Statistics and Probability, Epidemiology, Multidisciplinary
62
Scopus Publications
Scopus Publications
Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial Marketa Nevelikova, Filip Zlamal, Filip Dosbaba, Jing Jing Su, Ladislav Batalik Hong Kong Physiotherapy Journal, 2026 Background: Chronic low back pain (CLBP) is a highly prevalent condition and a leading cause of disability worldwide. Given its complex etiology, there is growing interest in applying the biopsychosocial model to CLBP management in order to address psychological barriers — such as low motivation — that influence pain perception, exercise adherence, and overall treatment outcomes. Physiotherapy-informed Acceptance and Commitment Therapy (PACT) — a third-wave cognitive-behavioral approach — has shown promise in chronic pain management by promoting psychological flexibility and values-based action. Objective: The primary objective of this study is to evaluate patients’ exercise motivation of PACT versus usual physiotherapy care (UC). Secondary objectives are to assess and compare the efficacy of PACT versus UC on functioning and disability, adherence to exercise, acceptance of pain and autonomy support from physiotherapists. Both interventions incorporated dynamic neuromuscular stabilization (DNS)-based graded exercise as a core physiotherapy approach. Methods: Fifty patients with CLBP participated in this study. All participants completed paper-and-pencil self-reported questionnaires to assess relevant outcome measures. Data were collected at two time points: baseline (prior to the first therapy session) and at week 6, immediately following the completion of the intervention period (post-intervention). Participants were randomly assigned to one of two groups. The PACT group received ACT-based physiotherapy combined with DNS-based graded exercise. The usual care (UC) group received individualized graded therapeutic exercise based on the DNS concept, complemented by manual therapy. Results: The PACT group showed significantly higher levels of exercise motivation compared to the UC group, with greater scores in introjected motivation (baseline: [Formula: see text] versus [Formula: see text], [Formula: see text], [Formula: see text]; post-intervention: [Formula: see text] versus [Formula: see text], [Formula: see text], [Formula: see text]) and identified motivation (post-intervention: [Formula: see text] versus [Formula: see text], [Formula: see text], [Formula: see text]). Within-group comparisons revealed no significant changes in the UC group, whereas the PACT group demonstrated a decrease in external motivation ([Formula: see text], [Formula: see text], [Formula: see text]) and increases in identified ([Formula: see text], [Formula: see text], [Formula: see text]) and intrinsic motivation ([Formula: see text], [Formula: see text], [Formula: see text]). Participants in the PACT group also reported significantly higher perceived autonomy support from the physiotherapist ([Formula: see text], [Formula: see text]) than those in the UC group ([Formula: see text]) ([Formula: see text], [Formula: see text]). Furthermore, adherence to the recommended physical activity was significantly greater in the PACT group ([Formula: see text], [Formula: see text]) compared with the UC group ([Formula: see text]) ([Formula: see text], [Formula: see text]). No statistically significant differences were observed between groups for measures of functioning and pain acceptance, however, both groups demonstrated significant within-group improvements. Disability decreased in UC ([Formula: see text], [Formula: see text], [Formula: see text]) and PACT ([Formula: see text], [Formula: see text], [Formula: see text]) while pain acceptance increased in UC ([Formula: see text], [Formula: see text], [Formula: see text]) and PACT ([Formula: see text], [Formula: see text], [Formula: see text]). Conclusions: PACT, combined with DNS-based graded exercise, enhanced exercise motivation, perceived autonomy support, and adherence to exercise in patients with CLBP compared to UC. However, no significant improvements were observed in functioning or pain acceptance. These findings suggest that integrating ACT into physiotherapy care may improve motivational outcomes and engagement in physical activity, which are crucial in the management of CLBP. However, further studies with larger samples and longer follow-up periods are necessary to confirm the stability and durability of these positive effects.
PERCEPTION OF OTHERNESS AND THE DEGREE OF VARIABILITY OF MORAL EMOTIONS: AN EXPERIENCE SAMPLING STUDY , Nikola Doubková, Filip Zlámal, Radek Heissler, Edel Marie Sanders, Marek Preiss Ceskoslovenska Psychologie, 2026 Objectives. Just as people have distinct attitudes toward others, they also experience qualitatively different emotions toward them. However, the relationship between variability in the emotional component of attitudes toward diverse targets remains under-researched. This study explored how positive and negative moral emotions relate to various categories of otherness, focusing on emotional intensity and variability, the tendency to report negative or positive emotions, and the association with personality functioning as a background indicator of mental health.Sample and settings. Data were collected using the experience sampling method over the span of 30 consecutive days from three study groups (N = 144): 1) general population (GP, n = 52), 2) people with high neuroticism levels (HN, n = 40), and 3) individuals with personality disorders (PDs, n = 52). Participants rated the intensity of six moral emotions toward various forms of otherness, such as the self, close others, and national and ethnic minorities.Statistical analyses. Multivariate mixed-effects models were used to account for repeated measurements of emotional intensity and within- and between-person variability over time across the three study groups.Results. Significant between-group differences were found for (self-directed) anger and disgust; other emotions varied depending on the interaction between the study group and the category of otherness. The PDs group exhibited the highest within-person emotional variability. General time trends in emotional responses differed by group and otherness category. Contrary to expectations, personality functioning did not significantly explain these differences.Limitations. Limitations include challenges in emotion differentiation, selection of otherness categories, and between-group differences in demographic characteristics.
