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      Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity—A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

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          Abstract

          Background

          The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level.

          Methods and findings

          Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI ≥30 kg/m 2, 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI ≥35 kg/m 2, 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53–0.81] and severe obesity (OR 0.56, 95% CI 0.42–0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06–1.29) among the obese patients.

          Conclusion

          Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.

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          Most cited references49

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          Economic Burden of Obesity: A Systematic Literature Review

          Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.
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            The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).

            The complexity of chronic pain has represented a major dilemma for clinical researchers interested in the reliable and valid assessment of the problem and the evaluation of treatment approaches. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was developed in order to fill a widely recognized void in the assessment of clinical pain. Assets of the inventory are its brevity and clarity, its foundation in contemporary psychological theory, its multidimensional focus, and its strong psychometric properties. Three parts of the inventory, comprised of 12 scales, examine the impact of pain on the patients' lives, the responses of others to the patients' communications of pain, and the extent to which patients participate in common daily activities. The instrument is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings. The utility of the WHYMPI in empirical investigations of chronic pain is also discussed.
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              Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample.

              The Hospital Anxiety and Depression Scale (HAD) was evaluated in a Swedish population sample. The purpose of the study was to compare the HAD with the Beck Depression Inventory (BDI) and Spielberger's State Trait Anxiety Inventory (STAI). A secondary aim was to examine the factor structure of the HAD. The results indicated that the factor structure was quite strong, consistently showing two factors in the whole sample as well as in different subsamples. The correlations between the total HAD scale and BDI and STAI, respectively, were stronger than those obtained using the different subscales of the HAD (the anxiety and depression subscales). As expected, there was also a stronger correlation between the HAD and the non-physical items of the BDI. It was somewhat surprising that the factor analyses were consistently extracting two factors, 'depression' and 'anxiety', while on the other hand both BDI and STAI tended to correlate more strongly with the total HAD score than with the specific depression and anxiety HAD subscales. Nevertheless, the HAD appeared to be (as was indeed originally intended) a useful clinical indicator of the possibility of depression and clinical anxiety.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 September 2020
                2020
                : 15
                : 9
                : e0239818
                Affiliations
                [1 ] Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
                [2 ] Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden
                [3 ] Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden
                University of Maiduguri College of Medical Sciences, NIGERIA
                Author notes

                Competing Interests: AFA Insurance provided support in the form of a research grant, which was used for salaries for the author BG and for language revision, publication costs and participation in scientific conferences. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0001-7051-1234
                Article
                PONE-D-19-34615
                10.1371/journal.pone.0239818
                7521725
                32986777
                0dee5fc5-9fbe-4cae-a00f-a664d4a7db48
                © 2020 Dong et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 December 2019
                : 14 September 2020
                Page count
                Figures: 3, Tables: 4, Pages: 19
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100002706, AFA Försäkring;
                Funded by: County Council of Östergötland (Research-ALF)
                Award ID: LIO-608021
                Award Recipient :
                Funded by: County Council of Östergötland
                Award ID: SC-2017-00202-28
                Award Recipient :
                This study was supported by grants from AFA insurance, the County Council of Östergötland (Research-ALF, LIO-608021, BG and SC-2017-00202-28, H-JD). AFA Insurance, a commercial founder, is owned by Sweden's labor market parties: The Confederation of Swedish Enterprise, the Swedish Trade Union Confederation (LO), and The Council for Negotiation and Co‐operation (PTK). These parties insure employees in the private sector, municipalities and county councils. The funding sources did not participate in the design of the study, collection, analysis, or interpretation of the data; or in the decision to submit the manuscript for publication. There was no additional external funding received for this study.
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Pain
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Medicine and Health Sciences
                Pain Management
                Pain Psychology
                Biology and Life Sciences
                Psychology
                Pain Psychology
                Social Sciences
                Psychology
                Pain Psychology
                Medicine and Health Sciences
                Medical Conditions
                Sleep Disorders
                Dyssomnias
                Insomnia
                Medicine and Health Sciences
                Neurology
                Sleep Disorders
                Dyssomnias
                Insomnia
                People and places
                Geographical locations
                Europe
                European Union
                Sweden
                Custom metadata
                The datasets generated and/or analysed in this study are not publicly available as the Ethical Review Board has not approved the public availability of raw data. The data that support the findings of this study are available from SQRP ( https://www.ucr.uu.se/nrs/) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available upon reasonable request and with permission of SQRP research group (address: NRS, Skånes Universitetssjukhus, Smärtrehabilitering, Lasarettsgatan 13, SE 221 85 Lund, Sweden; Register holder: Marcelo Rivano Fischer, Marcelo.rivanofischer@ 123456skane.se ). Analyzing data also requires permission from the Swedish Ethical Review authority (In Swedish: Etikprövningsmyndigheten; address: Etikprövningsmyndigheten, Box 2110, SE 750 02 Uppsala, Sweden, e-mail: registrator@ 123456etikprovning.se ).

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