Background: Low Back Pain (LBP) is commonly reported as a very frequent disorder in sports, but its prevalence in runners remains unclear. Objectives: To determine the prevalence of LBP in a wide sample of Italian runners. Design: A cross-sectional online survey. Setting: A national survey, according to the CHERRIES and STROBE guidelines, was performed in 2019. Participants: 2539 Italian runners. Methods: A sample of Italian runners registered with national running associations was recruited. The survey was conducted using an online survey development platform. The questionnaire was self reported and included 38 questions. Main outcome measures: Descriptive statistics and frequencies were used to analyze results. Relationships between demographics, daily habits and running characteristics and the responses given was calculated with Cramer's V. Only correlation values higher 0.60 were deemed of interest. Results: 2539 questionnaires (63.5%) were valid for analysis. In total, 22.6% of runners reported having experienced LBP in the past year. Most participants (77.0%) reporting episodes of LBP believed it was not caused by running. No significant correlations (Cramer's V < 0.60) were found between LBP and demographics, training characteristics or lifestyle habits. Conclusion: The prevalence of LBP among Italian runners was 22,57%. LBP was not associated with training, equipment or lifestyle. (C) 2021 Elsevier Ltd. All rights reserved.

Background: Fibromyalgia (FM) is the second most frequent disorder in rheumatic patients. Other than widespread pain, fatigue, sleep disturbance and cognitive impairments, patients complain also symptoms of suspected neuropathic origin, like burning pain, thermal sensitive skin, hyperalgesia, pins and needles sensations. Recent studies highlighted the presence of small- fibers pathology (SFP) and/or large-nerve fibers involvement in about 50% of FM patients, which could be the cause of neuropathic pain. Objectives: The aim of the study was to investigate the prevalence of neuropathic pain and symptoms indicative for the presence of SFP in Italian FM patients, studying the association with clinical variables. Methods: An on-line survey was designed according to the Checklist for Reporting Results of Internet E-Surveys guidelines (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The on-line Survey Monkey® platform was adopted to collect data. We calculated a-priori minimum number of 800 responders. We administered the survey by involving 7 FM patients’ associations distributed nationwide between July and September 2019. We explored demographic and clinical variables including pain and stiffness intensity, symptoms duration, and counting of painful sites. Neuropathic Pain Symptoms Inventory (NPSI) and Fibromyalgia Impact Questionnaire (FIQ) were administered. To study the presence of symptoms indicative of potential SFP we asked for the presence of 8 signs and symptoms reported in literature as characteristics of SFPs. Two groups of FM patients were considered: those positive (FM+) to the Fibromyalgia Research Criteria (FRC) (Wolfe et al., 2011), and those complaining typical FM symptoms but not fulfilling the FRC (FM-). Results: The survey was correctly completed by 76% of participants (892/1173). A total sample of 854 patients (749 in FM+ and 105 in FM-) was analyzed after the exclusion of subjects with major comorbidities. The mean NPSI score was significantly higher in FM+ (56.3/100) respect to FM- (34.2/100). NPSI score was ≥50/100 in 62.4% of FM+ patients and in 21.0% of FM-. More than 3 symptoms indicative for SFP were found in 51% of FM+ patients and in 15.2% of FM-. Dry eyes/mouth, allodynia and changed pattern of sweating on body were the 3 most frequently reported symptoms. We found statistically significant strong associations ( p <0.001) for the NPSI score with disability ( rho =0.53) and pain ( rho =0.63), and a moderate correlation with stiffness levels ( rho =0.45) and counting of painful sites ( rho =0.33). Symptoms indicative for SFP were significantly correlated ( p <0.001) with all clinical variables with low grade of association (Cramer’s V or rho <0.30). Although the higher prevalence of neuropathic pain and symptoms potentially indicative for SFPs, electromyography and electroneurography were performed in 40%-44% of cases, and skin biopsy in 1%-2% of the sample, as well as the assumption of gabapentinoids (12.6% in FM+ and 18% in FM-). Conclusion: This findings highlight the importance of neuropathic pain symptoms identification, since we found a high prevalence and a strong correlation with clinical variables in our cohort of FM patients. The assessment of the neuropathic dimension of pain through self-administered questionnaire should be part of the routine clinical practice. References: [1]Wolfe, F., et al., 2011. Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. The Journal of Rheumatology 38, 1113–1122. Disclosure of Interests: : Antonello Viceconti: None declared, Tommaso Geri: None declared, Simone De Luca: None declared, Filippo Maselli: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Marco Testa: None declared, Giacomo Rossettini: None declared

