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1.
Gesundheitswesen ; 82(1): e9-e16, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30340235

RESUMO

There is an increasing need for patient education in chronic low back pain with mental comorbidity. The present study was carried out in the setting of multidisciplinary inpatient rehabilitation and investigated the acceptance and feasibility of the Debora pain competence and depression prevention training comparing an intervention group with a control group. While patients of the intervention group took part in the pain competence and depression prevention training, patients of the control group only participated in pain competence training. METHOD: A total of 3 partial studies were used for formative evaluation. The triangulative design consisted of problem-centered interviews and focus groups with rehabilitation patients as well as focus groups with experts. The interviews were transcribed, anonymized, and content analysis was performed. RESULTS: The training was well accepted and feasible from the perspective of the patients and experts. The therapists had a significant influence on the participants' satisfaction. Suggestions for improvement focused on developing extensions of the pain and stress management aspects and on discussing individual problems. Compared to the intervention group and independent of depression, the control group assessed the training as being less satisfatory and showed poor group coherence. CONCLUSIONS: Results of the formal evaluation support the combined implementation of the Debora pain competence and depression prevention training program and suggest its long-term establishment in multidisciplinary inpatient rehabilitation.


Assuntos
Depressão , Dor Lombar , Educação de Pacientes como Assunto , Depressão/complicações , Estudos de Viabilidade , Alemanha , Humanos , Pacientes Internados , Dor Lombar/complicações
2.
J Clin Neurosci ; 69: 170-174, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31495653

RESUMO

To investigate the impact of obesity on the restoration of sagittal balance after posterior lumbar interbody fusion (PLIF). To examine the correlation between obesity and sagittal balance and their influence on clinical efficacy. A total of 183 patients who underwent PLIF for degenerative lumbar diseases between Jan 2015 and Dec 2015 were enrolled in this study. Based on their BMI, patients were divided into three groups: normal weight group (Group A), overweight group (Group B), and obesity group (Group C). Demographic data, intraoperative data, sagittal balance parameters, and clinical function scores were compared between each group. Correlation analysis was conducted between the BMI scores and each sagittal balance parameter. Multiple linear regression was used to assess the impact of each variable on clinical outcomes. All patients finished an average of 22.3 months follow-up. Group C had significantly higher blood loss and longer operations than Group A. SL and PT improved significantly in Group A while did not change in Group C. Compared with Group C, Group postoperative pelvic tilt (PT) was better restored in Group A. BMI was significantly correlated with change of lumbar lordosis (LL) and PT. Multiple linear regression analysis indicated that BMI and change of PT had a great influence on ODI improvement. Obesity may hinder the correction of sagittal balance and improvement of clinical efficacy in patients who undergo PLIF. Restoration of PT should be paid more attention to during surgery, as it may be associated with satisfactory clinical outcomes especially for obesity.


Assuntos
Dor Lombar/complicações , Obesidade/complicações , Postura , Fusão Vertebral , Resultado do Tratamento , Adulto , Idoso , Feminino , Humanos , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos
4.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 94-97, sept. 2019. ilus.
Artigo em Espanhol | LILACS | ID: biblio-1048277

RESUMO

Las fístulas arteriovenosas durales medulares son malformaciones vasculares adquiridas que constituyen una causa muy infrecuente de mielopatía progresiva (5-10 casos por millón de habitantes por año). La resonancia magnética es el estudio por imágenes de elección para su diagnóstico. A continuación presentamos el caso de una paciente femenina de 89 años, que consultó a la guardia de nuestra institución por un cuadro de paraparesia moderada asociada a parestesias e incontinencia urinaria posterior a esfuerzo físico. Se le diagnosticó una fístula arteriovenosa dural medular como causante de su cuadro. (AU)


Spinal dural arteriovenous fistulas (SDAVF) are acquired spinal vascular malformations and a rare cause of progressive myelopathy (5-10 new cases per year and per 1 million inhabitants). Magnetic resonance imaging is the diagnosis modality of choice. We present a case of a 89-year-old female patient who consulted the emergency department of our institution because of paraparesis and lower extremities paresthesias associated with urinary incontinence post physical effort. With the final diagnosis of spinal dural arteriovenous fistula, as a cause of the clinical symptoms. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/diagnóstico por imagem , Dura-Máter/anormalidades , Parestesia , Fibrilação Atrial/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Tabagismo/complicações , Incontinência Urinária , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/epidemiologia , Dor Lombar/complicações , Aneurisma da Aorta Abdominal/complicações , Paraparesia , Incontinência Fecal , Hipertensão/complicações , Hipestesia , Disfunção Erétil , Anticoagulantes/uso terapêutico
5.
J Headache Pain ; 20(1): 82, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307372

