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1.
BMC Musculoskelet Disord ; 20(1): 439, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597562

RESUMO

BACKGROUND: Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. METHODS: This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. RESULTS: Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. CONCLUSIONS: This study extends previous results confirming the program's contribution to recovering work capability among chronic LBP patients.


Assuntos
Ansiedade/reabilitação , Dor Crônica/reabilitação , Depressão/reabilitação , Dor Lombar/reabilitação , Terapia Ocupacional/métodos , Reabilitação Psiquiátrica/métodos , Adulto , Ansiedade/diagnóstico , Ansiedade/etiologia , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Terapia Combinada/métodos , Depressão/diagnóstico , Depressão/etiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Dor Lombar/complicações , Dor Lombar/diagnóstico , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Equipe de Assistência ao Paciente , Questionário de Saúde do Paciente , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
2.
BMC Health Serv Res ; 19(1): 714, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31639016

RESUMO

BACKGROUND: To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated. METHODS: Using Zelen's design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff's Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool). RESULTS: Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline. CONCLUSIONS: After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it. TRIAL REGISTRATION: The trial was registered at the German Clinical Trials Register under DRKS00015463 retrospectively (dated 4 Sept 2018).


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Promoção da Saúde , Adulto , Dor nas Costas/reabilitação , Dor Crônica/reabilitação , Estudos de Viabilidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida
3.
Medicine (Baltimore) ; 98(26): e16173, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261549

RESUMO

BACKGROUND: Various exercises have been proposed to mitigate chronic low back pain (LBP). However, to date, no one particular exercise has been shown to be superior. Hence, the aim of this study was to compare the efficiency between 2 exercises: the individualized graded lumbar stabilization exercise (IGLSE) and walking exercise (WE). METHODS: A randomized controlled trial was conducted in 48 participants with chronic LBP. After screening, participants were randomized to 1 of 4 groups: flexibility exercise, WE, stabilization exercise (SE), and stabilization with WE (SWE) groups. Participants underwent each exercise for 6 weeks. The primary outcome was visual analog scale (VAS) of LBP during rest and physical activity. Secondary outcomes were as follows: VAS of radiating pain measured during rest and physical activity; frequency of medication use (number of times/day); Oswestry disability index; Beck depression inventory; endurances of specific posture; and strength of lumbar extensor muscles. RESULTS: LBP during physical activity was significantly decreased in all 4 groups. Exercise frequency was significantly increased in the SE and WE groups; exercise time was significantly increased in the SE group. The endurance of supine, side lying, and prone posture were significantly improved in the WE and SWE groups. CONCLUSIONS: Lumbar SE and WE can be recommended for patients with chronic LBP because they not only relieve back pain but also prevent chronic back pain through improving muscle endurance.


Assuntos
Dor Crônica/reabilitação , Terapia por Exercício , Dor Lombar/reabilitação , Caminhada , Músculos do Dorso/fisiopatologia , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Terapia por Exercício/métodos , Feminino , Humanos , Dor Lombar/fisiopatologia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Força Muscular , Medição da Dor , Resistência Física , Postura , Amplitude de Movimento Articular , Resultado do Tratamento
4.
Am J Health Syst Pharm ; 76(8): 554-559, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-31361866

RESUMO

PURPOSE: Implementation of the SAFE PAIN algorithm for reducing opioid use for chronic pain in older adults is described. SUMMARY: A multidisciplinary team at Sheppard Pratt Health System, the largest private provider of psychiatric care in Maryland, used lean methodology to identify the root causes for noncompliance to evidence-based practices for patients in the geropsychiatry unit treated for osteoarthritis or chronic back pain. The team collaborated to develop a facility-specific treatment algorithm, called SAFE PAIN (Sheppard Pratt Health System Algorithm For Elderly Patient Centered Analgesia Interdisciplinary Nagara), was based on the Center for Disease Control and Prevention's evidence-based recommendations that included nonpharmacologic interventions as a first-line therapy for patients with osteoarthritis or chronic back pain. Rates of prescribing new opioids and prescribing evidence-based alternative medications via the SAFE PAIN algorithm were evaluated from March 1 to September 30, 2017 and compared with baseline (2012-2016). The lean methodology interventions led to zero new opioid orders during the study period, a significant decrease compared with previous years (p < 0.01). The rates of prescribing evidence-based alternative medications increased significantly from the baseline period to postimplementation (p < 0.01). Lean methodology interventions also decreased waste in several processes. CONCLUSION: The prescribing rate of new opioids for osteoarthritis and chronic back pain decreased and the prescribing rate for evidence-based medications increased after implementation of the SAFE PAIN algorithm in a geropsychiatry unit.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Procedimentos Clínicos , Osteoartrite/tratamento farmacológico , Manejo da Dor/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/reabilitação , Prescrições de Medicamentos/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Feminino , Geriatria/organização & administração , Geriatria/normas , Fidelidade a Diretrizes , Implementação de Plano de Saúde , Humanos , Masculino , Maryland , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Osteoartrite/complicações , Osteoartrite/reabilitação , Manejo da Dor/normas , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psiquiatria/organização & administração , Psiquiatria/normas
5.
Pain Res Manag ; 2019: 9596421, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31346354

