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Azer G, Gibbs MT, Jones MD, Morrison NMV, Azer A, Marshall PW. How and why do people with chronic low back pain modify their physical activity? A mixed-methods survey. Musculoskeletal Care 2024; 22:e1885. [PMID: 38682684 DOI: 10.1002/msc.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND This study investigated the impact of Chronic Low Back Pain (CLBP) on individuals' physical activity (PA) behaviours, specifically, how they modify, cease, or continue PA when experiencing CLBP. The primary aim was to explore the relationship between CLBP and PA and how this is influenced in different contexts (e.g., necessity of a task). METHODS A mixed-methods survey was administered to 220 participants, including self-reported outcomes, and capturing responses to three distinct questions related to PA and CLBP. The data was analysed via a content analysis. RESULTS The findings revealed that individuals with CLBP are most likely to modify PA in work-related contexts and least likely to cease it in the same setting. Housework emerged as the most common domain for cessation of PA, while work/study activities were predominantly continued. Reasons for these trends were typically task-based rather than health or enjoyment based and influenced by the perceived necessity of the task in question. CONCLUSION The study highlights the role of occupational and educational settings in individual responses to CLBP. The findings also highlight a gap in public awareness regarding effective CLBP management strategies, emphasising the need for increased education and awareness programs.
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Affiliation(s)
- George Azer
- Faculty of Medicine & Health, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Mitchell T Gibbs
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Matthew D Jones
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Natalie M V Morrison
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Anthony Azer
- Faculty of Medicine & Health, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Paul W Marshall
- Faculty of Science, Department of Exercise Science, University of Auckland, Auckland, New Zealand
- School of Health Science, Western Sydney University, Sydney, New South Wales, Australia
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Dahill LM, Morrison NMV, Touyz S, Mitchison D, Bussey K, Mannan H, Hay P. An exploration of how adolescents experience and reason their parents' comments on their weight, shape, and eating. J Adolesc 2023; 95:1488-1504. [PMID: 37464918 DOI: 10.1002/jad.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Disordered eating among adolescents is of increasing concern given associated physical and mental health sequelae. Cognitions underlying disordered eating are formed in childhood and adolescence. Parents are a significant presence during this period, so it is critical to understand how they influence their adolescent's eating cognitions and behaviors. METHODS Qualitative analysis using interpretative phenomenological analysis (IPA) methodology was employed to consider the lived experiences of 10 Australian adolescents (14-19 years), 60% female, as they engaged with their parents in a range of weight, shape, and eating communications. RESULTS Our inductive IPA revealed three key themes representing adolescents' experiences and meaning-making: Parents as Influencers-adolescents acknowledged parents are influencers (objects) within a wider context of community and cultural norms (symbols) and can be protective for peer influence on body image ideals; Expression and Perception-the "what" (weight-talk as an object) and the "how" (objects as independent influences) of gendered parental communication related to health and fitness ideals and illustrated diverse interpretations of both verbal and non-verbal expression; and Fertile Soil and Maturity-the adolescent's characteristics and context influence perceptions of communication, a fear of deviating from norms, and an overarching focus on being "healthy" yet not always knowing what that was. Perception of bidirectional communication also offered valuable insights into potential dangers through family loyalty and in-group permissions. CONCLUSIONS Findings highlight implications for the nuanced influence of parental communication and illustrate the pivotal role of parents within the bioecosystem of adolescent development.
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Affiliation(s)
- Lucy M Dahill
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Natalie M V Morrison
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Stephen Touyz
- University of Sydney Inside Out, Camperdown, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- University of Technology Sydney, Broadway, New South Wales, Australia
| | - Kay Bussey
- Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- South West Sydney Local Health District, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, Australia
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Dahill LM, Hay P, Morrison NMV, Touyz S, Mitchison D, Bussey K, Mannan H. Correction: Dahill et al. Associations between Parents' Body Weight/Shape Comments and Disordered Eating Amongst Adolescents over Time-A Longitudinal Study. Nutrients 2023, 15, 1419. Nutrients 2023; 15:3993. [PMID: 37764876 PMCID: PMC10508266 DOI: 10.3390/nu15183993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
There was an error in the original publication [...].
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Affiliation(s)
- Lucy M. Dahill
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia (H.M.)
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia (H.M.)
- South West Sydney Local Health District, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
| | - Natalie M. V. Morrison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia (H.M.)
| | - Stephen Touyz
- School of Psychology and Inside Out Institute, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia (H.M.)