RESUMO

BACKGROUND: To systematically review studies quantifying the association between primary chronic headaches and persistent low back pain (LBP). MAIN TEXT: We searched five electronic databases. We included case-control, cross-sectional and cohort studies that included a headache and back pain free group, reporting on any association between persistent LBP and primary headache disorders. Methodological quality was assessed using Newcastle-Ottawa Scale. Our primary outcome was the association between primary headache disorders and persistent LBP. Our secondary outcomes were any associations between severity of LBP and severity of headache, and the relationship between specific headache sub-types classified as per International Classification of Headache Disorders (ICHD) criteria and persistent LBP. We included 14 studies. The sizes of the studies ranged from 88 participants to a large international study with 404, 206 participants. Odds ratios for the association were between 1.55 (95% confidence interval (CI) 1.13-2.11) and 8.00 (95% CI 5.3-12.1). Study heterogeneity meant statistical pooling was not possible. Only two studies presented data investigating persistent LBP and chronic headache disorders in accordance with ICDH criteria. CONCLUSIONS: We identified a positive association between persistent LBP and primary headache disorders. The quality of the review findings is limited by diversity of populations, study designs and uncertainly about headache and LBP definitions. TRIAL REGISTRATION: PROSPERO 2018 CRD42018086557 .


Assuntos
Cefaleia/epidemiologia , Dor Lombar/epidemiologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Estudos Transversais , Feminino , Cefaleia/complicações , Humanos , Dor Lombar/complicações , Masculino , Razão de Chances
6.
Medicina (Kaunas) ; 55(7)2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31284666

RESUMO

Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.


Assuntos
Terapia por Exercício/estatística & dados numéricos , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/normas , Educação de Pacientes como Assunto/normas , Volta ao Esporte/estatística & dados numéricos , Inglaterra , Exercício/fisiologia , Terapia por Exercício/métodos , Humanos , Dor Lombar/complicações , Dor Lombar/cirurgia , Vértebras Lombares/lesões , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Folhetos , Educação de Pacientes como Assunto/métodos , Período Pós-Operatório , Pesquisa Qualitativa , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos
7.
BMC Musculoskelet Disord ; 20(1): 273, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159812

RESUMO

BACKGROUND: Previous studies have indicated that trunk muscle strength decreases with chronic low back pain, and is associated with poor balance, poor functional performance, and falls in older adults. Strengthening exercises for chronic low back pain are considered the most effective intervention to improve functional outcomes. We developed an innovative exercise device for abdominal trunk muscles that also measures muscle strength. The correlation between muscle weakness, as measured by our device, the presence of chronic low back pain, and decreased physical ability associated with a risk of falling were evaluated in older women. METHODS: Thirty-eight elderly women, who could walk without support during daily activities and attended our outpatient clinic for treatment of chronic low back pain, knee or hip arthritis, or osteoporosis, were included in this study. Anthropometric measurements were performed. Grip power and one-leg standing time with eyes open were measured, and abdominal trunk muscle strength was measured using our device. History of falling in the previous 12 months was noted. Subjects with chronic low back pain (visual analog scale score ≥ 20 mm) for over 3 months were assigned to the low back pain group (n = 21). The remaining subjects formed the non-low back pain group (n = 17). RESULTS: Abdominal muscle strength of subjects in the low back pain group, and with history of falling, was significantly lower compared with that of subjects in the non-low back pain group, and in subjects without a history of falling, respectively. There was a moderate positive correlation between abdominal trunk muscle strength and one-leg standing time with eyes open. CONCLUSION: We measured abdominal muscle strength in older women with chronic low back pain using our device, and it was significantly lower than that of those without chronic low back pain. Muscle weakness was associated with a history and risk of falling.


