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1.
J Man Manip Ther ; 30(2): 105-115, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34678129

RESUMO

INTRODUCTION: Low back pain (LBP) is ranked as the first musculoskeletal disorder considering years lived with disability worldwide. Despite numerous guidelines promoting a bio-psycho-social (BPS) approach in the management of patients with LBP, many health care professionals (HCPs) still manage LBP patients mainly from a biomedical point of view. OBJECTIVE: The purpose of this pilot study was to evaluate the feasibility of implementing an interactive e-learning module on the management of LBP in HCPs. METHODS: n total 22 HCPs evaluated the feasibility of the e-learning module with a questionnaire and open questions. Participants filled in the Back Pain Attitude Questionnaire (Back-PAQ) before and after completing the module to evaluate their attitudes and beliefs about LBP. RESULTS: The module was structured and easy to complete (91%) and met the expectations of the participants (86%). A majority agreed that the module improved their knowledge (69%). Some participants (77%) identified specific topics that might be discussed in more detail in the module. HCPs knowledge, beliefs and attitudes about LBP significantly improved following module completion (t = -7.63, P < .001) with a very large effect size (ds = -1.63). CONCLUSION: I The module seems promising to change knowledge, attitudes and beliefs of the participants. There is an urgent need to develop and investigate the effect of educational interventions to favor best practice in LBP management and this type of e-learning support could promote the transition from a biomedical to a bio-psycho-social management of LBP in HCPs.


Assuntos
Instrução por Computador , Dor Lombar , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Dor Lombar/terapia , Projetos Piloto
2.
J Bodyw Mov Ther ; 30: 132-139, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35500961

RESUMO

BACKGROUND: Dynamic lumbar motor control training (MCT) is frequently used in low back pain management; however, whether it affects lumbar proprioception remains unclear. Objectives The purpose of this study was to investigate the effect of dynamic lumbar MCT on lumbar proprioception and to determine the effectiveness of dynamic lumbar MCT in patients with low back pain. DESIGN: Randomized controlled trial. METHOD: The study included patients with chronic non-specific low back pain, who were randomized into two groups: general trunk-training group and dynamic lumbar MCT group. Training was conducted for 8 weeks, and measurements were recorded at the beginning and end of the intervention period. The outcomes were the Fremantle Back Awareness Questionnaire score (FreBAQ; subjective proprioception) and the active joint repositioning sense (AJRS; objective proprioception) in trunk-forward bending. RESULTS/FINDINGS: Nine participants in the general trunk-training group and 10 in the dynamic lumbar MCT group were included in the final analysis. In the pre- and post-intervention comparisons, FreBAQ score decreased in the dynamic lumbar MCT group only. AJRS was not significantly different between pre- and post-intervention in both groups. Between-group comparisons of pre- and post-intervention differences showed no significant differences in either FreBAQ or AJRS. CONCLUSIONS: Although the effect of dynamic lumbar MCT on lumbar proprioception is no different from that of general trunk training without moving the lower limbs, dynamic lumbar MCT is effective in training to improve subjective proprioception in patients with low back pain.


Assuntos
Dor Lombar , Humanos , Dor Lombar/terapia , Extremidade Inferior , Região Lombossacral , Propriocepção , Tronco
3.
J Bodyw Mov Ther ; 30: 140-147, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35500962

RESUMO

BACKGROUND: Chronic low back-related leg pain may involve mixed pain mechanisms. A strategy to address both neuropathic and nociceptive pain symptoms would be combining treatments. OBJECTIVE: To assess the effects of adding neurodynamic exercises to extension-oriented exercises in patients with chronic low back-related leg pain and a directional preference. DESIGN: Two arm, single blind, randomized clinical trial. METHOD: Eligible participants were aged between 18 and 65 years, had low back pain radiating below gluteus for at least 3 months, pain intensity greater than 3 points in the numerical pain rating scale, positive SLR test and a directional preference for lumbar extension movements. Thirty-one participants were randomly allocated into one of two groups: extension-oriented exercises (EE) or extension exercises plus neurodynamic exercises (EEN). Primary outcomes were leg pain intensity and function at 3 weeks. Secondary outcomes were low back pain intensity, disability, global perceived effect and quality of life at 3 weeks and at 1 month. RESULTS: Retention rate was 100% (n = 14) in EE and 94% (n = 16) in EEN for primary outcome analysis. There was no between-group difference for the primary outcomes and for low back pain intensity, GPE and quality of life at 3 weeks. For some outcomes, EE was superior to EEN. CONCLUSIONS: We found no benefits in adding neurodynamic exercises to extension-oriented exercises for patients with nerve-related leg pain and a directional preference. As this study has a small and very specific sample, results may be interpreted with caution.


