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2.
Am Fam Physician ; 102(8): 465-477, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33064421

RESUMO

Chronic low back pain, neck pain, hip and knee osteoarthritis, and fibromyalgia are the most common types of chronic musculoskeletal pain. Because no individual therapy has consistent benefit, a multimodal treatment approach to chronic musculoskeletal pain is recommended. Many nonpharmacologic, noninvasive treatment approaches yield small to moderate improvement and can be used with pharmacologic or more invasive modalities. Systematic reviews and guidelines support the effectiveness of various forms of exercise in improving pain and function in patients with chronic pain. Cognitive behavior therapy and mindfulness techniques appear to be effective for small to moderate short- and long-term improvement of chronic low back pain. Cognitive behavior therapy may also be effective for small short- and intermediate-term improvement of fibromyalgia. Spinal manipulation leads to a small benefit for chronic neck and low back pain. Acupuncture has a small to moderate benefit for low back pain and small benefit for nonpain fibromyalgia symptoms. Massage or myofascial release yields a small improvement in low back pain, hip and knee osteoarthritis, and fibromyalgia. Low reactive level laser therapy may provide short-term relief of chronic neck and low back pain, and ultrasound may provide short-term pain relief for knee osteoarthritis. Multidisciplinary rehabilitation may be effective for short- and at least intermediate-term improvement in pain and function for chronic low back pain and fibromyalgia. Patients should be encouraged to engage in a variety of therapies aligned with their preferences and motivation.


Assuntos
Dor Crônica/terapia , Dor Musculoesquelética/terapia , Terapia por Acupuntura , Terapia Cognitivo-Comportamental , Exercício Físico , Fibromialgia/terapia , Humanos , Dor Lombar/terapia , Terapia com Luz de Baixa Intensidade , Manipulação da Coluna , Massagem , Atenção Plena , Relaxamento Muscular , Cervicalgia/terapia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Clínicas de Dor , Educação de Pacientes como Assunto , Terapia por Ultrassom
3.
Rev Epidemiol Sante Publique ; 68(5): 306-313, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32893028

RESUMO

BACKGROUND: Musculoskeletal disorders are increasing in prevalence, principally due to sedentary behaviors. Strong evidence supports an early need for first-line treatment including physiotherapy. New and innovative models in primary and emergency care have been drawn up and put the physiotherapist's skills to work in early and first-line management of patients with musculoskeletal disorders. The objectives of this review were to identify and describe studies assessing models of care integrating direct access to physiotherapy in primary care and in emergency care for patients with musculoskeletal disorders and to provide perspectives on the application of these two models in France. METHODS: A literature review was carried out including studies extracted from four scientific databases: PubMed, CINAHL, Embase, and PEDro. The selected articles had to address the clinical effectiveness or efficiency of these models for the provision of care in primary or in emergency care. A narrative literature review method was used. The synthesis deals with the qualitative analysis of the included studies. RESULTS: Thirty-nine studies were included in this review: 19 on assessment of the direct access to physiotherapy model in primary care and 20 on the direct access to physiotherapy model in emergency departments as concerns patients with musculoskeletal disorders. The studies showed that the different models incorporating direct access to physiotherapy in primary or in emergency care provided better outcomes in terms of quality and access to care while maintaning a similar degree of safety. However, the methodology of the studies included was estimated as being of heterogeneous quality. CONCLUSION: The studies dealing with the new models for provision of care integrating direct access to physiotherapy in primary care or emergency care impart two lessons: (1) they are not designed to replace the physician; (2) collaboration between different health professionals aimed at improving patients' access to efficient care is to be encouraged. It would be worthwhile to focus upon dissemination factors that would enhance the efficiency of these innovative models in other countries, as in France.