RESUMO

Background: The Treatment Beliefs Questionnaire has been developed to measure patients' beliefs of necessity of and concerns about rehabilitation. Preliminary evidence suggests that these beliefs may be associated with attendance of rehabilitation. The aim of this study was to translate and adapt the Treatment Beliefs Questionnaire for interdisciplinary pain rehabilitation and to examine the measurement properties of the Dutch translation including the predictive validity for dropout. Methods: The questionnaire was translated in 4 steps: forward translation from English into Dutch, achieving consensus, back translation into English, and pretesting on providers and patients. In order to establish structural validity, internal consistency, construct validity, and predictive validity of the questionnaire, 188 participants referred to a rehabilitation centre for outpatient interdisciplinary pain rehabilitation completed the questionnaire at the baseline. Dropout was measured as the number of patients starting, but not completing the programme. For reproducibility, 51 participants were recruited at another rehabilitation centre to complete the questionnaire at the baseline and one week later. Results: We confirmed the structural validity of the Treatment beliefs Questionnaire in the Dutch translation with three subscales, necessity, concerns, and perceived barriers. internal consistency was acceptable with ordinal alphas ranging from 0.66-0.87. Reproducibility was acceptable with ICC2,1 agreement ranging from 0.67-0.81. Hypotheses testing confirmed construct validity, similar to the original questionnaire. Predictive validity showed the questionnaire was unable to predict dropouts. Conclusion: Cross-cultural translation was successfully completed, and the Dutch Treatment Beliefs Questionnaire demonstrates similar psychometric properties as the original English version.


Assuntos
Dor Crônica/reabilitação , Conhecimentos, Atitudes e Prática em Saúde , Reabilitação/psicologia , Inquéritos e Questionários , Tradução , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Traduções
6.
Rehabilitación (Madr., Ed. impr.) ; 53(2): 70-77, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185461

RESUMO

Introducción: La Escuela de la Espalda (EE) es un tratamiento en pacientes con lumbalgia crónica con contenidos educativos asociados a otras medidas terapéuticas como ejercicios. Es eficaz si se realiza y es bien conocido que las modificaciones en los hábitos diarios son difíciles de cumplir. Este trabajo de investigación evalúa si los pacientes que al terminar la EE tienen un predominio de estrategias activas en su afrontamiento del dolor se adhieren mejor a las enseñanzas de la EE. Material y método: Estudio observacional prospectivo para valorar la adherencia a la EE en pacientes con dolor lumbar crónico. Se incluyeron pacientes adultos que aceptaban realizar la EE. Se excluyeron aquellos cuyo nivel cultural, enfermedad concomitante o situación personal les impidiera completar el estudio. Los pacientes fueron evaluados al inicio y tras la tercera sesión de la EE. Las variables estudiadas fueron: adherencia a los ejercicios y recomendaciones, afrontamiento al dolor, intensidad del dolor, discapacidad funcional y características sociodemográficas. Resultados: El 67,2% de los 116 pacientes que participaron reconocen que no cumplen diariamente con los ejercicios y enseñanzas realizadas en la EE. No se ha podido establecer relación entre los pacientes con estrategias activas de afrontamiento del dolor y la adherencia a la EE. La capacidad funcional y la intensidad del dolor no difieren entre pacientes cumplidores y no cumplidores. Conclusiones: No se ha podido demostrar que la adherencia a los ejercicios y hábitos de la EE guarde relación con las estrategias de afrontamiento al dolor, la intensidad del dolor y la capacidad funcional de los pacientes con lumbalgia


