Fear Avoidance Research Articles

Psychometric properties of the Turkish version of the fear avoidance components scale in patients with chronic pain related to musculoskeletal disorders.

The fear avoidance components scale (FACS) evaluates patients' cognitive, emotional and behavioral fear avoidance behavior. The aim of the study was to conduct the cross-cultural adaptation, reliability and validity of the Turkish version of the FACS. Aprospective cross-sectional study was carried out with 208patients (46.2 ± 11.4years, 116women, 92men) diagnosed with chronic pain related to musculoskeletal disorders. Individuals were assessed with FACS, Tampa scale of kinesiophobia (TSK), Beck depression inventory (BDI), Oswestry disability index (ODI), numerical pain scale (NPS), and pain catastrophizing scale (PCS). A total of 70 patients completed the FACS for the second time 3 days later. Internal consistency of the total score was excellent (Cronbach's alpha: 0.815). There was astrong correlation between FACS and TSK and PCS (r1 0.555, r2 0.678, p < 0.001). In addition, the relationship between FACS and BDI and NPS was moderate in terms of construct validity (r1 0.357, r2 0.391, p < 0.001). FACS had atwo-factor structure, as expected. The test-retest reliability of the FACS was acceptable to excellent (ICC = 0.526-0.971). The Turkish version of FACS is avalid and reliable questionnaire for patients with chronic pain related to musculoskeletal disorders. The FACS provides afurther advantage over identical questionnaires by evaluating cognitive, behavioral and emotional fear avoidance components.

Relation among, trait anxiety, intolerance to uncertainty and early maltreatment experiences on fear discrimination learning and avoidance generalization online task

Background and objectivesEarly aversive experiences, which have been associated with elevated anxiety and intolerance of uncertainty (IUS), may contribute negatively to fear conditioning learning. The aim of the present study was to analyze the relation among individual differences in childhood maltreatment experiences, trait anxiety, and IUS in adulthood; and to determine how these variables could affect fear learning discrimination and avoidance generalization. MethodsWe adapted an avoidance procedure in an online fear learning task. Two pictures of different lamp colors (CS+) were first associated with two aversive images (US), while a third color was not (CS-). Next, clicking a button during one CS + could effectively avoid the US (CS + av), but not during the other (CS + unav). Finally, avoidance generalization was tested to lamp colors that were between CS- and CS + av (safety dimension) and CS + av and CS + unav (avoidability dimension). With a sample of 67 participants, we measured ratings of relief, expectancy, and anxiety, as well as button presses and individual differences (STAI, IUS and MAES). ResultsAversive early experiences were positively related to trait anxiety and intolerance of uncertainty. The results of the task further suggested that maltreatment experience contributes to be more attentive to aversive signals, which could be implicated in leading to difficulties in discrimination learning. LimitationsOnline experiments implies some loss of control over subjects and environment that can threaten internal validity. Likewise, the commitment of participants may be low. ConclusionsResults suggest that early aversive experience and anxiety could contribute to the development of IUS, which likely contributes to the development of avoidance behavior.

P.087 Early and late exercise intervention after lumbar microdiscectomy reduces low back pain, fear avoidance, and improve neurodynamic mobility

Background: Exercise is commonly recommended to patients following a lumbar microdiscectomy although controversy remains as to the timing and protocols for exercise intervention (early vs late intervention). Our study aimed to evaluate low back pain level, fear avoidance, neurodynamic mobility, and function after early versus later exercise intervention following a unilateral lumbar microdiscectomy. Methods: Forty patients who underwent unilateral lumbar microdiscectomy were randomly allocated to early (Group-1) or later (Group-2) exercise intervention group. The low back pain and fear avoidance were evaluated using Oswestry Low Back Pain Disability Questionnaire, Numeric Pain Rating Scale, and Fear-Avoidance Beliefs Questionnaire. The neurodynamic mobility and function were recorded with Dualer Pro IQ Inclinometer, 50-foot walk test, and Patient-Specific Functional Scale. Measurements were performed before surgery and post-surgery (1-2, 4-6, and 8-10 weeks) after exercise intervention. Results: Both groups showed a significant decrease in low back pain levels and fear avoidance as well as a significant improvement in neurodynamic mobility and function at 4 and 8 weeks post-surgery. No significant difference was detected between the two groups. Conclusions: These findings showed that early exercise intervention after lumbar microdiscectomy is safe and may reduce the low back pain, decrease fear avoidance, and improve neurodynamic mobility and function.

