Search Results (848)

Background: Panvascular disease (PVD) is a systemic atherosclerotic condition that poses a substantial threat to global health. Despite the recognized importance of early proactive screening, proactive screening beliefs among high-risk populations are poorly understood. Objective: To explore the proactive screening beliefs among Chinese high-risk patients for PVD based on the Health Belief Model (HBM), so as to provide evidence for developing targeted nursing intervention strategies and health policies. Methods: A descriptive qualitative study was conducted. Employing a purposive sampling strategy with maximum variation, participants at elevated risk for PVD were recruited from a tertiary hospital in Shanghai between October and December 2025 to conduct semi-structured interviews. Data saturation guided sample size (n = 22; 14 male, 8 female; mean age 62.68 years). Data were analyzed using qualitative content analysis. Results: Five main themes were extracted: multifaceted perceptions of susceptibility, multidimensional fear of severity, positive attitudes toward the benefits of proactive screening, multiple perceived barriers to proactive screening, and significant differences in self-efficacy for proactive screening. Conclusions: The proactive screening beliefs in Chinese high-risk patients of PVD were deeply embedded in local cultural values and healthcare realities. Tailored health education, age-friendly service optimization, and stratified intervention strategies are urgently needed to reduce screening barriers and improve population-wide proactive screening beliefs. Full article

Introduction: Population aging is a growing and challenging phenomenon, primarily due to its association with functional decline and sarcopenia, which increase the risk of falls. These events have significant impacts on public health and the quality of life of older adults. Regular physical activity has shown benefits in reducing falls and their consequences, with systemic vibratory therapy (SVT) emerging as a promising strategy to mitigate these adverse outcomes. However, evidence on the actual effectiveness of this therapeutic approach remains limited, as does clarity regarding optimal body position, protocol parameters, and equipment when combined with physical activity programs. Objectives: To compare the effect of systemic vibratory therapy (SVT) associated with a physical activity program on the perception of fear of falling in older adults (M01.060.116.100). As secondary outcomes, the study will assess functional physical conditioning, electromyographic activity, muscular synergy, and center of pressure oscillation in this population. Methods: A randomized controlled clinical trial with blinded outcome assessors and blinded statistical analysis will be conducted with 192 older adults participating in the UNATI/UNISUAM program. Participants will be allocated into three groups: (A) usual physical activity; (B) usual physical activity + SVT in a semi-squat position; and (C) usual physical activity + SVT in a seated position. Assessments will include sociodemographic data, concern about falling assessed using the Falls Efficacy Scale-International (FES-I), physical performance (2 min stationary march test), surface electromyography of the tibialis anterior and medial gastrocnemius muscles, along with posturography using a force platform. Results: This study will provide information on outcomes related to fall risk, balance, physical fitness, and neuromuscular variables in older adults undergoing two distinct SVT protocols. Clinical Trials Registration: Brazilian Registry of Clinical Trials RBR-68pry5j. Registered on 8 December 2025. Full article

