Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population.

BACKGROUND: To date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain. METHODS: We included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach's alpha to assess internal consistency, and ceiling and floor effects. RESULTS: The study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains ("somatic focus" and "activity avoidance") and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach's alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed. CONCLUSION: The TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.

Unilateral seated shot-put test, muscle strength, and range of motion on recreational athletes with chronic shoulder pain: Cross-sectional study.

OBJECTIVE: To correlate the functional performance assessed by means of the Unilateral Seated Shot-Put Test (SSPT) with shoulder muscle strength, range of motion (ROM), and handgrip strength in recreational athletes with chronic shoulder pain. METHODS AND MATERIALS: The sample was composed of recreational athletes with nonspecific pain in the dominant shoulder ≥3 months, both sexes, aged between 18 and 45 years. We diagnosed shoulder pain by reporting pain intensity ≥3 points on the Numerical Rating Pain Scale and used the Shoulder Pain and Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Baecke Questionnaire. Moreover, shoulder muscle strength, handgrip strength, ROM, and functional performance using the SSPT were evaluated. We used the Spearman correlation coefficient to investigate the correlation between the variables. RESULTS: Nineteen participants were included. Most of the sample consisted of adult women with adequate body mass and pain predominantly in the right shoulder. We observed higher correlation magnitudes of the SSPT with handgrip strength (rho = 0.818 to 0.833, p < 0.05). Correlations of the SPPT with shoulder musculature strength were of low to moderate magnitude (rho = 0.461 to 0.672, p < 0.05). The only significant correlation (p < 0.05) found was between the SSPT and ROM (horizontal adduction), however, with a weak magnitude (rho <0.50). CONCLUSION: SSPT correlates strongly with handgrip strength and moderately with shoulder muscle strength in recreational athletes with chronic shoulder pain.

Fear of Return to Sport Scale (FRESS): a new instrument for use in injured professional or recreational athletes in rehabilitation.

Objective: To create, develop, and validate the Fear of Return to Sport Scale (FRESS) for injured professional or recreational athletes in rehabilitation. Methods: This is a questionnaire validation study. To determine the structural and construct validity, 192 injured professional or recreational athletes of different sports modalities were included. We used a subsample with 32 participants to analyze test-retest reliability and internal consistency. Main outcome measures were the FRESS, Numerical Pain Scale (NPS), Pain-Related Catastrophizing Thoughts Scale (PCTS), Self-Estimated Functional Inability because of Pain Questionnaire for athletes (SEFIP-sport), and Hospital Anxiety and Depression Scale (HADS). Results: Initially, 25 questions were proposed by the specialists. Of these, 4 questions were excluded due to similarity with others. After applying the content validity coefficient, 8 questions were excluded for presenting a value lower than 0.80, leaving 13 items. The exploratory factor analysis identified the one-dimensional structure of the FRESS with 13 items. However, five items were excluded for presenting high covariance with the error of several other FRESS items in the confirmatory factor analysis. Thus, the final version of the FRESS was defined with one domain and eight items. Regarding the construct validity, we observed a magnitude of correlation varying between 0.257 and 0.470 between the FRESS and the instruments used here. We observed adequate test-retest reliability (intraclass correlation coefficient = 0.896) and internal consistency (Cronbach's alpha = 0.868). Ceiling and floor effects were not observed. Conclusion: The FRESS with one domain and eight items has acceptable measurement properties and its use in clinical and sports environments to measure the fear of returning to sport in injured professional or recreational athletes is supported. Supplementary Information: The online version contains supplementary material available at 10.1007/s11332-022-00975-4.

Measurement properties of the Brazilian version of the Copenhagen Neck Functional Disability Scale in patients with chronic neck pain.

OBJECTIVE: To evaluate the measurement properties of the Brazilian version of the Copenhagen Neck Functional Disability Scale (CNFDS) in patients with chronic neck pain. METHODS: One hundred and five patients were included in the study. The structural validity of the CNFDS was assessed by exploratory and confirmatory factor analysis with the following fit indices: chi-square divided by degrees of freedom (chi-square/df), root mean square error of approximation (RMSEA), comparative fit index (CFI), and Tucker-Lewis index (TLI). To test the construct validity, the CNFDS score was correlated with the Numerical Pain Rating Scale, the Tampa Scale of Kinesiophobia, the Pain-Related Catastrophizing Thoughts Scale, and Neck Disability Index (NDI). A subsample of 43 patients filled the CNFDS at two different times, and test-retest reliability was measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). The internal consistency of the CNFDS was analyzed by Cronbach's alpha. RESULTS: CNFDS presented a unidimensional structure, with goodness of fit indices: chi-square/df = 1.37, CFI = 0.94, TLI = 0.93, RMSEA = 0.059. The CNFDS showed satisfactory results of reliability (ICC = 0.93) and internal consistency (Cronbach's alpha = 0.84). The SEM was 1.72 and the MDC was 4.76. The CNFDS showed a high correlation with the NDI (rho = 0.718) and a low correlation with the other instruments. There were no floor and ceiling effects. CONCLUSION: The Brazilian version of the CNFDS with a one-dimensional structure and 15 items has adequate measurement properties.

