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1.  mHealth and eHealth for Obesity and Types 2 and 1 Diabetes 
Journal of Diabetes Research  2016;2016:9627602.
doi:10.1155/2016/9627602
PMCID: PMC5108871  PMID: 27882333
2.  A Novel Technique for Improving Bodily Experience in a Non-operable Super–Super Obesity Case 
Introduction: The available clinical guidelines for super-super obese patients (i.e., with body mass index (BMI) > 60 kg/m2) that are not suitable for bariatric surgery mandate a palliative multidisciplinary treatment (i.e., production and maintenance of weight loss) provided in a center of excellence. However, the modality and the impact of this approach are still controversial. Moreover, it is not able to address the high level of body dissatisfaction and body distortions that are common among these patients.
Clinical Presentation: We report the case of a non-operable super–super obesity – a 37 year old woman with a BMI of 62 kg/m2 – receiving a specialized treatment for her obstructive sleep apnea. She entered a multidisciplinary program that promoted healthy behaviors, including physical activities and psychological intervention. To improve body dissatisfaction, which was linked to a significant multisensory impairment of body perception, she also entered a virtual reality (VR) body-swapping illusion protocol. At the end of the current investigation, the patient continued her multidisciplinary program, reporting an increase in the motivation for undertaking healthy behavior and a decrease in the anxiety feelings associated with her clinical condition.
Conclusion: This case provides preliminary evidence that both body dissatisfaction and body-size distortions of non-operable super-super obesity patients could be addressed by a VR body-swapping protocol, which is important because the palliative multidisciplinary treatment recommended for these patients is not able to address them. Interestingly, the use of a VR body-swapping illusion protocol seems to be able to improve not only the experience of the body in these patients but their motivation for change, too.
doi:10.3389/fpsyg.2016.00837
PMCID: PMC4909741  PMID: 27378965
super–super obesity; virtual reality; body dissatisfaction; body-size distortions; bodily illusion
3.  Challenges in Internet Addiction Disorder: Is a Diagnosis Feasible or Not? 
An important international discussion began because of some pioneer studies carried out by Young (a) on the internet addiction disorder (IAD). In the fifth and most recent version of the Diagnostic, and Statistical Manual of Mental Disorders (DSM) there is no mention of this disorder and among researchers there are basically two opposite positions. Those who are in favor of a specific diagnosis and those who are claiming the importance of specific criteria characterizing this behavior and the precise role it has in the patient’s life. The aim of the present paper is to answer the question whether it is possible or not to formulate diagnoses of internet-related disorders. We revised literature on the history of diagnostic criteria, on neurocognitive evidence, on the topic debate and on IAD instrumental measures. We found that the disorder was not univocally defined and that the construct was somehow too broad and generic to be explicative for a diagnosis. Indeed, the models are borrowed from other addiction pathologies and they are often formulated before the development of internet as intended in current society. In conclusion, we think we need a more innovative, integrated and comprehensive model for an IAD diagnosis.
doi:10.3389/fpsyg.2016.00842
PMCID: PMC4894006  PMID: 27375523
internet addiction disorder; addiction; internet-related psychopathology; diagnosis
4.  Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis 
doi:10.3389/fpsyg.2016.00563
PMCID: PMC4860399  PMID: 27242562
psychological therapy; cost-effectiveness; evidence-based psychological therapies; evidence-based psychotherapy; evidence based in clinical psychology; mental health burden; psychotherapy
5.  Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation 
Background: In order to provide effective care to patients suffering from chronic pain secondary to neurological diseases, health professionals must appraise the role of the psychosocial factors in the genesis and maintenance of this condition whilst considering how emotions and cognitions influence the course of treatment. Furthermore, it is important not only to recognize the psychological reactions to pain that are common to the various conditions, but also to evaluate how these syndromes differ with regards to the psychological factors that may be involved. As an extensive evaluation of these factors is still lacking, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) aimed to collate the evidence available across these topics.
Objectives: To determine the psychological factors which are associated with or predictive of pain secondary to neurological conditions and to assess the influence of these aspects on the outcome of neurorehabilitation.
