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1.
Phys Med Rehabil Clin N Am ; 32(2): 355-372, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33814062

RESUMO

Telerehabilitation for pain management uses communication technology to minimize geographic barriers. Access to such technology has proven critically important during the coronavirus disease-2019 pandemic and has been useful for patients with chronic pain disorders unable to travel. The evaluation and treatment of such disorders requires a whole health approach that individualizes treatment options and delivers care through a biopsychosocial approach. The goals of care are unchanged from an in-person patient-provider experience. Telerehabilitation can be successfully implemented in pain management with appropriate consideration for staging an evaluation, a structured approach to the visit, and application of standard clinical metrics.


Assuntos
Dor Crônica/tratamento farmacológico , Dor Crônica/reabilitação , Manejo da Dor/métodos , Telemedicina/métodos , /epidemiologia , Terapia Cognitivo-Comportamental , Acesso aos Serviços de Saúde , Humanos , Medição da Dor , Pandemias , Exame Físico , Modalidades de Fisioterapia
3.
Fisioterapia (Madr., Ed. impr.) ; 42(5): 277-280, sept.-oct. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-195144

RESUMO

ANTECEDENTES: La cervicalgia crónica (CC) es una afección frecuente, siendo una de las principales causas de discapacidad. Dentro de los tratamientos fisioterapéuticos más utilizados se encuentran el ejercicio y la movilización manual vertebral (MMV). No obstante, la aplicación de MMV se basa en fundamentos artrocinemáticos y no en el propósito directo de favorecer la ejecución de un ejercicio específico. OBJETIVO: Describir el efecto de un programa de fisioterapia a corto y medio plazo basado en MMV destinada a favorecer el ejercicio de flexión cráneo-cervical (EFCC). Descripción de los casos: Se evaluaron la intensidad de dolor, el umbral de dolor a la presión, el rango de movimiento, el control neuromuscular y la discapacidad cervical en 12 mujeres con CC al inicio, al término y a 3 meses de finalizada la intervención. Intervención: Se ejecutó un programa de 10 sesiones de tratamiento basadas en EFCC y MMV. RESULTADOS: Todas las participantes experimentaron una mejoría clínicamente relevante de su condición a corto plazo, la que se mantuvo 3 meses postintervención. CONCLUSIÓN: El EFCC sumado a una técnica de MMV que busca potenciar la ejecución del ejercicio presentó resultados positivos en mujeres con CC a corto y medio plazo


BACKGROUND: Chronic neck pain is a frequent condition, considered one of the main causes of disability. Among the most used physiotherapeutic treatments are exercise and vertebral manual mobilisation (VMM). However, the application of VMM is based on arthrokinematic fundamentals and not on directly favouring the execution of a specific exercise. OBJECTIVE: to describe the effect of a short- and medium-term physiotherapy programme based on VMM aimed at promoting the exercise of cranio-cervical flexion (CCFE). Cases description: Pain intensity, pressure pain threshold, range of motion, neuromuscular control and cervical disability were evaluated in 12 women with chronic neck pain at the beginning, end and 3 months after the intervention. Intervention: A programme of 10 treatment sessions based on CCFE and VMM was executed. RESULTS: all participants experienced a clinically relevant improvement of their condition in the short term, which remained 3 months post-intervention. CONCLUSION: The CCFE added to a VMM, which seeks to enhance the execution of the exercise, presented positive results in women with chronic neck pain in the short and medium term


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cervicalgia/reabilitação , Cervicalgia/terapia , Fenômenos Biomecânicos/fisiologia , Modalidades de Fisioterapia , Dor Crônica/reabilitação , Medição da Dor , Dor Crônica/terapia , Doenças Neuromusculares/reabilitação , Monitoração Neuromuscular
4.
PLoS One ; 15(9): e0239818, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986777

RESUMO

BACKGROUND: The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level. METHODS AND FINDINGS: Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI ≥30 kg/m2, 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI ≥35 kg/m2, 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53-0.81] and severe obesity (OR 0.56, 95% CI 0.42-0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06-1.29) among the obese patients. CONCLUSION: Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.


