[Quality of life and physical activity in prefrail individuals over 70 years in primary care.] / Calidad de vida y actividad física en individuos prefrágiles mayores de 70 años en atención primaria.

OBJECTIVE: Frailty is an increasing problem among the elderly people and it is more frequent in women. Physical activity improves either the function and quality of life. Given the diferences reported by the literature about the quality of life perception and the physical activity practice between men and women, the aim of this study is to analyze the association between health related quality of life (HRQoL) and physical activity in a pre-frail population and to study its relationship with gender. METHODS: Descriptive study in pre-frail individuals over 70 years old assigned to twelve primary care health centers carried out between 2018 Jun and 2020 March in Madrid. The studied variables were registered by clinical interview: Physical activity (Yale), HRQoL (EQ-5D-3L), sociodemographic and clinical variables (comorbidity, depression and pain). Descriptive analysis and multiple linear regression for the whole population and stratified by gender, using the quality of life as dependent variable. RESULTS: The study involved 206 pre-frail individuals (152 women) wih an average age of 78 years. Women had less comorbidity (32.3% versus 55.6%) but more pain (60.5% versus 44.4%) than men. The median of physical activity was 40 points (55.9% of that score was attributable to relaxed walk). HRQoL was 0.74 in utility score and 68 in the EQ-VAS. No differences were found by gender. To walk more than 5 hours a week was found associated with better quality of life by EQ-5D utility score (0.08, IC95%: 0.03 to 0.14), and by EQ-VAS score (5.38, IC95%: 0.25 to 10.51). CONCLUSIONS: Physical activity was associated to better quality of life in a pre-frail population of individuals older than 70 years old.

OBJETIVO: La fragilidad es un problema de creciente magnitud entre los mayores que afecta en mayor proporción a mujeres. La actividad física mejora tanto la funcionalidad como la calidad de vida. Dadas las diferencias en la percepción de la calidad de vida y en la práctica de actividad física entre hombres y mujeres, se planteó como objetivo analizar la asociación entre calidad de vida y actividad física en mayores de 70 años prefrágiles y su relación con el sexo. METODOS: Estudio descriptivo en mayores de 70 años prefrágiles realizado entre junio de 2018 y marzo de 2020 en 12 centros de salud de Madrid. Se recogieron mediante entrevista clínica, variables de actividad física (cuestionario de Yale), calidad de vida (Euroqol-5D); variables sociodemográficas y de salud (comorbilidad, depresión y dolor). Se realizó análisis descriptivo y modelos de regresión lineal múltiple con calidad de vida como variable dependiente (total población y por sexo). RESULTADOS: Participaron en el estudio 206 individuos (152 mujeres), con una edad media de 78 años. Las mujeres presentaron menos comorbilidad (32,3% versus 55,6%) y más dolor (60,5% versus 44,4%) que los hombres. La media de actividad física fue de 40 puntos (55,9% de la puntuación corresponde a pasear relajadamente). La calidad de vida fue de 0,74 segun utilidades y de 68 en la EVA-EQ5D, sin diferencias según sexo. Pasear más de 5 horas/semana se asoció a mejor calidad de vida según utilidades (0,08, IC95%: 0,03 a 0,14), y según EVA (5,38, IC95%: 0,25 a 10,51). CONCLUSIONES: La actividad física se asoció a una mejor calidad de vida en población prefrágil mayor de 70 años.

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.

Relationship between healthcare seeking and pain expansion in patients with nonspecific chronic low back pain.

OBJECTIVES: Low back pain (LBP) is the most prevalent musculoskeletal problem, which implies a high rate of chronicity. The chronicity of symptoms can lead to pain expansion. The main objective of this study was to assess whether there were differences between patients with nonspecific chronic LBP (CLBP) who sought healthcare compared to those who did not in terms of pain expansion. METHODS: Ninety individuals participated in the study and were divided into three groups: 30 patients who sought care; 30 patients who did not seek care; and 30 asymptomatic individuals. The primary variable analyzed was pain expansion. Secondary physical and psychological variables were assessed later, and a regression analysis was performed. RESULTS: Patients who sought help showed significant differences in pain expansion and pain intensity compared with the group who did not seek help, with a medium effect size (0.50-0.79). The regression model for the care-seeking group showed that dynamic balance with the left leg and depression were predictors of percentage pain surface area (34.6%). The combination of dynamic balance, range of movement in flexoextension and depression were predictors of widespread pain (48.5%). CONCLUSION: Patients who soughtcare presented greater pain expansion than patients whodidnot. A combination of functional and psychological variables can significantly predict pain expansion in patients with nonspecific CLBP who seek help.