Motivation to exercise in patients with chronic low back pain Marketa Nevelikova, Filip Zlamal, Filip Dosbaba, Jing Jing Su, Ladislav Batalik BMC Musculoskeletal Disorders, 2025 BACKGROUND: Chronic low back pain (CLBP) is one of the most common musculoskeletal problems worldwide. Even though regular exercise is recommended as the primary conservative approach in treating this condition, significant part of patients lead sedentary lifestyle. Motivation to exercise is one of the variables that effects the adherence of exercise-based treatments. This study aimed to characterize the motives for exercise, as posited by self-determination theory, in persons with CLBP, and to identify subgroups (clusters) of motivational profiles in combination with socioeconomic and clinical characteristics using k-means cluster analysis. METHODS: Data were collected between September 2022 and September 2023. A total of 103 adults with CLBP completed the paper-pencil Exercise Self-Regulation Questionnaire (SRQ-E) and provided self-reported measures on anthropometric and socio-economic characteristics. Inclusion criteria were age (≥ 18 years) and non-specific CLBP (lasting longer than 12 weeks). Exclusion criteria included specific lumbar spine pathology (e.g., fracture, cancer), worsening neurological symptoms, recent injection therapy (within 3 months), and current alcohol or drug misuse. RESULTS: Three distinct motivational clusters were identified among the 103 participants: two clusters were characterized by predominantly autonomous motivation (moderately motivated cluster: 31.1%; highly motivated cluster: 54.4%), while one cluster (controlled convinced cluster: 14.6%) showed a higher level of controlled motivation. Associations were observed between the controlled cluster and factors such as higher disability scores, longer duration of pain, greater number of completed physiotherapy sessions, and elevated BMI. Notably, the controlled motivation cluster was linked with poorer clinical outcomes. CONCLUSIONS: This study provides insights into the exercise motivation of patients with CLBP, revealing that while most patients were primarily autonomously motivated, a notable subgroup exhibited lower, controlled motivation. The presence of controlled motivation was associated with worse functioning, longer pain duration, and increased utilization of physiotherapy services. Although these findings suggest a link between motivational profiles and clinical outcomes, the cross-sectional design limits causal inferences. Further research is needed to explore these relationships longitudinally. TRIAL REGISTRATION: ClinicalTrials.Gov Identifier: NCT05512338 (22.8.2022, NCT05512338).
Correlation of FSTL1 and its paralogs with body composition in adult survivors of childhood cancer Lucie Štrublová, Filip Zlámal, Tomáš Pískovský, Jan Kučera, Jana Fialová Kučerová, Tomáš Kepák, Jaroslav Štěrba, Julie Bienertová-Vašků Scientific Reports, 2025 This retrospective, cross-sectional study investigated the relationship between body composition and circulating plasma levels of follistatin-like proteins (FSTLs; FSTL1, FSTL4, and FSTL5) in adult survivors of childhood cancer. This is the first study to investigate the association between plasma levels of FSTL4, FSTL5 and skeletal muscle mass. The cohort consisted of 61 CCS (26 females and 35 males) aged 18-36 years (mean age 24.6 ± 4.4 years) who were followed up at the Long-Term Follow-Up Clinic of St. Anne's Hospital in Brno, Czech Republic. The mean age at diagnosis was 10.9 ± 4.9 years, and the mean time after treatment was 12.0 ± 5.1 years. Body composition was assessed using anthropometric indicators and bioelectrical impedance analysis (BIA; InBody 370). Plasma FSTL levels were quantified using commercially available ELISA kits. Correlations were examined by linear regression analysis. A significant negative correlation was found between the FSTL1 plasma level and body fat mass index (BFMI), and a significant positive correlation was observed between FSTL1 and skeletal muscle mass index (SMI). Our results suggest that FSTL1 may be a potential indicator of adiposity and skeletal muscle loss in CCS.
