Persistent musculoskeletal pain is a leading cause of disability and need for rehabilitation globally. Many people with the condition attend pain management programmes (PMPs) for rehabilitation and support with self-management. Physical activity (PA) is an essential self-management strategy facilitated on PMPs as it benefits symptoms, general health and well-being. PA needs to be maintained in the long term to continue to be beneficial. However, while many patients increase their PA during or immediately after a PMP, they commonly find it difficult to maintain it in the long term. This study aims to address this problem by developing an intervention to support PA maintenance after a PMP.

This mixed-methods study will be guided by the Medical Research Council guidelines for developing complex interventions and the Behaviour Change Wheel intervention development framework. Participants will be recruited from multiple UK National Health Service PMPs. Participants will include patients with persistent musculoskeletal pain who have completed PMPs, their PA partners (people who support them with PA) and healthcare professionals who facilitate PA on PMPs. The study will be conducted in three phases. In phase 1, qualitative interviews will explore the experiences, barriers and facilitators of PA maintenance after a PMP and potential characteristics for a PA maintenance intervention from patient, PA partner and healthcare professional perspectives. Phase 2 will consist of a prospective longitudinal pilot study to identify factors associated with PA maintenance after a PMP. Phase 3 will involve developing a logic model and co-designing the intervention with patient, PA partner and healthcare professional stakeholder groups.

The project received research ethics committee (REC) and Health Research Authority approval on 4 June 2024 (REC: North West-Liverpool Central, REC reference: 24/NW/0174, IRAS Project ID: 340674). Findings will be disseminated by peer-reviewed publications, conference presentations, social media and lay summaries for patients and the public.

A concussion can lead to anxiety, pain, kinesiophobia, and/or postural control deficits. We conducted a cross-sectional study evaluating adolescents with a recent concussion. We hypothesized that those reporting higher levels of anxiety, pain-interference, and kinesiophobia would perform worse on postural control tests. Participants completed anxiety, pain-interference, and kinesiophobia ratings and postural control tests (single/dual-task tandem gait and a modified balance error scoring system). Using a multivariable linear regression model, we evaluated the relationship among anxiety, pain-interference, and kinesiophobia (predictors) with postural control measures (tandem gait and a modified balance error scoring system, outcomes), adjusting for sex and anxiety history. We enrolled 128 participants (53% female, age=15.4±1.7 y, and 9.3±4.0 d post-concussion). Higher anxiety was weakly correlated with slower dual-task tandem gait times (r=0.31; p=0.001) and more modified balance error scoring system errors (r=0.22; p=0.01). Multivariable modeling indicated that a higher post-concussion anxiety rating was associated with a slower dual-task tandem gait time (β=0.21, 95% confidence interval=0.01-0.41; p=0.04). The female sex was associated with slower single-task tandem gait (β=-3.01, 95% confidence interval=-6.01, -0.01; p=0.049). Adolescents with a higher anxiety post-concussion performed worse on dual-task tandem gait assessments, while pain-interference and kinesiophobia were not associated with postural control. Anxiety and impaired postural control are independently associated with poor concussion outcomes; thus, this association may inform individualized concussion care strategies.

Although individuals with chronic low back pain (CLBP) show increased fatty infiltration in the lumbar multifidus muscle (LMM), it remains unclear whether LMM changes are related to clinical outcomes (such as pain and disability) after considering confounders (spinal phenotypes, fear-avoidance beliefs [FABs] and insomnia). This study examined: (1) differences in confounders and LMM characteristics between individuals with and without CLBP; and (2) associations between confounders, LMM parameters, and clinical outcomes in the CLBP group alone.

Participants (CLBP = 70 and asymptomatic people = 67) underwent lumbar magnetic resonance imaging. Outcome measures comprised the numeric pain rating scale, the Roland-Morris Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Insomnia Severity Index (ISI) Scale. LMM morphometry at L3-S1 (cross-sectional area, total volume, and fatty infiltration) was measured using a customized MATLAB program. Spinal phenotypes (disc degeneration, high-intensity zones, Modic changes [MCs], Schmorl's nodes, facet joint degeneration [FJD], and facet tropism [FT]) were scored. The between-group differences were analyzed using linear mixed models and chi-squared/Fisher's exact tests. Univariate and multivariate analyses evaluated associations between clinical outcomes and other outcome measures in the CLBP group.

The CLBP group demonstrated more severe disc degeneration and FJD at all levels, and greater FT at L5/S1 than asymptomatic participants (p < 0.05). The average LMM total volume at L3/4 and the percentage of fatty infiltration in LMM in the L3-S1 region were greater in the CLBP group than in asymptomatic counterparts (p < 0.05). The presence of MC at L4 and FJD at L4/5 and L4-S1 was significantly related to pain intensity in the CLBP group. Similarly, FABQ-Work and ISI scores were significantly related to pain intensity (explaining 37% of the variance in pain).

The CLBP group displays more fatty infiltration in the LMM, but their LMM morphometric parameters are unrelated to pain/disability after considering spinal phenotypes, FABs, and insomnia.

Pilates and PNF exercises reduce pain, and improve function in chronic low back pain (CLBP) patients.

To compare the effects of PNF and Pilates exercises on pain, body image, fear-avoidance beliefs, core stability, and balance functions in patients with CLBP.

Sixty CLBP patients were randomly assigned to PNF (n = 30) or Pilates (n = 30). Patients received PNF or Pilates exercise for 20 sessions over the course of 4 weeks. The outcome measures were the Numerical Pain Rating Scale, Body Cathexis Scale, Fear Avoidance Beliefs Questionnaire, Trunk Stabilization Test, and Fullerton Advanced Balance Scale. Evaluations were performed at baseline (0 weeks) and the end of treatment (4 weeks).

The Pilates group showed more significant improvements in core stability (F = 8.647, p = 0.005, η2 = 0.134) than the PNF group. In both groups, the pain was reduced, and fear-avoidance behaviors were decreased. Improvements in balance were observed in each group. Only the Pilates group improved in terms of body image (p = 0.050, r = 0.35) and core stability (p = 0.002, r = 0.57).

Patients with CLBP who participated in either Pilates or PNF exercises showed similar improvements in pain, body image, fear-avoidance beliefs, and balance, while Pilates exercises were more effective in improving core stability. CLBP patients in both groups showed improvements in pain severity, fear-avoidance beliefs, and balance. Only the Pilates group improved in body image and core stability. Pilates, a mind-body technique that encourages movement control and self-awareness, may offer additional advantages over PNF.

Low back pain (LBP) is the leading cause of chronic disability and is predicted to escalate in the next 20 years globally. Fear Avoidance Beliefs (FAB) are one of the most important factors associated with low back pain outcomes, including the first onset of back pain, pain intensity, pain episodes, disability and quality of life. With the prevalence rate of low back pain in young adults increasing exponentially, the factors associated with fear avoidance beliefs among university students in the United Kingdom (UK) are currently unknown. This study, therefore, aims to investigate the factors associated with fear avoidance beliefs among UK university students with low back pain. An online cross-sectional study will be conducted. University students with low back pain in the UK will be recruited through university contacts and social media of the 131 universities in the UK. The online survey will collect demographic information (sex, age, ethnicity, religion, the regional location of the university, the faculty the participant is currently studying in, working status and hours of work), perceived cause of LBP, severity of pain, pain site and symptoms, pain duration, previous surgeries in the lower back area, treatment received for low back pain, the experience of seeing family members/ significant others with disabling low back pain, advice received from others, physical activity levels, mental health status and disability levels, and fear avoidance beliefs will be collected. Descriptive analysis (frequencies and percentages, means and standard deviations, median and interquartile range) will summarise data. Correlation analysis will be used to assess bivariate associations between variables. Multiple linear regression analysis will determine the factors associated with fear avoidance beliefs.

