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Background: Stroke is one of the leading causes of death and the main cause of long-term disability in the United States. The significant risk factors of stroke among Hispanics are well-documented. The majority of stroke survivors return home following a stroke and are cared for by family caregivers. Due to the abrupt nature of strokes, caregivers experience unexpected changes and demands that oftentimes lead to caregiver burden and depression. Given the significant risk factors for stroke in Hispanics and the influence of culture in family norms and family management, we developed a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers. This study tests the impact of a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers on caregiver outcomes. Methods: The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 290 caregivers from 3 Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a problem-solving intervention that uses telephone and online education and care management tools on the previously developed and nationally available RESCUE en Español Caregiver website. In the usual care group, participants receive the information and/or support caregivers of veterans with stroke normally receive through existing VA resources (e.g., stroke-related information and support). The primary outcome is change in caregiver's depressive symptoms at 1- and 12-weeks post-intervention. Secondary outcomes include changes in stroke caregivers' burden, self-efficacy, problem-solving, and health-related quality of life (HRQOL) and veterans' functional abilities. We will also determine the budgetary impact, the acceptability of the intervention and participation barriers and facilitators for Spanish-speaking stroke caregivers. Discussion: This is an ongoing study. It is the first known randomized controlled trial testing the effect of a telephone and online problem-solving intervention in Spanish for caregivers of veterans post-stroke. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post-stroke. Trial registration: ClinicalTrials.gov: NCT03142841— Spanish Intervention for Caregivers of Veterans with Stroke (RESCUE Español). Registered on February 23, 2018. Protocol version 8. 08.11.2022. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To determine whether a multifaceted implementation strategy for American Physical Therapy Association neck and low back pain clinical practice guidelines (CPGs) was associated with changes in clinician and patient outcomes. * DESIGN: Cross-sectional stepped-wedge pilot study. * METHODS: Physical therapy clinics (n = 9) were allocated to 1 of 4 clusters that varied by CPG implementation timing. Clinics crossed over from usual care (control) to CPG implementation (intervention) every 8 weeks and ended with a 24-week follow-up period. Implementation outcomes were measured at the clinician (perspectives and behaviors) and patient (pain and disability outcomes) levels. Descriptive statistics were used to summarize clinician perspectives and behaviors. Generalized linear mixed models were used to analyze patient-level outcomes data (pain and disability) and total number of physical therapy visits. * RESULTS: Improvements in several clinician perspectives about CPGs were observed 8 weeks after training and sustained at 16 weeks (P<.05), although it is unclear whether these changes were meaningful. Training on CPGs was relevant to physical therapists and more acceptable at 16 weeks (P<.05). In a random sample (n = 764/1994, 38.3%), the overall rate of CPG classification was 65.0% (n = 497/764), and CPG intervention concordance was 71.2% (n = 354/497). Implementation of a CPG was not associated with final pain and disability scores (P>.05) but was associated with an approximate increase of 8% in total visits. * CONCLUSION: Our multifaceted implementation strategy was associated with statistical changes in clinician perspectives and behaviors, but not in patient outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a measure of familial support of Multiracial individuals' unique racial experiences to advance the field's understanding of how familial processes influence Multiracial development. A sample of 422 Multiracial college students (77.7% female, M age = 20.05) from three different regions of the United States completed the survey. Exploratory factor analysis results suggested a two-factor measure. Multiracial Conscious Support, a 15-item subscale, represented support strategies unique to Multiracial individuals' experiences of discrimination and identity exploration. The second 7-item subscale, Multiple Heritage Validation, represented validation of membership in multiple racial groups. The factor structure was supported by confirmatory factor analysis findings with a separate sample. Support was found for the reliability and validity of each subscale. This study provides evidence validating the first measure of familial support of Multiracial experiences, highlighting two themes of support addressing unique experiences of being Multiracial, and validating multiple racial group memberships. [ABSTRACT FROM AUTHOR]