Daily Stress Variability in Two Generations of Survivors of the War in the Former Yugoslavia Nikola Doubková, Filip Zlámal, Monika Fňašková, Marek Preiss, Markéta Nečasová, Nikola Wolframová, Vojtěch Svoboda, David Ulčák, Ivan Rektor Stress and Health, 2025 The war in the former Yugoslavia had a profound impact on millions of civilians, leaving long‐lasting psychological consequences. This study aimed to examine stress sensitivity and variability in the daily lives of survivors using a longitudinal design. First‐generation survivors (G1; n = 79), second‐generation survivors born after the war (G2; n = 28), and a non‐war‐exposed control group (n = 60) participated. The baseline assessment included measures of stress‐ and trauma‐related symptoms, life satisfaction, and coping mechanisms. Daily perceived stress was then monitored over 21 consecutive days using the experience sampling method. Although there were no group differences in baseline measures or mean daily stress levels, variability in daily stress showed distinct generational patterns. G1 exhibited lower variability compared to both controls and G2, which showed the highest variability. Variability was significantly associated with trauma‐related symptoms, dysfunctional coping, and life satisfaction. This study showed that the lasting psychological consequences of the war in the former Yugoslavia may not be reflected in elevated daily stress levels or baseline psychopathology but rather may be subtly expressed through altered perceptions and sensitivity to daily stress, even decades after the war. These findings provide novel support for the latent vulnerability hypothesis.
Oxidative stress, microparticles, and E-selectin do not depend on HIV suppression Katerina Havlickova, Svatava Snopkova, Miroslav Pohanka, Radek Svacinka, David Vydrar, Petr Husa, Jirina Zavrelova, Filip Zlamal, Lenka Fabianova, Miroslav Penka, Petr Husa Biomedical Papers, 2025 BACKGROUND Oxidative stress and inflammation are considered predictors of diseases associated with aging. Markers of oxidative stress, inflammation, and endothelial activation were investigated in people with HIV on antiretroviral treatment to determine whether they had an immunosenescent phenotype that might predispose to the development of premature age-related diseases. PATIENTS AND METHODS This study was conducted on 213 subjects with HIV. The control groups consisted of healthy HIV-negative adults. The level of oxidative stress was measured by assessing the production of malondialdehyde levels, which were detected by thiobarbituric acid reactive substance (TBARS) assay. The level of microparticles indicated the presence of inflammation and endothelial activation was measured by E-selectin levels. Significant differences were determined by appropriate statistical tests, depending on the distribution of variables. Relationships between continuous variables were quantified using Spearman's rank correlation coefficient. RESULTS TBARS, and microparticle and E-selectin levels were significantly higher in untreated and treated subjects with HIV compared with HIV-negative controls (P<0.001). The levels of the investigated markers were not significantly different between untreated and treated patients and no significant correlation of these markers was found with CD4+ count, CD4+/CD8+ ratio, and the number of HIV-1 RNA copies. CONCLUSIONS Elevated markers of oxidative stress, inflammatory and endothelial activation were independent of the virologic and immunologic status of people with HIV. These results support the hypothesis that residual viremia in cellular reservoirs of various tissues is a key factor related to the premature aging of the immune system and predisposition to the premature development of diseases associated with aging.
Physiological evidence of stress reduction during a summer Antarctic expedition with a significant influence of previous experience and vigor Lucie Ráčková, Tomáš Pompa, Filip Zlámal, Miloš Barták, Daniel Nývlt, Julie Bienertová-Vašků Scientific Reports, 2024 Antarctica provides a unique environment for studying human adaptability, characterized by controlled conditions, limited sensory stimulation, and significant challenges in logistics and communication. This longitudinal study investigates the relationship between stress indicators, with a specific focus on mean sleep heart rate, during a COVID-19 quarantine and subsequent 83 days long summer Antarctic expedition at the J. G. Mendel Czech Antarctic Station. Our novel approach includes daily recordings of sleep heart rate and weekly assessments of emotions, stress, and sleep quality. Associations between variables were analyzed using the generalized least squares method, providing unique insights into nuances of adaptation. The results support previous findings by providing empirical evidence on the stress reducing effect of Antarctic summer expedition and highlight the importance of previous experience and positive emotions, with the novel contribution of utilizing physiological data in addition to psychological measures. High-frequency sampling and combination of psychological and physiological data addresses a crucial gap in the research of stress. This study contributes valuable knowledge to the field of psychophysiology and has implications for expedition planners, research organizations, teams in action settings, pandemic prevention protocols, global crises, and long-duration spaceflight missions. Comprehensive insights promote the well-being and success of individuals in extreme conditions.
