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1.
BMC Med Educ ; 24(1): 331, 2024 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-38519899

RESUMEN

BACKGROUND: Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain. METHODS: This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders. RESULTS: The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals' possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; 'capability', 'opportunity', and 'motivation'. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice. CONCLUSION: We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs.


Asunto(s)
Dolor Crónico , Humanos , Dolor Crónico/terapia , Manejo del Dolor , Personal de Salud , Atención a la Salud , Cognición
2.
Pain Med ; 21(10): 2553-2563, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32289826

RESUMEN

OBJECTIVE: Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs). DESIGN: Case-control study. SETTING: A single medical center in Belgium. SUBJECTS: The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study. METHODS: All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs. RESULTS: No between-group differences were found for stimulus intensity, which was supraliminal for Aδ fibers. The amplitudes and latencies of LEP wave components N1, N2, and P2 in patients with cWAD and CFS were statistically similar to those of HCs. There were no significant differences between the time-frequency maps of EEG oscillation amplitude between HCs and both patient populations. CONCLUSIONS: EEG responses of heat-sensitive Aδ fibers in patients with cWAD and CFS revealed no significant differences from the responses of HCs. These findings thus do not support a state of generalized central nervous system hyperexcitability in those patients.


Asunto(s)
Síndrome de Fatiga Crónica , Potenciales Evocados por Láser , Bélgica , Estudios de Casos y Controles , Humanos , Rayos Láser
3.
J Manipulative Physiol Ther ; 41(2): 92-101, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29329739

RESUMEN

OBJECTIVE: The objective of this cross-sectional study was to analyze the relationship between symptoms of central sensitization (CS) and important cognitive behavioral and psychosocial factors in a sample of patients with chronic nonspecific low back pain. METHODS: Participants with chronic nonspecific low back pain for at least 3 months were included in the study. They completed several questionnaires and a functional test. Pearson's correlation was used to analyze associations between symptoms of CS and pain behavior, functioning, pain, pain catastrophizing, kinesiophobia, and illness perceptions. Additionally, a between-group analysis was performed to compare patients with and without clinically relevant symptoms of CS. RESULTS: Data from 38 participants were analyzed. Significant associations were found between symptoms of CS and all other outcomes, especially current pain (r = 0.510, P = .001), mean pain during the past 7 days (r = 0.505, P = .001), and pain catastrophizing (r = 0.518, P = .001). Patients with clinically relevant symptoms of CS scored significantly worse on all outcomes compared with persons without relevant symptoms of CS, except on functioning (P = .128). CONCLUSIONS: Symptoms of CS were significantly associated with psychosocial and cognitive behavioral factors. Patients exhibiting a clinically relevant degree of symptoms of CS scored significantly worse on most outcomes, compared with the subgroup of the sample with fewer symptoms of CS.


Asunto(s)
Sensibilización del Sistema Nervioso Central/fisiología , Dolor Crónico/fisiopatología , Cognición , Dolor de la Región Lumbar/fisiopatología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
4.
Pain Pract ; 17(1): 115-128, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27206852

RESUMEN

OBJECTIVES: Musculoskeletal pain has major public health implications, but the theoretical framework remains unclear. It is hypothesized that sensorimotor incongruence (SMI) might be a cause of long-lasting pain sensations in people with chronic musculoskeletal pain. Research data about experimental SMI triggering pain has been equivocal, making the relation between SMI and pain elusive. The aim of this study was to systematically review the studies on experimental SMI in people with musculoskeletal pain and healthy individuals. METHODS: Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. A systematic literature search was conducted using several databases until January 2015. To identify relevant articles, keywords regarding musculoskeletal pain or healthy subjects and the sensory or the motor system were combined. Study characteristics were extracted. Risk of bias was assessed using the Dutch Institute for Healthcare Improvement (CBO) checklist for randomized controlled trials, and level of evidence was judged. RESULTS: Eight cross-over studies met the inclusion criteria. The methodological quality of the studies varied, and populations were heterogeneous. In populations with musculoskeletal pain, outcomes of sensory disturbances and pain were higher during all experimental conditions compared to baseline conditions. In healthy subjects, pain reports during experimental SMI were very low or did not occur at all. DISCUSSION: Based on the current evidence and despite some methodological issues, there is no evidence that experimental SMI triggers pain in healthy individuals and in people with chronic musculoskeletal pain. However, people with chronic musculoskeletal pain report more sensory disturbances and pain during the experimental conditions, indicating that visual manipulation influences pain outcomes in this population.


