INTRODUCTION:Low back pain (LBP) represents a frequent health issue in most of the countries; in recent years, there was a growing interest concerning the role of balance and postural stability in individuals with non-specific LBP (NS-LBP). The aim of this systematic review is to provide a synthesis of the evidence on the association between NS-LBP and an impaired dynamic balance. EVIDENCE ACQUISITION:The reporting of this study followed the 2020 PRISMA statement. Analytical observational studies, investigating the dynamic balance performance via functional or motor-tasks tests in LBP in comparison to healthy people, were searched in PubMed, Embase and Scopus up to December 2023. Their characteristics were reported in a standardized form, and their methodological quality was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies. EVIDENCE SYNTHESIS:A qualitative synthesis of the study findings and a discussion of the results are provided. 19 cross-sectional studies were included in this review, with an overall sample size of 894. A meta-analysis was not possible due to high levels of heterogeneity across the studies. None of the included studies were deemed to be of a good methodological quality. Overall, most studies reported differences between NS-LBP and healthy people in terms of dynamic balance, showing worst performances in NS-LBP, both at motor-task tests and at the posturography. CONCLUSIONS:Impaired dynamic balance seems to be correlated to NS-LBP. However, due to the presence of methodological issues in the included studies, further confirmations are needed. Clinicians should take into consideration the importance of a balance assessment in NS-LBP, by implementing proper functional tests. High-quality observational research is recommended, to assess dynamic balance with standardized and uniform modalities, in relation to specific stages of the condition.

OBJECTIVE:The aim of the study is to provide evidence that catastrophizing is the primer of the cognitive-behavioral model of fear of movement/(re)injury. DESIGN:A cross-sectional analysis of 180 outpatients with chronic nonspecific low back pain who completed the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia, the Roland-Morris Disability Questionnaire, the Hospital Anxiety and Depression Scale-Depression, and a pain intensity numerical rating scale. The intercorrelations of the outcome measures were estimated using Pearson's correlation coefficient (r), and regression analyses were used to examine their predictive values by following the left side of the fear of movement/(re)injury clockwise from the Pain Catastrophizing Scale ( P = 0.05). A postdictive analysis dichotomizing the sample into high- and low-level catastrophizers evaluated the effects of addressing catastrophizing on disability and pain. RESULTS:The intercorrelations of the Pain Catastrophizing Scale with the Tampa Scale of Kinesiophobia, Roland-Morris Disability Questionnaire, Hospital Anxiety and Depression Scale-Depression and numerical rating scale were respectively r = 0.59, r = 0.54, r = 0.18, and r = 0.44. Pain Catastrophizing Scale was a significant predictor of Tampa Scale of Kinesiophobia; Pain Catastrophizing Scale and Tampa Scale of Kinesiophobia significantly predicted Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale-Depression; and Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale-Depression significantly predicted numerical rating scale. The postdictive analysis showed that addressing catastrophizing reduces disability and pain experience by 14% in high-level catastrophizers and 86% in low-level catastrophizers. CONCLUSIONS:Our findings provide evidence that catastrophizing is the primer of the fear of movement/(re)injury.

BACKGROUND: There is growing evidence on Commitment Therapy for people with low back pain (LBP). A self-reported questionnaire is lacking which evaluates commitment by relying on the most recommended actions, the most important core outcome domains, and the most evidenced treatment options AIM: To describe the development and psychometric validation of the Work In Progress (WIP) questionnaire. DESIGN: Development and psychometric validation of the WIP questionnaire in the context of people with LBP, as a means to evaluate Commitment. SETTING: Outpatient facilities. POPULATION: People with LBP. METHODS: The new instrument was created by item generation and selection. Face validity, appropriateness, acceptability and feasibility were investigated. Psychometric testing was carried out in a cross-sectional study and included: 1) exploratory factor analysis; 2) reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intra-class Correlation Coefficient, ICC2.1 ); and 3) construct validity by hypothesis testing the correlation of the WIP questionnaire with the Pain Catastrophizing Scale (PCS), the Oswestry Disability Index (ODI), and a pain intensity Numerical Rating Scale (NRS) (Pearson's r correlations). RESULTS: The WIP questionnaire was successfully developed based on international guidelines and the testing of face validity, appropriateness, acceptability and feasibility were satisfactory. The instrument was administered to 102 people with LBP (39 females, mean age of 49.7 +/- 14.6 years [range 20-80], pain median duration of 42.1 weeks [range 3-360]). Factor analysis revealed a two-factor 10-item solution (57% of explained variance). The internal consistency was good (alpha= 0.70-85) and test-retest assessment was excellent (ICC2.1 =0.91-94). Construct validity was good, as >= 75% of hypotheses were confirmed. CONCLUSIONS: The WIP questionnaire is a self-reported tool to evaluate commitment in persons with LBP showing satisfactory psychometric properties. It can be recommended for clinical and research purposes.