Structural neuroplasticity in the brain may contribute to the persistence of low back pain (LBP) symptoms and the disability associated with them. It is not known if structural adaptations are evident early in the lifespan in young adults with LBP. This study compared gray matter in cortical sensorimotor regions in young adults with and without persistent LBP and identified gray matter and clinical predictors of pain-related disability. Eighty-two individuals with and without a history of LBP participated. Peak and average gray matter density in cortical sensorimotor regions of interest was quantified using voxel-based morphometry. Pain-related disability, pain intensity, pain duration, and pain-related fear were also assessed. Multiple linear regression was used to determine independent predictors of pain-related disability. We document significantly greater peak gray matter density in individuals with LBP in the primary somatosensory cortex, angular gyrus, and the midcingulate cortex. Pain-related disability positively correlated with average gray matter density in the posterior cingulate cortex. The most robust predictors of disability were average gray matter in the posterior cingulate, pain intensity, and pain-related fear. We demonstrate that in young adults, persistent LBP, and pain-related disability, are linked with structural differences in regions forming part of the brain network termed the pain matrix. In contrast with studies of LBP in older adults, our findings of increased rather than decreased gray matter in young adults with LBP suggest that gray matter may increase initially in response to nociceptive pain.

Prolonged periods of standing are linked to low back pain (LBP). Evaluating lumbar spine biomechanics in real-world contexts can provide novel insights into these links. This study aimed to determine if standing behaviour can be quantified, in individuals with LBP, in real-world environments. A three-stage design was used, (i) Verification of a bespoke algorithm characterising lumbar standing behaviour, (ii) Day-long assessment of standing behaviours of individuals with posture-related low back discomfort, and (iii) Case study application to individuals with clinical LBP. Analysis of standing posture across time included variability, fidgeting, and amplitude probability distribution function analysis. The study demonstrated that accelerometers are a valid method for extracting standing posture from everyday activity data. There was a wide variety of postures throughout the day in people with posture-related low back discomfort and people with clinical LBP. Frequency profiles ranged from slightly flexed to slightly extended postures, with skewed bell-shaped distributions common. Postural variability ranged from 3.4° to 7.7°, and fidgeting from 1.0° to 3.0°. This work presents a validated accelerometer-based method to capture, identify, and quantify real-world lumbar standing postures. The distinct characteristics of people with low back discomfort or pain highlight the importance of individualised approaches.

BackgroundOlive pickers confront ergonomic hazards when performing work activities that may lead to musculoskeletal pain (MSK) that must be adequately managed. The success of MSK pain prevention and treatment strategies is linked to olive pickers' state of empowerment, shaped by expectations and beliefs.ObjectiveThis study highlighted the prevalence of MSK pain among Italian olive pickers and explored their attitudes, expectations, and beliefs about MSK pain prevention and care.MethodsA web-based cross-sectional survey instrument was developed to collect data from an Italian olive pickers' cohort in the Liguria region. The survey investigated the sample on (1) MSK pain prevalence and characteristics, (2) preventive and treatment activities for MSK pain, (3) expectations about MSK pain treatments, and (4) beliefs about their job and MSK pain onset.ResultsFrom January to July 2021, we collected data from 127 participants (78% men); mean age 52 ± 13). Prevalence of MSK pain over one month, six months, and one year was 61.6%, 77.8%, and 84.8%, respectively. The most affected joints were the lumbar spine (61%), the shoulders (57%), and the cervical spine (46%). To prevent the onset of MSK pain, 44% of participants did nothing, and 94% of them never attended any preventive physical activity.ConclusionsMSK pain strongly impacts Ligurian olive pickers, as three out of four experienced it during the last six months. Participants emphasised the need to be educated on working ergonomics and the perceived importance of physical activity for health.

Protective behaviors in the context of pain fostered by fear are helpful in acute traumatic pain to enable a person to protect their body from further injury and promote healing in the short term. However, protective behavior that is ongoing in the absence of tissue damage may contribute to the persistence of disability in people with musculoskeletal pain. Current evidence highlights the importance of addressing pain-related fear, fear of movement-related pain, and avoidance behavior in the management of people with chronic musculoskeletal pain. But, physical therapists find it challenging to make sense of and implement the evidence in their clinical practice. This issue partly stems from the pervasiveness of the biomedical model, which fails to address important psychological factors such as fear of movement-related pain and avoidance behavior and their role in chronic musculoskeletal pain. Despite a wider acceptance of the biopsychosocial model of care, physical therapists lack confidence and guidance on how to implement this model into practice.

The aims of this masterclass are twofold: (1) to describe how the concepts/theory of fear learning can be applied in physical therapy practice for people with chronic musculoskeletal pain, (2) to illustrate the implementation of these concepts in clinical practice using an example of the management of a person with a chronic musculoskeletal pain condition.

We discuss how clinicians may identify and target fear of movement-related pain and avoidance behavior in clinical practice, with examples of how to understand and manage individuals with chronic musculoskeletal pain using an associative learning and behavioral framework.

Fear can significantly increase the experienced pain intensity in individuals with chronic musculoskeletal pain and limit their ability to engage in daily activities. Fear of movement-related pain (FMRP) is commonly assessed via self-report, but research suggests measuring psychophysiological or behavioral parameters as an alternative. The objective of this scoping review was to identify and evaluate existing paradigms to induce FMRP, as well as the psychophysiological, behavioral and neural measurements used for its assessment. Experimental studies, with adult participants (≥18 years, healthy and chronic pain) observing or performing movements, were included if they used a FMRP induction paradigm or measured psychophysiological and behavioral proxies of FMRP. A total of 1883 studies were screened; 34 eligible studies were included. Paradigms inducing FMRP involved anticipated pain paired with movement (via classical or operant conditioning) or elicited pre-existing FMRP through the observation of movements potentially associated with pain. The identified studies employed various psychophysiological and behavioral measures indicating FMRP, such as response latency/duration, decision-making behavior, eyeblink startle response, and autonomic nervous system responses (e.g., skin conductance, heart rate, respiratory rate), as well as neural correlates (fMRI). fMRI studies revealed activation in fear- and pain-processing brain areas that correlated with patient-reported measurements (e.g., amygdala, hippocampus, lateral orbitofrontal cortex). Among the psychophysiological and behavioral measures displaying significant differences between fear-evoking, and neutral conditions, heart rate, respiratory response, skin conductance, and eyeblink-startle response demonstrated the largest effect sizes. In conclusion, physiological reactions can be measured during imagined, observed, or performed movements as a proxy for FMRP. PERSPECTIVE: This review provides an overview of existing paradigms to induce or elicit already conditioned FMRP in participants with chronic pain and in healthy participants. Therefore, the results of this review can inform future research projects that aim to further analyze the learning mechanisms behind and the processing of FMRP at brain level. Furthermore, measuring psychophysiological or behavioral proxies of FMRP can be beneficial not only in research settings, but also in clinical settings, to complement patient-reported outcome measures or to measure the FMRP of people with communicating issues, that are not able to complete a self-reported questionnaire.

To translate and cross-culturally adapt the Back Pain Attitudes Questionnaire (Back-PAQ) to Dutch for the Belgian and Dutch populations, and to investigate its measurement properties in the general population and physiotherapists.

