Steve R. Woby

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.

Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients.

This study aimed to determine whether self‐efficacy beliefs mediated the relation between pain‐related fear and pain, and between pain‐related fear and disability in CLBP patients who exhibited high pain‐related fear. In a cross‐sectional design, 102 chronic low back pain (CLBP) patients completed measures for pain, disability, self‐efficacy and pain‐related fear (fear of movement and catastrophizing). Multistep regression analyses were performed to determine whether self‐efficacy mediated the relation between pain‐related fear and outcome (pain and/or disability). Self‐efficacy was found to mediate the relation between pain‐related fear and pain intensity, and between pain‐related fear and disability. Therefore, this study suggests that when self‐efficacy is high, elevated pain‐related fear might not lead to greater pain and disability. However, in instances where self‐efficacy is low, elevated pain‐related fear is likely to lead to greater pain and disability. In view of these findings, we conclude that it is imperative to assess both pain‐related fear and self‐efficacy when treating CLBP patients with high pain‐related fear.

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.

The association between cognitive factors, pain and disability in patients with idiopathic chronic neck pain.

Purpose. The aim of this study was to establish the relationship between known cognitive factors and levels of pain and disability in patients with idiopathic chronic neck pain. Method. Ninety-four patients referred for physiotherapy because of chronic neck pain completed measures of pain, disability, catastrophising, pain-related fear, pain vigilance and awareness and self-efficacy beliefs. Hierarchical multiple regression analyses were then performed to establish whether the cognitive factors were significant determinants of levels of pain and disability. Results. The cognitive measures were significantly related to levels of pain and disability, explaining 23% of the variance in pain intensity and 30% of the variance in disability. Specifically, greater catastrophising (β = 0.37, p < 0.05) and lower pain vigilance and awareness (β = − 0.32, p < 0.05) were associated with greater pain intensity. Moreover, greater catastrophising (β = 0.26, p < 0.05) and lower functional self-efficacy beliefs (β = − 0.34, p < 0.001) were significantly associated with greater levels of disability. Conclusions. Cognitive factors were strongly related to levels of pain and disability in patients with chronic neck pain. In view of this, targeting the modification of these cognitive factors should be an integral part of therapy when treating patients with idiopathic chronic neck pain.

Short-Term Effect of Superficial Heat Treatment on Paraspinal Muscle Activity, Stature Recovery, and Psychological Factors in Patients With Chronic Low Back Pain

OBJECTIVE To test the hypothesis that patients with chronic low back pain (CLBP) would have reduced paraspinal muscle activity when wearing a heat wrap and that this would be associated with increased stature recovery and short-term improvements in psychological factors. DESIGN A within-subject repeated-measures design. Muscle activity and stature recovery were assessed before and after a 40-minute unloading period, both without a heat wrap and after 2 hours of wear. Questionnaires were completed after both sessions. SETTING Hospital physiotherapy department. PARTICIPANTS Patients with CLBP (n=24; age, 48.0±9.0 y; height, 166.6±7.3 cm; body mass, 80.2±12.9 kg) and asymptomatic participants (n=11; age, 47.9±15.4 y; height, 168.7±11.6 cm; body mass, 69.3±13.1 kg) took part in the investigation. Patients on the waiting list for 2 physiotherapist-led rehabilitation programs, and those who had attended the programs during the previous 2 years, were invited to participate. INTERVENTION Superficial heat wrap. MAIN OUTCOME MEASURES Paraspinal muscle activity, stature recovery over a 40-minute unloading period, pain, disability, and psychological factors. RESULTS For the CLBP patients only, the heat wrap was associated with a reduction in nonnormalized muscle activity and a positive short-term effect on self-report of disability, pain-related anxiety, catastrophizing, and self-efficacy. Changes in muscle activity were correlated with changes in stature recovery, and both were also correlated to changes in psychological factors. CONCLUSIONS Use of the heat wrap was associated with a decrease in muscle activity and a short-term improvement in certain aspects of well-being for the CLBP patients. The results confirm the link between the biomechanical and psychological outcome measures.

Activity Pacing is Associated with Better and Worse Symptoms for Patients with Long-term Conditions.

Background: Activity pacing has been associated with both improved and worsened symptoms, and its role in reducing disability among patients with long-term conditions has been questioned. However, existing studies have measured pacing according to unidimensional subscales, and therefore the empirical evidence for pacing as a multifaceted construct remains unclear. We have developed a 26-item Activity Pacing Questionnaire (APQ-26) for chronic pain/fatigue containing 5 themes of pacing: activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance. Objective: To assess the associations between the 5 APQ-26 pacing themes and symptoms of pain, physical fatigue, depression, avoidance, and physical function. Methods: Cross-sectional questionnaire study design. Data analyzed using multiple regression. Participants: A total of 257 adult patients with diagnoses of chronic low back pain, chronic widespread pain, fibromyalgia, and chronic fatigue syndrome/myalgic encephalomyelitis. Results: Hierarchical multiple regression showed that activity adjustment was significantly associated with increased physical fatigue, depression, and avoidance, but decreased physical function (all Ps⩽0.030). Activity consistency was associated with decreased pain, physical fatigue, depression, and avoidance, but increased physical function (all Ps⩽0.003). Activity planning was associated with reduced physical fatigue (Ps=0.025) and activity acceptance was associated with increased avoidance (Ps=0.036). Conclusions: Some APQ-26 pacing themes were associated with worse symptoms and others with symptom improvement. Specifically, pacing themes involving adjusting/reducing activities were associated with worse symptoms, whereas pacing themes involving undertaking consistent activities were associated with improved symptoms. Future study will explore the causality of these associations to add clarification regarding the effects of pacing on patients’ symptoms.

