the CS + compared to the CS-. However, expectancy and fear ratings to the novel generalization stimuli (GS+ and GS-) were comparable to the responses elicited by the CS-. Participants reported equal levels of pain expectancy and fear to the CS1 and CS2 in the unpredictable context. However, the acquired fear did not spread in this context either: participants reported less pain expectancy and fear to the GS1 and GS2 than to the CS1 and CS2. As in our previous study, we did not observe differential acquisition in the startle responses. Conclusions Whilst our findings for the acquisition of fear of touch replicate the results from our previous study (Biggs et al., 2017), there was no evidence of fear generalization. We discuss the limitations of the present study, with a primary focus on procedural issues that were further investigated with post-hoc analyses, concluding that the present results do not show support for the hypothesis that stimulus generalization underlies spreading of fear of touch to new locations, and discuss how this may be the consequence of a context change that prevented transfer of acquisition.
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Affiliation(s)
- Emma E Biggs
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Ann Meulders
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Amanda L Kaas
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
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32
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Moraes ÉBD, Martins Júnior FF, Mattos-Pimenta CAD. In vivo exposure for fear of pain and avoidance of movement in low back pain. Rev Bras Enferm 2020; 73:e20190125. [PMID: 32638936 DOI: 10.1590/0034-7167-2019-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/12/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to verify the effects of hierarchization and in vivo exposure for fear of pain, avoidance of movement, and anxiety in chronic low back pain. METHODS quasi-experimental study. The 27 patients who participated graded the damage associated with the movements in each of the 40 activities of daily living depicted in pictures using a scale from 0 to 100. The patients chose five out of all the activities that received a score higher than 50 to carry out the exposure. The intensities of fear and anxiety were measured before and after each exposure session. RESULTS the frequencies of the gender were equal, and the mean age was 44.9 years. The activities chosen more frequently for the exposure were shoveling (33.3%) and running (33.3%). There was reduction of fear and anxiety before and after exposure (p<0.001). CONCLUSIONS hierarchization and in vivo exposure were effective in reducing fear and anxiety.
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33
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Baadjou VA, Hollander MD, Meulenbroek TV, Verbunt JA, Timmers I. Clinicians' Initial Experiences of Transition to Online Interdisciplinary Pain Rehabilitation During the Covid-19 Pandemic. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2020; 3:1000036. [PMID: 33884138 PMCID: PMC8008721 DOI: 10.2340/20030711-1000036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/23/2022]
Abstract
Objective Public health legislation during the CO-VID-19 pandemic has resulted in forced transitioning to the use of remote care in order to continue the provision of pain rehabilitation worldwide. The objective of this study was to gain insight into clinicians’ initial experiences with the provision of interdisciplinary pain rehabilitation via videoconferencing. Design Observational, cross-sectional design. Participants Twelve team members (specialists in rehabilitation medicine -MD-, psychologists, physiotherapists and occupational therapists) from a tertiary expertise centre in pain rehabilitation. Methods Quantitative and qualitative data were collected via a digital survey. Theme-based content analysis was performed for qualitative data. Results The themes that emerged were: the compulsory context; prerequisites for proper use of videoconferencing methods, which are strongly associated with the clinicians’ experiences; changes experienced in specific components of pain rehabilitation; and overarching changes experienced, including opportunities and limitations (sub-themes: therapeutic relationship, system involvement, efficiency, hands-on possibilities, interdisciplinary teamwork, and formalities). Overall, clinicians expressed moderate agreement with the statements that the quality of the pain rehabilitation programme can be maintained using videoconferencing, and that the COVID-19 pandemic offers opportunities for growth and innovation in telehealth. Conclusion It is feasible to provide valid and satisfactory pain rehabilitation via videoconferencing. This study identified facilitators and barriers to the use of videoconferencing, and great potential for integrating aspects of telehealth into standard care after the pandemic.