Effects of core-stabilization and trunk balance exercises on clinical parameters in patients with non-specific chronic low back pain – a randomized pilot study

Introduction and aim. This study compared the efficacy of core stabilization (CSE) and trunk balance exercises (TBE) with flexibility training on pain-related disability (PRD), psychological status (PS) and fear avoidance belief (FAB) in patients with non-specific chronic low back pain (NSCLBP). Material and methods. Twenty-eight (28) participants diagnosed of NSCLBP were randomly assigned into CSE, TBE, and control groups (CG). Participants in CSE (n=10); TBE (n=8) and CG groups (n=10) received core stabilization exercise, trunk balance exercise and back care advice respectively. All participants received flexibility training in addition to treatment in their respective groups. Assessment of outcomes were done at baseline, end of 4 th and 8 th week. Results. There was significant improvement in all outcomes in the CSE, TBE and CG at 8 weeks; PRD (p=0.005, p=0.008, p=0.005), PS: depression (p=0.005, p=0.008, p=0.007); anxiety (p=0.005, p=0.007) and FAB about work (p=0.005, p=0.007, p=0.005); about physical activity (p=0.005, p=0.018, p=0.006). Comparison of outcomes between CSE and TBE groups showed no significant difference (p&gt;0.05) Conclusion. Both CSE and TBE with flexibility training are effective in improving PRD, PS and FAB of patients with NSCLBP.

The role of Dental Fear, Pain anticipation and Self-efficacy in Endodontic Therapy.

Cognitive-behavioural interventions may be important for the prevention and treatment of oral diseases. One cognitive factor that has generated considerable interest as a possible mediator is self-efficacy. One hundred patients diagnosed with pulpal or periapical pathology that required endodontic therapy were treated. Data were collected at baseline in the waiting room before therapy and then during treatment. Positive correlations were found between dental fear, pain anticipation and dental avoidance (p⟨0.001). The correlation between dental fear and pain anticipation showed the largest effect sizes. Healthy participants had higher scores in self-efficacy (Mean=32.55; SD=7.15) than those with systemic diseases (n=15; Mean=29.33; SD=4.76, p=0.04). Participants who not taking medication before treatment had lower scores for pain anticipation (Mean=3.63; SD=2.85) than those taking medication. The contribution of pain anticipation to dental avoidance varied at different values of self-efficacy. The indirect effect of dental fear on dental avoidance via dental anxiety was significant in individuals with higher self-efficacy. Self-efficacy had an essential moderation role between pain anticipation and dental avoidance during endodontic treatment.

Breaking the Disability Spiral: A Case Series Report Illustrating the Delivery of a Brief Skills Based Coaching Intervention to Prevent Chronic Dysfunction and Pain After Orthopedic Injury.

Orthopedic traumas are common, costly, and burdensome - particularly for patients who transition from acute to chronic pain. Psychosocial factors, such as pain catastrophizing and pain anxiety, increase risk for poor outcomes after injury. The Toolkit for Optimal Recovery (TOR) is a novel multi-component mind-body intervention informed by the fear-avoidance model to promote re-engagement in daily activities and prevent transition toward chronic pain and physical dysfunction. The current case series aims to 1) describe the intervention and 2) showcase the treatment course of three TOR completers from diverse geographic locations in the U.S. with distinct injury types and varying personal identities to illustrate how the intervention can be delivered flexibly. Results indicate pre-to-post program improvement in physical function, pain severity, pain catastrophizing, pain anxiety, and other relevant outcomes targeted by the intervention (i.e., depression, mindfulness, coping). Experiences of our three TOR completers suggest that integrating TOR with standard orthopedic care may promote physical recovery after injury.

