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1.
Rev Lat Am Enfermagem ; 27: e3172, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596408

RESUMO

OBJECTIVE: to relate nonspecific low back pain within the nursing work context with their workloads, attrition processes and the risks of illness. METHOD: a cross-sectional study with 301 workers from a general hospital in the south of the country. The Nordic Musculoskeletal Questionnaire and the Work Context Assessment Scale composed of three dimensions were used: working conditions, work organization and socio-professional relations. The association of variables with low back pain was tested using bivariate and multivariate analyzes. The measure of association used was the Odds Ratio and its respective intervals with 95% confidence. The data collected were discussed under the theoretical framework of the work process within the marxist conception and the theory of social determination of the health-disease process. RESULTS: there was a statistically significant association between the dimensions of work organization and working conditions with low back pain and they obtained a critical classification meaning moderate risks to the professional illness. CONCLUSION: the study allowed a better understanding of the nursing work process and its relation with nonspecific low back pain and signaled that changes in the organization and working conditions should occur in order to reduce the risks of nursing workers' illness.


Assuntos
Dor Lombar/terapia , Processo de Enfermagem/organização & administração , Equipe de Enfermagem/organização & administração , Enfermagem/normas , Doenças Profissionais/terapia , Adulto , Estudos Transversais , Feminino , Humanos , Dor Lombar/classificação , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Inquéritos e Questionários , Carga de Trabalho , Local de Trabalho , Adulto Jovem
2.
Physiother Theory Pract ; 35(11): 1078-1086, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29723124

RESUMO

Objective: To examine the agreement between telerehabilitation and face-to-face assessments of patients with acute and subacute low back pain (LBP) using a modified treatment-based classification (TBC) system. A secondary aim was to evaluate patient satisfaction with the telerehabilitation assessment. Methods: Patients with LBP of less than 90 days' duration underwent both telerehabilitation and face-to-face assessments. After physical examination, patients were classified into one of three intervention groups (mobilization/manipulation, specific exercise, and stabilization). The assessment order and clinicians were randomized, and the clinicians were blinded to each other's classification decision. Results: Forty-seven patients participated (mean [SD] age, 48.6 [15.0] years; 70% female). The overall rate of percentage agreement was 68.1% (κ = 0.52; 95% confidence interval, 0.32-0.72). There was no difference in classification distributions between assessments (χ2 = 2.14, p = 0.54). The percentage agreement was 48.9%-59.6% for the modified TBC algorithm variables except for straight leg raise greater than 91°, which was markedly lower at 35.1%. This was the only variable that was significantly different between the telerehabilitation and face-to-face scenarios. The overall satisfaction with the telerehabilitation assessment was good. Conclusions: The results suggest that a telerehabilitation assessment using the modified TBC system may be able to direct treatment of patients with acute and subacute LBP. However, challenges still remain in applying this approach to clinical practice.


Assuntos
Dor Lombar/classificação , Exame Físico , Consulta Remota , Telerreabilitação , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Distribuição Aleatória
3.
Physiother Res Int ; 24(1): e1747, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30226651

RESUMO

OBJECTIVES: The evidence for the effectiveness of interventions targeting acute low back pain (LBP) is suboptimal. It is difficult to identify those patients who are more likely to develop chronic pain and disability after an acute episode of LBP. These shortcomings may be attributed to considering LBP as one homogenous condition. METHODS: In this quasi-experimental study, we examined and analysed a prospective cohort of 267 patients with first-onset LBP and classified them into one of the groups based on treatment-based classification: direction-specified exercises (Group 2), manipulation (Group 3), stabilization exercises (Group 4), traction (Group 5), and a physician care group (Group 1). Disability and pain were assessed at baseline, after treatment, and at 6 months using the Oswestry Disability Index and the Numerical Rating Scale, respectively. Comparisons were made between the groups, and we predicted measures of disability and pain intensity at 6 months with age, gender, fear avoidance behaviour, centralization phenomenon (CP), expectations about recovery, CP, group classification, baseline pain, and disability. RESULTS: Analysis showed that all the heterogeneous groups of LBP improved their outcomes with the respective treatment provided. However, when the entire sample was considered as one homogenous group of LBP, the results showed improvement with time (p < 0.05) only and no difference was found between groups (p > 0.05). None of the studied factors, except baseline pain (R = 0.227, R2  = 0.051, p < 0.05), were able to accurately predict the development of chronic pain in our study sample. CONCLUSION: Though our results showed no differences between the subgroups in the reduction of pain and disability, we conclude that classifying and treating patients with LBP into subgroups based on signs and symptoms produce better outcomes. Baseline pain alone may predict a small percentage of people who may develop chronic pain.


