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Janet Pope,1 Axel Finckh,2 Lucia Silva-Fernández,3 Peter Mandl,4 Haiyun Fan,5 Jose L Rivas,6 Monica Valderrama,6 Maria Montoro6 1Division of Rheumatology, University of Western Ontario, London, Ontario, Canada; 2Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland; 3Rheumatology Department, A Coruña University Hospital Complex, A Coruña, Spain; 4Division of Rheumatology, Medical University of Vienna, Vienna, Austria; 5Pfizer Inc, Collegeville, PA, USA; 6Pfizer SLU, Madrid, SpainCorrespondence: Maria Montoro, Pfizer SLU, Madrid, Spain, Email maria.montoro@pfizer.comPurpose: To evaluate the characteristics, efficacy, and retention of tofacitinib monotherapy in patients with rheumatoid arthritis using data from randomized controlled trials (RCTs) and real-world data (RWD).Patients and Methods: Three patient groups receiving tofacitinib 5 mg twice daily (BID) monotherapy were defined for post hoc RCT/long-term extension (LTE) analyses: (1) disease-modifying antirheumatic drug (DMARD)-inadequate responder patients from phase 3/3b/4 RCTs; (2) methotrexate-naïve patients from a phase 3 RCT; and (3) index study patients continuing in an LTE study. Outcomes included low disease activity (LDA)/remission rates defined by Clinical Disease Activity Index (CDAI); Disease Activity Score in 28 joints (DAS28-4), erythrocyte sedimentation rate; DAS28-4, C-reactive protein (DAS28-4[CRP]); and rates of/time to discontinuation due to lack of efficacy/adverse events. RWD were identified by non-systematic literature searches of PubMed, Embase, and American College of Rheumatology/European Alliance of Associations for Rheumatology congress abstracts (2012– 2022).Results: RCT/LTE analyses included 1000/498 patients receiving tofacitinib 5 mg BID monotherapy. Baseline disease activity was high; patients tended to receive concomitant glucocorticoids; most were biologic DMARD-naïve. CDAI LDA rates were 32.2– 62.2% for Groups 1/2 (months 3– 12) and 64.0– 70.7% for Group 3 (months 12– 72). In Groups 1, 2, and 3, 4.0%, 15.6%, and 27.7% of patients, respectively, discontinued tofacitinib monotherapy due to lack of efficacy/adverse events. From 11 RWD publications, 16.6– 66.1% received tofacitinib monotherapy. Consistent with clinical data, tofacitinib monotherapy effectiveness (month 6 CDAI LDA, 30.2%; month 3 DAS28-4[CRP] remission, 53.4%) and persistence were observed in RWD, with retention comparable to tofacitinib combination therapy.Conclusion: Tofacitinib monotherapy demonstrated clinically significant responses/persistence in RCT/LTE analyses, with effectiveness observed and persistence comparable to combination therapy in RWD.Trial Registration: NCT00814307, NCT02187055, NCT01039688, NCT00413699, NCT00661661 (ClinicalTrials.gov).Keywords: autoimmune, JAK inhibitor, clinical practice, long-term, efficacy, retention