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Affiliation(s)
- Vera A Baadjou
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marlies Den Hollander
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Thijs Van Meulenbroek
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Inge Timmers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Riecke J, Rief W, Vlaeyen JW, Glombiewski JA. Generalizability of harm and pain expectations after exposure in chronic low back pain patients. Eur J Pain 2020; 24:1495-1504. [DOI: 10.1002/ejp.1604] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/10/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Jenny Riecke
- Department of Clinical Psychology and Psychotherapy Philipps‐University Marburg Marburg Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy Philipps‐University Marburg Marburg Germany
| | - Johan W.S. Vlaeyen
- KU Leuven Health Psychology Research GroupLeuven Belgium
- Department of Experimental Health Psychology Maastricht University Maastricht Netherlands
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Lotzke H, Gutke A, den Hollander M, Smeets R, Lundberg M. Developing an evidence-based prehabilitation programme designed to improve functional outcomes after lumbar fusion surgery - A feasibility study using the Medical Research Council framework. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2018.1553999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hanna Lotzke
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Division of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marlies den Hollander
- Adelante Centre of Expertise in Rehabilitation, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Mari Lundberg
- Department of Health and Rehabilitation, Division of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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36
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Evaluation of Exposure Instructions to Pain: Should Therapist Focus on Fear Reduction or Expectation Violation? COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10070-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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37
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Caneiro JP, O'Sullivan P, Lipp OV, Mitchinson L, Oeveraas N, Bhalvani P, Abrugiato R, Thorkildsen S, Smith A. Evaluation of implicit associations between back posture and safety of bending and lifting in people without pain. Scand J Pain 2019; 18:719-728. [PMID: 29982241 DOI: 10.1515/sjpain-2018-0056] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022]
Abstract
Background and aims Despite lack of support from recent in vivo studies, bending and lifting (especially with a round-back posture) are perceived as dangerous to the back. In light of this view, it has been proposed that pain-free people may hold a common implicit belief that is congruent with the idea that bending and lifting with a round-back represents danger to a person's back, however this has not been evaluated. The aims of this study were: (1) to evaluate implicit associations between back posture and safety related to bending and lifting in pain-free people; (2) to explore correlations between the implicit measure and explicit measures of back beliefs, fear of movement and safety of bending; (3) to investigate self-reported qualitative appraisal of safe lifting. Methods Exploratory cross-sectional study including 67 pain-free participants (no pain, or average pain ≤3/10 for less than one week over the previous 12 months) (52% male), who completed an online survey containing demographic data and self-reported measures of: fear of movement (Tampa Scale for Kinesiophobia for General population - TSK-G), back beliefs (Back Pain Attitudes Questionnaire BackPAQ), and bending beliefs (Bending Safety Belief - BSB - a pictorial scale with images of a person bending/lifting with round and straight back postures). Implicit associations between back posture and safety related to bending and lifting were evaluated with the Implicit Association Test (IAT). A qualitative assessment of descriptions of safe lifting was performed. Results An implicit association between "danger" and "round-back" bending/lifting was evident in all participants (IATD-score=0.65 (SD=0.45; 95% CI [0.54, 0.76]). Participants' profile indicated high fear of movement, unhelpful back beliefs, and perceived danger to round-back bending and lifting (BSBThermometer: 5.2 (SD=3.8; 95% CI [4.26, 6.13] range -10 to 10; t(67)=11.09, p<0.001). There was a moderate correlation between IAT and BSBThermometer (r=0.38, 95% CI [0.16, 0.62]). There were weaker and non-statistically significant correlations between IAT and TSK-G (r=0.28, 95% CI [-0.02, 0.47]), and between IAT and BackPAQDanger (r=0.21, 95% CI [-0.03, 0.45]). Qualitative assessment of safe lifting descriptions indicated that keeping a "straight back" and "squatting" when lifting were the most common themes. Conclusions Pain-free people displayed an implicit bias towards bending and lifting with a "round-back" as dangerous. Our findings support the idea that pain-free people may have a pre-existing belief about lifting, that the back is in danger when rounded. Research to evaluate the relationship between this implicit bias and lifting behaviour is indicated. Implications The findings of this study may have implications for ergonomic guidelines and public health information related to bending and lifting back postures. Additionally, clinicians may need to be aware of this common belief, as this may be reflected in how a person responds when they experience pain.