This study aimed to examine variables associated with manipulation tendency levels in adults and to describe current patterns using a decision tree method as a classification-based analytical approach. The research sample consisted of 543 adults (358 women, 65.93%; 185 men, 34.07%) residing in Turkey, aged 18 to 45 years (M = 25.79, SD = 4.23). Data were collected using a researcher-developed personal information form, the Manipulation Scale in Human Relations, the Rosenberg Self-Esteem Scale, and the Relationship Scales Questionnaire. The total composite score of the Manipulation Scale was used as the outcome variable and is referred to throughout as “manipulation tendency.” Manipulation tendency scores were dichotomized into low versus high groups using a median split to facilitate C&RT-based classification. Classification and Regression Tree was used to examine the hierarchical structure of variables related to manipulation tendency levels and to identify classification patterns among study variables. The decision tree approach was used not merely as an alternative statistical technique, but as an interpretable classification framework capable of identifying hierarchical and conditional pathways associated with manipulation tendency. Data were stratified-randomly split into training and test sets (70/30), and tree complexity was tuned via cross-validation using cost-complexity pruning. Model performance indicated acceptable classification accuracy within this sample, with a test-set accuracy of 0.81 (sensitivity = 0.74, specificity = 0.88, precision = 0.86, F1 = 0.79) and training accuracy of 0.86. The findings indicated several influential variables in classifying manipulation tendency levels, ranked by importance: preoccupied attachment style, self-esteem, age, dismissive attachment style, gender, secure attachment style, and fearful attachment style. Preoccupied attachment style was identified as the most salient variable in differentiating between high and low manipulation tendency groups. The decision tree structure showed that younger adults with higher preoccupied attachment scores were more frequently classified into the high manipulation tendency group. Self-esteem emerged as the second most influential variable, with lower self-esteem levels being more commonly observed among individuals classified in the high manipulation tendency group. Age also played a notable role in classification, with higher manipulation tendency classifications occurring more frequently among younger individuals. Dismissive attachment style contributed to the differentiation of manipulation tendency levels, particularly within specific attachment and age profiles. Gender-related patterns indicated that men were more frequently classified into higher manipulation tendency groups, especially among individuals with low self-esteem. Overall, the findings highlight the multifactorial and hierarchical nature of manipulation tendency classifications. They contribute to the literature by showing how attachment-related characteristics, developmental factors, and psychological variables jointly differentiate manipulation tendency profiles. These findings highlight the value of decision tree modelling for translating conventional psychological predictors into interpretable classification profiles of manipulation tendency. Full article

Artificial intelligence (AI) is increasingly embedded in marketing work, yet employees who use AI tools may not always disclose AI’s role in producing their outputs. This study examines AI disclosure silence, defined as employees’ intentional withholding of information about the use, role, or contribution of AI tools in work-related outputs after AI has already been used. Unlike AI avoidance or resistance, this construct concerns post-adoption concealment; unlike general employee silence, it focuses on the hidden technological contribution behind visible work. Drawing on Conservation of Resources Theory and Psychological Safety Theory, the study investigates how threat-based conditions, safety and governance conditions, and AI-related capability are associated with AI disclosure silence. Data were collected through a two-wave survey of 635 marketing employees who actively used AI tools at work. The analysis combined measurement validation, Necessary Condition Analysis (NCA), fuzzy-set Qualitative Comparative Analysis (fsQCA), and explainable machine learning. The findings show that no single condition operated as a strong necessary bottleneck. Instead, AI disclosure silence appeared through multiple pathways involving AI anxiety, fear of negative evaluation, perceived creativity threat, perceived job insecurity, low trust in management, weak psychological safety, and unclear AI policy. SHapley Additive exPlanations (SHAP)-based interpretation further indicated that fear of negative evaluation, AI anxiety, perceived creativity threat, and trust in management had the strongest model-based predictive relevance. The study contributes to workplace AI and employee silence research by positioning AI disclosure silence as an emerging post-adoption disclosure construct. It also highlights the need for clear AI disclosure norms, non-punitive managerial responses, AI-assisted authorship guidelines, and psychologically safe AI-governance practices. The findings should be interpreted as configurational and predictive evidence rather than causal effects, and further scale validation across sectors and cultures is encouraged. Full article

