Fear Avoidance Research Articles

Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana

Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.

Self-reported physical function is strongly related to pain behavior and pain interference and weakly related to physical capacity in people with chronic low back pain

BackgroundInclusion of self-reported and capacity-based measures may help to further elucidate the interactive link between how people think and move. ObjectiveTo characterize the relationship between self-reported factors of physical function and pain with objective physical capacity measures. DesignCross-sectional study of 328 adults with chronic low back pain (CLBP). MethodSpearman correlations assessed the relationship between pairs of measures. Multiple linear regression models assessed the association between self-reported measures of physical function and the grouping of physical capacity measures. Self-reported measures included Roland Morris Disability Questionnaire (RMDQ), PROMIS Physical Function, Pain Behavior, and Pain Interference; Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and Chronic Pain Acceptance Questionnaire (CPAQ). Capacity measures included walking speed and endurance, lower extremity functional strength, lumbopelvic range of motion, and trunk endurance. ResultsPROMIS Physical Function was directly and weakly correlated with walking speed (ρ = 0.26, 2-min walk) and inversely and weakly correlated with lower extremity strength (ρ = −0.29, 5x sit-to-stand). RMDQ was not correlated with any of the capacity-based measures. PROMIS Physical Function was inversely and moderately correlated with Pain Interference (ρ = −0.48) and Pain Behavior (ρ = −0.43), PCS (ρ = −0.36), and FABQ (ρ = −0.31). The RMDQ was strongly correlated with PROMIS Physical Function (ρ = −0.56), Pain Behavior (ρ = 0.51) and Pain Interference (ρ = 0.49); and moderately correlated with PCS (ρ = 0.37) and FABQ (ρ = 0.33). PROMIS Physical Function and RMDQ were not correlated with CPAQ. Lower scores on PROMIS Physical Function were weakly associated with lower measures of lower extremity strength (−0.30, 95% CI: −0.51 to −0.09, p = 0.005). Higher scores on RMDQ were also weakly associated with lower measures of lower extremity strength (0.26, 95% CI: 0.11 to 0.41, p = 0.001). ConclusionsA strong association emerged between self-reported limitations in physical function, pain behavior, and pain interference. A weak association emerged between self-reported physical function and lower extremity strength.

The Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRQ): Development, reliability and validity across several long-term conditions.

Cognitive and behavioural responses to symptoms can worsen or maintain the severity of symptoms across long-term conditions (LTCs). Although the Cognitive and Behavioural Responses Questionnaire (CBRQ) has been used in research, its original development and psychometric properties as a transdiagnostic measure have not been reported. Our aim was to evaluate the psychometric properties of the CBRQ and a recently proposed short version, across different LTCs. Psychometric validation study. Confirmatory factor analysis (CFA) tested the factor structure of the CBRQ in two datasets from the CBRQ's original development; (chronic fatigue syndrome, N=230; and multiple sclerosis, N=221) and in additional groups: haemodialysis (N=174), inflammatory bowel disease (N=182) and chronic dizziness (N=185). Scale reliability and construct validity were assessed. The factor structure of the shortened CBRQ (CBRQ-SF) was also assessed. CFA revealed that a 7-or 8-factor structure had generally appropriate fit supporting the originally proposed 7 factors (Fear avoidance, Damage beliefs, Catastrophising, Embarrassment avoidance, Symptom focusing, All-or-nothing behaviour and Avoidance/Resting behaviour). Omega coefficients indicated satisfactory internal reliability. Correlations with related constructs suggested construct validity. The scale appeared sensitive to change. The CBRQ-SF also displayed good psychometric quality, with a better model fit than the CBRQ. The CBRQ and the shortened version were shown to be reliable and valid at assessing a range of cognitive and behavioural responses to symptoms, highlighting the multi-symptom, transdiagnostic properties of this questionnaire. Further research is necessary to determine the test-retest reliability and sensitivity to change of the CBRQ and CBRQ-SF and a thorough evaluation of the content validity of the items.