Introduction: Back School (BS) is a treatment modality for patients with chronic low back pain with educational contents associated with other therapeutic measures such as exercise. If followed, it is effective but it is well known that it is difficult to make changes to daily habits. This study evaluated whether patients completing BS had a predominance of active strategies in coping with pain, as they adhered better to the recommendations of BS. Material and method: Prospective observational study to evaluate BS adherence in patients with chronic low back pain. Adult patients attending BS were included in the study. Patients whose educational level, concomitant pathology or personal situation prevented them from completing the study were excluded. The patients were evaluated at the beginning and after the third session of BS. The variables studied were adherence to exercises and recommendations, coping with pain, pain intensity, functional disability and other sociodemographic characteristics. Results: A total of 67.2% of the 116 included patients acknowledged that they did not perform the exercises and recommendations of BS every day. No relationship was established between patients with active strategies for coping with pain and adherence to BS. Functional capacity and pain intensity did not differ between adherent and non-adherent patients. Conclusions: This study did not demonstrate that adherence to the exercises and habits taught in BS is related to coping with pain strategies, pain intensity and functional capacity in patients with chronic low back pain


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Dor Lombar/reabilitação , Técnicas de Exercício e de Movimento/métodos , Adaptação Psicológica , Dor Crônica/reabilitação , Manejo da Dor/métodos , Estudos Prospectivos , Desempenho Físico Funcional , Centros de Reabilitação/estatística & dados numéricos , Doenças da Coluna Vertebral/prevenção & controle
7.
PLoS One ; 14(5): e0216858, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120892

RESUMO

OBJECTIVES: Chronic pain, such as low-back pain, can be a highly disabling condition degrading people's quality of life (QoL). Not every patient responds to pharmacological therapies, thus alternative treatments have to be developed. The chronicity of pain can lead to a somatic dysperception, meaning a mismatch between patients' own body perception and its actual physical state. Since clinical evaluation of pain relies on patients' subjective reports, a body image disruption can be associated with an incorrect pain rating inducing incorrect treatment and a possible risk of drug abuse. Our aim was to reduce chronic low-back pain through a multimodal neurorehabilitative strategy using innovative technologies to help patients regain a correct body image. METHODS: Twenty patients with chronic low-back pain were included. Before and after treatment, patients underwent: a neurological exam; a neuro-psychological evaluation testing cognitive functions (memory, attention, executive functions) and personality traits, QoL and mood; pain ratings; sensorimotor functional abilities' testing. Patients underwent a 6 week-neurorehabilitative treatment (total 12 sessions) using virtual reality (VRRS system, Khymeia, Italy). Treatment consisted on teaching patients to execute correct movements with the painful body parts to regain a correct body image, based on the augmented multisensory feedback (auditory, visual) provided by the VRRS. RESULTS: Our data showed significant reductions in all pain rating scale scores (p<0.05); significant improvements of QoL in the domains of physical functioning, physical role functioning, bodily pain, vitality, and social role functioning; improvements in cognitive functions (p<0.05); improvements in functional scales (p<0.05) and mood (p = 0.04). CONCLUSION: This non-pharmacological approach was able to act on the multi-dimensional aspects of pain and improved patients' QoL, pain intensity, mood and patient's functional abilities.


Assuntos
Dor Crônica , Técnicas de Exercício e de Movimento , Dor Lombar , Reabilitação Neurológica , Qualidade de Vida , Atividades Cotidianas , Adulto , Afeto , Idoso , Imagem Corporal , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Dor Crônica/reabilitação , Feminino , Humanos , Itália , Dor Lombar/fisiopatologia , Dor Lombar/psicologia , Dor Lombar/reabilitação , Masculino , Pessoa de Meia-Idade , Realidade Virtual
8.
BMC Musculoskelet Disord ; 20(1): 188, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054564

