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OBJECTIVES: Hench introduced the fibromyalgia syndrome almost 50 years ago. In the meantime, the prevalence has increased, the clinical criteria have changed and the way we explain (chronic) pain has altered. DESIGN: In the current study, we conducted a worldwide survey in which we investigate whether medical doctors are familiar with the American College of Rheumatology (ACR) criteria for fibromyalgia and, if so, whether these medical doctors adhere to the clinical guidelines following evidence-based treatments. RESULTS: In total, 286 medical doctors from 43 countries spread over 6 continents filled out the survey. In most of the countries, the diagnosis fibromyalgia was used. Only 10% adhere to the ACR criteria, widespread pain (44%), unrefreshed sleep (24%), fatigue (20%) and cognitive problems (8%) were most used diagnostic criteria. Of the respondents, 94 (32%) mentioned that the cause is unknown or idiopathic, but also a wide variety of other causes was mentioned. More than 70 different treatment options were provided, of which 24% of the responses were classified as according to the clinical guidelines. From this study, we conclude that many medical doctors do not follow the ACR criteria; the majority has an inappropriate knowledge of causes for fibromyalgia and that a minority of treatment advice adhere to the guidelines.
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Dolor Crónico , Fibromialgia , Reumatología , Humanos , Fibromialgia/diagnóstico , Fibromialgia/epidemiología , Fibromialgia/terapia , Dolor Crónico/etiología , Encuestas y Cuestionarios , FatigaRESUMEN
BACKGROUND: Although clinical practice guidelines recommend pain education as the first-line option for the management of chronic musculoskeletal pain, there is a lack of pain education programmes in healthcare. Thus, digital health programmes can be an effective tool for implementing pain education strategies for public health. This trial will aim to analyse the implementation and effectiveness outcomes of three online pain science education strategies in the Brazilian public health system (SUS) for individuals with chronic musculoskeletal pain. METHODS: We will conduct a hybrid type III effectiveness-implementation randomised controlled trial with economic evaluation. We will include adult individuals with chronic musculoskeletal pain, recruited from primary healthcare in the city of Guarapuava, Brazil. Individuals will be randomised to three implementation groups receiving a pain science education intervention (EducaDor) but delivered in different modalities: group 1) synchronous online; group 2) asynchronous videos; and group 3) interactive e-book only. Implementation outcomes will include acceptability, appropriateness, feasibility, adoption, fidelity, penetration, sustainability, and costs. We will also assess effectiveness outcomes, such as pain, function, quality of life, sleep, self-efficacy, and adverse effects. Cost-effectiveness and cost-utility analyses will be conducted from the SUS and societal perspectives. The evaluations will be done at baseline, post-intervention (10 weeks), and 6 months. DISCUSSION: This study will develop and implement a collaborative intervention model involving primary healthcare professionals, secondary-level healthcare providers, and patients to enhance self-management of chronic pain. In addition to promoting better pain management, this study will also contribute to the field of implementation science in public health by generating important insights and recommendations for future interventions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05302180; 03/29/2022).
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Dolor Crónico , Dolor Musculoesquelético , Adulto , Humanos , Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Análisis Costo-Beneficio , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/terapia , Brasil , Calidad de Vida , Salud Pública , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: The aims of this study were twofold: (1) to compare the body image and tactile acuity of patients with fibromyalgia and asymptomatic participants, and (2) to investigate the effects of an 8-week exercise-based intervention (aerobic or Pilates exercises) on the body image, tactile acuity, and pain intensity in patients with fibromyalgia. METHODS: A cross-sectional study and a secondary analysis of a randomized controlled trial were carried out, which assessed the following outcomes in 24 patients with fibromyalgia and 24 asymptomatic participants: subjective body image (Drawing Test), tactile acuity (Two-Point Discrimination Test), limb circumference (Cirtometry), and pain (Pain Numerical Rating Scale). After the assessment, the 24 patients with fibromyalgia were randomly allocated to one of the intervention groups: aerobic or Pilates. RESULTS: There was no significant difference in the tactile acuity of the cervical, lumbar, hands, and feet regions between the participants with fibromyalgia and the asymptomatic participants (p > 0.05). However, patients with fibromyalgia showed changes in subjective body image when the drawings were compared to the cirtometry measurements. After the intervention, there was no significant difference between aerobic exercise and Pilates for pain and tactile acuity in the cervical, lumbar, hands, and feet regions of patients with fibromyalgia (p > 0.05). CONCLUSIONS: Patients with fibromyalgia presented altered perception in subjective body image but not on tactile acuity, when compared to asymptomatic participants. In addition, there was no difference between aerobic exercise and Pilates for pain and tactile acuity in these patients.