The Indonesian Version of the Liebowitz Social Anxiety Scale - Self Report (LSAS-SR-Indonesia): Psychometric Evaluation and Analysis Related to Gender and Age

Aim: This study aimed to examine the psychometric properties of the Indonesian version of LSAS-SR (LSAS-SR-Indonesia), and determine the analysis related to gender and age. Background: A previous study reported that social anxiety exists in Indonesia. The psychometric properties of the instruments were not reported because it was not the focus of the study. Further studies were recommended, and it was necessary to develop an instrument for social anxiety in Indonesian (Bahasa Indonesia). The Liebowitz Social Anxiety Scale (LSAS) is one of the most frequently used scales for assessing social anxiety. The psychometric properties of LSAS-SR-Indonesia must be assessed so that the instrument can be more properly used. Objective: This study examined the psychometric properties of LSAS-SR-Indonesia, including internal consistency and item discrimination, as well as validity (convergent, internal structure, factorial, and content). In addition to the psychometric properties, this study analyzed its correlation to gender and age. Methods: A total of 2074 participants from the general population were involved in the current cross-sectional study applying multi-stage cluster sampling. They lived in seven big cities in Indonesia, representing the major ethnic groups, i.e., Bandung, Denpasar, Banjarmasin, Makassar, Yogyakarta, Padang and Medan. The participants were 16-38 years old, and 73% of them were female. The internal consistency was analyzed using a coefficient of Cronbach’s alpha, and the item discrimination was examined by calculating the corrected item-total correlation. Convergent validity was analyzed using the correlation with the Brief Fear of Negative Evaluation Scale (BFNE) and the Taijin Kyofusho Scale (TKS) using Pearson Product Moment Correlation. Internal structure validity was examined using Pearson Product Moment Correlation between LSAS subscales (LSAS Fear and LSAS Avoidance) and their subscales (LSAS Fear Performance, LSAS Avoidance Performance, LSAS Fear Social Interaction, LSAS Avoidance Social Interaction). Factorial validity was used to analyze construct validity using Confirmatory Factor Analysis (CFA). Content validity was carried out using the evaluation of an expert panel. The analysis of gender and age was performed using factorial analysis of variance (ANOVA). All the statistical analysis was performed using the computer programs SPSS v.21 and LISREL v.10.3. Results: The LSAS-SR-Indonesia has good internal consistency. The majority of items demonstrate good discrimination. A good convergent validity is found in the total score and the two subscales. The internal structure is empirically proved. All factor models fit the data, and RMSEA, RMR, NNFI, CFI, and AGFI are in the fit range. The CFA demonstrates that all items in all models have a significant loading factor of 5%. The result of the content validity shows a high degree of relevance and representativeness, with an agreement of 60-100%. There are significant differences both in fear and avoidance across gender. However, there are no significant differences in fear and avoidance across ages. Conclusion: The LSAS-SR-Indonesia is a reliable and valid instrument to assess social anxiety symptoms in Indonesia. It can be used to identify and assist in the preparation for promotion and intervention programs to prevent the development of the symptoms.

The burden of preoperative fear-avoidance beliefs in workers after thoracic and lumbar spine surgery: a 2-year follow-up study.

Spinal disorders are the main reasons for sick leave and early retirement among the working population in industrialized countries. When "red flags" are present, spine surgery is the treatment of choice. However, the role of psychosocial factors such as fear-avoidance beliefs in spine surgery outcomes is still debated. The study aims to investigate whether patients presenting high or low levels of fear-avoidance thoughts before the spine surgery reported different surgical results and return-to-work rates over 2 years. From an institutional spine surgery registry, workers surgically treated with a preoperative score in the Oswestry Disability Index (ODI) higher than 20/100 and provided ODI questionnaires, return-to-work status at 3-, 6-, 12-, and 24-month follow-ups were analyzed. A total of 1769 patients were stratified according to the work subscale of the Fear-Avoidance Beliefs Questionnaire (FABQ-W) in high fear (FABQ-W ≥ 34/42) or low fear (FABQ-W < 34/42). Multivariate regression was used to search for preoperative factors, which might interact with FABQ-W. The higher-fear group showed a different recovery pattern, with higher levels of disability according to the ODI (total score, absolute change, frequency of clinically relevant change, and disability categories) and lower return-to-work ratios over the 24-month follow-up. High fear, high disability, greater age, female gender, smoking, and worse physical status at baseline were associated with worse ODI outcomes 2 years after the surgery. In summary, fear-avoidance beliefs significantly influence the speed and the entity of surgical outcomes in the working population. However, the contribution of FABQ-W in predicting long-term disability levels was limited.