Assuntos
Dor Crônica/epidemiologia , Dor Crônica/reabilitação , Exercício Físico , Obesidade/epidemiologia , Clínicas de Dor , Sistema de Registros , Adulto , Índice de Massa Corporal , Estudos de Coortes , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Risco , Autorrelato , Suécia/epidemiologia , Adulto Jovem
6.
Sante Publique ; Vol. 32(1): 19-28, 2020 Jun 18.
Artigo em Francês | MEDLINE | ID: mdl-32706223

RESUMO

Purpose of research: The objective of this article is to investigate, from the perspective of patients, the disruptions of the biographical trajectories induced by chronic low back pain and the impact of a multidisciplinary rehabilitation program on their reconstruction. METHODS: Based on an interdisciplinary qualitative research, we investigated the experience of 20 participants with chronic low back pain following a three-week rehabilitation program at the hospital. Semi-directive interviews were conducted before and after inclusion in the program. RESULTS: Although affecting each person in a singular way, chronic low back pain induces biographical linearity disruptions related to the apparition of pain, and the disruption of daily and professional activities. For the majority of participants, the rehabilitation program provided a repairative space to restore continuity between past, present and future life. Whether or not there is a significant improvement in pain, most participants report benefits that give them the feeling of getting back to normality. Nevertheless, they identify those more for the domestic, family, and social spheres than at the professional level, effects remaining moderate to mitigated in that area. CONCLUSIONS: The rehabilitation program influences the dynamics of biographical trajectories and promotes a return to what is perceived as normality. By providing individuals with theoretical and practical tools and increasing their functional capacities, it promotes autonomous pain and problem management. Immediate effects are seen as restorative for domestic, family and social activities, but remain limited on the professional level.


Assuntos
Dor Crônica/reabilitação , Dor Lombar/reabilitação , Humanos , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Procedimentos Cirúrgicos Reconstrutivos , Ruptura Espontânea/cirurgia
7.
Arch Phys Med Rehabil ; 101(10): 1771-1779, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32682936

RESUMO

OBJECTIVES: This study assessed the utility of the Multidimensional Patient Impression of Change (MPIC) questionnaire in a pediatric pain population after interdisciplinary treatment. DESIGN: Observational study with retrospective chart review. The observed treatment program included psychological counseling, relaxation training, physical therapy, occupational therapy, and physician management. SETTING: Outpatient pain management center affiliated with an academic rehabilitation hospital. PARTICIPANTS: A heterogeneous group of pediatric patients with chronic pain (N=202) who completed an interdisciplinary pain management program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures assessing pain, mood, development, social functioning, physical functioning, and family functioning were administered pre- and posttreatment, and the MPIC was administered posttreatment. RESULTS: Statistically significant improvements were observed in all outcomes (P<.05). The majority of patients perceived themselves to be improved (minimally to very much) in all clinical domains of the MPIC, ranging from 60% (medication efficacy) to 96% (coping with pain). The MPIC ratings were significantly correlated with improvements in most of the outcome measures. The MPIC domains accounted for more than half of the unique variance in predictive models when added to the Patient Global Impression of Change, and most of the variance when added to the models first. CONCLUSIONS: The MPIC was found to be an effective screening tool for assessing patient perceived progress in a pediatric chronic pain population.


Assuntos
Dor Crônica/reabilitação , Medição da Dor/métodos , Medição da Dor/normas , Inquéritos e Questionários/normas , Adaptação Psicológica , Adolescente , Afeto , Criança , Estudos de Coortes , Aconselhamento/organização & administração , Relações Familiares , Feminino , Humanos , Relações Interpessoais , Masculino , Terapia Ocupacional , Equipe de Assistência ao Paciente/organização & administração , Desempenho Físico Funcional , Modalidades de Fisioterapia , Psicometria , Terapia de Relaxamento/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
Arch Phys Med Rehabil ; 101(8): 1322-1331, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32376326

RESUMO

OBJECTIVE: To investigate whether a family history of low back pain (LBP) influences patient outcomes and treatment effects following home exercises in older people with chronic LBP. DESIGN: Secondary analysis of a randomized controlled trial. SETTING: Local community. PARTICIPANTS: People older than 55 years with chronic LBP (N=60). INTERVENTIONS: Participants in the intervention group completed video game exercises for 60 minutes 3 times per week for 8 weeks. Participants in the control group were instructed to maintain their usual levels of activity and care seeking behaviors. MAIN OUTCOMES MEASURES: Participants indicated whether any of their immediate family members had a history of "any" LBP or "activity-limiting" LBP at baseline. We collected self-reported measures of pain, function, pain self-efficacy, care seeking, physical activity, disability, fear of movement and/or reinjury, and falls efficacy at baseline, 8 weeks, 3 months, and 6 months. We performed regression analyses to determine whether a family history of LBP predicted patient outcomes and moderated the effects of home exercise. RESULTS: Participants with a family history of any LBP were less likely to be highly active than those without a family history (odds ratio, 0.08; 95% CI, 0.01-0.42; P=.003). Home-based video game exercises led to improvements in function in those without a family history of activity-limiting LBP (ß=1.78; 95% CI, 0.56-3.00; P=.006) but not in those with a family history (ß=-0.17; 95% CI, -2.56 to 2.21; P=.880) (interaction P=.049). A family history of LBP did not influence the remaining patient outcomes or treatment effects. CONCLUSIONS: A family history of LBP appears to negatively influence physical activity levels in older people with chronic LBP. Further, home-based video game exercises appear to be beneficial for older people with chronic LBP that do not have a family history of LBP.


