Neil K. Roach

Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia.

&NA; The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed measures for assessing pain‐related fear in back pain patients. Despite its widespread use, there is relatively little data to support the psychometric properties of the English version of this scale. This study investigated the psychometric properties of the English version of the TSK in a sample of chronic low back pain patients. Item analysis revealed that four items possessed low item total correlations (4, 8, 12, 16) and four items had response trends that deviated from a pattern of normal distribution (4, 9, 12, 14). Consequently, we tested the psychometric properties of a shorter version of the TSK (TSK‐11), having excluded the six psychometrically poor items. The psychometric properties of this measure were compared to those of the original TSK. Both measures demonstrated good internal consistency (TSK: α=0.76; TSK‐11: α=0.79), test–retest reliability (TSK: ICC=0.82, SEM=3.16; TSK‐11: ICC=0.81, SEM=2.54), responsiveness (TSK: SRM=−1.19; TSK‐11: SRM=−1.11), concurrent validity and predictive validity. In respect of specific cut‐off scores, a reduction of at least four points on both measures maximised the likelihood of correctly identifying an important reduction in fear of movement. Overall, the TSK‐11 possessed similar psychometric properties to the original TSK and offered the advantage of brevity. Further research is warranted to investigate the utility of the new instrument and the cut‐off scores in a wider group of chronic pain patients in different clinical settings.

The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy.

The aim of this study was to determine the extent to which a number of distinct cognitive factors were differentially related to the levels of pain and disability reported by 183 chronic low back pain (CLBP) patients presenting for physiotherapy. After adjusting for demographics, the cognitive factors accounted for an additional 30% of the variance in pain intensity, with functional self‐efficacy (β=−0.40; P<0.001) and catastrophizing (β=0.21; P<0.01) both uniquely contributing to the prediction of outcome. The cognitive factors also explained an additional 32% of the variance in disability after adjusting for demographics and pain intensity (total R2=0.61). Higher levels of functional self‐efficacy (β=−0.43; P<0.001) and lower levels of depression (β=0.23; P<0.01) were uniquely related to lower levels of disability. Our findings clearly show that there is a strong association between cognitive factors and the levels of pain and disability reported by CLBP patients presenting for physiotherapy. Functional self‐efficacy emerged as a particularly strong predictor of both pain intensity and disability. In view of our findings it would seem that targeting specific cognitive factors should be an integral facet of physiotherapy‐based treatments for CLBP.

COPING STRATEGY USE: DOES IT PREDICT ADJUSTMENT TO CHRONIC BACK PAIN AFTER CONTROLLING FOR CATASTROPHIC THINKING AND SELF-EFFICACY FOR PAIN CONTROL?

OBJECTIVE To explore whether coping strategy use predicted levels of adjustment in chronic low back pain after controlling for the influence of catastrophic thinking and self-efficacy for pain control. METHODS Eighty-four patients with chronic low back pain completed the Coping Strategies Questionnaire, a pain VAS and the Roland Disability Questionnaire. To derive composite measures of coping, the Coping Strategies Questionnaire subscales, excluding the Catastrophizing subscale and 2 single-item scales, were entered into a principal components analysis. The extent to which scores on the coping measures predicted levels of adjustment after controlling for catastrophic thinking (Catastrophizing subscale) and self-efficacy for pain control (2 single-item scales) was explored using sequential multiple regression analysis. RESULTS Two coping dimensions emerged from the principal components analysis, which were labelled Distraction and Praying or Hoping, and Denial of Pain and Persistence. Scores obtained on these coping measures explained an additional 5% and 13% of the variance in pain intensity and disability, respectively. Interestingly, however, the scores on the coping measures did not predict pain intensity or disability after controlling for the influence of catastrophic thinking and self-efficacy for pain control. CONCLUSION Coping strategy use might only be related to levels of adjustment via the effect it has on catastrophic thinking and self-efficacy for pain control.

