The relationship between levels of physical activity and participation in everyday life in stroke survivors: A systematic review and meta-analysis.

BACKGROUND: Stroke survivors demonstrate decreased physical activity (PA) and take time to return to participation in everyday life, but the relationship between the two variables is unknown. OBJECTIVE: To investigate the correlation and trajectory over time between levels of PA and participation in everyday life in stroke survivors. METHODS: PubMed, Web of Science, Scopus, SPORTDiscus, Rehabilitation&Sport Medicine Source, and PEDro databases were searched from inception to January 2024. Cross-sectional and prospective studies evaluating both levels of PA and participation in stroke survivors were included. Two reviewers independently conducted the study selection, data extraction, and quality assessment. Meta-analyses of pooled correlation coefficients were calculated when at least two studies reported a correlation coefficient between the same PA and participation outcomes. RESULTS: Of 4962 studies identified, 49 were included in the systematic review. Studies were rated high (55%%) or fair (45%) quality. A wide range of monitoring methodologies for assessing PA and participation were found in the 23 prospective studies. Seven studies were included in the meta-analyses, showing a positive moderate correlation between PA time and participation in activities of daily living (n = 148; r = 0.52; P < 0.01; I2 = 81%) in participants <6 months post-stroke, and between PA time and the participation in all areas (n = 126; r = 0.44; P < 0.01; I2 = 0%) in participants ≥6 months post-stroke. Overall, while PA showed significant improvements over time, participation only showed a tendency. CONCLUSIONS: Despite the heterogeneity, consistent positive associations were found between PA time and participation levels in some areas. Establishing consensus is crucial to reduce heterogeneity and facilitate data pooling.

Recovery of spatio-temporal gait and functional parameters following unilateral eccentric exercise-induced muscle damage in the hamstrings.

OBJECTIVES: This study aimed to analyze how spatiotemporal gait parameters, active knee extension range of motion, muscle activity, and self-perceived function change over a seven-day period in healthy individuals after exercise-induced muscle damage (EIMD) in the hamstrings. DESIGN: Longitudinal cohort study. METHODS: Twenty-four healthy males participated in four sessions before and after EIMD (pre-EIMD, 48 h, 96 h, and 168 h post-EIMD). A single-leg deadlift exercise was performed to provoke EIMD in the hamstrings of the dominant leg. Lower limb function perception, spatiotemporal gait parameters, active knee extension range of motion, and electromyographic (EMG) activity of the semitendinosus and biceps femoris muscles during gait and maximal isometric contraction were assessed bilaterally. RESULTS: At 48 h, the EIMD-side showed reduced step length, active knee extension range of motion, maximal strength and EMG activity compared to baseline (P < 0.042), while increased relative EMG activity in the biceps femoris during gait (P = 0.001). At 96 h, step length and EMG activity on the EIMD-side reached similar values to those at baseline, whereas lower limb function perception and active knee extension range of motion returned to baseline state at 168 h post-EIMD. No changes over time were observed on the control-side. CONCLUSIONS: Recovery from EIMD requires a multimodal assessment since the different parameters affected by EIMD recover at different paces. Active range of motion appears to be the last variable to fully recover. Self-perceived function should not be considered in isolation as it does not represent complete functional recovery.

Does the distribution of musculoskeletal pain shape the fate of long-term sick leave? A prospective cohort study with register follow-up.