Instruction Modes for Motor Control Skills Acquisition: A Randomized Controlled Trial.

The objective was to compare two different instruction modes used to teach patients with nonspecific chronic low back pain (CLBP) to perform a lumbar motor control task. The three intervention instruction modes used were: common verbal explanation of a motor task based on a motor control therapeutic exercise (MCTE-control group), MTCE instructed using motor imagery (MI) and MCTE instructed using tactile feedback (TF). The main outcome measure was lumbar motor control of the neutral position test. Forty-eight patients with CLBP were randomly allocated into three groups of 16 patients per group. The MI strategy was the most effective mode for developing the motor control task in an accurate and controlled manner, obtaining better outcomes than TF or verbal instruction.

Psychological and physical factors related to disability in chronic low back pain.

BACKGROUND: Chronic low back pain (CLBP) is a public health problem that causes high levels of disability. Psychological and physical factors could play a critical role in the disability perception of patients. OBJECTIVE: The objective was to identify the psychological and physical factors associated with CLBP disability in patients and assess differences between asymptomatic subjects and CLBP patients through physical tests and psychological self-reports. METHODS: A cross-sectional study was performed. Total sample of 80 participants were classified into two groups: patients with CLBP (n= 49) and asymptomatic subjects (i.e. the control group) (n= 31). The physical tests included lower back range of motion (LBROM), postural stability, lower back strength (LBS), and lumbopelvic motor control tests. The psychological self-reports included low back disability (Roland Morris Disability Questionnaire), self-efficacy, pain catastrophizing, and pain-related fear. RESULTS: Self-efficacy and LBS displayed moderate negative correlations with disability in patients with CLBP (R=-0.47 and -0.40, respectively). Disability was predicted by self-efficacy and LBROM (ß=-0.45 and -033 respectively, p< 0.01), explaining 30% of the variance in these patients. The comparative analysis showed statistically significant differences between groups in the physical/psychological variables (p< 0.01); however, the effect-sizes were small for all these variables. CONCLUSIONS: The results of this study highlight the relevance of psychological and physical factors in CLBP patient disability. Evaluation and treatment in CLBP patients should take these factors into account.

Reliability and minimal detectable change of a modified passive neck flexion test in patients with chronic nonspecific neck pain and asymptomatic subjects.

BACKGROUND: The Passive Neck Flexion Test (PNFT) can diagnose meningitis and potential spinal disorders. Little evidence is available concerning the use of a modified version of the PNFT (mPNFT) in patients with chronic nonspecific neck pain (CNSNP). OBJECTIVES: To assess the reliability of the mPNFT in subjects with and without CNSNP. The secondary objective was to assess the differences in the symptoms provoked by the mPNFT between these two populations. DESIGN: We used repeated measures concordance design for the main objective and cross-sectional design for the secondary objective. METHOD: A total of 30 asymptomatic subjects and 34 patients with CNSNP were recruited. The following measures were recorded: the range of motion at the onset of symptoms (OS-mPNFT), the range of motion at the submaximal pain (SP-mPNFT), and evoked pain intensity on the mPNFT (VAS-mPNFT). RESULTS: Good to excellent reliability was observed for OS-mPNFT and SP-mPNFT in the asymptomatic group (intra-examiner reliability: 0.95-0.97; inter-examiner reliability: 0.86-0.90; intra-examiner test-retest reliability: 0.84-0.87). In the CNSNP group, a good to excellent reliability was obtained for the OS-mPNFT (intra-examiner reliability: 0.89-0.96; inter-examiner reliability: 0.83-0.86; intra-examiner test-retest reliability: 0.83-0.85) and the SP-PNFT (intra-examiner reliability: 0.94-0.98; inter-examiner reliability: 0.80-0.82; intra-examiner test-retest reliability: 0.88-0.91). The CNSNP group showed statistically significant differences in OS-mPNFT (t = 4.92; P < 0.001), SP-mPNFT (t = 2.79; P = 0.007) and in VAS-mPNFT (t = -10.39; P < 0.001) versus the asymptomatic group. CONCLUSION: The mPNFT is a reliable tool regardless of the examiner and the time factor. Patients with CNSNP have a decrease range of motion and more pain than asymptomatic subjects in the mPNFT. This exceeds the minimal detectable changes for OS-mPNFT and VAS-mPNFT.