Beliefs and expectations of patients with fibromyalgia about telerehabilitation during Covid-19 pandemic: A qualitative study.

BACKGROUND: Telerehabilitation as an alternative to physiotherapeutic care has been increasingly implemented in diverse populations. However, this mode of service can evoke beliefs and expectations in patients with fibromyalgia, depending on sociocultural and clinical context, that can cause poor adaptation and dropout from treatment. OBJECTIVE: To explore beliefs and expectations of individuals with fibromyalgia about physical exercises delivered through telerehabilitation. METHODS: Thirty individual semi-structured interviews were conducted via videoconference with women with fibromyalgia recruited during COVID-19 pandemic through intentional sampling. These interviews were guided by four questions addressing the beliefs and expectations about telerehabilitation. The interviews were recorded after consent and transcribed using the MAXQDA® software. The inductive approach was performed in which raw data were coded into categories and subcategories. RESULTS: Participants expect to benefit from telerehabilitation due to flexible hours, no need of travel, socialization, and lower risk of contamination. However, they believe they have difficulties related to the physical absence of the therapist, complexity of the exercises, internet connection problems, adaptation to the domestic routine and availability of schedules. CONCLUSION: Women with fibromyalgia showed positive expectations about telerehabilitation, relating better socialization with other individuals diagnosed with fibromyalgia, home care with flexible schedule and, to provide needed service to underserved. However, they listed barriers such as the physical absence of the therapist and instability of the internet connection and, the FM symptoms themselves.

Effect of proprioceptive neuromuscular facilitation in the treatment of dysfunctions in facial paralysis: a systematic literature review.

BACKGROUND: Facial palsy (FP) is defined as an injury of the seventh cranial nerve pair, partial or total, which can be classified as central or peripheral. Proprioceptive neuromuscular facilitation (PNF) is primarily used in the functional recovery of upper and lower limb conditions, however the technique has also been used for FP. OBJECTIVE: To analyze the effect of PNF in the treatment of dysfunctions in FP. METHODS: Ten databases including BVS, CENTRAL Cochrane, CINAHL, PEDro, PubMed, Scielo, ScienceDirect, SCOPUS, Web of Science, and Google Scholar were comprehensively searched for dates prior to April 2021. Randomized controlled trials of PNF in individuals with dysfunctions caused by facial paralysis were eligible. Outcomes measures were recovery rate and clinical recovery, both measured by using the House Brackmann Scale. Recovery time was measured in days and synkinesis assessed with the Synkinesis Assessment Questionnaire. RESULTS: A total of 184 patients were included. In general, the included studies have low methodological quality. None of the five studies used PNF as the sole intervention. In all of the included studies PNF was used in combination with other interventions. Our findings show very low evidence that PNF is more effective than minimal intervention for treating FP. CONCLUSION: We conclude that given the limited number of studies included and the low methodological quality presented, recommendations based on these studies should be interpreted with caution. The effects of PNF on facial paralysis are not clear.

Pain measurement techniques: spotlight on mechanically ventilated patients.

BACKGROUND: Procedural pain is a frequent problem in intensive care units (ICUs). For that, pain assessment has been increasingly introduced to the ICU professional's routine, and studies have been developed to show the relevance of measuring pain in critically ill patients. OBJECTIVE: This review aimed to describe pain measurement techniques for mechanically ventilated adult patients based on evidence and already published. METHOD: Systematic literature search was performed on PubMed and Google Scholar. Keywords "pain", "pain measurement", "intensive care units" and "respiration, artificial" were combined to the Boolean operator AND. No language or publication year was limited in this search. The purpose and method of all papers were analyzed and only studies which described pain assessment in mechanically ventilated patients were included in this review. RESULTS: Objective methods were found in the literature to assess pain in mechanically ventilated adults. Behavioral scales were the most used method for pain measurement in noncommunicative patients. Vital signs were used, but the reliability of this method was questioned. Pupillometry, bispectral index and skin conductance were found and described as pain assessment methods. CONCLUSION: This review showed that objective measures, as behavioral scales, are the gold standard tools to measure pain intensity in noncommunicative subjects. These data contribute to professionals' knowledge about ICU pain measurement and emphasize its importance and consequences for adequate pain management.