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Fibromialgia , Humanos , Fibromialgia/terapia , Imagen Corporal , Estudios Transversales , Terapia por Ejercicio/métodos , DolorRESUMEN
BACKGROUND: Chronic musculoskeletal pain is one of the main causes of years lived with disability and generates the highest cost of health care among chronic pain conditions. Internet-based treatments have been shown to be an alternative for the treatment of musculoskeletal conditions, in addition to reducing barriers such as travel, high demands on the public health system, lack of time, lack of insurance coverage for private care, and high costs for long-term treatment. The aim of this clinical trial is to develop and test the effectiveness and cost-effectiveness of, an internet-based self-management program based on pain education and exercise for people with chronic musculoskeletal pain. METHODS: This is a prospectively registered, assessor-blinded, two-arm randomised controlled trial with economic evaluation comparing the Internet-based pain education and exercise intervention with a control group that will receive an online booklet. One hundred and sixty patients will be recruited from Sao Paulo, Brazil. Follow-ups will be conducted in post-treatment, 6 and 12 months after randomisation. The conduct of the study, as well as the evaluations and follow-ups will be carried out entirely remotely, through online platforms and telephone calls. The primary outcome will be pain intensity at post-treatment (8 weeks) measured using the 11-item Pain Numerical Rating Scale. Secondary outcomes will be biopsychosocial factors presents in the chronic musculoskeletal pain condition. Costs due to chronic musculoskeletal pain will be also measured, and cost-effectiveness analysis from a societal perspective will performed. DISCUSSION: Our hypothesis is that internet-based pain education and exercise will be better than an online booklet in reducing pain and improving biopsychosocial outcomes in patients with chronic musculoskeletal pain. In addition, we believe that there will be good acceptance of patients for the internet-based intervention and that internet-based intervention will be more cost effective than the online booklet. TRIAL REGISTRATION: The study was prospectively registered at ClinicalTrials.gov ( NCT04274439 , registered 18 February 2020).
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Dolor Crónico/terapia , Internet , Dolor Musculoesquelético/terapia , Folletos , Brasil , Dolor Crónico/economía , Análisis Costo-Beneficio , Terapia por Ejercicio/métodos , Estudios de Seguimiento , Humanos , Dolor Musculoesquelético/economía , Dimensión del Dolor , Estudios Prospectivos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Automanejo/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Computerized methods to analyze pain drawings (PDs) have been developed and may aid to measure the pain area more precisely. OBJECTIVE: The aim of this study was to verify whether examiners can reproduce the patient's PDs with acceptable reliability. METHODS: This was an intra-rater and inter-rater reliability study. The protocol consisted of 4 steps: (1) scanning of paper PDs; (2) sharing the digitalized PD images between examiners; (3) reproducing the PD images in the sketching application; and (4) calculating the pain area in pixels and percentages. We calculated intraclass correlation coefficients (ICCs; 2,1), the standard error of the measurement (SEM), and the smallest detectable difference (SDD). RESULTS: Reliability was tested using 31 PDs from 17 patients in our database (11 female [64.7%], mean age: 53.23 ± 11.57 years). Intra-rater reliability varied from ICC (2,1) = 0.991 (95% confidence interval [CI] = 0.982 to 0.996; SEM = 3,432.45; SDD = 162.39 pixels; P < 0.001) to ICC (2,1) = 0.992 (95% CI = 0.978 to 0.997; SEM = 3,412.96; SDD = 161.93 pixels; P < 0.001). Inter-rater reliability for the measurement between all examiners was considered excellent (ICC [2,1] = 0.976; 95% CI = 0.956 to 0.987; SEM =8,580.75; SDD = 256.76 pixels; P < 0.001), being higher between Examiners A and C (ICC [2,1] = 0.970; 95% CI = 0.936 to 0.986; SEM = 6,453.34; SDD = 222.67 pixels; P < 0.001). CONCLUSION: Our results show that intra- and inter-rater reliabilities were excellent when an examiner reproduced the paper PDs into digitalized PDs. This process gives clinicians and researchers the opportunity to analyze pain extent more precisely using a computerized method.
