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Kissi A, Vorensky M, Sturgeon JA, Vervoort T, van Alboom I, Guck A, Perera RA, Rao S, Trost Z. Racial Differences in Movement-Related Appraisals and Pain Behaviors Among Adults With Chronic Low Back Pain. THE JOURNAL OF PAIN 2024; 25:104438. [PMID: 38065466 PMCID: PMC11058036 DOI: 10.1016/j.jpain.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
Research documents racial disparities in chronic low back pain (CLBP). Few studies have examined racial disparities in movement-related appraisals and no studies have examined anticipatory appraisals prior to or pain behaviors during functional activities among individuals with CLBP. This cross-sectional study examined racial differences in anticipatory appraisals of pain, concerns about harm, and anxiety, appraisals of pain and anxiety during movement, and observed pain behaviors during 3 activities of daily living (supine-to-standing bed task, sitting-to-standing chair task, floor-to-waist lifting task) in a sample (N = 126) of non-Hispanic Black (31.0%), Hispanic (30.2%), and non-Hispanic White (38.9%) individuals with CLBP. Hispanic participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed and chair tasks compared to non-Hispanic White participants. Hispanic participants reported more pain during the bed task and more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed task and more pre-movement anxiety prior to the chair task compared to non-Hispanic White participants. Non-Hispanic Black participants reported more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants were observed to have significantly more verbalizations of pain during the bed task compared to non-Hispanic White participants. Current findings identify racial disparities in important cognitive-behavioral and fear-avoidance mechanisms of pain. Results indicate a need to revisit traditional theoretical and treatment models in CLBP, ensuring racial disparities in pain cognitions are considered. PERSPECTIVE: This study examined racial disparities in anticipatory and movement-related appraisals, and pain behaviors during activities of daily living among Non-Hispanic Black, Non-Hispanic White, and Hispanic individuals with CLBP. Racial disparities identified in the current study have potentially important theoretical implications surrounding cognitive-behavioral and fear-avoidance mechanisms of pain.
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Affiliation(s)
- Ama Kissi
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Mark Vorensky
- Rusk Rehabilitation, NYU Langone Health, 333 East 38 Street, New York, NY 10016, United States of America
- Department of Physical Therapy, New York University, 380 2 Ave, New York, NY 10010, United States of America
- Department of Physical Therapy, Touro University, 3 Times Square, New York, NY 10036, United States of America
| | - John A. Sturgeon
- Department of Anesthesiology, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48105, United States of America
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Ischa van Alboom
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, United States of America
| | - Robert A. Perera
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E Marshall St, Richmond, VA 23298, United States of America
| | - Smita Rao
- Department of Physical Therapy, New York University, 380 2 Ave, New York, NY 10010, United States of America
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E Marshall St, Richmond, VA 23298, United States of America
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[Evaluation of muscle strength in rehabilitation: from subjective assessment scales to instrumental examinations]. Rehabilitacion (Madr) 2020; 55:2-4. [PMID: 33077184 DOI: 10.1016/j.rh.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022]
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Ansuategui Echeita J, van der Wurff P, Killen V, Dijkhof MF, Grootenboer FM, Reneman MF. Lifting capacity is associated with central sensitization and non-organic signs in patients with chronic back pain. Disabil Rehabil 2020; 43:3772-3776. [PMID: 32309992 DOI: 10.1080/09638288.2020.1752318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To analyze the associations between lifting capacity, and central sensitization (CS) and non-organic signs (NOS) in patients with chronic back pain (CBP) attending vocational rehabilitation.Materials and methods: Cross-sectional observational multicenter study among patients with CBP undergoing a return to work assessment within care as usual. Main analyses: step 1: partial correlation between lifting capacity, and CS, NOS, and additional variables; step 2: multiple regression in stepwise forward method for dependent variable lifting capacity, and for independent variables CS and NOS, and additional variables significant (p < 0.05) at step 1. All analyses were controlled for sex.Results: Fifty-six patients of mean age 42.5 years and 59% women participated in the study. Correlations between lifting capacity and CS and NOS were r = -0.53 and r = -0.50, respectively. CS and NOS, as well as age and sex, contributed significantly to the final regression model, which explained 57.6% of variance.Conclusions: After controlling for confounders, CS and NOS were negatively associated with lifting capacity in patients with CBP. Explained variance was substantially higher than previously reported studies.Implications for RehabilitationThe identification of central sensitization and non-organic signs (NOS) in patients with chronic back pain can alert clinicians about central nervous system being in a hypersensitive state and about pain behavior.Central sensitization and NOS are relevant determinants of lifting capacity.Better understanding of the factors affecting lifting capacity lead to better design and tailoring of interventions, resulting in optimized vocational rehabilitation programs and faster return to work.