Asunto(s)
Retroalimentación Sensorial/fisiología , Dolor Musculoesquelético/fisiopatología , Humanos
5.
Pain Pract ; 17(2): 156-165, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-26913494

RESUMEN

BACKGROUND: Whiplash-associated disorders (WAD) are a debilitating condition. In chronic WAD, sensorimotor incongruence exacerbates symptoms. Sensorimotor incongruence occurs when somatosensory input and predicted motor output are in conflict, which can trigger pain. On the other hand, there is evidence that visual feedback can decrease pain in certain chronic pain conditions. Therefore, the aim of this study was to examine the effect of visual feedback and sensorimotor incongruence on pain thresholds in chronic WAD. METHODS: Sixty-four participants (healthy controls and patients with chronic WAD) were subjected to six experimental conditions. Participants watched correct real-time or modified visual feedback of the neck or hand (without movement as well as during repetitive neck lateroflexion). Sensorimotor incongruence was induced by manipulating visual feedback. Pressure pain thresholds were measured at baseline and during each condition. RESULTS: Marked between-group differences were observed. Visual feedback of the neck-correct or modified-did not influence pain thresholds in chronic WAD. In contrast, healthy controls had significantly higher pain thresholds when provided with the correct or modified visual feedback. When a movement of the neck was added during visual feedback, patients with chronic WAD showed no significant difference in pain thresholds, while an increase in pain thresholds was found in the healthy control group. CONCLUSION: In contrast to the healthy controls, visual feedback and sensorimotor incongruence did not alter pain thresholds in patients with chronic WAD. These findings suggest an abnormal pain response to visual feedback and somatosensory incongruence as well as failing mechanisms of pain inhibition in chronic WAD.


Asunto(s)
Vértebras Cervicales/fisiopatología , Dolor Crónico/psicología , Retroalimentación Sensorial , Lesiones por Latigazo Cervical/psicología , Adulto , Femenino , Mano , Humanos , Masculino , Persona de Mediana Edad , Movimiento , Cuello , Dimensión del Dolor , Umbral del Dolor , Lesiones por Latigazo Cervical/fisiopatología
6.
Pain Pract ; 16(8): 1048-1053, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26614574

RESUMEN

Vagally mediated heart rate variability (vmHRV) is widely respected as a psychophysiological measure of emotion regulation capacity and serves as a readily available index of executive brain areas that exert an inhibitory influence on subcortical structures. Pain catastrophizing (PC) is conceptualized as the tendency to misinterpret and exaggerate pain-related situations that may be threatening. Chronic pain patients show lower vmHRV and higher PC. Previously, no study has investigated the association of PC and vmHRV. We examined the association of PC and vmHRV in a sample of patients with chronic whiplash-associated disorders (WAD, n = 30) and healthy controls (n = 31). Patients with WAD showed lower vmHRV, indexed by high-frequency HRV (effect size, Cohen's d = 0.442), and greater PC (d = 0.815). Zero-order and partial correlations controlling for age and sex revealed that vmHRV and PC are inversely related. The results provide evidence for a psychophysiological mechanism underlying PC, in particular in chronic pain patients.

7.
J Manipulative Physiol Ther ; 38(8): 587-600, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26387860

RESUMEN

OBJECTIVE: A systematic review was performed to evaluate the existing evidence related to the prevalence, incidence, localization, and pathophysiology of myofascial trigger points (MTrPs) in patients with spinal (back and neck) pain. METHODS: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in 2 electronic databases (PubMed and Web of Science) using predefined keywords regarding MTrPs and spinal pain. A "PICOS" questionnaire was used to set up the search strategies and inclusion criteria. Full-text reports concerning MTrPs in patients with back or neck pain, which described their prevalence, incidence, location, or underlying physiopathology were included and screened for methodological quality by 3 independent researchers. Each study was assessed for risk of bias using a checklist derived from the Web site of the Dutch Cochrane Centre. RESULTS: Fourteen articles were retrieved for quality assessment and data extraction. Studies reporting the incidence of MTrPs in patients with spinal pain were lacking. Within spinal pain, patients with neck pain were found to have the highest prevalence rates of MTrPs. The trapezius descendens, levator scapulae, and suboccipitales muscles were the most prevalent locations for active MTrPs in patients with neck pain. Latent MTrPs were present in asymptomatic people, but no significant differences were found in the prevalence rate of latent MTrPs between patients with spinal (neck) pain and healthy controls. The only study investigating prevalence of MTrPs in different localizations of the same muscle reported no significant differences in prevalence between active and latent MTrPs within the trapezius descendens muscle. Studies examining pathophysiological mechanisms underlying MTrPs demonstrated an acidic environment, high concentration of algogenic/inflammatory substances, stiffer muscle tissue, retrograde diastolic blood flows, spontaneous muscle activity at rest, and loss of muscle contractibility in muscles with MTrPs. Altered central processing was also found to play a role in the development of MTrPs. CONCLUSIONS: Myofascial trigger points are a prevalent clinical entity, especially in patients with neck pain. Evidence was not found to support or deny the role of MTrPs in other spinal pain. Compelling evidence supports local mechanisms underlying MTrPs. Future research should unravel the relevance of central mechanisms and investigate the incidence of MTrPs in patients with spinal pain.


