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Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.

Objectives Avoidance, persistence, and pacing are activity patterns that have different adaptive effects in chronic pain patients. Some inconsistent findings have been explained from a contextual perspective that underlines the purpose of the activity. In this way, avoidance, persistence, and pacing are multidimensional constructs, nuanced by their goals. This multidimensionality has been supported with a new instrument, the Activity Patterns Scale, in heterogeneous chronic pain samples. Owing to the clinical implications of this conceptualization, the complexity of the activity patterns and their relationships with health outcomes in fibromyalgia (FM), our aim was to explore the construct validity of this scale in this pain problem, testing its internal structure and the relationships with other constructs. Materials and methods The sample included 702 women with diagnosis of FM from tertiary (53.3%) and community settings (46.7%). Confirmatory factor analysis was conducted to test different factor structures of the activity patterns and Pearson correlation to explore the relationships with health outcomes and psychosocial variables. Results A 6-factor structure showed acceptable fit indices (standardized root mean square residual=0.062; root mean-square error of approximation=0.066; comparative fit index=0.908). The highest significant relationships for health outcomes was between activity avoidance and FM impact (r=0.36) and excessive persistence and negative affect (r=0.41). Discussion Avoidance and persistence activity patterns are shown as multidimensional constructs but not pacing. The ongoing pain in these women may make it difficult to regulate their activity taking into account other goals not contingent on pain fluctuations.

Pain catastrophizing and pain acceptance have been associated with functioning in fibromyalgia. In relation to activity patterns, pacing has been defined as a helpful pattern to regulate activities in the context of value-based goals, but results regarding whether it is adaptive or not are controversial. This study analyzes the moderating role of pain acceptance between pain catastrophizing and pacing in 231 women with fibromyalgia. Moderation analyses were conducted with model 1 from the PROCESS Macro version 3.4. The results showed a clear moderating effect of pain acceptance. At low levels of pain acceptance, catastrophizing and pacing patterns maintained significant and positive associations. However, at high levels of pain acceptance, pacing was independent of catastrophizing. Far from considering pacing patterns as functional or dysfunctional per se, our results suggest that women with low pain acceptance carry out pacing influenced by catastrophizing independently of their goal pursuit, while patients who accept their pain may use pacing as a regulatory mechanism according to their goals.

The objective of this study is to test the efficacy of a group motivational plus implementation intentions intervention in promoting adherence to an unsupervised walking program recommended for fibromyalgia, compared to an implementation intentions condition and to an active control condition. A triple-blind, randomized, longitudinal study with measures at baseline, short (seven weeks post-intervention), mid (12 weeks) and long-term (36 weeks) is performed. Data are analyzed using multilevel longitudinal growth curve two-level modelling. Participants are 157 women with fibromyalgia. In the short-term, adherence to the minimum and to the standard walking program (primary outcome measures) is explained by time (both

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = −2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0–1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = −3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

(1) Background: Partner violence prevention programmes do not produce the expected behavioural changes. Accordingly, experts suggest applying evidence-based behavioural models to identify the determinants of abusive behaviours. In this research, we applied the reasoned action approach (RAA) to predict the performance (boys) and acceptance (girls) of abusive behaviours in adolescents. (2) Method: We designed a questionnaire based on the RAA and performed a cross-sectional study. We analysed the predictive capacity of the RAA constructs on intentions with the sample of single adolescents (n = 1112). We replicated the analysis only with those who were in a relationship (n = 587) and in addition analysed the predictive capacity of intention on future behaviour (3 months later). (3) Results: The hierarchical regression analysis performed with the sample of single adolescents showed that the model explained 56% and 47% of the variance of boys’ intentions to perform the controlling and devaluing behaviours, respectively; and 62% and 33% of girls’ intention to accept them. With those in a relationship, the model explained 60% and 53% of the variance of boys’ intentions to perform the controlling and devaluating behaviour, respectively, and 70% and 38% of girls’ intention to accept them. Intention exerted direct effects on boys’ performance of controlling and devaluing behaviours (31% and 34% of explained variance, respectively) and on girls’ acceptance (30% and 7%, respectively). (4) Conclusions: The RAA seems useful to identify the motivational determinants of abusive behaviours, regardless of adolescents´ relationship status, and for their prediction. Perceived social norms emerge as a relevant predictor on which to intervene to produce behavioural changes with both sexes.