Angela Leitner,1 Erin Hanson,1 Nicole Soliday,1 Peter Staats,2 Robert Levy,3 Jason Pope,4 Jan W Kallewaard,5,6 Daniel Doleys,7 Sean Li,2 Jacqueline Weisbein,8 Kasra Amirdelfan,9 Lawrence Poree10 1Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia; 2National Spine and Pain Centers, Shrewsbury, NJ, USA; 3Departments of Neurosurgery and Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA; 4Evolve Restorative Center, Santa Rosa, CA, USA; 5Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Arnhem, the Netherlands; 6Department of Anesthesiology and Pain Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands; 7Pain and Rehabilitation Institute, Birmingham, AL, USA; 8Napa Valley Orthopaedic Medical Group, Napa, CA, USA; 9Boomerang Healthcare, Walnut Creek, CA, USA; 10Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USACorrespondence: Angela Leitner, Saluda Medical, Ground Floor, 407 Pacific Hwy, Artarmon, NSW, 2064, Australia, Email angela.leitner@saludamedical.comBackground: Spinal cord stimulation (SCS) is an established chronic pain treatment, but the effectiveness of traditional, open-loop paradigms has been plagued by variable sustainability in a real-world setting. A new approach, utilizing evoked compound action potential (ECAP) controlled closed-loop (CL) SCS, continuously monitors spinal cord activation and automatically adjusts the stimulation amplitude of every pulse, maintaining stimulation at the prescribed ECAP level through this continual feedback mechanism. Recent studies demonstrated the long-term safety and efficacy of ECAP-controlled CL-SCS. Here, we report the design of a prospective, multicenter, single-arm feasibility study to characterize clinical outcomes in a real-world chronic pain population utilizing ECAP-controlled CL-SCS. Objective neurophysiological measurements such as device performance and patient therapy compliance, will be analyzed against baseline biopsychosocial assessments, to explore the clinical utility of these objective physiologic biomarkers in patient phenotyping.Methods: This study will enroll up to 300 subjects with chronic, intractable trunk and/or limb pain in up to 25 United States investigation sites. Subjects meeting eligibility criteria will undergo a trial procedure and a permanent implant following a successful trial. Neurophysiological measurements (measured in-clinic and continuously during home use) and clinical outcomes including pain, quality-of-life, psychological, emotional, and functional assessments will be collected at baseline, trial end, and up to 24-months post-implantation.Discussion: Associations between objective neurophysiological data, clinical evaluation and patient-reported outcomes may have important clinical and scientific implications. They may provide novel insights about the chronic pain pathophysiology, its modulation during CL-SCS, and identification of pain phenotypes and/or mechanisms associated with treatment response during SCS trials and long-term therapy. Data from the ECAP study could lead to improvements in diagnosis, assessment, patient identification and management of chronic pain. It could also provide the foundation for development of a new SCS treatment approach customized by the patient’s pain phenotype, unique neurophysiology, and disease severity.Keywords: chronic pain, closed-loop, evoked compound action potentials, spinal cord stimulation

Dawood Sayed,1 Nasir Khatri,1 Adam Rupp,1 Christopher Bovinet,2 Nomen Azeem,3 Sean Li,4 Youssef Josephson,5 Jason Pope6 1Department of Anesthesiology, University of Kansas, Kansas City, KS, USA; 2The Spine Center of Southeast Georgia, Brunswick, GA, USA; 3Florida Spine & Pain Specialists, Riverview, FL, USA; 4Premier Pain Centers, Shrewsbury, NJ, USA; 5National Spine & Pain Centers, Voorhees Township, NJ, USA; 6Evolve Restorative Center, Santa Rosa, CA, USACorrespondence: Dawood Sayed, Department of Anesthesiology, University of Kansas, Kansas City, KS, USA, Email dsayed1@yahoo.comBackground: Studies have found that up to one-third of patients with LBP have sacroiliac joint (SIJ) dysfunction as a contributing cause. Historically, the management of SIJ dysfunction has been plagued by ineffectiveness or significant morbidity. In 2008, minimally invasive lateral SIJ fusion was developed. While this procedure is a safe and effective treatment, there is still a significant proportion of patients who will not experience therapeutic success. There is a paucity of data in the literature regarding the management of these patients. Recently, a novel posterior sacroiliac joint fusion device has been developed which minimizes complications compared to lateral approaches and may serve to salvage therapeutic failures in this patient population.Objective: Determine the efficacy and feasibility of a posterior SIJ fusion device as a salvage technique in patients who have not experienced therapeutic success following lateral SIJ fusion.Design: Multi-center retrospective observational study.Methods: Patients who had previously undergone lateral SIJ fusion and had persistent LBP were evaluated and diagnosed to have persistent primary SIJ pathology. All patients underwent posterior SIJ fusion utilizing a machined allograft transfixing sacroiliac fusion device. Demographic data and patient reported pain scores were collected.Results: A total of 7 patients who had undergone lateral SIJ fusion were included in the study and underwent posterior SIJ fusion. The mean patient reported pain improvement following posterior fusion was 80% with an average follow-up time of 10 months. Median morphine milliequivalents were 20 pre-procedure and 0 post-procedure.Conclusion: We were able to show significant reductions in pain scores and opioid consumption, which suggests that minimally invasive posterior SIJ utilizing a novel implant and technique may be a viable treatment option to salvage pain relief in this patient population. Further, the favorable safety profile of this posterior technique uniquely positions it to be an appropriate first-line surgical therapy.Keywords: sacroiliac joint pain, posterior SIJ fusion, lateral SIJ fusion, salvage, low back pain

