Search

Background: Understanding pain and its mechanisms can play an important role in (post-) cancer rehabilitation. In order to test patient's knowledge of pain, the Revised Neurophysiology of Pain Questionnaire was developed and translated into Dutch (RNPQ-NL). However, its psychometric properties have not been examined yet., Objective: The goal is to examine the psychometric properties of the RNPQ-NL as a tool to measure the knowledge of pain; in addition, its cross-cultural validity between Belgian and Dutch participants is examined., Methods: 277 persons from Belgium and the Netherlands participated in this study. Cancer patients and survivors (CPaS) (n = 115) were compared to a group of experts with medical training (n = 97). Highly educated individuals without medical background (n = 65) served as control group. The RNPQ-NL was filled out twice and scores analysed in accordance with the COSMIN-recommendation for assessing the methodological quality of studies on measurement properties of health status instruments., Results: The RNPQ-NL was able to distinguish between high and low knowledge of pain. The CPaS group scored significantly lower on the RNPQ-NL compared to the expert group (p < 0.001), but not in comparison to the control group (p=1.00). The Belgian CPaS scored lower than the Dutch CPaS (p=0.001), with a medium effect size (d = 0.481), showing acceptable cross-cultural validity. The Cronbach's α was 0.625, showing some heterogeneity of the items. The test-retest reliability was adequate (ICC = 0.794)., Conclusion: This study supports the interpretability, test-retest reliability, discriminative, and cross-cultural validity of the RNPQ-NL. Internal consistency is suboptimal but acceptable for measuring the knowledge of pain in CPaS., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Astrid Lahousse reports financial support was provided by Research Foundation Flanders. Eva Roose reports financial support was provided by Fight against Cancer. Jo Nijs reports financial support was provided by Berekuyl Academy. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Studies usually investigate a limited number or a predefined combinations of risk factors for sickness absence in employees with pain. We examined frequently occurring combinations across a wide range of work-related factors and pain perceptions., Design: Cross-sectional study., Setting: Belgian companies that are under supervision of IDEWE, an external service for prevention and protection at work., Participants: In total, 249 employees experiencing pain for at least 6 weeks were included and filled out an online survey., Outcomes: Latent profile analysis was used to differentiate profiles of work-related factors (physical demands, workload, social support and autonomy) and pain perceptions (catastrophising, fear-avoidance beliefs and pain acceptance). Subsequently, profiles were compared on sociodemographics (age, gender, level of education, work arrangement, duration of complaints, multisite pain and sickness absence in the previous year) and predictors of sickness absence (behavioural intention and perceived behavioural control)., Results: Four profiles were identified. Profile 1 (38.2%) had favourable scores and profile 4 (14.9%) unfavourable scores across all indicators. Profile 2 (33.3%) had relatively high physical demands, moderate autonomy levels and favourable scores on the other indicators. Profile 3 (13.7%) showed relatively low physical demands, moderate autonomy levels, but unfavourable scores on the other indicators. Predictors of profiles were age (OR 0.93 and 95% CI (0.89 to 0.98)), level of education (OR 0.28 and 95% CI (0.1 to 0.79)) and duration of sickness absence in the previous year (OR 2.29 and 95% CI (0.89 to 5.88)). Significant differences were observed in behavioural intention (χ 2 =8.92, p=0.030) and perceived behavioural control (χ 2 =12.37, p=0.006) across the four profiles., Conclusion: This study highlights the significance of considering the interplay between work-related factors and pain perceptions in employees. Unfavourable scores on a single work factor might not translate into maladaptive pain perceptions or subsequent sickness absence, if mitigating factors are in place. Special attention must be devoted to employees dealing with unfavourable working conditions along with maladaptive pain perceptions. In this context, social support emerges as an important factor influencing sickness absence., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Spinal cord stimulation (SCS) can reduce the need for opioids; however, the influence on the full spectrum of pain medication is less known. The aims of this study were to explore general prescription practices for patients scheduled for SCS, potential differences in prescriptions between Belgium and United Kingdom, and the influence of SCS on pain medication., Materials and Methods: Individual patient data from the TRIAL-STIM study in the United Kingdom and DISCOVER in Belgium were pooled. Medication use was collected before SCS and three months after SCS from 180 chronic pain patients. The Medication Quantification Scale III (MQS) was used to calculate a total score for medication use, as well as subscores for several classes. Differences in prescription practices between United Kingdom and Belgium were evaluated with two-sided Wilcoxon tests. To evaluate differences in medication use after three months of SCS between United Kingdom and Belgium, Tweedie-generalized linear models were calculated., Results: There was a statistically significant difference (-6.40 [95% CI from -3.40 to -9.10]) between the median total MQS score in United Kingdom and Belgium before SCS. Additionally, a significant difference was found for nonsteroidal anti-inflammatory drugs (NSAIDs) (-3.40 [95% CI -3.40 to -6.80]), neuropathic agents (-2.30 [95% CI -0.40 to -3.80]), and benzodiazepines (1.83e -05 [95% CI 2.64 -05 to 7.45 -05 ]) between United Kingdom and Belgium, before SCS. Tweedie-generalized models revealed a statistically significant interaction between country and time for MQS, neuropathic agents, and opioids., Conclusions: Our combined analysis revealed differences in prescription practice in patients scheduled for SCS implantation between Belgium and United Kingdom. NSAIDs and neuropathic mood agents are more frequently used in the United Kingdom, presumably due to easier access to repeat prescriptions and over the counter medications. After three months of SCS, a decrease in medication use is observed in both countries, with higher reductions in Belgium, presumably due to strict regulations concerning reimbursement criteria., (Copyright © 2022. Published by Elsevier Inc.)