The adaptation followed established guidelines. Content validity, internal consistency, test-retest reliability (intraclass correlation coefficient), floor and ceiling effects, minimal detectable change (MDC), construct validity, and structural validity were assessed in physiotherapists and the general population. The modified Fear-Avoidance Beliefs Questionnaire (mFABQ) investigated the Back-PAQ's convergent validity, and Confirmatory Factor Analysis evaluated structural validity. Discriminant validity was assessed between physiotherapists and the general population.

Two hundred and sixty participants (mean age: 29 ± 13.3) completed the initial survey and 147 completed the test-retest survey. All Back-PAQ versions (34-item, 20-item, and 10-item) demonstrated good internal consistency, good to excellent test-retest reliability. Moderate correlations with the mFABQ (p < 0.001) and adequate discriminant validity between physiotherapists and the general population supported robust construct validity. The Back-PAQ 10 exhibited a good model fit and enables meaningful sub-score comparisons.

This collaboration produced a validated Dutch Back-PAQ suitable for use in both the Netherlands and Belgium. All versions demonstrated robust measurement properties, supporting their use in clinical and research settings assessing unhelpful beliefs in back pain management.

Background/Objective: Inconsistencies exist regarding the exact multidimensional structure underlying the Fear-Avoidance Beliefs Questionnaire (FABQ), with no prior study examining the internal structure of the Arabic FABQ. This study aimed to examine validity evidence of the Arabic FABQ in patients with low back pain (LBP), based on two sources: validity evidence based on the internal structure (dimensionality and reliability) and validity evidence based on relations with other variables (i.e., pain intensity and disability). Methods: Participants (N = 112) with LBP were recruited from physical therapy clinics. Data were collected through the completion of FABQ and other measures of pain and disability. CFA was performed using a diagonally weighted least squares estimation. The fit of the two-factor model recommended by the original scale developer was assessed using multiple fit indices. Reliability of FABQ subscale scores was assessed using McDonald's omega (ω) and Average Variance Extracted (AVE). Results: One hundred and twelve patients with LBP with mostly chronic complaints participated in the study. The CFA supported the two-factor model with modifications to account for residual correlations between items 4-5 and 6-7, yielding improved fit indices (χ2(41) = 77.82; p < 0.001; TLI = 0.98, CFI = 0.99, RMSEA = 0.09 (90% CI = 0.06-0.12), and SRMR = 0.08). All factor loadings were salient and significant with values ranging from 0.43 to 0.96. The two underlying factors reflecting physical activity-related and work-related fear avoidance beliefs showed a significant positive correlation of 0.58. These findings confirm the hypothesized dimensionality of the Arabic FABQ. The FABQ work subscale scores demonstrated higher reliability (ω = 0.86; AVE = 0.54) compared to the physical activity subscale scores (ω = 0.63; AVE = 0.44), with both factors measuring related but distinct constructs. The latent scores for the FABQ related to physical activity demonstrated stronger positive correlations with pain intensity (r = 0.37; p < 0.001) and disability (r = 0.43; p < 0.001), compared to the latent scores for work-related FABQ, which showed weaker correlations with pain intensity (r = 0.22; p < 0.001) and disability (r = 0.26; p < 0.001). Conclusions: This study provides evidence to support the two-factor structure of the Arabic FABQ and the common scoring method for the FABQ and facilitates the interpretation of the FABQ subscale scores as reflecting related but distinct domains of fear avoidance beliefs.

Impaired body perception could contribute to the pain experience and be a possible treatment target. The Fremantle Back Awareness Questionnaire (FreBAQ) is the only self-report questionnaire to assess back-specific self-perception.

The aim of this study was to develop a French version of the FreBAQ (FreBAQ-FR) and to evaluate its psychometric properties.

Observational study.

Department of Physical Medicine and Rehabilitation at University Hospital.

One hundred eighteen patients with chronic low back pain (cLBP) and 30 healthy participants were included.

A forward-backward method was used to translate the FreBAQ into French. Unidimensionality was assessed by exploratory factor analysis, and internal consistency was quantified by Cronbach's alpha coefficient. Known-groups validity was assessed by comparing results between cLBP patients and healthy participants. Temporal stability was assessed in participants who completed the FreBAQ-FR 7 days later using the intraclass correlation coefficient (ICC). Patients' FreBAQ-FR scores were correlated with functional questionnaires and two-point discrimination thresholds (TPD) for tactile acuity.

The FreBAQ-FR showed good internal consistency with a Cronbach's alpha coefficient of 0.78 and can be considered unidimensional. The cLBP group scored significantly higher than the control group (11 [6 ; 17] vs. 0.5 [0 ; 5], P<0.0001). The temporal stability of the FreBAQ-FR was acceptable, with an ICC of 0.84 (95% CI: 0.77 to 0.89) and an estimated bias of -0.71±4.2 (95% CI: -1.61 to 0.18, P=0.12). In the cLBP group, FreBAQ-FR total scores correlated moderately with the Oswestry Disability Index (r=0.53, 95% CI: 0.39 to 0.65) and the Pain Catastrophizing Scale total score (r=0.53, 95% CI: 0.38 to 0.65). TPD results did not correlate with FreBAQ-FR scores (r=0.06, 95% CI: -0.12 to 0.24).

The FreBAQ-FR showed acceptable psychometric properties and is suitable to assess back-specific body perception in the French-speaking population with cLBP.

This questionnaire may help researchers and clinicians to assess disrupted self-perception of the back, improve our understanding of the multifaceted experience of cLBP, and potentially offer better tailored treatment to patients.

Study DesignRetrospective Cohort Study.ObjectivesTo develop and validate a multivariable predictive model for length of hospital stay (LOS) following spine surgery, incorporating sociodemographic characteristics, medical data, and self-reported patient outcomes.MethodsA retrospective analysis of 4583 patients from a spine surgery registry was conduct-ed. Predictors included age, sex, BMI, ASA score, surgical complexity, and patient-reported outcomes. Binary logistic regression was used to model LOS (<3 days vs ≥3 days).ResultsLower age, active work status, lower ASA scores, and specific surgical procedures were associated with shorter LOS. The model demonstrated good accuracy and dis-criminative ability.ConclusionsSociodemographic, medical, and patient-reported outcomes are valuable predictors of LOS. These findings can help improve preoperative planning and resource allocation in spine surgery.

The current study investigated the relationship between sensorimotor cortical thickness, corticospinal excitability, corticomotor topography, and quadriceps strength after ACL reconstruction (ACLR). Ten women with a history of unilateral ACLR and 10 controls (CON) received single-pulse transcranial magnetic stimulation during unilateral, submaximal isometric knee extensions. Pulses were delivered to each vastus medialis oblique (VMO) hotspot with concurrent biceps femoris (BF) monitoring. Corticospinal excitability was assessed by delivering 40 pulses at various intensities to each hotspot. Motor-evoked potentials (MEPs) were averaged at each intensity and fitted to a Boltzmann sigmoidal curve using nonlinear regression to derive v50, slope, and MEPMAX. A motor mapping procedure included 120 pulses delivered in a 6 × 6 cm grid placed around each hotspot. Ultrasonography was used to measure VMO muscle thickness. Structural MRIs were acquired to derive paracentral lobule (PCL) cortical thickness. ACLR group's previously injured leg was weaker than the healthy leg, with no between-leg differences in CON. Regardless of group, v50 was asymmetrical between legs. Slope, MEPMAX, VMO map measures, and VMO thickness were similar between legs and groups. ACLR tended to have asymmetrical PCL thickness with BF map measures larger in the hemisphere of the previously injured leg than healthy leg, whereas CON had symmetrical PCL thickness and BF map measures. Results indicate that even years after ACLR corticomotor structure plasticity is homotopic with persistent asymmetrical knee extension strength but no differences in corticospinal excitability. Overall, the hemispheric asymmetry in leg-specific brain structure may contribute to the knee extensor strength deficits common after ACLR.