Methods: Two reviews were performed. In the first, a PUBMED search of the studies assessing the association between psychological factors and pain or the predictive value of these aspects with respect to chronic pain was conducted. The included papers were then rated with regards to their methodological quality and recommendations were made accordingly. In the second study, the same methodology was used to collect the available evidence on the predictive role of psychological factors on the therapeutic response to pain treatments in the setting of neurorehabilitation.
Results: The first literature search identified 1170 results and the final database included 189 articles. Factors such as depression, anxiety, pain catastrophizing, coping strategies, and cognitive functions were found to be associated with pain across the various conditions. However, there are differences between chronic musculoskeletal pain, migraine, neuropathy, and conditions associated with complex disability with regards to the psychological aspects that are involved. The second PUBMED search yielded 252 studies, which were all evaluated. Anxiety, depression, pain catastrophizing, coping strategies, and pain beliefs were found to be associated to different degrees with the outcomes of multidisciplinary programs, surgery, physical therapies, and psychological interventions. Finally, sense of presence was found to be related to the effectiveness of virtual reality as a distraction tool.
Conclusions: Several psychological factors are associated with pain secondary to neurological conditions and should be acknowledged and addressed in order to effectively treat this condition. These factors also predict the therapeutic response to the neurorehabilitative interventions.
doi:10.3389/fpsyg.2016.00468
PMCID: PMC4835496  PMID: 27148104
pain management; clinical psychology; health psychology; chronic pain; neurorehabilitation
6.  Brief strategic therapy for obsessive–compulsive disorder: a clinical and research protocol of a one-group observational study 
BMJ Open  2016;6(3):e009118.
Introduction
Obsessive–compulsive disorder (OCD) is a disabling psychopathology. The mainstay of treatment includes cognitive–behavioural therapy (CBT) and medication management. However, individual suffering, functional impairments as well as the direct and indirect costs associated with the disease remain substantial. New treatment programmes are necessary and the brief strategic therapy (BST) has recently shown encouraging results in clinical practice but no quantitative study has as yet been conducted.
Methods and analysis
The clinical effectiveness of the OCD-specific BST protocol will be evaluated in a one-group observational study. Participants will be sequentially recruited from a state community psychotherapy clinic in Dublin, Ireland. Outcome measures will be the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Beck Depression Inventory-II (BDI-II). Data will be collected at baseline, at treatment termination and at 3 month follow-up. The statistical significance of the post-treatment effect will be assessed by the paired-sample Student t test, while clinical significance will be evaluated by means of the equivalence testing method, which will be also used to assess the maintenance of effect at follow-up.
Ethics/dissemination
The present study is approved by the Hesed House Ethics Board in Dublin. Findings will enhance the evidence-based knowledge about the clinical effectiveness of BST in treating OCD symptoms, prior to assessing its efficacy in a randomised and controlled clinical trial, and will be disseminated through publication in peer-reviewed journals and conference presentations.
doi:10.1136/bmjopen-2015-009118
PMCID: PMC4809083  PMID: 27013594
7.  Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation 
Background: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams.
Objectives: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases.
Methods: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions.
Results: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive—Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post—Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache.
Conclusions: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.
doi:10.3389/fpsyg.2016.00115
PMCID: PMC4759289  PMID: 26924998
psychological treatments; psychotherapy; neurological rehabilitation; chronic pain; pain; clinical psychology; health psychology
8.  The Clinical Assessment in the Legal Field: An Empirical Study of Bias and Limitations in Forensic Expertise 
Frontiers in Psychology  2015;6:1831.
According to the literature, psychological assessment in forensic contexts is one of the most controversial application areas for clinical psychology. This paper presents a review of systematic judgment errors in the forensic field. Forty-six psychological reports written by psychologists, court consultants, have been analyzed with content analysis to identify typical judgment errors related to the following areas: (a) distortions in the attribution of causality, (b) inferential errors, and (c) epistemological inconsistencies. Results indicated that systematic errors of judgment, usually referred also as “the man in the street,” are widely present in the forensic evaluations of specialist consultants. Clinical and practical implications are taken into account. This article could lead to significant benefits for clinical psychologists who want to deal with this sensitive issue and are interested in improving the quality of their contribution to the justice system.
doi:10.3389/fpsyg.2015.01831
PMCID: PMC4663720  PMID: 26648892
assestment; clinical trials as topic; bias; forensic psychiatry; forensic psychology; systematic error
9.  Motivational Interviewing in Childhood Obesity Treatment 
Frontiers in Psychology  2015;6:1732.