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Procesamiento de Imagen Asistido por Computador/métodos , Dimensión del Dolor/métodos , Adulto , Anciano , Algoritmos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
Leprosy is widely known because of progressive damage to the peripheral nerves. In spite of multidrug therapy, some patients develop chronic neuropathic pain after bacteriological cure. Chronic pain is associated with psychological distress and is also an important predictor of poor quality of life. The aim of this study is to assess psychological distress in leprosy patients with chronic neuropathic pain, and its repercussions on their quality of life. The sample of this cross-sectional study comprised patients with chronic neuropathic pain after multidrug therapy. Neuropathic pain was confirmed by clinical examination and by the Douleur neuropathique en 4 questions questionnaire. Pain intensity was assessed using a visual analogic scale (VAS) ruler. The psychological health of the participants was measured using the 12-item General Health Questionnaire, and the WHOQOL-bref was used to assess quality of life. The mean pain intensity reported by participants on the VAS was 7.1 cm (SD = 2.9). No differences in pain intensity with respect to gender were observed. Psychological distress was present in 76.2% of participants, being higher in those with Grade 2 of disability. Patients with psychological distress had the lowest mean scores in all domains of the WHOQOL-bref. The lowest mean scores according to domain were physical (9.9; SD = 3.3), followed by environment (11.9; SD = 3.0), psychological (13.5; SD = 2.6) and social relations (14.0; SD = 3.7). In conclusion, our study identified the presence of psychological distress in most of the participants. Patients with chronic neuropathic pain who were also found to have high psychological distress levels had higher pain intensity and a poorer quality of life.
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Lepra/complicaciones , Neuralgia/psicología , Calidad de Vida , Adulto , Personas con Discapacidad/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuralgia/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: The development and application of Artificial Intelligence (AI) and Machine Learning (ML) in healthcare have gained attention as a promising and powerful resource to change the landscape of healthcare. The potential of these technologies for injury prediction, performance analysis, personalized training, and treatment comes with challenges related to the complexity of sports dynamics and the multidimensional aspects of athletic performance. OBJECTIVES: We aimed to present the current state of AI and ML applications in sports science, specifically in the areas of injury prediction, performance enhancement, and rehabilitation. We also examine the challenges of incorporating AI and ML into sports and suggest directions for future research. METHOD: We conducted a comprehensive literature review, focusing on publications related to AI and ML applications in sports. This review encompassed studies on injury prediction, performance analysis, and personalized training, emphasizing the AI and ML models applied in sports. RESULTS: The findings highlight significant advancements in injury prediction accuracy, performance analysis precision, and the customization of training programs through AI and ML. However, future studies need to address challenges such as ethical considerations, data quality, interpretability of ML models, and the integration of complex data. CONCLUSION: AI and ML may be useful for the prevention, detection, diagnosis, and treatment of health conditions. In this Masterclass paper, we introduce AI and ML concepts, outline recent breakthroughs in AI technologies and their applications, identify the challenges for further progress of AI systems, and discuss ethical issues, clinical and research opportunities, and future perspectives.