Alaa Abd-Elsayed,1 Jason Pope,2 Derick A Mundey,3 Konstantin V Slavin,4,5 Steven Falowski,6 Ahish Chitneni,7 Stephen R Popielarski,8 Jarod John,9 Samuel Grodofsky,10 Tony Vanetesse,11 Michael A Fishman,11 Philip Kim11 1Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 2Evolve Restorative Center, Santa Rosa, CA, USA; 3United Anesthesia Services, P.C., Plymouth Meeting, PA, USA; 4Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; 5Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA; 6Neurosurgical Associates of Lancaster, Lancaster, PA, USA; 7Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA; 8Thermaquil, Inc., Philadelphia, PA, USA; 9Argires Marotti Neurosurgical Associates, Lancaster, PA, USA; 10Philadelphia Smart Pain & Wellness, Bala Cynwyd, PA, USA; 11Center for Interventional Pain Spine, LLC., Wilmington, DE, USACorrespondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email alaaawny@hotmail.comAbstract: Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.Keywords: painful scar, surgical scar, chronic pain, scar pain, thermal nerve block

Steven M Falowski,1 Vipul Mangal,2 Jason Pope,3 Anish Patel,4 Mark Coleman,5 Dan Kendall,6 Richard Brouillette,7 Michael A Fishman8 1Neurosurgical Associates of Lancaster, Lancaster, PA, USA; 2National Spine and Pain, National Harbor, MD, USA; 3Evolve Restoration, Santa Rosa, CA, USA; 4National Spine and Pain, Frederick, MD, USA; 5National Spine and Pain, Pikesville, MD, USA; 6National Spine and Pain, McLean, VA, USA; 7National Spine and Pain, White Plains, MD, USA; 8Center for Interventional Pain and Spine, Lancaster, PA, USACorrespondence: Steven M FalowskiDirector Functional Neurosurgery, Neurosurgical Associates of Lancaster, 160 N Pointe Blvd Suite 200, Lancaster, PA, 17601, USATel +1 717-358-0800Email sfalowski@gmail.comIntroduction: Several treatment options exist for those with spinal stenosis, as well as degenerative changes. This series evaluates the use of an interspinous fixation (ISF) device as performed by interventional pain physicians.Methods: This is a retrospective analysis identifying 32 patients with the diagnosis of lumbar degenerative disc disease with secondary diagnosis of lumbar spinal stenosis being treated with ISF with Aurora Spine Zip Interspinous Spacer. Serious adverse events, specifically nerve injury, hematoma, infection, and death, were analyzed quantitatively for reported complications within 90 days from the procedure. In addition, VAS was analyzed for patient reported outcomes.Results: Adverse event rate was 0% with no incidences of reoperation, or device removal. Estimated blood loss was recorded as less than 50 cc for all patients. The preoperative pain assessment demonstrated an average pain score of 8.1 and a postoperative pain score of 2.65 equating to a percentage pain reduction of 67%.Conclusion: This case series demonstrates the success and safety of ISF being performed by interventional pain physicians in an outpatient setting. It is a valuable tool in the treatment of moderate to severe lumbar spinal stenosis and degenerative disc disease that has decreased morbidity and significant efficacy.Keywords: interspinous spacer, indirect decompression, interspinous fusion, interspinous fixation, lumbar degenerative disc disease, spinal stenosis, lumbar stenosis, spinal fusion