Self-Estimated Functional Inability Because of Pain Questionnaire for Athletes: A Reliability and Construct Validity Study.

OBJECTIVE: The purpose of this study was to measure the reliability, internal consistency, construct validity, and floor and ceiling effects of the Brazilian version of the Self-Estimated Functional Inability Because of Pain Questionnaire for athletes (SEFIP-sport). METHODS: This was a validity questionnaire study developed in a university community. Athletes or practitioners of any sport undertaking regular practice (weekly frequency of at least twice a week for at least 6 months), with the ability to read and write in Brazilian Portuguese, were included. We evaluated disability by means of the SEFIP-sport and the Roland-Morris Disability Questionnaire for general pain, pain intensity by means of a numerical rating scale, quality of life by means of the Short-Form Health Survey, and predicted disability by means of the Örebro Musculoskeletal Pain Questionnaire. RESULTS: Two hundred and twenty-one athletes or regular practitioners of sport were recruited and included in the study. We observed adequate values of reliability (κ ≥ 0.40, intraclass correlation coefficient = 0.91), internal consistency (Cronbach's α ≥ 0.81), and correlations (r s ≥ -0.376) of the total SEFIP-sport score with the numerical rating scale; the pain, vitality, and social aspects domains of the Short-Form Health Survey; the Roland-Morris questionnaire; and the Örebro Musculoskeletal Pain Questionnaire. CONCLUSION: The Brazilian Portuguese version of the SEFIP-sport demonstrated adequate psychometric properties for use in athletes.

Program of therapeutic exercises associated with electrotherapy in patients with chronic neck pain: Protocol for a randomized controlled trial.

Conservative treatment is the most common clinical management for the proper rehabilitation of patients with chronic neck pain, and there is a trend towards the use of therapeutic exercise. However, some uncertainty about the efficacy of therapeutic exercises remains, and it is necessary to conduct more studies with high methodological rigor, especially in regard to multimodal treatment, as in the combination of therapeutic exercises with electrotherapy. Thus, the objective of this study will be to evaluate the clinical effects of adding high- and low-frequency transcutaneous electrical nerve stimulation (TENS) in a program of specific therapeutic exercises for the treatment of patients with chronic neck pain. Sixty participants will be randomized into three groups: therapeutic exercise + placebo TENS group (n = 20), therapeutic exercise + high-frequency TENS group (n = 20), and therapeutic exercise + low-frequency TENS group (n = 20). Eight treatment sessions will be performed, and participants will be evaluated before and after the eight sessions and four weeks after the end of treatment. The Numerical Rating Pain Scale, Neck Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Tampa Scale for Kinesiophobia will be used for participant evaluations. In the statistical analysis, a linear mixed model will be applied considering interaction between time and group factors. The addition of this electrotherapeutic modality to a therapeutic exercise program is expected to generate clinical improvements for patients with chronic neck pain, and if the results demonstrate benefits in the treatment group, this form of care could be used.

Thomas Kuhn's 'Structure of Scientific Revolutions' applied to exercise science paradigm shifts: example including the Central Governor Model.

According to Thomas Kuhn, the scientific progress of any discipline could be distinguished by a pre-paradigm phase, a normal science phase and a revolution phase. The science advances when a scientific revolution takes place after silent period of normal science and the scientific community moves ahead to a paradigm shift. I suggest there has been a recent change of course in the direction of the exercise science. According to the 'current paradigm', exercise would be probably limited by alterations in either central command or peripheral skeletal muscles, and fatigue would be developed in a task-dependent manner. Instead, the central governor model (GCM) has proposed that all forms of exercise are centrally-regulated, the central nervous system would calculate the metabolic cost required to complete a task in order to avoid catastrophic body failure. Some have criticized the CGM and supported the traditional interpretation, but recently the scientific community appears to have begun an intellectual trajectory to accept this theory. First, the increased number of citations of articles that have supported the CGM could indicate that the community has changed the focus. Second, relevant journals have devoted special editions to promote the debate on subjects challenged by the CGM. Finally, scientists from different fields have recognized mechanisms included in the CGM to understand the exercise limits. Given the importance of the scientific community in demarcating a Kuhnian paradigm shift, I suggest that these three aspects could indicate an increased acceptance of a centrally-regulated effort model, to understand the limits of exercise.