Background: Falls are a major problem associated with ageing. Yet, fall-risk classification models identifying older adults at risk are lacking. Current screening tools show limited predictive validity to differentiate between a low- and high-risk of falling., Objective: This study aims at identifying risk factors associated with higher risk of falling by means of a quality-of-life questionnaire incorporating biological, behavioural, environmental and socio-economic factors. These insights can aid the development of a fall-risk classification algorithm identifying community-dwelling older adults at risk of falling., Methods: The questionnaire was developed by the Belgian Ageing Studies research group of the Vrije Universiteit Brussel and administered to 82,580 older adults for a detailed analysis of risk factors linked to the fall incidence data. Based on previously known risk factors, 139 questions were selected from the questionnaire to include in this study. Included questions were encoded, missing values were dropped, and multicollinearity was assessed. A random forest classifier that learns to predict falls was trained to investigate the importance of each individual feature., Results: Twenty-four questions were included in the classification-model. Based on the output of the model all factors were associated with the risk of falling of which two were biological risk factors, eight behavioural, 11 socioeconomic and three environmental risk factors. Each of these variables contributed between 4.5 and 6.5% to explaining the risk of falling., Conclusion: The present study identified 24 fall risk factors using machine learning techniques to identify older adults at high risk of falling. Maintaining a mental, physical and socially active lifestyle, reducing vulnerability and feeling satisfied with the living situation contributes to reducing the risk of falling. Further research is warranted to establish an easy-to-use screening tool to be applied in daily practice., (© 2022. The Author(s).)

Background: Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE])., Objective: To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients., Method: A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants., Results: No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < .05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < .001)., Conclusion: Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Non-alcoholic fatty liver disease (NAFLD) is the most important cause of chronic liver disease in the western world. Steatosis can be accompanied by inflammation and cell damage (non-alcoholic steatohepatitis, NASH), and even liver fibrosis. Sphingolipids are a heterogeneous class of lipids and essential components of the plasma membrane and plasma lipoproteins. The atypical class of deoxy-sphingolipids has been implicated in the metabolic syndrome and type 2 diabetes., Aim: To determine if circulating (deoxy)sphingolipids are associated with NAFLD and its different entities, steatosis, inflammatory changes (inflammation and ballooning) and fibrosis., Methods: Sphingolipids were analysed by LC-MS after hydrolysing the N-acyl and O-linked headgroups in plasma of obese adults who underwent a liver biopsy in suspicion of NAFLD., Results: Two-hundred and eighty-eight patients were included. There was no association between typical sphingolipids and NAFLD and its different entities. There was a significant association between the presence of steatosis and the concentrations of deoxy-sphinganine [exp(B) 11.163 with CI (3.432, 36.306) and p < 0.001] and deoxy-sphingosine [exp(B) 8.486 with CI (3.437, 20.949) and p < 0.001]. There was no association between these deoxy-sphingolipids and activity of the steatohepatitis, nor was there any association with fibrosis. Differences in deoxy-sphingolipids also correlated independently with the presence of the metabolic syndrome, but not diabetes., Conclusion: Deoxy-sphingolipids are elevated in patients with steatosis compared to those without fatty liver, but not different between the different NAFLD subtypes, suggesting that deoxy-sphingolipid bases might be involved in steatogenesis, but not in the further progression of NAFLD to NASH nor in fibrogenesis.

