Search Results (43)

Background and Objectives: Chronic low back pain (CLBP) is a prevalent condition that impairs quality of life, functionality, and work productivity. While most acute episodes of back pain resolve, 4–25% become chronic due to factors such as high pain intensity, psychological distress, and maladaptive behaviors. Nonspecific CLBP is best understood through the biopsychosocial model, encompassing biological, psychological, and social influences, including kinesiophobia. Management relies on physical activity, pain education, and psychological interventions, with therapist knowledge and attitudes affecting outcomes. This study aimed to assess the prevalence of CLBP among healthcare workers, examine their knowledge of pain neurophysiology, evaluate kinesiophobia, and explore how personal experience with CLBP influences their beliefs, attitudes, and interactions with patients. Materials and Methods: A cross-sectional observational study was conducted from January to May 2025 among healthcare professionals. A total of 50 participants completed an online questionnaire, of which 42 were valid and included in the analysis. The questionnaire collected demographic and professional data, determined the presence of CLBP, and included three standardized instruments: the Revised Neurophysiology of Pain Questionnaire (rNPQ) to assess knowledge of pain mechanisms, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) to evaluate beliefs about pain and disability, and the Tampa Scale of Kinesiophobia (TSK-11) to measure fear of movement. Data were analyzed using SPSS and Microsoft Excel. Results: Among the 42 participants, 11 demonstrated low, 28 moderate, and 3 high knowledge of pain neurophysiology (rNPQ), with a mean score of 5.66. On the HC-PAIRS, the majority (30 participants) scored above 60, indicating beliefs that pain leads to disability, while 12 scored below 60, reflecting a biopsychosocial perspective; gender did not significantly affect HC-PAIRS scores (p = 0.213). As for kinesiophobia (TSK-11), 24 participants had low, 17 moderate, and 1 clinically significant fear of movement. Correlation analysis revealed that younger participants had higher rNPQ scores (r = −0.358, p = 0.020) and lower TSK-11 scores (r = −0.389, p = 0.011). TSK-11 scores increased with age (r = 0.432, p = 0.004), while HC-PAIRS scores showed no significant correlations. Conclusions: Healthcare professionals, particularly physiotherapists, show gaps in knowledge of pain neurophysiology and a tendency toward biomedical beliefs regarding chronic low back pain. This cross-sectional study indicates that a greater understanding of pain mechanisms is associated with lower kinesiophobia, emphasizing the importance of education. Integrating the biopsychosocial model into undergraduate and continuing professional training, through interdisciplinary and practical modules, may improve knowledge, reduce maladaptive fear-avoidance behaviors, and enhance patient care. Future studies should include larger, more diverse samples and assess the long-term impact of educational interventions on clinical practice. Full article

Background and Objectives: Subacromial pain syndrome (SAPS) is one of the most common musculoskeletal problems affecting the shoulder joint. In this study, we aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SAPS. Materials and Methods: Participants were sequentially assigned to study and control groups in a quasi-randomized design. While the control group received standard physical therapy and rehabilitation, the study group underwent a combined progressive exercise program, including humeral head depressor strengthening, peri-articular muscle exercises, scapular stabilization, and proprioceptive training. Acromio–humeral distance (AHD) and tendon thickness measurements were evaluated via ultrasonography (USG), while pain intensity, upper-extremity disability, and kinesiophobia were measured using the VAS and McGill Pain Questionnaire, DASH-T, and the Fear Avoidance Beliefs Questionnaire, respectively. Results: Both the study and control groups showed statistically significant increments in AHD compared to the baseline. The first and final measurements changed from 7.92 mm to 10.54 mm and from 7.72 mm to 8.41 mm, respectively. However, the increase in AHD was greater in the study group relative to the control group, and the value was statistically significant. The study group showed significant improvements in pain and disability. Kinesiophobia levels, on the other hand, decreased in both groups, but a greater decrease was observed in the study group. Conclusions: In this study, both the study and control groups showed an increase in AHD, but the combined exercise program targeting humeral head depressor muscles resulted in a greater improvement. Reduced tendon thickness indicated the eased motion of the rotator cuff, supporting the improvements in pain and disability. The program had a positive impact on psychosocial parameters, including pain-related kinesiophobia. Given the limited literature on the effects of such exercises on AHD and tendon thickness, this study provides an original contribution. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07228455. Full article