Assuntos
Aprendizagem da Esquiva , Avaliação da Deficiência , Medo , Dor Lombar/classificação , Medição da Dor/métodos , Doença Aguda , Adulto , Pessoas com Deficiência/classificação , Exercício , Terapia por Exercício , Feminino , Humanos , Dor Lombar/reabilitação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
Musculoskelet Sci Pract ; 39: 10-15, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30447492

RESUMO

BACKGROUND: Classification of spinal pain has been a key goal identified in the research. However it is not clear if existing classification systems are comprehensive. OBJECTIVE: To examine the comprehensiveness and distribution of classifications within the McKenzie classification system (MDT), and the directional preference in consecutive patients with spine pain. STUDY DESIGN: Prospective, observational study. METHODS: Clinicians with a Diploma in MDT provided data on patients that they had assessed, classified, managed, and then confirmed their classification at discharge. They provided data on the spinal area, the MDT classification, and the loading strategy used in management. RESULTS: Fifty-four clinicians from at least 15 different countries provided data on 750 patients: lumbar 64.8%, cervical 29.6%, thoracic 5.6%. The distribution of classifications was as follows: Derangement 75.4%, OTHER 22.8%, Dysfunction 1.7%, Postural syndrome 0.1%. In Derangements 82.5% had a directional preference for extension, 12.9% for lateral forces, and 4.6% for flexion. Those patients classified as one of the OTHER subgroups were given specific classifications. CONCLUSION: Derangement was the most common classification and extension was by far the most common directional preference. A substantial proportion were classified as OTHER subgroups, for whom management is less straightforward.


Assuntos
Dor Lombar/classificação , Dor Lombar/diagnóstico , Fisioterapeutas/normas , Modalidades de Fisioterapia/normas , Feminino , Humanos , Internacionalidade , Vértebras Lombares/patologia , Masculino , Variações Dependentes do Observador , Medição da Dor , Estudos Prospectivos , Reprodutibilidade dos Testes , Síndrome
5.
Eur Spine J ; 27(11): 2814-2822, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30196420

RESUMO

PURPOSE: To translate, cross-culturally adapt, and validate the Croatian version of the Oswestry Disability Index (ODI). METHODS: The original English-language ODI was cross-culturally adapted into Croatian and then evaluated in a group of 114 patients with chronic low back pain (LBP) at the Department of Neurosurgery, Zagreb University School of Medicine. Confirmatory factor analysis (CFA) was conducted with three models: two were theory driven (unidimensional and two dimensional-static and dynamic factors); the other was based on our exploratory factor analysis (EFA). Internal consistency and test-retest reliability were evaluated using Cronbach's α and the intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by evaluating the correlation between the ODI and Visual Analogue Scale (VAS), and between the ODI and 36-item short form survey (SF-36) scores. RESULTS: The EFA-derived two-dimensional structure explained 82.7% of the total variance and was significantly better than the other models (P < 0.001); however, none of the models had acceptable fit. Internal consistency (Cronbach α = 0.84) and test-retest reliability (ICC = 0.94) were satisfactory. The ODI was positively correlated with VAS (rs = 0.54, P < 0.001) and negatively correlated with all of the SF-36 sections (rs = - 0.35 to - 0.64, P < 0.001, all), apart from the role-physical (rs = - 0.02, P = 0.767). CONCLUSIONS: The Croatian version of the ODI has acceptable psychometric properties. It appears to be suitable for assessment of LBP and treatment outcomes in Croatian-speaking patients. Overall, there was no evidence to reject the original unidimensional structure in favor of a two-factor solution. As such, the unidimensional structure should continue to be used in future studies. These slides can be retrieved under Electronic Supplementary Material.