RESUMO

BACKGROUND: Physical therapy and exercising are key components of biopsychosocial rehabilitation for chronic pain. Exercise helps reduce pain and improve physical functions. In addition, a high level of physical activity benefits quality of life and emotional well-being. However, the degree to which hospitalization for extensive rehabilitation effectively increases physical activity has not yet been studied. Therefore, we investigated the physical activity level and the walking behavior of inpatients with musculoskeletal pain. The objectives were 1) to compare physical activity level and walking with or without rehabilitation, 2) to evaluate whether pain site influences physical activity level, and 3) to measure the association between physical activity and pain-related interference with physical functioning. METHODS: During a rehabilitation stay, 272 inpatients with lower limb, spine, or upper limb pain wore an accelerometer over 1 week. We assessed the daily duration of the practice of moderate physical activity and walking. Weekend days, during which the participants went home (days off), were used as a reference for habitual activities. We also evaluated 93 patients before the hospitalization to validate the use of days off as a baseline. Pain interference was measured with the brief pain inventory questionnaire. Generalized linear mixed models analyzed the association between physical activity and walking levels, and 1) rehabilitation participation, 2) pain sites, and 3) pain interference. RESULTS: Weekend days during the stay have similar physical activity level as days measured before the stay (73 min / day at the clinic, versus 70 min / day at home). Rehabilitation days had significantly higher physical activity levels and walking durations than days off (+ 28 min [+ 37%] and + 32 min [+ 74%], respectively). Mixed models revealed 1) a negative association between physical activity and pain interference, and 2) no effect of pain sites. Overall, patients increased their physical activity level independently of reported pain interference. CONCLUSIONS: Despite their painful condition, the inpatients were able to engage themselves in a higher level of physical activity via increased participation in walking activities. We conclude that walking incentives can be a valid solution to help patients with chronic pain be more physically active.


Assuntos
Dor Crônica/reabilitação , Terapia por Exercício/métodos , Pacientes Internados/estatística & dados numéricos , Dor Musculoesquelética/reabilitação , Caminhada/estatística & dados numéricos , Adulto , Dor Crônica/fisiopatologia , Estudos Transversais , Terapia por Exercício/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/fisiopatologia , Equipe de Assistência ao Paciente , Participação do Paciente/estatística & dados numéricos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Caminhada/fisiologia
9.
Clin Rehabil ; 33(8): 1367-1381, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31007053

RESUMO

OBJECTIVE: To evaluate the benefit of adding occupational therapy or physiotherapy interventions to a standard rehabilitation programme targeted for chronic widespread pain. DESIGN: Randomized active-controlled non-blinded trial. SUBJECTS: Women with chronic widespread pain recruited in a tertiary outpatient clinic. METHODS: Participants were randomized to a two-week, group-based standard rehabilitation programme followed by 16 weeks of group-based occupational therapy (Group BOT, n = 43) or 16 weeks of group-based physiotherapy (Group BPT, n = 42). Group A only received the two-week rehabilitation programme acting as comparator (n = 96). OUTCOMES: Primary outcomes were the Assessment of Motor and Process Skills and Short Form-36 (SF36) Mental Component Summary score. RESULTS: Mean changes in motor and process ability measures were clinically and statistically insignificant and without differences across the three groups assessed 88 weeks from baseline. Motor ability measures: -0.006 (95% confidence interval (CI): -0.244 to 0.233) in Group BOT; -0.045 (95% CI: -0.291 to 0.202) in Group BPT; and -0.017 (95% CI: -0.248 to 0.213) in Group A, P = 0.903. Process ability measures: 0.087 (95% CI: -0.056 to 0.231) in Group BOT; 0.075 (95% CI: -0.075 to 0.226) in Group BPT; and 0.072 (95% CI: -0.067 to 0.211) in Group A, P = 0.924. Mean changes in patient-reported outcomes were likewise small; clinically and statistically insignificant; and independent of group allocation, except for the SF36 mental component summary score in the BPT group: 8.58 (95% CI: 1.75 to 15.41). CONCLUSION: Participants were on average stable in observation-based measures of functional ability and patient-reported outcomes, except in overall mental well-being, favouring the enhanced intervention. Efficacy of additional interventions on functional ability remains uncertain.


Assuntos
Dor Crônica/reabilitação , Processos Grupais , Terapia Ocupacional , Modalidades de Fisioterapia , Adulto , Feminino , Humanos
10.
Isr Med Assoc J ; 21(4): 255-259, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31032567

RESUMO

BACKGROUND: Multidisciplinary biopsychosocial rehabilitation for patients presenting with rheumatic diseases has been shown to produce better results in a warm climate. Dead Sea Climatotherapy (DSC) has been successfully used for decades to treat many patients with rheumatic diseases. OBJECTIVES: To evaluate the short-term improvement of Norwegian patients who presented with chronic pain following a multidisciplinary biopsychosocial approach to treatment combined with DSC. Both objective and subjective clinical parameters were evaluated. METHODS: This retrospective study included a statistical analysis of 938 patients presenting with rheumatoid arthritis and ankylosing spondylitis (n=105), osteoarthritis (n=342), fibromyalgia (n=374), and other orthopedic conditions (n=117). Clinical assessments were conducted before and after a 3 week treatment program at the Dead Sea. RESULTS: Six parameters improved significantly in the rheumatoid arthritis and ankylosing spondylitis group as well as in the osteoarthritis group. Five parameters in the fibromyalgia group improved, while two improved in the orthopedic conditions group. Overall, major significant changes occurred in the pain self-assessment, joint motility, and daily activities scores. CONCLUSIONS: A 3-week multidisciplinary biopsychosocial program combined with DSC induced positive changes in the clinical parameters of Norwegian patients presenting with chronic musculoskeletal pain.