Is it time to rethink disability assessment in low back pain? Reliability, internal consistency, and construct validity of the Brazilian WHODAS 2.0 for chronic low back pain.

The World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed to assess health and disability based on the biopsychosocial model. The WHODAS 2.0 has not been validated for Brazilians with chronic non-specific low back pain (LBP). We aimed to evaluate the reliability, internal consistency, and construct validity of the Brazilian version of the WHODAS 2.0 in patients with chronic LBP. Methodological study. The Brazilian version of the WHODAS 2.0 was applied to 100 volunteers with chronic nonspecific LBP. Test-retest reliability, internal consistency, and construct validity were assessed using the Spearman correlation test, Cronbach's alpha (α) coefficient, and Spearman's correlation test between WHODAS 2.0, the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Fear Avoidance Beliefs Questionnaire (FABQ), respectively. WHODAS 2.0 showed satisfactory test-retest reliability with a moderate correlation for total WHODAS 2.0 (r=0.75, p<0.05). Internal consistency was adequate for all domains and total score (α=0.82-0.96). Regarding construct validity, WHODAS 2.0, ODI (r=0.70, p<0.05), and WHODAS 2.0 and RMDQ (r=0.71, p<0.05) had significant correlations. Total WHODAS 2.0 and FABQ-Phys subscale scores correlated moderately (r=0.66, p<0.05). The Brazilian WHODAS 2.0 was proved to be a valid and reliable tool for patients with chronic LBP. The item referring to sexual intercourse had 27% and 30% of the missing values during the test and retest stage, respectively and had a high percentage of missing data for work-related questions (41% missing data) in the life activities domain; therefore, the data must be interpreted with caution. WHODAS 2.0can be used as a disability assessment strategy from a biopsychosocial perspective in this population.

Association between functional disability with postural balance among patients with chronic low back pain.

Postural balance is impaired in patients with chronic low back pain (CLBP). In addition, the swaying velocity can be affected by low back pain (LBP) dysfunction. However, the extent to which the dysfunction affects postural balance in CLBP patients remains unclear. Therefore, this study aimed to investigate the effect of LBP-related disability on postural balance among CLBP patients and determine factors associated with postural balance impairments. Participants with CLBP were recruited and instructed to complete the one-leg stance and Y-balance test. Moreover, they were divided into two subgroups (i.e., low and medium to high LBP-related disability groups) to compare the difference in postural balance based on the degree of LBP-related disability measured by the Roland Morris Disability Questionnaire. The relationships between postural balance and negative emotions as well as LBP characteristics were determined using the Spearman correlations. A total of 49 participants with low LBP-related disabilities and 33 participants with medium to high LBP-related disabilities participated in the study. Compared to the medium to high LBP-related disability group, patients in the low LBP-related disability group performed better in one-leg stance on the left leg (z = -2.081, p = 0.037). For Y-balance test, patients in the low LBP-related disability group also had greater normalized values of left leg reach in posteromedial (t = 2.108, p = 0.038) direction and composite score (t = 2.261, p = 0.026) and of right leg reach in posteromedial (t = 2.185, p = 0.032), and posterolateral (t = 2.137, p = 0.036) directions as well as composite score (t = 2.258, p = 0.027). Factors associated with postural balance impairments were also revealed, such as anxiety, depression, and fear avoidance belief. The greater the dysfunction degree, the worse the CLBP patient's postural balance impairment. Negative emotions could also be considered contributing factors for postural balance impairments.