Assuntos
Dor Crônica/reabilitação , Terapia por Exercício/métodos , Dor Lombar/reabilitação , Anamnese , Idoso , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente , Desempenho Físico Funcional , Resultado do Tratamento , Jogos de Vídeo
10.
Pain Res Manag ; 2020: 5904743, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32377287

RESUMO

Introduction: Osteoarthritis of the musculoskeletal system is accompanied with chronic pain which is the main factor in mood lowering, causing anxiety. Rehabilitation conducted in the framework of spa therapy and outpatient care aims at eliminating or reducing pain and improving physical fitness. Pain relief is an expected phenomenon because it improves the quality of life. Aim of the study. The aim of the study was to evaluate the effect of rehabilitation in the spa and in outpatient clinic on the level of pain and anxiety in patients with degenerative joints and disc disease. Material and methods. The study included a comprehensive treatment conducted in the spa and in outpatient clinic. Observation included 120 persons with disorders of the musculoskeletal system treated in the spa Przerzeczyn-Zdrój. The second group of patients was treated in the rehabilitation clinic. The examinations were performed before and after treatment. The scope of the observations included self-evaluation of anxiety treated as a state and a trait, the level of intensity of pain, medical history, and sociodemographic background interview. In the observations, there were VAS scale and State Trait Anxiety Inventory STAI used. Result: As a result of the spa therapy and therapy performed in an outpatient clinic, there was an improvement in lowering the level of pain and anxiety noted. Conclusions: 1. Spa therapy and treatment performed in an outpatient clinic reduce the level of pain and anxiety in patients with degenerative disease of the musculoskeletal system. 2. It was found that the therapy conducted in the spa was more effective in lowering the level of pain and anxiety. This trial is registered with NCT03405350.


Assuntos
Ansiedade/etiologia , Osteoartrite/psicologia , Osteoartrite/reabilitação , Manejo da Dor/métodos , Adulto , Idoso , Dor Crônica/psicologia , Dor Crônica/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Terapia de Relaxamento/métodos
11.
Occup Med (Lond) ; 70(4): 268-277, 2020 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-32449768

RESUMO

BACKGROUND: Chronic pain (CP) remains the second commonest reason for being off work. Tertiary return to work (RTW) interventions aim to improve psychological and physical capacity amongst workers already off sick. Their effectiveness for workers with CP is unclear. AIMS: To explore which tertiary interventions effectively promote RTW for CP sufferers. METHODS: We searched eight databases for randomized controlled trials evaluating the effectiveness of tertiary RTW interventions for CP sufferers. We employed the Cochrane Risk of Bias (ROB) and methodological quality assessment tools for all included papers. We synthesized findings narratively. Meta-analysis was not possible due to heterogeneity of study characteristics. RESULTS: We included 16 papers pertaining to 13 trials. The types, delivery format and follow-up schedules of RTW interventions varied greatly. Most treatments were multidisciplinary, comprising psychological, physical and workplace elements. Five trials reported that tertiary interventions with multidisciplinary elements promoted RTW for workers with CP compared to controls. We gave a high ROB rating for one or more assessment criteria to three out of the five successful intervention trials. Two had medium- and low-risk elements across all categories. One compared different intensity multidisciplinary treatment and one comprised work-hardening with a job coach. Seven trials found treatment effects for secondary outcomes but no RTW improvement. CONCLUSIONS: There is no conclusive evidence to support any specific tertiary RTW intervention for workers with CP, but multidisciplinary efforts should be considered. Workers' compensation is an important area for RTW policymakers to consider.


