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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
The Relationship between Kinesiophobia, Pain Intensity and Functional Disability among Elderly Individuals with Low Back Pain: A Cross-sectional Study
Correspondence Address :
Dr. KU Dhanesh Kumar,
Professor, Nitte Institute of Physiotherapy (Nitte Deemed to be University), Deralakatte, Mangaluru-575022, Karnataka, India.
E-mail: dhaneshphysio1975@gmail.com
Introduction: Low Back Pain (LBP) is the most common health problem among elderly individuals, leading to pain and disability. Alongside pain, psychosocial factors have a significant impact on patients with LBP. Kinesiophobia is defined as a fear of physical movement and activity, which can result in avoidance of activities and movement, leading to deconditioning. The relationship between kinesiophobia and pain severity is complex and interrelated, with each affecting the other and restricting the patient’s participation in daily activities.
Aim: To investigate the relationship between kinesiophobia, pain severity, and functional disability in older people with LBP.
Materials and Methods: A total of 49 participants over 60 years old with LBP were recruited for this cross-sectional study at the Department of Physiotherapy, Nitte Institute of Physiotherapy, Deralakatte, Mangaluru, Karnataka, India. Subjects were recruited from March 2022 to February 2023 based on inclusion criteria. Screened participants completed a self-reported questionnaire, The subjects themselves filled out the outcome tools. including the Tampa Scale of Kinesiophobia (TSK) Questionnaire, the Roland Morris Disability Questionnaire tool, and the Numerical Pain Rating Scale (NPRS) to assess various aspects of kinesiophobia, functional disability, and pain severity. Pearson’s correlation coefficient was used to determine the correlation between kinesiophobia, pain severity, and functional disability. A p-value <0.05 was considered statistically significant.
Results: The age of the elderly participants ranged from 60 to 84 years, with a mean age of 70.9±6.5 years. Positive correlation was found between kinesiophobia and functional disability (r value=0.464, p-value=0.001), while no correlation was observed between kinesiophobia and pain intensity.
Conclusion: It is concluded that kinesiophobia may contribute to disability, as a positive relationship between kinesiophobia and functional disability was observed in individuals with LBP. However, no correlation was found between kinesiophobia and pain intensity.
Numerical pain rating scale, Roland-Morris disability questionnaire, Tampa scale of kinesiophobia
Low back pain is the most common health problem among elderly individuals, leading to pain and disability. Older individuals, especially those aged 60 years or older, have a higher risk of experiencing persistent back pain lasting longer than three months and represent the second most common age group seeking care for LBP (1). This population also faces challenges in completing functional activities, which further diminishes their mobility. Mobility is essential for older individuals to maintain functional independence (2).
The prevalence of LBP increases from adolescence to 60 years of age. Across the world, the prevalence of LBP in seniors ranges from 13% to 50% (1). The prognosis of LBP may be directly related to the duration of symptoms (3). In assessing the level of disability in LBP and identifying factors influencing the relationship between pain severity and rehabilitation, the intensity of pain plays a crucial role (4). Additionally, psychosocial factors have a significant impact on patients, as movements that increase pain can elicit fear and lead individuals to avoid such movements, resulting in reduced activity and strength (3).
According to the fear-avoidance model, psychological behaviours, such as pain and fear of pain associated with movements, are related to cognitive-behavioural factors affecting pain intensity and disability (4). Kinesiophobia is defined as a state where an individual experiences excessive fear of physical movement and activity due to the perceived susceptibility to painful injury (2). Kinesiophobia has been identified as a significant factor in the progression of pain from the acute to chronic stage. It is recognised as a risk factor for chronicity in LBP and a significant predictor of pain disability in the chronic pain population (5). This fear may lead individuals with chronic pain to avoid activities and movements, resulting in deconditioning and disuse (6). Research has shown that a history of pain and its memory can trigger pain and initiate the fear of movement, causing patients to adopt pain avoidance behaviours. Prolonged pain can result in disengagement from functional activities (7).
Back pain is subjective, making it challenging to assess a patient’s perception of their level of physical function in relation to their impairment (8). Kinesiophobia not only limits the musculoskeletal system by deconditioning it but also creates functional disabilities and restrictions on social and recreational activities, which may lower the quality of life. LBP can affect sleep patterns, cause muscle weakness, and reduce movement in the spine and limbs. Extrinsic factors, including the person’s living situation and health status, also play a role in disability. These two factors frequently overlap and have complexities that impact one another, limiting the patient’s ability to perform daily activities. Therefore, it is necessary to develop strategies to prevent kinesiophobia in individuals with LBP (3).
Hence, the primary aim of the present study was to determine the relationship between kinesiophobia, pain severity, and functional disability in older people with LBP, using the TSK, the NPRS, and the Roland-Morris Disability Questionnaire.
A cross-sectional study was conducted from March 2022 to February 2023 at the Department of Physiotherapy in Justice KS Hegde Hospital, Deralakatte, Mangaluru, India. Institutional Ethics Committee (IEC) approval (NIPT/IEC/Min/14/2021-2022 dated 12-02-2022) was obtained and prospectively registered in the Clinical Trial Registry of India database (CTRI/2022/08/045028). Additionally, written informed consent was obtained from all participants.
Inclusion and Exclusion criteria: Both males and females aged 60 years or above, experiencing non specific LBP with pain, were included in the study (9). Participants with a history of significant back trauma, recent trauma or back fracture, surgery, spinal cord injuries, tumours, neurogenic or radicular conditions, or cognitive impairment preventing them from providing signed informed consent were excluded from the study.
Sample size calculation: The required sample size was determined to be 49 based on the correlational coefficient value of 0.373 between the TSK and the Roland-Morris Disability Questionnaire, with 80% power and a 5% alpha error for a two-sided hypothesis. The sample size calculation was performed using “n Master” software version 2.0.