Assuntos
Serviços Médicos de Emergência/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Modelos Organizacionais , Doenças Musculoesqueléticas/terapia , Modalidades de Fisioterapia/organização & administração , Atenção Primária à Saúde/organização & administração , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Doenças Musculoesqueléticas/epidemiologia , Dor Musculoesquelética/epidemiologia , Dor Musculoesquelética/terapia , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/estatística & dados numéricos , Modalidades de Fisioterapia/normas , Modalidades de Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Resultado do Tratamento
4.
Clin Sports Med ; 39(4): 859-876, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892972

RESUMO

Painful accessory navicular and spring ligament injuries in athletes are different entities from more common posterior tibialis tendon problems seen in older individuals. These injuries typically affect running and jumping athletes, causing medial arch pain and in severe cases a pes planus deformity. Diagnosis requires a detailed physical examination, standing radiographs, and MRI. Initial treatment focuses on rest, immobilization, and restriction from sports. Orthotic insoles may alleviate minor pain, but many patients need surgery to expedite recovery and return to sports. The authors review their approach to these injuries and provide surgical tips along with expected rehabilitation to provide optimal outcomes.


Assuntos
Traumatismos em Atletas/terapia , Traumatismos do Pé/terapia , Ligamentos Articulares/lesões , Dor Musculoesquelética/etiologia , Procedimentos Ortopédicos/métodos , Ossos do Tarso/anormalidades , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/fisiopatologia , Pé Chato/etiologia , Pé Chato/terapia , Doenças do Pé/diagnóstico , Doenças do Pé/fisiopatologia , Doenças do Pé/terapia , Traumatismos do Pé/diagnóstico , Traumatismos do Pé/etiologia , Traumatismos do Pé/fisiopatologia , Humanos , Ligamentos Articulares/cirurgia , Dor Musculoesquelética/terapia , Ossos do Tarso/lesões , Ossos do Tarso/fisiopatologia , Resultado do Tratamento
5.
Clin Sports Med ; 39(4): 911-930, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892975

RESUMO

Posterior ankle pain is a common complaint, and the potential causative pathologic processes are diverse. The constellation of these numerous etiologies has been collectively referred to as posterior ankle impingement syndrome. The pain associated with posterior ankle impingement is caused by bony or soft tissue impingement of the posterior ankle while in terminal plantar flexion. This condition is most frequently encountered in athletes who participate in sports that involve forceful, or repetitive, ankle plantar flexion. This article discusses the associated pathology, diagnosis, conservative treatment, and surgical techniques associated with flexor hallucis longus and posterior ankle impingement syndrome.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/terapia , Músculo Esquelético/lesões , Procedimentos Ortopédicos/métodos , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/anatomia & histologia , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/patologia , Traumatismos em Atletas/terapia , Hallux/anatomia & histologia , Hallux/fisiopatologia , Humanos , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Síndrome , Resultado do Tratamento
6.
Med Clin North Am ; 104(5): 855-872, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773050

RESUMO

Persistent pain in older adults is a widely prevalent and disabling condition that is the manifestation of multiple contributing physical, mental, social, and age-related factors. To effectively treat pain, the clinician must assess and address contributing factors using a comprehensive approach that includes pharmacologic and nonpharmacologic therapies within the context of a strong therapeutic relationship among the patient, caregivers, and a multidisciplinary team. This article reviews the current understanding of persistent pain in older adults and suggests a general approach to its assessment and management, followed by specific considerations for musculoskeletal pain conditions commonly seen in older adults.