Assuntos
Dor Crônica/reabilitação , Doenças Profissionais/reabilitação , Reabilitação Vocacional/métodos , Retorno ao Trabalho , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Arch Phys Med Rehabil ; 101(8): 1304-1312, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32325162

RESUMO

OBJECTIVE: To assess the effectiveness of an individualized comprehensive rehabilitation program (ICPR) on impaired postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain. DESIGN: Randomized controlled trial. SETTING: Women with chronic pelvic pain were recruited from the Gynecology Department of the University Hospital San Cecilio in Granada, Spain. PARTICIPANTS: Participants (N=38) who were randomly divided into 2 groups. INTERVENTIONS: The intervention group received an 8-week ICRP, and the control group received a leaflet with ergonomic information. MAIN OUTCOME MEASURES: The main outcomes included were postural control (Mini Balance Evaluation Systems [Mini BESTest] and timed Up and Go [TUG]), pain (Brief Pain Inventory), self-perceived health status (EuroQol 5 dimensions [EQ-5D]), and functionality (Oswestry Disability Index [ODI]). RESULTS: Significant differences were found between groups in the Mini BESTest and TUG scores with large effect sizes. The Brief Pain Inventory, EQ-5D, and ODI also presented significant differences in the between-groups analysis, with better scores in the intervention group after treatment. In the follow-up analysis, significant differences were found between groups in the Mini BESTest (P<.001), the cognitive TUG subscale (P=.032), interference of pain (P<.001), anxiety and depression (P=.001), and visual analog scale EQ-5D (P=.026) subscales, as well as the ODI (P<.001). CONCLUSIONS: Our results show significant improvements on postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain who received an 8-week ICRP.


Assuntos
Dor Crônica/reabilitação , Dor Pélvica/reabilitação , Modalidades de Fisioterapia , Equilíbrio Postural , Adulto , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Teste de Esforço , Feminino , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Dor Pélvica/fisiopatologia , Desempenho Físico Funcional , Método Simples-Cego
13.
J Med Internet Res ; 22(3): e14766, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32149720

RESUMO

BACKGROUND: Serious gaming could support patients in learning to cope with chronic pain or functional somatic syndromes and reduce symptom burdens. OBJECTIVE: To realize this potential, insight is needed into how, why, for whom, and when it works in actual treatment circumstances. METHODS: Following a realist approach, process evaluations were performed before, during, and after a two-armed, natural quasi-experiment (n=275). A group of patients with interfering chronic pain or fatigue symptoms received a short additional blended mindfulness-based serious gaming intervention during a multidisciplinary rehabilitation program. A control group only received the regular rehabilitation program. During two sessions before and one session after the experiment, expectations about serious gaming processes were discussed in focus groups with local care providers, implementers, and experts. Patients participated in a survey (n=114) and in semistructured interviews (n=10). The qualitative data were used to develop tentative expectations about aspects of serious gaming that, in certain patients and circumstances, trigger mechanisms of learning and health outcome change. Hypotheses about indicative quantitative data patterns for tentative expectations were formulated before inspecting, describing, and analyzing-with regression models-routinely collected clinical outcome data. An updated program theory was formulated after mixing the qualitative and quantitative results. RESULTS: Qualitative data showed that a subset of patients perceived improvement of their self-awareness in moments of daily social interactions. These results were explained by patients, who played the serious game LAKA, as a "confrontation with yourself," which reflected self-discrepancies. Important characteristics of serious gaming in the study's context included innovation factors of relative advantage with experiential learning opportunity, compatibility with the treatment approach, and the limited flexibility in regard to patient preferences. Perceived patient factors included age and style of coping with stress or pain. Learning perceptions could also depend on care provider role-taking and the planning and facilitating (ie, local organization) of serious gaming introduction and feedback sessions in small groups of patients. Quantitative data showed very small average differences between the study groups in self-reported depression, pain, and fatigue changes (-.07

Assuntos
Dor Crônica/reabilitação , Fadiga/reabilitação , Avaliação de Processos em Cuidados de Saúde/métodos , Jogos de Vídeo/normas , Adolescente , Adulto , Idoso , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Pain Pract ; 20(6): 600-614, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32187789