ABSTRACT: Although multisite pain can markedly reduce work ability, the relevance of the bodily pain distribution as a predictor of long-term sick leave is still unknown. This study aimed to investigate the association between musculoskeletal pain distributions and long-term sick leave in the general working population of Denmark and included 66,177 currently employed wage earners without long-term sick leave during the prior 52 weeks. Participants reported whether they had pain in the lower extremity (hips/knees), upper extremity (neck/shoulders), or the low back. The analysis controlled for age, sex, year of survey reply, educational level, occupational group, psychosocial work factors, body max index, smoking, leisure-time physical activity, and mental health confounders. The results demonstrated that the risk of long-term sick leave increased with the number of pain sites. Compared with no pain, localized pain in any body region increased the risk/hazard by 25% to 29% (HR [95% CI]: 1.29 [1.07-1.54] for pain only in the low back), whereas pain in 2 regions increased the risk by 39% to 44% (HR [95% CI]: 1.41 [1.18-1.69] for pain in the low back + hips/knees). Workers reporting pain in all 3 regions experienced a 72% increased risk (HR [95% CI]: 1.72 [1.55-1.91]). Thus, the number of pain regions seems to matter more than the exact pain location. The spatial extension of musculoskeletal pain in workers functions as a gradient system, where pain spread throughout the body is an independent indicator of the high risk of long-term sick leave.

Longitudinal Changes and Associations Between Quantitative Sensory Testing and Psychological Factors in Whiplash-Associated Disorders: A Systematic Review and Meta-Analyses-Based Data Synthesis.

Whiplash-associated disorders (WAD) represent a multifactorial condition often accompanied by altered nociceptive processing and psychological factors. This systematic review on acute and chronic WAD aimed to investigate the relationship between quantitative sensory testing (QST) and psychological factors and quantify whether their trajectories over time follow a similar pattern to disability levels. Eight databases were searched until October 2022. When 2 prospective studies examined the same QST or psychological variable, data synthesis was performed with random-effects meta-analysis by pooling within-group standardized mean differences from baseline to 3-, 6-, and 12-month follow-ups. From 5,754 studies, 49 comprising 3,825 WAD participants were eligible for the review and 14 for the data synthesis. Altered nociceptive processing in acute and chronic WAD, alongside worse scores on psychological factors, were identified. However, correlations between QST and psychological factors were heterogeneous and inconsistent. Furthermore, disability levels, some QST measures, and psychological factors followed general positive improvement over time, although there were differences in magnitude and temporal changes. These results may indicate that altered psychological factors and increased local pain sensitivity could play an important role in both acute and chronic WAD, although this does not exclude the potential influence of factors not explored in this review. PERSPECTIVE: Acute WAD show improvements in levels of disability and psychological factors before significant improvements in nociceptive processing are evident. Facilitated nociceptive processing might not be as important as psychological factors in chronic WAD-related disability, which indicates that chronic and acute WAD should not be considered the same entity although there are similarities. Nonetheless, pressure pain thresholds in the neck might be the most appropriate measure to monitor WAD progression.

Identification of the needs of children with neurodisability and their families at different stages of development: A qualitative study protocol.

BACKGROUND: Within the field of childhood neurodisability, the tendency in the study of needs has been to categorize them based on ability (motor, verbal, cognitive). However, current perspectives such as F-words, family-centered practices, or the principles of family empowerment, lead the researcher to ask: What are these needs according to the stage of development? METHODS AND ANALYSIS: A descriptive qualitative study will be carried out. Several methods will be followed to ensure the reliability and validity of the results, and the Standards for Reporting Qualitative Research and the Consolidated criteria for reporting qualitative research checklists will also be used to guide the project. Data collection is sought from three main sources: Focus groups (detection of needs), a survey to collect sociodemographic and clinical data necessary to obtain an overview of the context of the participants, and a survey to find out the level of satisfaction with this initiative. DISCUSSION: The results expected to be obtained after this study will respond to the main needs of families with childhood neurodisability, based on age groups and covering the whole territory of the Spanish population. Thanks to these detected needs, it will be possible to design future lines of work to improve the design of family-centered practices and increase the empowerment of families. The intention is to detect needs by stage of development, which can be categorized within the F-words framework, showing families and professionals a clear picture of the needs of this population.

Sensory, functional and electromyographic variables show different recovery patterns over a seven day period following exercise-induced pain in the hamstrings.