Assuntos
Músculos Abdominais/fisiopatologia , Acidentes por Quedas/estatística & dados numéricos , Dor Lombar/complicações , Debilidade Muscular/diagnóstico , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Terapia por Exercício/instrumentação , Terapia por Exercício/métodos , Feminino , Humanos , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Força Muscular/fisiologia , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia
8.
BMC Health Serv Res ; 19(1): 406, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226997

RESUMO

BACKGROUND: There is limited research on the economic burden of low back-related leg pain, including sciatica. The aim of this study was to describe healthcare resource utilisation and factors associated with cost and health outcomes in primary care patients consulting with symptoms of low back-related leg pain including sciatica. METHODS: This study is a prospective cohort of 609 adults visiting their family doctor with low back-related leg pain, with or without sciatica in a United Kingdom (UK) Setting. Participants completed questionnaires, underwent clinical assessments, received an MRI scan, and were followed-up for 12-months. The economic analysis outcome was the quality-adjusted life year (QALY) calculated from the EQ-5D-3 L data obtained at baseline, 4 and 12-months. Costs were measured based on patient self-reported information on resource use due to back-related leg pain and results are presented from a UK National Health Service (NHS) and Societal perspective. Factors associated with costs and outcomes were obtained using a generalised linear model. RESULTS: Base-case results showed improved health outcomes over 12-months for the whole cohort and slightly higher QALYs for patients in the sciatica group. NHS resource use was highest for physiotherapy and GP visits, and work-related productivity loss highest from a societal perspective. The sciatica group was associated with significantly higher work-related productivity costs. Cost was significantly associated with factors such as self-rated general health and care received as part of the study, while quality of life was significantly predicted by self-rated general health, and pain intensity, depression, and disability scores. CONCLUSIONS: Our results contribute to understanding the economics of low back- related leg pain and sciatica and may provide guidance for future actions on cost reduction and health care improvement strategies. TRIAL REGISTRATION: 13/09/2011 Retrospectively registered; ISRCTN62880786 .


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Perna (Membro)/patologia , Dor Lombar/economia , Dor/economia , Atenção Primária à Saúde/economia , Ciática/economia , Adulto , Feminino , Humanos , Dor Lombar/complicações , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Manejo da Dor , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Ciática/etiologia , Ciática/terapia , Resultado do Tratamento , Reino Unido
9.
Scand J Prim Health Care ; 37(2): 218-226, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31057021

RESUMO

Objective: To identify factors associated with sick leave due to lumbopelvic pain (LPP) in pregnancy. Design: Prospective cohort study using participants from a randomized controlled trial (RCT) designed to study the effect of exercise during pregnancy on pregnancy related diseases. Setting: St. Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital, April 2007 to December 2009. Subjects: Healthy pregnant women. Main outcome measures: Self-reported sick leave due to LPP in late pregnancy (gestation week 32-36). Results: In total, 532/716 (74%) women reported LPP at 32-36 weeks of pregnancy, and 197/716 (28%) reported sick leave due to LPP. Not receiving job adjustments when needed (Odds ratio, OR with 95% confidence interval, CI, was 3.0 (1.7-5.4)) and having any pain in the pelvic girdle versus no pain (OR 2.7 (1.3-5.6), OR 2.7 (1.4-5.2) and OR 2.2 (1.04-4.8)) for anterior, posterior and combined anterior and posterior pain in the pelvis respectively, were associated with sick leave due to LPP in late pregnancy. Also higher disability, sick listed due to LPP at inclusion and lower education, were significant explanatory variables. There was a trend of reduced risk for sick leave due to LPP when allocated to the exercise group in the original RCT (OR 0.7 (0.4-1.0)). Conclusion: Facilitating job adjustments when required might keep more pregnant women in employment. Furthermore, pain locations in pelvic area, disability, lower education and being sick listed due to LPP in mid pregnancy are important risk factors for sick leave in late pregnancy. Key points Current awareness: More than half of pregnant women are on sick leave during pregnancy and the most frequently reported cause is lumbopelvic pain. This paper adds: Inability to make job adjustments, pain locations in pelvic area, disability and lower education level were the most important risk factors for sick leave in late pregnancy. Facilitating early job adjustment might be a precaution to keep more pregnant women in work. Allocation to an exercise group tended to reduce the risk of sick leave in late pregnancy.Registration number: Clinical trial gov (NCT00476567).