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%).

Acceptance in chronic neck pain: associations with disability and fear avoidance beliefs

Chronic neck pain can result in significant levels of disability. Physiotherapy treatments often aim to modify cognitive factors and this approach benefits some, but not all, patients. Research from other pain conditions suggests that acceptance may be related to disability; however, it is unclear whether these associations exist in patients with neck pain. Moreover, it is unclear to what extent other cognitive factors are related to acceptance. Feasibly, if these factors are related, existing treatments may already be indirectly modifying acceptance. The aim of this study was therefore to establish the associations between acceptance and disability, and between acceptance and other cognitive factors. Cross-sectional data were collected from 149 patients and regression analyses were carried out. In the first analysis, disability was the dependent variable and the proportion of variance explained by two acceptance subscales (activities engagement and pain willingness) was calculated. In the second analyses, the acceptance subscales were the dependent variables. Measures of pain-related fear, catastrophizing and pain vigilance and awareness were entered as explanatory variables and the proportion of variance explained was calculated. In the first analysis, acceptance explained 18% of variance in disability (P<0.001). In the second analysis, cognitive factors explained 7% (P<0.05) of variance in activities engagement and 58% (P<0.001) of pain willingness. On this basis, treatments that enhance acceptance may reduce disability. Moreover, as cognitive factors were strongly related to pain willingness, but not activity engagement, alternative treatments may be required to maximize acceptance. Further studies are warranted to assess acceptance-based treatments in patients with neck pain.

A randomised controlled trial (RCT) of telephone delivered cognitive behaviour therapy (TCBT) and exercise in the management of chronic widespread pain (CWP): Identifying long-term outcome and who benefits from which treatment

SUPPLEMENTSex Bias In Autoimmune Diseases : Increased Risk Of 47,XXX In Systemic Lupus Erythematosus (SLE) and Sjogrens Syndrome (SS) Supports The Gene Dose HypothesisBackground/Purpose: Human FoxP3+ Th-cells are heterogeneous in function and include not only suppressive cells (TRegs) but also nonsuppressive cells that abundantly secrete proinflammatory cytokines. We have previously shown that FoxP3+ Th-cells were increased in GPA-patients during remission as compared to healthy controls (HCs). In this group of patients, however, we observed a defective suppressor function of TRegs, and an increase in the percentage of Th-17 cells. These observations make it tempting to investigate whether increased FoxP3+ Th-cells in GPA-patients are attributed to an increase in the cytokine-secreting non-suppressive FoxP3+Th-cells. Methods: Peripheral blood mononuclear cells (PBMCs) were isolated from 46 GPA-patients in remission and from 22 age- and sex-matched HCs. Expression of CD4, CD45RO, and FoxP3 were determined by flow cytometric analysis. The expression levels of FoxP3 and CD45RO were used for distinction between activated suppressor TRegs (FoxP3HighCD45RO+; ASTReg), resting suppressor TRegs (FoxP3LowCD45RO-; RSTReg), and cytokine-secreting non-suppressor TRegs (FoxP3LowCD45RO+; NONTReg) cells. Intracellular expression of IFNg, IL-17, and IL-21 were determined in the various FoxP3+ Th-cell subsets after in vitro activation of PBMCs by PMA and Ca-Ionophore. Results: A significant increase in the frequency of NONTReg cells was observed in GPA-patients as compared with HCs, whereas no differences were detected in RSTReg- and ASTReg cells between GPA-patients and HCs. The distribution of RSTReg- and NONTReg cells did not differ between ANCA-negative and ANCA-positive patients, whereas lower percentages of ASTReg cells were observed in ANCA-positive patients as compared to ANCA-negative patients and HCs. Importantly, a significant increase in the percentage of IL-17+ and IL-21+ cells was seen within the NONTRegcells from ANCA-positive patients (n= 9) when compared to ANCA-negative (n= 10) and HCs (n= 12), whereas no differences were found between ANCA-negative and HCs. Conclusion: Increased FoxP3 expression in Th-cells from GPA-patients is related to an increase in a subset of non-suppressive Th-cells. Increased production of IL-17 and IL-21 cytokines, in NONTReg cells from ANCApositive patients points towards FoxP3+ effector cells and decrease in suppressive TReg cells in relation to ANCA production.Complex Functional Effects Within The HLA Contribute To Sjogrens Syndrome Pathogenesis and May Influence Both Transcriptional Regulation and Peptide Binding