Knowledge related to low back pain and its associated factors in patients with low back pain: A cross-sectional study.

Patients' knowledge about low back pain (LBP) negatively influences LBP prognosis. Studying the extent of patients' knowledge about LBP may help clinicians design effective LBP treatment strategies. To explore the level of LBP knowledge and its associated factors in patients with LBP. A cross-sectional study with a representative sample. Participants with acute or chronic LBP completed a self-administered questionnaire including sociodemographic and clinical characteristics. We used the Low Back Pain Knowledge Questionnaire (LBP_KQ) to assess knowledge, the Fear-Avoidance Beliefs Questionnaire for LBP (FABQ_LBP) to assess fear of movement, the Oswestry Disability Index (ODI) to assess functional disability, Depression Anxiety Stress Scales (DASS 21) to assess mental health status, and the Numeric Pain Rating Scale (NPRS) to assess pain intensity. A total of 271 individuals with LBP completed the study. The mean age of participants was 39.86 (± 11.27), the LBP chronicity median was 18 (IQR = 44) months, and 56.5% of the participants were females. The mean LBP_KQ score was 9.29 (± 3.89)/24. An educational level higher than high school (diploma education (β= 1.202 [95%CI: 5.633 to 11.498], p< 0.001), bachelor or higher education (β= 2.270 [95%CI: 1.107 to 3.433], p< 0.001)), and using pain killers (β= 1.180 [95%CI: 0.140 to 2.221], p= 0.026) were significantly associated with higher LBP_KQ score. While being employed (β=-1.422 [95%CI: -2.462 to -0.382], p= 0.008) and having higher DASS Anxiety score (β=-0.144 [95%CI: -0.240 to -0.048], p= 0.003) were significantly associated with lower LBP_KQ score. Individuals with chronic LBP in Jordan demonstrated relatively low levels of LBP knowledge related to their condition. Rehabilitation personnel, healthcare stakeholders, and policymakers should carefully monitor the level of LBP knowledge and its associated factors.

Correlation of Toe Grip Strength among Individuals with Knee Osteoarthritis with and without Fear of Pain: A Cross-sectional Study

Introduction: Knee Osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide. It is characterised by progressive loss of joint cartilage, resulting in pain, stiffness, and significant disability, leading to a reduced quality of life. Fear of pain is a significant psychosocial factor that affects individuals with knee OA, leading to decreased physical activity. However, the relationship between Toe Grip Strength (TGS) and fear of pain in individuals with knee OA is poorly understood, even though fear of pain has been known to impact strength in both the upper and lower limbs. Aim: To examine the correlation between fear and TGS among individuals with knee OA, both with and without fear of pain. Materials and Methods: This cross-sectional study was conducted at the Department of Physiotherapy, Nitte Institute of Physiotherapy, affiliated with the University of Mangalore, Karnataka, India, from April 2022 to March 2023. The study included 60 individuals, with 30 in each group, diagnosed with knee OA using the Kellgren and Lawrence (KL) grading system (grade 2 and above). The participants, both men and women aged between 45 and 80 years, were informed about the study’s purpose. The Fear Avoidance Belief Questionnaire (FABQ) form was completed by the screened patients, who were then divided into fear and non fear groups. Body Mass Index (BMI) was determined by measuring height with a wall-mounted device and weight using a traditional analog scale. TGS was evaluated in both groups using a pinch grip dynamometer. The Pearson correlation coefficient was used for data analysis, with a p-value &lt;0.05 considered statistically significant. Results: The results of the current study indicated that the FABQ showed a negative correlation (p-value &gt;0.05) with TGS (both right and left-side) (r: -0.296 (right) and -0.302 (left)), and a positive correlation (p-value&lt;0.05) with the Numerical Pain Rating Scale (NPRS) (both during activity and at rest). Conclusion: This study revealed a significant association between fear and TGS in individuals with knee OA. Notably, Fear Avoidance Beliefs (FAB) exhibited a negative correlation with TGS while demonstrating a positive correlation with pain levels.

