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1.
Fisioterapia (Madr., Ed. impr.) ; 42(3): 145-156, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191004

RESUMO

OBJETIVOS: Evaluar la eficacia de las técnicas de energía muscular en el tratamiento de síndromes musculoesqueléticos. ESTRATEGIA DE BÚSQUEDA: Se realizó una búsqueda bibliográfica de artículos publicados hasta noviembre de 2018 en las siguientes bases de datos: Medline (PubMed), Scopus, Web of Science, Cochrane Library y Science Direct. SELECCIÓN DE ESTUDIOS: Se seleccionaron 13 artículos con más de 6 puntos en la escala PEDro. RESULTADOS: Se seleccionaron 13 artículos con una muestra total de 694 sujetos y una media de 7,85 sobre 10 en la escala PEDro. Todos los estudios señalan que las técnicas de energía muscular disminuyen el dolor, aumentan los rangos articulares y también la funcionalidad. Se observaron diferencias significativas al comparar estas técnicas con otras intervenciones, como el concepto Mulligan, inyecciones de corticoesteroides intramusculares o tratamientos pasivos. Aplicar las técnicas de energía muscular junto con la punción seca o el método McKenzie ha demostrado ser más eficaz que su empleo de forma individual. CONCLUSIONES: Las técnicas de energía muscular muestran resultados positivos en la disminución del dolor, el aumento del rango articular y la funcionalidad en pacientes con síndromes musculoesqueléticos


OBJECTIVES: To assess the efficacy of muscle energy techniques in the treatment of musculoskeletal syndromes. SEARCH STRATEGY: A literature search was made for articles published up to November 2018 in the following databases: Medline (PubMed), Scopus, Web of Science, Cochrane Library, and Science Direct. STUDY SELECTION: A total of 13 articles with more than 6 points on the PEDro scale were selected RESULTS: The 13 articles selected had a total sample of 694 subjects, and a mean of 7.85 out of 10 on the PEDro scale. All studies indicated that muscle energy techniques decrease pain and increase ranges of motion, as well as motor function. Significant differences were observed when comparing these techniques with others interventions such as the Mulligan concept, intramuscular corticosteroid injections, or passive treatments. Applying muscle energy techniques in conjunction with dry needling or the McKenzie method has been shown to be more effective than using them individually. CONCLUSIONS: Muscle energy techniques show positive results in pain reduction, increased joint range, and functionality in patients with musculoskeletal síndromes


Assuntos
Humanos , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Modalidades de Fisioterapia , Resultado do Tratamento , Dor Musculoesquelética/epidemiologia , Manejo da Dor/instrumentação , Dor Musculoesquelética/reabilitação
2.
J Altern Complement Med ; 26(1): 44-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31580695

RESUMO

Background: Chronic neck pain (NP) attributed to myofascial pain syndrome is one of the particularly common skeletal muscle disorder associated with the hyperirritable zone in the taut band of muscle. Trigger points (TPs) are the physical interpretation of the myofascial pain syndrome. In the United States, 30%-85% of pain patients have been affected by myofascial TPs. Objectives: To reveal preliminary evidence on the clinical efficacy of ischemic compression therapy, dry cupping, and their combination on improving the TPs' pressure pain threshold (PPT), neck range of motion (NROM), and neck disability index (NDI) in patients with TPs and nonspecific NP. Besides, assess the feasibility of conducting a randomized clinical trial (RCT). Design: A randomized pilot study was conducted on 24 patients with TPs and nonspecific NP. Patients were randomly assigned to three groups: the cupping group, the ischemic compression group, and the combination therapy group. PPT, NROM, and NDI were assessed before and after 4 weeks of treatment. Results: The results showed a statistically significant improvement in NDI, PPT, and NROM compared with values before the treatment (p < 0.05) in all groups. Although no significant difference was detected between ischemic compression (IC) and dry cupping, the combination approach showed significantly higher and faster improvement (p < 0.05). Conclusions: It is feasible to conduct a main RCT. Both IC and dry cupping may hold promise in treating TPs; a combination of the two therapies may provide superior improving rate.


