Comparative analysis of the burnout syndrome index between contract and freelance physiotherapists: An observational study.

BACKGROUND: Burnout syndrome has been extensively studied in different health science professions. It has been less studied in physiotherapy than in professions such as medicine. Moreover, it is not known how the working condition influences this syndrome. OBJECTIVE: The main objective of this study was to compare the burnout index between contract and freelance physiotherapists in the private sector in the Community of Madrid, Spain. METHODS: A cross-sectional study was performed with 174 participants divided into 2 groups; one group was composed of contract physiotherapists (n = 87) and the other group was composed of freelance physiotherapists (n = 87). A Mann-Whitney U test was performed for comparison between the groups. Spearman's correlation coefficient was used to analyze the correlations between the burnout syndrome index and the secondary variables. RESULTS: There were statistically significant differences when comparing the groups, with a large effect size for the burnout index with a higher rate among contract physiotherapists (78 [71-84.75]) than in freelance physiotherapists (61.5 [55-72.75]).There were also significant differences in the type of patients treated, number of patients treated per day, time spent per patient, and the annual salary range between the contract and freelance physiotherapists. CONCLUSION: Contract physiotherapists who participated in this study had a significantly higher burnout syndrome index than freelance physiotherapists. Other socio-occupational variables were also found to be related to the burnout syndrome index in freelance physiotherapists and contract physiotherapists. The results of this study could be of interest for new occupational health strategies to reduce the burnout index in contract physiotherapists.

Influence of the Generation of Motor Mental Images on Physiotherapy Treatment in Patients with Chronic Low Back Pain.

BACKGROUND: Patients with nonspecific chronic low back pain (NCLBP) have greater difficulty generating kinesthetic and visual motor imagery. OBJECTIVES: The main aim of this study was to determine whether the ability to generate mental motor imagery (MIab) influences psychological, motor, and disability variables in patients with NCLBP. The secondary aim was to determine whether an approach based on therapeutic exercise (TE) and therapeutic education (TEd) could improve the MIab in those patients with less ability to perform it. STUDY DESIGN: Cross-sectional and quasiexperimental study. SETTING: Physical Therapy Unit of primary health care center in Madrid, Spain. METHODS: A total of 68 patients were divided into 2 groups according to a greater (n = 34) or lesser (n = 34) MIab. Treatment was based on TEd and TE for the group with less ability to generate kinesthetic and visual motor imagery. The outcome measures were imagery requested time, self-efficacy, disability, pain intensity, lumbar strength, psychological variables, and MIab. RESULTS: The group with lesser MIab showed lower levels of self-efficacy (P = 0.04; d, -0.47) and lower levels of lumbar strength and extension strength (P = 0.04; d, -0.46 and P = 0.02; d, -0.52, respectively). After the intervention with TE and TEd, MIab (both kinesthetic and visual) improved significantly, with a moderate to large effect size (P <= 0.01; d, -0.80 and P <= 0.01; d, -0.76, respectively), as did pain intensity, lumbar strength, disability, and psychological variables (P < 0.05), but not levels of self-efficacy (P > 0.05). Based on the results, the patients with NCLBP with lesser MIab achieved lower levels of self-efficacy and lower strength levels. LIMITATIONS: The results of this study should be interpreted with caution because of its quasiexperimental design and a bias selection. CONCLUSIONS: A clinical TE approach, coupled with a TEd program, resulted in significant improvement in MIab (both kinesthetic and visual), reduced pain intensity, increased lumbar strength, reduced disability, and improved psychological variables, but it did not significantly improve self-efficacy levels in the patients with NCLBP. KEY WORDS: Chronic low back pain, motor imagery, disability, lumbar strength.

Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis.

BACKGROUND: There is a lack of evidence to assess whether gait functionality can be affected by the condition of the pelvic floor musculature in patients with multiple sclerosis (MS). OBJECTIVE: To evaluate the relationship between pelvic floor functionality and general functional performance, and also their relationship depending on dependence degree in MS patients. PARTICIPANTS: Forty-three MS patients performed the study. The pelvic floor musculature and its functionality were evaluated by urinary incontinence (UI), fecal incontinence, and constipation. General functional performance was evaluated by the Barthel index, the Health Status Questionnaire Short Form-12 (SF-12), and the Timed Up and Go (TUG) test. RESULTS: UI was moderately related to general functional performance (SF-12 Physical: R = -0.413; Barthel index: R = -0.501; TUG: R = 0.482). The comparative analysis showed differences between UI and gait functionality (P = .008), with poorer results in the TUG in patients with moderate/severe dependence (P < .001). CONCLUSION: UI appears to have a negative impact on the performance of daily living activities, walking, and the physical dimension of quality of life in patients with MS. In addition, patients with moderate or severe dependence showed higher UI and gait disturbance compared with those with mild dependence or independence.