Objective: Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs)., Design: Case-control study., Setting: A single medical center in Belgium., Subjects: The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study., Methods: All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs., Results: No between-group differences were found for stimulus intensity, which was supraliminal for Aδ fibers. The amplitudes and latencies of LEP wave components N1, N2, and P2 in patients with cWAD and CFS were statistically similar to those of HCs. There were no significant differences between the time-frequency maps of EEG oscillation amplitude between HCs and both patient populations., Conclusions: EEG responses of heat-sensitive Aδ fibers in patients with cWAD and CFS revealed no significant differences from the responses of HCs. These findings thus do not support a state of generalized central nervous system hyperexcitability in those patients., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To examine if combining neuromuscular training (NMT) with knee valgus control instructions (VCIs) can affect lower limb biomechanics and injury incidence in male novice runners and assess over 1-year follow-up., Design: Controlled laboratory Study., Setting: University research laboratory., Participants: 60 male novice runners randomly assigned into NMT (n = 20), NMT plus VCIs (n = 20), and sham (n = 20)., Main Outcome Measures: Kinematic and kinetic were measured at pre- and post-test and 1-year follow-up. Injury incidence assessed at pre-test and 1-year follow up., Results: There were significant between-group differences in kinetics after 6 weeks in NMT plus VCIs group. No significant differences were observed between NMT and NMT plus VCIs in kinematic variables. No significant change was seen in the sham in all variables. At 1-year follow-up, the minimal changes were seen in kinetic variables. Reduction reported running-related injuries were 31.58% in the NMT alone group, 65.52% in NMT plus VCIs group. In sham, it increased to 13.46%., Conclusions: NMT plus VCIs was effective to reduce kinetics and improve kinematics in novice runners. Also, it could reduce injury incidence. This protocol may be an option for both athletic trainers and coaches for preventing of lower limbs' injury in male runners., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Pain Neuroscience Education (PNE) has been recognized as an efficacious approach for chronic pain, but evidence for these findings have mainly been gathered in Caucasian patient populations. In recent years, it has been proposed that the treatment of pain and patient information materials should be culturally sensitive for different ethnic populations and cultures since cultural variations in pain beliefs and cognitions., Objectives: To culturally adapt PNE material for first-generation Turkish patients with chronic pain., Design: A modified Delphi study with three consecutive rounds., Method: A total of 10 participants (8 experts and 2 first-generation Turkish patients with chronic pain) were recruited for this study. Three online questionnaire rounds were conducted to synthesize the perspectives and to reach agreement on the suggested PNE materials., Results: Results on multiple-choice questions from the first round revealed that the compatibility of the visual information and the clarity of the message obtained lower scores. Examples, visual information (illustrations, pictures), and metaphors in the teaching materials and the home education leaflet were revised based on suggestions in Rounds 1 and 2. In Round 3, respondents reached an acceptable agreement level for the clinical usefulness of the PNE teaching materials and the home education material., Conclusions: Culturally sensitive PNE materials were produced for first-generation Turkish patients. Since the results of the present study only reveal perspectives of the experts, further validation of education materials may be required before they are recommended for Turkish patients in clinical practices., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Pain neuroscience education is effective in chronic pain management. Central sensitization (ie, generalized hypersensitivity) is often explained as the underlying mechanism for chronic pain, because of its clinical relevance and influence on pain severity, prognosis, and treatment outcome., Objectives: To examine whether patients with more or fewer symptoms of central sensitization respond differently to pain neuroscience education., Design: A secondary analysis of a multicenter, triple-blind randomized controlled trial., Setting: University Hospital Ghent and University Hospital Brussels, Belgium., Patients: 120 persons with chronic spinal pain with high or low self-reported symptoms of central sensitization., Interventions: Pain neuroscience education or neck/back school. Both interventions were delivered in 3 sessions: 1 group session, 1 online session, and 1 individual session., Main Outcome Measures: disability (primary), pain catastrophizing, kinesiophobia, illness perceptions, and hypervigilance., Results: Pain disability did not change in any group (P = .242). Regarding secondary outcomes: significant interaction effects were found for pain catastrophizing (P-values: P = .02 to P = .05), kinesiophobia (P = .02), and several aspects of illness perceptions (chronicity: P = .002; negative consequences: P = .02; personal control: P = .02; and cyclicity: P = .02). Bonferroni post hoc analysis showed that only the pain neuroscience education group (high and low self-reported symptoms of central sensitization) showed a significant improvement regarding kinesiophobia (P < .001, medium effect sizes), perceived negative consequence (P = .004 and P < .001, small to medium effect sizes), and perceived cyclicity of the illness (P = .01 and P = .01, small effect sizes). Pain catastrophizing only significantly reduced in people with high self-reported central sensitization symptoms (P < .05)., Conclusion: Pain neuroscience education is useful in all patients with chronic spinal pain as it improves kinesiophobia and the perceived negative consequences and cyclicity of the illness regardless the self-reported signs of central sensitization. Regarding pain catastrophizing, pain neuroscience education is more effective in patients with high self-reported symptoms of central sensitization., Level of Evidence: I., (Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Purpose: Electric bicycles (e-bikes) may offer an opportunity to stimulate physical activity among older adults. The current study compared Flemish (Belgian) older e-bike users with those not using an e-bike on sociodemographics, health characteristics, and access to motorized transport. In addition, it examined the association between e-bike use and levels of cycling and the moderating effects of sex, body mass index (BMI), and cycling limitations., Methods: An online or interview version of the same questionnaire was completed by 1146 participants. Data were analyzed using logistic regression and hurdle models., Results: Women, those with a higher BMI, and those with one (compared with no) motorized vehicle in the household had higher odds of being an e-bike user. E-bike use was related to higher odds of having cycled for transport in the past week, and this relationship was stronger among those with a higher BMI (low BMI: odds ratio, 1.89; 95% confidence interval (CI), 1.24-2.91; high BMI: odds ratio, 3.34; 95% CI, 2.26-5.00). Among those who cycled for transport in the last week, e-bike use was associated with 35% more minutes of cycling for transport (95% CI, 17%-56%). E-bike use was related to 183% higher odds of having biked for recreation (95% CI, 115%-274%). Among women and those with cycling limitations who cycled for recreation in the last week, e-bike use was also related to 57% (95% CI, 18%-109%) and 180% (95% CI, 63%-381%) more minutes of cycling for recreation, respectively., Conclusion: E-bikes may provide an opportunity to promote cycling among older adults, particularly among subgroups at risk for physical inactivity.

