Kinesiophobia is associated with pain intensity in people suffering from chronic pain. The number of publications highlighting this relationship has increased significantly in recent years, emphasizing the importance of investigating and synthesizing research evidence on this topic. The purpose of this scoping review was to answer the following questions: (1) What types of interventions have been or are currently being studied in randomized controlled trials (RCTs) for the management of kinesiophobia in patients with chronic pain? (2) What chronic pain conditions are targeted by these interventions? (3) What assessment tools for kinesiophobia are used in these interventions? According to the studies reviewed, (1) physical exercise is the most commonly used approach for managing irrational fear of movement, (2) interventions for kinesiophobia have primarily focused on musculoskeletal pain conditions, particularly low back pain and neck pain, and (3) the Tampa Scale of Kinesiophobia is the most commonly used tool for measuring kinesiophobia. Future RCTs should consider multidisciplinary interventions that can help patients confront their irrational fear of movement while taking into account the patient’s personal biological, psychological, and social experiences with pain and kinesiophobia.

The interaction between pain and the motor system is well-known, with past studies showing that pain can alter corticomotor excitability and have deleterious effects on motor learning. The aim of this study was to better understand the cortical mechanisms underlying the interaction between pain and the motor system. Experimental pain was induced on 19 young and healthy participants using capsaicin cream, applied on the middle volar part of the left forearm. The effect of pain on brain activity and on the corticomotor system was assessed with electroencephalography (EEG) and transcranial magnetic stimulation (TMS), respectively. Compared to baseline, resting state brain activity significantly increased after capsaicin application in the central cuneus (theta frequency), left dorsolateral prefrontal cortex (alpha frequency), and left cuneus and right insula (beta frequency). A pain-evoked increase in the right primary motor cortex (M1) activity was also observed (beta frequency), but only among participants who showed a reduction in corticospinal output (as depicted by TMS recruitment curves). These participants further showed greater beta M1-cuneus connectivity than the other participants. These findings indicate that pain-evoked increases in M1 beta power are intimately tied to changes in the corticospinal system, and provide evidence that beta M1-cuneus connectivity is related to the corticomotor alterations induced by pain. The differential pattern of response observed in our participants suggest that the effect of pain on the motor system is variable from on individual to another; an observation that could have important clinical implications for rehabilitation professionals working with pain patients.

Background: The prevalence of chronic pain and sleep disturbances substantially increases with age. Pharmacotherapy remains the primary treatment option for these health issues. However, side effects and drug interactions are difficult to control in elderly individuals. Aims: The objective of this study was to assess the feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the efficacy of transcranial direct current stimulation (tDCS) to reduce pain and improve sleep in older adults suffering from chronic pain. Methods: Fourteen elderly individuals (mean age 71±7 years) suffering from chronic pain and sleep complaints were randomized to receive either anodal tDCS, applied over the primary motor cortex (2 mA, 20 minutes), or sham tDCS, for 5 consecutive days. Pain was measured with visual analog scales, pain logbooks and questionnaires, while sleep was assessed with actigraphy, sleep diaries and questionnaires. Results: There were no missing data for pain and sleep measures, except for actigraphy, that generated several missing data. Blinding was maintained throughout the study, for both the evaluator and participants. Active but not sham tDCS significantly reduced pain (P<0.05). No change was observed in sleep parameters, in both the active and sham tDCS groups (all P≥0.18). Conclusion: The present study provides guidelines for the implementation of future tDCS studies in larger populations of elderly individuals. M1 anodal tDCS in this population appears to be effective to reduce pain, but not to improve sleep.

Organizational readiness is a factor known to influence the predisposition of individuals within an organization to change. Based on Weiner’s organizational theory, the “Organizational Readiness for Implementing Change” (ORIC) questionnaire was developed and validated to measure organizational readiness in healthcare contexts. However, no such tools allow French-speaking organizations to measure this concept. The objectives of this study were to (1) conduct a French cultural adaptation of the ORIC questionnaire, and (2) initiate the study of its psychometric properties. (1) Cross-cultural adaptation and translation processes were first conducted with the methodologies of Beaton, Vallerand and Massoubre. (2) Subsequently, internal consistency was documented by calculating Cronbach’s alpha and inter-item and item-to-scale correlations. The study of construct validity was initiated with a confirmatory factor analysis. A French 10-item scale named the Réceptivité organisationnelle à l’implantation d’un changement (ROIC) was developed and pretested by 125 occupational therapists working in Quebec homecare services. Cronbach’s alpha values for the 2 item subscales show satisfactory internal consistency (Commitment: α = 0.84 and Efficacy: α = 0.86). Inter-item correlations revealed that the ROIC’s items are moderately related to each other while item-to-total scale correlations pinpoint items that accounts for variance and influence internal consistency. Confirmatory factor analysis allowed the initiation of a substantial documentation of ROIC’s model fit with the original version (CFI = 0.89, TLI = 0.85, SRMR = 0.08, and RMSEA = 0.12). The ROIC is a new theory-based and translated questionnaire that can be used to rigorously document the organizational readiness of French organizations. The ROIC has the potential to support members of different organizations in the identification of subsequent efforts for the implementation of a change.

Despite its widespread clinical use, the efficacy of transcutaneous electrical nerve stimulation (TENS) remains poorly documented in elderly individuals. In this randomized, double-blind crossover study, we compared the efficacy of high-frequency (HF), low-frequency (LF), and placebo (P) TENS in a group of 15 elderly adults (mean age: 67 ± 5 years). The effect of HF-, LF-, and P-TENS was also evaluated in a group of 15 young individuals (26 ± 5 years; same study design) to validate the effectiveness of the TENS protocols that were used in the elderly group. Each participant came to the laboratory on 3 separate occasions to receive, in random order, HF-, LF-, and P-TENS. Pain intensity and pain perception thresholds were assessed before, during, and after TENS, using an experimental heat pain paradigm. For the young group, there was a significant decrease in pain intensity during and after HF- and LF-TENS when compared with baseline, with both HF- and LF-TENS being superior to P-TENS. In the older group, HF- and LF-TENS did not reduce pain when compared with baseline and no difference was observed between the 2 active TENS sessions and P-TENS. High-frequency, LF-, and P-TENS all increased pain thresholds in young individuals, whereas in older individuals, only LF-TENS increased pain thresholds. Taken together, these results suggest that TENS is effective in young, but not in older, individuals. Future studies should be conducted to confirm these results in pain populations and to identify strategies that could enhance the effect of TENS in the elderly.