Motivational Determinants of Objective Physical Activity in Women with Fibromyalgia Who Attended Rehabilitation Settings

Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.

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

Information about task progress modulates cognitive demand avoidance

People tend to avoid engaging in cognitively demanding tasks unless it is ‘worth our while’—that is, if the benefits outweigh the costs of effortful action. Yet, we seemingly partake in a variety of effortful mental activities (e.g. playing chess, completing Sudoku puzzles) because they impart a sense of progress. Here, we examine the possibility that information about progress—specifically, the number of trials completed of a demanding cognitive control task, relative to the total number of trials to be completed—reduces individuals’ aversion to cognitively effort activity, across four experiments. In Experiment 1, we provide an initial demonstration that presenting progress information reduces individuals’ avoidance of cognitively demanding activity avoidance using a variant of the well-characterized Demand Selection Task (DST). The subsequent experiments buttress this finding using a more sophisticated within-subjects versions of the DST, independently manipulating progress information and demand level to further demonstrate that, 1) people prefer receiving information about temporal progress in a task, and 2) all else being equal, individuals will choose to exert greater levels of cognitive effort when it confers information about their progress in a task. Together, these results suggest that progress information can motivate cognitive effort expenditure and, in some cases, override individuals’ default bias towards demand avoidance.

What Does the Psychological Flexibility Model Contribute to the Relationship Between Depression and Disability in Chronic Pain? The Role of Cognitive Fusion and Pain Acceptance

This study examines the mediator role of cognitive fusion between depressive symptoms, activity avoidance and excessive persistence at different levels of pain acceptance (moderator) among fibromyalgia patients (FM). Using a sample of 231 women, multiple and moderate mediation analyses were conducted with PROCESS. Results showed that depression was positively associated with activity avoidance and excessive persistence. Furthermore, cognitive fusion and pain acceptance were found to mediate the effect of depression in both patterns. Additionally, pain acceptance was found to play a contextual role in cognitive fusion, as a moderator, between depressive symptoms and maladaptive patterns. Specifically, FM patients with high acceptance levels and low levels of depression presented the strongest associations between depression and cognitive fusion. Techniques aimed at reducing cognitive fusion, could be especially beneficial to FM women with high pain acceptance.

Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients

The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15–27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: ‘Fatigue-avoidance goal’ and ‘Mood-management goal’ (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.

Fall-Related Activity Avoidance among Persons with Late Effects of Polio and Its Influence on Daily Life: A Mixed-Methods Study

Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.

Activity Patterns and Functioning. A Contextual–Functional Approach to Pain Catastrophizing in Women with Fibromyalgia

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.