Krishnan Chakravarthy,1,2 Natalie Strand,3 Anne Frosch,4,5 Dawood Sayed,6 Lakshmi Rekha Narra,1 Rahul Chaturvedi,1 Prabhdeep K Grewal,7 Jason Pope,8 Michael E Schatman,9,10 Timothy Deer11 1Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA; 2VA San Diego Healthcare System, San Diego, CA, USA; 3Department of Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA; 4Hennepin Healthcare Research Institute, Minneapolis, MN, USA; 5Department of Medicine, University of Minnesota, Minneapolis, MN, USA; 6Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA; 7Pain Medicine, TSAOG Orthopaedics, San Antonio, TX, USA; 8Evolve Restorative Center, Santa Rosa, CA, USA; 9Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 10Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 11Department of Pain Medicine, The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Michael E Schatman Tel +1(425)647-4880Email Michael.Schatman@tufts.eduAbstract: To date, COVID-19 has spread to more than 108 million people globally, with a death toll surpassing 2 1/2 million. With the United States Food and Drug Administration (FDA) approval of two highly effective COVID-19 vaccines from Pfizer-BioNtech and Moderna, we now have a novel approach to contain COVID-19 related morbidity and mortality. Chronic pain care has faced unprecedented challenges for patients and providers in this ever-changing climate. With the approval of COVID-19 vaccines, we now face questions relating to the potential effects of pain treatments utilizing steroids on vaccine efficacy. In this analysis, we address these issues and provide guidance for steroid therapies based on available data and expert recommendations.Keywords: vaccines, chronic pain, interventional pain therapy, epidural steroid injections, COVID-19

Steven Falowski,1 Dawood Sayed,2 Jason Pope,3 Denis Patterson,4 Michael Fishman,5 Mayank Gupta,6 Pankaj Mehta7 1Neurosurgical Associates of Lancaster, Lancaster, PA 17601, USA; 2University of Kansas, Kansas City, KS, USA; 3Evolve Restorative Center, Santa Rosa, CA, USA; 4Nevada Advanced Pain Specialists, Reno, NV, USA; 5Center for Interventional Pain and Spine, Lancaster, PA, USA; 6Kansas Pain Management, Overland Park, KS, USA; 7Pain Specialists of America, Austin, TX, USACorrespondence: Steven FalowskiNeurosurgical Associates of Lancaster, 160 N Pointe Blvd #200, Lancaster, PA 17601, USATel +1 717-358-0800Email sfalowski@gmail.comIntroduction: The sacroiliac joint (SIJ) has been estimated to contribute to pain in as much as 38% of cases of lower back pain. There are no clear diagnostic or treatment pathways. This article seeks to establish a clearer pathway and algorithm for treating patients.Methods: The literature was reviewed in order to review the biomechanics, as well as establish the various diagnostic and treatment options. Diagnostic factors addressed include etiology, history, physical exam, and imaging studies. Treatment options reviewed include conservative measures, as well as interventional and surgical options.Results: Proposed criteria for diagnosis of sacroiliac joint dysfunction can include pain in the area of the sacroiliac joint, reproducible pain with provocative maneuvers, and pain relief with a local anesthetic injection into the SIJ. Conventional non-surgical therapies such as medications, physical therapy, radiofrequency denervation, and direct SI joint injections may have some limited durability in therapeutic benefit. Surgical fixation can be by a lateral or posterior/posterior oblique approach with the literature supporting minimally invasive options for improving pain and function and maintaining a low adverse event profile.Conclusion: SIJ pain is felt to be an underdiagnosed and undertreated element of LBP. There is an emerging disconnect between the growing incidence of diagnosed SI pathology and underwhelming treatment efficacy of medical treatment. This has led to an increase in SI joint fixation. We have created a clearer diagnostic and treatment pathway to establish an algorithm for patients that can include conservative measures and interventional techniques once the diagnosis is identified.Keywords: sacroiliac joint, SIJ pain, sacroiliac joint dysfunction, sacroiliitis, sacroiliac joint fusion

