Pain self-efficacy and physical activity during COVID-19-related social distancing: cross-sectional study

Santos-Júnior, Francisco Fleury Uchoa; Rodrigues, Isabela de Paula; Alaiti, Rafael Krasic; Oliveira, Anamaria Siriani de

doi:10.5935/2595-0118.20220036-en

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ORIGINAL ARTICLE • BrJP 5 (3) • Jul-Sep 2022 • https://doi.org/10.5935/2595-0118.20220036-en copy

Pain self-efficacy and physical activity during COVID-19-related social distancing: cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

Greater self-efficacy for pain management was associated with more time of physical activities during the pandemic.
More time of physical activities was also associated with lower pain intensity during the pandemic.
History of positive diagnosis for COVID-19 did not show association with time of physical activity during the pandemic.

ABSTRACT

BACKGROUND AND OBJECTIVES:

The COVID-19 pandemic has impacted the practice of physical activity in the population with musculoskeletal pain, and one of the ways to increase the performance of physical activity is to stimulate pain self-efficacy. However, to date, no study that brought the association between self-efficacy and physical activity in this population has been observed in the literature. The aim of this study was to analyze the association of the level of pain self-efficacy and physical activity weekly time in the population with pain during social distancing related to the COVID-19 pandemic in the states of Ceará and São Paulo.

METHODS:

This study is characterized as a cross-sectional study with a quantitative approach. Data collection was performed using an electronic form. To identify the association between pain self-efficacy (Pain Self-Efficacy Questionnaire) and physical activity weekly time (dependent variable) in the population with pain, a multiple linear regression was performed.

RESULTS:

Self-efficacy showed a direct association (ß = 0.015; p = 0.0016) with the time of physical activity practiced during the pandemic. Other variables were associated with longer time of physical activity, such as lower pain intensity during the pandemic (ß = -0.064; p = 0.0223), lower body mass index (ß = -0.036; p = 0.0004), the male gender (ß = -0.441; p<0.0001) and absence of reported comorbidities (ß = -0.297; p = 0.0116). The history of positive diagnosis for COVID-19 was not associated with the physical activity duration (p = 0.5347) in an alternative model.

CONCLUSION:

A direct association between pain self-efficacy and time of physical activity in the population with musculoskeletal pain during COVID-19-related social distancing was identified.

Keywords
Exercise therapy; Health belief model; Pain.

	Ceará (n=431) n (%)	São Paulo (n=482) n (%)	All data (n=913) n (%)
Gender Male Female	122 (28.3) 309 (71.7)	128 (26.6) 354 (73.4)	250 (27.4) 663 (72.6)
Age (years) 18 to 35 36 to 65 More than 65	276 (64) 148 (34.3) 7 (1.6)	243 (50.4) 228 (47.3) 11 (2.3)	519 (56.8) 376 (41.2) 18 (2)
Schooling Elementary incomplete Elementary complete Secondary incomplete Secondary complete Higher education incomplete Higher education complete Post-graduation	4 (0.9) 1 (0.2) 1 (0.2) 45 (10.4) 123 (28.5) 103 (23.9) 154 (35.7)	5 (1) 2 (0.4) 7 (1.5) 66 (13.7) 78 (16.2) 125 (25.9) 199 (41.3)	9 (1) 3 (0.3) 8 (0.9) 111 (12.2) 201 (22) 228 (25) 353 (38.7)
Alcoholism No Yes	191 (44.3) 240 (55.7)	164 (34) 318 (66)	355 (38.9) 588 (61.1)
Smoking No Yes	411 (95.4) 20 (4.6)	434 (90 48 (10)	845 (92.6) 68 (7.4)
Presence of comorbidities No Yes	310 (71.9) 121 (28.1)	347 (72) 135 (28)	657 (72) 256 (28)
Weekly time of exercise during the pandemic
No exercise Less than 30 minutes per week From 30 to 75 minutes per week From 75 to 150 minutes per week More than 150 minutes	129 (29.9) 39 (9.0) 94 (21.8) 88 (20.4) 81 (18.8)	123 (25.5) 46 (9.5) 119 (24.7) 96 (19.9) 98 (20.3)	252 (27.6) 85 (9.3) 213 (23.3) 184 (20.2) 179 (19.6)
Adherence to social distancing
No Partially Fully	26 (6) 327 (75.9) 78 (8.1)	40 (8.3) 386 (80.1) 56 (11.6)	66 (7.2) 713(78.1) 134(4.7)
	Ceará (n=431) n (%)	São Paulo (n=482) n (%)	All data (n=913) n (%)
Confirmed COVID-19 diagnosis
No Yes	311 (72.2) 120 (27.8)	411 (75.3) 71 (14.7)	722 (79.1) 191 (20.9)
Chronic pain prior to the pandemic
No Yes	176 (40.8) 255 (59.2)	181 (37.5) 301 (62.5)	357 (39.1) 556 (60.9)