Lymphoid neoplasms such as multiple myeloma (MM), indolent non-Hodgkin lymphoma, and chronic lymphocytic leukemia are increasingly managed as chronic, relapsing conditions characterized by prolonged surveillance, repeated treatment transitions, and cumulative self-management demands. These trajectories expose patients and caregivers to persistent illness uncertainty, fluctuating fear of progression, symptom and comorbidity burden, communication challenges, and treatment-related workload. This theory-informed framework development paper uses an overview of selected psycho-oncological, hematological, nursing, theoretical, and patient-reported outcome literature to propose the LUMINA framework: Longitudinal illness trajectory, Uncertainty fields, Multidimensional symptom and comorbidity load, Information and interaction context, Navigation work and self-management load, and Adaptive outcomes and alignment. LUMINA is intended as a hypothesis-generating conceptual structure to organize clinically relevant domains, clarify potential relationships among uncertainty, symptom burden, communication, navigation work, and adaptive outcomes, and guide future assessment, validation, and intervention research in chronic lymphoid neoplasms. The framework builds on prior theories of illness uncertainty, treatment burden, workload–capacity balance, fear of recurrence/progression, and lymphoma-specific qualitative work on uncertainty management and psychosocial adaptation. Potential research applications include structured assessment, shared decision-making research, and domain-matched supportive-care concepts; however, these applications remain theoretical and require empirical testing. Future studies should evaluate feasibility, acceptability, construct validity, domain overlap, predictive validity beyond quality of life, and the clinical utility of LUMINA-informed research profiles. Until such validation is available, LUMINA should be interpreted as a conceptual model rather than a validated clinical tool or care pathway. Full article

Digital isolation represents a contemporary paradox in which increased connectivity through social media and digital technologies does not necessarily translate into improved social integration or psychological well-being. This review synthesizes current evidence on the relationship between digital environments and mental health, with a focus on mechanisms underlying loneliness, anxiety, depression, and related outcomes. The findings indicate that problematic and passive use of social media—particularly when associated with social comparison processes and Fear of Missing Out (FoMO)—is consistently linked to increased levels of depressive symptoms, anxiety, sleep disturbances, and reduced well-being. At the same time, the evidence highlights substantial heterogeneity, suggesting that the impact of digital technologies is moderated by user characteristics, age, patterns of engagement, and psychosocial context. Importantly, digital technologies may also serve compensatory and protective functions by facilitating social support, especially in conditions of objective isolation. Key mediating mechanisms include cyberbullying, social exclusion, emotional contagion, and internalization of body image standards. The concept of “digital loneliness” emerges as a useful framework for understanding the discrepancy between constant connectivity and perceived relational insufficiency. Practical implications emphasize the need for targeted interventions focusing on digital literacy, healthy usage patterns, and psychosocial support rather than simplistic reduction in screen time. Overall, digital isolation should be conceptualized as a qualitative dysfunction of mediated social interaction rather than a purely quantitative effect of technology exposure. Full article

Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving tolerance of active rehabilitation. Osteoarthritis (OA) is a heterogeneous whole-joint disorder in which cartilage degeneration, subchondral bone remodeling, synovitis, peri-articular tissue dysfunction, neuromuscular impairment, and pain sensitization may interact to produce pain, stiffness, and activity restriction. As conservative therapy for OA, education, progressive therapeutic exercise, weight management when indicated, and self-management remain the core of care. Nevertheless, some patients cannot fully participate in exercise because of pain, fear of movement, load intolerance, comorbidity, or limited access to supervised rehabilitation. This narrative review synthesizes evidence published mainly between 2016 and 2026 for extracorporeal shock wave therapy (ESWT), photobiomodulation/low-level laser therapy (PBMT/LLLT), pulsed electromagnetic field therapy (PEMF), transfer energy capacitive and resistive/capacitive–resistive electric transfer (TECAR/CRET) therapy, body weight support and aquatic unloading strategies, and mechanosonic vibration therapies. The available literature suggests that ESWT and PBMT/LLLT may provide short- to mid-term pain and function benefits in selected patients with knee OA when parameters are aligned with evidence-supported dosing windows. PEMF and vibration therapies show promising but less consistent effects because protocols, devices, sham conditions, and populations vary. TECAR/CRET and unloading approaches are best interpreted as enabling tools that may reduce guarding, improve walking tolerance, or increase the quality of therapeutic exercise, rather than stand-alone disease-modifying treatments. Current national and society guidelines consistently prioritize exercise, education, and weight management; most of the modalities reviewed here are absent from guidelines or are supported only indirectly, which justifies cautious wording and individualized use. A practical application model is, therefore, time-limited and goal-oriented: identify the barrier to rehabilitation, select a modality with a plausible mechanism and published protocol, monitor pain and functional response, and discontinue the modality if it does not improve participation in active care. Full article