Study Procedure
The study procedure was explained, and written consent forms were obtained from the participants. Screening was conducted to ensure participants met the inclusion and exclusion criteria, and those meeting the inclusion criteria were recruited for the study.
Demographic data of the subjects were collected and recorded. The subjects themselves filled out the outcome tools. The TSK questionnaire was used to assess kinesiophobia (10), the NPRS was utilised to assess the intensity of pain (9), and the Roland-Morris Disability Questionnaire tool was used to assess functional disability (11).
Tampa Scale of Kinesiophobia (TSK)-17 (10): The TSK-17 measures the level of fear of movement. It consists of 17 items, and each item is scored on a 4-point scale ranging from “strongly disagree” to “strongly agree”. The scoring range for TSK-17 is 17 to 68, with scores above 37 generally indicating a high level of kinesiophobia (10). Higher scores indicate a higher level of kinesiophobia. The TSK-17 has an acceptable level of internal consistency (Cronbach’s alpha of 0.81) and test-retest reliability (ICC=0.91) (10).
Numerical pain rating scale: This scale is an 11-point numeric pain scale ranging from 0 to 10. A score of 0 indicates “no pain” and a score of 10 indicates the “worst possible pain” at the time of assessment. It is a simple instrument that is easy to apply (9). Participants choose a whole number that best represents their pain intensity. Higher scores indicate greater pain severity (9).
Roland-Morris disability questionnaire: The Roland-Morris Disability Questionnaire is a tool for assessing the functional state of individuals with LBP. This questionnaire has strong psychometric qualities and an internal consistency of 0.85 (12). It consists of 24 items that cover regular activities in daily living, and participants rate their level of difficulty in performing these activities. Each answer is given 1 point, and a total score ranging from 0 to 24 is computed. A score of zero signifies the least disability, while scores greater than or equal to 14 are classified as indicating limited functional ability (11).
Statistical Analysis
The data were analysed using Statistical Package for Social Sciences (SPSS) software (SPSS Inc.; Chicago, IL) version 26.0. Descriptive statistics such as frequency, percentage, mean, and Standard Deviation (SD) were used to summarise the collected data. Pearson’s correlation coefficient {r=xi-mean* yi-mean/(xi-mean)2* (yi-mean)2} was employed to determine the correlation between kinesiophobia, pain severity, and functional disability. A p-value <0.05 was considered significant.
The present study was conducted among 49 elderly individuals with LBP. The age of the elderly participants ranged from 60 to 84 years, with a mean age of 70.9±6.5 years. The NPRS scores ranged from 6 to 9, with a mean of 7.7±0.8 (Table/Fig 1). The majority of the participants (53.1%) were males (Table/Fig 2). The mean kinesiophobia score for the study population was 59.6±4.0, and the mean Roland-Morris Disability Questionnaire score was 22±1.4 (Table/Fig 3).
To examine the correlation between kinesiophobia, pain severity, and functional disability, Pearson’s correlation coefficient was used. There was a positive correlation between kinesiophobia and functional disability (p<0.01, r=0.464), which was statistically significant (Table/Fig 4).
According to the biopsychosocial model, some people with musculoskeletal pain develop chronic pain based on fear of pain, specifically the concern that movement may trigger pain or reinjure them. It is proposed that two conflicting behavioural responses exist: 1) people decide to manage discomfort to improve and engage in functional activities, reasoning that it shouldn’t hinder them, or 2) people choose to maintain a fear of movement, believing that doing so will cause pain (4).
In a study by Ishak NA et al., no correlation was found between kinesiophobia and pain intensity in elderly individuals with LBP (2). The present study yielded similar results, showing no correlation between kinesiophobia and pain severity. These findings do not support the hypothesis that kinesiophobia and pain severity are related.
Kinesiophobia not only limits the musculoskeletal system by causing deconditioning but also leads to functional disabilities. The present research deepens the understanding of the psychological factors contributing to disability. Fear of movement can result in avoidance and inactivity, which are seen as protective actions but ultimately increase functional limitations in daily life (13).
The progression of impairment in LBP is predicted by kinesiophobia. LBP commonly affects regular daily activities such as lifting, standing, sitting, and travelling. Therefore, identifying limitations that hinder daily tasks is important (13). One factor that could contribute to disability is kinesiophobia, which may also be one of the fundamental mechanisms through which pain leads to impairment. The current study found an association between kinesiophobia and functional disability, supporting the hypothesis that there is a correlation between kinesiophobia and functional disability.
In studies by Luque-Suarez A et al., it was found that functional impairment in elderly people with LBP was correlated with kinesiophobia. The present study also revealed a positive link between kinesiophobia and functional impairment in older people with LBP (7). While no correlation was found between kinesiophobia and pain, there is a direct correlation between kinesiophobia and functional impairment in older adults with LBP. Therefore, kinesiophobia contributes to disability in the elderly population.
Limitation(s)
The use of drugs or medication for pain was not questioned in the current study. Studies that take medication use into account can be conducted in the future.
The aim of the present study was to investigate the relationship between kinesiophobia, pain severity, and functional disability in older people with LBP. No correlation was found between kinesiophobia and pain intensity. However, a positive correlation was observed between kinesiophobia and functional disability, suggesting that kinesiophobia has a significant impact on functional disability in elderly patients with LBP.
DOI: 10.7860/JCDR/2024/65630.18888
Date of Submission: May 26, 2023
Date of Peer Review: Aug 11, 2023
Date of Acceptance: Nov 04, 2023
Date of Publishing: Jan 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 26, 2023
• Manual Googling: Sep 14, 2023
• iThenticate Software: Nov 02, 2023 (11%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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