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Affiliation(s)
- J P Caneiro
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,Body Logic Physiotherapy Clinic, 215 Nicholson Road, Shenton Park, WA 6008, Australia, Phone: +61(08)9381 7940, +61(08)433 803 683, Fax: +61(08)9381 7941, E-mail:
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Ottmar V Lipp
- School of Psychology and Speech Pathology, Curtin University, Bentley, Australia
| | - Lara Mitchinson
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Nicolai Oeveraas
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Priyanka Bhalvani
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Richard Abrugiato
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Sean Thorkildsen
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
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38
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Timmers I, de Jong JR, Goossens M, Verbunt JA, Smeets RJ, Kaas AL. Exposure in vivo Induced Changes in Neural Circuitry for Pain-Related Fear: A Longitudinal fMRI Study in Chronic Low Back Pain. Front Neurosci 2019; 13:970. [PMID: 31607840 PMCID: PMC6758595 DOI: 10.3389/fnins.2019.00970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Exposure in vivo (EXP) is a cognitive-behavioral treatment aimed at reducing pain-related fear in chronic pain, and has proven successful in reducing pain-related disability in patients with chronic low back pain (cLBP). The current longitudinal study aimed to reveal the neural correlates of changes in pain-related fear as a result of EXP. Twenty-three patients with cLBP were included in this study. Patients with cLBP underwent MRI scanning pre-treatment (pre-EXP), post-treatment (post-EXP), and 6 months after end of treatment (FU-EXP). Pain-free controls were scanned at two time points. In the scanner, participants were presented with pictures involving back-related movements, evoking pain-related fear in patients. Pre-treatment, functional MRI revealed increased activation in right posterior insula and increased deactivation in medial prefrontal cortex (mPFC) in patients compared to controls. Post-treatment, patients reported reduced fear and pre-EXP group differences were no longer present. Contrasting pre- to post- and FU-EXP in patients revealed that stimulus-evoked neural responses changed in sensorimotor as well as cognitive/affective brain regions. Lastly, exploratory analyses revealed a tendency toward an association between changes in neural activation and changes in fear ratings, including the hippocampus and temporal lobe (pre- to post-EXP changes), and mPFC and posterior cingulate cortex (pre- to FU-EXP changes). Taken together, we show evidence that neural circuitry for pain-related fear is modulated by EXP, and that changes are associated with self-reported decreases in pain-related fear.
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Affiliation(s)
- Inge Timmers
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.,Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Jeroen R de Jong
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Mariëlle Goossens
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.,Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Jeanine A Verbunt
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Rob J Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.,CIR Revalidatie, Zwolle/Eindhoven, Netherlands
| | - Amanda L Kaas
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
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39
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Leahy A, O’Keeffe M, Robinson K, O’Sullivan K. The beliefs of healthcare students about the harmfulness of daily activities for their back: a cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1630854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Aoife Leahy
- Barking Havering and Redbridge University Trust, Romford, England
| | - Mary O’Keeffe
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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40
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Van Laake-Geelen CCM, Smeets RJEM, Van Meulenbroek T, Den Hollander M, Goossens MEJB, Verbunt JA. Biopsychosocial Rehabilitation Treatment "Exposure In Vivo" for Patients with Painful Diabetic Neuropathy: Development of a Treatment Protocol. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2019; 2:1000015. [PMID: 33884116 PMCID: PMC8008735 DOI: 10.2340/20030711-1000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 11/16/2022]
Abstract
Objective Painful diabetic neuropathy is associated with low quality of life, depression and anxiety. Patients are limited in their performance of activities of daily living due to fears related to their condition. Treatment modalities are needed to help patients cope with their pain and pain-related disability. Exposure in vivo is an effective treatment in other chronic pain syndromes, increasing patients’ functional ability and quality of life. This paper presents an Exposure in vivo treatment protocol for patients with painful diabetic neuropathy. Protocol An 8-week Exposure in vivo treatment protocol was specifically adapted to the needs and risks of patients with painful diabetic neuropathy. New screening tools were developed for patients with PDN; the Painful Diabetic Neuropathy Anxiety Rasch-Transformed Questionnaire (PART-Q30) identifies specific fears related to painful diabetic neuropathy (e.g. fear of hypoglycaemia); and a customized version of the Photograph-series Of Daily Activities (PHODA-PDN) detects fear-eliciting activities related to the condition in individual patients. During Exposure in vivo, catastrophic interpretations regarding painful stimuli are challenged and corrected, thereby diminishing pain-related fear and enabling the patient to re-engage in activities of daily living. An interdisciplinary team provides Exposure in vivo in 1-h sessions twice a week. Discussion To the best of our knowledge, this treatment protocol is the first intervention using Exposure in vivo specifically adapted to the needs and risks of patients with painful diabetic neuropathy.