Assuntos
Dor Crônica/reabilitação , Climatoterapia/métodos , Terapia Cognitivo-Comportamental/métodos , Dor Musculoesquelética/reabilitação , Modalidades de Fisioterapia , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/psicologia , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/psicologia , Noruega , Oceanos e Mares , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Phys Ther ; 99(9): 1177-1188, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30939188

RESUMO

BACKGROUND: Different types of pillows have been proposed for neck pain, but no previous randomized controlled trial has investigated the effectiveness of a "spring pillow" for adults with chronic nonspecific neck pain. OBJECTIVE: We evaluated the effectiveness of using a pillow made from viscoelastic polyurethane and 60 independent springs compared with an educational intervention in individuals with chronic nonspecific neck pain. DESIGN: This was a randomized controlled trial with crossover study design. SETTING: The setting was the Occupational Medicine Unit, University Hospital, Bologna (Italy). PARTICIPANTS: We recruited 70 adults with chronic nonspecific neck pain, of whom 64 completed the trial. INTERVENTION: Participants were randomly assigned to 2 groups. One group used the spring pillow for 4 weeks, and the other group followed educational advice for 4 weeks while continuing to use their own pillows. After 4 weeks of treatment and 4 weeks of washout, groups were crossed over. Pain perceived in the neck, thoracic, and shoulder areas and headache were the primary outcome measures. In addition, disability, sleep quality, subjective improvement, and pillow comfort were assessed. Measures were captured at pretreatment, after 4 weeks, after the 4-week washout period, and 4 weeks after crossover. The mean differences (MD) in outcomes between groups were assessed. RESULTS: Treatment with the spring pillow appeared to reduce neck pain (MD = -8.7; 95% confidence interval [CI] = -14.7 to -2.6), thoracic pain (MD = -8.4; 95% CI = -15.2 to -1.5), and headache (MD = -16.0; 95% CI = -23.2 to -8.7). Reductions in shoulder pain were not statistically significant between groups (MD = -6.9; 95% CI = -14.1-0.3). Neither the crossover sequence nor the period (first vs second intervention administration) significantly affected the results. LIMITATIONS: Education may not have been the best comparator for the spring pillow; drug consumption, actual pillow use, and the implementation of the educational suggestions as prescribed were not controlled. CONCLUSIONS: Use of the spring pillow in this study was more effective than an educational intervention for improving cervical, thoracic, and head pain. Whether a spring pillow is more effective than other ergonomic pillows remains to be tested.


Assuntos
Roupas de Cama, Mesa e Banho , Dor Crônica/reabilitação , Cervicalgia/reabilitação , Educação de Pacientes como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/reabilitação , Intervalos de Confiança , Estudos Cross-Over , Desenho de Equipamento , Feminino , Cefaleia/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Medição da Dor , Poliuretanos , Tamanho da Amostra , Substâncias Viscoelásticas , Adulto Jovem
12.
Phys Ther ; 99(7): 933-945, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30921465

RESUMO

Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it.


Assuntos
Dor Crônica/psicologia , Dor Crônica/reabilitação , Dor Lombar/cirurgia , Manejo da Dor/métodos , Dor Pós-Operatória/psicologia , Dor Pós-Operatória/reabilitação , Radiculopatia/cirurgia , Humanos , Neurociências , Medição da Dor , Educação de Pacientes como Assunto
13.
Phys Ther ; 99(7): 946-952, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30916754