Background: Available evidence favors the use of pain neuroscience education (PNE) in patients with chronic pain. However, PNE trials are often limited to small sample sizes and, despite the current digital era, the effects of blended-learning PNE (ie, the combination of online digital media with traditional educational methods) have not yet been investigated., Objective: The study objective was to examine whether blended-learning PNE is able to improve disability, catastrophizing, kinesiophobia, and illness perceptions., Design: This study was a 2-center, triple-blind randomized controlled trial (participants, statistician, and outcome assessor were masked)., Setting: The study took place at university hospitals in Ghent and Brussels, Belgium., Participants: Participants were 120 people with nonspecific chronic spinal pain (ie, chronic neck pain and low back pain)., Intervention: The intervention was 3 sessions of PNE or biomedically focused back/neck school education (addressing spinal anatomy and physiology)., Measurements: Measurements were self-report questionnaires (Pain Disability Index, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire, and Pain Vigilance and Awareness Questionnaire)., Results: None of the treatment groups showed a significant change in the perceived disability (Pain Disability Index) due to pain (mean group difference posteducation: 1.84; 95% CI = -2.80 to 6.47). Significant interaction effects were seen for kinesiophobia and several subscales of the Illness Perception Questionnaire, including negative consequences, cyclical time line, and acute/chronic time line. In-depth analysis revealed that only in the PNE group were these outcomes significantly improved (9% to 17% improvement; 0.37 ≤ Cohen d ≥ 0.86)., Limitations: Effect sizes are small to moderate, which might raise the concern of limited clinical utility; however, changes in kinesiophobia exceed the minimal detectable difference. PNE should not be used as the sole treatment modality but should be combined with other treatment strategies., Conclusions: Blended-learning PNE was able to improve kinesiophobia and illness perceptions in participants with chronic spinal pain. As effect sizes remained small to medium, PNE should not be used as a sole treatment but rather should be used as a key element within a comprehensive active rehabilitation program. Future studies should compare the effects of blended-learning PNE with offline PNE and should consider cost-effectiveness.

Background: The association of electrocardiographic left ventricular hypertrophy (ECG-LVH) with blood pressure (BP) in Blacks living in sub-Saharan Africa remains poorly documented., Methods: In 225 Black Nigerians and 729 White Flemish, we analyzed QRS voltages and voltage-duration products and 12 criteria diagnostic of ECG-LVH in relation to office BP (mean of 5 consecutive readings) and home BP (duplicate morning and evening readings averaged over 1 week)., Results: In multivariable analyses, QRS voltage and voltage-duration indexes were generally higher in Blacks than Whites. By using any of 12 criteria, ECG-LVH was more prevalent among Black than White men (54.4% vs. 36.0%) with no ethnic difference among women (17.1%). Precordial voltages and voltage-duration products increased with office and home systolic BP (SBP), and increases were up to 3-fold steeper in Blacks. In Blacks vs. Whites, increases in the Sokolow-Lyon voltage associated with a 10-mm Hg higher SBP were 0.18 mV (95% confidence interval [CI], 0.09-0.26) vs. 0.06 mV (0.02-0.09) and 0.17 mV (0.07-0.28) vs. 0.11 mV (CI, 0.07-0.15) for office and home BP, respectively, with a significant ethnic gradient (P < 0.05). The risk of ECG-LVH increased more with office and home BP in Blacks than Whites., Conclusions: Associations of ECG voltages and voltage-duration products and risk of ECG-LVH with BP are steeper in Black Nigerians compared with a White reference population. In resource-poor settings of sub-Saharan Africa, the ECG in combination with office and home BP is an essential instrument in risk stratification across the entire BP range., (© The Author 2017. Published by Oxford University Press on behalf of the American Journal of Hypertension, Ltd.)

