How to Promote Walking in Women with Fibromyalgia: A Look at Catastrophizing, Goal Conflict, and Avoidance from a Self-Emotional Regulatory Perspective

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper uses epidemiological and statistical methods to clarify that a psychological and cognitive factor called “helplessness”, which is one of the factors of catastrophizing, influences PA (physical activity) through a behavioral factor called “activity avoidance”. It seems to be very interesting in promoting walking in FM patients and improving their symptoms.

The conclusion of the study is expressed in the following two sentences: “Thus, the indirect effect of helplessness on minutes of walking measured by accelerometer via activity avoidance was higher in individuals with higher importance given to exercise (lines 297-299) and “It appears that helplessness and activity avoidance influences minutes of walking assessed through and (?) objective measure in women with (who?) give high importance to exercise (lines 412-414).”

However, how this conclusion is drawn from Table 3 is very confusing to the readers who are not familiar with the method. A little more straightforward explanation is needed.

Furthermore, it is necessary to discuss how to make use of this conclusion in actual clinical practice.

Comments on the Quality of English Language

Due to wording and grammatical mistakes, the sentences are often difficult to understand. It is not possible to point out all of them here, but some are listed below.

Line 47: Within fear-avoidance model (18) in the cornification (chronification?) of pain, the motivational perspective of goal conflict and catastrophism (catastrophizing?) play a key role.

Lines 89-90: we can hypothesize that catastrophizing and, specifically, hopelessness, may influence FM thought (through?) the contextual role of activity avoidance.

Lines 119-120: which took 20-30 minutes to complete in their associations, in the presence of a psychology (psychologist?)

Lines 328-330: our second aim was focused on analyze (the analysis of?) the differential role of psychological and contextual variables on perception and actual performance.

Lines 336-338: first model was focused on analyze (the analysis of?) if activity avoidance mediated the relationship between hopelessness and minutes walked during a week assessed by both measures.

Lines 376-379: Thus, (to?) promote walking, it is necessary to improve levels of hopelessness, but thorough prevent avoidance as an activity avoidance pattern trying to give women the opportunity to obtain reinforcement through their own behavior, and thus improve their self-efficacy with respect to their functional capacity. This sentence is quite difficult to understand. What is “thorough prevent avoidance”?

Lines 380-384: Secondly, when the interaction between hopelessness and (?) has been evaluated, although does not exert a direct role on activity avoidance, influences the relationship exerted by hopelessness on activity avoidance, but only in women with medium and high levels of, effect that has been maintained related to walking evaluated by the accelerometer. This sentence is also quite difficult to understand.

Editing by a native English speaker scientist is required.

Author Response

Reviewer(s)' Comments to Author:

Reviewer: 1

This paper uses epidemiological and statistical methods to clarify that a psychological and cognitive factor called “helplessness”, which is one of the factors of catastrophizing, influences PA (physical activity) through a behavioral factor called “activity avoidance”. It seems to be very interesting in promoting walking in FM patients and improving their symptoms.

Thank you.

The conclusion of the study is expressed in the following two sentences: “Thus, the indirect effect of helplessness on minutes of walking measured by accelerometer via activity avoidance was higher in individuals with higher importance given to exercise (lines 297-299) and “It appears that helplessness and activity avoidance influences minutes of walking assessed through and (?) objective measure in women with (who?) give high importance to exercise (lines 412-414).”

This sentence has been improved: “It appears that helplessness and activity avoidance influences minutes of walking assessed through an objective measure in women who give high importance to exercise”.

However, how this conclusion is drawn from Table 3 is very confusing to the readers who are not familiar with the method. A little more straightforward explanation is needed.

Furthermore, it is necessary to discuss how to make use of this conclusion in actual clinical practice.

An explanation has been added including how to make use of this conclusion in actual clinical practice “It appears that helplessness and activity avoidance influences minutes of walking assessed through an objective measure in women who give high importance to exercise. Helplessness seems to have a distinct impact on the behavior of walking as assessed by an objective measure. This influence manifests through the avoidance of activity, particularly in individuals who possess higher levels of hedonic goals, which involves shunning activities due to pain. It can be concluded that promoting exercise among women with fibromyalgia (FM) is crucial, considering not only the amount of exercise but also how it is performed. Helplessness and activity avoidance are measured against the goals women set for their activity levels. Therefore, we should aim to promote work on contextual variables both as a preventive measure and to identifying profiles in women with FM, asthese variables directly and indirectly influence the ability to exercise and, consequently, the well-being of women with FM”.

Comments on the Quality of English Language

Due to wording and grammatical mistakes, the sentences are often difficult to understand. It is not possible to point out all of them here, but some are listed below.

Following your guidance, the text has been revised by a specialized translator. Furthermore, the suggested amendments from the reviewer have been incorporated. Thank you very much.

Line 47: Within fear-avoidance model (18) in the cornification (chronification?) of pain, the motivational perspective of goal conflict and catastrophism (catastrophizing?) play a key role.