RESUMO

BACKGROUND: In the context of interventions aimed at reducing pain, disability, and maladaptive pain cognitions in chronic neck pain, it is hypothesized that patients who have greater symptom reduction possibly also demonstrate greater improvement in cervical motor output. Therefore, the aim of this study was to examine the effect of pain neuroscience education plus cognition-targeted motor control training on cervical motor output. METHODS: Impairments in cervical motor output were measured in 64 subjects with chronic neck pain using standardized tests. Cervical muscle strength, cervical mobility, balance, and cervical neuromuscular control were derived. To assess the differences between groups in response to treatment, a random-intercept linear mixed-models analysis, applying a diagonal covariance matrix, was used. RESULTS: A significant treatment × time interaction effect was found for neuromuscular control of the deep cervical flexors, favoring the experimental treatment at 3 months' follow-up (mean group difference: 1.982; 95% confidence interval 0.779, 3.185; large effect size d = 0.82). Significant main effects of time were found for the neuromuscular capacity of scapulothoracic muscles and for cervical mobility. No significant effects were found for balance, cervical muscle strength, or endurance of cervical flexors. CONCLUSION: Pain neuroscience education combined with cognition-targeted motor control training is not more effective than biomedically focused education and exercise therapy for improving cervical motor output in people with chronic neck pain. Our findings question the relative importance of factors such as pain, disability, and maladaptive pain cognitions on cervical motor output and the need to address it in treatment.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Cervicalgia/reabilitação , Educação de Pacientes como Assunto/métodos , Adulto , Dor Crônica/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Músculos do Pescoço/fisiologia , Amplitude de Movimento Articular , Resultado do Tratamento
15.
BMC Health Serv Res ; 20(1): 213, 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171308

RESUMO

BACKGROUND: For studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol. OBJECTIVES: To evaluate whether an interdisciplinary graded exposure program, for adolescents with chronic musculoskeletal pain reporting pain-related fear, was performed according to protocol, and whether it is feasible to implement the program in rehabilitation care. METHODS: A process evaluation where quantitative and qualitative data on participant characteristics (adolescents, parents and therapists), attendance and participants' opinion on the program were collected, by means of registration forms, questionnaires and group interviews. To evaluate treatment fidelity, audio and video recordings of program sessions were analyzed. RESULTS: Thirty adolescents were offered the program, of which 23 started the program. Adolescents attended on average 90% of the sessions. At least one parent per adolescent participated in the program. Analysis of 20 randomly selected recordings of treatment sessions revealed that treatment fidelity was high, since 81% of essential treatment elements were offered to the adolescents. The program was considered client-centered by adolescents and family-centered by parents. Treatment teams wished to continue offering the program in their center. CONCLUSION: The interdisciplinary graded exposure program was performed largely according to protocol, and therapists, adolescents and their parents had a favorable opinion on the program. Implementation of the program in rehabilitation care is considered feasible. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02181725 (7 February 2014).


Assuntos
Dor Crônica/psicologia , Dor Crônica/reabilitação , Medo , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/reabilitação , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pais/psicologia , Avaliação de Processos em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Inquéritos e Questionários
16.
Arch Phys Med Rehabil ; 101(5): 750-761, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32004517

RESUMO

OBJECTIVE: To investigate the effectiveness of chronic pain self-management support with pain science education and exercise (COMMENCE) on improving function, pain interference, work status, pain intensity, fatigue, psychological factors associated with pain, health care visits, satisfaction, and perceived change compared with usual care. DESIGN: Parallel group randomized controlled trial with 1- and 12-week follow-ups. SETTING: Community health center. PARTICIPANTS: Adults (N=102) with chronic noncancer pain referred for self-management support. Eighty of 102 participants completed 12-week follow-up assessments. No participants withdrew with adverse events. INTERVENTIONS: Participants were randomized to COMMENCE or usual care. MAIN OUTCOME MEASURES: Primary: Function measured using the Short Musculoskeletal Function Assessment-Dysfunction Index. Secondary: Short Musculoskeletal Function Assessment-Bother Index, Patient Reported Outcomes Measurement Information System pain interference, work status, numeric pain, and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of health care visits, satisfaction, and global rating of change. RESULTS: COMMENCE resulted in greater improvements in function (mean difference [MD] at 12-wk follow-up=-8.0; 95% CI, -14.7 to -1.3), bother with functional difficulties (MD, -12.0; 95% CI, -20.8 to -3.2), pain intensity (MD, -1.0; 95% CI, -2.1 to -0.1), catastrophizing (MD , -8.2; 95% CI, -14.5 to -2.0), self-efficacy (MD, 7.0; 95% CI, 0.8-13.2), knowledge (MD, 2.8; 95% CI, 1.6-3.9), satisfaction (MD, 1.2; 95% CI, 0.7-1.8), and perceived change (MD, 1.4; 95% CI, 0.8-2.1). There were no significant between-group differences in pain interference, work, fatigue, depressive symptoms, or health care visits. CONCLUSION: COMMENCE is more effective than usual care at improving function, pain, catastrophic thinking, self-efficacy, pain knowledge, satisfaction, and perceived change but not pain interference, work status, fatigue, depressive symptoms, or health care visits.