Fracture injection/shut-in tests are commonly used to measure the state of stress in the subsurface. Injection creates a hydraulic fracture (or in some cases, opens a preexisting fracture), and then the pressure after shut-in is monitored to identify fracture closure. Different interpretation procedures have been proposed for estimating closure, and the procedures sometimes yield significantly different results. In this study, direct, in-situ strain measurements are used to observe fracture reopening and closure. The tests were performed as part of the EGS Collab project, a mesoscale project performed at 1.25 and 1.5 km depth at the Sanford Underground Research Facility. The tests were instrumented with the SIMFIP tool, a double-packer probe with a high-resolution three-dimensional borehole displacement sensor. The measurements provide a direct observation of the fracture closure signature, enabling a high-fidelity estimate of the fracture closure stress (ie, the normal stress on the fracture). In two of the four tests, injection created an opening mode fracture, and so the closure stress can be interpreted as the minimum principal stress. In the other two tests, injection probably opened preexisting natural fractures, and so the closure stress can be interpreted as the normal stress on the fractures. The strain measurements are compared against different proposed methods for estimating closure stress from pressure transients. The shut-in transients are analyzed with two techniques that are widely used in the field of petroleum engineering – the ‘tangent’ method and the ‘compliance’ method. In three of the four tests, the tangent method significantly underestimates the closure stress. The compliance method is reasonably accurate in all four tests. Closure stress is also interpreted using two other commonly-used methods – ‘first deviation from linearity’ and the method of (Hayashi and Haimson, 1991). In comparison with the SIMFIP data, these methods tend to overestimate the closure stress, evidently because they identify closure from early-time transient effects, such as near-wellbore tortuosity. In two of the tests, microseismic imaging provides an independent estimate of the size of the fracture created by injection. When combined with a simple mass balance calculation, the SIMFIP stress measurements yield predictions of fracture size that are reasonably consistent with the estimates from microseismic. The calculations imply an apparent fracture toughness 2-3x higher than typical laboratory-derived values.

Objective: People are living longer than ever before. Many arrive at a later stage of life in poor health and with inadequate financial and social resources. The purpose of this paper is to describe people's general state of preparedness for their future as older persons, identify specific attitudes towards ageing and key characteristics that portend a lesser degree of preparedness, and identify the issues that need greater emphasis. Design: Cross-sectional survey. Setting: 502 adult participants enlisted on an online polling panel in Canada. Methods: Demographics, attitudes towards the future self and ageing and the responses to the 'Preparedness for the Future Questionnaire' (Prep-FQ) were analysed. Descriptive statistics were used to highlight overall and domain scores (possible score 0-100). Regression models were used to link key demographic characteristics and attitudes to a lower Prep FQ score. Results: The average age of participants was 54.1 years old (range 30-91). The majority (97%) felt it was important to think about themselves as an older person, yet less than 25% of people regularly spent time thinking about what it would be like for them as an older person. The average score on the Prep FQ was 61.6 (range 25-99). Items with the lowest scores were related to advance serious illness planning (medical care, funeral and legacy planning). Factors associated with a higher Prep FQ score included being female, having more education, thinking about when they are older and feeling positive about themselves as an older person. Conclusion: Helping people think and plan ahead more for healthy ageing may help some people move forward with confidence in creating a long, high-quality life and high-quality death. Helping 'at-risk' people plan for serious illness in advance is a high-priority target for improving people's general state of preparedness for the future.