Objectives: The central nervous system plays a fundamental role in chronic pain; however, its behavior in this condition remains unclear, especially when associated with interventions such as kinesiotaping (KT). This study aimed to analyze the effects of KT on the somatosensory cortex of women with chronic low back pain. Methods: This case series involved 15 women with chronic low back pain. Participants underwent a progressive-tension KT protocol for 8 weeks, and electroencephalogram recordings were performed in two positions, namely sitting and standing while load bearing (10% of body weight), in the first and eighth weeks. The following instruments were employed: Oswestry lumbar disability index, fear avoidance beliefs questionnaire, and the numerical pain intensity scale. Results: All participants showed significant pain improvement and a reduction in Oswestry disability index scores from moderate to minimal. Additionally, activity in the alpha band within the somatosensory cortex and insula (central region—represented by the electrode Cz) decreased. This was confirmed by reduced power spectral density, indicating diminished cortical activity in these regions. Conclusions: KT positively affects women with chronic low back pain, providing pain reduction and improved functional capacity, as indicated by the fear avoidance beliefs questionnaire and numerical pain intensity scale. Moreover, KT reduces cortical activity in the somatosensory cortex, which is related to the progression of painful sensations, described above after the intervention. Full article

Chronic neck pain is a multifactorial condition involving physical, psychological, and neurological dimensions. This case report describes the clinical course of a 25-year-old female with chronic neck pain and recurrent headaches who underwent a 6-week integrative intervention consisting of manual therapy and pain neuroscience-based sensorimotor retraining, administered three times per week. Outcome measures included the Headache Impact Test-6 (HIT-6), Neck Pain and Disability Scale (NPDS), Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ), pressure pain threshold (PPT), cervical range of motion (CROM), and functional near-infrared spectroscopy (fNIRS) to assess brain activity. Following the intervention, the patient demonstrated marked reductions in pain and psychological distress: HIT-6 decreased from 63 to 24 (61.9%), NPDS from 31 to 4 (87.1%), FABQ from 24 to 0 (100%), and PCS from 19 to 2 (89.5%). Improvements in PPT and CROM were also observed. fNIRS revealed decreased dorsolateral prefrontal cortex (DLPFC) activation during pain stimulation and movement tasks, suggesting a possible reduction in central sensitization burden. These findings illustrate that an integrative approach targeting biopsychosocial pain mechanisms may be beneficial in managing chronic neck pain, improving function, and modulating cortical responses. This report provides preliminary evidence in support of the clinical relevance of combining manual therapy with neurocognitive retraining in similar patients. Full article

Background and Objectives: Questionnaires are patient-reported outcome measures that require a validation process to assess their reliability and replicability. Over time, questionnaires have not only focused on a single health condition, such as neck pain, but also expanded their assessment spectrum to other areas in order to gather additional and relevant information from the patient. The main objective of this study was to conduct a systematic review of the different structural and psychometric characteristics of neck pain questionnaires. Materials and Methods: A systematic review was conducted following the PRISMA recommendations. The search strategy was implemented across various databases (PubMed, Cochrane, EMBASE, CINHAL, Trip Medical Database, Scopus) using terms such as neck pain, cervicalgia, cervical pain, questionnaire, survey, index, validity, validation, and reliability. COSMIN criteria were used to identify valid questionnaires for this systematic review based on their psychometric properties. Results: A total of 15 articles were identified in this systematic review, of which 8 assessed the level of disability, while the rest evaluated dizziness in neck pain, anxiety and/or depression, beliefs about fear and avoidance, and perception of scarring and symptoms after neck surgery. The main findings show that neck pain questionnaires exhibit very good values for reliability and internal consistency, along with a high variability for construct validity. Conclusions: This study highlights the good values exhibited by neck pain questionnaires despite their heterogeneity in structural characteristics, demonstrating good values in psychometric properties. Nevertheless, the latter should be further investigated to gather more information. Full article

