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Natoli AR, Jones MD, Walker ED, Gibbs MT. "I could 100% see myself getting hurt if I did it wrong": a qualitative exploration of exercise perceptions in people with chronic low back pain. Disabil Rehabil 2024:1-10. [PMID: 39264041 DOI: 10.1080/09638288.2024.2400592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE Traditionally, a specific "core" exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative. MATERIALS AND METHODS Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens. RESULTS All participants (n = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. "Core" exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions. CONCLUSION People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts.
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Affiliation(s)
- Andrew R Natoli
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Emily D Walker
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Mitchell T Gibbs
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Christe G, Benaim C, Jolles BM, Favre J. Changes in spinal motor behaviour are associated with reduction in disability in chronic low back pain: A longitudinal cohort study with 1-year follow-up. Eur J Pain 2024; 28:1116-1126. [PMID: 38299715 DOI: 10.1002/ejp.2245] [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: 08/04/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP. METHODS Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups. RESULTS After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001). CONCLUSIONS Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability. SIGNIFICANCE STATEMENT This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Benaim
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne, Sion, Switzerland
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MacIntyre E, Pinto E, Mouatt B, Henry ML, Lamb C, Braithwaite FA, Meulders A, Stanton TR. The influence of threat on visuospatial perception, affordances, and protective behaviour: A systematic review and meta-analysis. Clin Psychol Rev 2024; 112:102449. [PMID: 38901066 DOI: 10.1016/j.cpr.2024.102449] [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: 12/22/2023] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024]
Abstract
Perception has been conceptualised as an active and adaptive process, based upon incoming sensory inputs, which are modified by top-down factors such as cognitions. Visuospatial perception is thought to be scaled based on threat, with highly threatening objects or contexts visually inflated to promote escape or avoidance behaviours. This meta-analytical systematic review quantified the effect and evidence quality of threat-evoked visuospatial scaling, as well as how visuospatial scaling relates to affordances (perceived action capabilities) and behavioural avoidance/escape outcomes. Databases and grey literature were systematically searched inclusive to 10/04/24. Studies were assessed with a customised Risk of Bias form and meta-analysis was performed using a random-effects model. 12,354 records were identified. Of these, 49 experiments (n = 3027) were included in the review. There was consistent evidence that threat the of height influenced contextual perception (g = 0.66, 95% CI: 0.45, 0.88) and affordances (g = -0.43, 95% CI: -0.84, -0.03). Threatening objects were viewed as larger (g = 0.76, 95% CI: 0.26, 1.26) and as closer (g = 0.30, 95% CI: 0.17, 0.42). Bodily threat (pain) yielded conflicting effects on visuospatial perception/affordances. We conclude that threat may influence visuospatial perception and affordances. However, since behavioural measures were poorly reported, their relationship with visuospatial perception/affordances remains elusive.
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Affiliation(s)
- Erin MacIntyre
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Medical Research Institute (SAHMRI), Adelaide, Australia; IIMPACT in Health, University of South Australia, Adelaide, Australia.
| | - Eleana Pinto
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Brendan Mouatt
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Medical Research Institute (SAHMRI), Adelaide, Australia; IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Michael L Henry
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Christopher Lamb
- Brain Behaviour Laboratory, Musculoskeletal Sport, Exercise, & Health Lab, University of British Columbia, Canada
| | - Felicity A Braithwaite
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Medical Research Institute (SAHMRI), Adelaide, Australia; IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Ann Meulders
- Experimental Health Psychology, Maastricht University, The Netherlands; Research Group Health Psychology, KU Leuven, Belgium
| | - Tasha R Stanton
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Medical Research Institute (SAHMRI), Adelaide, Australia; IIMPACT in Health, University of South Australia, Adelaide, Australia.
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O'Hagan ET, Traeger AC, Schabrun SM, O'Neill S, Wand BM, Cashin AG, Williams CM, Harris IA, McAuley JH. It's OK to Move! Effect of a Brief Video on Community Confidence in Activity Despite Back Pain: A Randomized Trial. J Orthop Sports Phys Ther 2024; 54:400-407. [PMID: 38635937 DOI: 10.2519/jospt.2024.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE: To estimate the difference in confidence to become active despite low back pain in people who were exposed to one of 2 video interventions delivered on social media, compared to no intervention. DESIGN: A proof-of-concept, 3-group randomized controlled trial, in a 1:1:1 ratio. METHODS: Participants aged 18 years and over, with and without low back pain, were recruited via the social media channel Facebook, to view either a humorous video, a neutral video, or to no intervention. The videos were delivered online, explained evidence-based management for low back pain, and were designed to "go viral." The primary outcome was confidence in becoming active despite pain, measured using the Pain Self Efficacy Questionnaire (Item 10) (ranges from 0 [not at all confident] to 6 [completely confident]) immediately after watching the video. We aimed to capture the real-time impact and immediate reactions that contributed to the content's reach. RESULTS: Among 1933 randomized participants (mean [standard deviation] age: 58.9 [14.0] years, 1285 [75%] women), 1232 [70%] had low back pain and 88.8% completed the primary outcome. One thousand two hundred sixty-four participants were randomized to receive a video intervention, and 633 participants did not receive a video. On a 6-point scale, individuals exposed to either video (n = 1088) showed a mean confidence level 0.3 points higher (95% confidence interval: 0.1, 0.6) compared with no video (n = 630). CONCLUSION: Participants who viewed a brief video intervention reported a very small difference in confidence to become active despite low back pain, compared with no intervention. The difference may lack clinical relevance. J Orthop Sports Phys Ther 2024;54(6):1-8. Epub 18 April 2024. doi:10.2519/jospt.2024.12412.
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Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Musculoskeletal Clinical Academic Group, Maridulu Budyari Gumal (SPHERE), Sydney, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
- Musculoskeletal Clinical Academic Group, Maridulu Budyari Gumal (SPHERE), Sydney, Australia
- School of Physical Therapy, University of Western Ontario, London, Canada
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, Canada
| | - Sean O'Neill
- Musculoskeletal Clinical Academic Group, Maridulu Budyari Gumal (SPHERE), Sydney, Australia
- South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Liverpool, Australia
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, St. Leonards, Australia
| | - Benedict M Wand
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
| | - Christopher M Williams
- University Centre for Rural Health, School of Health Sciences, University of Sydney, Lismore, Australia
| | - Ian A Harris
- Musculoskeletal Clinical Academic Group, Maridulu Budyari Gumal (SPHERE), Sydney, Australia
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, The University of New South Wales, Kensington, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
- Musculoskeletal Clinical Academic Group, Maridulu Budyari Gumal (SPHERE), Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
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