[Validation of the Brazilian version of Behavioral Pain Scale in adult sedated and mechanically ventilated patients]. / Validação da versão Brasileira da Escala Comportamental de Dor (Behavioral Pain Scale) em adultos sedados e sob ventilação mecânica.

BACKGROUND AND OBJECTIVES: The Behavioral Pain Scale is a pain assessment tool for uncommunicative and sedated Intensive Care Unit patients. The lack of a Brazilian scale for pain assessment in adults mechanically ventilated justifies the relevance of this study that aimed to validate the Brazilian version of Behavioral Pain Scale as well as to correlate its scores with the records of physiological parameters, sedation level and severity of disease. METHODS: Twenty-five Intensive Care Unit adult patients were included in this study. The Brazilian Behavioral Pain Scale version (previously translated and culturally adapted) and the recording of physiological parameters were performed by two investigators simultaneously during rest, during eye cleaning (non-painful stimulus) and during endotracheal suctioning (painful stimulus). RESULTS: High values of responsiveness coefficient (coefficient=3.22) were observed. The Cronbach's alpha of total Behavioral Pain Scale score at eye cleaning and endotracheal suctioning was 0.8. The intraclass correlation coefficient of total Behavioral Pain Scale score was ≥ 0.8 at eye cleaning and endotracheal suctioning. There was a significant highest Behavioral Pain Scale score during application of painful procedure when compared with rest period (p≤0.0001). However, no correlations were observed between pain and hemodynamic parameters, sedation level, and severity of disease. CONCLUSIONS: This pioneer validation study of Brazilian Behavioral Pain Scale exhibits satisfactory index of internal consistency, interrater reliability, responsiveness and validity. Therefore, the Brazilian Behavioral Pain Scale version was considered a valid instrument for being used in adult sedated and mechanically ventilated patients in Brazil.

Pain assessment during blood collection from sedated and mechanically ventilated children.

OBJECTIVE: This study assessed pain and observed physiological parameters in sedated and mechanically ventilated children during a routine procedure. METHODS: This observational study was performed in a pediatric intensive care unit. Thirty-five children between 1 month and 12 years of age were assessed before, during, and five minutes after an arterial blood collection for gas analysis (painful procedure). Face, Legs, Activity, Cry and Consolability scale was used to assess pain. In addition, patients' heart rate, respiratory rate, peripheral saturation of oxygen and blood pressure (diastolic and systolic) were recorded. COMFORT-B scale was applied before the pain and physiological parameter assessments to verify sedation level of the subjects. RESULTS: There was an increase in Face, Legs, Activity, Cry and Consolability score (p = 0.0001) during painful stimuli. There was an increase in heart rate (p = 0.03), respiratory rate (p = 0.001) and diastolic blood pressure (p = 0.006) due to pain caused by the routine procedure. CONCLUSIONS: This study suggests that assessments of pain using standard scales, such as Face, Legs, Activity, Cry and Consolability score, and other physiological parameters should be consistently executed to optimize pain management in pediatric intensive care units.

Joint mobilization associated or not to other therapies reduces chronic musculoskeletal pain: a systematic review

ABSTRACT BACKGROUND AND OBJECTIVES: Joint mobilization is a non-pharmacological technique used to treat chronic musculoskeletal pain. However, it is controversial due to a lack of studies comparing its effects on this painful condition. The objective of this study was to assess the risk of bias in clinical trials investigating the effect of joint mobilization on chronic musculoskeletal pain. CONTENTS: A systematic search on Pubmed, Cochrane Library, ScienceDirect, Scielo, PEDro, CINAHL, SPORTDiscus, LILACS, BVS, PsycINFO, Web of Science, and Scopus was performed on September 2019 from the combination of three keywords: Musculoskeletal Manipulations AND Chronic Pain AND Musculoskeletal Pain. Randomized controlled clinical trials that evaluated the use of joint mobilization associated or not to other therapies in chronic musculoskeletal pain treatment were included. Five thousand five hundred eighty-seven articles were screened, and 14 studies were analyzed, including 812 participants, with a mean age of 54 years, and female being the most affected. According to these articles, joint mobilization promoted the reduction of pain intensity in short and long terms, increase in range of motion, strength and function when used alone or in association with conventional physiotherapy. Regarding methodological quality, most of the studies were classified with low risk for selection, performance, detection and reporting bias. In the "other bias" item, which considered therapists experience time and types of treatment applied, only one study presented low risk and other study presented an unclear risk. CONCLUSION: Joint mobilization seems to be an effective technique for the treatment of chronic musculoskeletal pain. However, it is still necessary to investigate and compile studies with greater methodological quality, thus promoting greater support to evidence-based practice.