- Centre for Emotional Health, Macquarie University, North Ryde, NSW 2109, Australia
| | - Kay Bussey
- Centre for Emotional Health, Macquarie University, North Ryde, NSW 2109, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia (H.M.)
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Dahill LM, Hay P, Morrison NMV, Touyz S, Mitchison D, Bussey K, Mannan H. Associations between Parents' Body Weight/Shape Comments and Disordered Eating Amongst Adolescents over Time-A Longitudinal Study. Nutrients 2023; 15:1419. [PMID: 36986150 PMCID: PMC10059676 DOI: 10.3390/nu15061419] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Parents are key influencers of adolescents' attitudes on weight, shape, and eating, and make more positive than negative comments, with negative comments most impactful. This study examined prospective unique associations of parental positive and negative comments in a community sample of adolescents with paediatric psychosocial quality of life (PED-QoL), Eating Disorder Weight/Shape Cognitions (EDEQ-WS), BMI percentile, and Psychological Distress (K10) scales. Data were from 2056 adolescents from the EveryBODY study cohort. Multiple regressions were conducted for the impacts of parental positive and negative comments on four dependent variables at one year after controlling for their stage of adolescence (early, middle, late). Multiple imputation and bootstrapping were used for handling missing data and violations of normality. Results indicated that positive maternal comments on eating were associated with increased EDCs and better quality of life at one year. Paternal positive weight shape comments were associated with a decrease in psychological distress, but positive eating comments saw a decrease in quality of life. Findings highlight the nuances of parental comments and how these are perceived and interpreted, and could alert health care workers and family practitioners who have weight, shape, and eating conversations to be aware of the potential influence of their communication.
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Affiliation(s)
- Lucy M. Dahill
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia; (P.H.); (N.M.V.M.); (D.M.); (H.M.)
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia; (P.H.); (N.M.V.M.); (D.M.); (H.M.)
- South West Sydney Local Health District, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
| | - Natalie M. V. Morrison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia; (P.H.); (N.M.V.M.); (D.M.); (H.M.)
| | - Stephen Touyz
- School of Psychology and Inside Out Institute, University of Sydney, Sydney, NSW 2006, Australia;
- Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia; (P.H.); (N.M.V.M.); (D.M.); (H.M.)
- Centre for Emotional Health, Macquarie University, North Ryde, NSW 2109, Australia;
| | - Kay Bussey
- Centre for Emotional Health, Macquarie University, North Ryde, NSW 2109, Australia;
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2051, Australia; (P.H.); (N.M.V.M.); (D.M.); (H.M.)
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Gibbs MT, Morrison NMV, Jones MD, Burgess D, Marshall PW. Reductions in movement-associated fear are dependent upon graded exposure in chronic low back pain: An exploratory analysis of a modified 3-item fear hierarchy. Musculoskeletal Care 2023; 21:25-34. [PMID: 35661387 DOI: 10.1002/msc.1661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore the effectiveness of a modified fear hierarchy on measuring improvements in movement-associated fear in chronic low back pain. METHODS A modified 3-item fear hierarchy was created and implemented based on principles of graded exposure. This study was an exploratory analysis of the modified 3-item fear hierarchy from a larger clinical trial data set. Both groups received pain education and exercise, either bodyweight or strength training. Both groups performed item one on the hierarchy, the squat. Only the strength training group performed item 2, the deadlift. Neither group performed item 3, the overhead press. Analysis of Covariance and stepwise linear regression were used to explore results. RESULTS Improvement in movement-associated fear was conditional upon graded exposure. Both groups improved in the squat movement (p ≤ 0.05), which both performed. Only the strength training group improved in the deadlift (p ≤ 0.01), and neither improved in the overhead press (p ≥ 0.05). CONCLUSION Reductions in movement-associated fear are conditional upon graded exposure, based on the use of a novel modified 3-item fear hierarchy. Further research is needed to understand the utility of this tool in a patient-led approach to co-designing a graded exposure-based intervention.