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Affiliation(s)
- Jone Ansuategui Echeita
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter van der Wurff
- Research & Development, Military Rehabilitation Center Aardenburg, Doorn, The Netherlands.,Institute for Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Vera Killen
- Department of Vocational Rehabilitation, Libra Rehabilitation Medicine and Audiology, Eindhoven, The Netherlands
| | - Mike F Dijkhof
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Floor M Grootenboer
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Predictive validity of a customized functional capacity evaluation in patients with musculoskeletal disorders. Int Arch Occup Environ Health 2020; 93:635-643. [DOI: 10.1007/s00420-020-01518-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
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Schindl M, Wassipaul S, Wagner T, Gstaltner K, Bethge M. Impact of Functional Capacity Evaluation on Patient-Reported Functional Ability: An Exploratory Diagnostic Before-After Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:711-717. [PMID: 30796579 DOI: 10.1007/s10926-019-09829-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction Work capacity in patients with orthopedic trauma and long-lasting inactivity is significantly reduced. Functional capacity evaluation (FCE) is a diagnostic approach for developing recommendations for a return to work and further occupational rehabilitation when the ability to carry out previous job demands is uncertain. However, FCE may also have direct effects on the patients' appraisal of their functional ability. Our study therefore evaluated the change in patient-reported functional ability after the performance of an FCE. Methods We performed a diagnostic before-after study in 161 consecutively recruited patients with trauma who were referred for FCE at the end of an interdisciplinary inpatient rehabilitation program in Austria. Patients completed the Spinal Function Sort to assess patient-reported functional ability both prior to the FCE and after completing it. Results Patient-reported functional ability (0-200 points) improved by 14.8 points (95% CI 11.3-18.2). The number of participants who rated their functional ability below their functional capacity as observed by the FCE decreased from 82.6 to 64.6% by about 18 percentage points. Conclusions The performance of the FCE in patients with trauma was associated with an improvement of patient-reported functional ability. The performance of an FCE in trauma rehabilitation may possibly have a direct therapeutic effect on the patient by allowing a more realistic appraisal of the ability to perform relevant work activities.
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Affiliation(s)
- Martin Schindl
- Rehabilitationszentrum Weißer Hof, AUVA, Holzgasse 350, 3400, Klosterneuburg, Austria.
| | - Sylvia Wassipaul
- Rehabilitationszentrum Weißer Hof, AUVA, Holzgasse 350, 3400, Klosterneuburg, Austria
| | - Tanja Wagner
- Abteilung Statistik, Hauptstelle AUVA, A. Stifter-Straße 65, 1200, Wien, Austria
| | - Karin Gstaltner
- Rehabilitationszentrum Weißer Hof, AUVA, Holzgasse 350, 3400, Klosterneuburg, Austria
| | - Matthias Bethge
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Gelfman R, Hill JJ. Rehabilitating the Injured/Ill Worker to Maximum Medical Improvement (MMI). Phys Med Rehabil Clin N Am 2019; 30:657-669. [PMID: 31227140 DOI: 10.1016/j.pmr.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concepts associated with work disability are not identical to those associated with medical disability. In addition to a worker's medical condition, the resultant functional limitations, and loss of participation in society, the injured or ill worker must often navigate a complex administrative system that often seems adversarial. This process is made less adversarial with the willingness to participate of knowledgeable clinicians. This article informs the interested clinician in regard to the unique aspects of work disability, including the issues of work accommodations, restrictions, and fitness for duty; prolonged work disability; and other return-to-work considerations at maximum medical improvement.