Chronic non-specific low back pain (cNSLBP) is a leading cause of disability, influenced by bio-psycho-social factors. However, its impact on everyday activities such as navigating streets and interacting with other pedestrians remains underexplored. This study aimed to assess the effect of cNSLBP on perceptual-motor processes in a pedestrian crossing task, focusing on 1) collision avoidance behaviours, 2) the walker's role in avoiding collisions, and 3) the influence of pain perception.

Seventeen asymptomatic adults (AA, 11 females, 46.4 ± 12.8 years) and seventeen cNSLBP participants (10 females, 47.9 ± 12.7 years) performed a task involving crossing paths at a 90° angle with another walker. Participants interacted in three groups pairings: AA-AA, AA-cNSLBP, and cNSLBP-cNSLBP. Key metrics included crossing order inversion, collision risk threshold informing movement adaptation, crossing distance, and the walker's contribution (speed/orientation).

No significant differences were observed between groups for the collision risk threshold (≈0.93 m) or crossing distance (≈0.8 m). However, cNSLBP participants exhibited distinct avoidance strategies, especially in cNSLBP-cNSLBP interactions, which showed more frequent inversions. When crossing first, cNSLBP participants contributed less, whereas when crossing second, they contributed more, primarily by adjusting their speed. A significant negative correlation emerged between depression scores and the level of contribution when cNSLBP participants crossed second.

These findings suggest that pain perception may influence collision avoidance behaviours. Further research, potentially incorporating virtual reality, is needed to control environmental factors and deepen our understanding of these interactions.

The expectation for all clinicians to deliver person-centred practices extends to the growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED). Research on ED patients' experience of this physiotherapy role has yet to consider this through the lens of person-centredness. A qualitative exploration of person-centredness among ED physiotherapists through the experiences of attending patients targeted this knowledge gap to inform future clinical practice.

Semi-structured interviews with thematic analysis.

13 interviews were completed with four overarching themes generated: (1) patient experience of the ED; (2) the importance of connection, competence, and time; (3) recognising the benefits of being seen by a physiotherapist in ED; and (4) patient experience of the ED physical environment.

Novel contributions from the patient perspective, here, reflected a cognisance of certain environment limitations to PCP, as well as institutional challenges to their personhood, with a suggestion that ED patients anticipated a validation of their visit and valued the educational aspects that the physiotherapists provided. Considering this new knowledge can help ED physiotherapists to be more person-centred.

Cervical radiculopathy is typically caused by disc herniation or spondylosis. Few trials have compared the efficacy of surgical versus nonsurgical treatment for these conditions.

We conducted two randomized clinical trials among 180 patients presenting to the Oslo University Hospital in Norway with disabling radicular arm pain and cervical disc herniation (trial 1; n=89) or spondylosis (trial 2; n=91) proven by magnetic resonance imaging or computerized tomography. Patients were randomly assigned in a 1:1 ratio to receive either surgical or nonsurgical treatment. Surgery involved anterior cervical discectomy and fusion. Nonsurgical treatment involved three sessions with physical medicine/rehabilitation physicians and three sessions with physiotherapists for functional and cognitive behavioral support. The primary outcome in both trials was the Neck Disability Index (NDI) score (range, 0 to 100; higher scores indicate greater disability; minimal important difference is 15) at 12 months, which was self-reported by the patients.

Among the 87 patients in the disc herniation trial with 12-month data (surgical group, n=45; nonsurgical group, n=42), the mean difference in NDI adjusted for baseline was 7.4 (95% confidence interval [CI], 1.6 to 13.3; P=0.01) in favor of surgical treatment. Among the 88 patients in the spondylosis trial with 12-month data (surgical, n=44; nonsurgical, n=44), the mean difference in NDI adjusted for baseline was 2.3 (95% CI, -4.9 to 9.6; P=0.52). In the disc herniation trial, two patients in the nonsurgical group crossed over to have surgery. In the spondylosis trial, 11 patients in the nonsurgical group crossed over to have surgery. There were no serious adverse events.

In patients with cervical radiculopathy, we found a statistically significant difference for NDI at 12 months in favor of surgical versus nonsurgical treatment in the disc herniation trial, but no difference in the spondylosis trial. (Funded by the Southern and Eastern Norway Regional Health Authority; HSØ#2017057; ClinicalTrials.gov number, NCT03674619.).

ObjectiveThe purpose of this study was to evaluate the effects of the threshold value of Fear-Avoidance Beliefs Subscales on quantified movement as a function of gender.Design studyRetrospective cohort study.SettingsSingle center study.ParticipantsOne hundred forty patients (aged 38.4) with chronic low back pain and referred to functional restauration program.InterventionPatients participated in a five-week multidisciplinary Functional Restoration Program between 1 April 2013 and 1 April 2019, evaluated with clinical scales, psychosocial care and objective gait analysis. This study was a noninterventional retrospective study.Main measuresObjective gait analysis with the Vicon Motion Systems (Ltd, Oxford, UK), Fear-Avoidance Belief Scale, Visual Analog Scale, the DALLAS Pain Questionnaire, and the Hospital Anxiety and Depression Scale.ResultsData from 131 patients were studied. Patients with significant Fear-Avoidance Beliefs scores walked with significantly higher cadence. Patients with higher work subscale values presented significantly lower cadence, without effects on step length and self-selected speed. Women with significant fear-avoidance belief score walked with higher step length (0.58 m (0.05)) than men with significant fear-avoidance belief score (0.61 m (0.05). Correlations between Fear Avoidance Beliefs Questionnaire and spatiotemporal parameters were gender-dependent but nonsignificant or low.ConclusionsThe threshold values depicted in the literature on psychometric analysis reveal low but quantitative effect of fear-avoidance on spatiotemporal parameters. These threshold values can be used by clinicians to evaluate the significance of the clinical scale. Considering gait, cadence should help the clinician to assess the fear-avoidance, particularly for patients are not able to complete all clinical scale items.

Chronic low back pain continues to be a challenge in everyday rehabilitation services as improvement keeps being unpredictable.

To evaluate the role of pain coping strategies, fear-avoidance beliefs, anxiety and depression in pain and disability in patients with chronic low back pain.

A cross sectional study.

Rehabilitation and Orthopedic departments in four tertiary hospitals in Spain.

Overall, 276 patients (200 women) with nonspecific low back pain according COST-B13 guidelines and lasting more than 6 months.

Pain, disability, coping strategies, catastrophizing, anxiety, depression and fear-avoidance beliefs were evaluated with validated questionnaires. Predictive associations of disability and pain were analyzed by Pearson's test and by multivariate regression.

Catastrophizing is the pain coping strategy with the highest association with disability (r=0.52, P<0.01). Low back pain and disability showed little correlation in between (r=0.40, P<0.01). The correlation between fear-avoidance ideas and pain and disability was slight (r=0.20, P<0.01). No association was found between anxiety and depression with low back pain and disability. In the regression model, catastrophizing, kinesiophobia and gender explained 35% of the variance in disability. In the subanalysis of patients with surgical indication the influence of catastrophizing was maintained. However, correlation between pain and disability is lower than in patients without surgical indication.

The limited correlation between pain and disability suggests that pain alone cannot explain the variability of disability. Catastrophizing and kinesiophobia are predictors of the degree of disability in chronic low back pain and are cognitions potentially modifiable.