Post-COVID Patients With New-Onset Chronic Pain 2 Years After Infection: Cross-Sectional Study

BackgroundAlthough pain is common in non-hospitalized post-COVID-19 syndrome, only a few studies have provided information on the pain experience of these patients. AimTo identify the clinical and psychosocial profile associated with pain in non-hospitalized patients with post-COVID-19 syndrome. MethodIn this study there were three groups: healthy control group, successfully recovered group, and post-COVID syndrome group. Pain-related clinical profile and pain-related psychosocial variables were collected. Pain-related clinical profile included: pain intensity and interference (Brief Pain Inventory), central sensitization (Central Sensitization Scale), insomnia severity (Insomnia Severity Index), and pain treatment. Pain-related psychosocial variables were: fear of movement and (re)injury (Tampa Scale for Kinesiophobia), catastrophizing (Pain Catastrophizing Scale), depression, anxiety and stress (Depression, Anxiety and Stress Scale), and fear-avoidance beliefs (Fear Avoidance Beliefs Questionnaire). ResultsIn all, 170 participants were included in the study (healthy control group n = 58, successfully recovered group n = 57, and post-COVID syndrome group n = 55). Post-COVID syndrome group obtained significantly worse punctuation in pain-related clinical profile and psychosocial variables than the other two groups (p < .05). ConclusionsIn conclusion, patients with post-COVID-19 syndrome have experienced high pain intensity and interference, central sensitization, increased insomnia severity, fear of movement, catastrophizing, fear-avoidance beliefs, depression, anxiety, and stress.

Kids B.E.A.R. Pain: A Pediatric Chronic Pain Protocol

Patients with chronic pain utilize health care services up to five times the rate of the general population while pediatric chronic pain admissions from 2004-2010 increased by 831% (Coffelt et al., 2013; Reddy, 2006). Further complicating this public health epidemic are co-morbid conditions resulting in poor sleep, depression, and anxiety as well as psycho-social problems related to school truancy and poor social networks. Caregiver attitude towards pain may also negatively contribute to the illness, i.e., caregivers may increase chronic pain and functional disability by promoting sedentary lifestyles due to fear avoidance behaviors (Palermo et al., 2014). Interventions are needed to assist adolescents that experience chronic pain. The following is a detailed overview of the Kids B.E.A.R. Pain intervention protocol, a support program for pediatric patients experiencing chronic pain and their caregivers.

Predicting persisting disability in musculoskeletal pain patients with the STarT MSK screening tool: Results from aprospective cohort study.

The STarT MSK screening tool aims to categorise musculoskeletal patients into three risk groups for treatment stratification. The tool has been translated and validated into Hebrew. However, its ability to predict persistent disability in patients has yet to be evaluated. The primary aim of this study was to assess the ability of the Hebrew version of the STarT MSK tool to predict persistent disability in patients experiencing musculoskeletal pain. A prospective observational cohort study was conducted, recruiting 135 patients with musculoskeletal pain in five common areas: back, neck, shoulder, knee, or multisite pain over the age of 21. At the first consultation, all patients completed demographic information, the Focus On Therapeutic Outcomes (FOTO) questionnaire (function, pain, and fear avoidance score), and the STarT MSK questionnaire. The patients completed the FOTO questionnaire again at the end of the physiotherapy treatments. 25 patients (18.5%) were classified into the low-risk group, 68 patients (50.3%) into the medium-risk group, and 42 (31.1%) into the high-risk group. The baseline STarT MSK tool score demonstrated an excellent ability to identify patients at high risk of developing persistent disability (AUC=0.795, 95% CI 0.716-0.873). The Hebrew version of the STarT MSK tool can differentiate between three chronic risk groups and has high predictive validity for chronicity. This may provide a tool to assist clinicians in identifying patients who require more intensive care, and thus, potentially prevent the transition to chronic disabling pain.

The Relationship Between Health-Related Quality of Life and Lower-Extremity Visuomotor Reaction Time in Young Adult Women Following Ankle Sprain.