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Inteligencia Artificial , Aprendizaje Automático , Deportes , Humanos , Traumatismos en Atletas , Rendimiento AtléticoRESUMEN
ABSTRACT: Recent studies highlight an interplay between pain perception and emotional responses. This necessitates a thorough investigation into how beliefs and motivational influences respond to visual stimuli of movements. Such an analysis is crucial for understanding the extent to which these factors contribute to disability levels associated with shoulder pain. We aimed to investigate the relationship between the perception of harm and the valence in images depicting shoulder movements and determine how these perceptions are linked to disability levels associated with shoulder pain. This cross-sectional study recruited 42 individuals with chronic shoulder pain. Participants were presented with 58 shoulder movements images. Each participant evaluated these images for emotional valence and arousal using the self-assessment manikin. For every image, they provided their level of avoidance, fear, and perception of harm in a numerical scale. We measured disability levels and pain catastrophizing using the Shoulder Pain and Disability Index and the Pain Catastrophizing Scale. A direct acyclic graph was used. Multiple linear regression analysis was conducted with shoulder disability as the dependent variable and perception of harm and valence as independent variables, adjusted for the confounders catastrophizing and arousal. This analysis resulted in a significant model (F4,37 = 11.44; adjusted R2 = 0.547; P < 0.01). The perception of harm to shoulder movement (ß = 0.11; P < 0.001; 95% confidence interval = 5.6-11.8) was significantly associated with the level of shoulder disability, whereas valence did not show a significant association (ß = 0.26; P = 0.15; 95% confidence interval = 1.7-10.8). The perception of harm associated with shoulder movements images during daily activities was associated with disability. Individuals who believe that shoulder movements are harmful have greater disability.
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OBJECTIVES: The rise in opioid prescriptions with a parallel increase in opioid use disorders remains a significant challenge in some developed countries (opioid epidemic). However, little is known about opioid consumption in low- and middle-income countries (LMICs). In this short report, we aim to discuss the increase in opioid consumption in LMICs by providing an update on the opioid perspective in Brazil. METHODS: We analyzed opioid sales on the publicly available Brazilian Health Regulatory Agency (ANVISA) database from 2015 to 2020. RESULTS: In Brazil, opioid sales increased 34.8â¯%, from 8,839,029 prescriptions in 2015 to 11,913,823 prescriptions in 2020, this represents an increase from 44 to 56 prescriptions for every 1,000 inhabitants. Codeine phosphate combined with paracetamol and tramadol hydrochloride were the most common opioids prescribed with an increase each year. CONCLUSIONS: The results suggest that opioid prescriptions are rising in Brazil in a 5 years period. Brazil may have a unique opportunity to learn from other countries and develop consistent policies and guidelines to better educate patients and prescribers and to prevent an opioid crisis.
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Trastornos Relacionados con Opioides , Tramadol , Humanos , Analgésicos Opioides/uso terapéutico , Países en Desarrollo , Prescripciones de Medicamentos , Trastornos Relacionados con Opioides/tratamiento farmacológicoRESUMEN
BACKGROUND: Subjective pain intensity can be measured using instruments like the Faces Pain Scale-Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Pain Rating Scale (NPRS), and Visual Analogue Scale (VAS). However, information on physiotherapists' and patients' knowledge and preference for these tools is scarce. OBJECTIVE: We investigated the knowledge and preference of physiotherapists and participants with musculoskeletal pain (MP) regarding the pain intensity measurement scales. METHODS: This cross-sectional study consisted of physiotherapists and participants with MP. Physiotherapists were recruited via social media for an online open survey, gathering sociodemographic, professional data, and their knowledge and preferences for pain intensity scales. Participants over 18 with MP, participated in interviews focusing on their familiarity and preferences for pain intensity scales. Data was analyzed descriptively, and Chi-squared test evaluated scale preferences. RESULTS: We included 352 physiotherapists (mean experience = 10.5 years) and 94 participants with MP. Of the physiotherapists, 94.3% were familiar with pain scales, but 30.4% struggled to differentiate them. The NPRS was the most used (56.3%) and preferred scale (52.4%). Among participants with MP, unfamiliarity was noted with all scales. After instruction, 46% preferred FPS-R, with preference varying by income and education levels (p < 0.001). CONCLUSION: We found a knowledge gap among physiotherapists in identifying pain intensity scales, with a preference for the NPRS among those familiar with the scales. Participants with MP had limited familiarity with these scales. After instructions, these participants preferred the FPS-R, particularly those with lower income and education levels.
