RESUMEN
El objetivo de la presente revisión sistemática consistió en determinar el efecto de la comunicación en el ámbito sanitario sobre la kinesiofobia. Para ello, se realizó una búsqueda bibliográfica en siete bases de datos entre noviembre de 2022 y febrero de 2023. La revisión se efectuó acorde a la declaración Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) y para el análisis de la calidad metodológica se utilizaron: la escala Physiotherapy Evidence Database (PEDro), los criterios de Van Tulder y el análisis del riesgo de sesgo de la Colaboración Cochrane. Se incluyeron un total de 13 artículos que presentaron una calidad metodológica media de 7,1 sobre 10. Se obtuvieron resultados significativos para al menos una variable (kinesiofobia, discapacidad o nivel de actividad física) en 12 trabajos. Existe evidencia sólida de que la comunicación puede influir sobre la kinesiofobia del sujeto. Es más probable que esta influencia ocurra en un sentido negativo o discapacitante, pero también puede actuar en sentido positivo disminuyendo la misma. (AU)
The aim of the present systematic review was to determine the effect of communication in the health care setting on kinesiophobia. To this end, a literature search was conducted in seven databases between November 2022 and February 2023. The review was carried out following the PRISMA statement and for the analysis of methodological quality we used: PEDro Scale, Van Tulder criteria and risk of bias analysis of the Cochrane Collaboration. A total of 13 articles were included with a mean methodological quality of 7.1 out of 10. Significant results were obtained for at least one variable (kinesiophobia, disability or level of physical activity) in 12 articles. There is strong evidence that communication can influence a subject's kinesiophobia. This influence is most likely to be in a negative or disabling sense, but it can also act in a positive sense by decreasing it. (AU)
Asunto(s)
Humanos , Información de Salud al Consumidor , Efecto Placebo , Efecto Nocebo , Conducta Sedentaria , Factores de RiesgoRESUMEN
The aim of the present systematic review was to determine the effect of communication in the health care setting on kinesiophobia. To this end, a literature search was conducted in seven databases between November 2022 and February 2023. The review was carried out following the PRISMA statement and for the analysis of methodological quality we used: PEDro Scale, Van Tulder criteria and risk of bias analysis of the Cochrane Collaboration. A total of 13 articles were included with a mean methodological quality of 7.1 out of 10. Significant results were obtained for at least one variable (kinesiophobia, disability or level of physical activity) in 12 articles. There is strong evidence that communication can influence a subject's kinesiophobia. This influence is most likely to be in a negative or disabling sense, but it can also act in a positive sense by decreasing it.
Asunto(s)
Personas con Discapacidad , Kinesiofobia , Humanos , Ejercicio Físico , Comunicación , Dimensión del DolorRESUMEN
Los sistemas no lineales no son susceptibles de ser investigados con métodos reduccionistas. En este sentido, la teoría de la complejidad ofrece un enfoque alternativo para cuantificar la importancia de los factores contextuales en el paciente con dolor musculoesquelético. El resultado del uso positivo (placebo) o negativo (nocebo) de factores contextuales en el entorno terapéutico, podría ser responsable de gran parte de un componente inespecífico en la eficacia del tratamiento, afectando directamente la calidad de los resultados relacionados con la salud del paciente (por ejemplo, dolor, funcionalidad o satisfacción). En los últimos años, se ha incrementado la comprensión del valor de estos efectos. A pesar del creciente interés, el conocimiento y el reconocimiento de los efectos terapéuticos, continúan siendo limitados y heterogéneos entre los fisioterapeutas, lo cual reduce su valor traslacional en el campo de la fisioterapia. El propósito de este estudio es presentar el abordaje el paciente con dolor musculoesquelético desde la perspectiva la teoría de la complejidad.
Nonlinear systems are not susceptible to research with a reductionist approach. In this sense, the complexity theory provides an alternative approach to quantify the importance of contextual factors in patients with musculoskeletal pain. The use of positive (placebo) or negative (nocebo) contextual factors in the therapeutic setting could largely account for the non-specific component of treatment efficacy, directly affecting the quality of patients' health-related outcomes (e.g., pain, disability, or satisfaction). In recent years, there has been a better understanding of the effects of contextual factors. However, the knowledge and awareness of them is limited and heterogeneous among physical therapists, reducing their translational value in the field of physiotherapy. The purpose of this essay is to describe the management of patients with musculoskeletal pain from the complexity theory perspective.
Asunto(s)
Análisis de Sistemas , Dolor Musculoesquelético , Placebos , Modalidades de Fisioterapia , Efecto NoceboRESUMEN
When we apply a physical or pharmacological treatment, there are many things that may explain the clinical improvement experienced by a patient. The drugs or physical agents applied are important, but we must also add other elements in the context of the patient-therapist relationship. Scientific evidence has proven that the placebo effect exists. This is a true biopsychosocial phenomenon produced by the context in which an intervention is carried out. Biases aside, placebo and nocebo responses are changes in patients' symptoms, due to their participation at the therapeutic meeting, with its rituals, symbols and interactions. This multitude of signals inherent in any intervention, is perceived and interpreted by patients and can create positive or negative expectations.
Asunto(s)
Efecto Placebo , Relaciones Profesional-Paciente , Actitud Frente a la Salud , Conducta Ceremonial , Humanos , Efecto Nocebo , SimbolismoRESUMEN
O respeito ao princípio da autonomia e consentimento informado obriga o médico a explicar ao paciente os efeitos secundários das terapêuticas que prescreve. Entre eles, há o chamado efeito nocebo, cujas especificidades, detalhadas neste artigo a partir da oftalmologia, implica que o fornecimento da informação possa vir a contrariar o princípio da não maleficência a pacientes vulneráveis. O consentimento informado em oftalmologia para drogas off-label traz nova questão ético-jurídica, que este artigo aborda a partir dos riscos do efeito nocebo. O médico tem o dever de esclarecer e o paciente, o direito de ser esclarecido sobre as vantagens, desvantagens, riscos, benefícios de qualquer medicação. O "consentimento informado contextualizado" pretende atenuar a resposta nocebo de modo a preservar tanto a autonomia do paciente quanto a ação não maleficente do médico...
The respect to the principle of autonomy and informed consent obligates physicians to explain patients the possible side effects when prescribing medications. This disclosure may itself induce adverse effects or negative placebo. This fact contradicts the principle of non-maleficence in vulnerable patients as in ophthalmological disease. There is some tension between information to the patient that takes into account possible side effects. The Informed consent to patient for off label drugs used for example in ophthalmology is a new contextualized legal ethical question. This article has for objective to alert to the doctor for the effect risk nocebo. The doctor has the duty to explain and the patient the right to be explained about the advantages, disadvantages, risks and benefits of any medication. The contextualized informed consent suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through, by means of the form as it informs...
El respeto al principio de la autonomía y consentimiento informado obliga al médico explicar al paciente los efectos secundarios de las terapéuticas prescritas. Entre ellos, existe el llamado efecto nocebo, cuyas especificidades, detalladas en este artículo desde la oftalmología, supone que el suministro de la información pueda contradecirse al principio de la no maleficencia a pacientes vulnerables. El consentimiento informado en oftalmología para drogas off-label trae una nueva cuestión ético-jurídico que plantea este artículo a partir de los riesgos del efecto nocebo. El médico tiene el deber de aclarar y el paciente el derecho de ser aclarado acerca de las ventajas, las desventajas, los riesgos, beneficios de cualquier medicamento. El "consentimiento informado contextualizado" pretende mitigar la respuesta nocebo para preservar tanto la autonomía del paciente cuanto a la acción no maleficente del médico...
