Cognitive functional therapy compared with core exercise and manual therapy in patients with chronic low back pain: randomised controlled trial.

ABSTRACT: Cognitive functional therapy (CFT) is a physiotherapy-led intervention that has evolved from an integration of foundational behavioral psychology and neuroscience within the physiotherapist practice directed at the multidimensional nature of chronic low back pain (CLBP). The current evidence about the comparative effectiveness of CFT for CLBP is still scarce. We aimed to investigate whether CFT is more effective than core training exercise and manual therapy (CORE-MT) in pain and disability in patients with CLBP. A total of 148 adults with CLBP were randomly assigned to receive 5 one-hour individualized sessions of either CFT (n = 74) or CORE-MT (n = 74) within a period of 8 weeks. Primary outcomes were pain intensity (numeric pain rating scale, 0-10) and disability (Oswestry Disability Index, 0-100) at 8 weeks. Patients were assessed preintervention, at 8 weeks and 6 and 12 months after the first treatment session. Altogether, 97.3% (n = 72) of patients in each intervention group completed the 8 weeks of the trial. Cognitive functional therapy was more effective than CORE-MT in disability at 8 weeks (MD = -4.75; 95% CI -8.38 to -1.11; P = 0.011, effect size= 0.55) but not in pain intensity (MD = -0.04; 95% CI -0.79 to 0.71; P = 0.916). Treatment with CFT reduced disability, but the difference was not clinically important compared with CORE-MT postintervention (short term) in patients with CLBP. There was no difference in pain intensity between interventions, and the treatment effect was not maintained in the mid-term and long-term follow-ups.

Pain Characteristics and Their Relationship With Motor Dysfunction in Individuals With Parkinson Disease-A Cross-Sectional Study.

BACKGROUND: Pain is a common symptom in Parkinson disease (PD). OBJECTIVES: To analyze the relationship between pain and motor dysfunction in individuals with PD. METHODS: Fifty-four individuals with PD were screened: Hoehn and Yahr scale score = 2.5 (1 to 4); median (range) age in the "on" period of anti-Parkinson medication was 66 (44 to 85) years. Pain was assessed using King's Parkinson's Disease Pain Scale (KPPS) and the Brief Pain Inventory (BPI). Performance in routine activities and motor function were assessed using Unified Parkinson Disease Rating Scale (UPDRS II and III); gait was assessed using the Dynamic Gait Index; and balance was assessed using the Mini-BESTest. RESULTS: Thirty-eight participants (70.3%) reported mild to moderate pain. A positive correlation was found between the total KPPS score and performance in general activities (UPDRS II) (rho = 0.29, P = 0.04); a negative correlation was found between pain intensity (BPI intensity) and motor function (UPDRS III; rho = -0.28, P = 0.04); and a negative correlation was found between pain intensity (BPI intensity) and the bradykinesia subscore of the UPDRS III (rho = -0.29, P = 0.04). There was no correlation between pain and gait performance or balance. The musculoskeletal pain was the predominant type (in 81.5% of subjects), followed by nocturnal pain (52.6%) and fluctuation-related pain (47.3%). The most painful areas were lower limbs (33.0%) and shoulders/cervical area (31.0%). Twenty-one of 38 participants (55.3%) reported pain interference in their working and walking ability and general activities. CONCLUSIONS: Pain was weakly correlated with performance in general activities and with bradykinesia but was not correlated with the remaining classic motor PD symptoms, either gait or balance performance. Pain was a prevalent symptom in the present sample, and the individuals reported its interference with functionality.

Patients with Subacromial Pain Syndrome Present no Reduction of Shoulder Proprioception: A Matched Case-Control Study.