The EGS Collab project is performing well-monitored rock stimulation and flow tests at the 10-m scale in an underground research laboratory to inform challenges in implementing enhanced geothermal systems (EGS). This project, supported by the US Department of Energy, is gathering data and observations from the field tests and comparing these to simulation results to understand processes and to build confidence in numerical modeling of the processes. Experiment 1 (now complete) examined hydraulic fracturing in an underground test bed at the Sanford Underground Research Facility (SURF) in Lead, South Dakota, at a depth of approximately 1.5 km in a well-characterized phyllite. Geophysical monitoring instrumentation in six of eight sub-horizontal boreholes monitored stimulation events and flow tests. The other two boreholes were used to perform and carefully measure water injection and production. More than a dozen stimulations and nearly one year of flow tests in the testbed were performed. Detailed observations of processes occurring during stimulation and dynamic flow tests were collected and analyzed. Flow tests using ambient-temperature and chilled water were performed with intermittent tracer tests to examine system behavior. We achieved adaptive control of the tests using close monitoring of rapidly disseminated data and near-real-time simulation. Numerical simulation was critical in answering key experimental design questions, forecasting fracture behavior, and analyzing results. We were successful in performing many simulations in near-real-time in conjunction with the field experiments, with more detailed simulations performed later. The primary objective of Experiment 2 is to examine hydraulic shearing of natural fractures at a depth of 1.25 km in amphibolite at SURF. The stresses, rock type, and fracture conditions are different than in Experiment 1. The testbed consists of 9 boreholes, in addition to two earlier-drilled characterization boreholes. One borehole is used for injection, two fans of 2 monitoring wells have several geophysical measurement tools grouted in, and four open boreholes surrounding the injection hole are adaptively used for production and monitoring. We have encountered approximately five fracture set orientations in the testbed, and designed our testbed accordingly to maximize the potential for shear stimulation. Three stimulations have been performed to date from the injection borehole, each intersecting at least one production borehole. Different methods have been used for each stimulation, including a ramped flow, a high flow rate, and oscillating pressure.

We investigate the influence of foliation orientation and fine-scale folding on the static and dynamic elastic properties and unconfined strength of the Poorman schist. Measurements from triaxial and uniaxial laboratory experiments reveal a significant amount of variability in the static and dynamic Young’s modulus depending on the sample orientation relative to the foliation plane. Dynamic P-wave modulus and S-wave modulus are stiffer in the direction parallel to the foliation plane as expected for transversely isotropic mediums with average Thomsen parameters values 0.133 and 0.119 for epsilon and gamma, respectively. Static Young’s modulus varies significantly between 21 and 117 GPa, and a peculiar trend is observed where some foliated sample groups show an anomalous decrease in the static Young’s modulus when the symmetry axis (x3-axis) is oriented obliquely to the direction of loading. Utilizing stress and strain relationships for transversely isotropic medium, we derive the analytical expression for Young’s modulus as a function of the elastic moduli E1, E3, ν31, and G13 and sample orientation to fit the static Young’s modulus measurements. Regression of the equation to the Young’s modulus data reveals that the decrease in static Young’s modulus at oblique symmetry axis orientations is directly influenced by a low shear modulus, G13, which we attribute to shear sliding along foliation planes during static deformation that occurs as soon as the foliation is subject to shear stress. We argue that such difference between dynamic and static anisotropy is a characteristic of near-zero porosity anisotropic rocks. The uniaxial compressive strength also shows significant variability ranging from 21.9 to 194.6 MPa across the five sample locations and is the lowest when the symmetry axis is oriented 45° or 60° from the direction of loading, also a result of shear sliding along foliation planes during static deformation.

Older adults spend more time, on average, engaged in sedentary behaviors (SBs) compared with younger cohorts. This is concerning, because prolonged SB is associated with detrimental outcomes. The purpose of this study was to explore the degree to which older adults' motives to limit their SB were internalized, consistent with self-determination theory. Following the qualitative description approach, seven focus groups (n = 27) of community-dwelling older adults were conducted. Focus groups were transcribed verbatim and coded using a thematic approach. Results revealed some motivation subthemes, which appeared to endorse similar content, varied in the degree to which participants internalized them, differentiating these motives along the self-determination theory motivational continuum. These findings demonstrated that not all motives are equal, highlighting the importance of theory-driven future SB interventions. [ABSTRACT FROM AUTHOR]