Assuntos
Ventosaterapia , Manipulações Musculoesqueléticas , Dor Musculoesquelética , Modalidades de Fisioterapia , Pontos-Gatilho/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/reabilitação , Dor Musculoesquelética/terapia , Projetos Piloto
3.
Spine (Phila Pa 1976) ; 45(2): 134-140, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31415468

RESUMO

STUDY DESIGN: A cohort study with 12 months of follow-up. OBJECTIVE: To assess (1) the unidimensionality of the Fear-Avoidance Beliefs Questionnaire (FABQ) and (2) whether single questions in the FABQ predict future sickness absence as well as the whole scale. SUMMARY OF BACKGROUND DATA: The fear-avoidance model is a leading model in describing the link between musculoskeletal pain and chronic disability. However, reported measurement properties have been inconsistent regarding the FABQ. METHODS: Individuals (n = 722) sick listed due to musculoskeletal, unspecified or common mental health disorders undergoing rehabilitation was included. A Rasch analysis was applied to evaluate the measurement properties of FABQ and its two subscales (physical activity and work). Linear regression was used to assess how well single items predicted future sickness absence. RESULTS: The Rasch analysis did not support the FABQ or its two subscales representing a unidimensional construct. The 7-point scoring of the items was far too fine meshed and in the present population the data only supported a yes or no or a 3-point response option. The items were invariant to age, whereas two of the items revealed sex differences. The item "I do not think that I will be back to my normal work within 3 months" was the best predictor of future sickness absence. Adding the item "I should not do my regular work with my present pain" improved the prediction model slightly. CONCLUSION: The FABQ is not a good measure of fear-avoidance beliefs about work or physical activity, and the predictive property of the FABQ questionnaire is most likely related to expectations rather than fear. Based on these results we do not recommend using the FABQ to measure fear-avoidance beliefs. LEVEL OF EVIDENCE: 1.


Assuntos
Aprendizagem da Esquiva , Medo/psicologia , Dor Musculoesquelética/psicologia , Licença Médica , Inquéritos e Questionários , Adulto , Pessoas com Deficiência/psicologia , Feminino , Seguimentos , Previsões/métodos , Humanos , Modelos Lineares , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Dor Musculoesquelética/reabilitação , Reprodutibilidade dos Testes , Retorno ao Trabalho/psicologia
4.
Undersea Hyperb Med ; 46(5): 647-654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683363

RESUMO

Introduction: The effects of hyperbaric oxygen (HBO2) therapy on sprains, ligament injuries, and muscle strains have been reported in several animal studies. In a dog model of compartment syndrome and in a rat contused skeletal muscle injury model, the significant effects of HBO2 therapy on the reduction of edema and muscle necrosis have been reported. In basic research HBO2 therapy stimulated fibroblast activity to improve the healing process. Because of this it expected that HBO2 therapy might improve focal edema and pain in the acute phase and accelerate the healing of injured tissues in athletes with a medial collateral ligament (MCL) injury of the knee. This study aimed to examine the short-term effects of HBO2 application subjectively, and the long-term effects of HBO2 therapy in Japanese professional or semi-professional rugby players with grade 2 MCL injury of the knee. Methods: Thirty-two professional or semi-professional rugby players with grade 2 MCL injury of the knee were investigated. First, in the HBO2 group (n=16), HBO2 therapy was performed during the acute phase. Visual analog scales (VASs) immediately before and after HBO2 therapy on the same day were compared. Next, we retrospectively evaluated the time to return to play in the HBO2 (n=16) and non-HBO2 (n=16) groups. Results: VAS scores for pain while walking immediately before and after HBO2 therapy on the same day were 37.4 ± 20.1 (mean ± standard deviation) and 32.4 ± 21.8, respectively (p⟨0.001). The VAS scores for pain while jogging were 50.7 ± 25.6 and 43.9 ± 25.0, respectively (p⟨0.001). The time to return to play was 31.4 ± 12.2 days in the HBO2 group and 42.1 ± 15.8 days in the non-HBO2 group, indicating a significant difference between the groups (p⟨0.05). Conclusion: HBO2 therapy may reduce pain and accelerate the return to play in athletes with grade 2 MCL injury of the knee in this non-randomized study.