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Affiliation(s)
- Charlotte C M Van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Libra Rehabilitation and Audiology, Eindhoven/Weert
| | - Thijs Van Meulenbroek
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Marlies Den Hollander
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Marielle E J B Goossens
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Research Group Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
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41
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Whitley MD, Coulter ID, Gery RW, Hays RD, Sherbourne C, Herman PM, Hilton LG. Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 3: Designing Instruments With Patient Input. J Manipulative Physiol Ther 2019; 42:307-318. [PMID: 31255308 PMCID: PMC6698201 DOI: 10.1016/j.jmpt.2019.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 12/28/2018] [Accepted: 02/07/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this article is to describe how we designed patient survey instruments to ensure that patient data about preferences and experience could be included in appropriateness decisions. These actions were part of a project that examined the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain. METHODS We conducted focus groups, cognitive interviews, a literature review of measures in prior chiropractic and complementary and integrative health research, and a pilot study to develop questionnaires of patient preferences, experiences, values, and beliefs. RESULTS Questionnaires were administered online to 2024 individuals from 125 chiropractic clinics. The survey included 3 long questionnaires and 5 shorter ones. All were administered online. The baseline items had 2 questionnaires that respondents could complete in different sittings. Respondents completed shorter biweekly follow-ups every 2 weeks and a final questionnaire at 3 months. The 2 initial questionnaires had 81 and 140 items, the 5 biweekly follow-up questionnaires had 37 items each, and the endline questionnaire contained 121 items. Participants generally responded positively to the survey items, and 91% of the patients who completed a baseline questionnaire completed the endpoint survey 3 months later. We used "legacy" measures, and we also adapted measures and developed new measures for this study. Preliminary assessment of reliability and validity for a newly developed scale about coping behaviors indicates that the items work well together in a scale. CONCLUSIONS This article documents the challenges and the efforts involved in designing data collection tools to facilitate the inclusion of patient data into appropriateness decisions.
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Affiliation(s)
| | - Ian D Coulter
- RAND Corporation, University of California Los Angeles, Southern California Health Sciences, Santa Monica, California.
| | - Ryan W Gery
- RAND Corporation, Health, Santa Monica, California
| | - Ron D Hays
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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42
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Matheve T, De Baets L, Bogaerts K, Timmermans A. Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear. Eur J Pain 2019; 23:1171-1184. [PMID: 30793429 DOI: 10.1002/ejp.1384] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Most studies fail to show an association between higher levels of pain-related fear and protective movement behaviour in patients with chronic low back pain (CLBP). This may be explained by the fact that only general measures of pain-related fear have been used to examine the association with movement patterns. This study explored whether task-specific, instead of general measures of pain-related fear can predict movement behaviour. METHODS Fifty-five patients with CLBP and 54 healthy persons performed a lifting task while kinematic measurements were obtained to assess lumbar range of motion (ROM). Scores on the Photograph Daily Activities Series-Short Electronic Version (PHODA-SeV), Tampa Scale for Kinesiophobia and its Activity Avoidance and Somatic Focus subscales were used as general measures of pain-related fear. The score on a picture of the PHODA-SeV, showing a person lifting a heavy object with a bent back, was used as task-specific measure of pain-related fear. RESULTS Lumbar ROM was predicted by task-specific, but not by general measures of pain-related fear. Only the scores on one other picture of the PHODA-SeV, similar to the task-specific picture regarding threat value and movement characteristics, predicted the lumbar ROM. Compared to healthy persons, patients with CLBP used significantly less ROM, except the subgroup with a low score on the task-specific measure of pain-related fear, who used a similar ROM. CONCLUSIONS Our results suggest to use task-specific measures of pain-related fear when assessing the relationship with movement. It would be of interest to investigate whether reducing task-specific fear changes protective movement behaviour. SIGNIFICANCE This study shows that lumbar range of motion in CLBP is predicted by task-specific, but not by general measures of pain-related fear. This suggests that both in clinical practice and for research purposes, it might be recommended to use task-specific measures of pain-related fear when assessing the relationship with movement behaviour. This may help to disentangle the complex interactions between pain-related fear, movement and disability in patients with CLBP.