Intimate partner violence against adolescent girls is of increasing political and social concern. This paper presents formative research on the reasoned action approach (RAA) to the prediction of boys’ perpetration and girls’ acceptance of four psychologically abusive behaviors. Our objectives were: (1) to identify the behavioral and normative modal beliefs behind males’ performance and girls’ acceptance of the behaviors and (2) to explore the relationship between attitudes, perceived social norm, intention and behavior. A total of 479 adolescents between 14 and 18 years of age completed questionnaires on the performance (boys) or acceptance (girls) of a specific behavior. We used a grouping process to identify modal beliefs and carried out eight exploratory multiple regression analysis (one per behavior) to study attitude and social norm as predictors of intention and behavior. Positive and negative behavioral beliefs coexist in boys’ and girls’ minds, which can reflect an unclear positioning against abusive behaviors. Positive outcomes seem to be influenced by socialization processes and love myths. Peers can be a risk factor whereas parents are a protective factor against the performance and acceptance of these behaviors. Results showed significant relationships between the constructs in the sense specified by the model. Prevention programs could benefit by: managing participants’ individual behavior, intervening separately with boys and girls, overcoming adolescents’ confusion regarding these behaviors, and targeting parents as a means of discouraging their performance and acceptance. The RAA appears a useful tool for explaining and predicting the performance and acceptance of abusive behaviors.

Introducción: La fibromialgia es un trastorno crónico que cursa con dolor músculo-esquelético generalizado, con frecuencia acompañado de numerosa comorbilidad. Dentro de la necesidad de un abordaje multidisciplinar, el ejercicio físico aeróbico se recomienda como tratamiento de primera elección. Objetivo: Analizar las creencias, bajo el modelo de la Teoría de la Acción Planeada, asociadas a la intención de “caminar 2-4 veces por semana, un mínimo de 30 minutos, intercalando un pequeño descanso, durante al menos 6 semanas consecutivas”. Método: se utilizó un diseño longitudinal con dos medidas (T1-T2) con una diferencia de 6 semanas, con 275 (T1) y 219 (T2) mujeres con fibromialgia. Resultados: Existe una tendencia a la significación en la relación entre intención y conducta de caminar (x2= 3.336, p=.068). Se observan diferencias estadísticamente significativas en las creencias comportamentales positivas (p=.004), en las creencias comportamentales negativas (p=.008) y en las creencias normativas prescriptivas (p=.002) entre las pacientes con alta y baja intención.La recomendación medica de caminar y la intensidad de dolor percibida se asocian significativamente con las creencias comportamentales positivas y con las creencias de control inhibidoras. Conclusiones: La intención de caminar según la pauta establecida se relaciona con creencias comportamentales positivas relativas a consecuencias generales de salud, y no a la mejora específica de la sintomatología relacionada con la fibromialgia.

Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents–Behaviors–Consequences) model. This study followed a qualitative descriptive research method and a deductive–inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants’ conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U’s Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients.