Assuntos
Terapia por Exercício , Exercício , Dor Lombar/complicações , Dor Pélvica/complicações , Complicações na Gravidez , Licença Médica , Trabalho , Adulto , Pessoas com Deficiência , Escolaridade , Feminino , Humanos , Estudos Longitudinais , Razão de Chances , Gravidez , Trimestres da Gravidez , Gestantes , Estudos Prospectivos , Fatores de Risco
10.
Pain Manag ; 9(3): 251-258, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140935

RESUMO

Background: Sacroiliac joint (SIJ) pain is a common source of lower back pain; the factors associated have not been studied in cancer patients. Observing patients with bone marrow aspiration and biopsy (BMAB) who subsequently developed SIJ-pain led to this investigation. Aim: To investigate this possible relationship. Methods: A cohort study of cancer patients diagnosed with SIJ pain. The association of BMAB with SIJ pain was evaluated, as were variables that differed between the groups. Results: The prevalence of SIJ pain was 4.95% (231/4669). Among 231 patients with SIJ pain, 34% (78/231) did not have prior history of lower back pain and had undergone BMAB prior to their diagnosis of SIJ pain. A statistically significant association between BMAB-SIJ-pain was found (p < 0.01). Conclusion: We found linear correlation between BMAB and subsequent SIJ pain.


Assuntos
Artralgia/fisiopatologia , Medula Óssea/patologia , Dor Lombar/complicações , Neoplasias/complicações , Articulação Sacroilíaca/patologia , Articulação Sacroilíaca/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Dor Lombar/patologia , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Adulto Jovem
11.
Mil Med ; 184(Suppl 1): 550-556, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901415

RESUMO

Low back pain (LBP) is a common condition suffered by military personnel. Psychosocial factors play a role in LBP prognosis and can be addressed with self-management tools. This study's purpose was to (1) describe clinical changes in psychosocial factors of LBP following a self-management intervention and (2) explore the LBP experience of military trainees. Ten participants in Initial Entry Training (IET) were included in this mixed methods study. A self-management intervention of exercises and psychosocial education was provided. Quantitative instruments assessing psychosocial factors were delivered at baseline and 6 weeks. Qualitative data were gathered after treatment and analyzed using a phenomenological approach. Low levels of psychosocial risk factors were reported. Patient satisfaction (COPM-Satisfaction subscale) was the only outcome that achieved statistical significance at 6 weeks (p = 0.037). Three themes emerged from the qualitative results: the influence of the military culture on recovery from LBP, the LBP experience of a trainee, and promoting the self-management of LBP. While this cohort of IET soldiers exhibited low levels of psychosocial risk factors, qualitative reports indicate that LBP has a negative impact on participation in training, academics, and interpersonal relationships. The constraints of military training make seeking care and applying treatment strategies challenging.


Assuntos
Tratamento Conservador/normas , Dor Lombar/psicologia , Militares/psicologia , Satisfação do Paciente , Adulto , Tratamento Conservador/métodos , Tratamento Conservador/psicologia , Feminino , Humanos , Dor Lombar/complicações , Masculino , Militares/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Percepção , Estudos Prospectivos , Fatores de Risco , Autogestão , Estatísticas não Paramétricas , Inquéritos e Questionários , Ensino/estatística & dados numéricos
12.
Spine (Phila Pa 1976) ; 44(17): E1038-E1044, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30921292