The current availability of low-cost immersive Virtual Reality (VR) systems, opens interesting perspectives for neurorehabilitation of people with Multiple Sclerosis (pwMS). However, it is known that immersive VR can trigger the onset of unpleasant effects such as dizziness, headache, nausea, disorientation and balance alterations. Since MS is associated with similar symptoms, it appears important to clarify the role of disability in exacerbating such possible negative effects. To this aim, we combined instrumental data on postural sway (using Center of Pressure COP data) and perceived discomfort in 56 pwMS and 33 unaffected individuals before and after a 10-minute session of immersive VR consisting in a simulated rollercoaster. The results indicate the presence of temporary impairments of postural control in terms of significantly increased sway area in presence of visual input. Interestingly, when the visual input was removed, a reduction of sway area and COP path length in pwMS with mild-moderate disability and unaffected individuals was observed, thus suggesting the existence of a sort of "balance training" effect. All participants complain about blurred vision and nausea after the VR session. In pwMS, changes in most postural sway parameters originated by the VR session were found moderately correlated with changes in SSQ symptoms scores, particularly those of the disorientation domain. Such findings seem to indicate that a short immersive VR session originates contrasting effects on postural control of pwMS, according to their disability level and to the presence of the visual sensory input. At the same time, participants relevant negative symptoms especially in the disorientation domain. Although immersive VR can be generally considered safe and tolerable, the use in pwMS requires the definition of specific guidelines on aspects like exposure time, posture to assume during use and assessment of possible adverse effects to guarantee efficacy of the treatment, safety and comfort.

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0–6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild–moderate disability (i.e., EDSS in the range of 2.5–6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0–2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild–moderate disability) and COP path length relating to the use of VR (pwMS with mild–moderate disability and unaffected individuals), thus suggesting a sort of “balance training effect”. Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.

Abstract Background and aim There is evidence to suggest that assessing back-specific altered self-perception may be useful when seeking to understand and manage low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a patient-reported measure of back-specific body perception that has never been adapted and psychometrically analysed in Italian. Hence, the objectives of this research were to cross-culturally adapt and validate the Italian version of this outcome measure (namely, the FreBAQ-I), to make it available for use with Italians suffering from chronic LBP. Methods The FreBAQ-I was developed by forward and backward translation, review by a committee skilled in patient-reported measures and test of the pre-final version to assess its clarity, acceptability, and relevance. The statistical analyses examined: structural validity based on Rasch analysis; hypotheses testing by investigating correlations of the FreBAQ-I with the Roland Morris Disability Questionnaire (RMDQ), a pain intensity numerical rating scale (PI-NRS), the Pain Catastrophising Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) (Pearson’s correlations); reliability by internal consistency (Cronbach’s alpha) and test–retest repeatability (intraclass correlation coefficient, ICC (2,1)); and measurement error by determining the minimum detectable change (MDC). After the development of a consensus-based translation of the FreBAQ-I, the new outcome measure was delivered to 100 people with chronic LBP. Results Rasch analysis confirmed the substantial unidimensionality and the structural validity of the FreBAQ-I. Hypothesis testing was considered good as at least 75% of the hypotheses were confirmed; correlations: RMDQ (r = 0.35), PI-NRS (r = 0.25), PCS (r = 0.41) and TSK (r = 0.38). Internal consistency was acceptable (alpha = 0.82) and test–retest repeatability was excellent (ICC (2,1) = 0.88, 95% CI: 0.83, 0.92). The MDC95 corresponded to 6.7 scale points. Conclusion The FreBAQ-I was found to be a unidimensional, valid, and reliable outcome measure in Italians with chronic LBP. Its application is advised for clinical and research use within the Italian speaking community.