BACKGROUND: Delayed-onset muscle soreness (DOMS) is common after unaccustomed exercises and can restrict performance if intense physical activities are performed while the muscle is still sore. This study aimed to evaluate the recovery process following exercise-induced DOMS over a seven-day period by evaluating sensory, functional, and electromyographic parameters. METHODS: Twenty-four healthy males participated in four experimental sessions (Day-0, Day-2, Day-4, Day-7). Pain perception, pressure pain sensitivity, active range of motion, maximal isometric strength, and muscle activity of the hamstrings during the maximal isometric contraction were assessed bilaterally at each session. A single-leg deadlift eccentric exercise (5-sets of 20-reps) was performed at the end of Day-0 to induce DOMS in the dominant leg. FINDINGS: At Day-2, the DOMS-side showed increased pain sensitivity and decreased active range of motion, strength and muscle activity compared to Day-0 (P < 0.015). Muscle activity on the DOMS-side reached similar values than at baseline on Day-4, whereas pain perception, pressure pain sensitivity, maximal isometric strength, and active range of motion had returned to the baseline state on Day-7. No changes over time were observed on the control-side, showing all variables an excellent reliability between values at Day-0 and Day-7 (Intraclass Correlation Coefficient > 0.90). INTERPRETATION: Surface electromyographic values during a maximal isometric contraction recover faster than the other parameters. Given the heterogeneous path of altered variables towards DOMS recovery, trainers and clinicians should consider a multimodal assessment, including quantitative sensory and functional measures in addition to the subjective perception of recovery.

Relationship between Participation in Daily Life Activities and Physical Activity in Stroke Survivors: A Protocol for a Systematic Review and Meta-Analysis.

Stroke survivors undertake low levels of physical activity and participation in daily life activities, but the correlation between these two domains still carries some degree of uncertainty. This systematic review and meta-analyses-based data synthesis will aim to describe and estimate the relationship between participation in daily life activities and physical activity in stroke survivors. Six databases (MEDLINE/PubMed, Web of Science, Scopus, PEDro, SPORTDiscus, and Rehabilitation & Sport Medicine Source) will be searched. Studies assessing participation alongside physical activity levels in adult stroke survivors in English or Spanish will be included. The study selection, assessment of the risk of bias, and data extraction will be conducted independently by two investigators. If available, correlation values between physical activity and participation outcomes will be extracted. The Hedges-Olkin method will be used for pooling correlation values between participation and physical activity measures. Subgroup analyses will be performed according to the time elapsed since the stroke (i.e., ≤6 months and >6 months). This will be the first systematic review with a meta-analysis to provide information on the relationship between physical activity and participation in stroke survivors. Findings are likely to inform the design of health prevention protocols and the development of healthy behavior change interventions.

Spanish version of the pain beliefs questionnaire: Translation, cross-cultural adaptation, validation, and psychometric properties in a working population.

BACKGROUND: Chronic musculoskeletal pain is a major health problem and a common cause of disability in the workplace. Beliefs related to musculoskeletal pain may influence its onset and perpetuation. Consequently, tools designed to identify potentially harmful beliefs are needed. However, the Pain Beliefs Questionnaire (PBQ) is not available for individuals speaking European-Spanish. OBJECTIVES: To translate and culturally adapt the original English version of the PBQ into European-Spanish and evaluate its psychometric properties among Spanish workers with and without chronic musculoskeletal pain. DESIGN: Study on measurement properties. METHODS: A translation and cultural adaptation process was based on a forward-backward translation process. One hundred fifty-one active workers were included. Participants completed the PBQ (composed of the organic and psychological subscales), the Pain Catastrophizing Scale (PCS), and the Hospital Anxiety and Depression Scale (HADS). Finally, thirty participants completed the PBQ again two weeks later for test-retest reliability. RESULTS: The PBQ showed adequate internal consistency (Cronbach's alpha: 0.72-0.73), good item response stability (weighted Kappa: 0.65-0.90), and reliability (Intraclass Correlation Coefficient: 0.72-0.80). A positive correlation was found between the PCS and the organic subscale (r = 0.403). However, no significant correlations were found between the HADS and the PBQ subscales. Workers with chronic musculoskeletal pain showed greater scores in the organic subscale and lower scores in the psychological subscale than workers without pain. CONCLUSION: The Spanish version of the PBQ was linguistically accurate and acceptable for use by workers with and without musculoskeletal pain.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up.