RESUMO

STUDY DESIGN: A cross-sectional, retrospective cohort study. OBJECTIVE: To examine the prevalence of the pedicle stress injury, spondylolysis in children and adolescents with low back pain. And secondly, to test the hypothesis that these pathologies are associated with lumbar lordosis angle. SUMMARY OF BACKGROUND DATA: The prevalence of the pedicle stress injury has not been investigated in children with low back pain. In recent studies, lumbar lordosis angle was associated with spondylolysis, on the other hand the pedicle stress injury was not investigated yet. METHODS: In this retrospective study, 789 consecutive lumbar magnetic resonance imaging under 18 years of age were reviewed between January 2015 and July 2018. Seven hundred magnetic resonances imaging among them were included in the study (mean age: 14.87 ±â€Š2.41 yrs; range: 4-17). Prevalence of spondylolysis, spondylolisthesis, pedicle stress injury, pedicle deformation, disc degeneration, and increased lordosis was investigated and compared in terms of sex. The relationship between increased lordosis and other pathologies was evaluated with risk ratio. Nominal variables were evaluated between the two groups using chi-square, Mann-Whitney U test. RESULTS: Prevalence of pedicle stress injury (12.7%), spondylolysis (8.7%), spondylolisthesis (4.1%), pedicle deformation (3.1%), disc degeneration (24%), increase in lordosis (17.4%) was found. Spondylolysis and pedicle injury were more frequent in males (P = 0.025, P < 0.001, respectively). Increased lordosis was more frequent in females (P < 0.001). Pedicle stress injury was frequently observed between 13 to 17 years and often an isolated lesion (69.6%). Spondylolysis, spondylolisthesis, pedicle deformity were more frequent in increased lordosis (P < 0.001), whereas pedicle injury frequency was not found to be different (P = 0.997). CONCLUSION: Pedicle stress injury is a common cause of back pain under 18 years of age, more common in males, and often an isolated lesion. No relationship was found between pedicle stress injury and increased lordosis, unlike other pathologies. LEVEL OF EVIDENCE: 3.


Assuntos
Degeneração do Disco Intervertebral , Lordose , Dor Lombar , Espondilólise , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/epidemiologia , Lordose/complicações , Lordose/epidemiologia , Dor Lombar/complicações , Dor Lombar/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Espondilólise/complicações , Espondilólise/epidemiologia
13.
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
14.
BMC Psychiatry ; 19(1): 66, 2019 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744610

RESUMO

BACKGROUND: The World Health Organization (WHO) has included comorbidity between depression and a chronic disease among the 10 leading global health priorities. Although there is a high prevalence of multimorbidity, health care systems are mainly designed for the management of individual diseases. Given the difficulty in delivering face-to-face psychological treatments, alternative models of treatment delivery have been proposed, emphasizing the role of technologies such as the Internet. The aim of this study is to assess the efficacy in Primary Care (PC) of a blended low-intensity psychological intervention applied using information and communication technologies (ICTs) for the treatment of multimorbidity in PC (depression and type 2 diabetes/low back pain) by means of a randomized controlled trial (RCT). Our main hypothesis is that improved usual care combined with psychological therapy applied using ICTs will be more efficacious for improvement in the symptomatology of multimorbidity, compared to a group with only improved treatment as usual six months after the end of treatment. METHODS: A protocol has been designed combining a face-to-face intervention with a supporting online programme that will be tested by an RCT conducted in three different regions (Andalusia, Aragon and the Balearic Islands). The RCT will evaluate three hundred participants diagnosed with depression and type 2 diabetes/low back pain. Four highly experienced research groups specializing in clinical psychology are involved in this trial, and there will be ample possibilities for translation and transfer to usual clinical practice. DISCUSSION: This clinical trial will lead to improvement in financial sustainability, maximizing the use of resources and responding to principles of efficiency and effectiveness. Furthermore, based on the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. In conclusion, positive results of this study could have a significant impact on one of the most important health-related problems, multimorbidity. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03426709 . Registered retrospectively on 08 February 2018.


Assuntos
Depressão/terapia , Diabetes Mellitus Tipo 2/terapia , Dor Lombar/terapia , Atenção Primária à Saúde , Adulto , Doença Crônica , Depressão/complicações , Depressão/psicologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Internet , Dor Lombar/complicações , Dor Lombar/psicologia , Masculino , Multimorbidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Espanha
15.
J Man Manip Ther ; 27(1): 33-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30692841

RESUMO

Objectives: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up.Methods: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0-10 numerical rating scale, and 6) the Kellgren-Lawrence grade.Results: Data from 101 patients were extracted. The percentage of patients with the concluding classification of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP (p = .002) and without radiographic findings of knee osteoarthritis (p < .001). A concluding classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up.Discussion: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain.