Assuntos
Futebol Americano/lesões , Oxigenação Hiperbárica , Ligamento Colateral Médio do Joelho/lesões , Dor Musculoesquelética/terapia , Volta ao Esporte , Cicatrização/fisiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Humanos , Japão , Corrida Moderada , Instabilidade Articular/classificação , Masculino , Dor Musculoesquelética/reabilitação , Medição da Dor/métodos , Caminhada , Adulto Jovem
5.
BMC Musculoskelet Disord ; 20(1): 446, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610787

RESUMO

BACKGROUND: Subacromial impingement syndrome is a common problem in primary healthcare. It often include tendinopathy. While exercise therapy is effective for this condition, it is not clear which type of exercise is the most effective. Eccentric exercises has proven effective for treating similar tendinopathies in the lower extremities. The aim of this systematic review was therefore to investigate the effects of eccentric exercise on pain and function in patients with subacromial impingement syndrome compared with other exercise regimens or interventions. A secondary aim was to describe the included components of the various eccentric exercise regimens that have been studied. METHODS: Systematic searches of PubMed, Cochrane Library and PEDro by two independent authors. Included studies were assessed using the PEDro scale for quality and the Cochrane scale for clinical relevance by two independent authors. Data were combined in meta-analyses. GRADE was applied to assess the certainty of evidence. RESULTS: Sixty-eight records were identified. Seven studies (eight articles) were included, six were meta-analysed (n = 281). Included studies were of moderate quality (median PEDro score 7, range 5-8). Post-treatment pain was significantly lower after eccentric exercise compared with other exercise: MD -12.3 (95% CI - 17.8 to - 6.8, I2 = 7%, p < 0.001), but this difference was not clinically important. Eccentric exercise provided no significant post-treatment improvement in function compared with other exercise: SMD -0.10 (95% CI - 0.79 to 0.58, I2 = 85%, p = 0.76). Painful eccentric exercise showed no significant difference compared to pain-free eccentric exercise. Eccentric training regimes showed both similarities and diversity. Intervention duration of 6-8 weeks was almost as effective as 12 weeks. CONCLUSIONS: Evidence of low certainty suggests that eccentric exercise may provide a small but likely not clinically important reduction in pain compared with other types of exercise in patients with subacromial impingement syndrome. It is uncertain whether eccentric exercise improves function more than other types of exercise (very low certainty of evidence). Methodological limitations of existing studies make these findings susceptible to change in the future. TRIAL REGISTRATION: PROSPERO CRD42019126917 , date of registration: 29-03-2019.


Assuntos
Terapia por Exercício/métodos , Dor Musculoesquelética/reabilitação , Síndrome de Colisão do Ombro/reabilitação , Tendinopatia/reabilitação , Terapia por Exercício/efeitos adversos , Humanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Síndrome de Colisão do Ombro/complicações , Tendinopatia/etiologia , Resultado do Tratamento
6.
Musculoskelet Sci Pract ; 43: 58-63, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31260932

RESUMO

BACKGROUND: Patients with pain associated with musculoskeletal disorders often seek treatment from physiotherapists, necessitating these practitioners' competence to practice within the biopsychosocial framework. Qualitative research suggests musculoskeletal physiotherapists may not have adequate proficiency in psychosocial practice to assess and address psychosocial factors effectively. OBJECTIVE: To collect quantitative self-report data via an online survey from a large cross section of Australian musculoskeletal physiotherapists regarding their psychosocial practice. METHODS: The study involved an iterative survey development process followed by the conduct of this survey. A provisional survey named the 'Triple P Questionnaire' was developed, informed by the knowledge and experience of the research team. This Questionnaire was piloted by experts (n = 6) to provide feedback on the instrument. Changes were made to the survey based on this feedback. The finalised Triple P Questionnaire was distributed to Australian musculoskeletal physiotherapists. RESULTS: 181 participants completed the full survey. Not all demographic characteristics were representative of the population. Most participants indicated that they 'agree' to most statements posed in the questionnaire including confidence, routine practice of specific psychosocial skills and barriers. Some questions presented a majority response of 'disagree' or a spread of responses, indicating some evidence-practice gaps, including the use of questionnaires, and explicit assessment of psychological factors. Inferential statistics revealed no significant correlations between demographic characteristics and psychosocial practice. CONCLUSION: The Triple P Questionnaire identified musculoskeletal physiotherapists' general confidence in their psychosocial practice but highlights some apparent inconsistencies in reported practice and areas where confidence is not as strong, reflecting possible evidence practice gaps.


