The influence of pain, kinesiophobia and psychological comorbidities on the accuracy of rating of perceived exertion in UK military spinal rehabilitation

Abstract

IntroductionChronic low back pain (CLBP) is a leading cause of disability in the UK Military. Pain and psychological comorbidities have been reported to influence the rating of perceived exertion (RPE). Exercise rehabilitation can be monitored using RPE; however, the accuracy of RPE in inpatient CLBP rehabilitation is unknown.MethodsA prospective cohort correlation study of 40 UK Military inpatients with CLBP was completed. Disability (ODI), kinesiophobia (TSK), anxiety (GAD-7) and depression (PHQ-9) were subjectively reported at the beginning and end of a 3 week intervention. Pain (VAS) and HR were recorded in the first aerobic exercise (AE) session (T1) and the final aerobic exercise session (T2). RPE was reported for each AE session.ResultsAt T1, a positive correlation was observed between RPE accuracy (−7.2±20.9), and pre-exercise pain (2.7 mm ±1.6 mm) (p>0.001) and ODI (31.0±16.9) (p>0.05), and a negative relationship between RPE accuracy and average HR (135 bpm ±22 bpm) (p>0.001) was observed. At T2, there was no significant correlation between RPE accuracy (−4.4±22.6) and pre-exercise pain (2.8 mm ±1.6 mm) or ODI (34.0±16.5) (p>0.05). The strong negative relationship between RPE accuracy and average HR (137 bpm ±20 bpm) remained at T2. Improved RPE accuracy over the 3-week rehabilitation programme was correlated to the change in average HR (r=−0.314, p<0.05).ConclusionsComorbidities may negatively affect RPE accuracy in CLBP, but the magnitude of the influence reduces over intensive rehabilitation.

Analysis of the current status of rehabilitation motivation and its influencing factors in older adults with stroke: a cross-sectional study

“…Kinesiophobia is a risk factor for motor rehabilitation, which will cause patients to experience adverse emotions and respond negatively to the treatment and rehabilitation of the disease ( Baykal Şahin et al, 2021 ). Low levels of kinesiophobia are more inclined to opt for positive concepts that will make patients interested in exercise and able to adhere to it according to their personal abilities and personal rehabilitation plans ( Conway et al, 2022 ).…”

The BMJ Military Health Military Rehabilitation special issue

“…Within the constraints of ever-decreasing resources, clinical and research prioritisation is required. Measurement of the presence and impact of conditions can be done in many forms, from broad surveillance data11 to specific outcome measures: both patient-reported (PROMs)9 12 and clinician assessed 7 10. As a result, a significant amount of research is dedicated to ensuring the outcome measures are reliable, valid and are actually recording what the end user is hoping to record.…”

“…Allan et al highlight the benefits of PROMs allied to biomechanical assessment for individualised management, while raising the risks of inconsistency and bias 7. Further detail on these limitations is discussed by Conway et al who identify the impact of pain, kinesiophobia and psychological comorbidities on PROMs in their small prospective cohort study 12. Using a medically downgraded chronic hip pain population, Walters et al 10 assessed the feasibility and acceptability of the isometric midthigh pull (IMTP) test, an outcome measure used within the Army physical employment standards (PES).…”

Probabilistic Model of Patient Classification Using Bayesian Model

“…Retrieving patient information regarding comorbidities necessitates a systematic approach to ensure accuracy and confidentiality (de Girolamo et al, 2024;Shafqat et al, 2023;Conway et al, 2022;Lee & Kim, 2018). Initially, relevant comorbidities, such as diabetes or hypertension, are identified within the patient cohort (Davis & Miller, 2021).…”