ABSTRACT
Purpose Stressor events, such as COVID-19, may trigger adaptive or maladaptive pain management strategies among individuals with persistent low back pain (LBP). Emerging research shows individuals with lower fear avoidance, depression and anxiety, and greater positive affect and quality of life can better maintain positive pain management strategies during stressor events. For individuals with persistent LBP, physical activity (PA) has been shown to be a beneficial pain management strategy. This study investigated psychosocial variables of individuals with LBP who demonstrated adaptive pain management strategies during COVID-19, indicated by the maintenance of physical activity. Methods Twenty-five individuals with persistent LBP (age 22.4 (3.4) years, 7m, 18f) from an existing longitudinal cohort participated. Participants completed a baseline survey prior to COVID-19. This survey quantified demographics, pain severity, frequency, and duration. Other baseline measures were the Physical Activity Scale, the WHOQOL-Bref physical, psychological, social, and environmental quality of life subscales, Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, and Trait Affect scale. Participants then completed follow-up surveys for 18 months. During COVID-19 lockdown, the impact of lockdown on PA was assessed. The cohort was dichotomized into individuals reporting the same or more PA (MPA) and those reporting less PA (LPA) and baseline characteristics were compared between groups. Results The LPA group contained 17 individuals and the MPA group contained 8 individuals. There was no significant demographic difference between groups. The MPA group had greater duration of LBP symptoms (p=0.015, d =1.16). The MPA group trended towards higher physical quality of life (p=0.101, d=0.79) and higher environmental quality of life (p=0.057, d=0.96) at baseline. Individuals in the MPA group had lower negative affect (fatigue domain) scores than the LPA group (p=0.038, d=0.86). Depression scores were lower in the MPA group (p=0.006, d=1.12). Conclusions Individuals with persistent LBP who had greater duration of symptoms, better physical and environmental quality of life, lower negative affect, and less depression were more likely to maintain or increase physical activity during COVID-19. These characteristics may facilitate positive adaptation to a stressor event.
ABSTRACT
Keywords: Tendinopathy;Rotator cuff;Digital transformation Purpose: Similar associations between self-reported bio-psycho-social factors and the presentation of people with various shoulder disorders and rotator cuff (RC) tendinopathy have been reported;however, only limited numbers of variables have been assessed, often in small cohorts. We aimed to test whether RC tendinopathy could be distinguished from other shoulder problems using a range of bio-psycho-social self-reported factors and the degree to which they explain severity. Methods: Self-reported bio-psycho-social factors were collected via an online survey battery from an international sample. The dependent variables were diagnosis (having RC tendinopathy or other shoulder problems) and severity. After group comparison and univariate regression analyses, multivariable logistic and linear regression analyses were used to construct explanatory models for group differences and severity. Results: 82 people with RC tendinopathy (42.8 ± 13.9 years, 50 female) and 54 people with other shoulder problems (40.2 ± 14.1 years, 33 female) were recruited and found not to differ in severity on four patient-reported PROMs (Shoulder Pain and Disability Index (SPADI) = 37.3 ± 24.5 vs 33.7 ± 22.5, Western Ontario Rotator Cuff Index (WORCI) = 56.2 ± 22.0 vs 60.3 ± 22.2, Single Assessment Numeric Evaluation = 56.6 ± 25.3 vs 56.5 ± 28.7 and Patient Acceptable Symptomatic State (yes:no) 51:31 vs 23:22, respectively). Eight self-reported factors individually distinguished RC tendinopathy from other shoulder problems, with the model distinguishing tendinopathy from other shoulder problems including 4 variables;having a previous injury in the shoulder (OR (95% CI) = 0.30 (0.13–0.69)), activity effect on pain (OR (95% CI) = 2.24 (1.02–4.90)), General Self-Efficacy Score (OR (95% CI) = 1.12 (1.02–1.22)) and activity level according to Global Physical Activity Questionnaire (moderately active OR (95% CI) = 3.97 (1.29–12.18) and highly active OR (95% CI) = 3.66 (1.41–9.48)), with acceptable overall model accuracy. Univariate linear regression analysis showed that 32 variables were associated with RC tendinopathy severity with a multivariable model consisting of quality of life (β coefficient = −0.38), having night pain (β = 0.19), having unilateral morning stiffness (β = 0.25), BMI (β = 0.29), FABQ (work) score (β = 0.25);and pain catastrophising (β = 0.21) explaining 68% of the variance in severity. Conclusion(s): Well validated patient-reported outcomes to explain severity do not distinguish RC tendinopathy from other shoulder problems however self-reported bio-psycho-social factors do, so may be useful for clinical evaluation. Further, these factors were strongly associated with severity, reinforcing the potential to improve patient assessment, for example, using pre-consultation online data collection in usual care. The models warrant prospective validation and consideration alongside data from physical and imaging assessment. Impact: Online survey including self-reported bio-psycho-social factors may help augment diagnosis and, more importantly, provide some of the detail needed for holistic assessment by complementing physical examination and imaging. Therefore, the online survey may be useful to minimise the clinical time commitment and optimising safety during the Covid-19 pandemic. Funding acknowledgements: The review is a part of Mehmet Delen's Ph.D., which is sponsored by the Turkish Ministry of National Education. The sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.