This sentence has been modified.

Lines 89-90: we can hypothesize that catastrophizing and, specifically, hopelessness, may influence FM thought (through?) the contextual role of activity avoidance.

This sentence has been modified.

Lines 119-120: which took 20-30 minutes to complete in their associations, in the presence of a psychology (psychologist?)

This sentence has been modified.

Lines 328-330: our second aim was focused on analyze (the analysis of?) the differential role of psychological and contextual variables on perception and actual performance.

This sentence has been modified.

Lines 336-338: first model was focused on analyze (the analysis of?) if activity avoidance mediated the relationship between hopelessness and minutes walked during a week assessed by both measures.

This sentence has been modified.

Lines 376-379: Thus, (to?) promote walking, it is necessary to improve levels of hopelessness, but thorough prevent avoidance as an activity avoidance pattern trying to give women the opportunity to obtain reinforcement through their own behavior, and thus improve their self-efficacy with respect to their functional capacity. This sentence is quite difficult to understand. What is “thorough prevent avoidance”?

This sentence has been modified.

Lines 380-384: Secondly, when the interaction between hopelessness and (?) has been evaluated, although does not exert a direct role on activity avoidance, influences the relationship exerted by hopelessness on activity avoidance, but only in women with medium and high levels of, effect that has been maintained related to walking evaluated by the accelerometer. This sentence is also quite difficult to understand.

This sentence has been excluded.

 

 

Author Response File: Author Response.doc

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, first of all I would like to comment on the valuable scientific contribution of your manuscript. It is considered an adequate study that helps to increase research in this area.

Regarding the manuscript, I would like to comment on some considerations to be taken into account:

- The study is based on a sex-specific population sample, being only female. It would be appropriate to improve a justification explaining the reasons why this sample was taken and not another. 

- The Pain Catastrophizing Scale (PCS) is described in lines 55-60. However, the description of this scale would be justified in the results section if it is used. Constrarily, the importance of this scale in the study should be deleted or contextualised.

- Correct some references and bring them into line with citation regulations. In line 191: (Tudor-Locke, 2002), this citation should be introduced like the rest, in brackets under numbering, and its proper order in the references. As is the case with (DP, 2006) on line 197

- It would be considered interesting to introduce study limitations and future lines of research that would allow further study of the area.

- Finally, it would be advisable to revise the wording of the introduction and discussion sections, which provide a good theoretical basis, but could be better expressed. 

Thank you again. 

Kind regards

 

Comments on the Quality of English Language

It would be advisable to review the wording of the language, but it appears to be of an adequate standard for acceptance and publication.

Author Response

Reviewer #2: Dear authors, first of all I would like to comment on the valuable scientific contribution of your manuscript. It is considered an adequate study that helps to increase research in this area.

Thank you

Regarding the manuscript, I would like to comment on some considerations to be taken into account:

- The study is based on a sex-specific population sample, being only female. It would be appropriate to improve a justification explaining the reasons why this sample was taken and not another.

This information has been included. We also included a new reference ( page.., line…).

- The Pain Catastrophizing Scale (PCS) is described in lines 55-60. However, the description of this scale would be justified in the results section if it is used. Constrarily, the importance of this scale in the study should be deleted or contextualised.

Following your recommendations, description of this scale has been justified in the measures section:

“The Pain Catastrophizing Scale (PCS) stands out as the most widely utilized tool for assessing pain catastrophizing (30). Its development was based on a multidimensional understanding of catastrophizing, encompassing aspects of magnification (e.g., pondering whether something serious might happen), rumination (e.g., unable to stop thinking about it), and helplessness (e.g., feeling powerless to alleviate pain intensity). It contains…..” (page 3,  line 133140).

- Correct some references and bring them into line with citation regulations. In line 191: (Tudor-Locke, 2002), this citation should be introduced like the rest, in brackets under numbering, and its proper order in the references. As is the case with (DP, 2006) on line 197

References have been revised.

- It would be considered interesting to introduce study limitations and future lines of research that would allow further study of the area.

Limitations and future lines of research has been added.

- Finally, it would be advisable to revise the wording of the introduction and discussion sections, which provide a good theoretical basis, but could be better expressed.

Following your guidance, the text has been revised by a specialized translator. Furthermore, the suggested amendments from the reviewer have been incorporated. Thank you very much.

 

Author Response File: Author Response.doc

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Grammatical errors in English have been improved and the manuscript has been made easier to understand.

The new discussion also satisfies the reviewer's question. However, the papers cited in Lines 410-451 are not incorporated into the references.

Fig.1 should be moved toward the right.

 

Author Response

Dear Reviewer,

Thank you very much for your comments.

The following actions have been taken as per your instructions:

The references have been included following the journal's guidelines. They have been highlighted in blue to differentiate them from previous changes.

Figure 1 has been moved toward the right.

Thank you very much,