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Furthermore, we studied the mediating roles of physical activity and\/or decline in physical activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This questionnaire\u2010based cross\u2010sectional study included 154 patients with <jats:styled-content style=\"fixed-case\">PDN<\/jats:styled-content>. Linear regression analyses, adjusted for age, gender, pain intensity, and insulin treatment, were performed to assess the association of pain catastrophizing (Pain Catastrophizing Scale [<jats:styled-content style=\"fixed-case\">PCS<\/jats:styled-content>]) with the outcome variables disability (Pain Disability Index [<jats:styled-content style=\"fixed-case\">PDI<\/jats:styled-content>]) and quality of life (Norfolk Quality of Life Questionnaire Diabetic Neuropathy Version [<jats:styled-content style=\"fixed-case\">QOL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">DN<\/jats:styled-content>]). The mediating roles of actual physical activity (Physical Activity Rating Scale [<jats:styled-content style=\"fixed-case\">PARS<\/jats:styled-content>]) and perceived Physical Activity Decline (<jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>) were assessed using mediation analyses according to Baron and Kenny.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 154 patients (62% male). Mean age was 65.7 years (<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> = 6.6). <jats:styled-content style=\"fixed-case\">PCS<\/jats:styled-content> (<jats:italic>M<\/jats:italic> = 20.3, <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> = 13.1) was significantly associated with <jats:styled-content style=\"fixed-case\">PDI<\/jats:styled-content> (<jats:italic>M<\/jats:italic> = 32.4, <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> = 17.0; <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.356, <jats:italic>P<\/jats:italic> &lt; 0.001), <jats:styled-content style=\"fixed-case\">QOL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">DN<\/jats:styled-content> (<jats:italic>M<\/jats:italic> = 52.6, <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> = 26.1; <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.437, <jats:italic>P<\/jats:italic> &lt; 0.001), and <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content> (<jats:italic>M<\/jats:italic> = 7.4, <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> = 5.7; <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.087, <jats:italic>P<\/jats:italic> = 0.045). <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content> acted as a partial mediator in the associations of <jats:styled-content style=\"fixed-case\">PCS<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">PDI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">QOL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">DN<\/jats:styled-content>, respectively. There was no association of <jats:styled-content style=\"fixed-case\">PCS<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">PARS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pain catastrophizing was associated with increased disability and decreased quality of life in patients with <jats:styled-content style=\"fixed-case\">PDN<\/jats:styled-content>. Also, it was associated with a perceived decline in physical activity, which had a mediating role in the association between catastrophizing and disability and quality of life, respectively. This study emphasizes the role of catastrophic thinking about pain and the experienced loss in daily activities due to <jats:styled-content style=\"fixed-case\">PDN<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12449","type":"journal-article","created":{"date-parts":[[2016,3,23]],"date-time":"2016-03-23T06:57:47Z","timestamp":1458716267000},"page":"320-328","source":"Crossref","is-referenced-by-count":39,"title":["Perceived Physical Activity Decline as a Mediator in the Relationship Between Pain Catastrophizing, Disability, and Quality of Life in Patients with Painful Diabetic Neuropathy"],"prefix":"10.1111","volume":"17","author":[{"given":"Charlotte C.","family":"Geelen","sequence":"first","affiliation":[{"name":"Adelante Centre of Expertise in Rehabilitation and Audiology Hoensbroek The Netherlands"},{"name":"Department of Rehabilitation Medicine Research School CAPHRI Maastricht University Maastricht The 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