RESUMO JUSTIFICATIVA E OBJETIVOS: Mobilização articular é uma técnica não farmacológica usada no tratamento da dor musculoesquelética crônica. No entanto, é controverso devido à falta de estudos que comparem seus efeitos sobre essa condição de dor. O objetivo deste estudo foi avaliar o risco de viés em ensaios clínicos que investigam o efeito da mobilização articular na dor musculoesquelética crônica. CONTEÚDO: Foi realizada uma busca sistematizada no Pu-bmed, Cochrane Library, ScienceDirect, Scielo, PEDro, CINAHL, SPORTDiscus, LILACS, BVS, PsycINFO, Web of Science e Scopus em setembro de 2019 com a combinação de três palavras-chave: Musculoskeletal Manipulations AND Chronic Pain AND Musculoskeletal Pain. Ensaios clínicos controlados e aleatorizados que avaliaram o uso de mobilização articular associada ou não a outras terapias no tratamento da dor muscu-loesquelética crônica foram incluídos. Foram encontrados 5587 artigos e analisados 14 estudos, incluindo 812 participantes, com idade média de 54 anos, sendo o sexo feminino o mais afetado. Nestes, a mobilização articular promoveu redução da dor em curto e longo prazo, amplitude de movimento, força e melhora da função quando utilizado isoladamente ou em associação à fisioterapia convencional. Em relação à qualidade metodológica, a maioria dos estudos foi classificada com baixo risco para seleção, desempenho, detecção e viés de relato. No item "other bias", que considerou terapeutas com tempo de experiência e tipos de tratamento aplicados, apenas um estudo apresentou baixo risco e outro estudo apresentou risco incerto. CONCLUSÃO: Mobilizaç ão articular parece ser uma técnica eficaz para o tratamento da dor musculoesquelética crônica. No entanto, é necessário realizar estudos com maior qualidade metodológica, promovendo maior apoio à prática baseada em evidências.

Does transcutaneous electrical nerve stimulation reduces pain free of adverse effects during pregnancy? Systematic review / Estimulação elétrica nervosa transcutânea reduz a dor sem efeitos adversos durante a gestação? Revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) is considered a current that should not be applied in pregnant women to avoid adverse effects. This systematic review aimed to analyze the scientific evidence about the use of TENS during pregnancy. CONTENTS: This study was conducted on November 2019 by searching the electronic databases: Pubmed, Scielo, LILACS, Science Direct, Cochrane Library and PEDro. The following descriptors were used: "transcutaneous electric nerve stimulation" combined with "pregnancy". Only randomized clinical trials that investigated the use of TENS during pregnancy were selected. Methodological quality was assessed by using the Cochrane Collaboration Tool (RevMan 5.3 software). Studies were classified according to the risk of bias (low, high or unclear). From 691 eligible publications, only two randomized clinical trials were selected according to inclusion criteria. Low risk of bias was detected in most items in one study and high risk for performance, detection and reporting bias were evidenced in the other study. Other bias (TENS intensity control by patient) was considered unclear in both studies. CONCLUSION: There is not enough support that TENS neither reduces pain intensity nor causes adverse effects in pregnant patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: Estimulação elétrica nervosa transcutânea (TENS) é considerada uma corrente não recomendada para gestantes a fim de evitar efeitos adversos. O objetivo deste estudo foi analisar as evidências científicas sobre o uso da TENS durante a gestação. CONTEÚDO: Estudo realizado em novembro de 2019 pela busca nas seguintes bases de dados: Pubmed, Scielo, LILACS, Science Direct, Cochrane Library e PEDro. Os descritores "transcutaneous electric nerve stimulation" e "pregnancy" foram utilizados. Ensaios clínicos randomizados que investigaram o uso da TENS durante a gestação foram selecionados. A qualidade metodológica dos estudos foi avaliada através da Ferramenta da Colaboração Cochrane (software RevMan 5.3). A partir de 691 estudos encontrados, somente dois estudos clínicos randomizados foram selecionados de acordo com os critérios de inclusão. Baixo risco de viés foi detectado na maioria dos itens em um dos estudos e alto risco de viés de desempenho, detecção e relato foram evidenciados em outro estudo. Outro viés, como controle da intensidade da TENS pelo paciente, foi considerado incerto em ambos os estudos. CONCLUSÃO: Não há evidências científicas suficientes que suportem a redução da intensidade de dor nem a ocorrência de efeitos adversos promovidas pela TENS em pacientes gestantes.