Assuntos
Avaliação da Deficiência , Dor Lombar , Inquéritos e Questionários/normas , Croácia , Humanos , Dor Lombar/classificação , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Psicometria , Reprodutibilidade dos Testes
6.
BMC Musculoskelet Disord ; 19(1): 309, 2018 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-30153815

RESUMO

BACKGROUND: Movement dysfunctions have been associated with persistent low back pain (LBP) but optimal treatment remains unclear. One possibility is that subgroups of persistent LBP patients have differing movement characteristics and therefore different responses to interventions. This study examined if there were patterns of flexion-related lumbo-pelvic kinematic and EMG parameters that might define subgroups of movement. METHODS: This was a cross-sectional, observational study of 126 people without any history of significant LBP and 140 people with persistent LBP (n = 266). Wireless motion and surface EMG sensors collected lumbo-pelvic data on flexion parameters (range of motion (ROM) of trunk, lumbar, and pelvis), speed, sequence coordination and timing, and EMG extensor muscle activity in forward bending (flexion relaxation)), and sitting parameters (relative position, pelvic tilt range and tilt ratio). Latent class analysis was used to identify patterns in these parameters. RESULTS: Four subgroups with high probabilities of membership were found (mean 94.9%, SD10.1%). Subgroup 1 (n = 133 people, 26% LBP) had the greatest range of trunk flexion, fastest movement, full flexion relaxation, and synchronous lumbar versus pelvic movement. Subgroup 2 (n = 73, 71% LBP) had the greatest lumbar ROM, less flexion relaxation, and a 0.9 s lag of pelvic movement. Subgroup 3 (n = 41, 83% LBP) had the smallest lumbar ROM, a 0.6 s delay of lumbar movement (compared to pelvic movement), and less flexion relaxation than subgroup 2. Subgroup 4 (n = 19 people, 100% LBP) had the least flexion relaxation, slowest movement, greatest delay of pelvic movement and the smallest pelvic ROM. These patterns could be described as standard (subgroup 1), lumbar dominant (subgroup 2), pelvic dominant (subgroup 3) and guarded (subgroup 4). Significant post-hoc differences were seen between subgroups for most lumbo-pelvic kinematic and EMG parameters. There was greater direction-specific pain and activity limitation scores for subgroup 4 compared to other groups, and a greater percentage of people with leg pain in subgroups 2 and 4. CONCLUSION: Four subgroups of lumbo-pelvic flexion kinematics were revealed with an unequal distribution among people with and without a history of persistent LBP. Such subgroups may have implications for which patients are likely to respond to movement-based interventions.


Assuntos
Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/fisiologia , Movimento/fisiologia , Adulto , Fenômenos Biomecânicos/fisiologia , Estudos Transversais , Eletromiografia/métodos , Feminino , Humanos , Dor Lombar/classificação , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/patologia , Adulto Jovem
7.
J Headache Pain ; 19(1): 52, 2018 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-30006760

RESUMO

BACKGROUND: To investigate the combinations of Musculoskeletal pain (MSP) (neck, shoulder, upper and low back pain) among a sample of Iranian school children. METHODS: The MSP combinations was modeled by latent class analysis (LCA) to find the clusters of high-risk individuals and multigroup LCA taking into account the gender and age (≤ 13 years and ≥ 14 years of age categories). RESULTS: The lowest and highest prevalence of MSP was 14.2% (shoulder pain in boys aged ≥14 years) and 40.4% (low back pain in boys aged ≤13 years), respectively. The likelihood of synchronized neck and low back pain (9.4-17.7%) was highest, while synchronized shoulder and upper back pain (4.5-9.4%) had the lowest probability. The probability of pain at three and four locations was significantly lower in boys aged ≥14 years than in other gender-age categories. The LCA divided the children into minor, moderate, and major pain classes. The likelihood of shoulder and upper back pain in the major pain class was higher in boys than in girls, while the likelihood of neck pain in the moderate pain class and low back pain in the major pain class were higher in children aged ≥14 years than those aged ≤13 years. Gender-age specific clustering indicated a higher likelihood of experiencing major pain in children aged ≤13 years. CONCLUSIONS: The findings highlight the importance of gender- and age-specific data for a more detailed understanding of the MSP combinations in children and adolescents, and identifying high-risk clusters in this regard.