Purpose: To investigate the factors related to the 1-month period prevalence of low back pain (LBP), neck pain (NP) and thoracic spine pain (TSP) in young adolescents, thereby considering potential correlates from the physical, sociodemographic, lifestyle, psychosocial and comorbid pain domains., Methods: In this cross-sectional baseline study, 69 factors potentially associated with spinal pain were assessed among 842 healthy adolescents before pubertal peak growth. With consideration for possible sex differences in associations, multivariable analysis was used to simultaneously evaluate contributions of all variables collected in the five domains., Results: A significantly higher odds of LBP was shown for having high levels of psychosomatic complaints (odds ratio: 4.4; 95 % confidence interval: 1.6-11.9), a high lumbar lordotic apex, retroversed pelvis, introverted personality, and high levels of negative over positive affect. Associations with a higher prevalence and odds of NP were found for psychosomatic complaints (7.8; 2.5-23.9), TSP in the last month (4.9; 2.2-10.8), backward trunk lean, high levels of negative over positive affect and depressed mood. Having experienced LBP (2.7; 1.3-5.7) or NP (5.5; 2.6-11.8) in the preceding month was associated with a higher odds of TSP, as were low self-esteem, excessive physical activity, sedentarism and not achieving the Fit-norm., Conclusions: Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that "physical factors" play in non-adult spinal pain may have been underestimated by previous studies.

Background: As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limits, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings., Methods: We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings., Results: For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested., Conclusions: Improving micro-scale attributes may increase the supportiveness of a street for children's transportation cycling. We call for on-site research to test effects of changes in micro-environmental attributes on transportation cycling among children.

Context: In jump-landing sports, the injury mechanism that most frequently results in an injury is the jump-landing movement. Influencing the movement patterns and biomechanical predisposing factors are supposed to decrease injury occurrence., Objectives: To evaluate the influence of a 3-mo coach-supervised jump-landing prevention program on jump-landing technique using the jump-landing scoring (JLS) system., Design: Randomized controlled trial., Setting: On-field., Participants: 116 athletes age 15-41 y, with 63 athletes in the control group and 53 athletes in the intervention group., Intervention: The intervention program in this randomized control trial was administered at the start of the basketball season 2010-11. The jump-landing training program, supervised by the athletic trainers, was performed for a period of 3 mo., Main Outcome Measures: The jump-landing technique was determined by registering the jump-landing technique of all athletes with the JLS system, pre- and postintervention., Results: After the prevention program, the athletes of the male and female intervention groups landed with a significantly less erect position than those in the control groups (P < .05). This was presented by a significant improvement in maximal hip flexion, maximal knee flexion, hip active range of motion, and knee active range of motion. Another important finding was that postintervention, knee valgus during landing diminished significantly (P < .05) in the female intervention group compared with their control group. Furthermore, the male intervention group significantly improved (P < .05) the scores of the JLS system from pre- to postintervention., Conclusion: Malalignments such as valgus position and insufficient knee flexion and hip flexion, previously identified as possible risk factors for lower-extremity injuries, improved significantly after the completion of the prevention program. The JLS system can help in identifying these malalignments., Level of Evidence: Therapy, prevention, level 1b.

Purpose: To determine the effect of active recovery (AR), passive rest (PR), and cold-water immersion (CWI) after 90 min of intensive cycling on a subsequent 12-min time trial (TT2) and the applied pacing strategy in TT2., Methods: After a maximal test and familiarization trial, 9 trained male subjects (age 22 ± 3 y, VO2max 62.1 ± 5.3 mL · min-1 · kg-1) performed 3 experimental trials in the heat (30°C). Each trial consisted of 2 exercise tasks separated by 1 h. The first was a 60-min constant-load trial at 55% of the maximal power output followed by a 30-min time trial (TT1). The second comprised a 12-min simulated time trial (TT2). After TT1, AR, PR, or CWI was applied for 15 min., Results: No significant TT2 performance differences were observed, but a 1-sample t test (within each condition) revealed different pacing strategies during TT2. CWI resulted in an even pacing strategy, while AR and PR resulted in a gradual decline of power output after the onset of TT2 (P ≤ .046). During recovery, AR and CWI showed a trend toward faster blood lactate ([BLa]) removal, but during TT2 significantly higher [BLa] was only observed after CWI compared with PR (P = .011)., Conclusion: The pacing strategy during subsequent cycling performance in the heat is influenced by the application of different postexercise recovery interventions. Although power was not significantly altered between groups, CWI enabled a differently shaped power profile, likely due to decreased thermal strain.