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Affiliation(s)
- Mitchell T Gibbs
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Health Science, Western Sydney University, Penrith, New South Wales, Australia
| | - Natalie M V Morrison
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Matthew D Jones
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain Impact, Neuroscience Research Australia, Adelaide, Queensland, Australia
| | - Danielle Burgess
- Department of Health Science, Torrens University Australia, Adelaide, Queensland, Australia
| | - Paul W Marshall
- School of Health Science, Western Sydney University, Penrith, New South Wales, Australia
- Department of Exercise Science, University of Auckland, Auckland, New Zealand
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Marshall PW, Morrison NMV, Mifsud A, Gibbs M, Khan N, Meade T. The Moderating Effect of Treatment Engagement on Fear-avoidance Beliefs in People With Chronic Low Back Pain. Clin J Pain 2021; 37:872-880. [PMID: 34636749 DOI: 10.1097/ajp.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The fear-avoidance model (FAM) is used to explain pain-related disability and design targeted interventions for people with chronic low back pain. While treatment engagement is critical, it is unknown how treatment moderates the FAM. METHODS This study examined whether pathways within the FAM were moderated by treatment engagement in 508 people with chronic low back pain. Measures of disability, pain, fear, catastrophizing, anxiety, depression, and self-efficacy were collected through self-report, and descriptors of treatment engaged within the last month (physical activity type, medication, allied and medical health practitioner). Moderated mediation analyses were performed to examine the conditional effect of treatment engagement on fear-avoidance pathways. RESULTS The conditional effect of anxiety on disability was only significant for people who did not report any treatment engagement in the last month (B=1.03, 95% confidence interval: 0.53-1.53, P<0.001). The effect of depression increased for people reporting more different types of treatment in the last month (1 level of treatment increase, B=0.27, 95% confidence interval: 0.05-0.50, P=0.019). Conversely, greater treatment engagement had a positive influence on the mediating effect of self-efficacy. That is, the effect of pain on efficacy reduced with greater treatment engagement, with a concomitant increased effect of self-efficacy on disability. DISCUSSION Clinicians should explore the history and rationale behind patient treatment seeking behavior to ensure this is not reinforcing the negative effects of depressive symptoms on pain-related disability.
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Affiliation(s)
- Paul W Marshall
- Schools of Health Science
- Department of Exercise Sciences, University of Auckland, Auckland, NSW, New Zealand
| | - Natalie M V Morrison
- Medicine
- Translational Health Research Institute, Western Sydney University, Sydney
| | | | | | | | - Tanya Meade
- Psychology
- Translational Health Research Institute, Western Sydney University, Sydney
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Dahill LM, Touyz S, Morrison NMV, Hay P. Parental appearance teasing in adolescence and associations with eating problems: a systematic review. BMC Public Health 2021; 21:450. [PMID: 33676473 PMCID: PMC7936414 DOI: 10.1186/s12889-021-10416-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/09/2021] [Indexed: 01/29/2023] Open
Abstract
Background The adolescent years see significant physical and emotional development that lay foundations for patterns of behaviour that can continue into adult life, including the shaping of eating behaviours. Given parents are key socio-environmental drivers and influencers of adolescent behaviours around physical health and wellbeing, it is critical to consider if specific forms of parental communication are potentially contributing to the associated emotional difficulties experienced in the adolescent years. The aim of this research was to systematically review the myriad of literature pertaining to the prevalence of parental weight or appearance-based teasing and adolescent eating problems to examine how the scientific and clinical community currently understands the relationship between these domains. Methods A systematic search of the literature, using the SCOPUS, APA PsycINFO, Medline, CINAHL databases, reference lists and Google Scholar, was undertaken to identify relevant literature for parental teasing and problem eating in adolescents aged 10–19 years, published between January 1980 to October 2020, in English or French. Results Six studies met criteria for inclusion, all were cross-sectional studies and two included additional prospective data. Although parents were not the most common perpetrators of teasing, often subsidiary to that of peers and siblings, the influence and impact of parental teasing remained significant, and in some cases, appeared to interact with sibling-based teasing. This teasing was associated with problem eating behaviours for adolescents. Conclusions There is evidence in the literature to suggest the existence of an association between ‘eating problems’ amongst adolescents and exposure to parental appearance or weight teasing. Parents are unlikely to be aware of the perception or impact of the words they use or the wider influence these words may have. Future research should employ representative longitudinal designs to develop a greater understanding of the relationships between parental communications around their adolescent’s appearance or weight and how that communication is perceived by adolescents within complex family processes. Trial registration PROSPERO 2018 CRD42018109623. Prospectively registered 15th October 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10416-5.