Assuntos
Dor Lombar , Pré-Escolar , Terapia por Exercício/métodos , Humanos , Lactente , Perna (Membro) , Dor Lombar/terapia , Qualidade de Vida , Método Simples-Cego
4.
JAMA ; 327(17): 1688-1699, 2022 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-35503342

RESUMO

Importance: Lumbar spinal stenosis is a prevalent and disabling cause of low back and leg pain in older persons, affecting an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis. Observations: The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age. The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI). Nonoperative treatment includes activity modification such as reducing periods of standing or walking, oral medications to diminish pain such as nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In a series of patients with lumbar spinal stenosis followed up for up to 3 years without operative intervention, approximately one-third of patients reported improvement, approximately 50% reported no change in symptoms, and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse. Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated. Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management. For example, in a randomized trial of 94 participants with symptomatic and radiographic degenerative lumbar spinal stenosis, decompressive laminectomy improved symptoms more than nonoperative therapy (difference, 7.8 points; 95% CI, 0.8-14.9; minimum clinically important difference, 10-12.8) on the Oswestry Disability Index (score range, 0-100). Among persons with lumbar spinal stenosis and concomitant spondylolisthesis, lumbar fusion increased symptom resolution in 1 trial (difference, 5.7 points; 95% CI, 0.1 to 11.3) on the 36-Item Short Form Health Survey physical dimension score (range, 0-100), but 2 other trials showed either no important differences between the 2 therapies or noninferiority of lumbar decompression alone compared with lumbar decompression plus spinal fusion (MCID, 2-4.9 points). In a noninferiority trial, 71.4% treated with lumbar decompression alone vs 72.9% of those receiving decompression plus fusion achieved a 30% or more reduction in Oswestry Disability Index score, consistent with the prespecified noninferiority hypothesis. Fusion is associated with greater risk of complications such as blood loss, infection, longer hospital stays, and higher costs. Thus, the precise indications for concomitant lumbar fusion in persons with lumbar spinal stenosis and spondylolisthesis remain unclear. Conclusions and Relevance: Lumbar spinal stenosis affects approximately 103 million people worldwide and 11% of older adults in the US. First-line therapy is activity modification, analgesia, and physical therapy. Long-term benefits from epidural steroid injections have not been established. Selected patients with continued pain and activity limitation may be candidates for decompressive surgery.


Assuntos
Vértebras Lombares , Estenose Espinal , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Dor nas Costas/terapia , Descompressão Cirúrgica/métodos , Glucocorticoides/uso terapêutico , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares/cirurgia , Fusão Vertebral , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/terapia , Espondilolistese/complicações , Espondilolistese/cirurgia , Resultado do Tratamento
5.
Zhongguo Zhen Jiu ; 42(5): 505-10, 2022 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-35543940