Assuntos
Dor Musculoesquelética/reabilitação , Fisioterapeutas/psicologia , Modalidades de Fisioterapia , Prática Privada , Adulto , Austrália , Competência Clínica , Estudos Transversais , Feminino , Humanos , Masculino , Manejo da Dor , Pesquisa Qualitativa , Inquéritos e Questionários
7.
BMC Musculoskelet Disord ; 20(1): 188, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054564

RESUMO

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


Assuntos
Dor Crônica/reabilitação , Terapia por Exercício/métodos , Pacientes Internados/estatística & dados numéricos , Dor Musculoesquelética/reabilitação , Caminhada/estatística & dados numéricos , Adulto , Dor Crônica/fisiopatologia , Estudos Transversais , Terapia por Exercício/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/fisiopatologia , Equipe de Assistência ao Paciente , Participação do Paciente/estatística & dados numéricos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Caminhada/fisiologia
8.
Arch Phys Med Rehabil ; 100(11): 2167-2178, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31004565

RESUMO

OBJECTIVE: This study systematically reviews previous work on the effects of whole body vibration exercise (WBVE) on pain associated with chronic musculoskeletal disorders. DATA SOURCES: Seven electronic databases (PubMed, Embase, CINAHL, Web of Science, Cochrane, Physiotherapy Evidence Database [PEDro], and the China National Knowledge Infrastructure) were searched for articles published between January 1980 and September 2018. STUDY SELECTION: Randomized controlled trials involving adults with chronic low back pain (CLBP), osteoarthritis (OA), or fibromyalgia were included. Participants in the WBVE intervention group were compared with those in the nontreatment and non-WBVE control groups. DATA EXTRACTION: Data were independently extracted using a standardized form. Methodological quality was assessed using PEDro. DATA SYNTHESIS: Suitable data from 16 studies were pooled for meta-analysis. A random effects model was used to calculate between-groups mean differences at 95% confidence interval (CI). The data were analyzed depending on the duration of the follow-up, common disorders, and different control interventions. RESULTS: Alleviation of pain was observed at medium term (standardized mean difference [SMD], -0.67; 95% CI, -1.14 to -0.21; I2, 80%) and long term (SMD, -0.31; 95% CI, -0.59 to -0.02; I2, 0%). Pain was alleviated in osteoarthritis (OA) (SMD, -0.37; 95% CI, -0.64 to -0.10; P<.05; I2, 22%) and CLBP (SMD, -0.44; 95% CI, -0.75 to -0.13; P<.05; I2, 12%). Long-term WBVE could relieve chronic musculoskeletal pain conditions of OA (SMD, -0.46; 95% CI, -0.80 to -0.13; P<.05; I2, 0%). WBVE improved chronic musculoskeletal pain compared with the treatment "X" control (SMD, -0.37; 95% CI, -0.61 to -0.12; P<.05; I2, 26%), traditional treatment control (SMD, -1.02; 95% CI, -2.44 to 0.4; P>.05; I2, 94%) and no treatment control (SMD, -1; 95% CI, -1.76 to -0.24; P<.05; I2, 75%). CONCLUSIONS: Evidence suggests positive effects of WBVE on chronic musculoskeletal pain, and long durations of WBVE could be especially beneficial. However, WBVE does not significantly relieve chronic musculoskeletal pain compared with the traditional treatment. Further work is required to identify which parameters of WBVE are ideal for patients with chronic musculoskeletal pain.


Assuntos
Dor Crônica/reabilitação , Dor Musculoesquelética/reabilitação , Modalidades de Fisioterapia , Vibração/uso terapêutico , Fibromialgia/reabilitação , Humanos , Dor Lombar/reabilitação , Osteoartrite/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Isr Med Assoc J ; 21(4): 255-259, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31032567

RESUMO

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


Assuntos
Dor Crônica/reabilitação , Climatoterapia/métodos , Terapia Cognitivo-Comportamental/métodos , Dor Musculoesquelética/reabilitação , Modalidades de Fisioterapia , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/psicologia , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/psicologia , Noruega , Oceanos e Mares , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
J Surg Res ; 240: 30-39, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30909063