Due to reduced cost and improved performance, immersive Virtual Reality (VR) is spreading in different fields such as education, industry, and rehabilitation. However, while considered promising for improving health and well-being, there is evidence regarding the possibility to originate adverse effects in terms of motion sickness symptoms, which can be objectively assessed by means of balance alterations. Among other factors that influence this phenomenon (i.e., exposure time, optical flow, hardware type, etc.) player's posture is particularly important especially in the case of immersive VR administration for training or rehabilitation purposes in special populations. However, empirical data on how user's posture is associated to cybersickness during immersive VR experiences are limited. To this aim, we investigated the impact of seated and standing postures on postural control, measured by postural sway, in response to immersive VR. Seventy-six healthy participants underwent pre- and post-VR assessments following a 10-minute simulated rollercoaster experience. Results revealed that postural control is differently affected by standing or sitting position only when sway analysis is performed in absence of visual cues. Both sway area and Center-of-Pressure (COP) path length significantly decreased for the sitting group, while no changes were observed for the standing position. These differences highlight the primary role of visual input in postural performance and elucidates distinct effects of VR player's posture on the postural control system. Standing during VR exposure posed challenges to balance maintenance due to conflicting sensory inputs, leading to temporary and slight increases in postural sway. Conversely, seated posture was characterized by decreased engagement of lower limbs, facilitating enhanced postural stability post-VR session, possibly due to VR training effect. Our study emphasizes the importance of considering user's posture in VR interventions, suggesting for customized approaches in therapeutic and training settings. Clinicians should carefully consider patients' postures during VR interventions to improve outcomes and safety.

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales.The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.

Background. Evaluating the psychometric and clinical performances of the RM-18, the shorter version of the Roland Morris Disability Questionnaire (RMQ), in Italian people with non-specific low back pain (NSLBP) as a time-saving and clinically useful method of assessing disability. Methods. This cross-sectional study included 74 people (52 females and 22 males, 53.03 ± 15.25 years old) with NSLBP. The RM-18, the RMQ, the Oswestry Disability Index (ODI), and a pain intensity numerical rating scale (NRS) were administered. Psychometric testing included reliability by internal consistency (Cronbach’s alpha) and test–retest measurement (Intraclass Correlation Coefficient, ICC2.1), and concurrent validity by comparing the RM-18 with the RMQ and the ODI (Pearson’s r correlation). Two separate regression analyses were performed to investigate the different impact of RM-18 and RMQ on NRS. Results. Cronbach’s α of RM-18 was 0.92 and ICC (2,1) = 0.96. Strong correlations were found with the RMQ and the ODI (r = 0.98; r = 0.78, respectively). The regression models showed that the RM-18 and the RMQ similarly impacted the NRS (p < 0.001). Conclusion. The RM-18 showed satisfactory psychometric testing and similarly impacted the NRS when compared to the RMQ. It can be recommended for clinical and research purposes in Italian people with NSLBP.