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Facilitated Central Pain Mechanisms Across the Menstrual Cycle in Dysmenorrhea and Enlarged Pain Distribution in Women With Longer Pain History.

Dysmenorrhea (DYS), or recurrent menstrual pain, is a highly prevalent pain condition among otherwise healthy women. However, the progression of DYS over time and the influence of the menstrual cycle phases need to be better understood. While the location and distribution of pain have been used to assess pain mechanisms in other conditions, they are unexplored in DYS. Thirty otherwise healthy women with severe DYS and 30 healthy control women were recruited into 3 subgroups (n = 10) according to the length of their menstrual history (<5, 5-15, or>15 years since menarche). The intensity and distribution of menstrual pain were recorded. Pressure pain thresholds at abdominal, hip, and arm sites, pressure-induced pain distribution, temporal summation of pain, and pain intensity after pressure cessation over the gluteus medius were assessed at 3 menstrual cycle phases. Compared with the healthy control women, those with DYS showed lower pressure pain thresholds in every site and menstrual cycle phase (P < .05), enlarged pressure-induced pain areas during menstruations (P < .01), and increased temporal summation and pain intensity after pressure cessation in the overall menstrual cycle (P < .05). Additionally, these manifestations were enhanced during the menstrual and premenstrual phases compared to ovulation in women with DYS (P < .01). Women with long-term DYS demonstrated enlarged pressure-induced pain distribution, enlarged menstrual pain areas, and more days with severe menstrual pain compared to the short-term DYS subgroup (P < .01). Pressure-induced and menstrual pain distributions were strongly correlated (P < .001). These findings suggest that severe DYS is a progressive condition underscored by facilitated central pain mechanisms associated with pain recurrence and exacerbation. PERSPECTIVE: Enlarged pressure-induced pain areas occur in DYS, associated with the length of the condition and the distribution of menstrual pain. Generalized hyperalgesia is present throughout the entire menstrual cycle and intensifies during premenstrual and menstrual phases.

Long-term consistency of clinical sensory testing measures for pain assessment.

Background: Understanding the stability of quantitative sensory tests (QSTs) over time is important to aid clinicians in selecting a battery of tests for assessing and monitoring patients. This study evaluated the short- and long-term reliability of selected QSTs. Methods: Twenty healthy women participated in three experimental sessions: Baseline, 2 weeks, and 6 months. Measurements included pressure pain thresholds (PPT) in the neck, upper back, and leg; Pressure-cuff pain tolerance around the upper-arm; conditioned pain modulation during a pressure-cuff stimulus; and referred pain following a suprathreshold pressure stimulation. Intraclass correlation coefficients (ICC) and minimum detectable change (MDC) were calculated. Results: Reliability for PPT was excellent for all sites at 2 weeks (ICC, 0.96-0.99; MDC, 22-55 kPa) and from good to excellent at 6 months (ICC, 0.88-0.95; MDC, 47-91 kPa). ICC for pressure-cuff pain tolerance indicated excellent reliability at both times (0.91-0.97). For conditioned pain modulation, reliability was moderate for all sites at 2 weeks (ICC, 0.57-0.74; MDC, 24%-35%), while it was moderate at the neck (ICC, 0.54; MDC, 27%) and poor at the upper back and leg at 6 months. ICC for referred pain areas was excellent at 2 weeks (0.90) and good at 6 months (0.86). Conclusions: PPT, pressure pain tolerance, and pressure-induced referred pain should be considered reliable procedures to assess the pain-sensory profile over time. In contrast, conditioned pain modulation was shown to be unstable. Future studies prospectively analyzing the pain-sensory profile will be able to better calculate appropriate sample sizes.