Assuntos
Dor Musculoesquelética , Manejo da Dor/métodos , Idoso , Dor Crônica , Avaliação Geriátrica , Humanos , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/terapia
7.
Medicine (Baltimore) ; 99(30): e21184, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791693

RESUMO

BACKGROUND: Degenerative knee osteoarthritis (KOA) shows an increase in morbidity with improvement in the living conditions and extended lifespans. Treatment for degenerative KOA has been gaining attention since it significantly affects the life of the elderly population and is also associated with increased expenses for medical services and high socioeconomic costs. Treatments for degenerative KOA include nondrug therapy, drug therapy, and surgical treatment. For cases that show little response to conservative treatment but have not involved severe deformation of the knee, procedures such as arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation can be performed. However, effective treatment is required for patients experiencing sustained knee pain after surgery. Although studies confirming the therapeutic effects of acupuncture or thread-embedding acupuncture (TEA) treatment for degenerative KOA have been reported, clinical studies on a combination of TEA and electroacupuncture (EA) in patients complaining of knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation have not yet been reported. Therefore, this study aimed to evaluate the effectiveness and safety of this combination treatment in patients with persistent knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation. METHODS/DESIGN: This study has been designed as a 2-group, parallel, single-center, randomized, controlled, assessor-blinded trial. Thirty-six patients with degenerative KOA who complained of pain even after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation will be randomized to either the (TEA + EA + Usual care) group or the (Usual care only) group in a 1:1 ratio. The patients in the (TEA + EA + Usual care) group will receive TEA treatment once a week for 4 weeks for a total of 4 sessions and EA twice a week for a total of 8 sessions while continuing usual care. The (Usual care only) group will only receive usual care for 4 weeks. To assess the efficacy of the TEA and EA combination treatment, the visual analogue scale, the Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index, the EuroQol 5-Dimension 5-Level, and the doses of the rescue drug taken will be evaluated at baseline (1W) and weeks 2 (2W), 4 (4W), 6 (6W), and 8 (8W). The primary efficacy endpoint is the mean change in visual analogue scale at week 4 (4W) compared to baseline. Adverse events will be assessed at every visit. DISCUSSION: This study will provide useful data for evaluating the clinical efficacy and safety of TEA and electroacupuncture combination treatment for improving pain and quality of life after surgery for degenerative KOA. TRIAL REGISTRATION: Clinical Research Information Service of Republic of Korea (CRIS- KCT0004804), March 6, 2020.


Assuntos
Terapia por Acupuntura/métodos , Dor Musculoesquelética/terapia , Osteoartrite do Joelho/terapia , Polidioxanona/administração & dosagem , Artroscopia , Transplante Ósseo , Cartilagem/transplante , Condrócitos/transplante , Terapia Combinada , Eletroacupuntura , Humanos , Dor Musculoesquelética/etiologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Medição da Dor , Projetos Piloto , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Método Simples-Cego
8.
J Orthop Sports Phys Ther ; 50(8): 418-430, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736497

RESUMO

OBJECTIVE: To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019. STUDY SELECTION CRITERIA: Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain. DATA SYNTHESIS: We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively. RESULTS: Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication. CONCLUSION: There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418-430. doi:10.2519/jospt.2020.9319.


Assuntos
Dor Crônica/psicologia , Dor Crônica/terapia , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/terapia , Autoeficácia , Terapia Cognitivo-Comportamental , Terapia por Exercício , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão
9.
Pain Physician ; 23(4): 429-438, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709178