Electrically assisted bicycles (EAB) as a form of transport not only offer the potential to reduce energy use and environmental impact but could also be an effective way of encouraging active living. The purpose of this study is to assess the influence of physical active commuting to work using an EAB, on physiological parameters in 20 untrained men and women. Tests were performed at three different time points over a 10-week period, including four weeks of passive (control period) and six weeks of active commuting (intervention period). ANOVA for repeated measures was used to test differences between the testing series for the most important physiological parameters: Pmax·kg(-1), V˙O2peak·kg(-1), fixed blood lactate concentration (2, 4 mmol·l(-1)). The subjects performed over a 6-week period a mean total cycling distance of 405.1±156.0 km with a weekly frequency of 4.1±1.7 days·week(-1) for men and 246.0±116.3 km with a frequency of 2.9±1.0 days·week(-1) for women. Pmax·kg(-1) significantly increased in men and women after 6 weeks of active commuting. Power output at 2 mmol·l(-1) significantly increased in women (P=0.001) but not in men (P=0.0604). Power output at 4 mmol·l(-1) significantly increased for men and women. V˙O2peak·kg(-1) did not differ. With respect to the study limitations, it is concluded that cycling to work on an EAB was effective in increasing the maximal power output and power output at 4 mmol·l(-1) in these untrained subjects. Cycling on an EAB seems to be a promising tool as a health enhancing physical activity, for those who will benefit the most in terms of health related fitness, namely the physically inactive, unfit and older people.

The purpose of this study is to gain insight into bicycle accidents. Bicycle accident data and weekly exposure data were prospectively collected for one year to calculate the incidence rate (IR) of bicycle accidents. An accident was included if it occurred during utilitarian cycling, resulting in an acute injury with corporal damage. If an accident occurred, a detailed questionnaire was filled out to collect detailed information about its circumstances and consequences. A sample of 1087 regular (≥2 cycling trips to work a week) adult (40±10 years) cyclists was analyzed. Over the 1-year follow-up period, 20,107 weeks were covered, accumulating 1,474,978 cycled kilometers. Sixty-two participants were involved in 70 bicycle accidents, of which 68 were classified as 'minor'. The overall IR for the 70 accidents was 0.324 per 1000 trips (95% CI 0.248-0.400), 0.896 per 1000 h (95% CI 0.686-1.106) and 0.047 per 1000 km (95% CI 0.036-0.059) of exposure. Brussels-capital region is the region with the highest IR (0.086; 95% CI 0.054-0.118), with a significantly (P<0.05) higher IR compared to Flanders (0.037; 95% CI 0.025-0.050). Injuries were mainly caused by 'slipping' (35%) or 'collision with a car' (19%). The accidents caused abrasions (42%) and bruises (27%) to the lower (45%) and upper limbs (41%). Police, hospital emergency department or insurance companies were involved in only 7%, 10% and 30% of the cases, respectively. It is noteworthy that 37% of the participants indicated that they could have avoided the accident. In order to decrease the number of accidents, measures should be taken to keep cycling surfaces clean and decrease the number of obstacles on bicycle infrastructure. Roads and intersections need to be built so that the collisions between cars and bicycles are decreased to a minimum. Car drivers and cyclists should pay more attention towards each other. Underreporting of minor bicycle accidents in Belgium is confirmed, and is higher than expected. Reliable accident statistics, taking into account exposure, are needed to decide which road safety measures are the most effective. The 'safety in numbers' principle is also applicable for minor bicycle accidents., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Purpose: Kinesiophobia and catastrophizing are frequent among people with chronic fatigue syndrome (CFS). This study was aimed at examining (1) whether kinesiophobia, anticipated symptoms and fatigue catastrophizing are related to stair climbing performance in people with CFS; and (2) whether kinesiophobia and fatigue catastrophizing are related to daily physical activity in CFS., Method: Patients with CFS filled in a set of questionnaires, performed a physical demanding task (two floors stair of climbing and descending) with pre-test and post-test heart rate monitoring and immediate post-stair climbing symptom assessment. Real-time activity monitoring was used between the baseline and second assessment day (7 days later)., Results: Kinesiophobia and fatigue catastrophizing were strongly related (ρ = 0.62 and 0.67, respectively) to poorer stair climbing performance (i.e. more time required to complete the threatening activity). Kinesiophobia and fatigue catastrophizing were unrelated to the amount of physical activity on the first day following stair climbing or during the seven subsequent days., Conclusion: These findings underscore the importance of kinesiophobia and fatigue catastrophizing for performing physical demanding tasks in everyday life of people with CFS, but refute a cardinal role for kinesiophobia and fatigue catastrophizing in determining daily physical activity level in these patients.