Objective: To assess changes in walking function and walking-related prefrontal cortical activity following two post-stroke rehabilitation interventions: an accurate adaptability (ACC) walking intervention and a steady state (SS) walking intervention. Design: Randomized, single blind, parallel group clinical trial. Setting: Hospital research setting. Subjects: Adults with chronic post-stroke hemiparesis and walking deficits. Interventions: ACC emphasized stepping accuracy and walking adaptability, while SS emphasized steady state, symmetrical stepping. Both included 36 sessions led by a licensed physical therapist. ACC walking tasks recruit cortical regions that increase corticospinal tract activation, while SS walking activates the corticospinal tract less intensely. Main measures: The primary functional outcome measure was preferred steady state walking speed. Prefrontal brain activity during walking was measured with functional near infrared spectroscopy to assess executive control demands. Assessments were conducted at baseline, post-intervention (three months), and follow-up (six months). Results: Thirty-eight participants were randomized to the study interventions (mean age 59.6 ± 9.1 years; mean months post-stroke 18.0 ± 10.5). Preferred walking speed increased from baseline to post-intervention by 0.13 ± 0.11 m/s in the ACC group and by 0.14 ± 0.13 m/s in the SS group. The Time × Group interaction was not statistically significant (P = 0.86). Prefrontal fNIRS during walking decreased from baseline to post-intervention, with a marginally larger effect in the ACC group (P = 0.05). Conclusions: The ACC and SS interventions produced similar changes in walking function. fNIRS suggested a potential benefit of ACC training for reducing demand on prefrontal (executive) resources during walking. [ABSTRACT FROM AUTHOR]

PURPOSE Debate continues over whether explicit recommendations for a clinical trial should be included as an element of shared decision making within oncology. We aimed to determine if and how providers make explicit recommendations in the setting of phase I cancer clinical trials. METHODS Twenty-three patient/provider conversations about phase I trials were analyzed to determine how recommendations are made and how the conversations align with a shared decision-making framework. In addition, 19 providers (9 of whose patient encounters were observed) were interviewed about the factors they consider when deciding whether to recommend a phase I trial. RESULTS We found that providers are comprehensive in the factors they consider when recommending clinical trials. The two most frequently stated factors were performance status (89%) and patient preferences (84%). Providers made explicit recommendations in 19 conversations (83%), with 12 of those being for a phase I trial (12 [63%] of 19). They made these recommendations in a manner consistent with a shared decision-making model; 18 (95%) of the 19 conversations during which a recommendation was made included all steps, or all but 1 step, of shared decision making, as did 11 of the 12 conversations during which a phase I trial was recommended. In 7 (58%) of these later conversations, providers also emphasized the importance of the patient's opinion. CONCLUSION We suggest that providers not hesitate to make explicit recommendations for phase I clinical trials, because they are able to do so in a manner consistent with shared decision making. With further research, these results can be applied to other clinical trial settings. [ABSTRACT FROM AUTHOR]