These results support the biopsychosocial model in the pathogenesis of chronic low back pain and support the use of cognitive behavioral therapy to modify maladaptive beliefs and attitudes as part of medical or surgical treatment in low back pain.

The Athlete Fear-Avoidance Questionnaire (AFAQ) is a validated instrument that measures athletes' fear and avoidance behaviors after an injury, particularly regarding their sporting activities.

This study aimed to adapt and validate the AFAQ for Arabic-speaking recreational players (AFAQ-Arabic) after anterior cruciate ligament reconstruction (ACLR).

Cohort study; level of evidence: 3.

The AFAQ underwent translation and cross-cultural adaptation according to the Beaton guidelines. A total of 104 male recreational players who had undergone ACLR completed the AFAQ-Arabic, the Fear-Avoidance Belief Questionnaire (FABQ), and the Numerical Pain Scale (NPS). To assess test-retest reliability, a subset of 38 recreational players were asked to complete the AFAQ-Arabic twice, 1 week apart. Statistical tests were conducted to test the internal consistency, reliability, and convergent validity of the AFAQ-Arabic.

The AFAQ-Arabic demonstrated high internal consistency (Cronbach alpha, 0.854) and excellent test-retest reliability (intraclass correlation coefficient, 0.885) (95% CI, 0.784-0.942; P < .001). Minimal floor (4.8% scoring the minimum) and ceiling effects (1% scoring the maximum) were observed. Convergent validity showed significant positive weak correlations between the AFAQ-Arabic and (1) the FABQ-Physical Activity (r = 0.340; P < .01), (2) the FABQ-Work (r = 0.272; P < .01), and (3) the NPS (r = 0.383; P < .01). Cross-cultural adaptation of the AFAQ-Arabic revealed linguistic and cultural relevance.

Our study demonstrated that the AFAQ-Arabic was a reliable and valid tool for assessing fear avoidance in Arabic-speaking recreational players after ACLR. Future studies are needed to measure athlete fear-avoidance in injured Arabic-speaking athletes to understand its psychological aspects in rehabilitation and potentially aid in tailored interventions for improving outcomes.

A number of efforts have been made to tailor behavioral healthcare treatments to the variable needs of patients with low back pain (LBP). The most common approach involves the STarT Back Screening Tool (SBST) to triage the need for psychologically informed care, which explores concerns about pain and addresses unhelpful beliefs, attitudes, and behaviors. Such beliefs that pain always signifies injury or tissue damage and that exercise should be avoided have been implied as psychosocial mediators of chronic pain and can impede recovery. The ability of physical therapy interventions guided by baseline stratification for risk of persistent LBP or related functional limitations to improve unhelpful pain beliefs has not been well assessed. Because treatments are aimed at addressing these beliefs, understanding a bit more about the nature of beliefs about pain (for example, attitudes and knowledge) might help us understand how to better tailor this care or even our risk-stratification approaches for future treatment of patients with LBP.

(1) Did patients assigned to receive risk-stratified care score higher on an assessment of pain science knowledge? (2) Did patients assigned to receive risk-stratified care have fewer unhelpful attitudes related to pain? (3) Did patients assigned to receive risk-stratified care have less pain-associated psychological distress? (4) Regardless of intervention received, is baseline SBST risk category (low, medium, or high) associated with changes in attitudes and knowledge about pain?

This is a secondary analysis of short-term changes in pain beliefs following the 6-week treatment phase of a randomized controlled trial that examined the effectiveness of a risk-stratified physical therapy intervention on pain-related disability at 1 year. Between April 2017 and February 2020, a total of 290 patients in the Military Health System seeking primary care for LBP were enrolled in a trial comparing a behavioral-based intervention to usual care. The intervention involved psychologically informed physical therapy using cognitive behavioral principles and included tailored education, graded exercise, and graded exposure. Individuals assigned to usual care followed treatment plans set forth by their primary care provider. Thirty-one patients were removed from Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool analyses due to missing assessments at 6 weeks (n = 15 intervention; n = 16 usual care). This resulted in 89% (259 of 290) of participants included for secondary analysis, with no difference in baseline demographic characteristics between groups. The usual-care group comprised 50% of the total study group (129 of 259), with a mean age of 34 ± 9 years; 67% (87 of 129) were men. The risk-stratified care group comprised 50% (130 of 259) of the total study group, with a mean ± SD age of 35 ± 8 years; 64% (83 of 130) were men. Six additional individuals were removed from Survey of Pain Attitudes harm scale (SOPA-h) and revised Neurophysiology of Pain Questionnaire (rNPQ) analyses for missing baseline data (n = 1 intervention) and 6-week data (n = 2 intervention; n = 3 usual care). The rNPQ captured current pain science knowledge, the SOPA-h examined patient attitudes about pain (the extent of beliefs that pain leads to damage and that movement is harmful), and the OSPRO-YF assessed patients for yellow flag clinical markers of pain-related psychological distress across 11 constructs within domains of negative mood, fear avoidance, and positive affect/coping indicative of elevated vulnerability and decreased resilience. Outcomes were assessed at baseline and 6 weeks, and data were analyzed per protocol. We assessed between-group differences at 6 weeks using linear mixed-effects models of pain attitudes and knowledge and related distress, controlling for age, gender, and baseline pain. Regardless of treatment group, we also analyzed differences in rNPQ and SOPA-h scores at 6 weeks based on SBST risk category (low versus medium or high) using generalized linear (Gaussian) regression models.

Risk-stratified treatment was associated with improvements in pain knowledge (rNPQ mean difference 6% [95% confidence interval (CI) 1% to 11%]; p = 0.01) and a reduction in indicators of pain-associated psychological distress (OSPRO-YF mean difference -1 [95% CI -2 to 0]; p = 0.01) at 6 weeks compared with usual care. There was no difference between groups for SOPA-h score at 6 weeks (mean difference -0.2 [95% CI -0.3 to 0.0]; p = 0.09). Patients with medium- or high-risk scores on the SBST, regardless of intervention, improved slightly more on SOPA-h (β = -0.31; p < 0.01) but not rNPQ (β = 0.02; p = 0.95) than those scoring low risk.

Patients receiving risk-stratified care showed small improvements in pain knowledge and reductions in pain-related psychological distress at 6 weeks, immediately after intervention, compared with usual care. Implementation of this risk-stratified care approach for LBP was able to change patients' perceptions about pain and reduce some of their psychological distress beyond what was achieved by usual care in this setting. As these factors are believed to favorably mediate treatment outcomes, future studies should investigate whether these improvements persist over the long term, determine how they influence clinical outcomes, and explore alternatives for risk stratification and treatment to elicit greater improvements.Level of Evidence Level III, therapeutic study.

BackgroundThe only survey that assesses the ability of individuals with low back pain to self-manage their condition is the Patient Enablement Instrument for Back Pain (PEI-BP).ObjectiveThe study aims to create a Turkish version of PEI-BP and test its validity and reliability.Methods67 individuals (47 females, 20 males) with low back pain participated, comprising. Reliability was evaluated through test-retest reliability, internal consistency, and repeatability measures. Validity was assessed via structural, content, face validity analyses. Floor and ceiling effects were examined to ensure a comprehensive evaluation. Additionally, the relationship between PEI-BP and pain intensity, Brief Illness Perception Questionnaire (BIPQ), Fear Avoidance Beliefs Questionnaire (FABQ), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) was explored.ResultsThe Intraclass Correlation Coefficient value (0.795) and Cronbach's α (0.886) of PEI-BP were high. The goodness-of-fit values for the model, including fit indices and reference ranges, indicated strong validity. The PEI-BP demonstrated the absence of both floor and ceiling effects. Correlations between PEI-BP and pain intensity, BIPQ, FABQ, ODI, and SF-36 exhibited a range from weak to good (0.258 to -0.440).ConclusionsPEI-BP has demonstrated high reliability and good validity. PEI-BP can be used to evaluate Turkish-speaking individuals with low back pain.ClinicalTrials.gov ID: NCT06109246 (Date: 10/25/2023).