RESUMO

BACKGROUND: Patients with pelvic pain due to pelvic floor myofascial pain syndrome are often referred for pelvic floor physical therapy, the primary treatment option. However, many patients do not adhere to the treatment. OBJECTIVE: The purpose of this study was to examine the adherence rate and outcomes of patients referred for physical therapy for pelvic floor myofascial pain syndrome and identify risk factors associated with nonadherence. DESIGN: This was a retrospective cohort study. METHODS: ICD-9 codes were used to identify a cohort of patients with pelvic floor myofascial pain syndrome during a 2-year time period within a single provider's clinical practice. Medical records were abstracted to obtain information on referral to physical therapy, associated comorbidities and demographics, and clinical outcomes. "Primary outcomes" was defined as attendance of at least 1 visit. Secondary outcomes included attendance of at least 6 physical therapist visits and overall improvement in pain. Statistical analysis was performed using chi-square, Fisher exact, and independent t tests. Nonparametric comparisons were performed using Wilcoxon signed rank test. Multivariate analysis was completed to adjust for confounders. RESULTS: Of the 205 patients, 140 (68%) attended at least 1 session with physical therapy. At least 6 visits were attended by 68 (33%) patients. Factors associated with poor adherence included parity and a preexisting psychiatric diagnosis. The odds of attending at least 1 visit were 0.75 (95% confidence interval = 0.62-0.90) and 0.44 (95% confidence interval = 0.21-0.90), respectively. Patients who attended ≥ 6 visits were more likely to have private insurance (78%) and travel shorter distances to a therapist (mean = 16 miles vs 22). Patients with an improvement in pain (compared with those who were unchanged) attended an average of 3 extra physical therapist visits (mean = 6.9 vs 3.1). LIMITATIONS: Limitations include reliance on medical records for data integrity; a patient population derived from a single clinic, reducing the generalizability of the results; the age of the data (2010-2012); and the likely interrelatedness of many of the variables. It is possible that maternal parity and psychiatric diagnoses are partial surrogates for social, logistic, or economic constraints and patient confidence. CONCLUSIONS: Initial adherence to pelvic floor physical therapy was less likely for multiparous women and women with a history of psychiatric diagnosis. Persistent adherence was more likely with private insurance or if the physical therapist location was closer. Pain improvement correlated with increased number of physical therapist sessions.


Assuntos
Dor Crônica/reabilitação , Síndromes da Dor Miofascial/reabilitação , Manejo da Dor/métodos , Cooperação do Paciente/estatística & dados numéricos , Dor Pélvica/reabilitação , Modalidades de Fisioterapia , Encaminhamento e Consulta , Adulto , Feminino , Humanos , Medição da Dor , Estudos Retrospectivos
14.
Phys Ther ; 99(7): 915-923, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30916768

RESUMO

BACKGROUND: Descending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a well-known treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures. OBJECTIVE: To the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM. DESIGN: This was a prospective cohort study in people with FBSS. METHODS: Seventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus. RESULTS: Before SCS, less than 30% of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment. LIMITATIONS: Limitations were the small sample size and the subjective outcome parameters in the CPM model. CONCLUSIONS: This study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.


Assuntos
Dor Crônica/reabilitação , Síndrome Pós-Laminectomia/reabilitação , Manejo da Dor/métodos , Estimulação da Medula Espinal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos
15.
Arch Phys Med Rehabil ; 100(7): 1226-1233, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30822389

RESUMO

OBJECTIVE: To investigate whether clinical tests used to detect motor control dysfunction can predict improvements in pain and disability in patients with chronic nonspecific low back pain (LBP) who have undergone an 8-week lumbar stabilization exercise program. STUDY DESIGN: A prospective cohort study. SETTING: Outpatient physical therapy university clinic. PARTICIPANTS: Seventy people with chronic nonspecific LBP were recruited, and 64 completed the exercise program (N=64). INTERVENTIONS: The lumbar stabilization program was provided twice a week for 8 weeks. MAIN OUTCOME MEASURES: Pain intensity (11-point numerical rating scale) and disability (Roland Morris Disability Questionnaire) and clinical tests, such as the Deep Muscle Contraction (DMC) scale, Clinical Test of Thoracolumbar Dissociation (CTTD), and Passive Lumbar Extension (PLE) test. Univariate and multivariate linear regression models were used in the prediction analysis. RESULTS: Mean changes in pain intensity and disability following the 8-week stabilization program were -3.8 (95% confidence interval [CI], -3.2 to -4.4) and -7.4 (95% CI, -6.3 to -8.5), respectively. Clinical test scores taken at baseline did not predict changes in pain and disability at 8-week follow-up. CONCLUSION: Our findings revealed that the DMC scale, CTTD, PLE test, clinical tests used to assess motor control dysfunction, do not predict improvements in pain and disability in patients with chronic nonspecific LBP following an 8-week lumbar stabilization exercise program.