* STUDY DESIGN: Observational, prospective cohort. * BACKGROUND: Musculoskeletal pain is a common reason to seek health care, and earlier nonpharmacological treatment and enhancement of personalized care options are 2 high-priority areas. Validating concise assessment tools is an important step toward establishing better care pathways. * OBJECTIVES: To determine the predictive validity of Optimal Screening for Prediction of Referral and Outcome (OSPRO) tools for individuals with neck, low back, shoulder, or knee pain. * METHODS: A convenience sample (n = 440) was gathered by Orthopaedic Physical Therapy-Investigator Network clinics (n = 9). Participants completed demographic, clinical, and comorbidity questionnaires and the OSPRO tools, and were followed for 12-month outcomes in pain intensity, region-specific disability, quality of life, and comorbidity change. Analyses predicted these 12-month outcomes with models that included the OSPRO review-of-systems (OSPRO-ROS) and yellow flag (OSPRO-YF) tools and planned covariates (accounting for comorbidities and established demographic and clinical factors). * RESULTS: The 10-item OSPRO-YF tool (baseline and 4-week change score) consistently added to predictive models for 12-month pain intensity, region-specific disability, and quality of life. The 10-item OSPRO-ROS tool added to a predictive model for quality of life (mental summary score), and 13 additional items of the OSPRO-ROS+ tool added to prediction of 12-month comorbidity change. Other consistent predictors included age, race, income, previous episode of pain in same region, comorbidity number, and baseline measure for the outcome of interest. * CONCLUSION: The OSPRO-ROS and OSPRO-YF tools statistically improved prediction of multiple 12-month outcomes. The additional variance explained was small, and future research is necessary to determine whether these tools can be used as measurement adjuncts to improve management of musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Purpose: The EORTC QLQ-C30 and the Brief Pain Inventory (BPI) are validated tools for measuring quality of life (QOL) and the impact of pain in patients with advanced cancer. Interpretation of these instrument scores can be challenging and it is difficult to know what numerical changes translate to clinically significant impact in patients' lives. To address this issue, our study sought to establish the minimal clinically important differences (MCID) for these two instruments in a prospective cohort of patients with advanced cancer and painful bone metastases.Methods: Both anchor-based and distribution-based methods were used to estimate the MCID scores from patients enrolled in a randomized phase III trial evaluating two different re-irradiation treatment schedules. For the anchor-based method, the global QOL item from the QLQ-C30 was chosen as the anchor. Spearman correlation coefficients were calculated for all items and only those items with moderate or better correlation (|r| ≥ 0.30) with the anchor were used for subsequent analysis. A 10-point difference in the global QOL score was used to classify improvement and deterioration, and the MCID scores were calculated for each of these categories. These results were compared with scores obtained by the distribution-method, which estimates the MCID purely from the statistical characteristics of the sample population.Results: A total of 375 patients were included in this study with documented pain responses and completed QOL questionnaires at 2 months. 9/14 items in the QLQ-C30 and 6/10 items in the BPI were found to have moderate or better correlation with the anchor. For deterioration, statistically significant MCID scores were found in all items of the QLQ-C30 and BPI. For improvement, statistically significant MCID scores were found in 7/9 items of the QLQ-C30 and 2/6 items of the BPI. The MCID scores for deterioration were uniformly higher than the MCIDs for improvement. Using the distribution-based method, there was good agreement between the 0.5 standard deviation (SD) values and anchor-based scores for deterioration. For improvement, there was less agreement and the anchor-based scores were lower than the 0.5 SD values obtained from the distribution-based method.Conclusion: We present MCID scores for the QLQ-C30 and BPI instruments obtained from a large cohort of patients with advanced cancer undergoing re-irradiation for painful bone metastases. The results from this study were compared to other similar studies which showed larger MCID scores for improvement compared to deterioration. We hypothesize that disease trajectory and patient expectations are important factors in understanding the contrasting results. The results of this study can guide clinicians and researchers in the interpretation of these instruments. [ABSTRACT FROM AUTHOR]

Orthorexia nervosa is characterized by an obsession with eating "pure" or "healthy" foods. Despite emergent interest, few studies have been published about orthorexia to date. This study examined the phenomenology, correlates, and associated impairment of orthorexia in 404 undergraduate students. A battery of self-report questionnaires assessed orthorexia symptoms, related functional impairment, disordered eating, perfectionism, obsessive-compulsive symptoms, appearance anxiety, fear of negative evaluation, anxiety, and depressive symptoms. In total, 35.4% of participants endorsed elevated orthorexia symptoms, with primary concerns related to guilt associated with dietary transgressions and experiencing control when eating in a desired manner. Orthorexia symptoms demonstrated small to medium correlations with associated impairment variables, perfectionism, disordered eating, appearance anxiety, and obsessive-compulsive symptoms. Mean differences were observed across all variables (except depressive symptoms) between individuals elevated and not elevated on orthorexia symptoms. Collectively, this study suggests a relatively high frequency of orthorexia symptoms using current methods (which have significant limitations) and demonstrate fairly modest associations with psychological symptomology. [ABSTRACT FROM AUTHOR]

The article presents a study which focused on the prevalence of influenza in Beijing and explored the relationship between socio-economic status indicators and the preventive measures for influenza.