RESUMO

OBJECTIVE: To compare the clinical efficacy and possible mechanism of warming acupuncture combined with "three steps and seven methods" of tuina and simple "three steps and seven methods" of tuina in treatment of chronic nonspecific low back pain (NLBP) of yang deficiency and cold-dampness blockage. METHODS: A total of 138 patients were randomized into an observation group (69 cases, 5 cases dropped off) and a control group (69 cases, 7 cases dropped off). In the control group, "three steps and seven methods" of tuina was applied. On the basis of the treatment in the control group, warming acupuncture was applied at Shenshu (BL 23), Yaoyangguan (GV 3), Mingmen (GV 4), Weizhong (BL 40) and ashi points. The treatment was given once a day, 6 times a week for 3 weeks in both groups. Before and after treatment, the short form of McGill pain questionnaire (SF-MPQ) score, Oswestry disability index (ODI) score, finger-to-floor distance (FFD), Schober test distance, fear-avoidance beliefs questionnaire (FABQ) score and yang deficiency and cold-dampness blockage score were observed, the serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6 and thromboxane B2 (TXB2) were detected in both groups. The recurrence rate was evaluated in follow-up of 6 months after treatment. RESULTS: After treatment, the scores of PRI, PPI, VAS, ODI, FABQ and FFD, yang deficiency and cold-dampness blockage scores were decreased compared before treatment in both groups (P<0.01), and those in the observation group were lower than the control group (P<0.01); the Schober test distances were increased compared before treatment in both groups (P<0.01), and that in the observation group was larger than the control group (P<0.01). After treatment, the serum levels of TNF-α, IL-1ß, IL-6 and TXB2 were decreased compared before treatment in both groups (P<0.01), and those in the observation group were lower than the control group (P<0.01). In follow-up, the recurrence rate was 12.8% (6/47) in the observation group, which was lower than 34.3% (12/35) in the control group (P<0.05). CONCLUSION: Warming acupuncture combined with "three steps and seven methods" of tuina can effectively alleviate pain in patients with chronic NLBP of yang deficiency and cold-dampness blockage, improve activity and dysfunction of waist, the clinical efficacy is superior to simple "three steps and seven methods" of tuina, its mechanism may be relate to the inhibition of inflammatory reaction.


Assuntos
Terapia por Acupuntura , Dor Lombar , Pontos de Acupuntura , Humanos , Interleucina-6 , Dor Lombar/terapia , Resultado do Tratamento , Fator de Necrose Tumoral alfa , Deficiência da Energia Yang/terapia
6.
Zhongguo Zhen Jiu ; 42(5): 511-4, 2022 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-35543941

RESUMO

OBJECTIVE: To compare the clinical effect between head acupuncture combined with exercise therapy and conventional acupuncture for nonspecific low back pain. METHODS: A total of 64 patients with nonspecific low back pain were randomized into an observation group (32 cases, 2 cases dropped off) and a control group (32 cases, 2 cases dropped off). In the control group, conventional acupuncture was applied at Jiaji (EX-B 2) of L1 to L3, ashi point, Shenshu (BL 23), Dachangshu (BL 25), Yaoyangguan (GV 3) and Weizhong (BL 40). The observation group was treated with head acupuncture combined with exercise therapy, head acupuncture was applied at foot-motor-sensory area on the healthy side and Cuanzhu (BL 2), Tongziliao (GB 1) on the affected side, and McKenzie therapy was performed during retention. The needles were retained for 40 min, once a day, continuous treatment for 6 days with the interval of 1 day, 14 days were required in the two groups. Before and after treatment, the pain visual analogue scale (VAS) score, Oswestry disability index (ODI) score and infrared thermography temperature of pain area in the low back were compared in the two groups. RESULTS: Compared before treatment, the VAS and ODI scores after treatment were decreased in the two groups (P<0.01), and those in the observation group were lower than the control group (P<0.01). Compared before treatment, the infrared thermography temperature of pain area in the low back after treatment was increased in the two groups (P<0.01), and that in the observation group was higher than the control group (P<0.01). CONCLUSION: Head acupuncture combined with exercise therapy could relieve pain, improve dysfunction and increase the local temperature of pain area in patients with nonspecific low back pain, and its curative effect is better than conventional acupuncture.