Asunto(s)
Dolor de Espalda/epidemiología , Dolor de Espalda/fisiopatología , Dolor de Cuello/epidemiología , Dolor de Cuello/fisiopatología , Puntos Disparadores/fisiopatología , Humanos , Incidencia , Prevalencia
8.
Pain Pract ; 15(8): 757-64, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25262578

RESUMEN

BACKGROUND: Chronic whiplash-associated disorders (chronic WAD) cover a large variety of clinical manifestations that can occur after a whiplash injury. Women have an increased risk of developing chronic WAD, and it is suggested that psychosocial factors are related to long-term pain and functioning following whiplash injury and persistence of chronic pain. This leads to the question whether there are sex differences in psychosocial factors in chronic WAD. METHODS: This study included 117 subjects who had experienced a whiplash injury at least 3 months before the start of the study (mean duration of pain: 67.29 ± 63.86 months, range: 297 months). They were selected as chronically symptomatic, by excluding those who had recovered from their whiplash injury. Psychosocial aspects (including depression, fear, somatization, social support, and personality traits) were assessed by validated questionnaires, and sex differences were tested using a univariate analysis of variance (ANCOVA), with age and time from whiplash injury as covariates. RESULTS: No differences in depression, fear, somatization, discrepancy in social support personality trait, Neck Disability Index scores, physical functioning, bodily pain, or general health were present between women and men with chronic WAD. Women with chronic WAD reported higher levels of emotional support in problem situations and social companionship. CONCLUSION: Except for emotional support in problem situations and social companionship, psychosocial factors do not differ between men and women with chronic WAD. These findings imply little to no risk for sex bias in studies investigating psychosocial issues in patients with chronic WAD.


Asunto(s)
Dolor Crónico/epidemiología , Dolor Crónico/psicología , Factores Sexuales , Lesiones por Latigazo Cervical/complicaciones , Adulto , Anciano , Dolor Crónico/etiología , Depresión/psicología , Miedo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personalidad , Apoyo Social , Encuestas y Cuestionarios
9.
Eur J Clin Invest ; 44(2): 153-9, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24313704

RESUMEN

BACKGROUND: Chronic fatigue syndrome (CFS) patients frequently complain of muscle fatigue and abnormally slow recovery, especially of the upper limb muscles during and after activities of daily living. Furthermore, disease heterogeneity has not yet been studied in relation to recovery of muscle function in CFS. Here, we examine recovery of upper limb muscle function from a fatiguing exercise in CFS patients with (CFS+FM) and without (CFS-only) comorbid fibromyalgia and compare their results with a matched inactive control group. DESIGN: In this case-control study, 18 CFS-only patients, 30 CFS+FM patients and 30 healthy inactive controls performed a fatiguing upper limb exercise test with subsequent recovery measures. RESULTS: There was no significant difference among the three groups for maximal handgrip strength of the non-dominant hand. A significant worse recovery of upper limb muscle function was found in the CFS+FM, but not in de CFS-only group compared with the controls (P < 0·05). CONCLUSIONS: This study reveals, for the first time, delayed recovery of upper limb muscle function in CFS+FM, but not in CFS-only patients. The results underline that CFS is a heterogeneous disorder suggesting that reducing the heterogeneity of the disorder in future research is important to make progress towards a better understanding and uncovering of mechanisms regarding the nature of divers impairments in these patients.