STUDY DESIGN: Clinical measurement, cross-sectional. BACKGROUND: Pain-associated psychological distress adversely influences outcomes for patients with musculoskeletal pain. However, assessment of pain-associated psychological distress (ie, yellow flags) is not routinely performed in orthopaedic physical therapy practice. A standardized yellow flag assessment tool will better inform treatment decision making related to psychologically informed practice. OBJECTIVES: To describe the development of a concise, multidimensional yellow flag assessment tool for application in orthopaedic physical therapy clinical practice. METHODS: A 136-item yellow flag item bank was developed from validated psychological questionnaires across domains related to pain vulnerability (negative mood, fear avoidance) and resilience (positive affect/coping). Patients seeking physical therapy with neck, back, knee, or shoulder pain completed the item bank. Iterative statistical analyses determined minimal item sets meeting thresholds for identifying elevated vulnerability or low resilience (ie, upper or lower quartile, as indicated). Further item reduction yielded a concise yellow flag assessment tool to assess 11 psychological constructs measuring pain-associated psychological distress. Correlations between the assessment tool and individual psychological questionnaires were measured and compared between anatomical regions. Concurrent validity was assessed by determining variance explained in pain and disability scores by the assessment tool. RESULTS: Subjects with elevated vulnerability and decreased resilience were identified with a high degree of accuracy (minimum of 85%) using a 17-item tool. Correlations were moderate to high between the 17-item tool and individual psychological questionnaires, with no significant differences in correlations between different anatomical regions. Shorter 10- and 7-item versions of the assessment tool allow clinicians the flexibility to assess for yellow flags quickly with acceptable trade-offs in accuracy (81% and 75%, respectively). All versions of the tool explained significant additional variance in pain and disability scores (range, 19.3%-36.7%) after accounting for demographics, historical variables, and anatomical region of pain. CONCLUSION: Concise assessment of yellow flags is feasible in outpatient physical therapy settings. This multidimensional tool advances assessment of pain-associated psychological distress through the addition of positive affect/coping constructs and estimation of full questionnaire scores. Further study is warranted to determine how this tool complements established risk-assessment tools by providing the option for efficient treatment monitoring. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the existence of discordance between perceived and measured balance in persons with stroke and to examine the impact on walking speed and falls. Design: A secondary analysis of a phase three, multicentered randomized controlled trial examining walking recovery following stroke. Subjects: A total of 352 participants from the Locomotor Experience Applied Post-Stroke (LEAPS) trial. Methods: Participants were categorized into four groups: two concordant and two discordant groups in relation to measured and perceived balance. Number and percentage of individuals with concordance and discordance were evaluated at two and 12 months. Walking speed and fall incidence between groups were examined. Main measures: Perceived balance was measured by the Activities-Specific Balance Confidence scale, measured balance was determined by the Berg Balance Scale and gait speed was measured by the 10-meter walk test. Results: Discordance was present for 35.8% of participants at two months post stroke with no statistically significant change in proportion at 12 months. Discordant participants with high perceived balance and low measured balance walked 0.09 m/s faster at two months than participants with concordant low perceived and measured balance (p < 0.05). Discordant participants with low perceived balance and high measured balance walked 0.15 m/s slower than those that were concordant with high perceived and measured balance (p ⩽ 0.0001) at 12 months. Concordant participants with high perceived and measured balance walked fastest and had fewer falls. Conclusions: Discordance existed between perceived and measured balance in one-third of individuals at two and 12 months post-stroke. Perceived balance impacted gait speed but not fall incidence. [ABSTRACT FROM AUTHOR]

Novel dietary assessment methods are needed to study chronic disease risk in agrarian cultures where food availability is highly seasonal. In 16,320 rural Nepalese women, we tested a novel food frequency questionnaire, administered once, to assess past 7-day intake and usual frequency of intake throughout the year for year-round foods and when in season for seasonal foods. Spearman rank correlations between usual and past 7-day intakes were 0.12–0.85 and weighted kappa statistics, representing chance-corrected agreement, were 0.10–0.80, with better agreement for frequently consumed foods. The questionnaire performed well, but may require refinement for settings of extremely low dietary diversity. [ABSTRACT FROM AUTHOR]

Background and Objectives: Socially anxious individuals often engage in various safety and avoidant behaviors to temporarily decrease distress. Similarly, friends or family members may engage in accommodating behaviors, commonly manifesting through the facilitation of avoidance, completion of tasks, or schedule modifications. Studies examining symptom accommodation in adult social anxiety are lacking, so this study seeks to better understand symptom accommodation and its consequent impairment in socially anxious adults. Design and Methods: There were 380 undergraduate students who completed a battery of self-report questionnaires through an online system. Constructs assessed include social anxiety, symptom accommodation, and impairment as well as related variables such as general anxiety, fear of negative evaluation, alcohol use, and anxiety sensitivity. Results: Symptom accommodation was positively correlated with social anxiety symptoms, functional impairment, general anxiety, anxiety sensitivity, fear of negative evaluation, and alcohol use. Individuals with considerable social anxiety reported significantly higher levels of symptom accommodation than individuals who reported lower levels of social anxiety. Anxiety sensitivity predicted symptom accommodation beyond the contribution of social anxiety. Symptom accommodation mediated the relationship between social anxiety and impairment. Conclusions: These data help elucidate the presentation and impact of symptom accommodation related to social anxiety. Implications for assessment, treatment, and future directions are presented. [ABSTRACT FROM AUTHOR]