Assuntos
Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/epidemiologia , Adolescente , Fatores Etários , Criança , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Dor Lombar/classificação , Dor Lombar/diagnóstico , Dor Lombar/epidemiologia , Masculino , Dor Musculoesquelética/classificação , Cervicalgia/classificação , Cervicalgia/diagnóstico , Cervicalgia/epidemiologia , Prevalência , Distribuição Aleatória , Fatores de Risco , Fatores Sexuais , Dor de Ombro/classificação , Dor de Ombro/diagnóstico , Dor de Ombro/epidemiologia , Inquéritos e Questionários
8.
J Orthop Sci ; 23(4): 643-648, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29728303

RESUMO

BACKGROUND: The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was developed in 2007, including the five domains of Pain-related disorder, Lumbar spine dysfunction, Gait disturbance, Social life disturbance, and Psychological disorder. It is used by physicians to evaluate treatment efficacy by comparing scores before and after treatment. However, the JOABPEQ does not allow evaluation of the severity of a patient's condition compared to the general population at a single time point. Given the unavailability of a standard measurement of back pain, we sought to establish reference scores and interquartile ranges using data obtained from a multicenter, cross-sectional survey taken in Japanese primary care settings. METHODS: The Lumbar Spinal Stenosis Diagnosis Support Tool project was conducted from 2011 to 2012 in 1657 hospitals in Japan to investigate the establishment of reference scores using JOABPEQ. Patients aged ≥ 20 years undergoing medical examinations by either non-orthopaedic primary care physicians or general orthopedists were considered for enrollment. RESULTS: A total of 10,651 consecutive low back pain patients (5331 men, 5320 women, 18 subjects with missing sex data) who had undergone a medical examination were included. Reference scores and interquartile ranges for each of the five domains of the JOABPEQ according to age and sex were recorded. The median score and interquartile range are the same in the domain of Pain-related disorder in all ages and sexes. The reference scores for Gait disturbance, Social life disturbance and Psychological disorder declined with increasing age in both age- and sex-stratified groups, while there was some different trend in Lumbar spine dysfunction between men and women. CONCLUSION: Reference scores and interquartile ranges for JOABPEQ were generated based on the data from the examination data. These provide a measurement standard to assess patient perceptions of low back pain at any time point during evaluation or therapy.


Assuntos
Dor Lombar/diagnóstico , Ortopedia/normas , Medição da Dor/normas , Sociedades Médicas/normas , Inquéritos e Questionários , Adulto , Idoso , Dor Crônica/classificação , Dor Crônica/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Japão , Dor Lombar/classificação , Masculino , Pessoa de Meia-Idade , Padrões de Referência , Sensibilidade e Especificidade
9.
Gait Posture ; 63: 296-301, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29807335

RESUMO

Low back pain(LBP) is one of the most prevalent diseases afflicting people today. Abnormal musculoskeletal loadings during activities of daily living (ADLs) have been deemed to be associated with spine rhythm. But no studies have reported abnormal continuous spine rhythms during ADLs in LBP patients. Therefore, the objective of this study was to investigate the continuous lumbar spine rhythms and their difference between people with and without lumbar disc herniation (LDH). Twenty-six healthy people and seven patients with LDH were recruited in this study. They performed level walking, stair climbing, and trunk flexion. Active optical markers placed on the landmark of the spinous process and pelvis were captured using motion analysis system to drive a musculoskeletal model to calculate the continuous lumbar spine rhythms. It was found that the lumbar spine rhythm was roughly constant throughout the analyzed cycle in both healthy people and LDH patients during trunk flexion. LDH patients displayed fluctuant lumbar spine rhythms during level walking and stair climbing and significantly higher segmental contributions of the lumbar segments in the lower lumbar region during stair climbing and trunk flexion. In conclusion, there were different compensatory responses to LDH in the continuous lumbar spine rhythms during different ADLs. This study provides a new insight into the abnormal spinal motion in LDH patients.