BACKGROUND: Shoulder pain is common among patients with musculoskeletal pain and the prevalence of patients with subacromial pain syndrome (SAPS) is high. Despite the high prevalence, there is a lack of an extensive evaluation of the proprioception acuity in patients with SAPS. Knowledge of the proprioceptive deficit would assist clinicians in the proper treatment and may offer an alternative explanation for the mechanisms underlying SAPS, which are poorly understood. OBJECTIVE: To compare the proprioceptive function of the shoulder in patients with SAPS and matched controls. STUDY DESIGN: Matched case-control study. SETTING: Physical Functional Rehabilitation Service of an outpatient clinic. PARTICIPANTS: A total of 32 consecutive patients with SAPS who sought physical therapy for shoulder pain and 32 healthy participants (control group) matched for age, sex, and handedness. INTERVENTIONS: All participants completed a questionnaire containing sociodemographic information, pain intensity and characteristics, the Numerical Pain Rating Scale, and the Shoulder Pain and Disability Index. MAIN OUTCOME MEASUREMENTS: The proprioceptive assessment was performed through kinesthesia, passive joint position sense (PJPS), and the active joint position sense (AJPS). RESULTS: The groups showed no statistically significant differences in kinesthesia, PJPS, and AJPS for internal or external rotation. The proprioceptive acuity was not associated with pain intensity or functional disability in patients with SAPS. CONCLUSIONS: Participants with SAPS did not present proprioceptive deficits in a pain-free motion of medial and lateral rotation when compared to their matched controls. The proprioceptive deficit may not be involved with the mechanisms underlying SAPS and seems not to interfere with the clinical outcomes of patients with SAPS. LEVEL OF EVIDENCE: Level III.

Analysis of the user satisfaction level in a public physical therapy service.

BACKGROUND: The concepts of quality management have increasingly been introduced into the health sector. Methods to measure satisfaction and quality are examples of this trend. OBJECTIVE: This study aimed to identify the level of customer satisfaction in a physical therapy department involved in the public area and to analyze the key variables that impact the usersâ€(tm) perceived quality. METHOD: A cross-sectional observational study was conducted, and 95 patients from the physical therapy department of the Hospital Universitário Gaffrée e Guinle - Universidade Federal do Estado do Rio de Janeiro (HUGG/UNIRIO) - Rio de Janeiro, Brazil, were evaluated by the SERVQUAL questionnaire. A brief questionnaire to identify the sociocultural profile of the patients was also performed. RESULTS: Patients from this health service presented a satisfied status with the treatment, and the population final average value in the questionnaire was 0.057 (a positive value indicates satisfaction). There was an influence of the educational level on the satisfaction status (χ²=17,149; p=0.002). A correlation was found between satisfaction and the dimensions of tangibility (rho=0.56, p=0.05) and empathy (rho=0.46, p=0.01) for the Unsatisfied group. Among the Satisfied group, the dimension that was correlated with the final value of the SERVQUAL was responsiveness (rho=0.44, p=0.01). CONCLUSIONS: The final values of the GGUH physical therapy department showed that patients can be satisfied even in a public health service. Satisfaction measures must have a multidimensional approach, and we found that people with more years of study showed lower values of satisfaction.

Analysis of the user satisfaction level in a public physical therapy service

BACKGROUND: The concepts of quality management have increasingly been introduced into the health sector. Methods to measure satisfaction and quality are examples of this trend. OBJECTIVE: This study aimed to identify the level of customer satisfaction in a physical therapy department involved in the public area and to analyze the key variables that impact the usersâ€(tm) perceived quality. METHOD: A cross-sectional observational study was conducted, and 95 patients from the physical therapy department of the Hospital Universitário Gaffrée e Guinle - Universidade Federal do Estado do Rio de Janeiro (HUGG/UNIRIO) - Rio de Janeiro, Brazil, were evaluated by the SERVQUAL questionnaire. A brief questionnaire to identify the sociocultural profile of the patients was also performed. RESULTS: Patients from this health service presented a satisfied status with the treatment, and the population final average value in the questionnaire was 0.057 (a positive value indicates satisfaction). There was an influence of the educational level on the satisfaction status (χ‡Â²=17,149; p=0.002). A correlation was found between satisfaction and the dimensions of tangibility (rho=0.56, p=0.05) and empathy (rho=0.46, p=0.01) for the Unsatisfied group. Among the Satisfied group, the dimension that was correlated with the final value of the SERVQUAL was responsiveness (rho=0.44, p=0.01). CONCLUSIONS: The final values of the GGUH physical therapy department showed that patients can be satisfied even in a public health service. Satisfaction measures must have a multidimensional approach, and we found that people with more years of study showed lower values of satisfaction. .