Obesity is one of today’s most diffused and severe public health problems worldwide. It affects both adults and children with critical physical, social, and psychological consequences. The aim of this review is to appraise the studies that investigated the effects of motivational interviewing techniques in treating overweight and obese children. The electronic databases PubMed and PsychINFO were searched for articles meeting inclusion criteria. The review included studies based on the application of motivational interviewing (MI) components and having the objective of changing body mass index (BMI) in overweight or obese children from age 2 to age 11. Six articles have been selected and included in this review. Three studies reported that MI had a statistically significant positive effect on BMI and on secondary obesity-related behavior outcomes. MI can be applicable in the treatment of overweight and obese children, but its efficacy cannot be proved given the lack of studies carried out on this specific sample.
doi:10.3389/fpsyg.2015.01732
PMCID: PMC4641908  PMID: 26617555
motivational interviewing; childhood; obesity; review; children; overweight; pediatric obesity
10.  Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based settings 
Frontiers in Psychology  2015;6:1557.
Obesity and being overweight could be real chronic conditions above all if there are other complications such as type 2 diabetes, cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer, and various psychosocial and psychopathological disorders. Due to the multifactorial etiology of obesity, evidence-based interventions to improve weight loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. There are significant limitations in this multidisciplinary chronic care management of obesity, most notably those regarding costs and long-term adherence and efficacy. Programs including eHealth platforms and new technologies could overcome limitations connected to the traditional in-patient chronic care management of obesity, thus providing promising opportunities in enhancing weight reduction and reducing complications in terms of long-term efficacy and effectiveness across clinical, organizational, and economic perspectives.
doi:10.3389/fpsyg.2015.01557
PMCID: PMC4606044  PMID: 26528215
obesity; type 2 diabetes; rehabilitation; mHealth; clinical psychology
11.  Treating the mind to improve the heart: the summon to cardiac psychology 
Frontiers in Psychology  2015;6:1101.
doi:10.3389/fpsyg.2015.01101
PMCID: PMC4523709  PMID: 26300804
HRV; heart rate variability; cardiac psychology; autonomic control of cardiovascular system; stress; psychological; PTSD
12.  Editorial: PsychOncology: clinical psychology for cancer patients—Cancer: the key role of clinical psychology 
doi:10.3389/fpsyg.2015.00947
PMCID: PMC4491594  PMID: 26217271
cancer; psychoncology; psychological distress; depression; caregiver
14.  Assessing motivation and readiness to change for weight management and control: an in-depth evaluation of three sets of instruments 
It is highly recommended to promptly assess motivation and readiness to change (RTC) in individuals who wish to achieve significant lifestyle behavior changes in order to improve their health, overall quality of life, and well-being. In particular, motivation should be assessed for those who face the difficult task to maintain weight, which implies a double challenge: weight loss initially and its management subsequently. In fact, weight-control may be as problematic as smoking or drugs-taking cessation, since they all share the commonality of being highly refractory to change. This paper will examine three well-established tools following the Transtheoretical Model, specifically assessing RTC in weight management: the University of Rhode Island Change Assessment Scale, the S-Weight and the P-Weight and the Decisional Balance Inventory. Though their strengths and weaknesses may appear to be rather homogeneous and similar, the S-Weight and P-Weight are more efficient in assessing RTC in weight management and control. Assessing motivation and RTC may be a crucial step in promptly identifying psychological obstacles or resistance toward weight-management in overweight or obese hospitalized individuals, and it may contribute to provide a more effective weight-control treatment intervention.