Low back pain (LBP) is a leading cause of disability worldwide, with up to 25% of cases become chronic (cLBP). Whilst multi-factorial, the relative importance of contributors to cLBP remains unclear. We leveraged a comprehensive multi-dimensional data-set and machine learning-based variable importance selection to identify the most effective modalities for differentiating whether a person has cLBP. The dataset included questionnaire data, clinical and functional assessments, and spino-pelvic magnetic resonance imaging (MRI), encompassing a total of 144 parameters from 1,161 adults with (n = 512) and without cLBP (n = 649). Boruta and random forest were utilised for variable importance selection and cLBP classification respectively. A multimodal model including questionnaire, clinical, and MRI data was the most effective in differentiating people with and without cLBP. From this, the most robust variables (n = 9) were psychosocial factors, neck and hip mobility, as well as lower lumbar disc herniation and degeneration. This finding persisted in an unseen holdout dataset. Beyond demonstrating the importance of a multi-dimensional approach to cLBP, our findings will guide the development of targeted diagnostics and personalized treatment strategies for cLBP patients.

Sleep disturbance is a prevalent condition in individuals with chronic low back pain (CLBP). Despite a strong association between the 2 conditions, the potential mechanisms underlying the role of sleep disturbance in CLBP remain unclear. This case-control study aimed to examine pain perception among females with or without nonspecific CLBP and comorbid insomnia. One hundred females were recruited (mean age: 34.3 ± 11.4 years), with 25 individuals with concomitant CLBP and insomnia (CLBP+I), 25 with CLBP (CLBP+), 25 with insomnia (Insomnia+), and 25 healthy controls. All participants completed self-report questionnaires and quantitative sensory testing (QST). Our study found that CLBP+I exhibited lower mechanical pain and pressure pain thresholds (PPT) in both painful and nonpainful areas and impaired conditioned pain modulation (CPM) as compared to healthy controls. Similar findings were found in PPT at the back and CPM when compared to CLBP+. However, no significant differences were noted in thermal pain thresholds and temporal summation of pain across the 4 groups. Furthermore, CLBP+I and Insomnia+ displayed higher levels of functional disability, maladaptive beliefs, and negative mood than CLBP+ or healthy controls. There were significant increases in pain sensitivity to pressure stimuli, decreases in descending pain inhibitory effects, and higher levels of maladaptive psychological status in CLBP+I compared to CLBP+. These findings underscore the importance of incorporating sleep assessments as a routine practice in treating CLBP cases. Future studies are warranted to validate our findings in males, establish the diagnostic and prognostic value of QST, and probe the neurophysiological mechanisms in comorbid conditions.

The high prevalence of chronic pain and comorbid depression, along with their negative impacts on individuals and society, highlights the need for accessible and effective interventions. This study examined the feasibility, efficacy, and acceptability of Lenio, an Internet-based self-help intervention, combined with the COGITO smartphone application for managing these conditions. The randomized controlled trial involved an intervention group (IG) using Lenio and COGITO, an active control group (ACG) using a transdiagnostic app, and a wait-list control group (WCG) receiving usual treatment. Lenio incorporates cognitive behavioral therapy and third-wave techniques, supported by COGITO's gamified daily exercises to enhance adherence. Across 263 participants assessed at three intervals over 16 weeks, the IG showed significant improvement in somatic-affective depressive symptoms compared to the WCG post-intervention and both control groups at follow-up. However, the ACG outperformed the IG in managing pain at post-intervention though these effects did not persist until follow-up. The interventions were well-received and feasible, with older participants benefiting more from the Lenio/COGITO combination. Lenio and COGITO could bridge gaps to conventional therapy, potentially easing pain by enhancing psychological well-being and coping strategies. Future studies should investigate tailored interventions for chronic pain and their long-term effectiveness.

Full trial protocol can be accessed via DOI: 10.1186/s13063-023-07440-8.

https://drks.de/register/de/trial/DRKS00026722/preview, identifier DRKS-IDDRKS00026722.

The Norwegian Neck and Back Registry (Norsk Nakke og Rygg Register, NNRR) was established to improve the quality of diagnosis and treatment in patients with neck and back complaints at Departments of Physical Medicine and Rehabilitation (PMR) in Norwegian hospitals. The purpose of this cohort profile is to describe the data from registered patients from 2016 to 2022 and linkage opportunities.

The registry includes adult patients with neck and back complaints referred to PMR multidisciplinary neck and back outpatient clinics in Norwegian hospitals. As of 2022, more than 8000 men and more than 10 000 women are included in the registry. Patients are predominantly diagnosed with non-specific neck or back conditions. The registry includes baseline and follow-up questionnaires from patients and their clinicians, collecting a broad range of self-reported data including demographic characteristics, employment, benefits, symptoms, diagnosis, treatment and treatment history, as well as quality of life. Participation is voluntary, and all patients in the registry have consented for the collected data to be linked with other national registries, presenting opportunities for large-scale registry-based scientific studies. Recruitment of patients to the registry is ongoing, and since 2016, an increasing number of patients have been included per year, with over 5000 in 2021 and 2022.

Data from the NNRR have been used to improve our understanding of what characterises neck and back patients in specialist healthcare compared with patients in primary healthcare, how neck and back symptoms differ according to ethnicity and language, how nationality influences outcome trajectories for neck and back patients, and for studying properties of measurement instruments.

Future plans involve expanding the registry to include patients from the remaining three neck and back outpatient clinics in order to obtain a complete national register in Norway, and to facilitate increased use of the data for quality improvement and research purposes. The registry welcomes collaboration with other researchers.

Symptoms of posttraumatic stress disorder (PTSD) are highly prevalent among Veterans with chronic pain. Considerable research has examined the intersection of chronic pain and PTSD symptoms. However, it remains unclear whether changes in PTSD may potentially serve a mechanistic role in improving unhelpful pain cognitions for individuals with chronic pain. The present research contributes to the foundational knowledge by addressing this question. Baseline data from a randomized controlled trial targeting pain-related disability for Veterans (n = 103; mean age 43.66; SD = 10.17) with musculoskeletal pain and depression and/or PTSD symptoms were used. Cross-sectional mediation analyses showed that PTSD symptoms mediated the relationship between pain severity and pain catastrophizing, and between pain severity and pain acceptance. After controlling for depression, the mediation involving pain catastrophizing remained significant, while the mediation for pain acceptance did not. Although limitations exist, results point to several treatment recommendations, including ensuring that depressive affect, PTSD-specific symptoms, and attention to both body and mind are included in treatment. Results also provide preliminary evidence for examining these associations longitudinally to improve our understanding of this population and corresponding treatment recommendations.

Chronic pain represents a global health challenge demanding a transition from traditional biomedical to patient-centered biopsychosocial models. This masterclass explores active coping strategies for effective chronic pain management within healthcare systems. It describes the Unit of Active Coping Strategies for Chronic Pain (UAAD - Unidad de Afrontamiento Activo para el Dolor) in Primary Care in Valladolid, Spain, as a successful example of implementing a biopsychosocial care model for treating chronic pain.

