Contextual Factors-Enriched Standard Care on mechanical neck pain (ContextualizAR trial): Protocol for a randomised controlled trial.

BACKGROUND: Understanding the influence of contextual factors (CFs) on interventions for mechanical neck pain (MNP) is essential for evidence-based practice in physical therapy. However, the specific effects and synergies of combining different CFs remain unclear. OBJECTIVE: The primary purpose of this study will be to determine if a CFs-Enriched Standard Care (SC) approach is an effective treatment for MNP in terms of reducing pain and improving function. METHODS: This will be an assessor-blinded, 2-group (1:1) randomised clinical trial (RCT) aiming to enrol 94 participants with neck pain persisting for more than 4 weeks. Both groups will undergo 4 weeks of SC twice weekly, following established clinical practice guidelines. In the intervention group, CFs will be enhanced, encompassing the physical, psychological, and social elements inherent in the clinical encounter, based on existing evidence. The primary outcomes will encompass changes in pain and disability after 4 weeks of treatment, with a follow-up reassessment at week 12 post-treatment. Secondary outcomes will include changes in Active Range of Motion, Global Rating of Change, and Satisfaction with treatment. The change between groups after treatment and at the 12-week follow-up will be reported for all outcomes, considering the difference from scores recorded at baseline. RESULTS: We hypothesise that a 4-week CFs-Enriched SC approach will be superior to SC alone in terms of patient-reported disability and pain, with measurements conducted using the Northwick Park Neck Pain Questionnaire and the Numeric Pain Rating Scale, respectively. CONCLUSION: This RCT rigorously assesses the effect of purposeful manipulation of CFs during MNP treatment. By elucidating the role of these factors, our findings have the potential to significantly refine clinical practice in managing MNP, thereby enhancing patient care, and advancing the fields of physical therapy and rehabilitation.

Prevalence of positive modified scapular assistance test in patients with shoulder pain with and without scapular dyskinesis: a cross-sectional study.

BACKGROUND: Scapular dyskinesis (SD) is defined as an altered position of the scapula or altered motion patterns and their relationship with shoulder pain (SP) is still under debate. The modified scapular assistance test (mSAT) modifies scapular kinematics and is used to determine the impact of scapular dyskinesis in shoulder pain. However, data about the relationship between SD and the result of mSAT is scarce. PURPOSE: The aim of this study is to establish the frequency of positive mSAT in patients with SP and compare the prevalence in those with and without SD. As a secondary objective, we compare changes in pain intensity during the mSAT in patients with a positive test between those with and without SD. STUDY DESIGN: Cross-sectional study. METHODS: Adult patients with a diagnosis of SP and with pain ≥2 during anterior flexion were included. The mSAT, scapular dyskinesis test (SDT), and shoulder function were assessed. RESULTS: The study was conducted between August 2018 and May 2022 and included 70 patients. The prevalence of SDT was 54.29%. No statistically significant associations were detected when assessing the relation between the presence of mSAT and SDT (p-value 0.83). When comparing pain response during the mSAT in patients with a positive test, no differences were seen between patients with SD and patients without SD (p-value 0.26). CONCLUSIONS: The prevalence of positive mSAT results was equal between individuals with and without SD. These findings suggest that the presence or absence of SD in individuals with SP was independent of the mSAT result. The mSAT should not be used solely for the assessment of SD in clinical practice nor be influenced by the SDT result. More research is needed to determine if the result of this test could inform prognosis and guide treatment choices.

Injury Surveillance and Training Load Methods Used by Health Professionals in Tennis: An Online Multinational Survey.

CONTEXT: Injury surveillance and training load monitoring are both essential for the development of preventative strategies for gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players on whether and how they monitor injuries and training load. DESIGN: A cross-sectional multinational online open-survey. METHODS: The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels, a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020 to April 2021. RESULTS: 72 health professionals from 27 different countries working with elite tennis players responded to the survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring are injury prevention (94%), training planning (81%), and player feedback (53%). CONCLUSIONS: Despite a high percentage of health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers reported for adequately monitoring injuries.

Complexity theory in the management of patients with musculoskeletal pain / Teoría de la complejidad en la atención del paciente con dolor musculoesquelético

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.

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.

Teoría de la complejidad en la atención del paciente con dolor musculoesquelético / Complexity theory in the management of patients with musculoskeletal pain

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.

