The use of a biopsychosocial model in the treatment of patients with chronic.

OBJECTIVE: To explore the available knowledge on the application of biopsychosocial model (BPS) in patients with chronic low back pain (CLBP). METHODS: A scoping review, including 32 papers that used a BPS to manage adult patients with CLBP, published in any language. Six different databases were searched. RESULTS: According to the description of the protocols, most of them use BPS for assessment of the patients. In this first stage the most often evaluated were pain and disability, kinesiophobia and quality of life, and work-related factors. The intervention most used associate psychological and physical domains using pain education or cognitive functional therapy and active exercise. Even though was not the most common, in the social domain occupational, behavioral and family interventions were observed. CONCLUSION: BPS is more often used as combination of physical and psychological aspects, being the social domain restricted to work-related factors. Patien'ts perception of their health status is little explored, and it is suggested that the International Classification of Functioning, Disability and Health be used. PRACTICE IMPLICATION: Patient perception as well as social factors in addition to occupational ones should be included in the clinical approach of the patient with CLBP and should be further explored in research.

Comparison between exercise therapy and non-hydrolyzed collagen (UC-II) in functionality and quality of life in women with knee osteoarthritis : A randomized controlled clinical trial.

BACKGROUND: Knee osteoarthritis (OA) is characterized by a progressive degeneration of cartilage and menisci, leading to pain and locomotor disability. Here, we aimed to assess the effect of an exercise protocol and the oral use of non-hydrolyzed collagen (UC-II) on the functionality and quality of life of women with knee OA. MATERIAL AND METHODS: Individuals were divided into three groups (CG [control group]; MG [medication group]; EG [exercise group]). In the CG there was no intervention, while MG received an oral dose (1 capsule/day) of UC-II and the EG held 12 sessions of an exercise protocol. RESULTS: In the functionality tests (6-min walk test, 6MWT and timed up and go test [TUG]) the EG (p < 0.001/p = 0.020) and MG (p = 0.010/p = 0.010) revealed a significant improvement when compared to the CG. In the analysis of quality of life by WOMAC, a significant improvement was found only in the EG (p = 0.030) when compared to the CG; the same happened in the stiffness domain (EG, p = 0.010), despite in the pain domain, both the EG (p < 0.001) and the MG (p = 0.060) were better than the CG. CONCLUSION: Data obtained here reveal that an exercise protocol and UC-II have similar effects for functionality, despite exercise being superior in promoting the quality of life score.

Do patients with low back pain and central sensitization have differences in physical fitness?

INTRODUCTION: Low back pain is one of the main musculoskeletal complaints, and may be associated with central sensitization (CS). The physical capacity of patients with low back pain and CS is not very clear. METHODS: A cross-sectional study, with 92 patients divided into two groups according to their risk of CS. The patient's physical capacity ability was assessed using 6-min walking test (6MWT); timed up and go test (TUG); sit-to-stand test (STS); and trunk flexor, extensor and side-bridge endurance tests. In addition, participants completed questionnaires regarding disability, kinesiophobia, catastrophization and quality of life. RESULTS: The group with a higher risk of CS had worst performance in the 6MWT (U = 1248; p < 0.001), STS (t(83) = 3.63; p < 0.001) and TUG (t(83) = -4.46; p < 0.001). Similarly, endurance in the right (U = 1453,5; p = 0,002) and left (U = 1467; p = 0,003) side-bridge tests, and the trunk extensor test (U = 1546; p = 0,003) was worse. Disability (U = 1272; p < 0.001), physical capacity kinesiophobia (t(83) = -2.21; p = 0.03) work kinesiophobia (U = 1452; p < 0.001), and pain catastrophization (t(77.57) = -5.03; p < 0.001), were also higher in the group with a higher risk of CS. Quality of life indicators were worse in the higher risk group for all domains of the EQ-5D-3L: Mobility (X2(1) = 12.92; p < 0.001), self-care (X2(1) = 16,3; p = 0,012), usual activities (X2(2) = 14.14; p = 0.001), pain (X2(2) = 27.79; p < 0.001), anxiety and depression (X2(2) = 15.05; p = 0.001). CONCLUSION: Patients with low back pain and higher risks of CS appear to show lower performance in physical capacity tests, higher rates of disability, kinesiophobia, pain catastrophization, and lower quality of life compared to those with lower risks of CS.

The Management between Comorbidities and Pain Level with Physical Activity in Individuals with Hip Osteoarthritis with Surgical Indication: A Cross-Sectional Study.

Background and Objectives: The degenerative pathology of the hip joint appears in young age groups, related to fem-oroacetabular impingement, and in advanced age, due to other inflammatory causes, with greater potential for severity in the presence of comorbidities. Objectives: To evaluate the participation of the main causes of osteoarthritis in relation to physical activities, s Body Mass Index (BMI) and television time (TV). Materials and Methods: 54 patients with surgical indication treated at an orthopedic referral university hospital were stratified into groups (Impact: I, Osteonecrosis/rheumatic: II, Infectious/traumatic: III), and the influence of comorbidities on physical activity performance, relative to BMI and TV time. Results: It was observed that the impact group was the most frequent (51.8%), with 79.6% under the age of 60 years. This group followed the general mean (p < 0.05), using the variables of comorbidity and the level of physical activity. Pain intensity, TV time, BMI showed no correlation with physical activity. Conclusion: Morphostructural changes (group I) represented the most frequent etiological group, and severe pain was common in almost the entire sample. Unlike BMI, comorbidity showed a significant relationship with the level of physical activity.

Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU.

BACKGROUND: Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. MATERIALS AND METHODS: This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). RESULTS: A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23-636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002-0.30). CONCLUSION: Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.