Assuntos
Artralgia/diagnóstico , Articulação do Joelho/patologia , Joelho/patologia , Vértebras Lombares , Exame Físico/métodos , Doenças da Coluna Vertebral/diagnóstico , Adulto , Idoso , Artralgia/etiologia , Artralgia/terapia , Feminino , Humanos , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Manejo da Dor , Medição da Dor , Exame Físico/classificação , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações
16.
Rehabil Nurs ; 44(1): 47-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30586021

RESUMO

PURPOSE: Lumbago, or low back pain (LBP), is a common musculoskeletal complaint among older adults that may also be associated with depression. The study objective was to investigate differences in Beck Depression Inventory depression symptoms scores among older adult patients with and without LBP. DESIGN: This was a case-control study. METHODS: A total of 152 older adult patients, recruited at an outpatient healthcare clinic (47 men, 105 women; 74.81 ± 6.9 years), were classified as having subacute LBP (n = 76) or non-LBP (n = 76) according to clinic records. FINDINGS: Beck Depression Inventory scores (mean ± SD) among LBP patients (10.93 ± 6.18) were significantly higher compared to the non-LBP group (7.62 ± 5.70; p = .000085), whose scores indicated no depression symptoms. CONCLUSION: Subacute LBP may represent a potential risk for increased depression among older adults. CLINICAL RELEVANCE: Early detection of depression will assist rehabilitation nurses in prescribing the beneficial physical rehabilitation and exercise programs or provide the information and treatment recommendations to older adults with subacute LBP and their families. Also, it should be part of a nursing staff prevention strategy for patients who suffer this common musculoskeletal disorder.


Assuntos
Depressão/etiologia , Dor Lombar/complicações , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Casos e Controles , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/psicologia , Masculino , Medição da Dor/métodos , Medição da Dor/psicologia
17.
Pain ; 160(4): 833-843, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30531308

RESUMO

Changes in central pain processing have been shown in patients with chronic low-back pain (cLBP). We used quantitative sensory testing methods to identify differences in pain sensitization between patients with cLBP (N = 167) and healthy controls (N = 33). Results indicated that, compared with healthy pain-free controls, cLBP patients showed increased sensitivity and greater painful aftersensations for mechanical pressure and pin-prick stimuli and lower tactile spatial acuity in the 2-point discrimination task (ps < 0.05). Then, we examined the role of pain catastrophizing as a mediator of the group differences in pain sensitization. We found that catastrophizing partially accounted for group differences in pressure required to produce moderate pain. Finally, we examined the relationship between pain sensitization, catastrophizing, and clinical pain among patients with cLBP. We found that catastrophizing and deep-tissue pressure pain were associated with greater pain intensity in the past month, week, and at the visit as well as low-back pain bothersomeness. Furthermore, deep-tissue pressure pain mediated the associations between catastrophizing and both pain in the past month and low-back pain severity. Taken together, these results indicate that not only do patients with cLBP demonstrate increased pain sensitization and decreased sensitivity to innocuous stimuli, but these changes are also linked with increased catastrophizing. Furthermore, both catastrophizing and sensitization are associated with increased clinical pain among cLBP patients.


Assuntos
Catastrofização/complicações , Dor Crônica/complicações , Dor Lombar/complicações , Dor Lombar/psicologia , Limiar da Dor/fisiologia , Adolescente , Adulto , Dor Crônica/psicologia , Feminino , Humanos , Hiperalgesia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estimulação Física/efeitos adversos , Autorrelato , Adulto Jovem
18.
Pain ; 160(1): 237-245, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30234697

RESUMO

The aim of this work was to quantify the prevalence and years lived with disability (YLDs) caused by low back pain (LBP) in China from 1990 to 2016. Data from the GBD 2016 (Global Burden of Diseases, Injuries, and Risk Factors Study 2016) were used. We analyzed the age-sex-province-specific prevalence and YLDs for LBP of 33 provinces/regions in China. Comparisons were made with the data retrieved from the 1990 GBD study. We estimated that 5.45 × 10 individuals had LBP in 1990, which rose to 6.73 × 10 in 2016. The age-standardized prevalence of LBP decreased from 5.6% (95% uncertainty interval [95% UI]: 4.9%-6.3%) in 1990 to 4.2% (95% UI: 3.8%-4.8%) in 2016. The YLDs for LBP increased from 6.2 million (95% UI: 4.3-8.3 million) in 1990 to 7.7 million (95% UI: 5.4-10.2) in 2016. Age-standardized YLD rate (per 100,000 person) decreased from 637.5 (95% UI: 449.9-848.8) in 1990 to 481.9 (95% UI: 338.6-637.0) in 2016. A female preponderance was observed for prevalence and YLDs. The prevalence and YLDs rate for LBP slightly decreased from 1990 to 2016 in China; however, the total individuals and YLDs increased. Low back pain still ranks as the second leading cause of YLD burden disease in China. Considerable attention should be paid for LBP, especially in the female population.