Exploring the Relationships Among Bias-Based Bullying, Fear, and School Avoidance in a National Sample of U.S. Adolescents: The Role of School Counselors

This study examined the associations among experiencing bias-based bullying on multiple social identities, fear, and school avoidance. The sample included 1177 adolescents who experienced bullying in a nationally representative dataset. Results indicated that 42% of students who were bullied reported that this was due to biases. We found a significant moderating effect of bias-based bullying between fear and school avoidance. We present suggestions for school counselors, including multitiered systems of support and trauma-informed approaches.

Scary Snakes and Cuddly Frogs: Exploring the Role of Storybooks in Children's Fear and Behavioral Avoidance of Animals

Abstract: Animal fears are common, emerging in early childhood and often continuing into adulthood. This study explores the outcomes of positive and negative storybooks about animals on children's attitudes and behaviors. Ninety-six children (ages 4–8 years) were exposed to either negative or positive information about two animals (snakes and frogs) via age-appropriate storybooks, and fear beliefs and avoidance behaviors were then measured. Our results suggest that prior knowledge influences learning and behavior, with children exhibiting more fear towards snakes than frogs, regardless of condition. Accordingly, children who showed fewer fear beliefs were more likely to reach for the animals. In addition, storybook information impacts learning and fear, with children exhibiting more fear in the negative storybook conditions than positive storybook conditions. Storybook information also influenced behavioral avoidance, especially for snakes, with more children reaching for the snake when they received positive information rather than negative information. Additionally, across negative conditions, more children reached for the frog compared to the snake. Finally, parental and child characteristics were associated with more both self-reported fear and observed fear. Implications for parents and educators are discussed.

Informal caregiver training for people with chronic pain in musculoskeletal services (JOINT SUPPORT): protocol for a feasibility randomised controlled trial

IntroductionChronic musculoskeletal (bone, joint or muscle) pain is disabling. People with it frequently have difficulties in managing everyday activities. Individuals may rely on family members or friends to support them....

Fear-Avoidance Beliefs for Physical Activity Among Chronic Low Back Pain: A Multicenter Cross-Sectional Study.

Among different psychological predictors of outcome in low back pain (LBP) adults, the negative influence of fear-avoidance beliefs in physical activity is an area of research attention. However, there is a lack of evidence on the burden of fear avoidance about physical activity among chronic LBP adults in Ethiopia. To describe fear-avoidance beliefs about physical activity and explore its association with socio-demographic and clinical factors among low back pain patients attending physiotherapy treatment in 3 Amhara regional comprehensive hospitals. A multi-center cross-sectional study was conducted and adults with chronic LBP (n = 263) participated. Data were collected by face-to-face interview using the modified Fear-Avoidance Belief Questionnaire about Physical Activity (mFABQ-PA) tool. Multivariable logistic regression at a p-value <0.05 significance level was used to identify predictors of fear-avoidance beliefs about physical activity. Among the 263 participants, 113 subjects (43%, 95% CI (36.9-49.0)) reported a higher cut-off (>15) mFABQ-PA. The logistic regression model demonstrated that LBP adults with a higher mFABQ-PA score were more likely to be urban residents (AOR 2.75, 95% CI (1.32, 5.88)), and ADL-related LBP (AOR 1.97 95% CI (1.18, 3.29)). The clinical-specific factor indicative of a higher cut-off score of mFABQ-PA was using analgesic medications (AOR 2.00, 95% CI (1.19, 3.37)). The model fit was 0.21 and 0.11 (R2 = Nagelkerke's, Cox & snell respectively). High fear avoidance beliefs about physical activity in adults with low back pain were found and associated with residence, work, and medication intake. These findings might urge the researchers to explore further associations and assist clinicians in choosing subgroups to use behavioral therapy and graded exposure to physical activity.

