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.

Translation, cross-cultural adaptation and validation of the Argentine version of the Pain Catastrophizing Scale in patients with chronic low back pain.

INTRODUCTION: Low back pain (LBP) is the leading cause of years lived with disability worldwide. Higher levels of catastrophizing were found in patients with LBP and this variable is associated with self-reported disability. The Pain Catastrophizing Scale (PCS) is a self-report questionnaire that assesses catastrophizing in the presence of pain. Currently, an Argentine version of the PCS is not available. OBJECTIVE: To translate and cross-culturally adapt the PCS into Argentine Spanish and test the psychometric properties of the new version with chronic LBP patients. STUDY DESIGN: Study of diagnostic accuracy/assessment scale. METHODS: The study was carried out in three consecutive phases following the COSMIN guidelines: translation, cross-cultural adaptation and validation. We included Argentine residents over 18 years with chronic LBP. We used the PCS and the Global rating of change (GROC) to assess the psychometric properties. RESULTS: No difficulties were present in the translation processes and the PCS-Arg was developed. The alfa Cronbach coefficient was 0.89. The standard error of measurement and the minimal detectable change were 5.4 and 15.1 points, respectively. In the explanatory factorial analysis 3 components were identified. For the construct validity, the correlation between the PCS-Arg and disability and pain were r = 0.35 and rho = 0.04, respectively. The mean PCS score was 29.9. The lowest and highest scores were 3 and 52 points, therefore, no roof or ceiling effects of the total score were observed. CONCLUSION: The PCS-Arg is a viable, reliable and valid tool for the assessment of catastrophizing in patients with chronic LBP.

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.

Disability is associated with catastrophizing and not with pain intensity in patients with low back pain: A retrospective study.

OBJECTIVE: Low back pain (LBP) is the leading cause of years lived with disability at a global scale. The development and chronicity of LBP are influenced by multiple factors, and among them is catastrophizing. We are unaware of the impact that catastrophizing may have on pain and disability in our population. We also lack the tools that allow us to determine in which cases catastrophizing should be assessed. The primary objective is to compare the disability and pain intensity values at baseline in low back pain patients with high and low catastrophizing. The secondary objectives are to analyse the correlation between variables and determine disability variance, and develop a prediction model to identify patients with high catastrophizing. METHOD: This is a retrospective study. We included the baseline data of patients with LBP. A PCS score ≥ 23 was classified as "high catastrophizing." RESULTS: A total 121 medical sheets were analysed. Patients with high catastrophizing showed greater disability, with no differences in pain intensity. The PCS value explained 20% of the variance of disability, and pain was 1%. A cut-off point of 11 in the RMQ allowed us to identify patients with high and low catastrophizing, with an accuracy of 76.67%. CONCLUSION: LBP patients with high catastrophizing reported greater disability than those with low catastrophizing, with no differences as to pain intensity. The PCS was the most relevant variable to explain variability in the RMQ. The RMQ allowed us to identify patients with high and low catastrophizing.

Minimal detectable change and reliability of the star excursion balance test in patients with lateral ankle sprain.

OBJECTIVE: Lateral ankle sprain (LAS) is one of the most prevalent musculoskeletal injuries in the general population and athletes. Dynamic postural control deficits and somatosensory alterations are common signs after an episode of LAS. It is important to detect these deficits to prevent a recurrent sprain and the development of chronic ankle instability. The Star Excursion Balance Test (SEBT) is a tool used to assess dynamic postural control in patients with LAS. SEBT test-retest reliability has been evaluated in several populations. However, no data on patients with LAS are available and we do not know the minimal detectable change (MDC). The primary objective of our study was to obtain the MDC for normalized reach distances of the eight SEBT directions in patients with LAS. The secondary objective was to determine test-retest reliability. METHODS: Cross-sectional study. Thirty-one patients (between 18 and 40 years old) diagnosed with a Grade I or II LAS. Participants were evaluated by two raters at two time-points separated by an interval of 24-72 hrs. In each assessment, four practice trials were allowed, then three test trials were performed in a randomized order. Normalized reaching distances were analyzed. RESULTS: From the initial 31 patients, two were eliminated, so 29 patients were considered for the final analysis. The MDC values obtained were 6.73-13.36%, and the medial and posteromedial directions showed the lowest and highest values, respectively. A statistically significant increase was found in lateral direction between T0 and T1. Intraclass correlation coefficients ranged from 0.72 to 0.93. CONCLUSION: The SEBT is an accurate and reliable tool to assess dynamic postural control in patients with LAS.

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.

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.

Postoperative rehabilitation of simultaneous rupture of anterior cruciate ligament and patellar ligament: A case report.

INTRODUCTION: The simultaneous rupture of anterior cruciate ligament (ACL) and patellar ligament (PL) is an infrequent condition. Each isolated injury has surgical techniques and rehabilitation protocols that differ widely among each other. Nonetheless, there is no established physical rehabilitation approach when both injuries are associated. OBJECTIVE: The aim of this report is to describe the rehabilitation and the outcomes obtained in the postoperative period of simultaneous rupture of ACL and PL and the follow-up period. CASE REPORT: A 21-year-old male patient suffered the rupture of ACL and PL after landing from a jump while playing soccer. The knee was immediately immobilized, and 10 weeks later, he was operated in a one-stage surgery. He initiated his rehabilitation 3 weeks after the surgical resolution. A three-times a week rehabilitation was implemented to restore range of motion and improve functional status. An extensive evaluation was carried out monthly using dynamic neuromuscular tests and self-reported questionnaires. RESULTS: At the end of the rehabilitation, he presented a complete extension and 130° of knee flexion in passive open kinetic chain. The Single Leg Squat and Landing Error Scoring System showed a good performance, while the Star Excursion Balance Test and the single hops assessments were symmetrical. The International Knee Documentation Committee and Lower Extremity Functional Scale questionnaires yielded values of 90.8% and 77 points, respectively. CONCLUSION: An approach based on mobility exercises and strengthening of the lower limbs and the core muscles, considering the biological healing times of each particular structure, made it possible to obtain satisfactory results in mobility, functional tests, self-reported questionnaires, and patient's satisfaction.