Assuntos
Pessoas com Deficiência , Carga Global da Doença/métodos , Dor Lombar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Estudos Longitudinais , Dor Lombar/complicações , Dor Lombar/epidemiologia , Dor Lombar/mortalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
19.
Scand J Med Sci Sports ; 29(3): 393-399, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30421820

RESUMO

INTRODUCTION: Low back pain (LBP) defined as ache or pain in the lowest part of the back is a common experience among people all over the world. The lifetime prevalence is reported to be as high as 84%, and the prevalence of LBP seems to be almost the same among adolescents as among adults. The risk for having LBP later in life if you experienced LBP in adolescence is high. MATERIAL AND METHODS: In this cross-sectional study of 2550 students aged 16-20 years, we used the Standardized Nordic Questionnaire for the analysis of musculo-skeletal symptoms. We studied gender difference, prevalence, and disability of Low back pain. We also studied differences in LBP in adolescent athletes depending on hours spent on sports or physical activity. RESULTS: Significantly, more girls than boys had had problems sometimes during their life. Those who participated in sports reported LBP to a significantly higher extent than those who were physically inactive in their spare time. Gender and spare time sports were important risk factors for getting LBP some time in life. There was a higher risk for girls to have low back pain problems more than 30 days or daily the last year if they had had low back pain some time earlier in life. CONCLUSION: This study shows that low back pain (LBP) is common among Swedish adolescents, more common among girls than boys. High sport activity was associated with the risk of having LBP, length of time with LBP, and disability due to LBP.


Assuntos
Avaliação da Deficiência , Dor Lombar/epidemiologia , Esportes , Adolescente , Estudos Transversais , Feminino , Humanos , Dor Lombar/complicações , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , Suécia/epidemiologia , Adulto Jovem
20.
Eur J Pain ; 23(3): 495-502, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30289190

RESUMO

BACKGROUND: Presenteeism (work productivity loss at work) and low back pain (LBP) are prevalent among eldercare workers. Presenteeism is a serious emerging problem in an occupational setting. While many studies report the impact of pain-related fear on absenteeism, its impact on presenteeism remains unclear. METHODS: We conducted a cross-sectional study to investigate the association between pain-related fear and presenteeism among 505 eldercare workers with LBP. We measured pain-related fear using the 11-item Tampa Scale for Kinesiophobia (TSK-11). We used the Work Limitations Questionnaire (WLQ) to estimate productivity loss due to presenteeism with items including Time Management, Mental-Interpersonal Demands, Physical Demands and Output Demands. The presenteeism was categorized into no (<5%), mild (5%-10.9%), moderate (11%-16.9%) and severe presenteeism (≥17%). We further performed ordinal logistic regression analyses, and the covariates were age, sex, pain intensity, pain disability and psychosocial factors. Multiple imputation was conducted to provide informed estimates for observations with missing data. RESULTS: After adjustment, a higher TSK score was significantly associated with a higher presenteeism (proportional OR = 1.10, 95% CI = 1.06-1.15). A significant association of TSK with all WLQ subscales was retained even after the adjustment (Time Management: proportional OR = 1.04, 95% CI = 1.01-1.08; Mental-Interpersonal Demands: proportional OR = 1.08, 95% CI = 1.04-1.12; Physical Demands: proportional OR = 1.04, 95% CI = 1.01-1.08; and Output Demands: proportional OR = 1.06, 95% CI = 1.02-1.10). CONCLUSIONS: Our findings suggest that pain-related fear is an important factor related to presenteeism among eldercare workers with LBP. SIGNIFICANCE: This study describes an independent association of pain-related fear with presenteeism among eldercare workers with low back pain. Pain-related fear could be considered a vital factor of presenteeism in addition to absenteeism.


Assuntos
Medo/psicologia , Pessoal de Saúde/psicologia , Serviços de Saúde para Idosos , Dor Lombar/psicologia , Presenteísmo , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
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