Functional performance and psychological readiness after 1–10 years ACL reconstruction: A comparison between dominant and nondominant legs

Background &amp; Aims: Injuries to the anterior cruciate ligament (ACL) are among the most common types of injuries that occur during sport activities. Some studies reported that the dominance leg is significant predictor for ACL injuries. However, it is unclear whether the dominant or non-dominant leg impacts functional status and psychological readiness to return to sport after ACL. The purpose of this study was to determine if there are difference in functional performance and psychological readiness to return to sport between individuals who injured their dominant leg and non-dominant leg after 1-10 years following ACL reconstruction. Methods: A cross-sectional study of 50 participants between 20 and 38 years was conducted, to investigate individuals who injured their dominant leg (n=25) and non-dominant leg (n=25) after 1-10 years following ACL reconstruction. All participants complete Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI), the Lower Extremity Functional Scale (LEFS) questionnaires and Fear Avoidance Belief Questionnaire physical activity (FABQ-PA). Results: No significant difference was found between the dominant leg and non-dominant leg groups in ACL-RSI, LEFS and FABQ-PA (U = 256, p = 0.27; U = 314.5, p = 0.96, and U=279.5 p=0.52) respectively. Conclusions: While it is essential to investigate the functional performance and patient's psychological state, dominance vs non- dominance leg does not influence these outcomes 1-10 years following ACL reconstruction. Therefore, injuries either dominance or non-dominance leg demonstrate equal long-term improvement. To enhance rehabilitation and optimize long-term functional outcomes for individual undergoing ACL reconstruction, future research should investigate other factors that impact recovery and return-to-sport outcomes.

The validity and reliability of Turkish adaptation of the Fear-Avoidance Beliefs Questionnaire in patients with neck pain.

"Fear-avoidance behavior" means that the individual avoids a specific activity or movement due to the perception that it may cause injury. Fear of movement associated with pain can reduce individuals' adaptation to exercise programs. This situation may cause individuals to refrain from taking action and increase the existing limitation. Our aim is investigating of Fear-Avoidance Beliefs Questionnaire (FABQ) in patients with neck pain and creating a questionnaire option for clinicians and researchers to evaluate the fear-avoidance behavior in neck pain in Turkish. The sample of the research was comprised 175 patients between the ages of 18-65, who have a complaint of neck pain that lasted for at least 3 months. The test was applied on patients with neck pain and no treatment, with an interval of 2-7 days. The Visual Analog Scale (VAS), Neck Disability Index (NDI), and Nottingham Health Profile (NHP) were applied on the participants to evaluate the validity of the FABQ. Accordingly, between FABQ and NHP (r=0.227), pain (NHPP) (r=0.214), emotional reactions (r=0.220), and physical activity (NHPPA) (r=0.243), a weak relationship was observed. A weak correlation was observed between physical activity (FABQ-PA) which are subscales of the FABQ questionnaire and NDI (r=0.210), NHPP (r=0.205), and NHPPA (r=0.267). FABQ is a valid and reliable tool for patients with neck pain. In our study, a weak relationship was detected between FABQ, NDI, and NHP, as like VAS.

The Expression of miRNAs Involved in Long-Term Memory Formation in the CNS of the Mollusk Helix lucorum

Mollusks are unique animals with a relatively simple central nervous system (CNS) containing giant neurons with identified functions. With such simple CNS, mollusks yet display sufficiently complex behavior, thus ideal for various studies of behavioral processes, including long-term memory (LTM) formation. For our research, we use the formation of the fear avoidance reflex in the terrestrial mollusk Helix lucorum as a learning model. We have shown previously that LTM formation in Helix requires epigenetic modifications of histones leading to both activation and inactivation of the specific genes. It is known that microRNAs (miRNAs) negatively regulate the expression of genes; however, the role of miRNAs in behavioral regulation has been poorly investigated. Currently, there is no miRNAs sequencing data being published on Helix lucorum, which makes it impossible to investigate the role of miRNAs in the memory formation of this mollusk. In this study, we have performed sequencing and comparative bioinformatics analysis of the miRNAs from the CNS of Helix lucorum. We have identified 95 different microRNAs, including microRNAs belonging to the MIR-9, MIR-10, MIR-22, MIR-124, MIR-137, and MIR-153 families, known to be involved in various CNS processes of vertebrates and other species, particularly, in the fear behavior and LTM. We have shown that in the CNS of Helix lucorum MIR-10 family (26 miRNAs) is the most representative one, including Hlu-Mir-10-S5-5p and Hlu-Mir-10-S9-5p as top hits. Moreover, we have shown the involvement of the MIR-10 family in LTM formation in Helix. The expression of 17 representatives of MIR-10 differentially changes during different periods of LTM consolidation in the CNS of Helix. In addition, using comparative analysis of microRNA expression upon learning in normal snails and snails with deficient learning abilities with dysfunction of the serotonergic system, we identified a number of microRNAs from several families, including MIR-10, which expression changes only in normal animals. The obtained data can be used for further fundamental and applied behavioral research.