To provide tools that allow the application of active coping strategies in the treatment of patients with chronic pain and how to implement the UAAD units in other healthcare systems.

This masterclass describes the UAAD's innovative approach, starting with its comprehensive and personalized methodology. This includes a referral system, a thorough assessment encompassing biological, psychological, and social factors, and a functional categorization system. These elements guide personalized treatment plans delivered through group and individual programs grounded in therapeutic exercise and pain science education. Four key pillars are highlighted: clinical care, teaching, resource management, research and dissemination.

Embracing this model empowers healthcare providers to address the growing burden of chronic pain. It also enables patients to take an active role in their recovery and self-management.

Little information exists on the potential differential response to functional restoration between non-specific chronic low back pain (NSCLBP) individuals with and those without Modic type 1 changes. Therefore, this case-control study investigated the response profile of NSCLBP patients with and without Modic type 1 changes undergoing functional restoration.

The present study included patients participating in a functional restoration program (day-hospital program lasting five weeks) at a French tertiary care center from 2009 to 2019. Each case with Modic type 1 changes was matched to one to two controls without Modic type 1 changes by sex, working incapacity, and lumbar spine surgery history. The primary effectiveness outcome was the Quebec Back Pain Disability Scale (QBPDS) score (0-100, with higher scores indicating higher disability). There were multiple secondary outcomes, such as subjective improvement and return to work.

The study included 83 patients (cases: median [IQR] age 47.8 [11.6] years, 77.4% women; controls: median [IQR] age 46.0 [16.2] years, 75.0% women). At three months, there were no statistically significant differences between cases and controls in the QBPDS score (34.0 versus 31.5), subjective improvement (67.7% versus 69.2%), return to work in those who were not working at the inclusion (72.7% versus 52.6%), and the consumption of different analgesics.

The response profile of NSCLBP adults undergoing functional restoration did not statistically differ between the groups with and without Modic type 1 changes. These findings suggest that patients may benefit from such a program irrespective of their Modic type 1 status.

This study aimed to translate, validate, and cross-culturally adapt the original FACS into the Arabic language.

The English version of the FACS was translated and culturally adapted into Arabic following international guidelines. The psychometric properties of the final version of the FACS-Arabic (FACS-A) were tested among 119 patients with different musculoskeletal (MSK) pain disorders.

The Cronbach's α for the FACS-A was 0.86. The test-retest reliability, measured with intraclass correlation coefficient, was 0.80. The FACS-A showed positive significant correlations with other psychological patient-reported measures, including the pain catastrophizing scale (PCS) (r = 0.545); p ≤ 0.01), Brief Pain Inventory (BPI)-pain score (r = 0.546; p ≤ 0.01), BPI-pain interference score (r = 0.511; p ≤ 0.01), and Hospital Anxiety and Depression Scale (HADS) (r = 0.451, 0.336, respectively; p ≤ 0.01). Confirmatory factor analysis of the FACS-A confirmed the two-factor structure found in the original English version.

This study determined the FACS-A to be a reliable and valid tool for the assessment of the fear-avoidance beliefs in Arabic-speaking individuals with MSK pain disorders.

BackgroundThe Low Back Activity Confidence Scale (LoBACS) was developed to evaluate self-efficacy in individuals with low back pain (LBP).ObjectiveThis study aimed to assess the psychometric properties of Turkish version of LoBACS in individuals with non-specific LBP.MethodsThe study included 105 participants (66 female, 39 male) with a mean age of 40.94 ± 14.65 years. The cultural adaptation and psychometric evaluation of LoBACS followed international standards and COSMIN guidelines. Reliability was assessed using the Cronbach's α and Intraclass Correlation Coefficient (ICC). Structural validity was tested with Confirmatory Factor Analysis (CFA). Pearson correlation analysis examined the relationships between LoBACS and the Waddell Disability Index (WDI), Modified Oswestry Disability Index (MODI), Roland Morris Disability Questionnaire (RMDQ), International Physical Activity Questionnaire (IPAQ), Short Form-36 (SF-36), Fear Avoidance Beliefs Questionnaire (FABQ), and Visual Analog Scale (VAS).ResultsThe Turkish version of LoBACS showed high reliability (ICC = 0.850, Cronbach's α = 0.919). CFA and fit indices supported its validity. Correlations between LoBACS and other measures ranged from -0.192 to 0.542. No floor or ceiling effects were noted.ConclusionThe Turkish version of LoBACS is a reliable and valid tool for assessing self-efficacy in individuals with non-specific LBP, suitable for both research and clinical settings.

This paper presents a protocol for a randomised control trial to compare the effect and durability of the effect of corrective exercise, and manual therapy focused on the back versus hip versus back and hip on disability, function, pressure pain threshold, pressure pain mapping, health and psychological status of the elderly with chronic back and hip pain. A total of 75 elderly participants will be assigned randomly into three groups, including back-focused exercises (n=25), hip-focused exercises (n=25) and back-focused and hip-focused exercises (n=25). Primary outcomes (disability and function) and secondary outcomes (pressure pain threshold, pressure pain mapping, health status and psychological factors) will be evaluated before, immediately after and 6 months after the 8 week exercise intervention. The data will be analysed using a general linear model repeated measures analysis of variance including both within and between factors (three groups*three times) with Bonferroni adjustments used as a post-hoc test at a significant level of 0.05. This trial will demonstrate whether back versus hip versus back-focused and hip-focused manual therapy can better improve the disability, function, pressure pain threshold, pressure pain mapping, health and psychological status of the elderly with chronic back and hip pain. If successful, this study's findings and information will potentially have implications for addressing back and hip pain in the elderly population by an alternative multidisciplinary approach. Trial registration number: IRCT20220911055941N1.

Persistent pain is a common complaint among civilians and military personnel after a lateral ankle sprain (LAS). Most individuals who experience pain after an LAS self-report a moderate pain intensity level that interferes with activity. This pain experience is mostly described through study designs and outcomes that limit the understanding of the acute to chronic pain transition after an LAS. The purpose of this prospective study is to quantify the prevalence rate of chronic ankle pain at 6-months post-injury and identify susceptibility and resiliency factors that contribute to pain chronification after an LAS. The objective of this study will be accomplished through a two-site prospective cohort study design with data collected at four timepoints (<7 days post-LAS, 3-, 6-, and 12-months post-LAS). A target sample size of 200 men or women (100 per site) between 18 and 45 years of age who sustain an acute LAS within the previous 7-days will be enrolled. Participants will complete a series of standardized electronic surveys at each timepoint to self-report the presence of chronic ankle pain, healthcare utilization patterns, subsequent musculoskeletal injury, and new co-morbid conditions. Additionally, participants will complete validated patient-reported outcomes (PROs) electronically to characterize the pain burden and undergo quantitative sensory testing to assess mechanical pain sensitivity via pressure pain thresholds, pain facilitation via temporal summation, and pain inhibition via a conditioned pain modulation response at all timepoints. Lastly, clinician-based outcomes will be completed at 3-, 6-, and 12-months post-LAS to examine dynamic postural control, functional performance, and walking mechanics. We hypothesize that 30% of participants will self-report chronic ankle pain at 6-months post-injury. In addition, chronic pain at 6-months will be predicted by a combination of healthcare utilization patterns, prolonged levels of peripheral sensitization and pain facilitation, and worse functional performance and PROs.

To investigate prevalence and associations of kinesiophobia on patients with axSpA, and its relation to global functioning and health, disease activity, function, spinal mobility and physical activity in comparison to healthy controls (HC).