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BACKGROUND: Computational linguistics allows an understanding of language structure and different forms of expression of patients' perceptions. AIMS: The aims of this study were (i) to carry out a descriptive analysis of the discourse of people with chronic low back pain using sentiment analysis (SA) and network analysis; (ii) to verify the correlation between patients' profiles, pain intensity and disability levels with SA and network analysis; and (iii) to identify clusters in our sample according to language and SA using an unsupervised machine learning technique. METHODS: We performed a secondary analysis of a qualitative study including participants with chronic non-specific low back pain. We used the data related to participants' feelings when they received the diagnosis. The SA and network analysis were performed using the Valence Aware Dictionary and sEntiment Reasoner, and the Speech Graph, respectively. Clustering was performed using the K-means algorithm. RESULTS: In the SA, the mean composite score was -0.31 (Sd. = 0.58). Most participants presented a negative discourse (n = 41; 72%). Word Count (WC) and Largest Strongly connected Component (LSC) positively correlated with education. No statistically significant correlations were observed between pain intensity, disability levels, SA, and network analysis. Two clusters were identified in our sample. CONCLUSION: The SA showed that participants reported their feeling when describing the moment of the diagnosis using sentences with negative discourse. We did not find a statistically significant correlation between pain intensity, disability levels, SA, and network analysis. Education level presented positive correlation with WC and LSC.
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Personas con Discapacidad , Dolor de la Región Lumbar , Humanos , Dolor de la Región Lumbar/diagnóstico , HablaRESUMEN
The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.
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Dolor de la Región Lumbar , Enfermedades del Sistema Nervioso Periférico , Humanos , Dolor de la Región Lumbar/diagnóstico , Consenso , Nocicepción , Dimensión del Dolor/métodos , AnalgésicosRESUMEN
Surgical nerve decompression in leprosy is indicated to prevent or treat nerve damage, and to improve sensory motor function and quality of life (QoL). The purpose of this study was to describe QoL of leprosy patients after surgical nerve decompression. Participants who underwent neurolysis in the last 5 years were recruited. The assessment consisted of collecting demographic and clinical information, QoL and its domain scores. Descriptive statistical analysis of demographic and clinical data was presented. Included 33 patients (43 +/- 11.0 years) who had neurolysis with a total of 61 nerves operated. The results of WHOQOL-bref showed that overall QoL mean was 11.2 (+/- 3.63) and domains scored as follow: physical (11.0 +/- 3.56), environment (11.47 +/- 2.11), psychological (13.29 +/- 2.79) and social relations (15.03 +/- 3.66). Measures of QoL should become part of the standard battery of tools used to assess health and well-being and it may contribute to identifying patients' needs in rehabilitation.
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Lepra/cirugía , Bloqueo Nervioso/métodos , Adulto , Estudios Transversales , Femenino , Humanos , Lepra/psicología , Masculino , Persona de Mediana Edad , Calidad de Vida , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Pain is a major public health concern associated with emotional disorders and physical disability and generates increased sick leave and healthcare expenditures. However, despite its social impact and the high pain-related costs, the training of healthcare professionals, such as physical therapists, in pain management is insufficient, leading to an inadequate therapeutic approach. This study aimed to determine the existence of a specific program on pain within the curricula of physical therapy careers in accredited universities in Chile. Out of 40 physical therapy careers, we analyzed 38 curricula. None of them had a specific discipline on pain management in their curricula. Although there is no concrete definition of the best modality for pain education in undergraduate students, it has been shown that following the International Association for The Study of Pain curricula improves students' knowledge and awareness of pain management.
El dolor es un importante problema de salud pública, asociado con trastornos emocionales y discapacidad física, generando un aumento en licencias laborales y gastos en el sistema de salud. Sin embargo, a pesar del impacto social y los altos costos relacionados con el dolor, hay una capacitación insuficiente en la formación de los profesionales de la salud, como kinesiólogos y fisioterapeutas sobre el manejo del dolor, lo que lleva a un abordaje terapéutico inadecuado. El objetivo de este estudio fue determinar la existencia de un programa específico en dolor dentro de las mallas curriculares de las carreras de kinesiología en universidades acreditadas en Chile. De 40 carreras de kinesiología, analizamos 38 mallas curriculares. Ninguna de ellas presentaba una disciplina específica sobre dolor en su plan de estudios. Si bien no hay una definición concreta sobre la mejor modalidad para la educación en dolor en alumnos de pregrado, se ha demostrado que seguir los planes de estudios de la impacta significativamente en el conocimiento y las creencias del dolor de los estudiantes.