Assuntos
Terapia por Acupuntura , Acupuntura , Dor Lombar , Pontos de Acupuntura , Terapia por Exercício , Humanos , Dor Lombar/terapia , Resultado do Tratamento
7.
Chiropr Man Therap ; 30(1): 23, 2022 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534902

RESUMO

BACKGROUND: The inappropriate use of lumbar spine imaging remains common in primary care despite recommendations from evidence-based clinical practice guidelines to avoid imaging in the absence of red flags. This study aimed to explore factors influencing ordering behaviours and adherence to radiographic guidelines for low back pain (LBP) in chiropractors in Newfoundland and Labrador (NL), Canada. METHODS: We conducted two focus groups in December 2018 with chiropractors in different regions of NL (eastern, n = 8; western, n = 4). An interview guide based on the Theoretical Domains Framework (TDF) served to identify perceived barriers to, and enablers of, target behaviours of guideline adherence and managing LBP without X-rays. We conducted thematic analysis of chiropractors' statements into relevant theoretical domains, followed by grouping of similar statements into specific beliefs. Domains key to changing radiographic guideline adherence, LBP imaging behaviours, and/or informing intervention design were identified by noting conflicting beliefs and their reported influence on the target behaviours. RESULTS: Six of the 14 TDF domains were perceived to be important for adherence to radiographic guidelines and managing non-specific LBP without imaging. Participating chiropractors reported varying levels of knowledge and awareness of guidelines for LBP imaging (Knowledge). Many chiropractors based their decision for imaging on clinical presentation, but some relied on "gut feeling" (Memory, attention, and decision processes). While chiropractors thought it was their role to manage LBP without imaging, others believed ordering imaging was the responsibility of other healthcare providers (Social/professional role and identity). Contrasting views were found regarding the negative consequences of imaging or not imaging LBP patients (Beliefs about consequences). Communication was identified as a skill required to manage LBP without imaging (Skills) and a strategy to enable appropriate imaging ordering behaviours (Behavioural regulation). Chiropractors suggested that access to patients' previous imaging and a system that facilitated better interprofessional communication would likely improve their LBP imaging behaviours (Behavioural regulation). CONCLUSION: We identified potential influences, in six theoretical domains, on participating chiropractors' LBP imaging behaviours and adherence to radiographic guidelines. These beliefs may be targets for theory-informed behaviour change interventions aimed at improving these target behaviours for chiropractors in NL.


Assuntos
Quiroprática , Dor Lombar , Prática Clínica Baseada em Evidências , Fidelidade a Diretrizes , Pessoal de Saúde , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/terapia
8.
Phys Med Rehabil Clin N Am ; 33(2): 251-265, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35526971

RESUMO

The sacroiliac joint complex (SIJC) is composed of complex anatomy of numerous potential pain generators that demonstrate varying pathophysiology and differing innervations. This heterogeneity has been a challenge to advancing research and clinical care. Moving forward, individualized approaches taking these factors into account may be a path forward to improved outcomes. Thus, as we move toward precision medicine in interventional spine care, it is imperative to investigate more targeted diagnostic and therapeutic approaches to the SIJC.


Assuntos
Dor Lombar , Articulação Sacroilíaca , Artralgia/terapia , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia
9.
BMJ Open ; 12(4): e053848, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379620

RESUMO

INTRODUCTION: Low back pain (LBP) is the most prevalent musculoskeletal condition worldwide and it is responsible for high healthcare costs and resources consumption. It represents a challenge for primary care services that struggle to implement evidence-based practice. Models of care (MoCs) are arising as effective solutions to overcome this problem, leading to better health outcomes. Although there is growing evidence regarding MoCs for the management of LBP patients, an analysis of the existing body of evidence has not yet been carried out. Therefore, this scoping review aims to identify and map the current evidence about the implementation of MoCs for LBP in primary healthcare. Findings from this study will inform policy makers, health professionals and researchers about their characteristics and outcomes, guiding future research and best practice models. METHODS AND ANALYSIS: This protocol will follow the Joanna Briggs Institute methodological guidelines for scoping reviews. Studies that implemented an MoC for LBP patients in primary healthcare will be included. Searches will be conducted on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PEDro, Scopus, Web of Science, grey literature databases and relevant organisations websites. This review will consider records from 2000, written in English, Portuguese or Spanish. Two researchers will independently screen all citations and full-text articles and abstract data. Data extracted will include the identification of the MoC, key elements of the intervention, organisational components, context-specific factors and patient-related, system-related and implementation-related outcomes. ETHICS AND DISSEMINATION: As a secondary analysis, this study does not require ethical approval. It will provide a comprehensive understanding on existing MoCs for LBP, outcomes and context-related challenges that may influence implementation in primary healthcare, which is meaningful knowledge to inform future research in this field. Findings will be disseminated through research papers in peer-reviewed journals, presentations at relevant conferences and documentation for professional organisations and stakeholders.