Background Exercise and physical activity are an evidence-based practice for chronic pain. Health professionals need instruments to assess self-efficacy for this practice taking into account the specific barriers of patients with these health problems. Purpose To develop and test the psychometric properties of a new self-efficacy scale for physical activity and walking exercise in patients with fibromyalgia. Design A cross-sectional and prospective study was conducted in a Spanish Fibromyalgia Unit. Two hundred and eleven new patients signed the informed consent and participated in the study. All of them were women, referred to by either Primary or Specialized Health Care. In addition to the new scale, they filled out several self-reported and validated instruments to collect the data present in this study. Results Exploratory factor analysis showed a three-factor model (GFI = .99; RMSR = .06) that explained 74.2% of the total variance. They assessed how confident patients felt about walking quickly in both 30- and 60-minute sessions, (Factor I: 10 items; α = .97), to perform daily physical activities (Factor II: 10 items; α = .93) and to undertake moderate physical activity (Factor III: 5 items; α = .95). The total score of the scale and the three-factor scores showed good criterion validity and adequate validity based on the relationships with other constructs. Conclusions The scale showed adequate psychometric properties and can be a useful tool to help health professionals monitor patients’ self-efficacy perception and customize both physical activity and walking exercise intervention goals and their implementation.

Fibromyalgia (FM) patients are known to be highly demanding of themselves in achieving goals. In fact, some authors suggest that perfectionism influences maladaptive coping regarding health and hinders routine tasks. Despite the evidence about the anxiety caused by this demanding pattern and the difficulty it creates in dealing with the conflict between goals, to date, there are no studies exploring the relationship between these psychological processes from motivational theories of pain. This study aims to explore the mediating role of pain catastrophizing and cognitive fusion between maladaptive perfectionism and anxiety among 230 FM women. Results found that pain catastrophizing and cognitive fusion contribute to the negative effect of maladaptive perfectionism on anxiety. These results can be interpreted from motivational theories of pain (conflict of goals), allowing action guidelines for the personalization of treatments. S0191886921005444

Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.

Occupational balance (OB) may be a major determinant of health outcomes due to its role in bringing a sense of purpose in the occupations that are personally experienced as a process of getting health and wellness. The Occupational Balance Questionnaire (OBQ) is a reliable instrument for measuring OB, although it has not been adapted and validated in Spain so far, therefore, this study had a double aim: (1) to translate and cross-culturally adapt the original OBQ version into Spanish (OBQ-E), (2) to analyze the psychometric properties for its use in the Spanish population. Standard procedures were used for the cross-adaptation process and pilot testing was carried out using three different samples to extend the applicability of the OBQ-E. Validation measures of the final version of the OBQ-E were conducted in a sample of 219 participants. The OBQ-E showed that items and instructions were culturally appropriate and written clearly. Psychometric testing showed excellent internal consistency (Cronbach’s alpha = 0.87, Guttman split-half coefficient = 0.85), good test–retest reliability (rs (Spearman rho) = 0.73), and acceptable convergent validity (overall status, rs = 0.37, Related Quality of Life, rs = 0.42, Satisfaction with Life Scale, rs = 0.54). The findings suggest that the OBQ-E may be a suitable instrument for assessing OB in the Spanish population, hence, it is a promising tool for epidemiological research that will significantly contribute to the understanding of OB as a health-related factor. Nevertheless, further investigation is also warranted to explore the potentiality of this instrument for clinical purposes.

The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15–27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: ‘Fatigue-avoidance goal’ and ‘Mood-management goal’ (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional, it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p &lt, 0.001), excessive persistence (p &lt, 0.001) and pacing (p &lt, 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.

Some motivational models understand health behavior as a result of the interaction between goal preferences and mood. However, this perspective has not been explored in fibromyalgia. Furthermore, in chronic pain, it has only been explored with regard to negative affect. Thus, our aims were: (1) to develop a Spanish version of the Goal Pursuit Questionnaire (GPQ); (2) to explore the relationships between goal preferences and health outcomes, testing the moderator role of affect and the mediating role of chronic pain activity patterns. We conducted two cross-sectional studies. In Study 1, after a double translation/back-translation process, we interviewed 94 women attending the Fibromyalgia Unit of the Community of Valencia in order to identify the cultural feasibility and the content validity of the GPQ. Study 2 comprised 260 women. We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Eight activities from the original GPQ were changed while maintaining the conceptual equivalence. Exploratory factor analysis showed two factors: ‘Pain-avoidance goal’ and ‘Mood-management goal’ (37 and 13% of explained variance, respectively). These factors refer to patients’ preference for hedonic goals (pain avoidance or mood-management) over achievement goals. Robust RMSEA fit index of the final models ranged from 0.039 for pain to 0.000 for disability and fibromyalgia impact. Pain avoidance goals and negative affect influenced pain mediated by task-contingent persistence. They also affected disability mediated by task and excessive persistence. Pain avoidance goals and positive affect influenced fibromyalgia impact mediated by activity avoidance. We also found a direct effect of negative and positive affect on health outcomes. Preference for pain avoidance goals was always related to pain, disability and fibromyalgia impact through activity patterns. Affect did not moderate these relationships and showed direct and indirect paths on health outcomes, mainly by increasing persistence and showing positive affect as an asset and not a risk factor. Intervention targets should include flexible reinforcement of achievement goals relative to pain avoidance goals and positive affect in order to promote task-persistence adaptive activity patterns and decreased activity avoidance.