doi:10.3389/fpsyg.2015.00511
PMCID: PMC4426708  PMID: 26029126
motivation; readiness to change; weight-management; Transtheoretical Model; assessment; obesity; overweight
15.  Could cognitive estimation ability be a measure of cognitive reserve? 
doi:10.3389/fpsyg.2015.00608
PMCID: PMC4423304  PMID: 25999909
cognitive estimation; cognitive reserve; executive functions; crystallized intelligence; neuropsychological assessment
16.  Social media and mobile applications in chronic disease prevention and management 
doi:10.3389/fpsyg.2015.00567
PMCID: PMC4423338  PMID: 25999884
social media; mobile health; prevention; health promotion; social network; chronic disease
17.  Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine 
Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of eHealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the “chronic care management” challenge in both traditional and mHealth settings.
doi:10.3389/fpsyg.2015.00407
PMCID: PMC4396192  PMID: 25926801
chronic care management; mHealth; e-health; clinical psychology; new technologies; rehabilitation; behavioral medicine; health psychology
18.  ACTonFOOD: opportunities of ACT to address food addiction 
doi:10.3389/fpsyg.2015.00396
PMCID: PMC4391226  PMID: 25914662
Acceptance and commitment therapy (ACT); food addiction; obesity; eating disorders; binge eating disorder; bed; weight management; weight loss; CBT; clinical psychology; health psychology; psychotherapy
19.  Meditation Training for People with Amyotrophic Lateral Sclerosis and Their Caregivers 
Abstract
Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease that is clinically characterized by progressive weakness leading to death by respiratory insufficiency, usually within three years. Although the patient's intellect and personality usually remain unimpaired, as the disease progresses, the patient becomes immobile, develops wasting, and speech becomes impaired, often resulting in social isolation and a high degree of psychological suffering. Mindfulness meditation has proven to be effective technique for reducing distress in many chronic diseases. However, to date, no study has investigated the effect of mindfulness meditation on patients with ALS.
Design: A mindfulness meditation training program for ALS patients needs to consider the particularities of ALS symptoms, including the loss of muscular functions and difficulties in respiration, together with the subsequent emotional impairments. With these caveats in mind, a modified protocol, based on original mindfulness meditation interventions, has been created specifically for the ALS population.
This article describes the protocol and preliminary results.
doi:10.1089/acm.2013.0268
PMCID: PMC3994974  PMID: 24328393
20.  Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit 
Background: Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients’ adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals’ confidence in their ability to do so.
Objective: The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI’s skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy.
Conclusion: By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors.
Clinical Implications: MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.
doi:10.3389/fpsyg.2015.00298
PMCID: PMC4364083  PMID: 25852614
heart failure; cardiovascular disease; cardiac rehabilitation; motivational interviewing; Brief Strategic Therapy; behavioral change; adherence; self-care
21.  New drugs and polydrug use: implications for clinical psychology 
doi:10.3389/fpsyg.2015.00267
PMCID: PMC4362076  PMID: 25852592
polydrug use; drug combinations; drugs; clinical psychology; toxicology; new drugs
22.  Psychological effects of implantable cardioverter defibrillator shocks. A review of study methods 
Background: The implantable cardioverter defibrillator (ICD) saves lives but clinical experience suggests that it may have detrimental effects on mental health. The ICD shock has been largely blamed as the main offender but empirical evidence is not consistent, perhaps because of methodological differences across studies.
Objective: To appraise methodologies of studies that assessed the psychological effects of ICD shock and explore associations between methods and results.
Data Sources: A comprehensive search of English articles that were published between 1980 and 30 June 2013 was applied to the following electronic databases: PubMed, EMBASE, NHS HTA database, PsycINFO, Sciencedirect and CINAHL.
Review Methods: Only studies testing the effects of ICD shock on psychological and quality of life outcomes were included. Data were extracted according to a PICOS pre-defined sheet including methods and study quality indicators.
Results: Fifty-four observational studies and six randomized controlled trials met the inclusion criteria. Multiple differences in methods that were used to test the psychological effects of ICD shock were found across them. No significant association with results was observed.