Assuntos
Dor Lombar , Atenção à Saúde , Humanos , Dor Lombar/terapia , Revisão por Pares , Atenção Primária à Saúde , Projetos de Pesquisa , Literatura de Revisão como Assunto
11.
BMJ Open ; 12(4): e059605, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35365544

RESUMO

OBJECTIVE: To describe management strategies used in public emergency departments in a middle-income country for patients with acute non-specific low back pain. DESIGN: A descriptive, cross-sectional analysis of baseline data from a prospective cohort study. SETTING AND PARTICIPANTS: A study with 600 patients with low back pain presenting in four public emergency departments from São Paulo, Brazil was conducted. OUTCOME MEASURES: Diagnostic tests, pharmacological interventions, and/or referral to other healthcare professionals were collected. Descriptive analyses were used to report all outcomes. RESULTS: Of all patients, 12.5% (n=75) underwent some diagnostic imaging tests. Medication was administered to 94.7% (n=568) of patients. The most common medications were non-steroidal anti-inflammatory drugs (71.3%; n=428), opioids (29%; n=174) and corticosteroids (22.5%; n=135). Only 7.5% (n=45) of patients were referred to another type of care. CONCLUSION: There is a need for research data on low back pain from middle-income countries. There was an acceptable rate of prescription for diagnostic imaging tests. However, there were high medication prescriptions and small rates of referrals to other healthcare services. Our findings indicate that there is still a need to implement best practices in the management of acute low back pain at public emergency departments in Brazil.


Assuntos
Dor Lombar , Brasil , Estudos Transversais , Serviço Hospitalar de Emergência , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia , Estudos Prospectivos
12.
Chiropr Man Therap ; 30(1): 20, 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35449074

RESUMO

BACKGROUND AND OBJECTIVE: Chronic low back pain is pervasive, societally impactful, and current treatments only provide moderate relief. Exploring whether therapeutic elements, either unrecognised or perceived as implicit within clinical encounters, are acknowledged and deliberately targeted may improve treatment efficacy. Contextual factors (specifically, patient's and practitioner's beliefs/characteristics; patient-practitioner relationships; the therapeutic setting/environment; and treatment characteristics) could be important, but there is limited evidence regarding their influence. This research aims to review the impact of interventions modifying contextual factors during conservative care on patient's pain and physical functioning. DATABASES AND DATA TREATMENT: Four electronic databases (Medline, CINAHL, PsycINFO and AMED) were searched from 2009 until 15th February 2022, using tailored search strategies, and resulted in 3476 unique citations. After initial screening, 170 full-text records were potentially eligible and assessed against the inclusion-exclusion criteria. Thereafter, studies were assessed for methodological quality using a modified Downs and Black scale, data extracted, and synthesised using a narrative approach. RESULTS: Twenty-one primary studies (N = 3075 participants), were included in this review. Eight studies reported significant improvements in pain intensity, and seven in physical functioning, in favour of the contextual factor intervention(s). Notable contextual factors included: addressing maladaptive illness beliefs; verbal suggestions to influence symptom change expectations; visual or physical cues to suggest pain-relieving treatment properties; and positive communication such as empathy to enhance the therapeutic alliance. CONCLUSION: This review identified influential contextual factors which may augment conservative chronic low back pain care. The heterogeneity of interventions suggests modifying more than one contextual factor may be more impactful on patients' clinical outcomes, although these findings require judicious interpretation.


