Antonio J Varela’s research while affiliated with University of Arkansas – Fort Smith and other places

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Publications (3)


The theatre of depression: a role for physical therapy
  • Article
  • Full-text available

March 2022

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2,784 Reads

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5 Citations

Antonio J Varela

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Ann Melvin

Introduction The world’s population is experiencing an increasing prevalence of depressive disorders. A comprehensive literature review identifies a schism between current medical interventions and the increasing prevalence. Current treatment paradigms warrant analysis. Objective This manuscript theorizes an interdisciplinary team inclusive of physiotherapy as a standard would reverse the increasing prevalence. Physiotherapists’ musculoskeletal expertise and biopsychosocial approach play a valuable role in mental health. Methods A clinical narrative review of depression, including parallels with chronic pain, is provided as a substantive foundation. The review includes challenges in primary care as the gateway to mental health. Depression’s underlying mechanisms, standard interventions, current theories, and future paradigms are explored. Results A theoretical construct was formulated. This construct identified compromised emotion-regulation and self-efficacy as common dysfunctions that enables and perpetuates depression. Physical activity with cognitive reappraisals positively influences these common dysfunctions and improves general intervention outcomes. The psychologically informed physiotherapist is defined. Physiotherapists can provide functional interventions and cognitive reappraisals that address biopsychosocial needs and build resilience. Conclusion Individualized physical and functional activity that facilitate therapeutic alliance, functional improvements, cognitive reappraisals, emotion-regulation and self-efficacy delivered by a physiotherapist provide sustainable behavioral change and completes the interdisciplinary mental health team.

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Bi-variate scatterplot of PSEQ and ODI
Model for pain self-efficacy’s inverse relationship with reported disability and its mediating relationship with fear, pain catastrophizing, and depression
The relationship between psychosocial factors and reported disability: the role of pain self-efficacy

November 2021

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118 Reads

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27 Citations

Abstract Background Chronic pain and the accompanying level of disability is a healthcare crisis that reaches epidemic proportions and is now considered a world level crisis. Chronic non-specific low back pain (CNLBP) contributes a significant proportion to the chronic pain population. CNLBP occurs with overlapping psychosocial factors. This study was design to investigate specific psychosocial factors and their influence on reported disability in a population with CNLBP. Methods The specific psychosocial factors examined included fear, catastrophizing, depression, and pain self-efficacy. This cross-sectional correlational study investigated the mediating role between pain self-efficacy, the specific psychosocial factors, and reported disability. The study recruited 61 female and 29 male participants from physical therapy clinics. The participants were between 20-to-60 years of age and diagnosed with CNLBP. All participants completed the Fear Avoidance Belief Questionnaire, The Pain Catastrophizing Scale, The Patient Health Questionnaire-9, The Pain Self-Efficacy Questionnaire, and The Lumbar Oswestry Disability Index. The battery of questionnaires measured fear of physical activity, pain catastrophizing, depression, pain self-efficacy, and reported disability. Multivariate regression and mediation analyses was used to analyse the data. Results The principal finding was a strong inverse relationship between pain self-efficacy and reported disability with a p-value


ODI, Pain, Age, and FABQpa Model Coecients
ODI, Pain, Age, FABQpa, and PSEQ Model Coecients
The relationship between psychosocial factors and reported disability: The role of pain self-efficacy

July 2021

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57 Reads

Background Chronic pain in all its forms and the accompanying level of disability is a healthcare crisis that reaches epidemic proportions and is considered a world level crisis. Chronic non-specific low back pain contributes a significant proportion of chronic pain. Specific psychosocial factors and their influence on reported disability in a chronic non-specific low back pain (CNLBP) population was researched. Methods Psychosocial factors examined include fear, catastrophizing, depression, and pain self-efficacy. This cross-sectional correlational study examined the mediating role between pain self-efficacy and the specific psychosocial factors with reported disability. The study included 90 participants with CNLBP between 20 and 60 years of age. Participants completed the Fear Avoidance Belief Questionnaire, The Pain Catastrophizing Scale, The Patient Health Questionnaire-9, The Pain Self-Efficacy Questionnaire, and The Lumbar Oswestry Disability Index to measure fear of physical activity, pain catastrophizing, depression, pain self-efficacy, and reported disability, respectively. The study used multivariate regression and mediation analyses. Results The principal finding of the study was a strong inverse relationship between pain self-efficacy and reported disability. Further, pain self-efficacy was considered a statistic mediator for all psychosocial factors investigated within this data set. Pain self-efficacy was strongly considered to have a mediating role between reported fear of physical activity and disability, reported pain catastrophizing and disability, and reported depression and disability. Additionally, adjusting for age and reported pain levels proved to be statistically significant, and it did not alter the role of pain self-efficacy. Conclusion The results identified that pain self-efficacy had a mediating role in the relationship between the specific psychosocial factors of fear, catastrophizing, and depression and reported disability. Pain self-efficacy plays a more significant role in the relationships between specific psychosocial factors and reported disability with CNLBP than previously considered.

Citations (2)


... Self-efficacy is an important construct to assess in individuals with CDH because it can guide treatment approaches that include self-management and coping strategies to reduce headache-related disability. [12][13][14] Lower self-efficacy can be a barrier to adherence to treatment. 15 In patients with headaches, greater self-efficacy is associated with lower headache-related disability. ...

Reference:

The Chronic Headache Self‐Efficacy Scale: Development and assessment of measurement properties
The relationship between psychosocial factors and reported disability: the role of pain self-efficacy

... Empowerment is initiated and develops through the exploration of suffering that re-establishes personal meaning and purposeful direction grounded in self-identified values, goals, and resources. The experience of suffering like depression narrows focus and the cognitive ability to process positive and regulate negative information (Varela and Melvin, 2023). The cognitive discrepancies were previously described as alignment of oneself with illness or pain, perceived disenfranchisement of identity and resources, an inability to accept current circumstance, and lacking any personal meaning or sense of purpose. ...

The theatre of depression: a role for physical therapy