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Background People with chronic musculoskeletal pain (CMSP) often have low physical activity. Various factors can influence the activity level. The aim of this study was to monitor physical activity, assessed by the number of steps per day, over time in people with CMSP and identify factors that could be associated with this activity feature. Methods This prospective study involved people undergoing rehabilitation following an orthopedic trauma that had led to CMSP. At entry, participants completed self-reported questionnaires assessing pain, anxiety, depression, catastrophyzing, kinesiophobia, and behavioural activity patterns (avoidance, pacing and overdoing). They also underwent functional tests, assessing walking endurance and physical fitness. To determine daily step counts, participants wore an accelerometer for 1 week during rehabilitation and 3 months post-rehabilitation. The number of steps per day was compared among three time points: weekend of rehabilitation (an estimate of pre-rehabilitation activity; T1), weekdays of rehabilitation (T2), and post-rehabilitation (T3). Linear regression models were used to analyze the association between daily steps at T2 and at T3 and self-reported and performance-based parameters. Results Data from 145 participants were analyzed. The mean number of steps was significantly higher during T2 than T1 and T3 (7323 [3047] vs. 4782 [2689], p  < 0.001, Cohen’s d = 0.769, and 4757 [2680], p  < 0.001, Cohen’s d = 0.693), whereas T1 and T3 results were similar ( p  = 0.92, Cohen’s d = 0.008). Correlations of number of steps per day among time points were low ( r  ≤ 0.4). Multivariable regression models revealed an association between daily steps at T2 and pain interfering with walking, anxiety and overdoing behaviour. Daily steps at T3 were associated with overdoing behaviour and physical fitness. Conclusions Despite chronic pain, people in rehabilitation after an orthopedic trauma increased their physical activity if they were given incentives to do so. When these incentives disappeared, most people returned to their previous activity levels. A multimodal follow-up approach could include both therapeutic and environmental incentives to help maintain physical activity in this population.

While intermittent hypoxic training (IHT) has been reported to evoke cellular responses via hypoxia inducible factors (HIFs) but without substantial performance benefits in endurance athletes, we hypothesized that repeated sprint training in hypoxia could enhance repeated sprint ability (RSA) performed in normoxia via improved glycolysis and O(2) utilization. 40 trained subjects completed 8 cycling repeated sprint sessions in hypoxia (RSH, 3000 m) or normoxia (RSN, 485 m). Before (Pre-) and after (Post-) training, muscular levels of selected mRNAs were analyzed from resting muscle biopsies and RSA tested until exhaustion (10-s sprint, work-to-rest ratio 1:2) with muscle perfusion assessed by near-infrared spectroscopy. From Pre- to Post-, the average power output of all sprints in RSA was increased (p<0.01) to the same extent (6% vs 7%, NS) in RSH and in RSN but the number of sprints to exhaustion was increased in RSH (9.4±4.8 vs. 13.0±6.2 sprints, p<0.01) but not in RSN (9.3±4.2 vs. 8.9±3.5). mRNA concentrations of HIF-1α (+55%), carbonic anhydrase III (+35%) and monocarboxylate transporter-4 (+20%) were augmented (p<0.05) whereas mitochondrial transcription factor A (-40%), peroxisome proliferator-activated receptor gamma coactivator 1α (-23%) and monocarboxylate transporter-1 (-36%) were decreased (p<0.01) in RSH only. Besides, the changes in total hemoglobin variations (Δ[tHb]) during sprints throughout RSA test increased to a greater extent (p<0.01) in RSH. Our findings show larger improvement in repeated sprint performance in RSH than in RSN with significant molecular adaptations and larger blood perfusion variations in active muscles.