Background: With the relatively high rate of injuries to the lower extremity due to jump-landing movement patterns and the accompanied high costs, there is need for determining potential preventive programs. A program on the intervention of jump-landing technique is possibly an important preventative measure since it appeared to reduce the incidence of lower extremity injuries. In real life situations, amateur sports lack the infrastructure and funds to have a sports physician or therapist permanently supervising such a program. Therefore the current prevention program is designed so that it could be implemented by coaches alone., Objective: The objective of this randomized controlled trial is to evaluate the effect of a coach supervised intervention program targeting jump-landing technique on the incidence of lower extremity injuries., Methods: Of the 110 Flemish teams of the elite division, 24 teams are included and equally randomized to two study groups. An equal selection of female and male teams with allocation to intervention and control group is obtained. The program is a modification of other prevention programs previously proven to be effective. All exercises in the current program are adjusted so that a more progressive development in the exercise is presented. Both the control and intervention group continue with their normal training routine, while the intervention group carries out the program on jump-landing technique. The full intervention program has a duration of three months and is performed 2 times a week during warm-up (5-10 min). Injuries are registered during the entire season., Discussion: The results of this study can give valuable information on the effect of a coach supervised intervention program on jump-landing technique and injury occurrence. Results will become available in 2011., Trial Registration Number: NTR2560.

The purpose was to examine (1) the effect of cycling to work on physical performance; (2) the minimum weekly energy expenditure needed for fitness improvement based on the dose-response relationship between total caloric expenditure and fitness changes. Healthy, untrained men and women, who did not cycle to work, participated in a 1-year intervention study. Sixty-five subjects were asked to cycle to work at least three times a week. Fifteen subjects were asked not to change their living habits. All measurements were performed on three consecutive occasions, with 6 months in between. Maximal external power (P(max)), heart rate, respiratory exchange ratio and peak oxygen uptake (VO(2peak)) were assessed. Cycling characteristics and leisure time physical activities were reported in a dairy. A significant change over time between both groups was seen for VO(2peak) (/kg) in the total group and the women and for P(max) in the total group. Correlations were found between VO(2peak) (/kg) (r>/=0.40) and kcal/week and min/week. Preliminary results indicate that the minimum expended energy needed for the improvement of indexes of fitness is higher for men compared with women.

Objective: This study determines the injury rate (%) and the associated direct medical and indirect costs of sports injuries in Flanders., Setting: Epidemiological cohort designs and a human capital method were set up to measure respectively the medical direct and indirect cost of sports injuries., Participants: 72 out of 82 Flemish sports federations participated., Intervention: Insurance statistics from 2003 were used to determine the overall rate of injury and injury localisations. Using these data, the medical direct cost and the impact sports injuries have on indirect costs were estimated. The indirect costs were determined by multiplying the days of absence from work with the daily cost resulting from a loss of production, being 200 euros., Main Outcome: The total direct medical cost extrapolated for the Flemish sports participants was 15,027,423 euros, which amounted to 0.07% to 0.08% of the total budget spent on healthcare. The indirect cost extrapolated for the Flemish sports participants was 111,420,813 euros, which is about 3.4% of the costs arising from absenteeism from work., Results: Of the 14 in-depth analysed sports, the rate of injury was highest in European team handball (8.96%; 95% confidence interval (CI) 8.95-8.96) and lowest in swimming (0.62%; 95% CI 0.62-0.62). The highest direct medical cost was found for anterior cruciate ligament (ACL) injuries (1358 euros per injury) and the lowest for foot injuries (52 euros per injury)., Conclusion: The costs calculated in this study could become critical statistics in medical care debates. Data obtained here will enable a cost-benefit analysis of the impact of preventive measures to be made.

The aim of this study was to examine psychosocial and environmental predictors of cycling for transportation. A sample of 343 Flemish adults (43% men) living at maximum 10 km from their workplace was surveyed. Self-report measures of cycling, demographic variables, psychosocial variables, self-efficacy, perceived benefits and barriers and environmental attributes (destination, traffic variables and facilities at the workplace) of cycling for transport were obtained by means of a mailing questionnaire. Modeling and social support by accompanying, external self-efficacy, ecological-economic awareness and lack of time and interest were positively associated with the likelihood of cycling for transport and varied in importance between cyclists and non-cyclists. Cyclists estimate the time to destination shorter than non-cyclists and indicate to have more facilities for cyclists at the workplace. The results suggest that when people live in a setting with adequate bicycle infrastructure, individual determinants (psychosocial, self-efficacy, perceived benefits and barriers) outperform the role of environmental determinants in this sample. Promotion campaigns aimed at increasing cycling for transportation should focus on creating social support by encouraging cycling with partners, increasing self-efficacy, raising ecological and economic awareness, decreasing lack of time and interest barriers and providing facilities for cyclists at the workplace.

The purpose of this study was to examine if a 1-year lifestyle intervention study (cycling to work) has an influence on coronary heart disease (CHD) risk factors and health-related quality of life, in previously untrained healthy adults. Healthy, untrained men and women, who did not cycle to work, participated in an intervention study. Sixty-five subjects (intervention group: IG) were asked to cycle to work at least 3 times a week and 15 controls (CG) were asked not to change their living habits. All measurements were performed on 3 consecutive occasions, with 6 months in between. Physical performance, venous blood samples, blood pressure (BP), and the SF-36 Health Status Survey were assessed. Cycling characteristics and leisure-time physical activities were reported in a dairy. Total cholesterol (TC), LDL, TC/HDL and diastolic BP decreased and HDL increased significantly in the IG. TC and LDL decreased significantly in the CG. Vitality for the total group and physical functioning for women significantly changed over time between IG and CG in the first 6 months. These results show that cycling to work has a positive influence on CHD risk factors and is likely to improve the health-related quality of life in previously untrained healthy adults.