Background Progression of radiographic damage in axial-spondyloarthropaties is related to higher functionality impairment in longstanding patients, resulting in poorer quality of life and autonomy. Its impact on gait has not been extensively studied yet. Time-up and go (TUG) test and GAIT analysis (GA) are currently used in neurological and musculoskeletal diseases to evaluate changes in patients gait and stance. Objectives The aim of this study is to evaluate with standardized procedures modifications of gait in patients with inactive longstanding axSpa with radiographic damage, comparing them with a cohort of sex, age and BMI matched healthy controls. Methods Patients followed at Rheumatology Unit of the University Hospital of Cagliari were enrolled. Inclusion criteria were: 1) having a diagnosis of axSpa, 2) having an inactive disease (BASDAI<4, PtGA<20, PhGA<20), 3) evidence of radiographic damage in the most recent spine x-ray available (mSASSS >20), 4) ability to walk autonomously. Exclusion criteria were: 1) deafness, 2) any medical condition that, according to investigators, could expose patients at any excess risk or interfere with the procedures of the study. Patients underwent a TUG test and a gait analysis at the Department of Mechanical, Chemical and Materials Engineering, University of Cagliari. For TUG Test the following parameters were recorded: TUG time, sit-to-stand time, first and second rotation time, stand-to-sit time, walking time. Walking speed and mean step length were recorded using GAIT analysis. Statistical analysis was performed with MANOVA (Pillai’s Trace, Wilk’s Lambda, Hotelling’s Trace, Roy’s Largest Roots). Level of statistical significance was set at<0,05. Results Fifteen patients and fifteen HC were enrolled in this study. Mean age was 60,1±7,8 years for patients and 61,3±7,8 for HC. Weight and height were similar in both groups (axSpa 76,7 ± 16,8kg vs HC 72 ±7,2kg; axSpa 169,33 ± 8,8cm vs HC 170,4 ± 5,2cm). Disease duration was 27.61±9,67 years, mean mSASSS was 46,33±16,84. All patients were inactive, but showed clinical signs of disease progression (BASMI 5,9±1,19). Thirteen patients were on treatment with bDMARDs (TNF inhibitors), while 2 were off treatment. MANOVA revealed differences between axSPa patients and HC for TUG test (p<0,05). TUG time and walking time were significant longer in axSpa (TUG time 12,88±1,92s vs 10,44±2,18s, p=0,003; walking time 5,69±1,17s vs 3,68±0,8, p<0,001), while other parameters were not different between groups. Finally, axSpa patients were slower (0,95±0,16 m/s vs 1,18±0,17 m/s; p<0,05), and had a shorter step (0,52±0,65 m vs 0,65±0,69 m; p<0,05). Conclusion Patients with longstanding axSpa showed a different gait when compared with matched HC: we found that axSpa patients walk slower than HC, and with shorter steps. This could be interpreted as a compensatory behaviour as walking speed slower than 1 m/s has been reported as a risk factor for falling in elderly. In conclusion, we found that disease progression in axSpa patients could interfere with walking speed. Clinical relevance of these findings should be confirmed in future studies, as well as if some medical intervention (e.g. physical therapy) could minimize the impact of disease progression on posture control and walking. Reference [1]Verghese et al. Quantitative Gait Markers and Incident Fall Risk in Older Adults. Gerontol, 2009. Vol. 64A, No. 8, 896–901 doi:10.1093/gerona/glp033 Acknowledgements: NIL. Disclosure of Interests None Declared.

Rehabilitation via virtual reality (VR) training tools allows repetitive, intensive, and task-specific practice in a controlled and safe environment. Our goal was to develop and validate a novel immersive VR system based on the practice of real-life activities in a kitchen environment in people with multiple sclerosis (pwMS) with upper-limb dysfunction. The novel immersive VR kitchen application includes several tasks, i.e., tidying up the kitchen, preparing a hamburger and soup meal, and dish washing. Following the development phase, the system was tested for an 8-week intervention period on a small sample of pwMS suffering from upper-limb dysfunction. The Suitability Evaluation Questionnaire for VR systems served as the primary outcome. The scores for enjoyment, sense of comfort with the system, feelings of success and control, realism, easy-to-understand instructions, assists in rehabilitation therapy, were between 4.0 and 4.6, indicating a high satisfaction. The scores for eye discomfort, dizziness, nausea, and disorientation during practice were between 2.8 and 1.3, indicating a low-to-moderate interference of the system. The virtual kitchen training system is feasible and safe for upper-limb training in pwMS and paves the way for future RCTs to examine the benefits of the system compared with standard care, thus improving the functionality of the upper limbs in pwMS.