Background and Objectives: The objective of our study was to describe the biopsychosocial profile of individuals diagnosed with axial spondyloarthritis (AxSpA) and to analyze how their clinical characteristics interact with disease activity. Materials and Methods: An observational study was conducted, involving 28 participants diagnosed with AxSpA. We evaluated clinical outcomes (perceived pain, range of motion [RoM], pressure pain threshold [PPT], and proprioceptive acuity), psychosocial outcomes (the Pain Catastrophizing Scale [PCS], Tampa Scale of Kinesiophobia [TSK-11], and the Fear-Avoidance Beliefs Questionnaire [FABQ]), and AxSpA-specific indices (the Bath Ankylosing Spondylitis Metrology Index [BASMI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]). Data were analyzed using Spearman’s correlation coefficients and simple and multiple linear regression models. Results: Cervical and lumbar RoM values were reduced compared to established normative values for the general population. Significant associations were found between perceived pain, pain catastrophizing, and FABQ scores with both BASDAI and BASFI (p < 0.05). The interaction between perceived pain and pain catastrophizing (p < 0.001) accounted for 45.7% of the variance in BASDAI, while the interaction between perceived pain and FABQ (p < 0.001) explained 52.1% of the variance in BASDAI. Conclusions: The biopsychosocial profile of patients with AxSpA is characterized by moderate-intensity perceived pain and reduced cervical and lumbar mobility. The observed associations between BASDAI, pain catastrophizing, and fear-avoidance beliefs underscore the influence of psychosocial factors on disease progression. Full article

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. Full article

Public health officials reported increases in stigma, discrimination, and verbal and physical abuse during the coronavirus (COVID-19) pandemic. This study, conducted in Vietnam, examined how stigma, fear of the virus, self-protective behaviors, and threats to and loss of resources during the pandemic were associated with post-traumatic stress and belief in vaccine effectiveness. Participants were 380 persons (237 women, 129 men, 14 unreported) who completed measures assessing demographics, stigma experienced during the pandemic, resource loss, fear about becoming infected with the virus, self-protective actions to avoid illness, post-traumatic stress, and belief in COVID-19 vaccination effectiveness. Hierarchical multiple regression showed post-traumatic stress was positively associated with COVID-19 stigma personal experience, minimizing the COVID-19 threat, personal characteristic and support resource loss, perceived susceptibility to illness, and fear of COVID-19. Vaccine support was positively associated with age, COVID-19 stigma personal experience, and self-protective behaviors to avoid illness, and negatively associated with number of people known who died due to the virus. The findings support the hypotheses and extend conservation of resources stress theory. The findings underscore the importance of promptly addressing stigma, enhancing public education, and addressing barriers to receiving the vaccine. Full article

Academic possible selves (PSs) are defined as future self-representations about education and academic outcomes, recognized for their motivational power, especially in challenging situations. This study aimed to (i) explore the salience of academic PSs among senior high school students, considering sociodemographic factors; (ii) investigate the relationships among perceived contextual factors, PS constructs, difficulty mindsets, and academic outcomes; and (iii) examine differences between general and vocational school students across these variables and their relationships. A sample of 598 10th graders (i) reported their two most important hoped-for and feared PSs as well as their strategies to achieve/avoid them and (ii) completed scales measuring demographics, perceptions about parents’ and teachers’ beliefs, perceived efficacy for attaining PSs, perception of school as a path, difficulty mindsets about academic tasks, academic self-regulation, and achievement. The results indicated that academic PSs were salient among adolescents’ hoped-for PSs, with general school students reporting academic PSs more frequently and showing more positive motivational beliefs. Path analysis indicated the role of the study variables in academic self-regulation and achievement, with school type moderating these effects. The findings emphasize the importance of supporting students’ academic PSs and tailoring context-based interventions to foster academic outcomes in diverse school settings. Full article