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Curriculum , Dolor , Humanos , Chile , Dolor/etiología , Escolaridad , Modalidades de FisioterapiaRESUMEN
OBJECTIVES: The identification of factors that influence the efficacy of endogenous pain inhibitory pathways remains challenging due to different protocols and populations. We explored five machine learning (ML) models to estimate the Conditioned Pain Modulation (CPM) efficacy. DESIGN: Exploratory, cross-sectional design. SETTING AND PARTICIPANTS: This study was conducted in an outpatient setting and included 311 patients with musculoskeletal pain. METHODS: Data collection included sociodemographic, lifestyle, and clinical characteristics. CPM efficacy was calculated by comparing the pressure pain thresholds before and after patients submerged their non-dominant hand in a bucket of cold water (cold-pressure test) (1-4 °C). We developed five ML models: decision tree, random forest, gradient-boosted trees, logistic regression, and support vector machine. MAIN OUTCOME MEASURES: Model performance were assessed using receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, recall, F1-score, and the Matthews Correlation Coefficient (MCC). To interpret and explain the predictions, we used SHapley Additive explanation values and Local Interpretable Model-Agnostic Explanations. RESULTS: The XGBoost model presented the highest performance with an accuracy of 0.81 (95% CI = 0.73 to 0.89), F1 score of 0.80 (95% CI = 0.74 to 0.87), AUC of 0.81 (95% CI: 0.74 to 0.88), MCC of 0.61, and Kappa of 0.61. The model was influenced by duration of pain, fatigue, physical activity, and the number of painful areas. CONCLUSIONS: XGBoost showed potential in predicting the CPM efficacy in patients with musculoskeletal pain on our dataset. Further research is needed to ensure the external validity and clinical utility of this model.
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Dolor Musculoesquelético , Humanos , Dolor Musculoesquelético/terapia , Estudios Transversales , Aprendizaje Automático Supervisado , Pacientes Ambulatorios , Umbral del DolorRESUMEN
Actions towards the health-related Sustainable Development Goal 3.4 typically focus on non-communicable diseases (NCDs) associated with premature mortality, with less emphasis on NCDs associated with disability, such as musculoskeletal conditions-the leading contributor to the global burden of disability. Can systems strengthening priorities for an underprioritised NCD be codesigned, disseminated and evaluated? A 'roadmap' for strengthening global health systems for improved musculoskeletal health was launched in 2021. In this practice paper, we outline dissemination efforts for this Roadmap and insights on evaluating its reach, user experience and early adoption. A global network of 22 dissemination partners was established to drive dissemination efforts, focussing on Africa, Asia and Latin America, each supported with a suite of dissemination assets. Within a 6-month evaluation window, 52 Twitter posts were distributed, 2195 visitors from 109 countries accessed the online multilingual Roadmap and 138 downloads of the Roadmap per month were recorded. Among 254 end users who answered a user-experience survey, respondents 'agreed' or 'strongly agreed' the Roadmap was valuable (88.3%), credible (91.2%), useful (90.1%) and usable (85.4%). Most (77.8%) agreed or strongly agreed they would adopt the Roadmap in some way. Collection of real-world adoption case studies allowed unique insights into adoption practices in different contexts, settings and health system levels. Diversity in adoption examples suggests that the Roadmap has value and adoption potential at multiple touchpoints within health systems globally. With resourcing, harnessing an engaged global community and establishing a global network of partners, a systems strengthening tool can be cocreated, disseminated and formatively evaluated.