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Affiliation(s)
- Lucy M Dahill
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Stephen Touyz
- Department of Psychology, University of Sydney, Sydney, Australia
| | - Natalie M V Morrison
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,School of Medicine, Western Sydney University, Penrith, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,School of Medicine, Western Sydney University, Penrith, Australia
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Khan MNU, Morrison NMV, Marshall PW. The Role of Fear-Avoidance Beliefs on Low Back Pain-Related Disability in a Developing Socioeconomic and Conservative Culture: A Cross-Sectional Study of a Pakistani Population. J Pain Res 2020; 13:2377-2387. [PMID: 33061553 PMCID: PMC7520149 DOI: 10.2147/jpr.s258314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background The relationship of low back pain, the world’s top disabling condition, with functional disability is often explained by the mediation effect of fear, catastrophizing, and psychological distress. These relationships have not been explored within chronic back pain patients from a low socio-economic, predominantly Muslim country. Thus, it was unclear whether previously established pathways would be consistent in Pakistani pain patients to help guide Pakistani clinicians caring for back pain patients. This cross-sectional study translated English versions of questionnaires within the fear-avoidance model into Urdu, tested the clinimetric properties of the Urdu versions for people with chronic low back pain (CLBP) in Pakistan, and performed mediation analysis to investigate pathways of the fear-avoidance model. Methods Translation of questionnaires was completed in 4 steps using the forward-backward technique, with subsequent analyses for internal consistency (Cronbach’s α), construct validity (Pearson’s r-value), and test–retest reliability (ICC r-value). Multiple mediation analysis with bootstrapping was performed to analyze pathways within the fear-avoidance model from the Urdu translated questionnaires. Results A total of 151 people from Pakistan with CLBP completed the questionnaires, with good results for internal consistency (r > 0.85), convergent validity (r > 0.59), and test–retest reliability (ICC r > 0.85). The association of pain with disability was significant (B=2.36, r2 = 0.19, p<0.001), and the indirect effect of the mediators explained 81% of pain intensity’s total effect on disability. All mediators, apart from physical activity-related fear-avoidance beliefs, were significant mediators of the effect of pain intensity on disability. Conclusion The Urdu versions of the fear-avoidance questionnaires show good clinimetric properties for use in clinical settings and research in Pakistan. These analyses support existing data for the mediation effect of catastrophizing, psychological distress, and self-efficacy on pain-related disability, and extends these findings to suggest that fear about work may be more important in a relatively lower socioeconomic sample of pain patients.
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Affiliation(s)
| | - Natalie M V Morrison
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Translation Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Paul W Marshall
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
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Page A, Morrison NMV. The effects of gender, personal trauma history and memory continuity on the believability of child sexual abuse disclosure among psychologists. Child Abuse Negl 2018; 80:1-8. [PMID: 29558670 DOI: 10.1016/j.chiabu.2018.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/04/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Gender, a personal history of trauma and attitudes towards continuous vs recovered memories of abuse significantly impact the believability of Child Sexual Abuse (CSA) disclosures in community samples. Yet, whether these variables influence the believability of CSA disclosure and subsequent clinical decisions made by practicing psychologists is underexplored. A vignette of trauma disclosure from a hypothetical adult client was presented via an online survey to 292 registered psychologists. Participants rated the believability of the disclosure, answered an open-ended item regarding treatment planning, and completed the Brief Betrayal Trauma Survey to measure personal trauma history. Results indicated that female psychologists believed disclosures significantly more than male psychologists and that disclosures comprised of continuous memories were believed more than recently recovered memories. A significant interaction between gender and personal trauma history was also revealed. Female psychologists believed disclosures regardless of their personal trauma history, while male psychologists with a personal history of trauma believed disclosures significantly more than male psychologists without personal trauma history. Reported believability of the disclosure, while unrelated to treatment planning, was associated with a reported intention to validate the client's experience. The results support that, similar to community samples, gender and a personal trauma history impact psychologist believability of CSA disclosure. The research further supports that psychologist level of belief then translates into clinical implications.
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Affiliation(s)
- Alexandra Page
- Discipline of Psychological Sciences, Australian College of Applied Psychology, 255 Elizabeth Street, Sydney, NSW, 2000, Australia
| | - Natalie M V Morrison
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia; Discipline of Psychological Sciences, Australian College of Applied Psychology, 255 Elizabeth Street, Sydney, NSW, 2000, Australia.
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Affiliation(s)
- Natalie M. V. Morrison
- MARCS Institute; University of Western Sydney; Sydney NSW Australia
- Australian College of Applied Psychology; Sydney NSW Australia
| | - Denis Burnham
- MARCS Institute; University of Western Sydney; Sydney NSW Australia
| | - Ben W. Morrison
- Australian College of Applied Psychology; Sydney NSW Australia
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