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Affiliation(s)
- Thomas Matheve
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Liesbet De Baets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Katleen Bogaerts
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Health Psychology, University of Leuven, Leuven, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Physiotherapists implicitly evaluate bending and lifting with a round back as dangerous. Musculoskelet Sci Pract 2019; 39:107-114. [PMID: 30553986 DOI: 10.1016/j.msksp.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/21/2018] [Accepted: 12/05/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Beliefs can be assessed using explicit measures (e.g. questionnaires) that rely on information of which the person is 'aware' and willing to disclose. Conversely, implicit measures evaluate beliefs using computer-based tasks that allow reduced time for introspection thus reflecting 'automatic' associations. Thus far, physiotherapists' beliefs about back posture and safety have not been evaluated with implicit measures. OBJECTIVES (1) Evaluate implicit associations between bending lifting back posture (straight-back vs round-back) and safety (safe vs danger); (2) Explore correlations between implicit and explicit measures of beliefs towards vulnerability of the back. DESIGN Exploratory cross-sectional quantitative study. METHODS 47 musculoskeletal physiotherapists completed explicit measures of fear of movement (TSK-HC), back beliefs (BackPAQDanger) and beliefs related to bending and lifting back posture and safety (BSB). An Implicit Association Test (IAT) was used to assess implicit associations between (i) images of people bending/lifting with a 'round-back' or with a 'straight-back' posture, and (ii) words representing 'safety' and 'danger'. A one-sample t-test assessed the degree and direction of the sample's IAT score. Cohen's d provided an effect size of the estimated bias. Correlation between IAT and each explicit measure was assessed using Pearson's coefficient. RESULTS The sample displayed an implicit association between 'round-back' and 'danger' (μ = 0.213, 95% CI [0.075-0.350], p = .003), with an effect size magnitude of 0.45. There were fair to moderate correlations between IAT and BSB (r = 0.320, 95% CI [0.036-0.556], p = .029) and, IAT and BackPAQDanger (r = 0.413, 95%CI [0.143-0.626], p = .004). CONCLUSIONS Physiotherapists displayed an implicit bias towards bending and lifting with a round-back as dangerous.
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Pain-Related Fear-Dissociable Neural Sources of Different Fear Constructs. eNeuro 2019; 5:eN-NWR-0107-18. [PMID: 30627654 PMCID: PMC6325558 DOI: 10.1523/eneuro.0107-18.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/03/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022] Open
Abstract
Fear of pain demonstrates significant prognostic value regarding the development of persistent musculoskeletal pain and disability. Its assessment often relies on self-report measures of pain-related fear by a variety of questionnaires. However, based either on “fear of movement/(re)injury/kinesiophobia,” “fear avoidance beliefs,” or “pain anxiety,” pain-related fear constructs plausibly differ while it is unclear how specific the questionnaires are in assessing these different constructs. Furthermore, the relationship of pain-related fear to other anxiety measures such as state or trait anxiety remains ambiguous. Advances in neuroimaging such as machine learning on brain activity patterns recorded by functional magnetic resonance imaging might help to dissect commonalities or differences across pain-related fear constructs. We applied a pattern regression approach in 20 human patients with nonspecific chronic low back pain to reveal predictive relationships between fear-related neural pattern information and different pain-related fear questionnaires. More specifically, the applied multiple kernel learning approach allowed the generation of models to predict the questionnaire scores based on a hierarchical ranking of fear-related neural patterns induced by viewing videos of activities potentially harmful for the back. We sought to find evidence for or against overlapping pain-related fear constructs by comparing the questionnaire prediction models according to their predictive abilities and associated neural contributors. By demonstrating evidence of nonoverlapping neural predictors within fear-processing regions, the results underpin the diversity of pain-related fear constructs. This neuroscientific approach might ultimately help to further understand and dissect psychological pain-related fear constructs.
