{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:09:13Z","timestamp":1785434953184,"version":"3.56.0"},"reference-count":59,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Reuth Rehabilitation Hospital","award":["2017-14"],"award-info":[{"award-number":["2017-14"]}]},{"award":["2017-14"],"award-info":[{"award-number":["2017-14"]}],"id":[{"id":"https:\/\/ror.org\/0540ewb14","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Body perception disturbances (BPDs) are highly prevalent in chronic limb pain, manifesting as hostile feelings towards the limb, reduced sensory\u2013motor function, and altered limb ownership. Various questionnaires and tests assess BPD, but their interrelation and associations with limb disability remain underexplored. This study aimed to evaluate BPD assessments, examine whether they capture overlapping or distinct aspects of BPD, and determine their associations with upper- and lower-limb disability. Methods: This observational cross-sectional study included 92 participants with chronic limb pain. Participants completed BPD questionnaires (Bath-BPD, Neurobehavioral) and tests (Laterality Recognition, Fingers\/Toe Perception, Human Figure Drawing), along with clinical pain measures and the symptom severity index. Dependent outcomes were upper- and lower-limb disability. Results: Cluster analysis grouped all measures into \u2018High\u2019 and \u2018Low\u2019 BPD severity clusters, with overall cluster quality rated as fair (silhouette = 0.40). The Neurobehavioral questionnaire emerged as the primary contributor to the cluster structure (silhouette = 1). The \u2018High\u2019 BPD cluster showed significantly greater symptom severity (t(63) = \u22124.13, p &lt; 0.001). Pain severity, Bath-BPD questionnaire, and symptom severity were significantly associated with upper-limb disability (p &lt; 0.001), whereas pain intensity alone accounted for 24% of lower-limb disability variance. Conclusions: Despite the diversity of BPD assessments, the clustering pattern suggests a partial convergence between measures, though a weak cohesiveness of BPD tests indicates that they capture partially distinct aspects of body perception. BPD questionnaires were associated with upper-limb disability, whereas lower-limb disability was associated with pain intensity. These findings emphasize the importance of assessing BPDs in musculoskeletal care and suggest their potential role as indicators of symptom severity.<\/jats:p>","DOI":"10.3390\/jcm15103876","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:36:40Z","timestamp":1779107800000},"page":"3876","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Body Perception Disturbances in Chronic Limb Pain: Exploring Different Assessment Tools and Their Associations with Upper- and Lower-Limb Disability in a Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Hana","family":"Karpin","sequence":"first","affiliation":[{"name":"Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3103301, Israel"},{"name":"Reuth Rehabilitation Hospital, Tel Aviv 6772829, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irit","family":"Weissman-Fogel","sequence":"additional","affiliation":[{"name":"Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3103301, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3905-2920","authenticated-orcid":false,"given":"Anatoly","family":"Livshitz","sequence":"additional","affiliation":[{"name":"Reuth Rehabilitation Hospital, Tel Aviv 6772829, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3006-9821","authenticated-orcid":false,"given":"Yishai","family":"Bachar Kirshenboim","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9473-2979","authenticated-orcid":false,"given":"Jean Jacques","family":"Vatine","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Department, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.15585\/mmwr.mm6736a2","article-title":"Prevalence of chronic pain and high-impact chronic pain among adults\u2014United States, 2016","volume":"67","author":"Dahlhamer","year":"2018","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_2","first-page":"60","article-title":"Body perception disturbance (BPD) in CRPS","volume":"10","author":"Lewis","year":"2010","journal-title":"Pract. Pain Manag."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Dagenais, M., Proulx, C., Augi\u00e8re, T., Roy, J.