Assuntos
Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiologia , Amplitude de Movimento Articular/fisiologia , Subida de Escada/fisiologia , Tronco/fisiopatologia , Caminhada/fisiologia , Atividades Cotidianas/classificação , Adulto , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/classificação , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valores de Referência
10.
J Orthop Sports Phys Ther ; 48(11): 837-846, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29739300

RESUMO

BACKGROUND: A diagnostic classification algorithm, "the Petersen classification," consisting of 12 categories based on a standardized examination protocol, was developed for the primary purpose of identifying clinically homogeneous subgroups of individuals with low back pain (LBP). OBJECTIVES: To investigate whether a diagnostic classification algorithm is associated with activity limitation and LBP intensity at follow-up assessments of 2 weeks, 3 months, and 1 year, and whether the algorithm improves outcome prediction when added to a set of known predictors. METHODS: This was a prospective observational study of 934 consecutive adult patients with new episodes of LBP who were visiting chiropractic practices in primary care and categorized according to the Petersen classification. Outcomes were disability and pain intensity measured with questionnaires at 2 weeks and 3 months, and 1-year trajectories of LBP based on weekly responses to text messages. Associations were analyzed with linear and logistic regression models. In a subgroup of patients, the numbers of visits to primary and secondary care were described. RESULTS: The Petersen classification was statistically significantly associated with all outcomes (P<.001) but explained very little of the variance (R2 = 0.00-0.05). Patients in the nerve root involvement category had the most pain and activity limitation and the most visits to primary and secondary care. Patients in the myofascial pain category were the least affected. CONCLUSION: The Petersen classification was not helpful in determining individual prognosis in patients with LBP receiving usual care in chiropractic practice. However, patients should be examined for potential nerve root involvement to improve prediction of likely outcomes. LEVEL OF EVIDENCE: Prognosis, level 1b. J Orthop Sports Phys Ther 2018;48(11):837-846. Epub 8 May 2018. doi:10.2519/jospt.2018.8083.


Assuntos
Algoritmos , Dor Lombar/classificação , Dor Lombar/diagnóstico , Adulto , Dinamarca , Feminino , Seguimentos , Humanos , Dor Lombar/terapia , Masculino , Manipulação Quiroprática , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
11.
BMC Musculoskelet Disord ; 19(1): 166, 2018 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-29793536

RESUMO

BACKGROUND: Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories. METHODS: An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen's Kappa coefficient, Pearson's r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool. RESULTS: A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ. CONCLUSION: The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care.


Assuntos
Dor Lombar/classificação , Dor Lombar/epidemiologia , Medição da Dor/classificação , Encaminhamento e Consulta/classificação , Atenção Secundária à Saúde/classificação , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Medição da Dor/métodos , Encaminhamento e Consulta/tendências , Fatores de Risco , Atenção Secundária à Saúde/métodos , Atenção Secundária à Saúde/tendências
12.
Eur Spine J ; 27(11): 2823-2830, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29671109

RESUMO

PURPOSE: (1) To analyse the clinical utility of the STarT Back Screening Tool (SBST) in emergency departments by describing changes in classification over time and; (2) to identify what would be the best time to use the SBST to predict long-term clinical outcomes in patients with acute nonspecific low back pain (LBP) seeking emergency care. METHODS: A 6 months prospective inception cohort study was conducted. 200 participants with LBP seeking emergency medical treatment were included. Pain intensity, disability and SBST were collected at baseline, 6 and 26 weeks. Categories of improvement, clinical worsening, and stability were created to calculate the changes in the SBST subgroups. Linear regression models were built to analyse the predictive ability of SBST when applied at baseline, 6 weeks as well as changes in the subgroup from baseline to 6 weeks. These models were adjusted for potential confounders. RESULTS: 45% of patients were classified as high risk of chronicity at baseline. Most patients classified as medium (86.7%) or high (52.4%) risk changed their risk subgroup after 6 weeks and most of them improved. The SBST improved the prediction for all outcomes when applied at 6 weeks (R2 = 22.1% for disability and R2 = 15.6% for pain intensity), but not at baseline. CONCLUSION: Most of patients seeking care in emergency departments with a new episode of acute LBP improved after 6 weeks. The use of SBST to guide initial treatment and to predict clinical outcomes are most indicated when the instrument is applied after 6 weeks after presentation to emergency care. These slides can be retrieved under Electronic Supplementary material.