Assuntos
Dor Lombar , Humanos , Dor Lombar/terapia , Medição da Dor , Resultado do Tratamento
13.
BMC Musculoskelet Disord ; 23(1): 376, 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35449043

RESUMO

BACKGROUND: Although it is generally accepted that physical activity and flares of low back pain (LBP) are related, evidence for the directionality of this association is mixed. The Flares of Low back pain with Activity Research Study (FLAReS) takes a novel approach to distinguish the short-term effects of specific physical activities on LBP flares from the cumulative effects of such activities, by conducting a longitudinal case-crossover study nested within a cohort study. The first aim is to estimate the short-term effects (≤ 24 h) of specific physical activities on LBP flares among Veterans in primary care in the Veterans Affairs healthcare system. The second aim is to estimate the cumulative effects of specific activities on LBP-related functional limitations at 1-year follow-up. METHODS: Up to 550 adults of working age (18-65 years) seen for LBP in primary care complete up to 36 "Scheduled" surveys over 1-year follow-up, and also complete unscheduled "Flare Window" surveys after the onset of new flares. Each survey asks about current flares and other factors associated with LBP. Surveys also inquire about activity exposures over the 24 h, and 2 h, prior to the time of survey completion (during non-flare periods) or prior to the time of flare onset (during flares). Other questions evaluate the number, intensity, duration, and/or other characteristics of activity exposures. Other exposures include factors related to mood, lifestyle, exercise, concurrent treatments, and injuries. Some participants wear actigraphy devices for weeks 1-4 of the study. The first aim will examine associations between 10 specific activity categories and participant-reported flares over 1-year follow-up. The second aim will examine associations between the frequency of exposure to 10 activity categories over weeks 1-4 of follow-up and long-term functional limitations at 12 months. All analyses will use a biopsychosocial framework accounting for potential confounders and effect modifiers. DISCUSSION: FLAReS will provide empirically derived estimates of both the short-term and cumulative effects of specific physical activities for Veterans with LBP, helping to better understand the role of physical activities in those with LBP. TRIAL REGISTRATION: ClinicalTrials.gov NCT04828330 , registered April 2, 2021.


Assuntos
Dor Lombar , Adolescente , Adulto , Idoso , Estudos de Coortes , Estudos Cross-Over , Exercício Físico , Humanos , Dor Lombar/diagnóstico , Dor Lombar/epidemiologia , Dor Lombar/terapia , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-35457772

RESUMO

Lumbar lordosis is one of the most important parts of the spine, which is of special importance due to its unique position and direct contact with the pelvis. The aim of this study was to combine the results of several studies and to evaluate the magnitude of the effect of different Lumbar lordotic angle correction programs through meta-analysis. This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Four databases were searched for articles collection: PubMed, Cochrane Library, Web of Science, and Google Scholar. The key search terms were: "Lumbar Lordotic angle", "Lordosis", "Hyperlordosis", "Corrective exercise", and "Low back pain. "The articles included in our study were limited to original articles written only in English that met the following inclusion criteria: (1) participants with lumbar lordosis or hyperlordosis or low back pain; (2) different programs of corrective exercises were applied; (3) Lumbar lordotic angle used as outcome measures. Ten studies are included in our systematic review and meta-analysis. The effect size for the Lumbar lordotic angle outcome was (SMD = 0.550, p ˂ 0.001, moderate effect size). Subgroup analysis for Lumbar lordotic angle: Subgroup Younger group (SMD = 0.640, p ˂ 0.001), Subgroup Older group, (SMD = 0.520, p ˂ 0.001). Subgroup Treatment (SMD = 0.527, p ˂ 0.001), Subgroup No treatment (SMD = 0.577, p = 0.002). This was the only outcome assessed in our analysis. The current meta-analysis indicates that different correction methods have a positive effect on subjects with lumbar lordosis or hyperlordosis. In the following research, we should try to determine which corrective methods have the best effects.