IntroductionHealth literacy (HL) is defined as the ability to access, understand, evaluate and apply health-related information, which can influence individuals’ health outcomes. Blue-collar workers, who often have lower educational attainment and experience language barriers, are at increased risk of limited HL. This systematic review aims to assess the prevalence of limited HL among blue-collar workers to inform the development of appropriate interventions for its improvement.Methods and analysisThe systematic review will assess the prevalence of limited HL among blue-collar workers. We will include all quantitative study designs using any instrument for measuring general HL. We will exclude studies that focus on specific types of HL and specific health conditions. We have performed a literature search from inception up to 30 April 2025, in the Medline, Embase, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We will also search eligible articles from Google Scholar and Open Grey as sources of unpublished studies/gray literature. Two independent reviewers will conduct the primary screening of articles, data extraction and quality assessment (using the Cochrane risk-of-bias tool for randomised trials and risk of bias in non-randomised studies of exposure), with a third individual available to resolve conflicts. We will assess heterogeneity using the χ² test and I² test. If there is sufficient homogeneity, we will pool studies in a meta-analysis or summarise the findings narratively if heterogeneity is too high. We will use a random effects model for our analysis, and we will use funnel plots to evaluate potential publication bias. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to assess the certainty of findings.Ethics and disseminationEthical approval will not be required for this review as there is no primary data collection involving humans. The results will be published in a peer-reviewed journal and presented at relevant conferences.PROSPERO registration numberCRD42024597732.

Three main activity patterns have been distinguished in describing chronic pain (avoidance, pacing and persistence). However, their influence on patient outcomes remains a question of debate. This observational study aimed to measure the associations between the avoidance, pacing, and persistence (labelled overdoing) scales of the Patterns of Activity Measure-Pain (POAM-P), self-reported outcomes (pain-interference, depression, functional ability), and observational outcomes (walking, lifting test, physical fitness). We conducted an observational study with cross-sectional and longitudinal analyses. The data were collected prospectively before and after treatment, which was a 5-week functional rehabilitation including vocational aspects. In addition to self-reported and observational outcomes, patients were asked if they thought they would be able to return to work at 6 months. Analyses were conducted with treatment effect sizes, correlations, and multiple regression models. In this sample (891 patients), we found on average small to moderate improvements for pain-interference and observational outcomes (Cohen's d: 0.37 to 0.64). According to the multivariable models, overdoing was associated with most of the beneficial psychosocial and observational outcomes (β -0.13 to 0.17; all p<0.01). Avoidance was related to negative psychosocial outcomes before treatment (β -0.09 to 0.17; all p<0.015). Pacing, which had moderate correlation with avoidance (r = 0.46), was not associated with most of the outcomes. The feeling that the goal of returning to work was attainable was associated with lower avoidance scores (adjusted OR 0.97; p = 0.024). The overdoing POAM-P scale probably measures a task-contingent persistence, which appears appropriate in the setting of this study. Persistent behavior was indeed related to small or moderate positive biopsychosocial outcomes, before and after treatment. Moreover feeling able to return to work was related to lower avoidance. Further studies should test the efficacy of motivational strategies that may promote functional task-contingent persistence and reduce avoidance of painful tasks.

Skeletal muscle atrophy occurs in many chronic diseases and disuse conditions. Its severity reduces patient recovery, independence and quality of life. The discovery of two muscle-specific E3 ubiquitin ligases, MAFbx/atrogin-1 and Muscle RING Finger-1 (MuRF1), promoted an expectation of these molecules as targets for therapeutic development. While numerous studies have determined the conditions in which MAFbx/atrogin-1 and MuRF1 mRNA levels are regulated, few studies have investigated their functional role in skeletal muscle. Recently, studies identifying new target substrates for MAFbx/atrogin-1 and MuRF1, outside of their response to the initiation of muscle atrophy, suggest that there is more to these proteins than previously appreciated. This review will highlight our present knowledge of MAFbx/atrogin-1 and MuRF1 in skeletal muscle atrophy, the impact of potential therapeutics and their known regulators and substrates. Finally, we will comment on new approaches that may expand our knowledge of these two molecules in their control of skeletal muscle function.