Assuntos
Avaliação da Deficiência , Serviço Hospitalar de Emergência , Dor Lombar , Humanos , Dor Lombar/classificação , Dor Lombar/diagnóstico por imagem , Dor Lombar/fisiopatologia , Estudos Prospectivos
13.
J Orthop Sports Phys Ther ; 48(6): 476-490, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29602304

RESUMO

Study Design Literature review with meta-analysis. Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT), a classification-based system, was designed to classify patients into homogeneous subgroups to direct treatment. Objectives To examine the effectiveness of MDT for improving pain and disability in patients with either acute (less than 12 weeks in duration) or chronic (greater than 12 weeks in duration) low back pain (LBP). Methods Randomized controlled trials examining MDT in patients with LBP were identified from 6 databases. Independent investigators assessed the studies for exclusion, extracted data, and assessed risk of bias. The standardized mean difference (SMD) and 95% confidence interval were calculated to compare the effects of MDT to those of other interventions in patients with acute or chronic LBP. Results Of the 17 studies that met the inclusion criteria, 11 yielded valid data for analysis. In patients with acute LBP, there was no significant difference in pain resolution (P = .11) and disability (P = .61) between MDT and other interventions. In patients with chronic LBP, there was a significant difference in disability (SMD, -0.45), with results favoring MDT compared to exercise alone. There were no significant differences between MDT and manual therapy plus exercise (P>.05) for pain and disability outcomes. Conclusion There is moderate- to high-quality evidence that MDT is not superior to other rehabilitation interventions for reducing pain and disability in patients with acute LBP. In patients with chronic LBP, there is moderate- to high-quality evidence that MDT is superior to other rehabilitation interventions for reducing pain and disability; however, this depends on the type of intervention being compared to MDT. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(6):476-490. Epub 30 Mar 2018. doi:10.2519/jospt.2018.7562.


Assuntos
Dor Aguda/diagnóstico , Dor Aguda/terapia , Dor Crônica/diagnóstico , Dor Crônica/terapia , Dor Lombar/diagnóstico , Dor Lombar/terapia , Dor Aguda/classificação , Dor Crônica/classificação , Terapia por Exercício , Humanos , Dor Lombar/classificação , Manipulações Musculoesqueléticas , Medição da Dor
15.
BMC Musculoskelet Disord ; 19(1): 62, 2018 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-29463258

RESUMO

BACKGROUND: Research into the clinical importance of spinal MRI findings in patients with low back pain (LBP) has primarily focused on single imaging findings, such as Modic changes or disc degeneration, and found only weak associations with the presence of pain. However, numerous MRI findings almost always co-exist in the lumbar spine and are often present at more than one lumbar level. It is possible that multiple MRI findings are more strongly associated with LBP than single MRI findings. Latent Class Analysis is a statistical method that has recently been tested and found useful for identifying latent classes (subgroups) of MRI findings within multivariable datasets. The purpose of this study was to investigate the association between subgroups of MRI findings and the presence of LBP in people from the general population. METHODS: To identify subgroups of lumbar MRI findings with potential clinical relevance, Latent Class Analysis was initially performed on a clinical dataset of 631 patients seeking care for LBP. Subsequently, 412 participants in a general population cohort (the 'Backs on Funen' project) were statistically allocated to those existing subgroups by Latent Class Analysis, matching their MRI findings at a segmental level. The subgroups containing MRI findings from the general population were then organised into hypothetical pathways of degeneration and the association between subgroups in the pathways and the presence of LBP was tested using exact logistic regression. RESULTS: Six subgroups were identified in the clinical dataset and the data from the general population cohort fitted the subgroups well, with a median posterior probability of 93%-100%. These six subgroups described two pathways of increasing degeneration on upper (L1-L3) and lower (L4-L5) lumbar levels. An association with LBP was found for the subgroups describing severe and multiple degenerative MRI findings at the lower lumbar levels but none of the other subgroups were associated with LBP. CONCLUSION: Although MRI findings are common in asymptomatic people and the association between single MRI findings and LBP is often weak, our results suggest that subgroups of multiple and severe lumbar MRI findings have a stronger association with LBP than those with milder degrees of degeneration.