Many individuals who sustain a lateral ankle sprain (LAS) fail to return to prior activity due to residual symptoms; and report elevated levels of injury-related fear, decreased function, and decreased health-related quality of life (HRQOL). Additionally, individuals with history of LAS exhibit deficits in neurocognitive functional measures like visuomotor reaction time (VMRT), which contributes to worse patient-reported outcome scores. The aim of this study was to examine the relationship between HRQOL and lower-extremity (LE) VMRT in individuals with LAS history. Cross-sectional. Young adult female volunteers with history of LAS (n = 22; age = 24 [3.5]y; height = 163.1 [9.8]cm; mass = 65.1 [11.5]kg; and time since last LAS = 67.8 [50.5]mo) completed HRQOL outcomes including the following: (1)Tampa Scale of Kinesiophobia-11, (2)Fear-Avoidance Beliefs Questionnaire, (3)Penn State Worry Questionnaire, (4)modified Disablement in the Physically Active Scale, and (5)Foot and Ankle Disability Index (FADI). Additionally, participants completed a LE-VMRT task by responding to a visual stimulus using their foot to deactivate light sensors. Participants completed trials bilaterally. Separate Spearman rho correlations were performed to assess the relationship between patient-reported outcomes assessing constructs of HRQOL and LE-VRMT bilaterally. Significance was set at P < .05. There was a strong, significant negative correlation between FADI-Activities of Daily Living (ρ = -.68; P = .002) and FADI-Sport (ρ = -.76; P = .001) scores and injured limb LE-VMRT; moderate, significant negative correlations between the uninjured limb LE-VMRT and FADI-Activities of Daily Living (ρ = -.60; P = .01) and FADI-Sport (ρ = -.60; P = .01) scores; and moderate, significant positive correlations between the injured limb LE-VMRT and modified Disablement in the Physically Active Scale-Physical Summary Component (ρ = .52; P = .01) and modified Disablement in the Physically Active Scale-Total (ρ = .54; P = .02) scores. All other correlations were not statistically significant. Young adult women with history of LAS demonstrated an association between self-reported constructs of HRQOL and LE-VMRT. As LE-VMRT is a modifiable injury risk factor, future studies should examine the effectiveness of interventions designed to improve LE-VMRT and the impact on self-reported HRQOL.

Kinesiophobia and fear avoidance behaviors in collegiate female athletes during menstruation

Background and Study Aim. The menstrual cycle can be a factor affecting performance in female athletes if accompanied by pain. In this study, authors aimed to examine how menstruation pain affects kinesiophobia and fear avoidance behavior in female athletes. Material and Methods. Study included a total of 50 female athletes aged 18-35 years. The athletes were divided into 3 groups as Group 1 (With Pain), Group 2 (No Pain) and Group 3 (Intermittent Pain) according to their pain experience during menstruation. The groups were compared in terms of kinesiophobia and fear avoidance behaviors. Kinesiophobia was evaluated with the Tampa Kinesiophobia Scale (TKS), fear avoidance behaviors were evaluated by using Fear Avoidance Beliefs Questionnaire (FABQ). Results. There was a significant difference between the 3 groups in terms of both TKS and FABQ scores (p&lt;0.05). In terms of TKS, there was no significant difference between Group 1 and Group 3 (p&gt;0.05), there was a significant difference between Group 1 and Group 2 and between Group 2 and Group 3 (p&lt;0.05). There was a significant difference in favor of Group 1 in all pairwise comparisons in terms of FABQ scores (p&lt;0.05). Pain intensity was associated with TKS and FABQ. Conclusions. A significant majority of female athletes experienced pain during menstruation, exhibited kinesiophobia and fear avoidance behavior due to pain. Since kinesiophobia and fear avoidance behavior can be a limiting factor for the athlete's optimum performance, female athletes should be supported in order for them to develop coping methods.

E092 Confirmatory factor analyses of the Tampa Scale of Kinesiophobia 11-item version and Pain Catastrophising Scale: A cross-sectional study in people living with axial spondyloarthritis