RESUMO

BACKGROUND: Ehlers-Danlos syndrome (EDS) is a multifaceted disease that can present with a variety of types of pain. Unfortunately, both the mechanisms and treatments for pain are poorly understood. The proposed treatments for the various musculoskeletal pain syndromes in EDS have had variable success, and it becomes much more imperative to better define and evaluate the current treatment modalities in treating this debilitating disease. OBJECTIVES: The purpose of this study was to investigate the currently available treatment modalities for patients with EDS and their efficacies in pain and symptom relief. STUDY DESIGN: Retrospective cohort study. SETTING: Institutional physical medicine and rehabilitation primary care clinic. METHODS: All patients were seen between January 2015 and April 2019, in which 98 patients with EDS were identified through retrospective chart review. Institutional review board approval was obtained, and all patients provided written consent to be included in the study. We reviewed various treatment modalities, including complimentary/alternative treatments, opioids/opioid-like medications, nonsteroidal antiinflammatory drugs, physical therapy, occupational therapy, muscle relaxants, neuropathic modulators, steroids, surgery/procedures, and acetaminophen. Treatment methods were extracted from individual patient charts, and efficacy was grouped into 3 categories: improvement, no effect, or worsened symptoms. RESULTS: The most common treatments used were complimentary/alternative treatments (n = 88). Occupational therapy and bracing were the most effective options with 70% of patients reporting improvement. Neuropathic modulators were the least well tolerated with 47% of patients reporting adverse effects. LIMITATIONS: Men were a small percentage of the study. Patients were not randomized, and pain score reporting was subjective. Patient data were extracted from a single practice setting. Timing and symptom onset were not measured. CONCLUSIONS: There is a relative paucity of published literature regarding the various treatment methods for EDS. Although our study is able to identify positive and negative trends with certain modalities, it is vital to understand that EDS is not a uniform diagnosis among patients, and that a combination of several different treatments usually is needed for optimal symptom control. Further research and investigation are necessary to develop a comprehensive treatment database for this complex condition. KEY WORDS: Ehlers-Danlos syndrome, pain, hypermobility, arthralgia, subluxation, genetic, physical therapy, interventional pain.


Assuntos
Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/terapia , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/terapia , Adolescente , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Artralgia/diagnóstico , Artralgia/terapia , Estudos de Coortes , Terapias Complementares/métodos , Terapias Complementares/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/administração & dosagem , Modalidades de Fisioterapia/tendências , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Ned Tijdschr Geneeskd ; 1642020 06 30.
Artigo em Holandês | MEDLINE | ID: mdl-32608925

RESUMO

A 12-year-old boy was referred by the general practitioner with a 3-week history of pain in the popliteal fossa. There was no sign of trauma or infection, physical examination was normal, and his CRP level was mildly elevated. X-ray and MRI revealed a Brodie's abscess, which was treated surgically and with antibiotics and he made a good recovery.


Assuntos
Abscesso/diagnóstico , Dor Musculoesquelética/diagnóstico , Osteomielite/diagnóstico , Abscesso/complicações , Abscesso/terapia , Antibacterianos/uso terapêutico , Criança , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Procedimentos Ortopédicos , Osteomielite/complicações , Osteomielite/terapia , Radiografia
11.
PLoS One ; 15(7): e0235364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628696

RESUMO

INTRODUCTION: The demand for musculoskeletal (MSK) care is rising, and is a growing challenge for general practice. Direct access to physiotherapy and other healthcare services may offer appropriate care for MSK pain patients but there is uncertainty regarding the effectiveness or efficiency of this approach in practice. This study aimed to review the evidence regarding characteristics, outcomes, barriers and facilitators of MSK triage and direct access services. METHODS: A comprehensive search of eight databases (including MEDLINE, EMBASE, and Cochrane library) up to February 2018 was conducted to identify studies (trials, cohorts and qualitative evidence) on direct access services for MSK in primary care settings. Using predefined inclusion and exclusion criteria, titles, abstracts, and subsequent full texts were independently screened by reviewers. Methodological quality of eligible studies was assessed using the mixed methods appraisal tool, and extracted data regarding study characteristics and results were independently reviewed. A narrative synthesis and grading of evidence was undertaken. Approaches to MSK triage and direct access were profiled along with their respective outcomes of care relating to patient-oriented and socioeconomic outcomes. Barriers and facilitators of each model of direct access services were also highlighted. RESULTS: 9010 unique citations were screened, of which 26 studies were eligible. Three approaches (open access, combination and service pathway models) to MSK triage and direct access shared similar goals but were heterogeneous in application. MSK patients using direct access showed largely similar characteristics (age, sex and duration of symptoms) compared to GP-led care, although they were often younger, slightly more educated and with better socio-economic status than patients seen through GP-led care. Although many studies showed limitations in design or methods, outcomes of care (patient oriented outcomes of pain, and disability) did not show large differences between direct access and GP-led care. In most studies direct access patients were reported to have lower healthcare utilisation (fewer physiotherapy or GP consultations, analgesics or muscle relaxants prescriptions, or imaging procedures) and less time off work compared to GP-led care. DISCUSSION: This study provides insight into the current state of evidence regarding MSK triage and direct access services and highlights potential implications for future research, healthcare services planning, resource utilisation and organising care for MSK patients in primary care. There is consistent, although limited, evidence to suggest that MSK triage and direct access services lead to comparable clinical outcomes with lower healthcare consumption, and can help to manage GP workload. However, due to the paucity of strong empirical data from methodologically robust studies, a scale up and widespread roll out of direct access services cannot as yet be assumed to result in long term health and socio-economic gains. PROSPERO-ID: CRD42018085978.


