Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial

Background Therapeutic exercises are used in clinical practice for patients with low back pain (LBP). Core stabilization exercises can retrain the important function of local trunk muscles and increase the accuracy of the sensory integration process for stability of the spine in individuals with LBP. The aim of this study was to compare the effects of two different exercise regimes, Core stabilization exercises (CSE) and Strengthening exercise (STE), on proprioception, balance, muscle thickness and pain-related outcomes in patients with subacute non-specific low back pain (NSLBP). Methods Thirty-six subacute NSLBP patients, [mean age, 34.78 ± 9.07 years; BMI, 24.03 ± 3.20 Kg/m2; and duration of current pain, 8.22 ± 1.61 weeks], were included in this study. They were randomly allocated into either CSE (n = 18) or STE groups (n = 18). Exercise training was given for 30 min, three times per week, for up to 4 weeks. Proprioception, standing balance, muscle thickness of transversus abdominis (TrA) and lumbar multifidus (LM), and pain-related outcomes, comprising pain, functional disability and fear of movement, were assessed at baseline and after 4 weeks of intervention. Results The CSE group demonstrated significantly more improvement than the STE group after 4 weeks of intervention. Improvements were in: proprioception [mean difference (95% CI): − 0.295 (− 0.37 to − 0.2), effect size: 1.38, (p < 0.001)], balance: single leg standing with eyes open and eyes closed on both stable and unstable surfaces (p < 0.05), and percentage change of muscle thickness of TrA and LM (p < 0.01). Although both exercise groups gained relief from pain, the CSE group demonstrated greater reduction of functional disability [effect size: 0.61, (p < 0.05)] and fear of movement [effect size: 0.80, (p < 0.01)]. There were no significant adverse effects in either type of exercise program. Conclusion Despite both core stabilization and strengthening exercises reducing pain, core stabilization exercise is superior to strengthening exercise. It is effective in improving proprioception, balance, and percentage change of muscle thickness of TrA and LM, and reducing functional disability and fear of movement in patients with subacute NSLBP. Trial registration Thai Clinical Trial Registry (TCTR20180822001; August 21, 2018).

Cross-Cultural Adaptation, Validity and Reliability of the Igbo Version of the Brief Fear of Movement Scale for Osteoarthritis

Background; the brief fear of movement scale for knee osteoarthritis (b-FMSKOA) is a valid instrument for assessing fear of movement in individuals with OA. The objective of this study was to translate and culturally adapt the b-FMSKOA into Igbo language (b-FMSKO-I) and assess its validity and reliability in patients with knee osteoarthritis to promote its use in Igbo speaking parts of Nigeria.Methods; the original b-FMSKOA was translated and culturally adapted from English into Igbo following a standardized procedure according to Beaton et al., 2000 in seven separate processes of translation, back translation, committee review and pre-testing before being tested for psychometric quality. It was administered (within a 2day interval) to 15 consenting outpatients with knee OA who attended physiotherapy unit 3times a week in a selected South-eastern Nigerian hospital. The b-FMSKOA (English version) was correlated with the Igbo version. Results; the concurrent validity of the b-FMSKOA-I was found to be satisfactory and comparable to the original version. The correlation coefficient of the variables of interest were within the range of 0.441 and 0.998 and all showed significant correlation (p< 0.05) between the scores obtained from the English and Igbo version of the questionnaire except for the fourth item (r= 0.441; p=0.131) which showed no significant relationship. Cronbach’s alpha showed the questionnaire to reach acceptable reliability α = 0.85. The Pearson correlation coefficient of the variables of interest was within the range of 0.441 and 0.945 with the fourth and first item recording the lowest (r=0.441) and highest (r=0.945) correlation coefficient respectively. All variables showed significant correlation (p< 0.05) between the scores obtained from Igbo version of the questionnaires except for the fourth item (r= 0.441; p=0.131) which showed no significant relationshipConclusion; the b-FMSKO-I like the original version is a reliable, consistent and valid instrument that can be considered for use in South-eastern Nigeria for evidence based quality healthcare promotion in patients with knee osteoarthritis.

Role of psychosocial factors on the effect of physical activity on physical function in patients after lumbar spine surgery

Background The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery. Methods We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition. Physical activity was measured using a triaxial accelerometer (Actigraph GT3X) at 6-weeks (6wk), 6-months (6M), 12-months (12M) and 24-months (24M) following spine surgery. Physical function (computerized adaptive test domain version of Patient-Reported Outcomes Measurement Information System) and psychosocial factors (pain self-efficacy, depression and fear of movement) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) techniques were utilized to analyze data, and results are represented as standardized regression weights (SRW). Overall SRW were computed across five imputed datasets to account for missing data. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed [(SRW for effect of activity on psychosocial factor X SRW for effect of psychosocial factor on function) ÷ SRW for effect of activity on function]. Each SEM model was tested for model fit by assessing established fit indexes. Results The overall effect of steps per day on physical function (SRW ranged from 0.08 to 0.19, p<0.05) was stronger compared to the overall effect of physical function on steps per day (SRW ranged from non-existent to 0.14, p<0.01 to 0.3). The effect of steps per day on physical function and function on steps per day remained consistent after accounting for psychosocial factors in each of the mediation models. Depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of steps per day at 6wk on physical function at 12M, respectively. Pain self-efficacy was not a statistically significant mediator. Conclusions The findings of this study suggest that the relationship between physical activity and physical function is stronger than the relationship of function to activity. However, future research is needed to examine whether promoting physical activity during the early postoperative period may result in improvement of long-term physical function. Since depression and fear of movement had a very small mediating effect, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy.