PURPOSE The aim of the study was to analyze the profile of fibromyalgia patients receiving medical advice to walk and who complied with the advice according to a specific clinical pattern. A further aim has been to analyze the elements that increase adherence to walking. DESIGN A cross-sectional study with 920 women with fibromyalgia. METHODS Sociodemographic and clinical variables, walking behavior, and medical advice to walk were assessed. FINDINGS AND CONCLUSIONS Patients who adhere to walking have a lower likelihood of being tired. Regular walkers (patients who walk according to a specific clinical pattern) have a lower likelihood of comorbidity. Patients who receive medical advice to walk are more likely to walk more than 30 minutes and to take a break between bouts. CLINICAL RELEVANCE Nurses caring for people with fibromyalgia should include strategies to promote walking, especially in patients with low adherence profiles, paying attention to all elements of behavior.

The main objective of this study is to identify fibromyalgia syndrome (FMS) clusters using the Revised Fibromyalgia Impact Questionnaire (FIQR), and to examine whether the clusters differ in sociodemographic characteristics, clinical measures, direct and indirect costs, levels of inflammatory markers, and brain morphometry. A hierarchical cluster analysis was performed to classify a large, pooled Spanish sample of patients with FMS (N = 947) using the FIQR as clustering variable. A latent profile analysis was subsequently conducted to confirm the optimal number of FMS clusters. To examine external validity, a battery of clinical measures, economic costs, inflammatory markers, and gray matter volumes of relevant cortical and subcortical areas were analyzed. We also compared the discriminant validity of the clusters with the original FIQR severity categories. To promote the implementation in real-world clinical practice, we built a free online cluster calculator. Our findings indicated that a four-cluster solution more clearly captured the heterogeneity of FIQR data and provided the best fit. This cluster solution allowed for detection of differences for most clinical outcomes and economic costs. Regarding the inflammatory and brain-based biomarkers, differences were found in C-reactive protein, and tendencies were found in the right medial prefrontal cortex, the right parahippocampal gyrus, and the right middle cingulate cortex; brain regions associated with executive functions and pain processing. The original FIQR categories presented similar results, although their precision in discriminating among the nonextreme categories (ie, moderate and severe) was not sound. These findings are discussed in relation to previous research on FMS clustering.