This study was designed to determine the relationship between an observational measure of motor skills for teachers (i.e., MOQ-T), age, and some objectively assessed cognitive and motor indices. Two further goals were to examine which motor and cognitive factors predicted MOQ-T scores and to explore whether pupils with very low motor skills identified through MOQ-T also exhibited lower scores on objectively assessed motor and visuo-spatial tasks. A sample of 156 pupils aged 8.4 years-11.3 years and attending Italian primary school completed a battery of tests assessing writing speed, visuo-spatial abstract reasoning, fluency, and static balance abilities objectively assessed by measuring postural sway. Small to medium associations were found between MOQ-T scores and age, motor, and cognitive parameters, respectively. Moreover, approximately 26% of the variance in MOQ-T was predicted by sway area in the eyes-open condition, visuo-spatial fluency, and writing speed. Finally, pupils at risk of developmental coordination disorder exhibited poorer writing speed, and motor and higher-order visuo-spatial deficits. In conclusion, the synergistic use of objective measures of motor and cognitive functioning and observational screening questionnaires such as MOQ-T should be encouraged at school to identify pupils at risk of developmental coordination disorder.

Excessive body mass represents a serious threat to the optimal psychophysical development of children, and it is known to be able to significantly affect their locomotor capabilities, making them more prone to the development of musculoskeletal disorders. However, despite the relevant number of existing studies, a clear gait pattern of overweight children has not been defined yet, particularly in the case of a mass excess that is relatively small (i.e., in those not obese). In the present study, we employed a wearable inertial measurement unit placed on the low back to derive spatio-temporal parameters and quantify the smoothness of gait (by means of harmonic ratio) from trunk accelerations acquired during gait trials carried out by 108 children aged 6–10 (46% males), stratified into two groups according to their body mass index (normal weight, n = 69 and overweight, n = 39). The results show that while gait speed, stride length, cadence and double support duration were found to be almost identical in the two groups, significant differences were observed in terms of harmonic ratio. In particular, overweight children exhibited a reduced harmonic ratio in the antero-posterior direction and higher harmonic ratio in the medio-lateral direction. While the significantly lower harmonic ratio in the antero-posterior direction is likely to be indicative of a loss of smoothness in the walking direction, probably due to a combination of factors associated with the altered movement biomechanics, the higher harmonic ratio in the medio-lateral direction might be associated with specific strategies adopted to increase lateral stability. Although further studies are necessary to elucidate the specific mechanisms that influence the smoothness of gait, it is noteworthy that harmonic ratios appear sensitive even to subtle change in locomotor control in overweight children characterized by apparently regular spatio-temporal parameters of gait and might be employed to assess the effectiveness of interventions designed to improve mobility functions.

Professional gaming requires rapid and repetitive mousing for long durations which may result in fatigue and discomfort that could increase the risk of work-related musculoskeletal disorders or impaired performance. This study aimed to determine whether mouse weight (80g versus 87g) or connection type (wireless versus wired) impacted gamers' muscle activity, performance, and device preference. Sixteen professional players were recruited to use four mice that differed in connection type and weight. The wireless mouse had a lower error rate (p = 0.05) and a higher overall comfort rating (p = 0.01). No statistically significant differences between mouse weight were found. The findings of this study indicate that professional gamers performed slightly better when using the wireless mouse and preferred the wireless mouse. These findings may provide some guidance to the design and selection of gaming mouse.