	Ceará (n = 431) Mean (SD)	São Paulo (n = 482) Mean (SD)	All data (n = 913) Mean (SD)
Pain self-efficacy (0-60 points)	47.8 (10.1)	44.4 (12.1)	46.0 (11.3)
Stress levels (0-10 points)	7.6 (2.5)	7.8 (2.4)	7.7 (2.4)
Anxiety levels (0-10 points)	7.3 (2.8)	7.7 (2.4)	7.5 (2.6)
Mean pain intensity before the pandemic (0-10 points)	3.9 (3.0)	3.8 (3.1)	3.8 (3.0)
Mean pain intensity during the pandemic (0-10 points)	6.6 (2.1)	6.6 (2.2)	6.6 (2.1)
BMI (kg/m²)	27 (5.1)	26.2 (5.2)	26.6 (5.2)

	Model influenced by COVID-19			Model not influenced by COVID-19
	β	95% CI	P value	β	95% CI	P value
Time of physical activity practice	-	-	-	-	-	-
Chronic pain prior to the pandemic	0.1514	-0.04299 to 0.3458	0.1267	0.1523	-0.04203 to 0.3465	0.1244
Anxiety levels (0-10 points)	0.03975	-0.01305 to 0.09256	0.1399	0.04069	-0.01201 to 0.09339	0.1301
Stress levels (0-10 points)	-0.04766	-0.1056 to 0.01026	0.1067	-0.04837	-0.1062 to 0.009492	0.1012
Pain during the pandemic (0-10 points)	-0.05840	-0.1120 to -0.004817	0.0327^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).	-0.05863	-0.1122 to -0.005075	0.0319^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).
Pain self-efficacy (0-60 points)	0.01477	0.005403 to 0.02414	0.0020^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).	0.01482	0.005456 to 0.02418	0.0020^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).
Brazilian state during the pandemic COVID-19	0.1307	-0.06063 to 0.3221	0.1803	0.1391	-0.05044 to 0.3286	0.1501
Age	-0.08943	-0.2788 to 0.09989	0.3541	-0.08300	-0.2712 to 0.1052	0.3869
BMI (kg/m²)	-0.03520	-0.05533 to -0.01508	0.0006^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).	-0.03547	-0.05557 to -0.01537	0.0006^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).
Gender	-0.4370	-0.6546 to -0.2193	<0.0001^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).	-0.4352	-0.6527 to -0.2177	<0.0001^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).
Presence of comorbidity	-0.3025	-0.5339 to -0.07113	0.0105^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).	-0.3038	-0.5351 to -0.07254	0.0101^* * Multiple linear regression (p<0.05). β= estimated values. 95% CI = 95% confidence interval. Practicing physical activities was answered with five options (0 = did not perform physical activity; 1 = less than 30 minutes per week; 2 = 30 to 75 minutes per week; 3 = 75 to 150 minutes per week; 4 = more than 150 minutes per week). Age (1 = 18 to 35 years; 2 = 36 to 65 years; 3 = over 65 years), gender (1 = male; 2 = female), presence of comorbidities (0 = no; 1 = yes), state during the pandemic (1 = Ceará; 2 = São Paulo), compliance with social distancing (0 = did not withdraw; 1 = did partial distancing, which included going to the supermarket, pharmacies, and work; 2 = fully adhered to social distancing, except for hospital emergencies), chronic pain longer than three months before the pandemic (1 = yes) or lasting less than three months or no report of pain (0 = no). Pain intensity before and during the pandemic (0 to 10 points scale), self-reported stress levels (0 to 10 points scale), self-reported anxiety level (0 to 10 points scale), and BMI (Weight/Height2). COVID-19 diagnosis (0 = no; 1 = yes).
COVID-19 diagnosis	-0.07292	-0.3033 to 0.1575	0.5347	-	-	-

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[1] Conflict of interests: none - Sponsoring sources: The study was partially funded by the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) - Code 001