Tradução e adaptação cultural da Neurological Impairment Scale (NIS) para a população brasileira / Translation and cross-cultural adaptation of Neurological Impairment Scale to brazilian population

As doenças neurológicas compreendem as afecções do sistema nervoso central (SNC) e/ou do sistema nervoso periférico (SNP) e afetam 1 bilhão de pessoas em todo o mundo e é previsto um grande número de novos casos para os próximos 30 anos. Estas doenças ocasionam perda funcional e consequente desenvolvimento de incapacidades, e por isto necessitam ser avaliadas minuciosamente. A Neurological Impairment Scale (NIS) engloba itens considerados essenciais para a avaliação funcional (incorporados da escala MIF e MAF) e ao mesmo tempo codifica as disfunções com base na CIF. Objetivo: Traduzir e adaptar culturalmente a versão brasileira da Neurological Impairment Scale (NIS) em pacientes com doença neurológica aguda. Método: O método de pesquisa desenvolvido foi dividido em 4 etapas: autorização, tradução, síntese, retrotradução, revisão de especialistas e pré-teste. No pré-teste, a Escala de Disfunção Neurológica (EDN) e a MIF foram aplicadas em 10 pacientes com doença neurológica internados em uma enfermaria hospitalar. Foram analisadas a confiabilidade e validade deste instrumento. Resultados: Foi evidenciada a validade de conteúdo, construto e de critério concorrente, além de alta consistência interna (confiabilidade) da EDN, quando aplicada na amostra de pacientes neurológicos na fase aguda. Não foi possível evidenciar no presente estudo a validade preditiva do instrumento. Conclusão: A Escala de Disfunção Neurológica foi considerada um instrumento válido, confiável e adaptado culturalmente para a população brasileira. Estima-se a realização de novos estudos utilizando esta escala com o intuito de difundir e consolidar o seu uso por profissionais de saúde no Brasil.

Neurological disorders include central and/or peripheral nervous system disorders and affect 1 billion people worldwide and a large number of new cases are expected over the next 30 years. These diseases cause functional loss and consequent development of disabilities, and therefore need to be thoroughly evaluated. The Neurological Impairment Scale (NIS) has items considered essential for functional assessment (incorporated from the FIM and FAM scales) and at the same time encodes dysfunctions based on the ICF. Objective: To translate and cross-cultural adapt the Brazilian version of the Neurological Impairment Scale (NIS) in patients with acute neurological disease. Method: The research method developed was divided into 4 stages: authorization, translation, synthesis, back translation, expert review and pretest. In the pretest, the Neurological Impairment Scale Brazilian version and the FIM were applied to 10 patients with neurological disease admitted to a hospital. The reliability and validity of this instrument were analyzed. Results: Content, construct and concurrent validity was evidenced, as well as the high internal consistency (reliability) of the Brazilian NIS when applied to the sample of neurological patients. It was not possible to evidence the predictive validity of this instrument. Conclusion: The Brazilian NIS was considered a valid, reliable and culturally adapted instrument for the Brazilian population. Further studies using this scale are estimated to disseminate and consolidate its use by health professionals in Brazil.