This pilot study examines how experimentally induced emotional states interact with the visual properties of urban environments to shape comfort perception. A controlled laboratory experiment was conducted with 17 participants assigned to one of four emotional conditions (Fear, Anger, Sad, Happy) through audio-visual induction. Participants evaluated 73 building façade and 42 pedestrian streetscape stimuli from three urban areas in Kitakyushu, Japan (Wakamatsu, Tobata, Mojiko) using a multi-method framework combining fractal analysis (D, Λ), six pedestrian visual metrics, webcam-based eye-tracking (Visual Attention Score, VAS), and self-reported comfort votes. Emotion induction was effective for Fear and Anger groups and partial for Sad and Happy groups, with the latter attributable to experimental fatigue. Cross-method correlation analysis revealed that fractal dimension D significantly predicted comfort vote consensus (Spearman r = 0.369, p = 0.013), while VAS showed no significant relationship with comfort votes (r = 0.097, ns) or with fractal dimension (r = 0.015, ns), confirming that visual attention and comfort preference are independent dimensions. For building façades, the ‘Complex but Organized’ fractal profile (D ≥ 1.70, Λ < 0.60) was the consistent comfort driver across all emotion groups. For pedestrian streetscapes, low spatial enclosure and spatially integrated tree canopy were the primary comfort predictors. Multi-method synthesis identified five empirical paradoxes and three design principles: (1) target D ≥ 1.70 with Λ < 0.60; (2) prioritize spatially integrated canopy over visible greenery quantity; and (3) leverage civic legibility as an independent comfort pathway. These findings support the development of emotion-independent frameworks for urban comfort evaluation. Replication with larger, more diverse samples is recommended. Full article

This study evaluated the effects of locally sourced ingredient dietary, with or without supplementation of black soldier fly (Hermetia illucens; BSF) larvae, on laying hen welfare. A total of 150 Lohman White hens aged 30 weeks were assigned to three treatments over ten weeks: a standard corn–soybean diet (CONTROL), an alternative diet incorporating triticale, faba beans and rapeseed meal (ALTER), and the ALTER diet supplemented with 5% dried BSF larvae provided separately (ALTER + BSF). Welfare assessments included larvae consumption time, a novel object test, an avoidance distance test, body condition scoring, and ethological observation of natural behaviors. Hens fed ALTER diet initially showed increased incidence of comb pecking wounds, which declined over the trial, along with reduced morning grooming compared to the CONTROL group (p = 0.009). However, the ALTER diet significantly improved plumage cleanliness (p < 0.001). Supplementation with BSF larvae partially mitigated early stress responses, maintained plumage cleanliness, and improved exploratory behavior and habituation to novelty (p < 0.001). Hens showed sustained and increased motivation to consume BSF larvae with an average consumption time of 5.5 min. Additionally, BSF supplementation was associated with increased resting and the emergence of dustbathing behavior during the afternoon (p < 0.05). No aggressive behaviors were observed, and no significant dietary effects were found for human fearfulness throughout the trial. In conclusion, dried BSF larvae can serve as effective environmental enrichment, improving hens’ adaptability to locally sourced diets in rural farming systems. Full article