-S., and Mercier, C. (2025). Self-reported questionnaires assessing body perception disturbances in adults with chronic non-cancer pain: A scoping review. Front. Pain Res., 6.","DOI":"10.3389\/fpain.2025.1497328"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1002\/ejp.2032","article-title":"Assessment of body perception disturbances in complex regional pain syndrome: A systematic review using the COSMIN guideline","volume":"26","author":"Acapo","year":"2022","journal-title":"Eur. J. Pain"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1002\/j.1532-2149.2012.00120.x","article-title":"Perceptions of the painful body: The relationship between body perception disturbance, pain and tactile discrimination in complex regional pain syndrome","volume":"16","author":"Lewis","year":"2012","journal-title":"Eur. J. Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.jpain.2021.04.007","article-title":"Validation of the bath CRPS body perception disturbance scale","volume":"22","author":"Halicka","year":"2021","journal-title":"J. Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jpain.2018.07.008","article-title":"Exploring the relationships between altered body perception, limb position sense, and limb movement sense in complex regional pain syndrome","volume":"20","author":"Brun","year":"2019","journal-title":"J. Pain"},{"key":"ref_8","first-page":"1337","article-title":"Psychological, social and biological correlates of body perception disturbance in complex regional pain syndrome","volume":"41","author":"Storz","year":"2020","journal-title":"Curr. Psychol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e70123","DOI":"10.1002\/ejp.70123","article-title":"A Model of Body Perception Disturbances in Chronic Limb Pain: The Predictive Role of Kinesiophobia, Depersonalization and Symptom Severity","volume":"29","author":"Karpin","year":"2025","journal-title":"Eur. J. Pain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.neuropsychologia.2009.09.022","article-title":"Body schema and body image\u2014Pros and cons","volume":"48","year":"2010","journal-title":"Neuropsychologia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.concog.2018.08.007","article-title":"How do the body schema and the body image interact?","volume":"65","author":"Pitron","year":"2018","journal-title":"Conscious. Cogn."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.pain.2007.03.013","article-title":"Body perception disturbance: A contribution to pain in complex regional pain syndrome (CRPS)","volume":"133","author":"Lewis","year":"2007","journal-title":"Pain"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kuttikat, A., Noreika, V., Shenker, N., Chennu, S., Bekinschtein, T., and Brown, C.A. (2016). Neurocognitive and Neuroplastic Mechanisms of Novel Clinical Signs in CRPS. Front. Hum. Neurosci., 10.","DOI":"10.3389\/fnhum.2016.00016"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1162\/0898929053467587","article-title":"Evidence for multiple, distinct representations of the human body","volume":"17","author":"Schwoebel","year":"2005","journal-title":"J. Cogn. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Biran, I., Book, A., Aviram, L., Bregman, N., Bahagali, E., and Tripto, A. (2022). Body structural description impairment in complex regional pain syndrome type I. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.853641"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4699","DOI":"10.2147\/JPR.S534655","article-title":"Comprehensive mechanisms and non-invasive treatment for complex regional pain syndrome: A narrative review","volume":"18","author":"Doan","year":"2025","journal-title":"J. Pain Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1002\/ejp.1766","article-title":"Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial","volume":"25","author":"Lewis","year":"2021","journal-title":"Eur. J. Pain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/jnp.12390","article-title":"How pain and body representations transform each other: A narrative review","volume":"19","author":"Beccherle","year":"2025","journal-title":"J. Neuropsychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1097\/j.pain.0000000000003872","article-title":"Perceiving pain alters body perception: The effects of acute pain on body image and sensory testing","volume":"167","author":"Budzisz","year":"2026","journal-title":"Pain"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Osumi, M., Imai, R., Ueta, K., Nobusako, S., and Morioka, S. (2014). Negative body image associated with changes in the visual body appearance increases pain perception. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0107376"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Shigetoh, H., Koga, M., Tanaka, Y., Hirakawa, Y., and Morioka, S. (Arch. Phys. Med. Rehabil., 2025). Pain qualities associated with body perception disturbances: Insights from machine learning and SHapley additive exPlanations, Arch. Phys. Med. Rehabil., in press.","DOI":"10.1016\/j.apmr.2025.11.021"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1093\/pm\/pnab226","article-title":"Predictors of self-reported neglect-like symptoms and involuntary movements in complex regional pain syndrome compared to other chronic limb pain conditions","volume":"22","author":"Bultitude","year":"2021","journal-title":"Pain Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Viceconti, A., Camerone, E.M., Luzzi, D., Pentassuglia, D., Pardini, M., Ristori, D., Rossettini, G., Gallace, A., Longo, M.R., and Testa, M. (2020). Explicit and implicit own\u2019s body and space perception in painful musculoskeletal disorders and rheumatic diseases: A systematic scoping review. Front. Hum. Neurosci., 14.","DOI":"10.3389\/fnhum.2020.00083"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.actpsy.2018.01.007","article-title":"The influence of vision, touch, and proprioception on body representation of the lower limbs","volume":"185","author":"Stone","year":"2018","journal-title":"Acta Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.pain.2010.04.030","article-title":"Validation of proposed diagnostic criteria (the \u201cBudapest Criteria\u201d) for complex regional pain syndrome","volume":"150","author":"Harden","year":"2010","journal-title":"Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.pain.2010.09.031","article-title":"Development of a severity score for CRPS","volume":"151","author":"Harden","year":"2010","journal-title":"Pain"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Chin, C.-L., and Yao, G. (2024). Convergent validity. Encyclopedia of Quality of Life and Well-Being Research, Springer.","DOI":"10.1007\/978-3-031-17299-1_573"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S0885-3924(99)00076-7","article-title":"Neglect-like symptoms in complex regional pain syndrome: Results of a self-administered survey","volume":"18","author":"Galer","year":"1999","journal-title":"J. Pain Symptom Manag."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.pain.2006.04.010","article-title":"Severity and specificity of neglect-like symptoms in patients with complex regional pain syndrome (CRPS) compared to chronic limb pain of other origins","volume":"124","author":"Maier","year":"2006","journal-title":"Pain"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1093\/pm\/pnw214","article-title":"Association of neglect-like symptoms with anxiety, somatization, and depersonalization in complex regional pain syndrome","volume":"18","author":"Michal","year":"2017","journal-title":"Pain Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1212\/01.WNL.0000130156.05828.43","article-title":"Why do people with complex regional pain syndrome take longer to recognize their affected hand?","volume":"62","author":"Moseley","year":"2004","journal-title":"Neurology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.pain.2004.05.019","article-title":"Impaired self-perception of the hand in complex regional pain syndrome (CRPS)","volume":"110","author":"Sailer","year":"2004","journal-title":"Pain"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1038\/nmeth.2089","article-title":"NIH Image to ImageJ: 25 years of image analysis","volume":"9","author":"Schneider","year":"2012","journal-title":"Nat. Methods"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.pain.2010.02.007","article-title":"Wherever is my arm? Impaired upper limb position accuracy in complex regional pain syndrome","volume":"149","author":"Lewis","year":"2010","journal-title":"Pain"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.neubiorev.2015.03.004","article-title":"Sensing the body in chronic pain: A review of psychophysical studies implicating altered body representation","volume":"52","author":"Tsay","year":"2015","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.jpain.2018.01.004","article-title":"Signs and symptoms in 1,043 patients with complex regional pain syndrome","volume":"19","author":"Ott","year":"2018","journal-title":"J. Pain"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/0304-3959(87)91074-8","article-title":"The short-form McGill pain questionnaire","volume":"30","author":"Melzack","year":"1987","journal-title":"Pain"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L","article-title":"Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder, and hand)","volume":"29","author":"Hudak","year":"1996","journal-title":"Am. J. Ind. Med."},{"key":"ref_40","first-page":"371","article-title":"The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application","volume":"79","author":"Binkley","year":"1999","journal-title":"Phys. Ther."},{"key":"ref_41","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/0377-0427(87)90125-7","article-title":"Silhouettes: A graphical aid to the interpretation and validation of cluster analysis","volume":"20","author":"Rousseeuw","year":"1987","journal-title":"J. Comput. Appl. Math."