Multidimensional analysis of sedentary behaviour and participation in Spanish stroke survivors (Part&Sed-Stroke): a protocol for a longitudinal multicentre study.

INTRODUCTION: Stroke survivors usually experience long-lasting functional, emotional and social consequences that might contribute to sedentary behaviour and participation restrictions, which are important targets to address during rehabilitation. However, the trajectory and inter-relationship between these factors are unknown. METHODS AND ANALYSIS: Part&Sed is a research project based on an observational study design with 6 and 12 months of follow-ups in stroke survivors. In addition, a qualitative analysis of the impact of the stroke on the stroke survivor, validation of the Satisfaction with Daily Occupation-Occupational Balance assessment tool and analysis of the reliability of the Fitbit Inspire 2 activity tracker wristband will be carried out. Participants will be chronic stroke survivors with independent walking capacity. Sociodemographic and clinical data, physical activity, ambulation, sleep, quality of life, anxiety and depression, community participation, and occupational satisfaction and balance, as well as data provided by the activity tracker wristband, will be collected. In addition, if the participant has a primary caregiver, the caregiver will also be monitored. A minimum of 130 participants will be recruited to conduct a random-effects multiple regression model. Mixed models for repeated measures will assess the variation over time of the different variables associated with participation and sedentary behaviour. Psychometric properties (eg, internal consistency, construct validity, test-retest reliability) of the Satisfaction with Daily Occupation-Occupational Balance will be determined. Additionally, intraclass correlation coefficients and minimum detectable change will be calculated to assess intrasubject reliability of physical activity and sleep parameters recorded by the Fitbit Inspire 2. The qualitative analysis process will be carried out using the analysis proposed by Giorgi. ETHICS AND DISSEMINATION: The study received ethical approval from the Spanish Regional Ethics Committee 'Comité de Ética de la Investigación de la Comunidad de Aragón' (PI21/333). The results will be made available via peer-reviewed publications, international conferences and official channels.

Skin temperature normalizes faster than pressure pain thresholds, pain intensity, and pain distribution during recovery from eccentric exercise.

INTRODUCTION: Acute musculoskeletal injuries have diverse symptomatology and a multidimensional recovery process, including changes in swelling, redness, hyperalgesia, and expanded pain distribution. In a small proportion of cases, the tissue heals, although these symptoms persist, reflecting altered peripheral and central pain mechanisms. However, the otherwise healthy multidimensional recovery process following damage and pain is less than clear. The objective was to assess mechanical muscle hyperalgesia, skin temperature, and pain intensity and distribution during the recovery process in response to eccentric exercise in the hamstring muscles. METHODS: Twenty-four healthy males participated in four sessions (Day-0, Day-2, Day-4, and Day-7). Exercise-induced muscle soreness was induced on Day-0 by five sets of 20 repetitions of an eccentric exercise involving the hamstrings on the dominant leg. Each session included assessments of thermography, pressure pain thresholds (PPTs), pain intensity, and area of exercise-induced pain. RESULTS: Decreased PPTs (P < 0.005), higher pain intensity (P < 0.001), and a larger area of pain (P < 0.001) were displayed on Day-2 and Day-4 than Day-0. Skin temperature decreased on Day-2 than Day-0 (P < 0.01) and returned to baseline assessments by Day-4, despite lower temperature than the contralateral tight (P < 0.01). Further, there was a positive correlation between pain intensity and area on Day-2 and Day-4 (P < 0.005), but no for changes in skin temperature. CONCLUSION: Thermographic changes and pain-related variables altered following eccentric exercise demonstrate different recovery times. These results provide insights into potential mechanisms and measures that can be used to assess recovery from exercise-induced damage.

Not just sensitization: sympathetic mechanisms contribute to expand experimental referred pain.