RESUMO

BACKGROUND: Performing surgery involves well-known risk factors for developing musculoskeletal pain. Multisite musculoskeletal pain has shown to have an even higher adverse impact on the individual. We examined prevalence and intensity of multisite musculoskeletal pain in surgeons and identified characteristics associated with two or more painful body sites. MATERIALS AND METHODS: Information on sociodemographic, work experience, work demands, health status, physical capacity, and prevalence and intensity of musculoskeletal pain were collected from an internet-based questionnaire in 284 surgeons. Descriptive statistics were used to report prevalence and intensity of musculoskeletal pain. A logistic regression model was conducted to assess the characteristics associated with multisite musculoskeletal pain. RESULTS: Musculoskeletal pain was reported by 93% of the surgeons and 77% experienced multisite pain. The reported median pain intensities ranged from 2 to 4. Multisite musculoskeletal pain was significantly associated with being a female surgeon (OR: 3.4; 95% CI: 1.5-7.4), physical work demands (OR: 1.5 95% CI: 1.2-1.7), work ability (OR: 3.4; 95% CI: 1.6-7.0), and feeling a sense of heaviness in the head/headache (OR:4.8; 95% CI: 2.0-11.5). In addition, 21%-40% of the surgeons who experienced multisite pain reported that pain influenced their work, leisure time, and sleep negatively. CONCLUSIONS: The observed high prevalence of multisite musculoskeletal pain and high pain intensities adds new knowledge to the emerging literature on surgeons' health. In addition, several characteristics, for example, work ability, were significantly associated with multiple pain sites. This is concerning as pain could ultimately shorten a surgeon's career. Therefore, it is pertinent to develop preventive and rehabilitating strategies.


Assuntos
Dor Musculoesquelética/epidemiologia , Doenças Profissionais/epidemiologia , Especialidades Cirúrgicas/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/reabilitação , Doenças Profissionais/diagnóstico , Doenças Profissionais/reabilitação , Medição da Dor/estatística & dados numéricos , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Carga de Trabalho/estatística & dados numéricos
11.
BMC Public Health ; 19(1): 320, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885182

RESUMO

BACKGROUND: The aim of the present study was to describe the development of strategies to prevent and rehabilitate musculoskeletal pain among surgeons. Musculoskeletal pain affects surgeons' life, and evidence on interventions for effective prevention and rehabilitation is lacking for this occupational group. METHODS: An Intervention Mapping approach was used to develop intervention strategies specifically tailored to surgeons. This approach entailed conducting a systematic scoping literature search and semi-structured interviews with six surgeons. RESULTS: The first step was to develop a logic model of the problem of musculoskeletal pain among surgeons. Step two was to formulate health-enhancing outcomes and performance objectives for the intervention, while in step three theory-based methods and practical strategies for the intervention were identified. CONCLUSION: The present Intervention Mapping study demonstrated that musculoskeletal pain among surgeons is a complex area that needs attention. Our findings highlight a need for individual behavioural changes as well as organisational, attitudinal, and management changes.


Assuntos
Dor Musculoesquelética/prevenção & controle , Dor Musculoesquelética/reabilitação , Doenças Profissionais/prevenção & controle , Doenças Profissionais/reabilitação , Saúde do Trabalhador , Cirurgiões , Humanos
12.
Clin Rehabil ; 33(6): 980-991, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30791696

RESUMO

OBJECTIVE: To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment. DATA SOURCES: Electronic databases (PubMed, Web of Science, Embase and PsycINFO) were searched until 14 January 2019. STUDY SELECTION: Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected. RESULTS: A total of 23 articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatization or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy. CONCLUSION: There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability.


Assuntos
Dor Musculoesquelética/reabilitação , Dor de Ombro/reabilitação , Ansiedade/psicologia , Catastrofização , Depressão/psicologia , Avaliação da Deficiência , Medo/psicologia , Humanos , Dor Musculoesquelética/psicologia , Modalidades de Fisioterapia , Autoeficácia , Dor de Ombro/psicologia
13.
J Athl Train ; 54(3): 255-269, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30721093