Background: Rotator cuff-related shoulder pain (RCRSP) is a common musculoskeletal condition characterized by pain, functional disability, reduced mobility, and weakness. There is a need for valid functional tests that can measure shoulder strength and power without exacerbating pain. The Seated Medicine Ball Throw (SMBT) and Unilateral Shot-Put Test (ULSPT) are throwing tests that use a weighted ball in a seated position, measuring throwing distance (m). This study aimed to evaluate the feasibility, discriminative validity, and convergent validity of these tests in individuals with RCRSP. Methods: This cross-sectional study included 64 participants: 30 with RCRSP and 34 asymptomatic controls. Participants completed the QuickDASH and Fear-Avoidance Beliefs Questionnaire (FABQ). Pain was assessed using a 10 cm visual analog scale (VAS) at multiple time points. The SMBT and ULSPT were performed using a 2 kg ball, with throwing distance calculated as the average of three trials. Active shoulder range of motion (AROM) and grip strength were also measured. A two-way mixed-model repeated-measures ANOVA was conducted to examine group effects, with post hoc analyses performed where relevant. Pearson correlations explored associations among outcome measures. Results: The RCRSP group presented with persistent moderate shoulder pain (mean duration = 6.33 ± 5.7 months, VAS = 5.03 ± 1.99 cm, QuickDASH = 26.2 ± 10.54). Pain did not significantly increase after throwing (VAS change = 0.5 ± 1.6 cm, P = 0.4), supporting the tests’ feasibility. ULSPT demonstrated significant differences between the RCRSP and control groups for both symptomatic (2.03 ± 0.81 m) and asymptomatic shoulders (2.04 ± 0.8 m) compared with controls (2.51 ± 0.93 m, P < 0.01). SMBT showed a trend toward group differences (P = 0.05). RCRSP participants showed reduced AROM (166.2 ± 10° vs. 175.1 ± 8.2°) but similar grip strength compared to controls. ULSPT strongly correlated with SMBT (r = 0.92–0.94, P < 0.0001). Both throwing tests correlated moderately with grip strength (r = 0.61–0.81, P < 0.05) and showed mild to moderate correlations with disability, pain, and fear-avoidance measures (r = 0.26–0.48, P < 0.05). Conclusions: The ULSPT demonstrated good discriminative validity in differentiating individuals with RCRSP from controls, while the SMBT showed a trend toward discrimination. Both tests were feasible to administer without significantly exacerbating pain. The strong correlation between ULSPT and SMBT, along with their associations with established measures, supports their potential as functional assessments of upper extremity performance in RCRSP. Full article

Background/Objectives: Supervised rehabilitation has been reported to improve motor and functional outcomes after lumbar spine surgery. However, the effects of supervised rehabilitation on psychosocial and participation-related outcomes are still debated. This study aimed to systematically review the effects of supervised rehabilitation on psychosocial and participation-related outcomes in patients after lumbar spine surgery. Methods: A systematic literature search was carried out using PubMed, EMBASE, CINAHL, PEDro, CENTRAL, and Google Scholar databases from inception to March 2024. Randomized controlled trials investigating the effects of supervised rehabilitation on psychosocial and participation-related outcomes after lumbar spine surgery were included. Methodological quality was assessed through the revised Cochrane risk of bias tool for randomized trials. Pooled effects were reported as the standardized mean difference (SMD) with a 95% confidence interval (CI₉₅) or reported qualitatively in the presence of clinical heterogeneity. The certainty of the evidence was rated through the GRADE approach. Results: Fifteen studies (1297 patients) were included. Very low evidence supported supervised rehabilitation to improve quality of life at 1 year (SMD: −0.28; CI₉₅ from −0.49 to −0.07, I² = 32%), while low evidence supported supervised rehabilitation to enhance self-efficacy at 6 months (SMD: −1.13; CI₉₅ from −1.54 to −0.72) and 1 year (SMD −1.03, CI₉₅ from −1.43 to −0.63). No effects of supervised rehabilitation were found on quality of life at 6 months or in terms of fear-avoidance belief, catastrophizing, anxiety, depression, and return to work at 6 months and 1 year (very low to low evidence certainty). Conclusions: Supervised rehabilitation improved quality of life and self-efficacy in patients after lumbar spine surgery. However, the certainty of the evidence ranged from very low to low, and further studies are needed. Full article

Anxiety-based cognitive distortions pertaining to somatic perception (ABCD-SPs)—primarily catastrophizing, fear avoidance, and kinesiophobia—have been repeatedly linked to worsening chronic, non-cancer pain (CNCP) outcomes of increased disability, amplified pain, ineffective opioid use, and opioid misuse. Several studies have suggested that treating ABCD-SPs can improve pain outcomes, yet identification and targeting of ABCD-SPs are not part of the standard medical pain assessment and treatment plan. Utilizing a narrative review of proposed mechanisms, published patient perspectives, and study correlations connecting these cognitive distortions with CNCP outcomes, an approach for better practice in the delivery of standard medical CNCP care can be deduced and formulated into a Belief and Behavior Action Plan (BBAP) for medical clinicians treating CNCP to implement into initial and maintenance care planning. These recommendations require relatively few resources to implement and have the potential to disseminate more effective CNCP treatment on a large scale now and in the future with the new frontier of cognitive computing in medicine. Full article