Background Functional tests are widely used to measure performance in patients with chronic musculoskeletal pain. Our objective was to determine the Minimal Clinically Important Differences (MCID) for the 6-min walk test (6MWT), the Steep Ramp Test (SRT), the 1-min stair climbing test (1MSCT), the sit-to-stand test (STS), the Jamar dynamometer test (JAM) and the lumbar Progressive Isoinertial Lifting Evaluation (PILE) in chronic musculoskeletal pain patients. Methods A single-center prospective observational study was conducted in a rehabilitation center. Patients with upper-limb, lower-limb or neck/back lesions were included over a period of 21 months. We used the anchor-based method as a reference method, supplemented by the distribution-based and opinion-based approaches, to determine the MCIDs. Results 838 chronic musculoskeletal pain patients were included. The estimation method and thelesion location had a significant influence on the results. MCIDs were estimated at +75m and +60m for the 6MWT (lower-limb and neck/back lesions, respectively), +18 steps for the 1MSCT (lower-limb and neck/back lesions) and +6kg for the JAM (upper limb lesions). The anchor-based method could not provide valid estimations for the three other scales, but distribution and opinion-based methods provided rough values of MCIDs for the SRT (+39w to +61w), the STS (-5 sec to -7 sec) and the PILE (+4kg to +7kg). Conclusion The above MCID estimations for the 6MWT, 1MSCT and JAM can be used in chronic musculoskeletal pain patients participating in vocational multidisciplinary rehabilitation programs or in therapeutic trials. The use of specific anchors might give better estimations of MCIDs for the three other scales in future research.

Background Validated clinician outcome scores are considered less associated with psychosocial factors than patient-reported outcome measurements (PROMs). This belief may lead to misconceptions if both instruments are related to similar factors. Questions We asked: In patients with chronic shoulder pain, what biopsychosocial factors are associated (1) with PROMs, and (2) with clinician-rated outcome measurements? Methods All new patients between the ages of 18 and 65 with chronic shoulder pain from a unilateral shoulder injury admitted to a Swiss rehabilitation teaching hospital between May 2012 and January 2015 were screened for potential contributing biopsychosocial factors. During the study period, 314 patients were screened, and after applying prespecified criteria, 158 patients were evaluated. The median symptom duration was 9 months (interquartile range, 5.5–15 months), and 72% of the patients (114 patients) had rotator cuff tears, most of which were work injuries (59%, 93 patients) and were followed for a mean of 31.6 days (SD, 7.5 days). Exclusion criteria were concomitant injuries in another location, major or minor upper limb neuropathy, and inability to understand the validated available versions of PROMs. The PROMs were the DASH, the Brief Pain Inventory, and the Patient Global Impression of Change, before and after treatment (physiotherapy, cognitive therapy and vocational training). The Constant-Murley score was used as a clinician-rated outcome measurement. Statistical models were used to estimate associations between biopsychosocial factors and outcomes. Results Greater disability on the DASH was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.64; 95% CI, 0.25–1.03; p = 0.002) and social factors (language, professional qualification combined coefficient, −6.15; 95% CI, −11.09 to −1.22; p = 0.015). Greater pain on the Brief Pain Inventory was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.076; 95% CI, 0.021–0.13; p = 0.006). Poorer impression of change was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia coefficient, 0.93; 95% CI, 0.87–0.99; p = 0.026) and social factors (education, language, and professional qualification coefficient, 6.67; 95% CI, 2.77–16.10; p < 0.001). Worse clinician-rated outcome was associated only with psychological factors (Hospital Anxiety and Depression Scale (depression only), Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia combined coefficient, −0.35; 95% CI, −0.58 to −0.12; p = 0.003). Conclusions Depressive symptoms and catastrophizing appear to be key factors influencing PROMs and clinician-rated outcomes. This study suggests revisiting the Constant-Murley score. Level of Evidence Level III, prognostic study.

