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      Regulatory Emotional Self-Efficacy Buffers the Effect of Heart Rate Variability on Functional Capacity in Older Adults With Chronic Low Back Pain

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          Abstract

          Introduction

          Chronic low back pain is one of the leading causes of disability globally among older adults. Prevailing research suggests that autonomic dysregulation places individuals at increased risk for chronic pain. This study examines the moderating role of emotional self-efficacy (ESE) on the relationship between heart rate variability (HRV) and pain related-outcomes, including movement-evoked pain (MEP) and physical functioning.

          Methods

          In a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA) study, a total of 58 adults (aged 60 and older) with chronic low back pain (cLBP) completed the PROMIS self-efficacy for managing emotions questionnaire and the 6-minute walk test (6 MWT) to assess functional capacity and MEP. Heart rate variability, indexed by the frequency domain, was assessed for 5 min during rest.

          Results

          For pain-related outcomes, having a lower body mass index ( p = 0.03) was associated with better functional capacity on the 6MWT, while higher education level ( p = 0.01) and less pain duration ( p = 0.00) were correlated with lower MEP. After controlling for sex, age, and body mass index, an increase in low-frequency HRV (LF-HRV) was associated with poorer physical functioning among individuals low in ESE ( b = −0.12 p = 0.03). No significant moderation effects were observed for MEP.

          Conclusion

          Our results bring attention to the degree to which ESE influences the relationship between LF-HRV and physical functioning. Interventions that enhance adaptive psychological processes such as ESE may dampen ANS dysregulation and mitigate risk for adverse pain outcomes among older adults with cLBP.

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          Most cited references63

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          An Overview of Heart Rate Variability Metrics and Norms

          Healthy biological systems exhibit complex patterns of variability that can be described by mathematical chaos. Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). A healthy heart is not a metronome. The oscillations of a healthy heart are complex and constantly changing, which allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges to homeostasis. This article briefly reviews current perspectives on the mechanisms that generate 24 h, short-term (~5 min), and ultra-short-term (<5 min) HRV, the importance of HRV, and its implications for health and performance. The authors provide an overview of widely-used HRV time-domain, frequency-domain, and non-linear metrics. Time-domain indices quantify the amount of HRV observed during monitoring periods that may range from ~2 min to 24 h. Frequency-domain values calculate the absolute or relative amount of signal energy within component bands. Non-linear measurements quantify the unpredictability and complexity of a series of IBIs. The authors survey published normative values for clinical, healthy, and optimal performance populations. They stress the importance of measurement context, including recording period length, subject age, and sex, on baseline HRV values. They caution that 24 h, short-term, and ultra-short-term normative values are not interchangeable. They encourage professionals to supplement published norms with findings from their own specialized populations. Finally, the authors provide an overview of HRV assessment strategies for clinical and optimal performance interventions.
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            Effect size estimates: current use, calculations, and interpretation.

            The Publication Manual of the American Psychological Association (American Psychological Association, 2001, American Psychological Association, 2010) calls for the reporting of effect sizes and their confidence intervals. Estimates of effect size are useful for determining the practical or theoretical importance of an effect, the relative contributions of factors, and the power of an analysis. We surveyed articles published in 2009 and 2010 in the Journal of Experimental Psychology: General, noting the statistical analyses reported and the associated reporting of effect size estimates. Effect sizes were reported for fewer than half of the analyses; no article reported a confidence interval for an effect size. The most often reported analysis was analysis of variance, and almost half of these reports were not accompanied by effect sizes. Partial η2 was the most commonly reported effect size estimate for analysis of variance. For t tests, 2/3 of the articles did not report an associated effect size estimate; Cohen's d was the most often reported. We provide a straightforward guide to understanding, selecting, calculating, and interpreting effect sizes for many types of data and to methods for calculating effect size confidence intervals and power analysis.
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              Heart rate variability: Standards of measurement, physiological interpretation, and clinical use

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                Author and article information

                Contributors
                Journal
                Front Pain Res (Lausanne)
                Front Pain Res (Lausanne)
                Front. Pain Res.
                Frontiers in Pain Research
                Frontiers Media S.A.
                2673-561X
                2673-561X
                20 May 2022
                2022
                : 3
                : 818408
                Affiliations
                [1] 1Division of Hematology and Oncology, University of Alabama at Birmingham , Birmingham, AL, United States
                [2] 2Department of Counseling and Higher Education, Northern Illinois University , DeKalb, IL, United States
                [3] 3Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida , Gainesville, FL, United States
                Author notes

                Edited by: Una Makris, University of Texas Southwestern Medical Center, United States

                Reviewed by: Laura Frey-Law, The University of Iowa, United States; Kelly Marie Naugle, Indiana University, Purdue University Indianapolis, United States

                *Correspondence: Calia A. Morais caliamorais@ 123456uabmc.edu

                This article was submitted to Geriatric Pain, a section of the journal Frontiers in Pain Research

                Article
                10.3389/fpain.2022.818408
                9163301
                35669039
                c1b7ec55-7538-4b0c-b3d6-8c6a3d855085
                Copyright © 2022 Morais, DeMonte and Bartley.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 19 November 2021
                : 31 March 2022
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 63, Pages: 9, Words: 7376
                Funding
                Funded by: National Institute on Aging, doi 10.13039/100000049;
                Award ID: K99AG052642
                Award ID: R00AG052642
                Categories
                Pain Research
                Original Research

                emotional self-efficacy,heart rate variability (hrv),emotional regulation,older adult,low back pain

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