Excessive muscle co-contraction is one of the factors related to the progression of knee osteoarthritis (OA). A previous study demonstrated that pain, joint instability, lateral thrust, weight, and lower extremity alignment were listed as factors affecting excessive co-contraction in knee OA. However, this study aimed to assess the association between fear-avoidance beliefs and muscle co-contraction during gait and stair climbing in people with knee OA. Twenty-four participants with knee OA participated in this cross-sectional study. Co-contraction ratios (CCRs) were used to calculate muscle co-contraction during walking and stair climbing, using surface electromyography. Fear-avoidance beliefs were assessed by the Tampa Scale for Kinesiophobia-11 (TSK-11) for kinesiophobia and the Pain Catastrophizing Scale (PCS) for pain catastrophizing. Secondary parameters that may influence co-contraction, such as degree of pain, lateral thrust, weight, and lower extremity alignment, were measured. The relationships between the CCR during each movement, TSK-11, and PSC were evaluated using Spearman’s rank correlation coefficient and partial correlation analysis, adjusted by weight and lower extremity alignment. Partial correlation analysis showed a significant correlation only between medial muscles CCR and TSK-11 during stair descent (r = 0.54, p < 0.05). Our study revealed that kinesiophobia could be associated with co-contraction during stair descent in people with knee OA. Full article

Objective: To investigate the effects of combining a Pilates program with photobiomodulation therapy (PBMT) in patients with chronic nonspecific low back pain (CNLBP). Methods: Thirty-eight adults with CNLBP were randomly assigned to two groups: Pilates exercise + active PBMT (PIL + PBMT) or Pilates exercise + sham PBMT (PIL + SHAM). Both groups performed an 8-week mat Pilates program and received PBMT on their lumbar muscles 10 min before and after each session. The following variables were assessed before and after intervention: peak pain intensity, postural balance (i.e., center of the pressure [A-COP], velocity anteroposterior [Vel AP], and velocity mediolateral [Vel ML]), perceived disability (i.e., Oswestry Disability Index [ODI] and Roland Morris Disability Questionnaire [RMDQ]), and pain-related fear of movement (i.e., Tampa Scale of Kinesiophobia [TSK], Fear Avoidance Beliefs Questionnaire [FABQ], and Pain Catastrophizing Scale [PCS]). Results: Postural balance variables showed no statistically significant differences (p > 0.05) across time or between groups. The groups showed similar (p < 0.05) reductions in peak pain intensity, ODI, RMDQ, and PCS scores, but no statistically significant difference (p > 0.05) in TSK and FABQ scores. Conclusion: The mat Pilates program reduced peak pain intensity, perceived disability, and pain catastrophizing in adults with CNLBP, but PBMT had no additional effect on these variables. Mat Pilates alone or combined with PBMT was not able to improve postural balance. Full article

The therapeutic actions indicated for low back pain, in addition to physiotherapy, include mobilization of the affected segment, as it is assumed that a loss of mobility may contribute to a patient’s pain. The aim of this study was to investigate the influence of back pain on the degrees of spinal mobility in young adults. Eighty-six volunteers participated in the study. Fingertip-to-floor distance, Schöber’s test, the fingertip-to-floor lateral flexion test, GHQ-12, the Fear-Avoidance Beliefs Questionnaire and the STarT Back Screening Tool were used. There were statistically significant differences between the two groups (pain and no pain) in degrees of spinal flexion (Schöber’s test and side flexion) showing greater mobility in the group with pain. However, the group with low back pain showed less rotational mobility. The presence or absence of back pain had an impact on the individual’s sporting practice and perception of pain, and they were able to carry out their sporting activities normally. Young adults with idiopathic low back pain showed some statistically significant differences in relation to the mobility of the spine in the different planes of movement (flexion and side flexion), conditioning their quality of life and sports practice. Full article