RESUMO

CONTEXT: Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its use has not been studied in a rehabilitation trial. OBJECTIVE: To determine the effects of a 4-week impairment-based rehabilitation program using PENS on subjective function, pain, strength, range of motion, and physical activity in individuals with PFP. DESIGN: Randomized controlled trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 21 patients with PFP (5 males, 16 females; age = 23.4 ± 7.6 years, height = 168.0 ± 7.5 cm, mass = 69.0 ± 19.5 kg). INTERVENTION(S): Participants completed a 4-week supervised rehabilitation program in conjunction with random assignment to receive PENS or sham treatments. MAIN OUTCOME MEASURE(S): Subjective function, pain, strength, range of motion, and physical activity levels were assessed prerehabilitation and postrehabilitation. Subjective function and pain were also assessed at 6 and 12 months postrehabilitation. Repeated-measures analyses of variance and Tukey post hoc testing were conducted with α ≤ .05. We calculated Cohen d effect sizes with 95% confidence intervals. RESULTS: Both groups had statistically and clinically meaningful differences in subjective function, pain, strength, range of motion, and activity level after 4 weeks of impairment-based rehabilitation. Improved subjective function was observed in both groups at 6 and 12 months after the interventions. The PENS group had improvements in current pain for all 3 postrehabilitation times compared with baseline measures. CONCLUSIONS: An impairment-based intervention effectively improved subjective function, pain, strength, range of motion, and physical activity levels in individuals with PFP. Participants who received PENS in addition to the rehabilitation program had improved current pain at 6 and 12 months postrehabilitation compared with baseline scores. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02441712.


Assuntos
Terapia por Estimulação Elétrica/métodos , Dor Musculoesquelética , Síndrome da Dor Patelofemoral , Adolescente , Adulto , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Força Muscular , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/reabilitação , Medição da Dor/métodos , Síndrome da Dor Patelofemoral/fisiopatologia , Síndrome da Dor Patelofemoral/reabilitação , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento
14.
Am J Phys Med Rehabil ; 98(6): 516-520, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30601162

RESUMO

Bayesian techniques, as an alternative method of statistical analysis in rehabilitation studies, have some advantages such as handling small sample sizes, allowing incorporation of previous experience of the researchers or clinicians, being suitable for different kinds of studies, and managing highly complex models. These characteristics are important in rehabilitation research. In the present article, the Bayesian approach is displayed through three examples in previously analyzed data with traditional or frequentist methods. The studies used as examples have small sample sizes and show that the Bayesian procedures enhance the statistical information of the results. The Bayesian credibility interval includes the true value of the corresponding parameter diminishing uncertainty about the treatment effect. In addition, the Bayes factor value quantifies the evidence provided by the data in favor of the alternative hypothesis as opposed to the null hypothesis. Bayesian inference could be an interesting and adaptable alternative statistical method for physical medicine and rehabilitation applications.


Assuntos
Teorema de Bayes , Pesquisa de Reabilitação , Humanos , Dor Musculoesquelética/reabilitação , Doença de Parkinson/reabilitação , Projetos de Pesquisa
15.
BMC Musculoskelet Disord ; 20(1): 16, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611242

RESUMO

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


Assuntos
Dor Crônica/diagnóstico , Avaliação da Deficiência , Diferença Mínima Clinicamente Importante , Dor Musculoesquelética/diagnóstico , Adolescente , Adulto , Idoso , Dor Crônica/fisiopatologia , Dor Crônica/reabilitação , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/reabilitação , Medição da Dor , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento , Teste de Caminhada , Adulto Jovem
16.
Arch Phys Med Rehabil ; 100(6): 1050-1060, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30543802

RESUMO

OBJECTIVE: To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics. DESIGN: Prospective cohort study with propensity score matching. SETTING: Data collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands. PARTICIPANTS: A consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes. INTERVENTIONS: Exercises and orthotics versus orthotics alone. MAIN OUTCOME MEASURES: Primary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100). RESULTS: A larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131). CONCLUSIONS: Non-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.