Fear of Missing Out (FoMO) has been increasingly recognized as a psychological driver of problematic mobile phone use and sleep disturbances among young adults. However, existing research is fragmented, with limited integration of cognitive–affective and behavioral mechanisms within a unified theoretical framework. Drawing on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, a process-oriented framework in which problematic smartphone use mediates the association between FoMO and sleep quality, with sensation seeking examined as a boundary condition. Data from 1124 Chinese undergraduate students showed that FoMO was associated with poor sleep quality. Problematic smartphone use partially mediated this association, suggesting that FoMO is linked to sleep outcomes through both direct cognitive–affective processes and indirect behavioral pathways. Sensation seeking significantly strengthened the associations between FoMO and problematic smartphone use, as well as between problematic smartphone use and sleep quality, whereas it was not significantly associated with the direct FoMO-sleep link, indicating pathway-specific moderation primarily operating at the behavioral execution level. These findings provide empirical support for an I-PACE-based process model of FoMO-related sleep problems and highlight behavioral engagement processes as a key target for interventions among high-risk individuals. Full article

Background/Objectives: Dentists, due to their close contact with patients, are in a unique position to recognize and report cases of child abuse and neglect. This study aimed to explore dentists’ knowledge and attitudes toward child abuse and neglect encountered in their professional practice. Methods: An anonymous questionnaire survey was conducted among 414 members of the Lithuanian Dental Chamber (general dentists, dental specialists, dental hygienists, and dental assistants) and 153 graduating dental students, yielding a total sample of 567 respondents. They reported knowledge and attitudes regarding reasons for child abuse within the family and barriers to referring suspected cases. The underlying structure of responses was examined using exploratory factor analysis, and differences in knowledge and attitudes across professional groups were tested using ANOVA. Results: Most respondents agreed that low family socioeconomic status (87.7%), child’s disability (65.3%), and medical conditions (53.2%) are the main reasons for child abuse. These and other reasons clustered into two factors: family social vulnerability, and child health-related vulnerability; however, professional specialization had only a very small effect on both factors (η² = 0.013 and η² = 0.017, respectively). The majority of respondents (75.6%) agreed that dentists should report cases of child abuse or violence against children in all circumstances. The barriers to reporting child abuse were fear of negative consequences, and professional uncertainty; professional specialization had a significant effect on both of these factors (η² = 0.019, p = 0.027 and η² = 0.037, p < 0.001, respectively). Dental specialists reported the highest levels of fear of negative consequences and professional uncertainty, whereas students reported the fewest difficulties in reporting. Dental specialists and students demonstrated the highest levels of knowledge, while dental hygienists demonstrated the lowest level of knowledge regarding child abuse (mean sum score of knowledge was 11.2 (SE 0.38) vs. 10.0 (SE 0.30), respectively, p = 0.014). Conclusions: Overall, Lithuanian dentists, including students, demonstrate moderate knowledge and attitude in recognizing cases of child abuse and neglect; however, differences across professional groups remain and should be addressed to ensure more effective child protection. Full article