Pain characteristics and its influence in the labor activities in northeastern Brazilian farmers / Características da dor e sua influência nas atividades laborais em agricultores do nordeste do Brasil

Introduction: Agricultural work is considered a dangerous activity with physical and mental stress. Pain is one of the most common disabilities among agricultural workers. Objective: To determine the incidence, intensity, characteristic of pain and its impact on labor activities in farmers. Methods: Transversal study, pain evaluations consist of: 1) presence / intensity; 2) characteristic of painful experience; 3) episode of pain in the last 30 days and 4) interference of pain at work. Validated and specific pain scales were used, and descriptive statistics were applied. Results: 157 rural farmers were recruited, 128 farmers, 40.4 (11.4) years, participated in the study, 25% of the farmers reported pain at the time of evaluation with mean of 5.5 (0.47) intensity. The predominant pain characteristic was the evaluative type (34%), followed by affective (30%), 83 (65%) of farmers reported pain in the last four weeks, and 60% of these farmers reported pain interference in work activity. Conclusion: Pain, according to farmers in this study, is the main cause of absence and poor performance at work. To accurately assess the intensity of work-related pain, instruments may need to be applied over a continuous period of time, preferably during work day. (AU)

Introdução: O trabalho agrícola possui elevada carga de estresse físico e mental. A dor é uma das incapacidades mais relatadas, compreender esse fenômeno e sua interferência no trabalho é fundamental para intervenções eficazes na saúde do trabalhador. Objetivo: Determinar a incidência, intensidade, característica da dor e seu impacto no trabalho em agricultores. Métodos: Estudo transversal, as avaliações da dor contemplaram: 1) presença/intensidade; 2) característica da experiência dolorosa; 3) dor no último mês e, 4) interferência da dor no trabalho. Todas as escalas eram validadas e específicas para cada objetivo e a análise estatística foi descritiva. Resultados: 157 agricultores foram recrutados, participaram 128 agricultores, 40,4 (11,4) anos, 25% dos agricultores referiram dor no momento da avaliação com intensidade média 5,5 (0,47). A característica da dor predominante foi do tipo avaliativa (34%), seguida pela afetiva (30%). 83 agricultores (65%) referiram ocorrência de dor no último mês, e 60% destes relataram interferência da dor no trabalho. Conclusão: A dor, segundo os agricultores, é causadora de ausência e mau rendimento no trabalho. Avaliar com precisão a intensidade da dor relacionada ao trabalho talvez necessite de instrumentos aplicados em um período contínuo no tempo, durante a jornada de trabalho. (AU)

Validation of the Brazilian version of Behavioral Pain Scale in adult sedated and mechanically ventilated patients / Validação da versão Brasileira da Escala Comportamental de Dor (Behavioral Pain Scale) em adultos sedados e sob ventilação mecânica

Abstract Background and objectives: The Behavioral Pain Scale is a pain assessment tool for uncommunicative and sedated Intensive Care Unit patients. The lack of a Brazilian scale for pain assessment in adults mechanically ventilated justifies the relevance of this study that aimed to validate the Brazilian version of Behavioral Pain Scale as well as to correlate its scores with the records of physiological parameters, sedation level and severity of disease. Methods: Twenty-five Intensive Care Unit adult patients were included in this study. The Brazilian Behavioral Pain Scale version (previously translated and culturally adapted) and the recording of physiological parameters were performed by two investigators simultaneously during rest, during eye cleaning (non-painful stimulus) and during endotracheal suctioning (painful stimulus). Results: High values of responsiveness coefficient (coefficient = 3.22) were observed. The Cronbach's alpha of total Behavioral Pain Scale score at eye cleaning and endotracheal suctioning was 0.8. The intraclass correlation coefficient of total Behavioral Pain Scale score was ≥ 0.8 at eye cleaning and endotracheal suctioning. There was a significant highest Behavioral Pain Scale score during application of painful procedure when compared with rest period (p ≤ 0.0001). However, no correlations were observed between pain and hemodynamic parameters, sedation level, and severity of disease. Conclusions: This pioneer validation study of Brazilian Behavioral Pain Scale exhibits satisfactory index of internal consistency, interrater reliability, responsiveness and validity. Therefore, the Brazilian Behavioral Pain Scale version was considered a valid instrument for being used in adult sedated and mechanically ventilated patients in Brazil.