espanolObjetivos: Las intenciones de implementacion (II) son planes “si…, entonces…” que han mostrado su eficacia en solucionar los problemas de auto-regulacion propios del esfuerzo hacia una meta. Suelen aplicarse de forma individualizada. Este trabajo pretende analizar su pertinencia y viabilidad en un formato de intervencion grupal para aumentar el ejercicio fisico no supervisado andando, en mujeres con fibromialgia. Material y metodos: En el marco de un estudio experimental, aleatorizado, triple ciego y con grupo control activo, 117 mujeres con fibromialgia pertenecientes a cinco asociaciones de pacientes de Alicante, Elche, Madrid y Talavera de la Reina, recibieron una intervencion con intenciones de implementacion. Un subgrupo (n = 59) recibio tambien una intervencion motivacional. La investigadora responsable de la aplicacion de las intenciones de implementacion desconocia la condicion experimental previa de las mujeres. El estudio conto con la aprobacion del comite de etica de la Universidad Miguel Hernandez de Elche. Las participantes acudieron a los laboratorios de las universidades para la aplicacion de las intervenciones y la evaluacion pre y postexperimental. Todas ellas firmaron el consentimiento informado. La sesion grupal con intenciones de implementacion tuvo una duracion aproximada de 30 minutos. En la evaluacion prexperimental valoramos el distres, el impacto percibido de la fibromialgia y la intensidad del dolor. Finalmente, se valoro la satisfaccion y la utilidad percibida de la intervencion. Resultados: El 83,6 % de las participantes selecciono un inhibidor (componente si). La fatiga fue el elegido con mayor frecuencia (n = 37; 31,9 %), seguido del dolor (n = 31; 26,7 %) y un “mal dia” de enfermedad (n = 29; 25 %). La estrategia de manejo (componente entonces) seleccionada con mayor frecuencia fue la aceptacion y compromiso (n = 55; 47,42 %) pero las diferencias no fueron significativas respecto de la eleccion del resto de estrategias. Las mujeres que seleccionaron el inhibidor dolor presentaron puntuaciones significativamente mas altas en los items de dolor (F = 3,09, p = 0,05) y dolorimiento general (F = 4,32; p = 0,02) del FIQ-R. Las mujeres que eligieron la aceptacion y compromiso como estrategia de manejo puntuaron significativamente mas bajo que las que optaron por la persistencia en la tarea, en la subescala funcion del mismo cuestionario (F = 3,528; p = 0,03). El 25,9 % (n = 30) de mujeres no formularon el componente “si” en la intencion de implementacion final y el 22,4 % (n = 26) no lo hicieron respecto del componente “entonces”. Hubo errores en la formulacion de este ultimo componente relacionados principalmente con la escritura incompleta de la autoinstruccion correspondiente (persistencia en la tarea: n = 7; aceptacion y compromiso; n = 3; relajacion: n = 5). La satisfaccion media con la intervencion recibida fue de 8,96 sobre 10 y, salvo una persona, todas la recomendarian a otros pacientes con fibromialgia. Conclusiones: Tanto los obstaculos como las estrategias presentadas para manejarlos son pertinentes y “significativos” para las mujeres participantes. La aplicacion grupal tambien parece un procedimiento adecuado siempre y cuando se realice en grupos cuyo tamano permita la supervision individual de las intenciones de implementacion para evitar errores. Por tanto, en terminos generales podemos concluir que las II aparecen como estrategias viables y aceptadas por las mujeres con fibromialgia. EnglishAims: Implementation intentions (II) are “if… then…” plans that have shown their efficacy in solving self-regulation problems related to goal striving. They are usually applied individually. This study aims to analyze their pertinence and feasibility in a group intervention setting to increase non-supervised walking as physical exercise, in fibromyalgia women. Material and methods: In the context of an experimental, randomized, triple blind study with an active control group, 117 women with fibromyalgia received an intervention based on II. They belonged to five patient associations from Alicante, Elche, Madrid and Talavera de la Reina. A sub-group (n = 59) also received a motivational intervention. The researcher in charge of the application of the II intervention was unaware of the experimental condition of the women. The Universidad Miguel Hernandez ethics committee approved the study. The participants went to the labs at the university to receive the interventions as well as the pre- and post-experimental assessment. All of them signed informed consent forms. The group session for II was approximately 30 minutes long. During the pre-experimental session, we assessed distress, perceived fibromyalgia impact and pain intensity. In the post-experimental session, we assessed satisfaction and perceived usefulness of the intervention. Results: Of the participants, 83.6 % selected one inhibitor from the three we presented (if component). Fatigue was the most frequently chosen (n = 37; 31.9 %), followed by pain (n = 31; 26.7 %) and have ‘a bad day’ for the illness (n = 29; 25 %). The strategy (then component) most frequently chosen was acceptance and commitment (n = 55; 47.42 %), but differences weren´t significant regarding the choice of the other strategies. Women who selected the pain inhibitor presented significantly higher pain scores (F = 3.09, p = 0.05) and general painful scores (F = 4.32; p = 0.02) in the FIQ-R. Women who chose acceptance and commitment as strategy, scored significantly lower on the function sub-scale of the same questionnaire than those who opted for task persistence (F = 3.528; p = 0.03). Of the participants, 25.9 % (n = 30) did not write the ‘if’ component in the final II and 22.4 % (n = 26) did not do so for the ‘then’ component. There were errors in the creation of this last component related especially with the incomplete writing of the corresponding self-instruction (persistence of the task: n = 7; acceptance and commitment: n = 3; relaxation: n = 5). Mean satisfaction with the intervention was 8.96 over 10, and all except for one participant would recommend the intervention to other fibromyalgia patients. Conclusions: It was found that both the behavioural inhibitors for exercise as well as the strategies for management are pertinent and ‘significant’ for the participants. Group application also seems to be an appropriate procedure as long as it is carried out in groups whose size allows individual supervision of the II. This is important to avoid errors that could ffect quality. In general terms, we can conclude that II is a viable and acceptable strategy for women with fibromyalgia.