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45
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Franklin ZC, Holmes PS, Fowler NE. Eye Gaze Markers Indicate Visual Attention to Threatening Images in Individuals with Chronic Back Pain. J Clin Med 2018; 8:jcm8010031. [PMID: 30602663 PMCID: PMC6352204 DOI: 10.3390/jcm8010031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 11/23/2022] Open
Abstract
Research into attentional biases and threatening, pain-related information has primarily been investigated using reaction time as the dependent variable. This study aimed to extend previous research to provide a more in depth investigation of chronic back pain and individuals’ attention to emotional stimuli by recording eye movement behavior. Individuals with chronic back pain (n = 18) were recruited from a back rehabilitation program and age and sex matched against 17 non-symptomatic controls. Participants’ eye movements were recorded whilst they completed a dot probe task, which included back pain specific threatening images and neutral images. There were no significant differences between chronic pain and control participants in attentional biases recorded using reaction time from the dot probe task. Chronic pain participants, however, demonstrated a significantly higher percentage of fixations, larger pupil diameter, a longer average fixation duration and faster first fixation to threatening compared to neutral images. They also had a significantly longer average fixation duration and larger pupil diameter to threatening images compared to control participants. The findings of this study suggest eye gaze metrics may provide a more sensitive measure of attentional biases in chronic pain populations. These findings may have important therapeutic implications for the patient and therapist.
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Affiliation(s)
- Zoë C Franklin
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester M15 6BH, UK.
| | - Paul S Holmes
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester M15 6BH, UK.
| | - Neil E Fowler
- Vice Chancellor's Office, University of Salford, Salford M5 4WT, UK.
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46
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Tang NKY. Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:281-289. [PMID: 28284902 DOI: 10.1016/j.pnpbp.2017.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
Cognitive Behavioural Therapy (CBT) is a form of evidence-based talking therapy that emphasises the importance of behaviour and conscious thoughts in shaping our emotional experiences. As pain becomes increasingly accepted as not only a sensory but also an emotional experience, success in using CBT to treat emotional disorders has resulted in the incorporation of cognitive-behavioural principles into the management of chronic pain. Outcomes of CBT-informed interdisciplinary pain management programmes are modest at best, despite rapid methodological improvements in trial design and implementation. Whilst the field searches for new treatment directions, a hybrid CBT approach that seeks to simultaneously tackle pain and its comorbidities shows promise in optimising treatment effectiveness and flexibility. This article provides a brief description of the core characteristics of CBT and the transformation this therapeutic model has brought to our understanding and management of chronic pain. Current evidence on efficacy of CBT for chronic pain is then reviewed, followed by a critical consideration of the advantages and disadvantages of the new hybrid treatment approach that conceptualises and treats chronic pain in connection with its comorbidities. Recent progress made in the area of pain and insomnia is highlighted as an example to project therapeutic innovations in the near future.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
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47
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Schemer L, Schroeder A, Ørnbøl E, Glombiewski JA. Exposure and cognitive-behavioural therapy for chronic back pain: An RCT on treatment processes. Eur J Pain 2018; 23:526-538. [DOI: 10.1002/ejp.1326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 08/26/2018] [Accepted: 10/10/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Lea Schemer
- Department of Clinical Psychology and Psychotherapy; Philipps-University Marburg; Marburg Germany
| | - Andreas Schroeder
- The Research Clinic for Functional Disorders and Psychosomatics; Aarhus University Hospital; Aarhus N Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics; Aarhus University Hospital; Aarhus N Denmark
| | - Julia Anna Glombiewski
- Department of Clinical Psychology and Psychotherapy; Philipps-University Marburg; Marburg Germany