Background/Objectives: Topical corticosteroids (TCS) are a cornerstone of dermatological treatment for inflammatory skin conditions; however, irrational fear of their use known as corticophobia undermines adherence and worsens clinical outcomes. This study investigated the prevalence of TCS-related concern and phobic behaviors among the general population in Saudi Arabia and identified factors associated with TCS-related concern and phobic attitudes. Methods: A cross-sectional study was conducted between October and December 2025 using an online self-administered questionnaire distributed via social media platforms among a non-probability convenience sample across multiple geographic zones of Saudi Arabia. A total of 481 participants were enrolled. Descriptive statistics summarized demographic and clinical characteristics. Chi-square and Fisher’s exact tests were used to examine differences in proportions between categorical variables and TCS concern, while independent-samples t-tests and one-way ANOVA compared mean phobia scores across subgroups. Results: Of 481 participants, 254 (52.8%, 95% CI 48.3–57.2) expressed concern about TCS use. The predominant reason for refusing prescribed TCS was fear of side effects (93.5%). Phobic behaviors included fear of long-term use (54.2%) and fear of application to sensitive skin areas (63.0%). On the Likert phobia-scale item, 237 (49.8%) totally agreed they would use TCS if prescribed; a separate dichotomous behavioral-intention item, administered only to non-current users (n = 308), showed that 201 (65.3%) would accept TCS if prescribed and 107 (34.7%) would refuse. Concern was significantly more prevalent among females (58.1%, BH-adj p = 0.005), married participants (61.7%, BH-adj p = 0.010), and those refusing prescribed TCS (77.6%, BH-adj p < 0.001). Mean phobia scores (theoretical range 7–28) were significantly higher among females (20.43 ± 4.06 vs. males 18.84 ± 4.68, p < 0.001), participants with Diploma-level education (21.64 ± 3.12, p < 0.001 across education strata), widowed/divorced individuals (21.82 ± 3.57, p = 0.008), and residents of the Southern (20.47 ± 3.99) and Northern (21.40 ± 3.34) regions (p = 0.002 across regions). Conclusions: TCS-related concern was expressed by over half the participants in this social media-recruited sample, posing a substantial barrier to effective dermatological care. Side-effect concern was the most frequently reported reason for refusing prescribed TCS. In adjusted analyses, female sex was the most consistent independent correlate of TCS-related concern and higher phobia score; married status was independently associated with greater concern. These associations should be replicated in probability-based samples before subgroup-targeted interventions are designed. Conclusions: TCS-related concern was prevalent (52.8%) among adults in Saudi Arabia and represented a substantial barrier to dermatological care. Female sex and married status were independently associated with greater concern. Clinicians should proactively address TCS misconceptions during dermatological consultations to improve treatment adherence. Full article

Background/Objectives: Regular physical exercise is strongly recommended for individuals with type 1 diabetes mellitus (T1DM) because of its beneficial effects on cardiovascular fitness, insulin sensitivity, metabolic control, and overall health. Nevertheless, participation in physical activity remains limited, largely due to the fear of exercise-induced hypoglycemia and glycemic instability. Glycemic responses to exercise in T1DM are influenced by the interaction between exercise modality, circulating insulin levels, nutritional status, and diabetes technologies. Continuous aerobic exercise, resistance training, high-intensity interval exercise, and mixed intermittent activities elicit distinct metabolic and hormonal responses, resulting in heterogeneous glycemic trajectories. This narrative review aimed to provide a clinically oriented synthesis of the physiological mechanisms underlying exercise-related glycemic fluctuations in T1DM and to discuss integrated insulin- and carbohydrate-based strategies to support safer participation in physical activity in the context of modern diabetes technologies. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and complementary searches in Google Scholar to identify experimental studies, observational studies, systematic reviews, consensus statements, and clinical guidelines focused on exercise-related glycemic responses in individuals with T1DM. Only articles published in English were considered. Evidence was selected and synthesized according to relevance to exercise modality, insulin therapy strategies, carbohydrate management, and diabetes technologies, including continuous glucose monitoring, continuous subcutaneous insulin infusion, and automated insulin delivery systems. The final narrative synthesis was based on 44 selected studies, reviews, consensus statements, and guidance documents considered most relevant to the objectives of this narrative review. Results: Available evidence indicates that continuous moderate-intensity aerobic exercise is most consistently associated with progressive glucose declines and increased risk of hypoglycemia, particularly when performed in the presence of elevated insulin on board. In contrast, resistance exercise and short-duration high-intensity or anaerobic exercise more frequently induce stable glycemia or transient hyperglycemia through adrenergic stimulation and increased hepatic glucose output. Mixed and intermittent exercise modalities often produce more variable responses depending on exercise sequencing, nutritional status, and insulin exposure. Across studies, integrated adjustment of basal and prandial insulin doses together with individualized carbohydrate supplementation emerged as the most effective strategy to reduce exercise-related glycemic instability. Continuous glucose monitoring and insulin pump technologies improved glucose trend awareness and management flexibility; however, physical exercise remains a challenging condition for current automated insulin delivery algorithms and still requires active user-driven decision-making. Conclusions: Exercise management in T1DM should be based on an individualized interpretation of exercise modality, glucose trends, insulin exposure, and nutritional context rather than on fixed glucose thresholds alone. Combining anticipatory insulin adjustments, tailored carbohydrate strategies, and appropriate use of diabetes technologies may substantially reduce glycemic variability and improve confidence toward physical activity participation. Structured education and individualized clinical guidance remain essential to translate physiological knowledge into effective real-world exercise management. Full article