Background Despite significant differences in terms of medical training and health care context, the phenomenon of medical students’ declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians’ professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. Methods/Design The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the "case" is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. Discussion This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians’ professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies. Electronic supplementary material The online version of this article (doi:10.1186/1472-6920-14-184) contains supplementary material, which is available to authorized users.

Identifying which warning signs (WS) of intimate partner violence against girls (IPV) must be included in prevention programs is essential, since there is not an explicit consensus. Our first aim was identifying the most frequent WS included in the reviewed Spanish prevention guides by means of a content analysis performed independently by three judges. Our second aim was subjecting these to a sample of adolescents (n=60) to know: (1) if they identify them as abusive behaviours; (2) how frequently do they consider they have to occur to be WS, and; (3) how frequently they observe them in their peer environment. Among the 23 identified WS, controlling (n=11) and devaluating behaviours (n=6) are the most frequent in the reviewed literature and the formers´ the most observed in the adolescents’ environment (rank: 52.5% - 90%). The majority labelled the 23 behaviours as abusive. Four controlling and 3 devaluating behaviours had to occur very often to be an IPV warning sign. Therefore their tolerance to these WS is high. The outcomes are valuable for the development of prevention programs and suggest the need of investigating on the explanatory factors of such tolerance.

Objetivo: Estudiar las relaciones y capacidad predictiva de la Autoeficacia, el Catastrofismo y el Miedo al Movimiento, sobre la experiencia de dolor en la Fibromialgia, además de identificar el papel de la Autoeficacia en el conjunto de estas relaciones. Método: Sesenta y un pacientes de la Unidad de Atención Integral a la Fibromialgia (Hospital San Vicente del Raspeig) cumplimentaron diferentes cuestionarios para evaluar las variables objeto de este estudio. Se utilizó el análisis de correlación de Pearson y el análisis de regresión múltiple. Resultados: No se encontraron relaciones significativas entre el Miedo al Movimiento y el resto de variables; solo la percepción del impacto global de la fibromialgia y del distrés presentó relaciones significativas tanto con el Catastrofismo como con la Autoeficacia. Esta última, no moduló la relación entre Catastrofismo y los resultados de salud. Sin embargo, además de su efecto directo en los mismos, mostró un efecto mediado por el Catastrofismo. Conclusión: La Autoeficacia aparece como la variable más relevante en la explicación de la experiencia de dolor de estos pacientes, constituyendo un objetivo terapéutico imprescindible también en el último nivel asistencial.