Assuntos
Dor Musculoesquelética/terapia , Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Triagem/métodos , Humanos , Dor Musculoesquelética/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Resultado do Tratamento , Triagem/estatística & dados numéricos
12.
Medicine (Baltimore) ; 99(21): e20085, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481275

RESUMO

INTRODUCTION: Chronic pain is a leading cause of disability and remains under-treated in nearly half of patients with cancer. The opioid crisis has highlighted an urgent public health need for effective nonpharmacological pain management. Electroacupuncture (EA) and Battlefield Acupuncture (BFA) represent nonpharmacological modalities used in clinical practice to manage pain; however, their effectiveness has not been rigorously evaluated in oncology settings. METHODS: We describe the design of a 3-arm, parallel, single-center, multisite randomized controlled trial that investigates EA and BFA versus usual-care wait-list control (WLC) for chronic musculoskeletal pain among 360 patients with diverse cancer types across various stages. The primary aim is to compare effects of EA and BFA versus WLC on pain, physical function, and co-morbid symptoms. The secondary aim is to examine the interaction between patient outcome expectancy and acupuncture modality (EA vs BFA) on pain reduction. The tertiary aim is to evaluate the association between genetic polymorphisms and responses to acupuncture. Patients will be randomized in a 2:2:1 ratio to EA:BFA:WLC. Acupuncture groups will receive weekly treatments over 10 weeks. WLC will receive usual care over the same evaluation period as the acupuncture groups. The primary endpoint will be the change in average pain intensity score from baseline to week 12. We will collect validated patient-reported outcomes and blood/saliva samples at multiple timepoints over 24 weeks. DISCUSSION: Our findings will advance nonpharmacological pain management in oncology and inform personalized treatment approaches that integrate individuals' expectations and genetic biomarkers to deliver "precision" acupuncture to cancer patients with chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02979574.


Assuntos
Terapia por Acupuntura/métodos , Sobreviventes de Câncer , Dor Crônica/terapia , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Adulto , Humanos , Medição da Dor/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
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
14.
J Cardiothorac Surg ; 15(1): 91, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398105

RESUMO

BACKGROUND: Thoracic surgeons have been incorporating enhanced recovery after surgery (ERAS) protocols into their practices, not only to reduce narcotic usage but also to improve complication rates and decrease lengths of stay. Here, we describe the utility of a regional block technique that can be used for patients undergoing urgent or elective thoracic surgical procedures or suffering from rib fractures. METHODS: We report our initial one-year experience with these erector spinae plane (ESP) blocks. RESULTS: ESP blocks were placed in 42 patients. The procedure was performed by a trained team of anesthesiologists and certified nurse practitioners. It included placement of a catheter on the ipsilateral chest, followed by a 20 ml of 0.2% ropivacaine bolus and continuous infusion. Patients were then followed by the regional team, as long as the catheter was in place. While it had some technical challenges, the block was effective in 83.3% of patients with no reported mortality or major complications. However, given the confounding factors of the study (such as simultaneous implementation of ERAS protocol) and heterogeneity of the patient population, a control group was difficult to ascertain and meaningful opioid consumption analysis was difficult to perform. CONCLUSIONS: Regional blocks, such as the ESP block, complement fundamental ERAS principles and serve as an adjunct to the available armamentarium for non-narcotic ways to control pain in thoracic surgical and chest trauma patients. Continued collaboration between the thoracic surgeons and anesthesiologists is needed for its success.