Assuntos
Dor Crônica/reabilitação , Terapia Cognitivo-Comportamental , Terapia por Exercício , Autogestão , Catastrofização/epidemiologia , Dor Crônica/epidemiologia , Depressão/epidemiologia , Avaliação da Deficiência , Fadiga/epidemiologia , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Ontário/epidemiologia , Medição da Dor , Satisfação do Paciente , Autoeficácia
17.
Pain Pract ; 20(5): 491-500, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32030853

RESUMO

BACKGROUND: Adolescents with chronic musculoskeletal pain face different impairments in daily life. After an inpatient pain rehabilitation program, adolescents function better on several domains. The aim of this study was to explore the long-term work participation of adults who followed inpatient pain rehabilitation during adolescence because of chronic musculoskeletal pain and to identify potential facilitators and barriers regarding work in later life. METHODS: A mixed-methods study with standardized questionnaires and semi-structured interviews. The questionnaires measured pain, disability, work status, and the quality and quantity of the work. The interviews contained questions about work participation. Potential participants were all patients who had participated in an inpatient pain rehabilitation program 15 to 20 years previously. Analyses were performed by thematic analysis. Using the Sherbrooke model as guidance, themes were classified into 4 systems: healthcare, workplace, legislative/insurance, and personal. RESULTS: Fourteen patients consented to participate (12 females). Seventy-one percent of them had paid work. The mean self-reported quality of the work delivered was 9.6 (standard deviation = 0.5). Eighteen facilitators and 12 barriers regarding work participation later on in life were mentioned. The inpatient pain rehabilitation program was the most frequently mentioned facilitator (n = 5), while the personal system and coping-related factors were the most frequently mentioned barriers (n = 5). CONCLUSIONS: Ten out of 14 participants are currently working, most of them despite experiencing pain. Several factors based on the 4 systems of the Sherbrooke model contribute as facilitators or barriers regarding current work participation. Pain rehabilitation is mostly regarded as a facilitator for work participation later on in life.


Assuntos
Dor Crônica/reabilitação , Avaliação da Deficiência , Emprego/estatística & dados numéricos , Dor Musculoesquelética/reabilitação , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Manejo da Dor , Inquéritos e Questionários , Tempo , Adulto Jovem
19.
Clin Rehabil ; 34(3): 382-393, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31912752

RESUMO

OBJECTIVE: To compare the effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme in patients with chronic low back pain. DESIGN: A single-centre, pragmatic, two-arm parallel, randomized controlled trial (1:1 ratio). SETTING: A rheumatology inpatient rehabilitation centre in Denmark. SUBJECTS: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. INTERVENTIONS: An integrated rehabilitation programme comprising an alternation of three weeks of inpatient stay and 12 weeks of home-based activities was compared with an existing rehabilitation programme of four weeks of inpatient stay. MAIN MEASURES: Patient-reported outcomes were collected at baseline and at the 26-week follow-up. The primary outcome was back-specific disability (Oswestry Disability Index). Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). A complete case analysis was performed. RESULTS: A total of 303 patients were assessed for eligibility of whom 165 (mean age: 50 years (SD 13) and mean Oswestry Disability Index score 42 (SD 11)) were randomized (83 to existing rehabilitation programme and 82 to integrated rehabilitation programme). Overall, 139 patients provided the 26-week follow-up data. Baseline demographic and clinical characteristics were comparable between programmes. The between-group difference in the Oswestry Disability Index score when adjusting for the corresponding baseline score was -0.28 (95% confidence interval (CI): -4.02, 3.45) which was neither statistically nor clinically significant. No significant differences were found in the secondary outcomes. CONCLUSION: An integrated rehabilitation programme was no more effective than an existing rehabilitation programme at the 26-week follow-up.


Assuntos
Dor Crônica/reabilitação , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Hospitalização , Dor Lombar/reabilitação , Adulto , Idoso , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Centros de Reabilitação , Resultado do Tratamento , Adulto Jovem
20.
J Rehabil Med ; 52(2): jrm00023, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-31993672

RESUMO

OBJECTIVES: To investigate the outcomes 1 year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after 1 year. METHODS: A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and 1 year after multimodal rehabilitation programmes. RESULTS: Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, confidence interval (CI) 1.21-1.06, p = 0.005). CONCLUSION: This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.


Assuntos
Dor Crônica/reabilitação , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
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