Isometric bite force control, via measures of force accuracy, force steadiness and force proprioception, was assessed in patients with myogenic temporomandibular disorders (TMDs) compared to healthy controls. Twelve people with myogenic TMDs and twelve age- and gender-matched asymptomatic controls performed maximal voluntary contractions (MVC) of unilateral jaw clenching followed by submaximal isometric contractions, with and without visual feedback of force, at 10, 30 50% and 70% MVC. Force performance was assessed with indices of accuracy (mean distance, MD) and precision (standard deviation, SD) and reported as a percentage of the MVC. A mixed-effect model was used to evaluate differences in MVC, MD and SD. The MVC was lower in the TMD group when clenching either ipsilateral or contralateral to the side of greatest pain (p < 0.05). No difference in MD was observed between groups. The SD depended on the interaction between group and painful side (p = 0.04) with the TMD group displaying higher SD when executing the task with the most painful side when compared to the ipsilateral or contralateral sides of the control group. The reduced maximal bite force and force steadiness observed in people with myogenic pain may interfere with masticatory function and should be considered when planning therapeutic interventions for TMDs.

Background Context effects are well known and were described as integral part of the clinical setting (1). The conscious use of contextual factors (CF) has been recently proposed as an effective modality capable to influence the physiotherapy outcome by facilitation of placebo responses. (2) To date, the knowledge about CF adoption in clinical practice of physical therapists is absent. Objectives The aim of this study was to investigate frequency of use, beliefs and attitudes about contextual factors among Italian physical therapists specialized in manual therapy (OMTs) Methods An invitation to participate in an online survey was sent to 906 OMTs through the database of the Master in Musculoskeletal Rehabilitation (MRDM) of University of Genova by SurveyMonkey Software®. These likely correspond to more than 85% of the whole OMTs population in Italy. A 17 items questionnaire and two clinical scenarios assessed behaviour, beliefs and attitudes of OMTs about CF adoption in clinical practice and data were analysed by descriptive statistic. Results 906 OMTs were invited to participate in the survey and 558 responded (62%). The majority of OMTs uses CF in their practice frequently (52%). They believe that an actual effect of CF can occur in acute pain (57%), chronic pain (78%) and rheumatologic disorders (56%). OMTs consider the use of CF ethically acceptable when it exerts beneficial psychological effects and their effectiveness was shown during clinical experience (31%). They disagree on the adoption of CF when they are based on deception, undermine the trust between OMT and patients, create legal problems or produce side effects (17%). 38% of respondents do not communicate the use of CF to their patients and they adopt CF as addition to other physical therapy interventions with the aim of optimizing clinical responses (20%). Expectation and psychological mechanisms are believed to be the main aspects behind placebo and nocebo effects induced by CF (7%). Conclusions The use of CF is quite common among Italian OMTs and they mostly had positive attitudes towards their use and effectiveness. References Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet. 2001 Mar 10;357(9258):757–62. Testa M, Rossettini G. Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. Man Ther. 2016;24:65–74. Disclosure of Interest None declared