PurposeTo determine the levels of perceived work demand capacity corresponding to the Modified Spinal Function Sort (M-SFS) score and precise reliability validity and responsiveness.MethodsThis prospective validation study included patients with chronic musculoskeletal impairments who underwent multidisciplinary occupational rehabilitation. After determining the percentiles of the work demand thresholds corresponding to the spinal function sort (SFS), the percentiles were transposed to the M-SFS. Reliability was assessed using the intraclass correlation coefficient and limits of agreement. Correlations with other questionnaires and a lifting task were measured to assess validity. Responsiveness was determined using anchor- and distribution-based approaches.Results288 patients were included. The following thresholds were obtained for the M-SFS: 0–43 points, minimal; 44–50, very light; 51–58, light; 59–64, light to medium; 65–70, medium; 71–76, heavy; and 77–80, very heavy. Reliability was confirmed. The correlation between the M-SFS and SFS scores was good at 0.89 (95% CI, 0.86–0.91) and moderate according to the PILE-test result of 0.60 (95% CI, 0.50–0.67). We could not calculate a valid anchor-based minimal clinically important difference. The standard error of measurement was 3.9 points, and the smallest detectable change was 10.8 points.ConclusionsOn the basis of the comparison of the M-SFS and SFS scores, the M-SFS score can be interpreted in relation to the levels of work demand. This study confirms the good reliability and validity of the M-SFS questionnaire in assessing perceived physical capacity. Further studies are needed to determine its responsiveness.

Purpose Multi-hour ski mountaineering energy balance may be negative and intake below recommendations. Methods Athletes on the ‘ Patrouille des Glaciers ’ racecourses (17 on course Z, 27 km, +2,113 m; 11 on course A, 26 km, +1,881 m) volunteered. Pre-race measurements included body mass, stature, V O 2max , and heart rate (HR) vs V O 2 at simulated altitude; race measurements HR, altitude, incline, location, and food and drink intake (A). Energy expenditure (EE) was calculated from altitude corrected HR derived V O 2 . Results Race time was 5 h 7 min ± 44 min (mean ± SD, Z) and 5 h 51 min ± 53 min (A). Subjects spent 19.2 ± 3.2 MJ (Z), respectively, 22.6 ± 2.9 MJ (A) during the race. Energy deficit was −15.5 ± 3.9 MJ (A); intake covered 20 ± 7 % (A). Overall energy cost of locomotion (EC) was 9.9 ± 1.3 J m −1  kg −1 (Z), 8.0 ± 1.0 J m −1  kg −1 (A). Uphill EC was 11.7 ± 1 J m −1  kg −1 (Z, 13 % slope) and 15.7 ± 2.3 J m −1  kg −1 (A, 19 % slope). Race A subjects lost −1.5 ± 1.1 kg, indicating near euhydration. Age, body mass, gear mass, V O 2max and EC were significantly correlated with performance; energy deficit was not. Conclusions Energy expenditure and energy deficit of a multi-hour ski mountaineering race are very high and energy intake is below recommendations.

Background Kinesiotape (KT) is widely used in musculoskeletal rehabilitation as an adjuvant to treatment, but minimal evidence supports its use. The aim of this study is to determine the immediate and short-term effects of shoulder KT on muscular activity, mobility, strength and pain after rotator cuff surgery. Methods Thirty-nine subjects who underwent shoulder rotator cuff surgery were tested 6 and 12 weeks post-surgery, without tape, with KT and with a sham tape (ST). KT and ST were applied in a randomized order. For each condition, the muscular activity of the upper trapezius, three parts of the deltoid and the infraspinatus were measured during shoulder flexion, and range of motion (ROM) and pain intensity were assessed. At 12 weeks, the isometric strength at 90° of shoulder flexion, related muscular activity and pain intensity were also measured. Subjects maintained the last tape that was applied for three days and recorded the pain intensity at waking up and during the day. Results Modifications in muscle activity were observed with KT and with ST. Major changes in terms of decreased recruitment of the upper trapezius were observed with KT ( P  < 0.001). KT and ST also increased flexion ROM at 6 weeks ( P  = 0.004), but the differences with the no tape condition were insufficient to be clinically important. No other differences between conditions were found. Conclusions Shoulder taping has the potential to decrease over-activity of the upper trapezius, but no clinical benefits of KT on ROM, strength or pain were noted in a population of subjects who underwent rotator cuff surgery. Trial registration The study was retrospectively registered on ClinicalTrials.gov PRS ( NCT03379636 ) on 21st December 2017.