Assuntos
Dor Crônica/reabilitação , Terapia por Exercício/métodos , Dor Lombar/reabilitação , Região Lombossacral/fisiopatologia , Adolescente , Adulto , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos
16.
J Rehabil Med ; 51(4): 281-289, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30847496

RESUMO

OBJECTIVES: To investigate: (i) changes in sick-leave benefits from 1 year prior to multimodal rehabilitation to 1 and 2 years after rehabilitation; (ii) sex differences in sick leave; and (iii) the impact of policy changes on sick leave. METHODS: All patients undergoing multimodal rehabilitation registered in a national pain database for 2007-11 (n = 7,297) were linked to the Swedish Social Insurance Agency database. Sick leave was analysed in 3-month periods: T0: 1 year before rehabilitation; T1: before start; T2: 1 year after; and T3: 2 years after rehabilitation. Four sick-leave benefit categories were constructed: no sick leave, part-time sick leave, full-time sick leave, and full-time permanent sick leave. The individual change in sick-leave category at each time-period was analysed. RESULTS: Sick-leave benefits increased from T0 to T1 (p < 0.001) and decreased from T1 to T3 (p < 0.001). Reductions were significant for both men and women from T1 to T3, but men had less sick-leave benefits at T2 and T3. Positive changes in sick-leave benefits at T2 and T3 were found both prior to and after policy changes, with less sick-leave benefits after policy changes at all time-points. CONCLUSION: Multimodal rehabilitation may positively influence sick-leave benefits for patients with chronic pain, regardless of their sick-leave situation, sex or policy changes.


Assuntos
Dor Crônica/reabilitação , Emprego/estatística & dados numéricos , Reabilitação/estatística & dados numéricos , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Bases de Dados Factuais , Feminino , Seguimentos , Política de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/estatística & dados numéricos , Sistema de Registros , Distribuição por Sexo , Suécia
17.
J Electromyogr Kinesiol ; 46: 28-34, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878650

RESUMO

Persons with low back pain (LBP) have demonstrated altered morphology and function of the deep multifidus (DM). This study examined the effects of postural cueing for increased lumbar lordosis on DM and longissimus thoracis (LT) activation during lumbar stabilization exercises (LSE) performed by persons with LBP. Nine adults with a history of chronic or recurrent LBP were recruited. Fine-wire EMG data was collected while participants performed 10 LSE's in neutral posture and with postural cueing. Percent maximum voluntary isometric contraction of L5 DM and T12 LT, and ratios of activation (DM/LT) were analyzed. There was a significant main effect for posture on DM activation (p < 0.001), indicating greater activation levels during exercises performed with postural cueing vs. neutral posture. LT activation did not increase significantly with postural cueing. Following a significant 1-way repeated measures ANOVA (p = 0.034) for the postural cueing condition, pairwise comparisons demonstrated significantly higher DM/LT activation ratios for prone leg lift, variable-angle Roman chair at 15°, bridging, and bilateral arm and leg lift. These results suggest postural cueing can be used across a range of LSE intensities to increase DM activation without a significant increase in LT activation in patients with chronic or recurrent LBP.


Assuntos
Eletromiografia , Terapia por Exercício , Dor Lombar/fisiopatologia , Dor Lombar/reabilitação , Região Lombossacral/fisiologia , Músculos Paraespinais/fisiopatologia , Postura , Adulto , Dor Crônica/reabilitação , Sinais (Psicologia) , Feminino , Humanos , Contração Isométrica , Lordose , Masculino , Parede Torácica , Adulto Jovem
18.
Clin Rehabil ; 33(6): 1088-1097, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30808203

RESUMO

PURPOSE: To assess the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis, who are overweight or obese. METHODS: We conducted causal mediation analyses of aggregated data from two randomized controlled trials (RCTs); which included 160 patients with chronic low back pain, and 120 patients with knee osteoarthritis. The intervention consisted of brief advice and referral to a six-month telephone-based healthy lifestyle coaching service. We used causal mediation to estimate the indirect, direct and path-specific effects of hypothesized mediators including: self-reported weight, diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). RESULTS: The intervention did not reduce weight, improve diet or physical activity or change pain beliefs, and these mediators were not associated with the outcomes. Sensitivity analyses showed that our estimates were robust to the possible effects of unknown and unmeasured confounding. CONCLUSIONS: Our findings show that the intervention did not cause a meaningful change in the hypothesized mediators, and these mediators were not associated with patient-reported outcomes.