Background Placebo and nocebo represent psycho-neuro-immuno-endocrinological responses commonly encountered in nursing care (1,2). A new paradigm proposed the contextual factors (CF) as mediators and moderators of these responses (3). To date, the knowledge about the awareness of CF and their use in nursing is scant. Objectives The goal of this study was to examine frequency of use, beliefs and attitudes of Italian specialised nurses regarding the contextual factors. Methods In December 2016, through SurveyMonkey Software®, an online survey was conducted by sending a questionnaire to the members of four Italian Nursing Association, grouping nurses specialized in Neuroscience, Medical, Geriatric and Diabetic care. Behaviours, beliefs and attitudes of nurses about the implementation of CF in clinical practice were assessed by a 17 items questionnaire and resulting data were analysed by descriptive statistic. Results Of the 1411 members of the involved Nursing Associations invited to participate to the survey 425 responded (30.1%). An high number of respondent nurses adopts CF often in their practice (42%). They believe that CF can positively influence acute pain (47.5%), chronic pain (61%) and rheumatologic disorders (42%). 34% of responders consider the use of CF, if it can determine beneficial psychological effects, as ethically accep table. 15.5% responders oppose to the adoption of CF when based on deception or if they undermines trust between nurses and patients. A relevant number of nurses (24%) do not communicate the use of CF to their patients and 19% implement CF as addition to other nursing interventions to optimize clinical responses. Nurses explain the power of CF through patient's expectation and psychological mechanism (11%). Conclusions The Italian specialised nurses use CF quite frequently and believe that their use has the capacity of positively influencing the clinical outcome. Larger surveys are needed to understand the proportion of use of CF by nurses in common clinical practice in Italy. References Miller LR, Miller FG. Understanding placebo effects: Implications for nursing practice. Nurs Outlook. 2015 Sep-Oct;63(5):601–6. Häuser W, Hansen E, Enck P. Nocebo phenomena in medicine: their relevance in everyday clinical practice. Dtsch Arztebl Int. 2012 Jun;109(26):459–65. Palese A, Rossettini G, Testa M. Placebo and nocebo responses in nursing practice: a discussion paper on the role of contextual factors. In revision at Nurs Inq. Disclosure of Interest None declared

Background Several questionnaires on neck pain are usually assumed to be unidimensional as their raw scores are considered interval measures. However, the assumption of unidimensionality requires the questionnaire data to satisfy certain criteria when tested with modern psychometric approaches, such as Item Response Theory. The Neck Bournemouth Questionnaire (NBQ) has already been cross-culturally adapted and validated in Italian on a population of subjects with chronic neck pain (Geri et al., 2014). We examined this scale by means of Rasch analysis an Item Response Theory model in order to provide a disease-specific questionnaire whose scores can be assumed as interval variables and, consequently, legitimately their change scores as meaningful. Objectives Validation of the Italian NBQ with Rasch analysis. Methods A sample of 161 subjects with chronic neck pain was assessed with the NBQ. The structure of the scale was preliminarily tested with both exploratory and confirmatory factor analyses. Rasch analysis was performed analysing the following features: the goodness of fit of the data to the model, thresholds ordering, unidimensionality, local independence of the items and Differential Item Functioning (DIF) were examined to consider the NBQ an interval scale. Further, the Person Separation Index and the Mean Location of Persons were used, respectively, to assess the internal consistency and the targeting of the scale. Results Both the exploratory and confirmatory factor analyses revealed a two factors structure of the NBQ. Factor 1 (item 1, 2, 3, 6) fitted the model (χ2=10.65, df 8, p=0.22) after removal of item 7, which had low communalities on exploratory factor analysis and further showed disordered thresholds (Figure). Item 2 presented a marginal uniform Differential Item Functioning across educational level. The Person Separation Index was 0.80 and the Mean Location of Persons was 0.48 (SD=1.02). Factor 2 (Item 4 and 5) fitted the model (χ2=3.86, df 4, p=0.42). The Person Separation Index and the Mean Location of Persons of factor 2 were, respectively, 0.77 and -0.71 (SD=1.57). Conclusions The NBQ is a useful tool for the assessment of patients with chronic neck pain. The NBQ showed a two factors structure, each factor fitted the Rasch model and therefore works as a unidimensional measure. Using the interval scores of the NBQ may provide meaningful change scores to establish the effectiveness of treatments for chronic neck pain in clinical trials. References Geri T, Signori A, Gianola S, Rossettini G, Grenat G, Checchia G, et al. Cross-cultural adaptation and validation of the Neck Bournemouth Questionnaire in the Italian population. Quality of Life Research. 2014. Epub ahead of print 23 September 2014. Disclosure of Interest None declared