Assuntos
Lordose , Dor Lombar , Terapia por Exercício , Humanos , Lordose/terapia , Dor Lombar/terapia , Vértebras Lombares , Pelve
16.
PLoS One ; 17(4): e0267157, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35482780

RESUMO

OBJECTIVES: Research suggests that attendance by physical therapists at continuing education (CE) targeting the management of low back pain (LBP) and neck pain does not result in positive impacts on clinical outcomes. The aim of this study was to determine if therapists attending a self-paced 3-hour online Pain Neuroscience Education (PNE) program was associated with any observed changes to patient outcomes and also clinical practice. METHODS: Participants were 25 different physical therapists who treated 3,705 patients with low back pain (LBP) or neck pain before and after they had completed an online PNE CE course. Change in outcomes measures of pain and disability at discharge were compared for the patients treated before and after the therapist training. Clinical practice patterns of the therapists, including total treatment visits, duration of care, total units billed, average units billed per visit, percentage of 'active' billing units and percentage of 'active and manual' billing units, were also compared for the patient care episodes before and after the therapist training. RESULTS: There was no significant difference for change in pain scores at discharge for patients treated after therapist CE training compared to those treated before regardless of the condition (LBP or neck pain). However, patients with LBP who were treated after therapist CE training did report greater improvement in their disability scores. Also after CE training, for each episode of care, therapists tended to use less total visits, billed fewer units per visit, and billed a greater percentage of more 'active' and 'active and manual' billing units. DISCUSSION: Attending an online 3-hour CE course on PNE resulted in improved disability scores for patients with LBP, but not for those with neck pain. Changes in clinical behavior by the therapists included using less visits, billing fewer total units, and shifting to more active and manual therapy interventions. Further prospective studies with control groups should investigate the effect of therapist CE on patient outcomes and clinical practice.


Assuntos
Dor Lombar , Manipulações Musculoesqueléticas , Educação Continuada , Humanos , Dor Lombar/terapia , Cervicalgia/terapia , Estudos Prospectivos
17.
Sci Rep ; 12(1): 6860, 2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35478206

RESUMO

As we stand upright, perceptual afferences are crucial to successfully help generating postural motor commands. Non-Specific Low Back Pain patients frequently demonstrate a lack of proprioceptive acuity, often translating into postural control deficiencies. For the first time, to our knowledge, we studied the postural effects of proprioceptive manipulations in orthograde posture on Non-Specific Low Back Pain patients. Using static posturography recordings, we computed sway speed, speed variance, and the main direction of sway. We also addressed the patient's subjective feedbacks after being manipulated. Five minutes after the proprioceptive manipulations, our results revealed decreased speed and speed variance outcomes, but the main direction of sway was not modulated. Furthermore, after the proprioceptive manipulations, the patients also self-reported improved clinical outcomes. These findings provide new knowledge opening new fields of research as well as potential treatment strategies in Low Back Pain patients.


Assuntos
Dor Lombar , Humanos , Dor Lombar/terapia , Projetos Piloto , Equilíbrio Postural , Postura , Propriocepção
18.
Medicine (Baltimore) ; 101(7): e28883, 2022 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-35363203

RESUMO

BACKGROUND: Chronic non-specific low back pain (CNLBP) is a common complaint about medical care and carries a heavy social burden. The efficacy of Tuina (TN) or physiotherapy (PT) for CNLBP has been evaluated in previous systematic reviews. However, there is no high-quality evidence to support the efficacy of Tuina. Therefore, this study aims to conduct a large-scale, multicenter, high-quality clinical trial to provide evidence for Tuina to treat CNLBP. METHODS: This is a multicenter, assessor-, and analyst-blinded, randomized controlled trial with 3 parallel arms: TN, PT, and TN combined with PT (Tuina combined with physiotherapy) group. Six hundred twelve eligible CNLBP patients will be randomly assigned to the groups in a 1:1:1 ratio in 3 centers. The TN intervention includes 9-step routine techniques, while the PT intervention includes a physiotherapy treatment plan based on a patient's symptoms. The interventions for both groups will last for 30 minutes and will be carried out for 6 sessions in 8 weeks. The primary outcome will be the visual analog scale pain score. And the secondary outcomes will include the Oswestry Disability Index, spinal range of motion, 36-item short-form health survey. Safety evaluation will be recorded during the whole study. All data in this randomized controlled trial will be analyzed by SAS 9.4. DISCUSSION: The results of this trial will provide evidence to evaluate the efficacy of Tuina's value as a treatment for CNLBP. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2000040288, November 27, 2020).