Este trabajo estudia la realización entre el distrés percibido por la hospitalización y una serie de variables psicosociales y demográficas en pacientes quirúrgicos hospitalizados. Se utilizó la escala de Volicer para medir el distrés hospitalario y, a partir de los resultados, los grupos de alto y bajo distrés fueron comparados según el nivel de depresión y ansiedad referidos: el grupo de alto distrés obtuvo unas puntuaciones en los niveles de depresión y ansiedad referidos significativamente mayores que las obtenidas por el grupo de bajo distrés. Las variables más altamente predictoras del distrés de los pacientes hospitalarios incluyen la edad, el sexo, la duración de la estancia hospitalaria y el tipo de enfermedad, el apoyo social y el estilo de afrontamiento de evitación. Los aspectos psicosociales del estrés se comparan con los índices de afrontamiento proporcionados por la escala de Billings y Moos. El grupo de bajo nivel de distrés hospitalario utilizó las estrategias de afrontamiento activo conductuales en mayor medida que el grupo de alto nivel. A su vez, el grupo de alto distrés hospitalario informó que utilizaba las estrategias de afrontamiento de evitación en un mayor grado que el grupo de bajo nivel. El grupo de afrontamiento evitativo obtuvo un nivel significativamente mayor de depresión y ansiedad que los otros grupos, y un nivel más bajo de apoyo social. El apoyo social percibido apareció como un buen predictor del nivel de distrés hospitalario. Se sugiere un modelo explicativo de la relación entre los estresores, activación del estrés y respuestas de afrontamiento, para una mejor comprensión de los efectos estresantes de la hospitalización. Los resultados concuerdan con los obtenidos en numerosos estudios sobre los efectos de la hospitalización, y señalan que no hay diferencias interculturales en este sentido. This paper studies the relationship between hospital patients' distress and a number of psychosocial and demographic variables in surgical in-patients. Volicer's scale was used to measure hospital distress, and from the results, the high and low distress groupwere compared on the reported level of depression and anxiety: the high distress level group obtained significantly a greater level of depression and anxiety scores than the low distress group. The variables most highly predictive of hospital patients' distress includes age, sex, hospital stay duration and type of illness, social support and avoidance coping way. Psychosocial aspects of stress are compared to indices of coping provided by the Billings and Moos' scale. The low level hospital distress group reported using active-behavioral coping ways more than the high level group. The high level hospital distress group reported using avoidance coping strategies to greater extent than the low level group. The avoidance coping group obtained a significant greater level of depression and anxiety than the other groups, but a significant lower level of social support. The social support appaired to be a very good predictor of level in hospital distress. A model to explain the relationship between stressors, stress appraisal and coping reponses is sugested in order to a better understanding of stressful effects of hospitalization. The results agree with those obtained in a number of studies upon hospitalization effects, and suggest that there is no significant cross-cultural differences in this regard.

Con el objetivo de explicar el estado de salud en el síndrome fibromiálgico (SFM) se exploran las relaciones entre cogniciones, afrontamiento centrado en la enfermedad y emociones. Asimismo, en este estudio ex post facto, se investiga el papel mediador del afrontamiento y las emociones entre las creencias de control (CC) y los resultados de salud. Se utilizó un modelo de ecuaciones estructurales. Participaron 315 pacientes con SFM de atención primaria y reumatología, que completaron medidas del estado de salud, creencias de control, afrontamiento, ansiedad y depresión. Los resultados mostraron que las CC que contienen el elemento de competencia (autoeficacia y competencia percibida en salud) tienen un efecto directo sobre todas las áreas del estado de salud; además, apoyaron el papel mediador de las emociones entre las creencias de competencia y el impacto físico y psicosocial, mientras que el afrontamiento únicamente medió la relación entre la autoeficacia y el impacto físico. Las CC y las emociones son elementos centrales en la explicación del impacto del SFM. Los esfuerzos terapéuticos deberían incrementar las creencias de competencia para mejorar significativamente los resultados de salud y el distrés emocional de la SFM. Estos hallazgos contribuyen al entendimiento sobre cómo los factores psicosociales influyen en la adaptación de pacientes con SFM.