Background Mastication requires a high degree of coordination between jaw and neck muscles. The spino-trigeminal system supports the hypothesis that the presence of pain in one of these two regions could affect the motor behaviour of the other. While experimental evidences showed that patients with temporomandibular disorders display electromyographic alterations of the neck flexor and extensor muscle (Armijo-Olivo and Magee, 2013), alterations of the jaw muscles in patients with neck pain have not been investigated yet. Objectives To investigate precision, accuracy and electromyographic activity of jaw muscles contraction during a unilateral bite task in subjects with neck pain. Methods Ten subjects with chronic neck pain and an age and gender-matched sample of healthy individuals volunteered for this study. The maximal voluntary bite force (MVC) was measured with a flexible force transducer positioned between the first molar teeth and used to set up a biting task requiring the subjects to match 4 targets (10, 30, 50 and 70%MVC) displayed on a computer monitor. Electromyographic (EMG) signals of the masseter and anterior temporalis muscles were recorded bilaterally. The subject's force performance was measured using error indices from the reference target like the Mean Distance (MD), Offset Error (OE) and the Standard Deviation (SD) of the delivered force. The Root Mean Square (RMS) of the electromyogram was calculated to detect differences in muscular activity. Between-group differences of the force indices (MD, OE, SD) and EMG activity (RMS) were assessed through Kruskal-Wallis test significance level was set to 0.05. Results There were no significant between-group differences in force production for MD (H =0.38, P=0.5), OE (H =1.81, P=0.2) and SD (H =0.26, P=0.6). A significant difference in electromyographic activity was however detected for the masseter muscle (H =7.19, P=0.007, please refer to Figure) but not for temporalis (H =3.82, P=0.05). Conclusions This study demonstrates that patients with neck pain present higher masticatory muscle activity during a unilateral biting task. Our results support the strong functional relationship between temporomandibular and neck regions and invite to consider, also in clinical setting, the possibility that a disorder affecting one region can have consequences on the functionality of the other. In fact, even though the motor output was comparable between groups, subjects with neck pain displayed higher RMS activity of masseter muscle to deliver the same force. References Armijo-Olivo S, Magee D. Cervical musculoskeletal impairments and temporomandibular disorders. J Oral Maxillofac Res. 2013;3:e4. Disclosure of Interest None declared

Background Neck pain is a musculoskeletal disorder causing high societal and economic costs. The comparison of different treatment strategies across several countries using validated outcome measure is vital in the field of neck pain research. As the Neck Bournemouth Questionnaire (NBQ) holds validated versions with acceptable psychometric properties in several languages, we studied the psychometric properties of the questionnaire in the italian population. Objectives Cross-cultural adaptation and validation of the Italian NBQ (NBQ-I). Methods The forward and back translations of the questionnaire produced the pre-final version, which was adopted as the italian version of the questionnaire (NBQ-I) after preliminary testing on the target population and final approval by an expert committee. The questionnaire was administered in two times, being respectively the beginning and the end of a physiotherapy treatment delivered to the patients with neck pain attending the rehabilitation unit of Santa Corona Hospital (Pietra Ligure, IT). The construct validity and responsiveness were computed by means of hypotheses testing regarding the absolute magnitude of correlations of, respectively, the test scores and change score of the NBQ-I using the Neck Pain and Disability Scale (NPDS), the Numerical Rating Scale for pain intensity (PAIN-NRS), the EuroQoL 5 Dimension Index (EQ5D-IND) and its Numerical Rating Scale for quality of life (EQ5D-NRS) as comparators. The mean change score between the two administrations, the Minimal Clinical Important Difference (MCID) and the floor and ceiling effects were the values used to describe the interpretability. Results The NBQ had acceptable psychometric characteristics ([Table 1][1]). 96 subjects with chronic neck pain completed the questionnaire's administration. The results of the hypotheses testing process revealed a moderate-to-high construct validity and a poor responsiveness of the NBQ-I. The change score had mean 9.4 (SD =13.3) and MCID 5.5 points. Floor and ceiling effects were not observed. ![Figure][2] Conclusions The NBQ-I was successfully validated in a sample of subjects with chronic neck pain. The good construct validity was further supported because the correlations of the test scores with the comparator instruments reflected those observed in different languages. Although the responsiveness was poor, the change score to detect a clinical improvement in the subjects was minimal and resembled those observed in similar populations.1 A limit of this study was the absence of the reliability analysis. References 1. Gay RE, Madson TJ, Cieslak KR. Comparison of the neck disability index and the neck bournemouth questionnaire in a sample of patients with chronic uncomplicated neck pain. J Manipulative Physiol Ther 2007;30:259-262. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2339 [1]: #F1 [2]: pending:yes