How We Perceive Places: Measuring Biomarkers of Stress in Urban Environments Using Personal Exposure Sensors, Deep Learning and Functional Data Analysis Tadeas Dvorak, Marketa Makarova, Devashish Khulbe, Radim Lískovec, Ondrej Malina, David Gorny, Pavel Morcinek, Tomas Pompa, Ondrej Mikes, Veronika Eclerova, Filip Zlamal, Stanislav Sobolevsky, Ondrej Mulicek, Julie Bienertova-Vasku Proceedings Sap 2024 ACM Symposium on Applied Perception, 2024 This study investigates the impact of visual stimuli and other environmental factors in urban settings on physiological markers of stress. Forty-four participants walked a predefined urban route while wearable sensors recorded street-level noise, air pollutants, and video footage. Stress responses were measured via heart rate, heart rate variability, and electrodermal activity. Urban scenes were categorized using the SegFormer model, and an LSTM model was applied to predict stress markers. Functional data analysis provided an interpretable model of heart rate responses to environmental variables. Data collection and analyses are ongoing.
Socioeconomic status and adiposity in childhood cancer survivors: A cross-sectional retrospective study Lucie Štrublová, Tomáš Kepák, Daniela Kuruczová, Filip Zlámal, Marta Holíková, Kateřina Kepáková, Jaroslav Štěrba, Julie Bienertová-Vašků Plos One, 2024 This is a retrospective cross-sectional study examining the association between unemployment, cancer type, treatment and total body fat percentage of childhood cancer survivors recruited at St. Anne’s University Hospital in Brno, Czech Republic. A total of 55 survivors aged 18–49 who were in remission of cancer and fulfilled the criteria for body composition measurements by the BIA and completed questionnaires investigating their socioeconomic status, employment status, and history. There was a significant relationship between the employment status and central nervous system-directed treatment (c2(1) = 7.53, p = 0.006, Cramér’s V = 0.38) and between the type of cancer and employment status (c2(3) = 7.83, p = 0.049, Cramér’s V = 0.38), the highest unemployment rate was recorded for brain and spine survivors (72.7%) compared to survivors with other diagnosis (35.7%) (uLR(1) = 4.91, p = 0.027; OR = 4.80, 95% CI:1.10–20.86, p = 0.036); these survivors did not have a significantly different body fat percentage compared to survivors with other diagnoses (t(53) = 1.29, p = 0.202, Cohen’s d = 0.41) Interestingly, the survivors reporting having a partner also had a significantly higher percentage of body fat (t(53) = 2.90, p = 0.005, Cohen’s d = 0.81). A linear regression model was used to model the percentage of body fat in relation to a set of selected variables and the we observed a significant effect of sex (female vs male: b = 6.37, 95% CI: 1.82–10.93, p = 0.007), partnership status (yes vs no: b = 5.65, 95% CI: 0.67–10.62, p = 0.027) and category of diagnosis (Brain and spinal column tumors vs Other solid tumors: b = 12.40, 95% CI: 0.59–24.21, p = 0.040; Brain and spinal column tumors vs Lymphoma: b = 14.02, 95% CI: 2.06–25.97, p = 0.023). Employment status and risk of adiposity in childhood cancer survivors depends on the type of treatment and diagnosis group, which may significantly impact their lifestyle and overall quality of life after treatment. Trial registration: This study was registered on July 29, 2022, at ClinicalTrials.gov (NCT05481229).
Biological factors and self-perception of stress in relation to freeze-like response in humans Michal Vít, Jan Kučera, Peter Lenárt, Jan Novák, Filip Zlámal, Zdenko Reguli, Martin Bugala, Jitka Čihounková, Pavel Přecechtěl, Vojtěch Malčík, Tomáš Vojtíšek, Jana Fialová Kučerová, Veronika Eclerová, Marie Tomandlová, Radek Šíp, Lucie Ráčková, Markéta Grulichová, Josef Tomandl, Julie Bienertová-Vašků Psychoneuroendocrinology, 2023
Antioxidants in patients living with HIV on antiretrovirals Katerina Havlickova, Svatava Snopkova, Miroslav Pohanka, Radek Svacinka, Petr Husa j., Filip Zlamal, Lenka Fabianova, Petr Husa Military Medical Science Letters Vojenske Zdravotnicke Listy, 2021
Two common ghrelin gene polymorphisms linked to anthropometric and dietary characteristics of the central European population Appetite Regulation Use of Stimulants and Cultural and Biological Influences, 2014
Adipsin (complement factor D) as a new biomarker of body fat distribution in extremely obese Central-European population Body Fat Composition Measurements and Reduction Procedures, 2011