Background: Widespread pain partially depends upon sensitization of central pain mechanisms. However, mechanisms controlling pain distribution are not completely known. The present study sought to assess skin temperature variations in the area of experimentally-induced pain and potential sex differences. Methods: Pressure-pain thresholds (PPTs) were measured on the right infraspinatus muscle. At the end of Day 0, all participants performed an eccentric exercise of the shoulder external rotators to induce muscle soreness 24 hours after. On Day 1, participants indicated on a body chart the area of pain induced by 60 seconds of suprathreshold pressure stimulation (STPS; PPT + 20%) on the right infraspinatus muscle. Skin temperature variations in the area of referred pain were recorded with an infrared thermography camera, immediately before and after the STPS. Results: Twenty healthy, pain-free individuals (10 females) participated. On Day 0, the pre-STPS temperature was higher than the post-STPS temperature on the arm (P = 0.001) and forearm (P = 0.003). On Day 1, the pre-STPS temperature was higher than the post-STPS temperature on the shoulder (P = 0.015), arm (P = 0.001), and forearm (P = 0.010). On Day 0, the temperature decrease after STPS in females was greater than in males on the forearm (P = 0.039). On Day 1, a greater temperature decrease was found amongst females compared with males at the shoulder (P = 0.018), arm (P = 0.046), and forearm (P = 0.005). Conclusions: These findings indicate that sympathetic vasomotor responses contribute to expand pressure-induced referred pain, especially among females.

Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain: A Longitudinal Study.

OBJECTIVES: To longitudinally investigate the relationships between neck/arm disability and pain profile measures in individuals with chronic nonspecific neck pain (NSNP) at baseline, one month, and six months after a standardized physiotherapy intervention. A secondary aim was to compare pain sensitivity of individuals with chronic NSNP at baseline to healthy controls. METHODS: A total of sixty-eight individuals with chronic NSNP and healthy controls were recruited. Neck disability index (NDI), the 11-item disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), temporal summation (TS), pressure pain thresholds (PPTs), pain intensity and pain extent were assessed in individuals with chronic NSNP. For the cross-sectional assessment, TS and PPTs were compared to healthy controls. RESULTS: After following a standardized physiotherapy intervention, local and distal PPTs to the neck region decreased at one and six month follow-ups, respectively. Pain extent decreased at one and six months. Furthermore, a positive correlation between neck/arm disability and pain intensity was found at baseline, whereas moderate positive correlations (e.g., between NDI and pain extent) at baseline, one and six month follow-ups and negative correlations at six months (e.g., between arm disability and PPTs) were found. DISCUSSION: Overall, these findings indicate that pain sensitivity can worsen following treatment despite reduced pain extent and unchanged neck disability and pain intensity scores over a six-month period in individuals with chronic NSNP.

Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2-pilot study for questionnaire development and validation.

OBJECTIVE: The aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders (WMSDs). DESIGN: Data were collected from otherwise healthy workers employed in three service areas at a specialist hospital in Italy: healthcare, administration and ancillary services. SETTING AND PARTICIPANTS: In all, 115 participants were enrolled (67% women; average age 41.5±9.94 years). The content of the tool for WMSDs was derived from three participation rounds of analysis involving a select group of experts who identified the questionnaire domains and items. Participants responded to 89 items in addition to the EuroQol 5 Dimensions Questionnaire (EQ-5D-5L), Fear-Avoidance Beliefs Questionnaire (FABq) and Oswestry Disability Index (ODI). The proportion of missing data and the distribution of responses were analysed for each item. Items with a discrimination index >0.40 and an interitem correlation <0.80 were retained. Factor analysis was performed using the VARIMAX rotation method, factor extraction, and identification, assignment of items to subscales, and assignment of scores to items. Internal consistency, reliability, construct validity and face validity were also assessed. RESULTS: A total of 52 items were included in the factor analysis and four subscales identified: Physical Stress Subscore (six items); Mental Stress Subscore (six items); Job Satisfaction Subscore (four items) and Kinesiophobia/Catastrophizing Subscore (four items). The items in the final questionnaire version had a factor loading >0.7. The questionnaire consisted of 20 items with good internal consistency (Cronbach's alpha 0.81-0.91), reliability (weighted kappa coefficient 0.617-1.00), good construct validity (EQ-5D-5L, r=-0.549, p<0.001; ODI, r=0.549, p<0.001; FABq work, r=0.688, p<0.001) and satisfactory face validity (universal validity index 96.04%). CONCLUSION: The P4Wq is a 20-item, multifactorial self-report risk assessment questionnaire. It may provide a useful tool for screening for WMSDs by specifically addressing back disorders. It investigates risks for individual workers and may inform educational programmes and preventive strategies tailored to a worker's needs. TRIAL REGISTRATION NUMBER: NCT04192604.