A Confirmatory Factor Analysis of the ‘Return to Duty Readiness Questionnaire’

The Readiness to Return to Duty Questionnaire (RDRQ) is a recently developed screening instrument for detecting fear-avoidance behavior in a military musculoskeletal pain population. The RDRQ was developed based on the Fear-Avoidance Model which postulates four factors resulting in overall fear-avoidance behavior. While research investigating the factor structure of the RDRQ does not exist, research investigating the factor structure of other measures of fear avoidance have found evidence of one and two factor solutions. In the present paper we assess the adequacy of the proposed factor structure of the RDRQ using confirmatory factor analysis. The results favor a three-factor model. Theoretical implications for research using the RDRQ are discussed.

Reduction in pain-related fear is not associated with improvement in spinal biomechanics but with decrease in movement-evoked pain in patients with chronic low back pain.

While a causal relationship between pain-related fear and spinal movement avoidance in patients with chronic low back pain (CLBP) has frequently been postulated, evidence supporting this relationship is limited. This study aimed to test if decreases in pain-related fear or catastrophizing were associated with improvements in spinal biomechanics, accounting for possible changes in movement-evoked pain. Sixty-two patients with CLBP were assessed before and after an interdisciplinary rehabilitation program (IRP). Pain-related fear was assessed with general and task-specific measures. Lower and upper lumbar angular amplitude and velocity as well as paraspinal muscle activity were recorded during five daily-life tasks to evaluate spinal biomechanics. Relationships were tested with multivariable linear regression analyses. The large decreases in pain-related fear and catastrophizing following the IRP were scarcely and inconsistently associated with changes in spinal biomechanics (< 3% of the models reported a statistically significant association). Results remained comparable for activities inducing more or less fear, for specific or general measures of pain-related fear, and for analyses performed on the entire population or limited to subgroups of patients with higher levels of task-specific fear. In contrast, reductions in task-specific pain-related fear were significantly associated with decreases in movement-evoked pain in all tasks (r=0.26-0.62, p ≤ 0.02). This study does not support an association between pain-related fear and spinal movement avoidance. However, it provides evidence supporting a direct relationship between decreased pain-related fear and decreased movement-evoked pain, possibly explaining some mechanisms of the rehabilitation programs.

Are fascial strains involved in chronic pelvic pain syndrome? An exploratory matched case-control study.

Chronic pelvic pain (CPP) and chronic pelvic pain syndrome (CPPS) do not have a definite cause, even if their impact on quality of life was demonstrated. Furthermore, there is evidence of myofascial dysfunctions in a large number of CPP/CPPS, so that the role of fascia can be hypothesized. The aim of this exploratory matched case-control study was to assess whether fascial strains (FS) represent a factor associated with CPP/CPPS. The study followed the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) statement. We collected data from 189 subjects (cases: 58; controls: 131) who attended the clinic. The participants were managed through a 2:1 enrollment ratio. A standardized booklet requested for clinical information, previous FS and the following questionnaires: "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI), "Hospital Anxiety and Depression Scale" (HADS), "Fear Avoidance Belief Questionnaire" (FABQ). Each subject underwent a palpatory assessment to detect abnormal palpatory findings in the pelvic area. The analyses showed that episiotomy, genito-urinary infections and surgery had a significantly increased odds ratio (OR) of 4.13, 3.1 and 3.08, respectively. FS as a whole had a significantly raised OR: 2.22 (1.14 to 4.33). The analysis was adjusted for physical activity and for type of job and OR decreased to 1.94 (0.82 to 4.61), losing its significance (p = 0.129). A strong correlation between symptoms' impact and CPP/CPPS was detected (rpbs = 0.710; p < 0.001) and a moderate one (0.3 < rpbs < 0.7; p < 0.001) was found considering anxiety, depression and abnormal palpatory findings. This exploratory study suggests that FS could represent an etiological factor for developing CPP/CPPS. However, further research on fascial dysfunctions and relative implications in CPP/CPPS is needed for confirmation.