Assuntos
Dor Lombar/classificação , Dor Lombar/diagnóstico por imagem , Imagem por Ressonância Magnética/classificação , Adulto , Estudos de Coortes , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Dor Lombar/epidemiologia , Imagem por Ressonância Magnética/tendências , Masculino , Inquéritos e Questionários
16.
Nurs Health Sci ; 20(2): 224-230, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29421851

RESUMO

Non-specific low back pain (NS-LBP) is known to cause respiratory dysfunction. In this study, we investigated alterations in breathing, respiratory strength and endurance, core stability, diaphragm mobility, and chest expansion among patients with NS-LBP and healthy individuals. The specific aim of the study was to correlate between respiratory function and other variables among NS-LBP patients. Thirty four patients with NS-LBP were matched with 34 healthy participants before undergoing total faulty breathing scale, spirometer, respiratory pressure meter, chest expansion, ultrasound, and pressure biofeedback measurements. There were signs of faulty breathing in the NS-LBP patients when compared to the healthy participants. Diaphragmatic mobility and respiratory muscle endurance were lower in the NS-LBP group. Chest expansion exhibited a significant decrease at the level of the fourth intercostal space in the NS-LBP group, but respiratory muscle strength and core stability were not significant between the two groups. Positive correlations were found to be fairly significant regarding respiratory muscle strength. The findings of this study indicated altered respiratory characteristics in the NS-LBP patients, and suggested that they would improve through respiratory exercises.


Assuntos
Dor Lombar/classificação , Mecânica Respiratória/fisiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/psicologia , Estatísticas não Paramétricas
17.
Musculoskelet Sci Pract ; 34: 66-76, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29367122

RESUMO

BACKGROUND: Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism(s) driving the disorder are clinically useful to guide specific interventions. OBJECTIVE: To establish consensus among experts regarding clinical criteria suggestive of a dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns (DPs) in NSLBP patients. STUDY DESIGN: A 2-phase sequential design of a focus group and Delphi-study. METHODS: A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group. RESULTS: Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two 'articular', 20 'myofascial', 21 'neural', 18 'central' and 11 'sensorimotor control' criteria reached a predefined ≥80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify 'referred pain below the knee' as a subjective examination criterion suggestive for a predominant 'neural DP'. CONCLUSION: These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.


Assuntos
Técnicas e Procedimentos Diagnósticos/normas , Guias como Assunto , Dor Lombar/classificação , Exame Físico/normas , Adulto , Técnica Delfos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Fisioterapeutas , Reprodutibilidade dos Testes , Inquéritos e Questionários
18.
Chiropr Man Therap ; 26: 1, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29321845