Abstract Background/Aims The Fear Avoidance Model (FAM) proposes pain-related fear of movement and pain catastrophising to be prominent psychological experiences that compromise physical function and activity behaviour in people living with chronic pain. Yet, little research has tested the FAM in people living with axial spondyloarthritis (axSpA) despite the evidenced benefits of physical activity and exercise. This study examines the structural aspect of construct validity of the 11-item Tampa Scale of Kinesiophobia (TSK-11) and Pain Catastrophising Sale (PCS) as an important first step, to establish valid measurement tools to effectively test the relevance of the FAM for people with axSpA. Methods An online survey was distributed via the National Axial Spondyloarthritis Society including the TSK-11 and PCS. Ninety-eight people with axSpA (M Age = 45.62 SD = 12.16, M BASFI = 3.7 SD = 2.60, Female = 70%, NSAID use = 58.76%, bDMARDS use = 62.24%) completed the survey (December 2020- April 2021). Internal consistency was examined via Cronbach alpha values and confirmatory factor analysis tested the TSK-11's two-factor structure and PCS's three-factor structure. A model has excellent fit to the data with values &amp;lt; 3 for the CMIN/DF, and around .95 for CFI, .06 for RMSEA, .08 for SRMR. Factor loadings &amp;lt; .40 support deletion. Results Alpha values supported the internal consistency of participant responses to the somatic (.78), avoidance behaviour (.80) and overall fear of movement (.89) TSK-11 items. Fit indices also showed a good fit to the data for the TSK-11’s two-factor structure once two error terms were correlated (CMIN/DF = 1.77/42, CFI = .93, RMSEA = .09 (.05 - .12), SRMR= .06). Standardised factors loadings for the somatic and avoidance factors ranged from .43 - .80 and .60 - .72, respectively. Internal consistency for the responses to the PCS-Helplessness (.92), PCS-Magnification (.82), PCS-Rumination (.94) and overall pain catastrophising (.95) scales were also supported. A good fit to the data was shown for the three-factor structure of the PCS (CMIN/DF = 2.15/61, CFI = .94, RMSEA= .11 (.08-.14), SRMR = .04) when two errors were correlated. Standardised factors loadings ranged from .67-.90, (Helplessness), .89 - .92 (Rumination) and .73 - .85 (Magnification). Conclusion The TSK-11 and PCS can be used to measure axSpA patient’s pain related fear of movement and pain catastrophising, but data support continued examination of their construct validity in larger samples of axSpA patients. One TSK-11 item revealed a border line factor loading (.43) for the somatic factor (“pain lets me know when to stop exercising so that I don’t injure myself”). Psychometrically valid instruments will help examine the role of pain related fear of movement and pain catastrophising on important health related outcomes for axSpA patients including physical function and physical activity behaviour. Disclosure P.C. Rouse: Grants/research support; PhD studentship matched funded by Bath Institute for Rheumatic Diseases (RAG-PR-33-120318). T.A. Ingram: None. M. Standage: None. R. Sengupta: Honoraria; Received honoraria for giving talks from Abbyie, Biogen, UCB, Novartis and Pfizer. Grants/research support; Research grants have been received from UCB, Abbvie, and Novartis.

Team Approach to Delayed Pediatric Vestibular Diagnosis: A Case Study.

This report highlights the challenges of diagnosing pediatric vestibular neuritis following dental treatment and addressing fear avoidance behaviors. An 11-year-old boy came to physical therapy with vestibular dysfunction following dental treatment that was unable to be diagnosed by emergency department staff. The participant received multispecialty treatment for 6 weeks. Computerized Dynamic Posturography, Limits of Stability, Dizziness Handicap Inventory, Functional Gait Assessment, Dynamic Visual Acuity, and Modified Clinical Test of Sensory Interaction on Balance. Most notable improvements were seen in Limits of Stability and Computerized Dynamic Posturography. The participant made a full return to school and sport. The difficulty of pediatric vestibular neuritis diagnosis led to fear avoidance behaviors that were addressed by a collaborative specialty approach. This is the first documented case of pediatric vestibular neuritis as a complication of a dental procedure with intervention focused on fear avoidance behaviors.

Validation of the Fear and Avoidance of Memory Loss scale in community-based older adults.