Veterans with blast-related mild traumatic brain injury (TBI) experience cognitive deficits that interfere with functional activities. Goal Management Training (GMT), which is a metacognitive intervention, offers an executive function rehabilitation approach that draws upon theories concerning goal processing and sustained attention. GMT has received empirical support in studies of patients with TBI but has not been tested in Veterans with blast-related mild TBI. GMT was modified from 7 weekly to 10 biweekly sessions. Participants included six combat Veterans who reported multiple blast exposures resulting in symptoms consistent with mild TBI. Group analysis showed a significant improvement in measures of executive function derived from performance on the computerized Tower of London. There were no significant changes on self/informant questionnaires of executive function, indicating a lack of generalization of improvement from the clinic to everyday activities. Overall, while the data indicate efficacy of GMT in the rehabilitation of combat Veterans with executive function deficits because of blast-related mild TBI, enhancement of generalization is needed. [ABSTRACT FROM AUTHOR]

Background. The step activity monitor (SAM) quantifies steps taken in the home and community by patient populations. Although the SAM has been used to study individuals after stroke, adherence to the use of SAMs has not been addressed. Participants' adherence to wearing the monitor is critical for obtaining accurate assessments. Objective. The purpose of this study was to determine the rate of and predictors for inferred adherence to the use of the SAM after stroke. Design. A cross-sectional design was used. Methods. Community-dwelling individuals (n=408) 2 months after stroke with moderate-to-severe gait impairment (gait speed of <0.8 m/s) were studied. Step activity was assessed for 2 days with the SAM. Inferred adherence was established in 3 periods: 6:00 am to 12:00 pm, 12:01 pm to 6:00 pm, and 6:01 pm to 12:00 am. Adherence was defined as activity recorded in all 3 periods. The percentage of participant adherence for the first day, second day, both days, and either day was calculated. Demographic and clinical characteristics of adherers and nonadherers were compared. Independent adherence predictors were identified by means of stepwise logistic regression. Results. Inferred adherence rates for the first day, second day, both days, and either day were 68%, 61%, 53%, and 76%, respectively. Upper and lower extremity impairment, balance control, and endurance were significantly different between adherers and nonadherers. On the other hand, older age, greater balance self-efficacy, and better walking endurance were significant predictors of adherence. Limitations. Participants were individuals with subacute stroke. Therefore, the findings of this study may not be generalized to individuals during the acute and chronic phases of stroke recovery. Conclusions. Strategies to improve adherence are needed when collecting data for more than 1 day and in samples with younger individuals and those with low levels of balance self-efficacy and walking endurance. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore the relationship between peer pressure and the health risk behaviors of secondary school students. Study design: Cross-sectional study using a self-completed questionnaire. Methods: Secondary school students in Year 3 were the target population of this study. Information was solicited from students on their perceptions of peer pressure using a questionnaire employing the Peer Pressure Inventory and their involvement in risk behaviors using a modified global school-based student health survey. Results: A total of 840 secondary students from Hong Kong completed the questionnaires. The prevalence of secondary students who had ever smoked was 6.4%, consumed alcohol 39.2%, ever used drugs 0.5%, were sexually active 3.9%, and involved in bullying 20.5%. A higher proportion of secondary students involved in risk behaviors were affiliated with peers who were involved in the same activities: smoking (48.9%), drinking alcohol (86.5%), using drugs (18.2%), engaged in sexual activity (34.5%), and bullying (82.6%). The perception of peer conformity and peer involvement was found to be significantly correlated with the students' health risk behaviors, particularly with regard to smoking, drinking alcohol, and bullying. A logistic regression analysis showed that having friends who are involved in the same risk behaviors is the single most important factor associated with the participation of secondary students in those specific risk behaviors. Conclusions: The results of this study provided a better understanding of the association between peer pressure and the adoption of health behaviors. The development of effective peer-led prevention programs to reduce the uptake of health risk behaviors should therefore be promoted to prevent adolescents from developing serious health problems. [ABSTRACT FROM AUTHOR]