Prevalence of Kinesiophobia in Post Spinal Surgery Patients

Background: The spinal column is a highly complex system of bones and connective tissues that provide support for the body and protect the delicate spinal cord and nerves. Back surgery carries higher risks than some other types of surgery because it is done closer to the nervous system. The most serious of these risks include paralysis and infections. Fear of movement/(re)injury is described as “a specific fear of movement and physical activity that is (wrongfully) assumed to cause reinjury”. In the extreme situation of fear of movement, the expression “kinesiophobia” is used. Tampa Scale for Kinesiophobia (TSK) was developed by Miller, Kori and Todd 1990 in order to assess fear of movement/(re)injury. It is a valid, reliable tool is used to assess Kinesiophobia.(1) Aim: The present study was done to Assess Prevalence of Kinesiophobia In patients undergone Spinal Surgery using Tampa Scale (6- 10 weeks post surgery). Method: In this study a total of 100 patients answered Tampa scale of kinesiophobia and were evaluated according to their level of kinesiophobia after post spinal surgical period 6- 10 weeks, that is after the healing period. Result: There was a high degree of kinesiophobia which was observed after post spinal surgical period 6-10 weeks in 61% of the participants. Conclusion: This study showed Prevalence of High Degree of Kinesiophobia noted after 6-10 weeks in 61% of the Post- Spinal Surgery patients even after 4-6 weeks of healing period. Key words: Kinesiophobia, Fear-avoidance, Spinal surgery, Tampa scale.

Kinematic analysis of movement impaired by generalization of fear of movement-related pain in workers with low back pain

Purpose To identify impaired trunk movement during work-related activity in individuals with low back pain (LBP) and investigate whether abnormalities were caused by generalized fear of movement-related pain. Methods This cross-sectional study was conducted at a hospital in Japan. We recruited 35 participants with LBP (LBP group; 26 males, 9 females) and 20 healthy controls (HC group) via posters at our hospital. The task required lifting an object. We used a 3D motion capture system to calculate the peak angular velocity of trunk flexion and extension during a lifting task. Pain-related factors for the LBP group were assessed using the visual analogue scale (VAS) for pain intensity over the past 4 weeks and during the task, the Tampa Scale for Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), and the Pain Anxiety Symptoms Scale-20 (PASS-20). We compared kinematic variables between groups with a generalized linear mixed model and investigated the relationship between kinematic variables, VAS scores, and psychological factors by performing a mediation analysis. Results The peak angular velocity of trunk extension showed significant main effects on the group factors (LBP group vs. HC group) and their interactions; the value of the kinematic variable was lower at Trial 1 in the LBP group. No LBP participant reported pain during the experiment. The mediation analysis revealed that the relationship between the VAS score for pain intensity over the past 4 weeks and the peak angular velocity of trunk extension in the first trial was completely mediated by the TSK (complete mediation model, 95% bootstrapped CI: 0.07–0.56). Conclusion Individuals with LBP had reduced trunk extension during a lifting task. Generalized fear of movement-related pain may contribute to such impaired trunk movement. Our findings suggest that intervention to ameliorate fear of movement may be needed to improve LBP-associated disability.

Consumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional survey

ObjectivesTo investigate (1) self-reported societal comprehension of common and usually non-serious terms found in lumbar spine imaging reports and (2) its relationship to perceived seriousness, likely persistence of low back pain (LBP), fear of movement, back beliefs and history and intensity of LBP.DesignCross-sectional online survey of the general public.SettingFive English-speaking countries: UK, USA, Canada, New Zealand and Australia.ParticipantsAdults (age >18 years) with or without a history of LBP recruited in April 2019 with quotas for country, age and gender.Primary and secondary outcome measuresSelf-reported understanding of 14 terms (annular fissure, disc bulge, disc degeneration, disc extrusion, disc height loss, disc protrusion, disc signal loss, facet joint degeneration, high intensity zone, mild canal stenosis, Modic changes, nerve root contact, spondylolisthesis and spondylosis) commonly found in lumbar spine imaging reports. For each term, we also elicited worry about its seriousness, and whether its presence would indicate pain persistence and prompt fear of movement.ResultsFrom 774 responses, we included 677 (87.5%) with complete and valid responses. 577 (85%) participants had a current or past history of LBP of whom 251 (44%) had received lumbar spine imaging. Self-reported understanding of all terms was poor. At best, 235 (35%) reported understanding the term ‘disc degeneration’, while only 71 (10.5%) reported understanding the term ‘Modic changes’. For all terms, a moderate to large proportion of participants (range 59%–71%), considered they indicated a serious back problem, that pain might persist (range 52%–71%) and they would be fearful of movement (range 42%–57%).ConclusionCommon and usually non-serious terms in lumbar spine imaging reports are poorly understood by the general population and may contribute to the burden of LBP.Trial registration numberACTRN12619000545167.