Background The muscle impairment in Temporomandibular disorders (TMDs)1, frequently observed in patients with different rheumatic diseases, contribute to diminished recruitment and force tuning ability. The quantitative assessment of the motor function is capital in the diagnosis and rehabilitation of TMDs. In this study, we propose an intuitive visual feedback of the bite force that promote the coordination and control of jaw muscles. Objectives Validity and reliability evaluation of a visual feedback system for masticatory muscle assessment Methods The force signals, measured by two customized force transducers positioned between the first molars teeth, became the spatial coordinates of a cursor which moved on a PC monitor according to the subject9s bite force on the right (axis x) and left sensors (axis y). The subject9s force during a maximal monolateral left (Lx, Ly), monolateral right (Rx, Ry) and bilateral (BILx, BILy) clenching outlined the boundaries of the Working Area (WA) (Figure 1). During a trial, the task required was to match the position of the 23 targets randomly displayed within the WA, each target being displayed for 5 s and alternated with 5 s of rest. Each subject performed two sessions of three trials in two consecutive days. Matching errors were measured by Mean Distance (MD), calculated as the mean cursor-target distance, and Offset Error (OE), calculated as the distance between the mean cursor position and the target. For the reliability analysis of MD and OE, we considered the Intraclass Correlation Coefficient (ICC), the Standard Error of Measurement (SEM), and the Limits of Agreement (LOA). The validity of both indices was investigated with a linear regression analysis. A 2-way repeated measures ANOVA with SESSION (2 levels) and TRIAL (3 levels) as factors was done to control for any learning effect. Results The 13 subjects included showed a wide range of WAs, geometrically representing functional aspects like maximal force, and left/right independence in force generation. MD showed a more acceptable reliability (ICC =0.78, 95%CI 0.43-0.93;SEM =26%;LOA = -29%, 23%) instead of OE (ICC=0.66, 95%CI 0.20–0.88; SEM=37%; LOA = -31%, 42%). The correlation between MD and OE was high (r=0.96, p<0.001). The 2-way ANOVA detected a significant decrease for MD (p=0.004) and OE (p=0.012) between the two sessions. Conclusions This visual feedback system provided a valid and reliable representation of the mandibular motor function to be extended in the evaluation of patients suffering from rheumatic diseases. The use of error indices (MD, OE) may characterize the individual performance during force control tasks of jaw elevator muscles in health and disease. This technique may also provide specific rehabilitation programs for TMDs because the subject9s improvement during the second session was most likely attributable to a learning effect. References Manfredini D, Guarda-Nardini L, Winocur E, et al., Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:453. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2332

Background Even if recent evidences suggest the absence of any relationship between body posture and dental occlusion in provoking spine or temporomandibular disorders,1 electromyographic studies evidenciated a relationship between temporomandibular disorders and neck pain. Since pain disorders often affect the force production and control because of a feedback impairment, the neck pain might cause a deficit in bite force control. To date no studies were conducted to ascertain such a phenomenon. Objectives To investigate the ability to control bite force in subjects with neck pain Methods A sample of 13 subjects affected by chronic neck pain and 13 healthy subjects, age and gender matched, were recruited after informed consent. Two flexible force transducers housed in a soft envelope positioned between the first molars teeth constituted the force measuring device. The values of two Maximal Voluntary Contractions (MVCs) were used to generate 4 targets representing percentages (10, 30, 50 and 70%) of the right and left MVCs. The task required was to reach and hold for 5” the force targets randomly displayed on the monitor, by tuning the force exerted on both sides. The subject9s force performance was measured using error indices from the reference target like the Mean Distance (MD) and Offset Error (OE). Between-group differences of the force errors (MD, OE) were analyzed using a wilcoxon rank sum test with alpha set at 0.05. Results 13 subjects (10 females, 3 males) with neck pain and a matched control group participated in the study. There were no significant between-group differences in force production for both MD and OE. Conclusions The neck pain subjects did not presented any significant difference in bite force control, compared with healty subjects. These results do not support an etiopathogenetic relationship between neck pain and temporomandibular disorders References Rocha CP, Croci CS, Caria PH. Is there relationship between temporomandibular disorders and head and cervical posture? A systematic review. J Oral Rehabil. 2013 Nov;40(11):875-81. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6029