Assuntos
Dor Lombar , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia , Estudos Multicêntricos como Assunto , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Resultado do Tratamento
19.
Syst Rev ; 11(1): 59, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379336

RESUMO

BACKGROUND: Low back pain is a disability that occurs worldwide. It is a heterogeneous disorder that affects patients with dominant nociceptive, neuropathic, and central sensitization pain. An important pathophysiology of low back pain involves pain sensitization. Various nonoperative interventions are available for treatment, but there is inconclusive evidence on the effectiveness of these interventions for pain sensitization, leading to arbitrary nonoperative treatments for low back pain. METHODS: We will conduct a systematic review of RCTs evaluating the effectiveness and safety of nonoperative treatment for pain sensitization in patients with low back pain. The primary outcomes will be static quantitative sensory testing, dynamic quantitative sensory testing, and pain algometry. The secondary outcome will be adverse events. We will search the PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library databases. Two independent authors will screen the titles and abstracts, review full texts, extract data, assess the risk of bias, and evaluate the quality of evidence. We will qualitatively and quantitatively synthesize the results using a random effects model for meta-analysis. DISCUSSION: This systematic review aims to provide evidence regarding which treatment, if any, provides the greatest benefit for pain sensitization and safety among patients with low back pain. Evidence synthesized from this systematic review will inform clinical practice and further research. Since there is still a small amount of research, additional studies might need to be conducted in the future. SYSTEMATIC REVIEW REGISTRATION: Submitted to PROSPERO on March 20, 2021, CRD42021244054.


Assuntos
Dor Lombar , Neuralgia , Bases de Dados Factuais , Humanos , Dor Lombar/terapia , Metanálise como Assunto , Revisões Sistemáticas como Assunto
20.
BMJ Open ; 12(4): e053468, 2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35414546

RESUMO

OBJECTIVE: To summarise the available clinical evidence on the efficacy and safety of osteopathic manipulative treatment (OMT) for different conditions. DESIGN: Overview of systematic reviews (SRs) and meta-analyses (MAs). PROSPERO CRD42020170983. DATA SOURCES: An electronic search was performed using seven databases: PubMed, EMBASE, CINAHL, Scopus, JBI, Prospero and Cochrane Library, from their inception until November 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: SRs and MAs of randomised controlled trials evaluating the efficacy and safety of OMT for any condition were included. DATA EXTRACTION AND SYNTHESIS: The data were independently extracted by two authors. The AMSTAR-2 tool was used to assess the methodological quality of the SRs and MAs. The overview was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: The literature search revealed nine SRs or MAs conducted between 2013 and 2020 with 55 primary trials involving 3740 participants. The SRs reported a wide range of conditions including acute and chronic non-specific low back pain (NSLBP, four SRs), chronic non-specific neck pain (CNSNP, one SR), chronic non-cancer pain (CNCP, one SR), paediatric (one SR), neurological (primary headache, one SR) and irritable bowel syndrome (IBS, one SR). Although with a different effect size and quality of evidence, MAs reported that OMT is more effective than comparators in reducing pain and improving functional status in acute/chronic NSLBP, CNSNP and CNCP. Due to small sample size, presence of conflicting results and high heterogeneity, questionable evidence existed on OMT efficacy for paediatric conditions, primary headache and IBS.No adverse events were reported in most SRs. According to AMSTAR-2, the methodological quality of the included SRs was rated low or critically low. CONCLUSION: Based on the currently available SRs and MAs, promising evidence suggests the possible effectiveness of OMT for musculoskeletal disorders. Limited and inconclusive evidence occurs for paediatric conditions, primary headache and IBS. Further well-conducted SRs and MAs are needed to confirm and extend the efficacy and safety of OMT.


Assuntos
Dor Crônica , Síndrome do Intestino Irritável , Dor Lombar , Manipulação Osteopática , Analgésicos Opioides , Criança , Dor Crônica/terapia , Cefaleia , Humanos , Dor Lombar/terapia , Cervicalgia , Revisões Sistemáticas como Assunto
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