Assuntos
Anestésicos Locais , Dor Musculoesquelética/terapia , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Músculos Paraespinais , Ropivacaina , Adulto , Idoso , Idoso de 80 Anos ou mais , Recuperação Pós-Cirúrgica Melhorada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Fraturas das Costelas/complicações , Procedimentos Cirúrgicos Torácicos , Tórax
15.
J Med Internet Res ; 22(6): e18315, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32442143

RESUMO

BACKGROUND: Digital technologies connect young people with health services and resources that support their self-care. The lack of accessible, reliable digital resources tailored to young people with persistent musculoskeletal pain is a significant gap in the health services in Australia. Recognizing the intense resourcing required to develop and implement effective electronic health (eHealth) interventions, the adaptation of extant, proven digital technologies may improve access to pain care with cost and time efficiencies. OBJECTIVE: This study aimed to test the acceptability and need for adaptation of extant digital technologies, the painHEALTH website and the iCanCope with Pain app, for use by young Australians with musculoskeletal pain. METHODS: A 3-phased, mixed methods evaluation was undertaken from May 2019 to August 2019 in Australia. Young people aged 15 to 25 years with musculoskeletal pain for >3 months were recruited. Phases were sequential: (1) phase 1, participant testing (3 groups, each of n=5) of co-designed website prototypes compared with a control website (painHEALTH), with user tasks mapped to eHealth quality and engagement criteria; (2) phase 2, participants' week-long use of the iCanCope with Pain app with engagement data captured using a real-time analytic platform (daily check-ins for pain, interference, sleep, mood, physical activity, and energy levels; goal setting; and accessing resources); and (3) phase 3, semistructured interviews were conducted to gain insights into participants' experiences of using these digital technologies. RESULTS: Fifteen young people (12/15, 80% female; mean age 20.5 [SD 3.3] years; range 15-25 years) participated in all 3 phases. The phase 1 aggregated group data informed the recommendations used to guide 3 rapid cycles of prototype iteration. Adaptations included optimizing navigation, improving usability (functionality), and enhancing content to promote user engagement and acceptability. In phase 2, all participants checked in, with the highest frequency of full check-ins attributed to pain intensity (183/183, 100.0%), pain interference (175/183, 95.6%), and mood (152/183, 83.1%), respectively. Individual variability was evident for monitoring progress with the highest frequency of history views for pain intensity (51/183, 32.3%), followed by pain interference (24/183, 15.2%). For the goals set feature, 87% (13/15) of participants set a total of 42 goals covering 5 areas, most frequently for activity (35/42, 83%). For phase 3, metasynthesis of qualitative data highlighted that these digital tools were perceived as youth-focused and acceptable. A total of 4 metathemes emerged: (1) importance of user-centered design to leverage user engagement; (2) website design (features) promoting user acceptability and engagement; (3) app functionality supporting self-management; and (4) the role of wider promotion, health professional digital prescriptions, and strategies to ensure longer-term engagement. CONCLUSIONS: Leveraging extant digital tools, with appropriate user-informed adaptations, can help to build capacity tailored to support young people's self-management of musculoskeletal pain.