Psychometric Properties of the Thai Tampa Scale of Kinesiophobia among Older People with Knee Osteoarthritis

Background: Kinesiophobia is described as fear of physical movement resulting in painful injury. Older adults with knee osteoarthritis usually suffer from joint pain. Assessment of kinesiophobia is beneficial for prevention of further deterioration in performing activity. Even though, the Tampa Scale of Kinesiophobia (TSK-11) has been developed to briefly examine pain related to fear of movement in patients with chronic pain, the TSK-11 Thai version has not been examined for its validity and reliability yet. Objective: To examine psychometric properties of the TSK-11 Thai version. Materials and Methods: A cross-sectional study with 200 older people with knee osteoarthritis living in the northeastern part of Thailand was used in the present study. Participants were asked to complete the demographic questionnaire, the TSK-11-Thai version, the numeric rating scale (NRS), and the Pain Catastrophizing Scale (PCS) Thai version. To confirm the TSK-11 Thai version validity, construct validity was examined using confirmatory factor analysis. Pearson correlation coefficients were used to confirm the TSK-11-Thai version’s convergent validities. For internal consistency reliability, Cronbach’s alpha coefficients were also assessed. Results: The results of confirmatory factor analysis indicated that a two-factor model, including somatic factor and activity avoidance, fitted with the data. The TSK11-Thai version was positively correlated with pain catastrophizing. Cronbach’s alpha coefficients of the total TSK11-Thai version was at 0.77. For subscale, Cronbach’s alpha coefficients of the TSK somatic factor and activity avoidance were 0.61 and 0.69, respectively. Conclusion: The Thai version of TSK-11 has acceptable validity and reliability. The TSK-11-Thai version is suitable to use to examine pain-related fear of movement in patients with knee osteoarthritis for clinical and research purposes. Keywords: Instrument; Knee osteoarthritis; Older people; Pain-related fear of movement; Tampa Scale of Kinesiophobia-Thai version; Psychometric properties; Validation

Fear of Movement/(Re)Injury: An Update to Descriptive Review of the Related Measures

The prevalence of fear of movement (kinesiophobia) in persistent pain ranges from 50 to 70%, and it may hinder the subsequent rehabilitation interventions. Therefore, the evaluation of fear of movement/(re)injury plays a crucial role in making clinical treatment decisions conducive to the promotion of rehabilitation and prognosis. In the decision-making process of pain treatment, the assessment of fear of movement/(re)injury is mainly completed by scale/questionnaire. Scale/questionnaire is the most widely used instrument for measuring fear of movement/(re)injury in the decision-making process of pain treatment. At present, the most commonly used scale/questionnaire are the Tampa Scale for Kinesiophobia (TSK), the Fear-Avoidance Beliefs Questionnaire (FABQ), the Kinesiophobia Causes Scale (KCS), the Athlete Fear-Avoidance Questionnaire (AFAQ), and the Fear-Avoidance Components Scale (FACS). In order to provide necessary tools and references for related research and rehabilitation treatment, this descriptive review is designed as an introduction to the background and content, score system, available language versions, variants of the original questionnaire, and psychometric properties of these scales/questionnaries.

Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women

ObjectivesTo examine contributory factors behind postpartum return-to-running and return to pre-pregnancy running level, in addition to risk factors for postpartum running-related stress urinary incontinence (SUI).Methods881 postpartum women completed an online questionnaire. Clinically and empirically derived questions were created relating to running experiences and multidisciplinary, biopsychosocial contributory factors. Logistic regression was used to determine predictors for return-to-running, returning to pre-pregnancy level of running and running-related SUI.ResultsMedian time to first postpartum run was 12 weeks. Running during pregnancy (OR: 2.81 (1.90 to 4.15)), a high weekly running volume (OR: 1.79 (1.22 to 2.63)), lower fear of movement (OR: 0.53 (0.43 to 0.64)) and not suffering vaginal heaviness (OR: 0.52 (0.35–0.76)) increased the odds of return-to-running. Factors that increased the odds of returning to pre-pregnancy running level were a low weekly running volume (OR: 0.38 (0.26 to 0.56)), having more than one child (OR: 2.09 (1.43 to 3.05)), lower fear of movement (OR: 0.78 (0.65 to 0.94)), being younger (OR: 0.79 (0.65 to 0.96)) and shorter time to running after childbirth (OR: 0.74 (0.60 to 0.90)). Risk factors for running-related SUI were having returned to running (OR: 2.70 (1.51 to 4.76)) and suffering running-related SUI pre-pregnancy (OR: 4.01 (2.05 to 7.82)) and during pregnancy (OR: 4.49 (2.86 to 7.06)); having a caesarean delivery decreased the odds (OR: 0.39 (0.23 to 0.65)).ConclusionRunning during pregnancy may assist women safely return-to-running postpartum. Fear of movement, the sensation of vaginal heaviness and running-related SUI before or during pregnancy should be addressed early by healthcare providers.