Complexity theory in the management of patients with pain

Nonlinear systems are not susceptible to being investigated with reductionist methods. In this sense, complexity theory offers an alternative approach to quantify the importance of contextual factors (CFs) in the patient with pain. The result of the positive (placebo) or negative (nocebo) use of CFs in the therapeutic setting could be responsible for a large part of a non-specific component of the efficacy of the treatment, directly affecting the quality of the results related to the patient's health (for example, pain, disability, or satisfaction). In recent years, understanding of the value of these effects has increased. Despite growing interest, knowledge, and awareness of them is currently limited and heterogeneous among health professionals, reducing their translational value in the field of health.Keywords: complexity, contextual factors, pain, health professionals, placebo, nocebo.

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 (FCs) en el paciente con dolor. El resultado del uso positivo (placebo) o negativo (nocebo) de FCs en el tratamiento podría ser responsable de gran parte de un componente no específico de 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 la conciencia de ellos es actualmente limitado y heterogéneo entre profesionales de la salud, lo que reduce su valor traslacional en el campo de la salud.Palabras clave: complejidad; factores contextuales; profesionales de la salud; dolor; placebo; nocebo.

Standard measurement error and minimal detectable change of the Back-PAQ ArgSpan questionnaire: Secondary analysis.

BACKGROUND: Negative attitudes and beliefs about back pain in patients with low back pain (LBP) are associated with high levels of pain and negatively influence clinical outcome. The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to assess back beliefs of patients and healthcare professionals. The minimal detectable change (MDC) is defined as the smallest amount of change that can be detected not due to inherent variation or "noise" in the measure. The MDC values at 68%, 90% and 95% confidence levels of the Back-PAQ ArgSpan are unknown. OBJECTIVE: to calculate standard error measurement (SEM) and MDC to confirm the feasibility of Back-PAQ ArgSpan as a reliable outcome measure in clinical and research settings. STUDY DESIGN: a secondary analysis was carried out using a subgroup of data from the cross-cultural adaptation and validation of the Argentine version of the Back PAQ. METHOD: SEM was calculated (SD × âˆš1 - ICC) and MDC as (SEM × z-value × âˆš2). MDC was calculated as percentage as well. RESULTS: the SEM was 5.16 points. The MDC68, MDC90 and MDC95 of the Back-PAQ were 7.30, 12 and 14.3 points, respectively. The percentages of MDC68, MDC90 and MDC95 of the Back-PAQ were 6.7%, 11.0% and 13.1%, respectively. CONCLUSION: The present study demonstrated that the Back-PAQ ArgSpan is a reliable and interpretable measurement tool. When assessing a patient, a change in the score in the Back-PAQ ArgSpan over 15 points shows a true change at 95% confidence level.

Beliefs and attitudes about low back pain in Argentina: A cross-sectional survey using social media.

BACKGROUND: low back pain (LBP) is highly prevalent, very disabling and carries an enormous economic burden. The multifactorial nature of LBP often does not allow identification of a single pathoanatomic driver of pain. Unhelpful beliefs are associated with elevated levels of pain and may have a negative impact on the recovery of an episode of LBP. Beliefs about the back and back pain have not been evaluated in the Argentine general population. OBJECTIVE: to assess the beliefs about the back and back pain of the Argentine population. The secondary objective was to compare the beliefs between respondents with and without LBP and between those who had and had not seen a health care professional (HCP). STUDY DESIGN: cross-sectional study. METHOD: we included Argentinians aged 18 years or more with or without LBP. The Argentine version of Back Pain Attitudes Questionnaire (Back-PAQ) was used to assess back beliefs. RESULTS: one thousand and ninety-two participants responded the survey. Current LBP was reported by 42.3% (95% CI 39.3-45.2) of respondents and the life-time prevalence was 88.4% (95% CI 82.6-94.5). The mean Back-PAQ score was 111.7 (95% CI 111-112.5). Significant differences were found when comparing means scores of the current pain group with past and never LBP groups (p < 0.001). There were no difference in mean scores between respondents who were and were not exposed to a HCP. CONCLUSION: Survey respondents sampled from the Argentine population had in general negative beliefs about back pain. Respondents with current pain had more unhelpful beliefs than pain free respondents in relation to the prognosis and recovery of an episode of LBP. Small differences were found in the beliefs of respondents who had received care for LBP from a HCP and those who did not seek care.

Spanish translation, cross-cultural adaptation and validation of the Argentine version of the Back Pain Attitudes Questionnaire.