Assuntos
Promoção da Saúde , Estilo de Vida Saudável , Dor Lombar/reabilitação , Obesidade/terapia , Osteoartrite do Joelho/reabilitação , Sobrepeso/terapia , Dor Crônica/complicações , Dor Crônica/reabilitação , Avaliação da Deficiência , Exercício , Humanos , Dor Lombar/complicações , Obesidade/complicações , Osteoartrite do Joelho/complicações , Sobrepeso/complicações , Medição da Dor , Qualidade de Vida , Perda de Peso
19.
BMC Musculoskelet Disord ; 20(1): 16, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611242

RESUMO

BACKGROUND: Functional tests are widely used to measure performance in patients with chronic musculoskeletal pain. Our objective was to determine the Minimal Clinically Important Differences (MCID) for the 6-min walk test (6MWT), the Steep Ramp Test (SRT), the 1-min stair climbing test (1MSCT), the sit-to-stand test (STS), the Jamar dynamometer test (JAM) and the lumbar Progressive Isoinertial Lifting Evaluation (PILE) in chronic musculoskeletal pain patients. METHODS: A single-center prospective observational study was conducted in a rehabilitation center. Patients with upper-limb, lower-limb or neck/back lesions were included over a period of 21 months. We used the anchor-based method as a reference method, supplemented by the distribution-based and opinion-based approaches, to determine the MCIDs. RESULTS: 838 chronic musculoskeletal pain patients were included. The estimation method and thelesion location had a significant influence on the results. MCIDs were estimated at +75m and +60m for the 6MWT (lower-limb and neck/back lesions, respectively), +18 steps for the 1MSCT (lower-limb and neck/back lesions) and +6kg for the JAM (upper limb lesions). The anchor-based method could not provide valid estimations for the three other scales, but distribution and opinion-based methods provided rough values of MCIDs for the SRT (+39w to +61w), the STS (-5 sec to -7 sec) and the PILE (+4kg to +7kg). CONCLUSION: The above MCID estimations for the 6MWT, 1MSCT and JAM can be used in chronic musculoskeletal pain patients participating in vocational multidisciplinary rehabilitation programs or in therapeutic trials. The use of specific anchors might give better estimations of MCIDs for the three other scales in future research.


Assuntos
Dor Crônica/diagnóstico , Avaliação da Deficiência , Diferença Mínima Clinicamente Importante , Dor Musculoesquelética/diagnóstico , Adolescente , Adulto , Idoso , Dor Crônica/fisiopatologia , Dor Crônica/reabilitação , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/reabilitação , Medição da Dor , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento , Teste de Caminhada , Adulto Jovem
20.
J Back Musculoskelet Rehabil ; 32(5): 755-767, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30689551

RESUMO

OBJECTIVE: To investigate the efficacy of a 4-week community aquatic physiotherapy program with Ai Chi or the Bad Ragaz Ring Method (BRRM) on pain and disability in adults with chronic low back pain (CLBP). METHODS: Adults with CLBP (n= 44; mean ± SD age, 52.6 ± 5.5 y; 37 women) were assigned to either an Ai Chi (n= 23) or BRRM (n= 21) program (4 weeks, twice weekly). RESULTS: Both the Ai Chi (-1.4; 95% CI -2.6 to -0.2; p= .025) and BRRM (-2.0, 95% CI -3.1 to -0.8; p= 0.003) groups demonstrated significant pre- to post-treatment decreases in Roland-Morris Disability Questionnaire scores and improvements in prone bridge duration (Ai Chi: 11.7 s; 95% CI 1.6 to 21.8; p= 0.025; BRRM: 19.0 s; 95% CI 6.1 to 31.8; p= 0.006). The Ai Chi group revealed a significant improvement in single-leg stand test duration (2.9 s; 95% CI 0.1 to 5.7; p= 0.045) and the BRRM group reported significant decrease in pain intensity (-11.6; 95% CI -19.1 to -4.2; p= 0.004). CONCLUSIONS: A 4-week aquatic physiotherapy program with Ai Chi or BRRM resulted in significant pre- to post-treatment improvements in disability and global core muscle endurance. Ai Chi appeared to have an additional benefit of improving single-leg standing balance and BRRM an additional benefit of reducing pain.


Assuntos
Dor Crônica/reabilitação , Dor Lombar/reabilitação , Músculo Esquelético/fisiopatologia , Resistência Física/fisiologia , Modalidades de Fisioterapia , Idoso , Dor Crônica/fisiopatologia , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Fisioterapeutas , Projetos Piloto , Equilíbrio Postural/fisiologia , Tronco/fisiopatologia , Resultado do Tratamento
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