Assuntos
Dor Musculoesquelética/terapia , Autogestão/métodos , Telemedicina/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
16.
PLoS One ; 15(4): e0231476, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32324821

RESUMO

BACKGROUND: Emergency department based Physical Therapy (ED-PT) has been practiced globally in various forms for over 20 years and is an emerging resource in the US. While there is a growing body of evidence suggesting that ED-PT has a positive effect on a number of clinical and operational outcomes in patients presenting with musculoskeletal (MSK) pain, there are few published narratives that quantify this in the US. Although there are international papers that offer outcome data on reduction of pain, imaging, throughput time, and the ability of physical therapists to appropriately manage MSK conditions in the ED setting, most papers to date have been descriptive in nature. The purpose of this study is to assess the impact of ED-PT on imaging studies obtained, rates of opioids prescribed, and ED length of stay. METHODS: We prospectively identified patients presenting with musculoskeletal pain to an urban academic ED in Salt Lake City between January 2017 and June 2018. During the study, a physical therapist was in the ED three days (24 hours) per week and was available to evaluate and treat patients after consultation by the ED provider. We noted patient demographic information, imaging performed in the ED, medications administered and prescribed, and ED length of stay. We classified patients as those who received PT in the ED and those who did not and compared clinical outcomes between groups. We performed a subgroup analysis of patients presenting with low back pain and matched patients by age and gender. RESULTS: Over the 18-month study period, we identified 524 patients presenting to the ED with musculoskeletal pain. 381 (72.7%) received ED-initiated PT. The PT and non-PT groups were similar in average age (42.8 years vs. 45.1 years, p = 0.155), gender (% female: 53% vs. 46.9%, p-0.209), and primary presenting chief complaint (cervical, thoracic, or lumbar pain: 57.7% vs. 53.1%, p = 0.345). Patients who received PT had lower rates of imaging (38.3% vs. 51%, p = 0.009), ED opioid administration (17.5% vs. 32.9%, p<0.001), and a shorter average ED length of stay (4 hours vs. 6.2 hours, p<0.001). Rates of outpatient opioid prescriptions were similar between groups (16% vs. 21.7%, p = 0.129). In a subgroup analysis of patients presenting with low back pain, we found that PT patients had fewer imaging studies (PT 25% vs. non-PT 57%, p = 0.029) but found no difference in average ED length of stay (PT 3.7 hours vs. non-PT 4.6 hours, p = 0.21), opioid administration in the ED (PT 36% vs. non-PT 43%, P = 0.792), nor outpatient opioid administration (PT 17.9%. vs non-PT 17.9%, p = 1.0). CONCLUSION: In our experience, being seen by a physical therapist for MSK pain within the ED was associated with reduced use of imaging and time spent in the ED. Patients seeing a Physical Therapist were also less likely to receive an opioid prescription within the ED, a potentially significant finding given the need for opioid reduction strategies.


Assuntos
Dor Lombar/terapia , Dor Musculoesquelética/terapia , Adulto , Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fisioterapeutas , Modalidades de Fisioterapia , Estudos Prospectivos , Encaminhamento e Consulta
17.
Medicine (Baltimore) ; 99(16): e19705, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311953

RESUMO

BACKGROUND: This systematic review is the first one to assess the effectiveness and safety of extracorporeal shock-wave therapy (ESWT) for patients with chronic musculoskeletal pain conditions (CMPC). METHODS: Seven electronic databases were searched for all relevant literature from inception to December 2019, including PubMed, the Web of Science, EMBASE, Cochrane library, China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang database. Only randomized controlled trials (RCTs) of ESWT for chronic musculoskeletal pain will be included. Two reviewers will independently select eligible studies and collected the detailed information, assessed the methodological quality. A third reviewer will join in discussion to solve disagreements. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) will be presented to demonstrate the effectiveness of ESWT for patients with chronic MSK pain conditions. RevMan 5.4 software will be used for statistical analysis. RESULTS: This systematic review will explore the effectiveness and safety of ESWT for patients with CMPC. The primary outcome includes pain level, and secondary outcome includes function limitation and adverse events. CONCLUSION: It can provide the updated evidence which is of great importance for patients, clinical practice and health related policy maker in ESWT treating CMPC.