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12859-022-04675-1","article-title":"Statistical power for cluster analysis","volume":"23","author":"Dalmaijer","year":"2022","journal-title":"BMC Bioinform."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1111\/j.1526-4637.2010.00909.x","article-title":"Objectification of the diagnostic criteria for CRPS","volume":"11","author":"Harden","year":"2010","journal-title":"Pain Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Tkaczynski, A. (2016). Segmentation using two-step cluster analysis. Segmentation in Social Marketing: Process, Methods and Application, Springer.","DOI":"10.1007\/978-981-10-1835-0_8"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1214\/aos\/1176344136","article-title":"Estimating the dimension of a model","volume":"6","author":"Schwarz","year":"1978","journal-title":"Ann. Stat."},{"key":"ref_47","first-page":"E231","article-title":"Can people with chronic neck pain recognize their own digital pain drawing?","volume":"23","author":"Abichandani","year":"2020","journal-title":"Pain Physician"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1097\/j.pain.0000000000002245","article-title":"The Valencia consensus-based adaptation of the IASP complex regional pain syndrome diagnostic criteria","volume":"162","author":"Goebel","year":"2021","journal-title":"Pain"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.neulet.2010.09.062","article-title":"Left is where the L is right. Significantly delayed reaction time in limb laterality recognition in both CRPS and phantom limb pain patients","volume":"486","author":"Reinersmann","year":"2010","journal-title":"Neurosci. Lett."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1016\/j.pain.2012.05.025","article-title":"Impaired spatial body representation in complex regional pain syndrome type 1 (CRPS I)","volume":"153","author":"Reinersmann","year":"2012","journal-title":"Pain"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2098","DOI":"10.1093\/brain\/124.10.2098","article-title":"Pain and the body schema: Evidence for peripheral effects on mental representations of movement","volume":"124","author":"Schwoebel","year":"2001","journal-title":"Brain"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1097\/j.pain.0000000000000927","article-title":"A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score","volume":"158","author":"Harden","year":"2017","journal-title":"Pain"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/j.pain.0000000000001822","article-title":"My body is not working right: A cognitive behavioral model of body image and chronic pain","volume":"161","author":"Flink","year":"2020","journal-title":"Pain"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.pain.2012.11.006","article-title":"Neglect-like symptoms in complex regional pain syndrome: Learned nonuse by another name?","volume":"154","author":"Punt","year":"2013","journal-title":"Pain"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1002\/hbm.22172","article-title":"Human finger somatotopy in areas 3b, 1, and 2: A 7T fMRI study using a natural stimulus","volume":"35","author":"Martuzzi","year":"2014","journal-title":"Hum. Brain Mapp."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.neuroimage.2017.06.021","article-title":"Anatomical and functional properties of the foot and leg representation in areas 3b, 1 and 2 of primary somatosensory cortex in humans: A 7T fMRI study","volume":"159","author":"Akselrod","year":"2017","journal-title":"Neuroimage"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.tics.2020.04.003","article-title":"Somatosensation in the brain: A theoretical re-evaluation and a new model","volume":"24","author":"Dijkerman","year":"2020","journal-title":"Trends Cogn. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1080\/08990220.2020.1823362","article-title":"Comparison of the lower extremity function of patients with foot problems according to the level of kinesiophobia","volume":"37","author":"Yildiz","year":"2020","journal-title":"Somatosens. Mot. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jpain.2019.06.004","article-title":"Predicting opioid use, increased health care utilization and high costs for musculoskeletal pain: What factors mediate pain intensity and disability?","volume":"21","author":"Lentz","year":"2020","journal-title":"J. Pain"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3876\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:05:28Z","timestamp":1779109528000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":59,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103876"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103876","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}