Alzheimer's disease and related dementias (ADRD) are among the most feared conditions. However, research around ADRD-specific fear and avoidance behaviors is lacking. Here, we validated a novel measure of fear and avoidance specific to memory loss, the Fear and Avoidance of Memory Loss (FAM) scale, and examined associations between fear avoidance and psychosocial functioning in older adults. We assessed FAM Scale internal reliability and concurrent validity, and candidate subscales across two samples (total N=813). We then examined associations between fear avoidance and memory performance, anxiety, depressive symptoms, sleep, social functioning, and quality of life. We identified two subscales: fear and avoidance, which yielded strong psychometric validity. Higher fear was associated with memory failures and sleep disturbance. Higher avoidance was associated with memory failures, poorer verbal memory, reduced social functioning, and quality of life. We present the first measure of fear avoidance specific to memory loss. We propose that targeting fear avoidance can promote ADRD risk reduction and resiliency.

Self-administered stretching exercises are as effective as motor control exercises for people with chronic non-specific low back pain: a randomised trial.

In people with chronic non-specific low back pain, what is the effect of self-administered stretching exercises relative to motor control exercises on pain intensity, disability, fear avoidance, global perceived effect and flexibility? Randomised trial with concealed allocation, intention-to-treat analysis and blinding of assessors. One hundred people with chronic non-specific low back pain. The self-stretching exercise group performed 6 stretches in 40-minute sessions. The motor control exercise group performed trunk stabilising exercises in 40-minute sessions. Both groups performed weekly supervised sessions for 8 weeks with one or more home sessions/week. The primary outcomes were pain intensity (0 to 10 scale) and disability (Oswestry Disability Index). The secondary outcomes were the Fear Avoidance Beliefs Questionnaire, global perceived effect, and the fingertip-to-floor test. Measures were taken at baseline and at 8, 13 and 26 weeks. On the 0 to 10 scale, the between-group difference in pain intensity was negligible, with a mean difference of roughly 0 (95% CI-1 to 1) at each time point. Similarly, the between-group difference on the 100-point disability scale was negligible: MD -1 (95% CI -3 to 1) at week 8, MD 1 (95% CI -1 to 3) at week 13 and MD 0 (95% CI -1 to 2) at week 26. The two interventions also had similar effects on the secondary outcomes. In people with chronic non-specific low back pain, self-stretching exercises had very similar effects to motor control exercises on pain intensity, disability, fear avoidance, global perceived effect and flexibility up to 18 weeks beyond the end of an 8-week program. Given the established effectiveness of motor control exercises, either intervention could be recommended to people with chronic low back pain. The choice of intervention might be directed by patient preference. NCT03128801.

Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: Randomized controlled trial

ObjectiveTo investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain. MethodsThis study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. ResultsThe OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = −6.59, 95% CI: −12.01 to −1.17, p = .01) and at the three-month evaluation (treatment effect = −6.02, 95% CI: −11.55 to −0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. ConclusionsThe OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.

Prevalence of self-reported fear of intraoral injections and its relationship to dental fear and subsequent avoidance of dental treatment among a group of Egyptian children: A Cross-Sectional Study

Prevalence of self-reported fear of intraoral injections and its relationship to dental fear and subsequent avoidance of dental treatment among a group of Egyptian children: A Cross-Sectional Study

Let's Get Physical! A Comprehensive Review of Pre- and Post-Surgical Interventions Targeting Physical Activity to Improve Pain and Functional Outcomes in Spine Surgery Patients.

The goal of this comprehensive review was to synthesize the recent literature on the efficacy of perioperative interventions targeting physical activity to improve pain and functional outcomes in spine surgery patients. Overall, research in this area does not yet permit definitive conclusions. Some evidence suggests that post-surgical interventions may yield more robust long-term outcomes than preoperative interventions, including large effect sizes for disability reduction, although there are no studies directly comparing these surgical approaches. Integrated treatment approaches that include psychosocial intervention components may supplement exercise programs by addressing fear avoidance behaviors that interfere with engagement in activity, thereby maximizing the short- and long-term benefits of exercise. Efforts should be made to test brief, efficient programs that maximize accessibility for surgical patients. Future work in this area should include both subjective and objective indices of physical activity as well as investigating both acute postoperative outcomes and long-term outcomes.