Assuntos
Dor Crônica/terapia , Tratamento por Ondas de Choque Extracorpóreas , Metanálise como Assunto , Dor Musculoesquelética/terapia , Revisões Sistemáticas como Assunto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
J Orthop Sports Phys Ther ; 50(3): 118-120, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32116105

RESUMO

Clinicians who provide high-value musculoskeletal care offer evidence-based management that can improve pain, function, and quality of life. However, the current approach to improving outcomes emphasizes treatment strategies at the expense of accurate diagnosis. Guidelines rarely provide quality information on differential diagnosis and prognosis. The disconnect is worrying, because accurate diagnosis can lead to more appropriate care and improved patient outcomes. In this Viewpoint, we reflect on how the clinician can refine musculoskeletal diagnoses to provide high-value care. We (1) argue that the link between musculoskeletal diagnosis and patient outcomes must be strengthened, (2) introduce a diagnostic framework to help clinicians go beyond "special tests," and (3) present new methods for researchers to move forward from diagnostic accuracy studies. J Orthop Sports Phys Ther 2020;50(3):118-120. doi:10.2519/jospt.2020.0603.


Assuntos
Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Avaliação de Resultados da Assistência ao Paciente , Qualidade da Assistência à Saúde , Tomada de Decisão Clínica , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/terapia , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Síndrome da Dor Patelofemoral/diagnóstico , Síndrome da Dor Patelofemoral/etiologia , Síndrome da Dor Patelofemoral/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Arch Phys Med Rehabil ; 101(8): 1288-1295, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32169459

RESUMO

OBJECTIVE: To assess the efficacy of a 12-week aquatic cycling training program for improving knee pain and physical functioning in patients with knee osteoarthritis (OA). DESIGN: Two-arm, single-blind, parallel-group randomized controlled trial. SETTINGS: OA outpatient clinic of the Maastricht University Medical Center+. PARTICIPANTS: Patients (N=111, 50-70y) with unilateral mild-to-moderate knee OA. INTERVENTIONS: Participants (aquatic cycling [AC] group, n=55) received AC sessions of 45 min each 2 times per week. Each session combined upright seated cycling with out-of-saddle positions and exercises for the upper and lower body. The usual care (UC) group (n=47) continued with UC and was offered 12 AC sessions in a local swimming pool after their trial participation. MAIN OUTCOME MEASURES: The Knee Injury and Osteoarthritis Outcome Score (KOOS) on knee pain and physical function was assessed at baseline, postintervention, and at 24-wk follow-up. Multilevel (mixed regression) analysis examined the effects. RESULTS: Average attendance rate for the AC sessions was 80%. Statistically significant differences at postintervention and follow-up were found for knee pain in mean ± SD (UC pretest, 57.89±15.26; posttest, 55.90±18.04; follow-up, 57.24±19.16; and AC pretest, 56.96±12.96; posttest, 63.55±15.33; follow-up, 64.35±17.26; estimate, 8.16; SE, 3.27; 95% confidence interval [CI], 1.67-14.64; effect size [ES], 0.50) and physical functioning (UC pretest, 66.32±16.28; posttest, 66.80±19.04; follow-up, 65.42±17.98; and AC pretest, 61.89±17.151; posttest, 70.14±17.52; follow-up, 69.00±16.84; estimate, 7.16; SE, 3.19; 95% CI, 0.83-13.49; ES, 0.43) in favor of the aquatic group. CONCLUSIONS: The results suggest that a 12-week AC training program improves self-reported knee pain and physical functioning in patients with mild-to-moderate knee OA compared to UC.


Assuntos
Terapia por Exercício/métodos , Dor Musculoesquelética/terapia , Osteoartrite do Joelho/reabilitação , Idoso , Ciclismo , Exercício Físico , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Cooperação do Paciente , Desempenho Físico Funcional , Qualidade de Vida , Método Simples-Cego , Água
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