Resumo Justificativa e objetivos: A Escala Comportamental de Dor (Behavioral Pain Scale) é uma ferramenta de avaliação da dor para pacientes não-comunicativos e sedados em unidade de tratamento intensivo (UTI). A falta de uma escala brasileira para a avaliação da dor em adultos sob ventilação mecânica justifica a relevância deste estudo que teve por objetivo validar a versão brasileira da Escala Comportamental de Dor (ECD), bem como correlacionar seus escores com os registros de parâmetros fisiológicos, nível de sedação e gravidade da doença. Métodos: Vinte e cinco pacientes adultos internados em UTI foram incluídos neste estudo. A versão brasileira da ECD (previamente traduzida e adaptada culturalmente) e os registros dos parâmetros fisiológicos foram realizados simultaneamente por dois avaliadores durante o repouso, durante a limpeza dos olhos (estímulo não doloroso) e durante a aspiração endotraqueal (estímulo doloroso). Resultados: Valores elevados do coeficiente de coeficiente de responsividade (coeficiente = 3,22) foram observados. O coeficiente alfa de Cronbach do escore total da ECD durante a limpeza dos olhos e aspiração endotraqueal foi de 0,8. O coeficiente de correlação intraclasse do escore total da ECD foi ≥ 0,8 durante a limpeza dos olhos e aspiração endotraqueal. Houve um escore significativamente mais alto na ECD durante a aplicação do estímulo doloroso em comparação com o período de descanso (p ≤ 0,0001). No entanto, não foram observadas correlações entre dor e parâmetros hemodinâmicos, nível de sedação e gravidade da doença. Conclusões: Este estudo pioneiro de validação da ECD brasileira apresenta índices satisfatórios de consistência interna, confiabilidade entre avaliadores, responsividade e validade. Portanto, a versão da ECD brasileira foi considerada um instrumento válido para ser usado em pacientes adultos sedados e ventilados mecanicamente no Brasil.

Avaliação da dor durante coleta de sangue em crianças sedadas e submetidas à ventilação mecânica / Pain assessment during blood collection from sedated and mechanically ventilated children

RESUMO Objetivo: Avaliar a dor e observar parâmetros fisiológicos em crianças sedadas e submetidas à ventilação mecânica durante um procedimento de rotina. Métodos: Estudo observacional realizado em uma unidade de terapia intensiva pediátrica. Foram avaliadas 35 crianças, com idades entre 1 mês e 12 anos, em três momentos distintos: antes, durante e 5 minutos após coleta de sangue arterial para análise gasométrica (procedimento doloroso). Utilizou-se a Escala Face, Legs, Activity, Cry and Consolability para avaliação da dor e foram registradas a frequência cardíaca, frequência respiratória, saturação periférica de oxigênio e pressão arterial (sistólica e diastólica). O nível de sedação dos participantes foi verificado utilizando-se a escala Comfort-B, aplicada antes da mensuração da dor e da avaliação dos parâmetros fisiológicos. Resultados: Durante os estímulos dolorosos, ocorreu aumento do escore da Escala Face, Legs, Activity, Cry and Consolability (p = 0,0001). Houve também aumento da frequência cardíaca (p = 0,03), da frequência respiratória (p = 0,001) e da pressão arterial diastólica (p = 0,006) em razão da dor causada pelo procedimento de rotina. Conclusões: Avaliação da dor com uso de escalas padrão, como a Escala Face, Legs, Activity, Cry and Consolability, e observação de parâmetros fisiológicos, deve ser realizada rotineiramente para melhorar o manejo da dor nas unidades de terapia intensiva pediátricas.

ABSTRACT Objective: This study assessed pain and observed physiological parameters in sedated and mechanically ventilated children during a routine procedure. Methods: This observational study was performed in a pediatric intensive care unit. Thirty-five children between 1 month and 12 years of age were assessed before, during, and five minutes after an arterial blood collection for gas analysis (painful procedure). Face, Legs, Activity, Cry and Consolability scale was used to assess pain. In addition, patients' heart rate, respiratory rate, peripheral saturation of oxygen and blood pressure (diastolic and systolic) were recorded. COMFORT-B scale was applied before the pain and physiological parameter assessments to verify sedation level of the subjects. Results: There was an increase in Face, Legs, Activity, Cry and Consolability score (p = 0.0001) during painful stimuli. There was an increase in heart rate (p = 0.03), respiratory rate (p = 0.001) and diastolic blood pressure (p = 0.006) due to pain caused by the routine procedure. Conclusions: This study suggests that assessments of pain using standard scales, such as Face, Legs, Activity, Cry and Consolability score, and other physiological parameters should be consistently executed to optimize pain management in pediatric intensive care units.