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Personas con Discapacidad , Enfermedades no Transmisibles , Humanos , Salud Global , Mortalidad Prematura , Estado de Salud , Enfermedades no Transmisibles/prevención & controlRESUMEN
Musculoskeletal (MSK) health impairments contribute substantially to the pain and disability burden in low- and middle-income countries (LMICs), yet health systems strengthening (HSS) responses are nascent in these settings. We aimed to explore the contemporary context, framed as challenges and opportunities, for improving population-level prevention and management of MSK health in LMICs using secondary qualitative data from a previous study exploring HSS priorities for MSK health globally and (2) to contextualize these findings through a primary analysis of health policies for integrated management of non-communicable diseases (NCDs) in select LMICs. Part 1: 12 transcripts of interviews with LMIC-based key informants (KIs) were inductively analysed. Part 2: systematic content analysis of health policies for integrated care of NCDs where KIs were resident (Argentina, Bangladesh, Brazil, Ethiopia, India, Kenya, Malaysia, Philippines and South Africa). A thematic framework of LMIC-relevant challenges and opportunities was empirically derived and organized around five meta-themes: (1) MSK health is a low priority; (2) social determinants adversely affect MSK health; (3) healthcare system issues de-prioritize MSK health; (4) economic constraints restrict system capacity to direct and mobilize resources to MSK health; and (5) build research capacity. Twelve policy documents were included, describing explicit foci on cardiovascular disease (100%), diabetes (100%), respiratory conditions (100%) and cancer (89%); none explicitly focused on MSK health. Policy strategies were coded into three categories: (1) general principles for people-centred NCD care, (2) service delivery and (3) system strengthening. Four policies described strategies to address MSK health in some way, mostly related to injury care. Priorities and opportunities for HSS for MSK health identified by KIs aligned with broader strategies targeting NCDs identified in the policies. MSK health is not currently prioritized in NCD health policies among selected LMICs. However, opportunities to address the MSK-attributed disability burden exist through integrating MSK-specific HSS initiatives with initiatives targeting NCDs generally and injury and trauma care.
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Países en Desarrollo , Enfermedades no Transmisibles , Humanos , Enfermedades no Transmisibles/prevención & control , Política de Salud , Atención a la Salud , DolorRESUMEN
BACKGROUND: Pain experience has a multidimensional nature. Assessment and treatment recommendations for pain conditions suggest clinicians use biopsychosocial approaches to treat pain and disability. The current pain research is overwhelmingly skewed towards the study of biological and psychological factors including interventions, whereas, cultural factors are often ignored. OBJECTIVE: The aims of this Masterclass is threefold: (1) to discuss cultural influences on pain, (2) to provide strategies for delivering appropriate pain education and exercises in culturally diverse people with chronic pain, and (3) to present challenges and future directions to clinicians and researchers. DISCUSSION: Cultural factors have a relevant influence on the way individuals experience and manage health and illness. Thus, people with different cultural experience perceive, respond, communicate and manage their pain in different ways. In this aspect, the contents of pain education should be presented using different culturally appropriate examples, metaphors, images, and delivery methods that may enhance the impact of the message. Efforts should be made to produce and spread culturally adapted evidence-based materials and resources. In addition, a culturally sensitive approach may help to introduce patients to graded activities, so that they can apply these strategies in culturally acceptable and meaningful ways. Future studies should investigate the effectiveness of culturally-adapted interventions in pain-related outcomes in different pain conditions in patients with different cultural backgrounds.
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Dolor Crónico , Dolor Musculoesquelético , Humanos , Dolor Musculoesquelético/terapia , Asistencia Sanitaria Culturalmente Competente , Modalidades de Fisioterapia , Dolor Crónico/terapiaRESUMEN
OBJECTIVES: We aim to determine the effectiveness of meditation for adults with non-specific low back pain. METHODS: We searched PubMed, EMBASE, PEDro, Scopus, Web of Science, Cochrane Library, and PsycINFO databases for randomized controlled trials that investigated the effectiveness of meditation in adults with non-specific low back pain. Two reviewers rated risk of bias using the PEDro scale and the certainty of the evidence using the GRADE approach. Primary outcomes were pain intensity and disability. RESULTS: We included eight trials with a total of 1,234 participants. Moderate-certainty evidence shows that meditation is better than usual care for disability at short-term (SMD = -0.22; 95% CI = -0.42 to -0.02). We also found that meditation is better than usual care for pain intensity at long-term (SMD = -0.28; 95% CI = -0.54 to -0.02). There is no significant difference for pain intensity between meditation and minimal intervention or usual care at short and intermediate-term. We did not find differences between meditation and minimal intervention for disability at intermediate-term or usual care in any follow-up period. CONCLUSIONS: We found small effect sizes and moderate-certainty evidence that meditation is slightly better than minimal intervention in the short-term for disability. Low-certainty of evidence suggests that meditation is slightly better than usual care for pain in the long-term. Meditation appears to be safe with most trials reporting no serious adverse events.