Background: Non-invasive respiratory supports (High-Flow Nasal Oxygen, HFNO; Continuous Positive Airway Pressure, CPAP; Non-Invasive Ventilation, NIV) are frequently used in Acute Hypoxemic Respiratory Failure (AHRF). However, the experience of assisted breathing may profoundly affect patients’ psychological balance, particularly during acute critical illness and subsequent rehabilitation. Aims and objectives: This longitudinal study investigated the psychological burden associated with non-invasive respiratory support use in patients with COVID-19-related AHRF, exploring changes in psychological functioning from acute hospitalization (RICU/ICU) (T0) to follow-up, conducted at a mean of 6.0 ± 3.1 months after respiratory rehabilitation (T1). Methods: Fifty-two patients (mean age = 66.9 ± 9.17 years) were assessed at T0 and T1. Standardized measures evaluated anxiety, psychological distress, post-traumatic stress symptoms, depression, and resilience, in relation to perceived illness severity and subjective experience of non-invasive respiratory support. Results: During acute care, patients reported high levels of fear and anxiety related to illness severity and uncertainty. The experience of non-invasive respiratory support, often perceived as a marker of critical condition, was associated with increased fear and anxiety (t(14) = 2.79, p = 0.014) compared to the recovery phase, leading to feelings of loss of control and diminished psychological well-being (t(17) = 2.35, p = 0.031). However, resilience significantly improved over time (t(16) = −4.78, p < 0.001). Conclusions: Non-invasive respiratory support may represent a psychologically demanding experience, often perceived as challenging to patients’ sense of safety and control. Encouragingly, psychological adaptation and resilience can improve during rehabilitation. Integrating structured psychological support within respiratory rehabilitation pathways may promote recovery and restore psychological balance in patients requiring assisted ventilation. Full article

Background: Patellar tendinopathy is a common musculoskeletal condition that may impair functional performance and limit physical activity. While structural and mechanical factors have been widely investigated, the role of proprioceptive function and its interaction with behavioral and central pain-related mechanisms remain unclear. This study aimed to investigate the relationship between knee joint position sense, kinesiophobia, and central sensitization in individuals with chronic patellar tendinopathy. Methods: A total of 42 recreational athletes with clinically diagnosed chronic patellar tendinopathy were included in this cross-sectional study. Knee joint proprioception was assessed using joint position sense testing at multiple knee flexion angles with a continuous passive motion device. Kinesiophobia and central sensitization were evaluated using the Tampa Scale of Kinesiophobia and the Central Sensitization Inventory, respectively. Joint position sense values of the involved and contralateral extremities were compared, and correlation analyses were performed to examine associations between joint position sense and psychosocial variables. Results: The involved extremity demonstrated significantly greater absolute angular error compared to the contralateral side at higher knee flexion angles (≥60°, p < 0.01), whereas no significant differences were observed at lower angles. A moderate positive correlation was found between joint position sense error and kinesiophobia at higher flexion angles (≥30°, p < 0.01). No significant association was identified between joint position sense error and central sensitization across any of the tested angles (p > 0.05). Conclusions: Proprioceptive function is impaired in individuals with chronic patellar tendinopathy, particularly under increased mechanical demand. The association between joint position sense deficits and kinesiophobia, but not central sensitization, suggests a potential relationship between movement-related fear and sensorimotor alterations. These findings highlight the importance of incorporating proprioceptive assessment and addressing kinesiophobia in the clinical management of patellar 36 tendinopathy. Full article