The relation between cognitive-behavioural responses to symptoms in patients with long term medical conditions and the outcome of cognitive behavioural therapy for fatigue – A secondary analysis of four RCTs

BackgroundCognitive behavioural therapy (CBT) is effective in reducing fatigue across long-term conditions (LTCs). This study evaluated whether cognitive and behavioural responses to symptoms: 1) differ between LTCs and 2) moderate and/or mediate the effect of CBT on fatigue. MethodData were used from four Randomized Controlled Trials testing the efficacy of CBT for fatigue in Chronic Fatigue Syndrome/ME (N = 240), Multiple Sclerosis (N = 90), Type 1 Diabetes Mellitus (N = 120) and Q-fever fatigue syndrome (N = 155). Fatigue severity, assessed with the Checklist Individual Strength, was the primary outcome. Differences in fatigue perpetuating factors, assessed with the Cognitive Behavioural Responses to Symptoms Questionnaire (CBRQ), between diagnostic groups were tested using ANCOVAs. Linear regression and mediation analyses were used to investigate moderation and mediation by CBRQ scores of the treatment effect. ResultsThere were small to moderate differences in CBRQ scores between LTCs. Patients with higher scores on the subscales damage beliefs and avoidance/resting behaviour at baseline showed less improvement following CBT, irrespective of diagnosis. Reduction in fear avoidance, catastrophising and avoidance/resting behaviour mediated the positive effect of CBT on fatigue across diagnostic groups. DiscussionThe same cognitive-behavioural responses to fatigue moderate and mediate treatment outcome across conditions, supporting a transdiagnostic approach to fatigue.

The development and measurement properties of the Dutch version of the fear-avoidance components scale (FACS-D) in persons with chronic musculoskeletal pain.

The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument assessing different constructs related to the fear-avoidance model of pain. The aim was to translate the original English FACS into Dutch (FACS-D) and assess its measurement properties in persons with chronic musculoskeletal pain. The original English FACS (20 item-scale, range: 0-100) was translated in Dutch through standard forward-backward translation methodology. The FACS-D's measurement properties were evaluated in 224 persons withchronic musculoskeletal pain. Internal consistency, test-retest reliability and measurement error were assessed with the Cronbach's alpha coefficient (α), intraclass correlation coefficient (ICC), and standard error of measurement (SEM). Construct validity was assessed through inter-item correlation analyses, exploratory factor analysis, association with other fear-avoidance-related constructs, and hypothesis testing. Internal consistency, test-retest reliability and hypotheses testing were good (α=0.92; ICC=0.92, CI 0.80-0.96; 7/8 hypotheses confirmed). Similar to the original FACS and other translated versions, a two-factor model best fit the data. However, the item distribution differed from other versions. One factor represented "pain-related cognitions and emotions" and a second factor represented "avoidance behaviour." In contrast to the original FACS, low inter-item correlations for item 12 were found. The FACS-D was more strongly associated with fear-avoidance-related constructs of pain severity, perceived disability, feelings of injustice, and depressive/anxiety symptoms than the other fear-avoidance-related scales studied here. The FACS-D demonstrated good reliability and construct validity, suggesting that it may be a useful measure for Dutch-speaking healthcare providers. Two clinically relevant factors, with a different item distribution than the original FACS, were identified: one covering items on pain-related cognitions and emotions, and one covering items on avoidance behaviour. The stronger association between FACS-D and fear-avoidance related constructs suggests that the FACS-D may be more effective in evaluating the cognitive, emotional and behavioural constructs of pain-related fear-avoidance than other similar measures.

Virtual Reality–Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced With a Single-Case Experimental Design

Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain. This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design. This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice. The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024. Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR. ClinicalTrials.gov NCT04636177; https://clinicaltrials.gov/ct2/show/NCT04636177. DERR1-10.2196/40705.