Cross-sectional, observational study in which consecutive axSpA patients with axSpA (n=100) and 20 healthy controls (HC) were examined by the Tampa scale of kinesiophobia (TSK), and the Fear avoidance belief questionnaire (FABQ). Patient reported outcomes and objective assessments of disease activity physical function, global health and functioning as well as the BASMI, the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and Epionics SPINE (ES) measurements, including range of motion (RoM) and kinematics (RoK) were collected.

AxSpA patients showed higher TSK (25.5±6.8 vs. 14.0±5.1) and FABQ scores (40.1±22 vs. 3.1±6.9) compared to HC, all P≤0.001. Categorical analyses of kinesiophobia levels revealed that patients with higher levels performed significantly worse in ASPI and SPPB tasks, and they also showed impairments in BASMI and ES measures. TSK and FABQ scores correlated with ASAS HI (r=0.45 and r=0.52) and BASFI (r=0.38 and r=0.44), but not with ASPI, SPPB and RoK. Weak correlations were found for BASMI (r=0.24 and r=0.38) and BASDAI (both r=0.35).

Kinesiophobia seems to be a clinically relevant problem of axSpA patients, since the mobility of patients with moderate to high TSK and FABQ scores was much more impaired in this study. Of interest, the level of kinesiophobia showed stronger correlations with physical function, global functioning and health than with mobility and PA.

Objective: To investigate the influence of sleep quality and associated factors on balance control in individuals with chronic low back pain (CLBP). Methods: 85 participants (mean age 33.2 ± 12.5 years) with CLBP were recruited. Physical and emotional well-beings were evaluated using a battery of questionnaires. Sleep quality over the last month was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants were dichotomized into the good sleep quality (GSQ) and poor sleep quality (PSQ) groups if their PSQI scores were ≤ 5 and > 5, respectively. Balance control was measured using the one-leg stance with eyes closed and Y-balance test. Results: The GSQ group included 37 participants, while the PSQ group comprised 48 participants. After controlling for confounds (including gender, age, disability, anxiety, depression, and fear avoidance beliefs), participants with PSQ displayed significantly poorer performance in the one-leg stance with eyes closed and lower normalized posteromedial, posterolateral, and composite scores of the Y-balance test compared with participants with GSQ. Additionally, sleep quality accounted for 16.9%-24.9% of the variance in balance control, while age explained an additional 5.2%-13.2% of the variance. Additionally, higher levels of physical disability and anxiety were associated with poorer balance control. Conclusions: Individuals with concurrent CLBP and PSQ exhibit significantly worse balance control than those with CLBP alone. Future studies should investigate whether improving sleep quality, physical disability, and anxiety can enhance balance in individuals with CLBP.

Mindfulness-Based Stress Reduction (MBSR) has shown efficacy for alleviating chronic low back pain (cLBP) and is included in current treatment guidelines. However, benefits are moderate. We aimed to optimize MBSR for chronic pain by using recent research to develop Mindfulness-Based Pain Reduction (MBPR) and test it in patients with cLBP.

Phase 1: We modified the MBSR curriculum with theory-driven components and convened focus groups with local and international mindfulness and clinical pain management experts to refine an 8-week MBPR program. Phase 2: We recruited participants with cLBP from Northern California using outreach in newsletters, social media, and other methods to test and iteratively modify the curriculum. MBPR was delivered in a group format by videoconference. The first three groups received MBPR; a fourth group was randomized to MBSR or MBPR to assess randomization feasibility. We assessed feasibility and acceptability by attendance, practice logs, and exit interviews. We assessed changes in patient-reported outcome measures for low back pain trials using a single arm (treatment group only) approach at 2 and 6 months with linear mixed models (primary: pain intensity and interference (PEG) scores).

Phase 1: The MBPR curriculum included: 1) mindful interoceptive exposure to pain, 2) pain neuroscience education, and 3) yoga postures specifically for cLBP. Phase 2: we enrolled 58 patients in 4 cohorts; 49 completed post-intervention and 41 completed 6-month follow-up assessments; 29 of the 41 received MBPR. Participants attended a mean of 80% of sessions and 23 of 24 participants accepted randomization in the 4th cohort. Mean PEG scores improved for 20 of 29 MBPR participants in a clinically meaningful way (PEG scores >30%).

MBPR was feasible and acceptable. Two-thirds of MBPR participants experienced clinically meaningful improvements in pain intensity and interference scores. MBPR warrants further investigation through a randomized, controlled trial.

Low back pain (LBP) is a global health concern. Approximately two-thirds of those who recover from LBP experience a relapse within a year, with many chronic cases encountering acute flare-ups (exacerbation). This systematic review will synthesise and analyse whether physical and/or psychological features can predict recurrent episodes of LBP or exacerbation of pain.

This systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Comprehensive literature searches will be conducted in MEDLINE, EMBASE, APA PsycInfo, PubMed, CINAHL Plus, Web of Science, Scopus and ZETOC, spanning from each database's inception through to January 2025. Google Scholar and grey literature sources, including OpenGrey, will also be searched to ensure comprehensive coverage. Two independent reviewers will screen titles, abstracts and full texts, assessing the risk of bias with a modified Quality in Prognosis Studies tool. The overall certainty of evidence will be evaluated using an adapted Grading of Recommendations Assessment, Development and Evaluation approach. If sufficient data homogeneity is present, a meta-analysis will be performed; otherwise, findings will be synthesised narratively. The results will identify the ability of physical and/or psychological factors to predict pain recurrence or acute exacerbation in case of persistent non-specific LBP.

This study protocol does not present any ethical concerns. The findings from the systematic review will be submitted for publication in a peer-reviewed journal and will also be presented at relevant conferences.

CRD42024599514.

The fear of pain (FOP) and fear avoidance belief (FAB) play a crucial role in the occurrence and development of chronic pain. However, the dynamics of these factors in postsurgical pain appear to differ, with the FOP often learned from others rather than directly caused by painful experiences. Psychological resilience refers to an individual's capacity to adapt effectively to adversity, challenges, and threats, and may play a significant role in overcoming the FOP and avoidance behavior.

The aim of this study was to investigate the role of psychological resilience in overcoming the FOP and avoidance behavior among surgical patients undergoing lung surgery.

Participants were recruited at the Wuhan Union Hospital. Psychological resilience was measured using the Connor-Davidson Resilience Scale. The FOP was assessed using the simplified Chinese version of the Fear of Pain-9 items. The FAB was measured using the Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire. Activity recovery was assessed through questions related to social activities and household responsibilities. The adaptive least absolute shrinkage and selection operator (Lasso) regression analysis under nested cross-validation was used to identify key factors affecting postoperative FOP and activity recovery.

A total of 144 participants were included in the final analysis. The results showed that preoperative FOP (coefficient=8.620) and FAB (coefficient=8.560) were mainly positively correlated with postoperative FOP, while psychological resilience (coefficient=-5.822) and age (coefficient=-2.853) were negatively correlated with it. These average R2 of these models was 73% (SD 6%). Psychological resilience was the most important factor in predicting activity recovery, and these models obtained an average accuracy of 0.820 (SD 0.024) and an average area under the curve of 0.926 (SD 0.044).

Psychological resilience was negatively associated with the postoperative FOP and positively with activity recovery in patients who underwent lung surgery. Patients with higher resilience are more likely to cope effectively with postsurgical pain and recover activities sooner. These findings highlight the importance of assessing and potentially enhancing psychological resilience in the perioperative period to improve postoperative outcomes.