Objectives: To investigate aspects of the validity of the total scores of the Tampa Scale for Kinesiophobia (TSK), Dutch Version, which was modified to make it an appropriate questionnaire for the assessment of kinesiophobia (fear of movement) in chronic fatigue syndrome (CFS) patients (the Dutch TSK-CFS), and, using this assessment tool, to examine the associations between kinesiophobia, exercise capacity, and activity limitations and participation restrictions in patients with CFS., Design: Prospective observational studies., Setting: An outpatient fatigue clinic., Participants: In the first study, 40 patients fulfilling the 1994 US Centers for Disease Control and Prevention (CDC) criteria for CFS were enrolled. The sample of the second study consisted of 51 CDC-defined patients with CSF., Interventions: Not applicable. Main outcome measures Study 1: Subjects completed a set of questionnaires; the Utrechtse Coping List (UCL), the Dutch TSK-CFS, and the Dutch Baecke Questionnaire of Habitual Physical Activity. Study 2: All patients completed 2 questionnaires (Chronic Fatigue Syndrome Activities and Participation Questionnaire [CFS-APQ], Dutch TSK-CFS) and performed a maximal exercise stress test on a bicycle ergometer. The heart rate was monitored continuously by use of an electrocardiograph. Metabolic and ventilatory parameters were measured through spirometry., Results: Study 1: The Cronbach alpha coefficient for the individual item scores on the TSK-CFS was .80. The total scores on the Dutch TSK-CFS showed a statistically significant correlation with both the avoidance/abide subscale of the UCL (Spearman rho=.35, P=.029) and the total score of the Baecke Questionnaire (rho=-.45, P=.004). Study 2: The total scores on the Dutch TSK-CFS showed a statistically significant correlation with the total scores on the CFS-APQ (rho=.39, P=.004). No statistically significant associations were observed between the exercise capacity parameters and the total scores on the Dutch TSK-CFS., Conclusions: These results provide evidence for the internal consistency and the convergent and congruent validity of the scores obtained by use of the Dutch TSK-CFS. Kinesiophobia appears to be associated with activity limitations/participation restrictions but not with exercise capacity in patients with CFS.

Objective: In an attempt to examine whether impairments in cardiorespiratory fitness are associated with daily functioning in patients with chronic fatigue syndrome (CFS), this study addresses the correlations between exercise capacity and activity limitations/participation restrictions., Design: Prospective observational study., Setting: An outpatient tertiary care, chronic fatigue clinic at the Vrije Universiteit Brussel (VUB), Belgium., Subjects: Seventy-seven patients fulfilling the 1994 Centers for Disease Control and Prevention (CDC) case definition for CFS., Interventions: All patients filled in the Chronic Fatigue Syndrome Activities and Participation Questionnaire (CFS-APQ) and performed a maximal exercise stress test on a bicycle ergometer. Heart rate was monitored continuously by use of an electrocardiograph. Metabolic and ventilatory parameters were measured through spirometry., Results: A statistically significant correlation between the score obtained with the CFS-APQ and the body weight-adjusted peak oxygen uptake (Spearman rho = -0.32; p = 0.005), functional aerobic impairment (rho = 0.33; p = 0.004), workload/body weight (rho = -0.30; p = 0.009), exercise duration (rho = -0.30; p = 0.008), and the percentage of target heart rate achieved (rho = -0.33; p = 0.004) was observed. The correlations between the remaining exercise capacity parameters and the scores obtained with the CFS-APQ all indicated a trend towards association (0.01

Purpose: This study assessed the validity and reliability of a self-administered physical activity questionnaire used in the WHO-MONICA project., Methods: Subjects (N = 167) were physical education and physical therapy alumni. The questionnaire (MOSPA-Q) covers a 1-yr period and measures the average weekly time and energy expenditure spent in one's occupation, transport-related activities, household chores, and leisure time activities. Test-retest reliability was reported as the intra-class correlation between calculated time or energy expenditure in different questionnaire items determined from two MOSPA-Q administrations. Validity was assessed using biometrical and physiological parameters as criterion measures., Results: Test-retest reliability ranged from 0.45 to 0.92 with the highest correlation coefficients obtained for the leisure time physical activities. The correlation between calculated daily total energy expenditure (TEE, Kcal.d-1) and lean body mass was 0.53 (P < 0.001). The correlation between energy expenditure in leisure time activities (Kcal.wk-1) and VO2peak was 0.44., Conclusions: The MOSPA-Q provides a relatively valid and reliable estimate of physical activity.