Conclusions: Methodological heterogeneity of study methods is too wide and limits any quantitative attempt to account for the mixed findings. Well-built and standardized research is urgently needed.
doi:10.3389/fpsyg.2015.00039
PMCID: PMC4316692  PMID: 25698991
implantable cardioverter defibrillator; ICD shock; quality of life; anxiety; depression; review
23.  Development and initial validation of the Cardiovascular Disease Acceptance and Action Questionnaire (CVD-AAQ) in an Italian sample of cardiac patients 
Frontiers in Psychology  2014;5:1284.
Psychological inflexibility refers to the attempt to decrease internal distress even when doing so is inconsistent with life values, and has been identified as a potential barrier to making and maintaining health behavior changes that are consistent with a heart-healthy lifestyle. Disease- and behavior-specific measures of psychological inflexibility have been developed and utilized in treatment research. However, no specific measure has been created for patients with heart disease. Thus, the CardioVascular Disease Acceptance and Action Questionnaire (CVD-AAQ) was developed. The present study is aimed to evaluate the psychometric properties of the CVD-AAQ and to explore its association with measures of psychological adjustment and cardiovascular risk factors in an Italian sample of 275 cardiac patients. Exploratory factor analysis showed a structural one-factor solution with satisfactory internal consistency and test–retest reliability. The relation with other measures was in the expected direction with stronger correlations for the theoretically consistent variables, supporting convergent and divergent validity. CVD-AAQ scores were associated with general psychological inflexibility, anxiety and depression and inversely correlated with psychological well-being. Moreover, the results showed that CVD-AAQ scores are associated with two relevant risk factors for cardiac patients, namely low adherence to medication and being overweight. In sum, results suggest that the CVD-AAQ is a reliable and valid measure of heart disease-specific psychological inflexibility with interesting clinical applications for secondary prevention care.
doi:10.3389/fpsyg.2014.01284
PMCID: PMC4231832  PMID: 25452737
psychological inflexibility; acceptance; cardiovascular disease; adherence to treatment; experiential avoidance; Cardiovascular Disease Acceptance and Action Questionnaire
24.  Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach 
Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area.
doi:10.3389/fpsyg.2014.00559
PMCID: PMC4051130  PMID: 24959157
obesity; rehabilitation; telemedicine; telecare; mHealth; clinical psychology; health psychology; psychotherapy
25.  Impact of Fibromyalgia on Functioning in Obese Patients Undergoing Comprehensive Rehabilitation 
PLoS ONE  2014;9(3):e91392.
A possible link between fibromyalgia (FM) and obesity has been recently suggested but very scanty data on the prevalence of FM in obese populations are available. The aims of the present cross-sectional study were: 1) to estimate the prevalence of FM in a population of obese patients undergoing rehabilitation and 2) to investigate the effect of FM on obese patients' functional capacities. One hundred and thirty Italian obese (Body Mass Index, BMI ≥30) patients admitted to hospital for 1-month rehabilitation treatment took part in the study. All participants were interviewed by a rheumatologist according to the 2010 American College of Rheumatology (ACR) diagnostic criteria for FM. At admission and discharge from hospital (on average, after 28 days), the following measures were compared between the group of patients with FM and the other patients: body weight, body mass index, functional independence (FIM), obesity-related disability (TSD-OC), self-reported functioning and the Timed-Up-Go (TUG) test. Thirty seven patients out of 130 fulfilled the diagnostic criteria for FM. The prevalence rate was 27.7% (95% CI: 20 to 35.4). Between-group comparisons showed that FM patients had higher disability level at the first assessment, had lower scores on the FIM at the final assessment, scored lower on self-reported functioning both at the first and the final assessments and had a lower body weight. The prevalence of FM in our study is much higher than the rates reported in the general normal-weight population (on average, 3.5%) and the 5.15% rate previously reported in a bariatric population. Functional data showed that the FM obese group yielded lower performance capacity and higher disability level as compared to the non-FM obese group. However, due to the relatively small sample size and the selected population, such results need to be confirmed in larger obese subpopulations.
doi:10.1371/journal.pone.0091392
PMCID: PMC3949991  PMID: 24618795

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