Background: Sedentary behavior, which is highly prevalent among office workers, is associated with multiple health disorders, including those of the musculoskeletal and cardiometabolic systems. Although prior studies looked at postures or physical activity during work or leisure time, few analyzed both posture and movement throughout the entire day. Objective: This cross-sectional pilot study examined the movement behavior of sedentary office workers during both work and leisure time to explore its association with musculoskeletal discomfort (MSD) and cardiometabolic health indicators. Methods: Twenty-six participants completed a survey and wore a thigh-based inertial measuring unit (IMU) to quantify the time spent in different postures, the number of transitions between postures, and the step count during work and leisure time. A heart rate monitor and ambulatory blood pressure cuff were worn to quantify cardiometabolic measures. The associations between movement behavior, MSD, and cardiometabolic health indicators were evaluated. Results: The number of transitions differed significantly between those with and without MSD. Correlations were found between MSD, time spent sitting, and posture transitions. Posture transitions had negative correlations with body mass index and heart rate. Conclusions: Although no single behavior was highly correlated with health outcomes, these correlations suggest that a combination of increasing standing time, walking time, and the number of transitions between postures during both work and leisure time was associated with positive musculoskeletal and cardiometabolic health indicators among sedentary office workers and should be considered in future research.

Upper limb lymphedema (ULLy) is an external (and/or internal) manifestation of lymphatic system insufficiency and deranged lymph transport for more than 3 months and frequently affects people as a consequence of breast cancer (BC). ULLy is often underestimated despite diminished motor skills, mood, and cognitive-behavioral complaints negatively condition the health-related quality of life (HRQoL) of persons. BC can also metastasize to the jawbone, further impacting on the HRQoL. In time, the implementation of robot-assisted rehabilitation (RR) for neurological diseases has grown to improve HRQoL and pain. This study aims to evaluate the effectiveness of a RR program in the treatment of individuals who develop an ULLy; as a further analysis, the study will assess the effectiveness of the same program in people with jawbone metastases from BC who will also develop ULLy. A randomized, parallel-group superiority-controlled trial will be conducted. 44 participants will be randomly allocated to either the experimental (receiving a RR program) or the control group (regular rehabilitation). Both groups will follow individual-based programs three times a week for 10 weeks. The main outcome measure will be the Lymphedema Quality of Life Questionnaire. Secondary outcomes will be a pain intensity numerical rating scale and the Cranio-Facial Pain Disability Inventory. Evaluations are before and after training and 6 months later. Findings may provide evidence on the effectiveness of a RR program on inducing improvements in the HRQoL and pain of individuals with ULLy due to BC. People with ULLy and jawbone metastases from BC are expected for similar or higher improvements as per the same comparisons above. This trial might contribute towards defining guidelines for good clinical rehabilitation routines and might be used as a basis for health authorities’ endorsements. Trial registration OSF REGISTRIES, osf-registrations-jz7ax-v1 . Registered on 26 June 2023.

Sedentary behavior has increased steadily over prior decades, primarily due to increased computer use at work and at home. The total sedentary time per day has been associated with increased risk of cardiometabolic diseases; increased sitting time at work has been associated with musculoskeletal discomfort particularly in the low back. Office workers spend many hours sitting, thus efforts to increase movement through changes of posture (sit to stand) or moving while sitting have been proposed as ways to mitigate the negative effects of prolonged sitting. Yet, few studies have investigated differences in the movement patterns of office workers while sitting performing their actual work. Therefore, the aim of this study was to characterize movement patterns during a prolonged sitting bout and to determine their association with musculoskeletal pain. Twenty-eight office workers participated in this field study that used a pressure sensitive mat to quantify seat pan pressure (4 regions) and trunk sway parameters over a 2-hour bout of computer work. Data were stratified by breakers who stood up at least once within the 2-hour test and prolongers who remained sitting throughout the test. Overall, there was a decreasing trend in trunk sway parameters (mean COP position, sway path, sway area, sway velocity, maximum displacement, and in-chair movements) over time (p < 0.05), with significant changes in sitting strategies. There were significant differences in trunk sway parameters and perceived musculoskeletal discomfort between breakers and prolongers with breakers having more consistent movement while sitting over the prolonged sitting bout (p < 0.05) and lower discomfort ratings. This may indicate that interrupting prolonged bouts of sitting with short periods of standing can maintain sitting movement patterns and reduce the development of musculoskeletal discomfort. Trunk sway monitoring and promoting periodic standing may be useful tools for maintaining in chair movements that may reduce or prevent the onset of musculoskeletal discomfort during prolonged sitting.