BACKGROUND: low back pain (LBP) is the main cause of years lived with disability worldwide. Psychosocial factors have been shown to be good predictors of persistent LBP. Within these, unhelpful beliefs about the back seem to be important in the development and chronicity of the symptoms. The Back Pain Attitudes Questionnaire (Back-PAQ) is an instrument that explores beliefs about the back that has been validated for people with and without back pain and healthcare professionals. However, until now, it has not been translated and validated for the Argentine population. OBJECTIVE: translate into Spanish, cross-cultural adapt and validate the Back-PAQ for the Argentine population with and without back pain. STUDY DESIGN: study of diagnostic accuracy/assessment scale. METHODS: the study was carried out in three consecutive phases: translation, cross-cultural adaptation and validation. We included Argentinians aged 18 years or more. We used the Back-PAQ, modified Fear Avoidance Beliefs Questionnaire (mFABQ) and the Global Rating of Change (GROC) scale to assess the psychometric properties. RESULTS: three hundred and seventy-two participants were included for the analysis. The time taken to answer and score the questionnaire was 5.6 and 1.6 min, respectively. Neither a ceiling nor a floor effect was observed. Internal consistency was 0.76. One hundred and eighty-six participants were considered stable. Test-retest reliability was 0.90. A weak correlation (0.33) was found between the Back-PAQ and the mFABQ. CONCLUSION: the Argentine version of the Back-PAQ is a viable, reliable and valid tool for the assessment of the back beliefs of the Argentine population.

Efficacy of core exercises in patients with osteoarthritis of the knee: A randomized controlled clinical trial.

TRIAL DESIGN: Randomized, evaluator blinded, controlled, parallel group. METHODS: This trial was conducted between July 2011 and January 2015 at a public hospital in Argentina. Patients older than 40 years with a medical diagnosis of osteoarthritis (OA) were randomly assigned to the experimental group (EG) or control group (CG). Both groups performed conventional exercises 3 times a week for 12 weeks and core exercises were added to the EG intervention. The objective was to compare the efficacy of conventional treatment combined with core muscle strengthening exercises, with conventional treatment alone in terms of short- and medium-term pain reduction and physical function in patients with knee OA. The primary outcome was knee pain assessed using a visual analog scale and the secondary outcome was physical function assessed at baseline, week 8 and 12, and 2 follow-up visits held 1 month and 3 months after the end of treatment. RESULTS: 113 patients were randomized to a CG (n = 60) or EG (n = 53). 66 patients were eliminated and 25 patients in the EG and 22 in the CG were analyzed. Both pain reduction and improved physical function were observed throughout the intervention in both groups. At the end of the treatment, a statistically and clinically significant pain reduction was observed in the EG. No adverse effects were reported. CONCLUSION: The combination of core muscle activation exercises and conventional treatment was more effective in short-term pain reduction in patients with knee OA.

Cross-cultural adaptation and validation of the Argentine "American Shoulder and elbow surgeons, patient self-report section" questionnaire.

BACKGROUND: American Shoulder and Elbow Surgeons questionnaire (ASES-p) has been translated into Spanish, but it has not been adapted to the Argentine population yet. Although Spain and Argentina speak the same language, linguistic differences between Spanish-speaking countries may affect the interpretation of the different items included in the questionnaire. OBJECTIVE: To conduct the translation, cross-cultural adaptation and validation of the self-report section of the ASES-p into Argentine Spanish for patients with musculoskeletal shoulder disorders, and to assess its psychometric properties. DESIGN: Study of diagnostic accuracy/assessment scale. METHOD: The study was carried out in three consecutive phases: translation, cross-cultural adaptation and validation for its use in Argentina. In the third phase, we used the ASES-p, Short Form 36 (SF-36), EuroQol-5D (EQ-5D), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, and the Global Rating of Change (GROC) scale. RESULTS: One hundred three participants completed a set of questionnaires on two occasions and were included in the final analysis. The time taken to answer and score the questionnaire was 118 and 52 s, respectively. Neither a ceiling nor a floor effect was observed. Cronbach's alpha coefficient was 0.85. Intraclass correlation coefficient was 0.83. A significant correlation was found between the DASH, the GROC and various SF-36 subscales. There were strong indices of concurrent-cross validation, longitudinal validity, and construct validity. The ASES-p questionnaire showed a minimal clinically important difference (MCID) value of 7.88 points. CONCLUSION: Some psychometric properties in reliability and validity were acceptable in the Argentine version of the ASES-p questionnaire.