RESUMO

Background: Causative factors may be different for the very first onset of symptoms of the 'disease' of low back pain (LBP) than for ensuing episodes that occur after a pain-free period. This differentiation hinges on a life-time absence of low back pain at first onset and short-term absence for further episodes. In this systematic review, we explored whether researchers make these distinctions when investigating the causality of LBP. Methods: A literature search of PUBMED, CINAHL, and SCOPUS databases was performed from January 2010 until September 2016 using the search terms 'low back pain' or 'back pain' and 'risk factor' or 'caus*' or 'predict*' or 'onset' or 'first-time' or 'inception' or 'incidence'. Two reviewers extracted information on study design, types of episodes of back pain to distinguish the disease of LBP and recurring episodes, and also to determine the definitions of disease- or pain-free periods. Results: Thirty-three articles purporting to study causes of LBP were included. Upon scrutiny, 31 of the 33 articles were unclear as to what type of causality they were studying, that of the 'disease' or the episode, or a mere association with LBP. Only 9 studies used a prospective study design. Five studies appeared to investigate the onset of the disease of LBP, however, only one study truly captured the first incidence of LBP, which was the result of sports injury. Six appeared to study episodes but only one clearly related to the concept of episodes. Therefore, among those 11 studies, nine included both first-time LBP and episodes of LBP. Consequently, 22 studies related to the prevalence of LBP, as they probably included a mixture of first-time, recurring and ongoing episodes without distinction. Conclusion: Recent literature concerning the causality of LBP does not differentiate between the 'disease' of LBP and its recurring episodes mainly due to a lack of a clear definition of absence of LBP at baseline. Therefore, current research is not capable of providing a valid answer on this topic.


Assuntos
Doença Crônica/classificação , Dor Lombar/classificação , Doenças Profissionais/classificação , Causalidade , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Medição da Dor , Fatores de Risco , Terminologia como Assunto
20.
Arch Phys Med Rehabil ; 99(1): 65-71, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28709881

RESUMO

OBJECTIVE: To evaluate whether current Dutch primary care clinicians offer tailored treatment to patients with low back pain (LBP) or neck pain (NP) according to their risk stratification, based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT). DESIGN: Prospective cohort study with 3-month follow-up. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs) and physiotherapists included patients (N=284) with nonspecific LBP, NP, or both. INTERVENTIONS: Patients completed a baseline questionnaire, including the Dutch SBT, for either LBP or NP. A follow-up measurement was conducted after 3 months to determine recovery (using Global Perceived Effect Scale), pain (using Numeric Pain Rating Scale), and function (using Roland Disability Questionnaire or Neck Disability Index). A questionnaire was sent to the GPs and physiotherapists to evaluate the provided treatment. MAIN OUTCOME MEASURES: Prevalence of patients' risk profile and clinicians' applied care, and the percentage of patients with persisting disability at follow-up. A distinction was made between patients receiving the recommended treatment and those receiving the nonrecommended treatment. RESULTS: In total, 12 GPs and 33 physiotherapists included patients. After 3 months, we analyzed 184 patients with LBP and 100 patients with NP. In the LBP group, 52.2% of the patients were at low risk for persisting disability, 38.0% were at medium risk, and 9.8% were at high risk. Overall, 24.5% of the patients with LBP received a low-risk treatment approach, 73.5% a medium-risk, and 2.0% a high-risk treatment approach. The specific agreement between the risk profile and the received treatment for patients with LBP was poor for the low-risk and high-risk patients (21.1% and 10.0%, respectively), and fair for medium-risk patients (51.4%). In the NP group, 58.0% of the patients were at low risk for persisting disability, 37.0% were at medium risk, and 5.0% were at high risk. Only 6.1% of the patients with NP received the low-risk treatment approach. The medium-risk treatment approach was offered the most (90.8%), and the high-risk approach was applied in only 3.1% of the patients. The specific agreement between the risk profile and received treatment for patients with NP was poor for low-risk and medium-risk patients (6.3% and 48.0%, respectively); agreement for high-risk patients could not be calculated. CONCLUSIONS: Current Dutch primary care for patients with nonspecific LBP, NP, or both does not correspond to the recommended stratified-care approach based on the SBT, as most patients receive medium-risk treatment. Most low-risk patients are overtreated, and most high-risk patients are undertreated. Although the stratified-care approach has not yet been validated in Dutch primary care, these results indicate there may be substantial room for improvement.


Assuntos
Dor Lombar/classificação , Dor Lombar/terapia , Cervicalgia/classificação , Cervicalgia/terapia , Atenção Primária à Saúde/normas , Adulto , Avaliação da Deficiência , Feminino , Medicina Geral , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Medição da Dor , Modalidades de Fisioterapia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco
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