Exertional symptoms and exercise capacity in individuals with brain injury

Purpose. To examine factors affecting cycling exercise performance in individuals with acquired brain injury. Methods. Thirty individuals with acquired brain injury and 18 sedentary controls (SC) participated. Heart rate, bicycle power output and rating of perceived exertional (RPE) were recorded, throughout incremental cycle ergometer exercise. The SC group and 18 moderately impaired individuals from the ABI group performed a 25-W (B25) protocol. The remaining 12 individuals performed a 10-W protocol (B10). Results. The B10 group terminated exercise at the lowest RPE, percentage age predicted maximal heart rate (% APMHR) and bicycle power output, followed by the B25 and then the SC group (RPE: Kruskal – Wallis test P < 0.001, %APMHR and bicycle power output: one-way ANOVA P < 0.01). RPE was correlated with %APMHR and percentage of peak bicycle output (B10 group: R2 0.1 to 0.67; B25 group: 0.69 – 0.83; SC group: 0.76 – 0.91). There was no difference in RPE at the same relative work intensity between the B25 and the sedentary control group (P > 0.05). Forward regression analysis revealed fatigue levels were predictive of %APMHR at test termination (β = −0.411, P < 0.05) and quadriceps strength was predictive of peak bicycle power output (β = 0.612, P < 0.05). Conclusions. Individuals with brain injury terminated exercise at lower exercise intensities but rated exertion no differently from healthy individuals. General fatigue levels predicted %APMHR and quadriceps strength predicted peak bicycle power output.

The effect of increasing effort on movement economy during incremental cycling exercise in individuals early after acquired brain injury

Objective: To investigate the effect of increasing effort on energy cost as measured by oxygen consumption (V.O2) during cycling exercise in individuals early after acquired brain injury (ABI). Design: An experimental correlation design. Setting: Specialist neurorehabilitation centre. Participants: Thirty-eight individuals were recruited early after acquired brain injury. Nine individuals had spasticity; Ashworth Scale >1 in either upper or lower limbs. Intervention: The V.O2 was measured in relation to workload during a graded exercise test. Results: The V.O2 increased in a linear fashion with increases in workload in 34 individuals. Only one individual with spasticity demonstrated a nonlinear relationship. Conclusion: Increasing the workload during cycling exercise does not disproportionately increase energy cost in most individuals with spasticity early after ABI.

Heart Rate as a Measure of Exercise Testing Early after Acquired Brain Injury

Summary Background The relationship between heart rate and oxygen consumption ( VO 2 ) in individuals with acquired brain injury has been described as being curvilinear; which could lead to under-estimation of exercise intensity when prescribed by heart rate. Purpose This study examines the linearity of the heart rate/oxygen consumption relationship during incremental cycle ergometer exercise in individuals early after brain injury and provides an estimate of the intra-individual reliability of the heart rate response.

The effect of a perceptual cognitive task on exercise performance: the dual-task condition after brain injury

Objective: To examine the effect of additional cognitive demand on cycling performance in individuals with acquired brain injury (ABI). Design: Prospective observational study. Setting: Rivermead Rehabilitation Centre. Participants: Ten individuals with ABI (7 men, 3 women) (traumatic brain injury 7, tumour 1, stroke 2) and 10 healthy controls (6 men, 4 women). Intervention: Individuals were asked to maintain a set cadence during a three-stage incremental cycling test in both single-task (no additional task) and dual-task (whilst performing an additional cognitive task) conditions. Results: The ABI group showed a slight slowing in cadence in stages 1 and 3 of the graded exercise test from the single-to the dual-task condition, although this was not significant (p £ 0.05). The control group showed no slowing of cadence at any incremental stage. When directly comparing the ABI with the control group, the change in cadence observed in dual-task conditions was only significantly different in stage 3 (p £ 0.05). Conclusions: Clinicians should be aware of the possibility that giving additional cognitive tasks (such as monitoring exercise intensity) while individuals with acquired brain injury are performing exercises may detrimentally affect performance. The effect may be more marked when the individuals are performing exercise at higher intensities.

Factors Related to Clinically Important Changes in Chronic Low Back Pain Disability

coping styles and self-efficacy. These measures were completed again at discharge, eight weeks later. Delta scores (pre- to post-treatment changes) were calculated for each of the measures. Based on the change scores of the Roland Disability Questionnaire (RDQ), patients were categorised into two mutually exclusive groups, namely clinically improved and not clinically improved (Stratford et al, 1998). Chi-square, Mann-Whitney U and independent t-tests were used to explore baseline differences and determine whether mean delta scores in the cognitive factors differed between the clinically improved and not clinically improved groups. Results No significant differences were observed between the two groups at baseline. Mean delta scores in six of the cognitive factors differed significantly between the two groups. To determine which of these factors contributed most to the prediction of clinically important changes in disability, delta scores were entered into a stepwise discriminant analysis. The discriminant analysis produced a significant effect (Wilks’ lambda = 0.682, P < 0.000) with two significant factors: current pain intensity and fear-avoidance beliefs about physical activity. With this solution, 71% of patients were correctly classified (sensitivity 67.7%; specificity 74%).