Do the commonly used standard questionnaires measure what is of concern to patients with low back pain?

OBJECTIVE: Evaluate whether questionnaires identified all the self-reported patient outcomes raised in focus groups. DESIGN: Mixed methods research combined with qualitative analysis of focus groups. SETTINGS: Physical therapy clinic in a teaching hospital in Brazil. SUBJECTS: A total of 27 patients (aged >18 years, mean age 55.2 years) with chronic non-specific low back pain. INTERVENTIONS: Three focus groups were conducted by the same investigator and analyzed by meaning unit condensation. The results obtained from the focus groups were codified according to the International Classification of Functioning. A similar process was adopted to codify the Roland-Morris Disability Questionnaire, the Quebec Back Pain Disability Scale and the Oswestry Disability Index according to the International Classification of Functioning. The results of both coding processes were compared. RESULTS: In the analysis, seven main concepts were identified, comprising 77 meaning units. Only three meaning units were not linked to the International Classification of Functioning. Most of the codes present in the questionnaires and focus groups represent limitations to activities. Some codes were identified in the questionnaires that were not mentioned by the focus group participants. No questionnaire assessed environmental factors or problems related to specific parts of the body, and very few assessed body function, all of which were issues raised in the focus groups. CONCLUSION: This study shows that not all fields considered important by patients to their function are being evaluated, and emotional and contextual factors should be included in clinical assessments in order to fully understand patient need.

The Influence of Clinical, Functional, and Psychosocial Factors on Walking Time in Individuals With Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to investigate whether clinical, functional, and psychosocial factors are associated with walking time in patients with chronic low back pain. METHODS: This study included patients aged ≥18 years with low back pain for at least 3 months who visited our outpatient clinic between October 2017 and February 2018. We used the following scales/questionnaires: International Physical Activity Questionnaire for self-reported walking time, Numerical Pain Rating Scale for pain intensity, self-report assessing symptom duration, Roland Morris Disability Questionnaire for disability, Patient-Specific Functional Scale for function, Pain Catastrophizing Scale for pain catastrophizing, and screening questions to assess depression and anxiety. Odds ratios (ORs) with their respective 95% CIs were obtained using logistic regression analysis. RESULTS: Neither clinical nor functional factors were associated with the total walking time. Among psychosocial factors, only anxiety showed a negative association with the total walking time (OR 0.23, 95% CI 0.06-0.82)-an association that persisted even after adjusting for confounders (OR 0.15, 95% CI 0.03-0.77). CONCLUSION: Anxiety was shown to be associated with the total walking time in patients with CLBP. No clinical or functional factors seem to be associated with walking in this study sample.

Assessment of Cardiometabolic Risk Factors, Physical Activity Levels, and Quality of Life in Stratified Groups up to 10 Years after Bariatric Surgery.

Obesity is a highly prevalent chronic metabolic disease, with an increasing incidence, and is currently approaching epidemic proportions in developing countries. Ouraim was to evaluate the activity levels, quality of life (QoL), clinical parameters, laboratory parameters, and cardiometabolic risk factors afterbariatric surgery (BS). We classified78 patients who underwentBS into four groups, as follows: Those evaluated 1-2 years after BS (BS2), 2-4 years after BS (BS4), 4-6 years after BS (BS6), and 6-10 years after BS (BS+6). Body weight (BW), body mass index (BMI), comorbidities associated with obesity (ACRO), physical activity level, and QoL were evaluated. Patients exhibited improvements in BW, BMI, cardiometabolic risk, hypertension, dyslipidemia, and diabetes and significant changes in lipid profiles in the first postoperative yearafter BS.The physical activity level inthe BS2, BS4, and BS6 groups was increased, compared with that in the first postoperative year, with a decrease in International Physical Activity Questionnaire scores at 1 year in the BS2 (207.50 ± 30.79), BS4 (210.67 ± 33.69), and BS6 (220.00 ± 42.78) groups. The QoL of patients in theBS2 and BS4 groups was excellent and that of patients in the BS4 and BS+6 groupswas very good. These findings suggest that BS promoted improved physical activity levels and QoL and reduced comorbidities in patients with morbid obesity.

Radiographic measurement of the cervical spine in patients with temporomandibular dysfunction.

AIM: To compare the craniocervical angles and distances between temporomandibular dysfunction (TMD) and free TMD subjects. CASUISTIC AND METHODS: The sample consisted of young adults, of both genders, with age ranging between 18 and 30 years. TMD diagnosis was based on the clinical criteria of the Research Diagnostic Criteria for TMD (RDC/TMD), associated with self-reported symptoms of TMD. For radiological analysis we measured three angles and two distances of craniocervical region. RESULTS: Of the 56 subjects, only 23 completed all stages of research, which were divided into two groups: (1) free TMD group - composed of 11 individuals; (2) TMD group - constituted of 12 subjects. The most common clinical diagnosis of TMD was arthralgia (75.0%) followed by myofascial pain without limited mouth opening (58.4%). Among the self-reported symptoms of TMD, the most frequents were facial (83.4%) and neck (66.6%) pain. Of radiological measurement, only plane atlas angle (APA) (p=0.026) and anterior translation distance (Tz C(2)-C(7)) (p=0.045) showed statistical difference between groups TMD (APA=16.7+/-1.63; Tz C(2)-C(7)=28.7+/-2.58) and free TMD (APA=21.64+/-1.24; Tz C(2)-C(7)=19.82+/-3.29). CONCLUSION: It could be verified that the symptomatic TMD patients presented a flexion of the first cervical vertebra associated with an anteriorization of the cervical spine (hyperlordosis).