European knowledge alliance for innovative measures in prevention of work-related musculoskeletal pain disorders (Prevent4Work Project): protocol for an international mixed-methods longitudinal study.

INTRODUCTION: Work-related musculoskeletal (MSK) pain is a highly prevalent condition and one of the main contributors to disability and loss of work capacity. Current approaches to the management and prevention of work-related MSK pain do not consistently integrate current evidence-based knowledge and seem to be outdated. The Prevent4Work (P4W) Project aims to collect and spread evidence-based information to improve the management and prevention of work-related MSK pain. P4W will longitudinally investigate (1) risk factors associated with the prevalence of work-related MSK pain, (2) predictive factors for new events of work-related MSK pain in the short term and (3) the modification of pain beliefs after participating in evidence-based e-learning courses. METHODS AND ANALYSIS: This project employs a mixed-methods design with international cohorts of workers from Spain, Italy and Denmark. All participants will be assessed using self-reported variables at baseline (ie, cross-sectional design) with follow-up after 3 and 6 months (ie, prospective-predictive design). Throughout the first phase (0-3 months), all participants will be offered to self-enrol in e-learning courses on work-related MSK pain. Changes in pain beliefs (if any) will be assessed. The dataset will include sociodemographic characteristics, physical and psychological job demands, lifestyle-related factors, MSK pain history and pain beliefs. At baseline, all participants will additionally complete the P4W questionnaire developed to detect populations at high risk of suffering work-related MSK pain.Descriptive statistics, binary logistic regression, and analysis of variance will be used to identify the significant factors that influence the history of work-related MSK pain, evaluate the short-term prediction capacity of the P4W questionnaire, and investigate whether workers' participation in e-learning courses will modify their pain beliefs. ETHICS AND DISSEMINATION: The study received ethical approval from the Ethical Committee of San Jorge University (USJ011-19/20). The results will be made available via peer-reviewed publications, international conferences and P4W official channels.

Changes in Pain Sensitivity and Conditioned Pain Modulation During Recovery From Whiplash-associated Disorders.

OBJECTIVE: The objective of this study was to investigate the pain-sensory profile of patients with whiplash-associated disorders (WADs) prior and post 2 weeks of standardized rehabilitation and after a 6-month follow-up. MATERIALS AND METHODS: Twenty-two WAD participants (grade II; 14 women) and 22 sex-matched and age-matched healthy pain-free controls were enrolled. Pressure pain thresholds (PPTs) were assessed at local and distal muscles. Conditioned pain modulation (CPM) of PPTs was assessed using cuff pressure around the upper arm. Referred area of pain following supra-threshold pressure stimulation of the infraspinatus muscle was recorded on a body chart. Psychometric variables (pain intensity, area of perceived pain, pain catastrophizing, kinesiophobia, sleep problems, and depression level) were assessed. WAD group additionally completed the Neck Disability Index. RESULTS: The WAD group demonstrated lower local PPTs compared with controls at all time points (P<0.05) and lower distal PPTs at baseline and at 2 weeks when compared with 6 months (within-group) (P<0.05). The WAD group had a reduced CPM response and larger induced referred pain areas compared with controls (P<0.05), while no within-group changes were observed at any time point. The WAD group reported higher pain intensity and perceived area of pain compared with controls at all time points (P<0.05) and a mean Neck Disability Index score of 41% at baseline, 16% at 2 weeks, and 4% at 6 months. Furthermore, the WAD group reported improvements in all other psychometric variables (P<0.05), although only pain catastrophizing levels were comparable to controls at 2 weeks. DISCUSSION: PPTs but not CPM improved in the WAD group and were comparable to controls following 2 weeks following standardized rehabilitation, indicating that normalization of CPM may not be required to recover from WAD.