Assuntos
Terapia por Exercício , Dor Musculoesquelética/reabilitação , Aparelhos Ortopédicos , Osteoartrite/reabilitação , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Articulação Metacarpofalângica/fisiopatologia , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Osteoartrite/complicações , Medição da Dor , Esforço Físico , Pontuação de Propensão , Estudos Prospectivos , Amplitude de Movimento Articular , Descanso , Inquéritos e Questionários , Polegar
17.
J Back Musculoskelet Rehabil ; 32(2): 197-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30248043

RESUMO

BACKGROUND: Patient satisfaction is a key point in evaluating the quality of physiotherapy services. OBJECIVE: The aim of this study was to determine the Turkish language validity and reliability of the Patient Satisfaction Scale in Physiotherapy (PSSP). METHODS: The study included 168 participants, aged 18-74 years, with musculoskeletal pain. The PSSP, which comprises 14 items in the four sub-dimensions of treatment, admission, logistics and general satisfaction, was applied to all participants. Structural validity was assessed using the principal components method with varimax rotation. Internal consistency and the intraclass correlation coefficient (ICC) were used for the reliability analysis. The Patient Satisfaction Scale for Physical Therapy Outpatient Clinics (PCCPTO) was used to assess concurrent validity. RESULTS: The participants comprised of 71% females and 29% males with a mean age of 41.9 ± 14.9 years. The sampling competency index was 0.874. The Turkish version of the scale was found to be perfectly reliable (Cronbach's alpha reliability coefficient = 0.922). Internal consistency ranged from 0.762 to 0.904 in the subscales. Factor analysis revealed that the 14-item scale had four factors explaining 75.59% of the total variance. Floor and ceiling effects were not determined. Concurrent validity analysis showed a strong correlation between the PSSP and PCCPTO (r= 0.78; p< 0.0005). CONCLUSION: The Turkish version of the PSSP is a valid, reliable and easily applicable measure.


Assuntos
Dor Musculoesquelética/reabilitação , Satisfação do Paciente , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Reprodutibilidade dos Testes , Turquia , Adulto Jovem
18.
Clin J Pain ; 35(2): 148-173, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30371517

RESUMO

OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR). MATERIALS AND METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE). DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/reabilitação , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/reabilitação , Dor Crônica/fisiopatologia , Humanos , Dor Musculoesquelética/fisiopatologia , Prognóstico
19.
Disabil Rehabil ; 41(7): 833-839, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29185366

RESUMO

PURPOSE: To assess the factor structure, related constructs and internal consistency of the Child Activity Limitation Interview 21-Child version for use in Dutch-language countries. METHODS: Cross-sectional validation study: After forward and back translation of the Dutch version of the Child Activity Limitation Interview 21-Child adolescents (11-21 years old) with chronic musculoskeletal pain completed an assessment. The assessment contained the Dutch Child Activity Limitation Interview, and questionnaires about demographics, pain intensity, functional disability, anxiety and depression. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain intensity, activity limitations, anxiety and depression as comparative constructs. RESULTS: Seventy-four adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 50% of the variance. Internal consistency was good (Cronbach's α = 0.91 total scale, α = 0.90 Factor 1, α = 0.80 Factor 2). All nine hypotheses were confirmed. CONCLUSION: The Dutch version can be used to assess pain-related disability in Dutch-speaking adolescents comparable to the study sample. Scores on both subscales provide insight into the severity of the pain-related disability in both daily routine and more physically vigorous activities. Implications for Rehabilitation Chronic pain is a disabling disorder which not only impacts physically but restricts quality of life. This study provides clinicians a questionnaire to measure pain-related disability and quantify the impact of pain on the daily living of adolescents. The advantage of the Dutch version of the Child Activity and Limitations Interview over other measurements is that it can distinguish limitations in daily activities from more physically vigorous activities.


Assuntos
Atividades Cotidianas , Dor Crônica , Dor Musculoesquelética , Desempenho Físico Funcional , Qualidade de Vida , Adolescente , Criança , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Dor Crônica/reabilitação , Estudos Transversais , Feminino , Humanos , Masculino , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/reabilitação , Países Baixos , Medição da Dor/métodos , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Traduções
20.
Scand J Public Health ; 47(1): 78-85, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28810814

RESUMO

AIMS: Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care. METHODS: This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the constant comparative method, which is a variation of grounded theory. RESULTS: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were (1) the timing of referrals to the VA, (2) the perceived lack of patient demand for the service and (3) role uncertainty experienced by VAs. CONCLUSIONS: Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Clínicos Gerais/psicologia , Dor Musculoesquelética/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Atenção Primária à Saúde , Reabilitação Vocacional , Adulto , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Papel Profissional/psicologia , Pesquisa Qualitativa , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo
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