- Department of Clinical Psychology and Psychotherapy; University of Koblenz - Landau; Landau Germany
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Ariza-Mateos MJ, Cabrera-Martos I, Ortiz-Rubio A, Torres-Sánchez I, Rodríguez-Torres J, Valenza MC. Effects of a Patient-Centered Graded Exposure Intervention Added to Manual Therapy for Women With Chronic Pelvic Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 100:9-16. [PMID: 30312595 DOI: 10.1016/j.apmr.2018.08.188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore the effects of a 6-week patient-centered graded exposure intervention added to manual therapy in women with chronic pelvic pain (CPP) and fear of movement/(re)injury. DESIGN Prospective 3-armed randomized controlled trial. SETTING Faculty of Health Sciences. PARTICIPANTS A total of 49 women with CPP and substantial fear of movement were randomly allocated to 1 of 3 groups: (1) patient-centered graded exposure intervention added to manual therapy; (2) manual therapy; (3) control group. INTERVENTIONS The 6-week intervention consisted of 12 sessions in the group receiving manual therapy and 6 additional sessions of graded exposure therapy in the group receiving both interventions. MAIN OUTCOME MEASURES Primary outcomes were fear-avoidance behavior assessed using the Fear-Avoidance Beliefs Questionnaire and pain interference and severity evaluated with the Brief Pain Inventory. The secondary outcome was disability evaluated with the Oswestry Disability Index. All the variables were assessed in a blinded manner at baseline, after the treatment, and at 3-month follow-up. RESULTS Our results show interaction effects (P<.05) for all the outcomes. Graded exposure added to manual therapy is distinctly superior to manual therapy alone in maintaining improvements for long-term fear-avoidance behavior and physical functioning. CONCLUSIONS Graded exposure added to manual therapy is a promising approach with long-term effects for women with CPP and fear of movement/(re)injury.
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Psychometric Properties of the Photograph Series of Daily Activities-Short Electronic Version (PHODA-SeV) in Patients With Chronic Low Back Pain. J Orthop Sports Phys Ther 2018; 48:719-727. [PMID: 29792106 DOI: 10.2519/jospt.2018.7864] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The Photograph Series of Daily Activities-short electronic version (PHODA-SeV) assesses perceived harmfulness of daily activities in patients with low back pain (LBP). Although there is some evidence that the PHODA-SeV is a reliable and valid tool, its psychometric properties have not been fully investigated. Objectives To investigate the test-retest reliability, measurement error, interpretability, construct validity, and internal and external responsiveness of the PHODA-SeV in patients with chronic LBP. Methods Ninety-one patients were included in the analysis for this prospective cohort study. For reliability purposes, the PHODA-SeV was administered twice, with a 1-week interval before beginning treatment. Pain, disability, and measures of pain-related fear (ie, PHODA-SeV, Fear-Avoidance Beliefs Questionnaire [FABQ], and Tampa Scale of Kinesiophobia [TSK]) were collected before and after the 8-week treatment period. Results The PHODA-SeV showed excellent reliability (intraclass correlation coefficient model 2,1 = 0.91), without evidence of ceiling and floor effects. The construct validity analysis demonstrated fair correlations (r = 0.25-0.50) of the PHODA-SeV with the FABQ, but no correlation with the TSK (r<0.25). For internal responsiveness, the PHODA-SeV showed an effect size of 0.87 and a standardized response mean of 0.92, interpreted as a large effect (greater than 0.80). For external responsiveness, the correlations between the PHODA-SeV and changes in the TSK and FABQ were considered low, and the receiver operating characteristic curve analyses revealed an area under the curve lower than the proposed threshold of 0.70. Conclusion The PHODA-SeV is a reliable tool that can detect changes over time in pain-related fear in patients with chronic LBP undergoing physical therapy treatment. This tool, however, failed to identify those patients who did or did not improve, according to other pain-related fear measures. J Orthop Sports Phys Ther 2018;48(9):719-727. Epub 23 May 2018. doi:10.2519/jospt.2018.7864.
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Schemer L, Vlaeyen JW, Doerr JM, Skoluda N, Nater UM, Rief W, Glombiewski JA. Treatment processes during exposure and cognitive-behavioral therapy for chronic back pain: A single-case experimental design with multiple baselines. Behav Res Ther 2018; 108:58-67. [DOI: 10.1016/j.brat.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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