Pain referral area is reduced by remote pain.

BACKGROUND: Endogenous pain inhibitory mechanisms are known to reduce pain intensity, but whether they influence the size and distribution of pain referral is unclear. This study aimed to determine if referred pain is reduced by applying a remote, conditioning painful stimulus. METHODS: Twenty-four healthy men participated in this randomized, crossover study with a control and conditioning session. Referred pain was induced from the infraspinatus muscle (dominant side) by a painful pressure for 60 s. When applying pressure, the intensity was adjusted to a local pain intensity of 7/10 on a numerical rating scale. In the conditioning session, tonic painful pressure was simultaneously applied to the non-dominant leg during induction of referred pain. The area of referred pain was drawn onto a digital body chart and size extracted for data analysis. RESULTS: For the total group and in a subgroup with distinct patterns of referred pain (n = 15/24), the pain area perceived in the back and front+back was smaller during the conditioning compared with the control (p < 0.05). No significant difference was found between sessions in a subgroup only demonstrating local pain (n = 9/24). CONCLUSIONS: Engaging the descending noxious inhibitory control reduced the size of pain areas predominately when distinct pain referral was present. Assuming a conditioning effect of descending inhibitory control acting on dorsal horn neurons, these findings may indicate that mechanisms underlying pain referral can be modulated by endogenous control. The findings may indicate that referred pain may be a useful proxy to evaluate sensitivity of central pain mechanisms as previously suggested. SIGNIFICANCE: The current results indicate a link between endogenous inhibition and pain referral. Descending inhibitory control effects on pain referral support a spinal mechanism involved in pain referral. Future studies should investigate whether the spatial characteristics of referred pain (e.g. size, frequency of affected body regions and distribution away from the primary nociceptive stimulus) can useful to evaluate the efficiency of endogenous pain modulation.

Development of the Prevent for Work questionnaire (P4Wq) for assessment of musculoskeletal risk in the workplace: part 1-literature review and domains selection.

OBJECTIVE: This study aims to define appropriate domains and items for the development of a self-administered questionnaire to assess the risk of developing work-related musculoskeletal disorder (WMSD) and the risk of its progression to chronicity. DESIGN: Literature review and survey study. SETTING AND PARTICIPANTS: A literature review and a two-round interview with 15 experts in musculoskeletal pain were performed to identify the available domains for WMSD assessment. INTERVENTIONS AND OUTCOME: To ensure quality, only validated questionnaires were included for the Delphi process. A three-round Delphi method, with three round steps, was used to select the most pertinent and relevant domains and items. RESULTS: Nine questionnaires were identified through the expert discussion and literature review, comprising 38 candidate domains and 504 items. In the first round of the Delphi group, 17 domains reached more than 70% agreement and were selected. In the second round, 10 domains were rejected, while 11 were selected to complete the pool of domains. In the third and final round, 89 items belonging to 28 domains were defined as significant to develop a WMSDs risk assessment questionnaire. CONCLUSIONS: No specific risk assessment questionnaires for WMSDs were identified from the literature. WMSD risk of presence and chronicity can be defined by an assessment tool based on the biopsychosocial model and the fear-avoidance components of chronic pain. The present study provides the formulation and operationalisation of the constructs in domains and items needed for developing and validating the questionnaire.