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Affiliation(s)
- Russell Gelfman
- Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905-0001, USA.
| | - James J Hill
- UNC Department of Physical Medicine & Rehabilitation, NC Memorial Hospital, CB #7200, 101 Manning Drive, Room N1183, Chapel Hill, NC 27599, USA
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The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population. Clin J Pain 2018; 33:1088-1099. [PMID: 28328697 DOI: 10.1097/ajp.0000000000000501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure. MATERIALS AND METHODS In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later. RESULTS Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution. DISCUSSION Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.
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Turk DC, Fillingim RB, Ohrbach R, Patel KV. Assessment of Psychosocial and Functional Impact of Chronic Pain. THE JOURNAL OF PAIN 2016; 17:T21-49. [DOI: 10.1016/j.jpain.2016.02.006] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/08/2016] [Accepted: 02/16/2016] [Indexed: 12/20/2022]
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Neblett R, Hartzell M, Mayer T, Bradford E, Gatchel R. Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13). Eur J Pain 2015; 20:701-10. [DOI: 10.1002/ejp.795] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/11/2022]
Affiliation(s)
- R. Neblett
- PRIDE Research Foundation; 5701 Maple Ave. #100 Dallas TX 75235
| | - M.M. Hartzell
- PRIDE Research Foundation; 5701 Maple Ave. #100 Dallas TX 75235
| | - T.G. Mayer
- Department of Orthopedic Surgery; University of Texas Southwestern Medical Center; Dallas USA
| | - E.M. Bradford
- PRIDE Research Foundation; 5701 Maple Ave. #100 Dallas TX 75235
| | - R.J. Gatchel
- Department of Psychology; College of Science; The University of Texas at Arlington; 313 Life Science Building Arlington Texas 76019
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Neblett R, Mayer TG, Hartzell MM, Williams MJ, Gatchel RJ. The Fear-avoidance Components Scale (FACS): Development and Psychometric Evaluation of a New Measure of Pain-related Fear Avoidance. Pain Pract 2015; 16:435-50. [PMID: 26228238 DOI: 10.1111/papr.12333] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/25/2015] [Indexed: 11/30/2022]
Abstract
Pain-related fear avoidance (FA), a common problem for patients with painful medical conditions, involves pain-related catastrophizing cognitions, hypervigilance, and avoidance behaviors, which can ultimately lead to decreased functioning, depression, and disability. Several patient-reported instruments have been developed to measure FA, but they have been criticized for limited construct validity, inadequate item specificity, lack of cutoff scores, and missing important FA components. The Fear-Avoidance Components Scale (FACS) is a new patient-reported measure designed to comprehensively evaluate FA in patients with painful medical conditions. It combines important components of FA found in prior FA scales, while trying to correct some of their deficiencies, within a framework of the most current FA model. Psychometric evaluation of the FACS found high internal consistency (α = 0.92) and high test/retest reliability (r = 0.90-0.94, P < 0.01). FACS scores differentiated between 2 separate chronic pain patient samples and a nonpatient comparison group. When clinically relevant severity levels were created, FACS severity scores were highly associated with FA-related patient-reported psychosocial and objective lifting performance variables. These results suggest that the FACS is a psychometrically strong and reliable measure that can help healthcare providers assess FA-related barriers to function and recovery.
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Affiliation(s)
| | - Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | | | | | - Robert J Gatchel
- Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, Texas, U.S.A
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