Background: Pain flare occurs after palliative radiotherapy, and dexamethasone has shown potential for prevention of such flare. We aimed to compare the efficacy of dexamethasone with that of placebo in terms of reduction of incidence of pain flare.Methods: In this double-blind, randomised, placebo-controlled phase 3 trial, patients from 23 Canadian centres were randomly allocated (1:1) with a web-based system and minimisation algorithm to receive either two 4 mg dexamethasone tablets or two placebo tablets taken orally at least 1 h before the start of radiation treatment (a single 8 Gy dose to bone metastases; day 0) and then every day for 4 days after radiotherapy (days 1-4). Patients were eligible if they had a non-haematological malignancy and bone metastasis (or metastases) corresponding to the clinically painful area or areas. Patients reported their worst pain scores and opioid analgesic intake before treatment and daily for 10 days after radiation treatment. They completed the European Organisation for Research and Treatment of Cancer (EORTC) quality of life QLQ-C15-PAL, the bone metastases module (EORTC QLQ-BM22), and the Dexamethasone Symptom Questionnaire at baseline, and at days 10 and 42 after radiation treatment. Pain flare was defined as at least a two-point increase on a scale of 0-10 in the worst pain score with no decrease in analgesic intake, or a 25% or greater increase in analgesic intake with no decrease in the worst pain score from days 0-10, followed by a return to baseline levels or below. Primary analysis of incidence of pain flare was by intention-to-treat (patients with missing primary data were classified as having pain flare). This study is registered with ClinicalTrials.gov, number NCT01248585, and is completed.Findings: Between May 30, 2011, and Dec 11, 2014, 298 patients were enrolled. 39 (26%) of 148 patients randomly allocated to the dexamethasone group and 53 (35%) of 150 patients in the placebo group had a pain flare (difference 8·9%, lower 95% confidence bound 0·0, one-sided p=0·05). Two grade 3 and one grade 4 biochemical hyperglycaemic events occurred in the dexamethasone group (without known clinical effects) compared with none in the placebo group. The most common adverse events were bone pain (61 [41%] of 147 vs 68 [48%] of 143), fatigue (58 [39%] of 147 vs 49 [34%] of 143), constipation (47 [32%] of 147 vs 37 [26%] of 143), and nausea (34 [23%] of 147 vs 34 [24%] of 143), most of which were mild grade 1 or 2.Interpretation: Dexamethasone reduces radiation-induced pain flare in the treatment of painful bone metastases.Funding: The NCIC CTG's programmatic grant from the Canadian Cancer Society Research Institute. [ABSTRACT FROM AUTHOR]

Purpose: The pain experience has multiple influences, but little is known about how specific biological and psychological factors interact to influence pain responses. The current study investigated the combined influences of genetic (pro-inflammatory) and psychological factors on several preclinical shoulder pain phenotypes. Methods: An exercise-induced shoulder injury model was used, and a priori selected genetic (IL1B, TNF/LTA region, and IL6 single nucleotide polymorphisms (SNP)) and psychological (anxiety, depression symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as the predictors of interest. The phenotypes were pain intensity (5-d average and peak reported on numerical rating scale), upper extremity disability (5-d average and peak reported on the Quick Disabilities of the Arm, Shoulder and Hand instrument), and duration of shoulder pain (d). Results: After controlling for age, sex, and race, the genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each pain phenotype. Results from the recruited cohort (n = 190) indicated strong statistical evidence for the interactions between 1) TNF/LTA SNP rs2229094 and depression symptoms for average pain intensity and duration and 2) IL1B two SNP diplotype and kinesiophobia for average shoulder pain intensity. Moderate statistical evidence for prediction of additional shoulder pain phenotypes included interactions of kinesiophobia, fear of pain, or depressive symptoms with TNF/LTA rs2229094 and IL1B. Conclusions: These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts to determine their involvement in the transition from acute to chronic pain conditions. [ABSTRACT FROM AUTHOR]