Direct and Indirect Relationships Between Physical Activity, Fitness Level, Kinesiophobia, and Health-Related Quality of Life in Patients with Rheumatic and Musculoskeletal Diseases: A Network Analysis.

INTRODUCTION: Using a network analysis, the present study investigated the extent to which physical activity (PA), objective fitness level, kinesiophobia, and health-related quality of life (HRQoL) interact in patients with rheumatic and musculoskeletal diseases. The objectives were twofold: 1) to clarify the direct and indirect relationships between these variables while controlling for the shared variance between them, and 2) to establish a potential ranking of influence among them. METHODS: This cross-sectional design study involved patients recruited from a rheumatology unit. One hundred and twenty patients completed self-reported measures of PA, the Tampa scale of kinesiophobia and the 36-item Short-Form Health Survey, and ninety-seven of those patients performed the six-minute walking test and the thirty-second sit-to-stand test. Network analyses were conducted using bootnet and qgraph packages. RESULTS: Weekly time spent on PA, as well as physical fitness measures, were directly linked to kinesiophobia and the HRQoL physical dimension, but indirectly linked to HRQoL mental dimension through the mediation of kinesiophobia. Specifically, weekly PA time had direct relationships to physical functioning, vitality, and role limitations due to physical and emotional problems. Fitness measures had direct relationships with physical functioning, bodily pain, and mental health. The analyses did not clearly highlight one variable as the most influential in the network. DISCUSSION: The study highlights the complexities of direct and indirect biopsychosocial relationships that are at the core of patients' daily functioning. Measurement of PA, use of a longitudinal design, and interventions are discussed.

Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this review was to investigate the relationship between prenatal exercise, and low back (LBP), pelvic girdle (PGP) and lumbopelvic (LBPP) pain. DESIGN: Systematic review with random effects meta-analysis and meta-regression. DATA SOURCES: Online databases were searched up to 6 January 2017. STUDY ELIGIBILITY CRITERIA: Studies of all designs were eligible (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (prevalence and symptom severity of LBP, PGP and LBPP). RESULTS: The analyses included data from 32 studies (n=52 297 pregnant women). 'Very low' to 'moderate' quality evidence from 13 randomised controlled trials (RCTs) showed prenatal exercise did not reduce the odds of suffering from LBP, PGP and LBPP either in pregnancy or the postpartum period. However, 'very low' to 'moderate' quality evidence from 15 RCTs identified lower pain severity during pregnancy and the early postpartum period in women who exercised during pregnancy (standardised mean difference -1.03, 95% CI -1.58, -0.48) compared with those who did not exercise. These findings were supported by 'very low' quality evidence from other study designs. CONCLUSION: Compared with not exercising, prenatal exercise decreased the severity of LBP, PGP or LBPP during and following pregnancy but did not decrease the odds of any of these conditions at any time point.

Clinical experience changes the combination and the weighting of audio-visual sources of information.

OBJECTIVE: Although audio and visual information constitute relevant channels to communicate pain, it remains unclear to what extent observers combine and weight these sources of information when estimating others' pain. The present study aimed to examine this issue through the theoretical framework of the Information Integration Theory. The combination and weighting processes were addressed in view of familiarity with others' pain. METHOD: Twenty-six participants familiar with pain (novice podiatry clinicians) and thirty non-specialists were asked to estimate the level of pain associated with different displayed locomotor behaviors. Audio and visual information (i.e., sound and gait kinematics) were combined across different intensities and implemented in animated human stick figures performing a walking task (from normal to pathological gaits). RESULTS: The novice clinicians and non-specialists relied significantly on gaits and sounds to estimate others' pain intensity. The combination of the two types of information obeyed an averaging rule for the majority of the novice clinicians and an additive rule for the non-specialists. The novice clinicians leaned more on gaits in the absence of limping, whereas they depended more on sounds in the presence of limping. The non-specialists relied more on gaits than on sounds. Overall, the novice clinicians attributed greater pain levels than the non-specialists did. CONCLUSION: Depending on a person's clinical experience, the combination of audio and visual pain-related behavior can qualitatively change the processes related to the assessment of others' pain. Non-verbal pain-related behaviors as well as the clinical implications are discussed in view of the assessment of others' pain.

Contribution of Load Expectations to Neuromechanical Adaptations During a Freestyle Lifting Task: A Pilot Study.

OBJECTIVES: The main goal of this study was to determine to what extent load expectations modulate neuromechanical adaptations in individuals with and without chronic low back pain (cLBP) when lifting and lowering various loads. The second goal was to assess the feasibility of a simple lifting protocol during which expectations about loads were manipulated. METHODS: Seventeen participants with cLBP and 18 participants without low back pain were asked to lift and lower boxes of mild to moderate loads. Two kinds of expectations (lighter and heavier) were respectively associated to each experimental block. Self-reported exertion was assessed to control for expectations modulation. Erector spinae and vastus lateralis electromyography (EMG) activity were recorded and kinematics angle calculated. RESULTS: The results showed a main effect of expectations, with loads introduced as heavier being associated to a higher exertion compared with loads introduced as lighter. EMG activity analyses revealed significant interaction involving expectations, movement phase, and loads, as well as significant differences between groups. Kinematic angles did not reveal any significant effect of expectations nor group during the lifting phase. CONCLUSIONS: Psychological factors may contribute to neuromechanical adaptations to low back pain. Our preliminary findings show that expectations about loads may result in neuromechanical differences between individuals with cLBP and those without cLBP. This pilot study showed that testing the manipulation of expectations and EMG records was feasible but highlighted the need to go beyond single infrared markers to assess kinematics.

Passion for leisure activity contributes to pain experiences during rehabilitation.

The primary aim of this study was to determine whether the levels of obsessive passion (OP) and harmonious passion for a suspended leisure activity contribute to pain catastrophizing and pain intensity in patients undergoing the rehabilitation process. The secondary aim was to examine whether the levels of passion associated with a maintained leisure activity offset the contribution of having a leisure activity suspended to pain intensity and catastrophizing. Ninety-one outpatients from functional rehabilitation units (Mage=37, SD=13.44 years) completed measures of pain catastrophizing, pain intensity, and passion about valued leisure activities (one they were prevented from practicing and one they remained able to practice). Correlation analysis showed that the level of OP for a suspended valued leisure activity was positively associated with pain catastrophizing and pain intensity. Results showed that pain catastrophizing mediated the relationship between this level of passion and pain intensity. The levels of harmonious passion and OP for a maintained valued leisure activity did not offset the contribution of OP for a suspended leisure activity to pain-related outcomes. When prevented from practicing a valued leisure activity, only OP contributes to the prediction of pain catastrophizing and pain intensity. The contribution of pain catastrophizing provides a potential explanation for why the level of OP for a suspended leisure activity is related to pain intensity ratings. The benefits of maintaining a valued leisure activity during rehabilitation do not seem sufficient to counterbalance the maladaptive effects of being prevented from the practice of a previous/another valued leisure activity.