Asunto(s)
Síndrome de Fatiga Crónica/fisiopatología , Fibromialgia/fisiopatología , Músculo Esquelético/fisiología , Extremidad Superior/fisiología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Prueba de Esfuerzo , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular/fisiología , Recuperación de la Función/fisiología , Adulto Joven
10.
Exerc Immunol Rev ; 20: 94-116, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24974723

RESUMEN

An increasing number of studies have examined how the immune system of patients with Chronic Fatigue Syndrome (CFS), or myalgic encephalomyelitis, responds to exercise. The objective of the present study was to systematically review the scientific literature addressing exercise-induced immunological changes in CFS patients compared to healthy control subjects. A systematic literature search was conducted in the PubMed and Web of science databases using different keyword combinations. We included 23 case control studies that examined whether CFS patients, compared to healthy sedentary controls, have a different immune response to exercise. The included articles were evaluated on their methodological quality. Compared to the normal response of the immune system to exercise as seen in healthy subjects, patients with CFS have a more pronounced response in the complement system (i.e. C4a split product levels), oxidative stress system (i.e. enhanced oxidative stress combined with a delayed and reduced anti-oxidant response), and an alteration in the immune cells' gene expression profile (increases in post-exercise interleukin-10 and toll-like receptor 4 gene expression), but not in circulating pro- or anti-inflammatory cytokines. Many of these immune changes relate to post-exertional malaise in CFS, a major characteristic of the illness. The literature review provides level B evidence for an altered immune response to exercise in patients with CFS.


Asunto(s)
Ejercicio Físico/fisiología , Síndrome de Fatiga Crónica/inmunología , Adulto , Sesgo , Estudios de Casos y Controles , Proteínas del Sistema Complemento/inmunología , Citocinas/sangre , Citocinas/metabolismo , Medicina Basada en la Evidencia , Prueba de Esfuerzo , Síndrome de Fatiga Crónica/fisiopatología , Femenino , Predicción , Perfilación de la Expresión Génica , Humanos , Interleucina-10/biosíntesis , Interleucina-10/genética , Leucocitos/metabolismo , Peroxidación de Lípido , Masculino , Estrés Oxidativo , Proyectos de Investigación , Factores Sexuales , Receptor Toll-Like 4/biosíntesis , Receptor Toll-Like 4/genética
11.
Braz J Phys Ther ; 28(1): 100592, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38368840

RESUMEN

BACKGROUND: In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work. OBJECTIVES: To assess the differences in physical therapy students' attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020. METHODS: In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity, and work. RESULTS: In 2013, 927 second-year and 695 fourth-year students; in 2020, 695 second-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations. CONCLUSIONS: Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low.


Asunto(s)
Dolor de la Región Lumbar , Osteoartritis de la Rodilla , Fisioterapeutas , Humanos , Actitud del Personal de Salud , Dolor de la Región Lumbar/rehabilitación , Modalidades de Fisioterapia , Estudiantes , Encuestas y Cuestionarios
12.
J Clin Med ; 12(15)2023 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-37568380

RESUMEN

(1) Background: Noradrenaline and serotonin have modulatory roles in pain signaling and in exercise-induced hypoalgesia. Patients with chronic whiplash-associated disorders often show impaired exercise-induced hypoalgesia. Therefore, this study aimed to examine the isolated effect of activating serotonergic or noradrenergic descending pathways on hypoalgesia at rest and in response to exercise in patients with chronic WAD by using respectively a single dose of a selective serotonin reuptake inhibitor (SSRI) and a selective norepinephrine reuptake inhibitor (NRI). (2) Methods: Twenty-five people with chronic WAD participated in this double-blind randomized controlled crossover experiment. Serotonin and noradrenaline concentrations were modulated by the oral ingestion of a single dose of citalopram (i.e., SSRI) or atomoxetine (i.e., SNRI). Quantitative sensory testing (including pressure pain thresholds and conditioned pain modulation) was measured before and after exercise in combination with no medication (1), atomoxetine (2), or citalopram (3) at three different test days. (3) Results: Random-intercept linear mixed models analysis was used to analyze pain outcomes (i.e., pain at rest and exercise-induced hypoalgesia) before and after exercise over the three conditions in patients with chronic WAD. No differences in pain at rest were found between the three conditions before exercise. The effect of exercise on pain outcome measures was not influenced by medication intake. The occupational status of the participants had a significant influence on the effect of exercise and medication on pain outcomes (p < 0.05). Patients working full-time had some positive effect of atomoxetine on pain facilitation (p < 0.05). Unemployed patients had some negative effect of citalopram on pain tolerance and experienced exercise-induced hypoalgesia (p < 0.05). (4) Conclusions: A single dose of citalopram or atomoxetine did not result in changes in hypoalgesia at rest and in response to exercise. These results do not support the use of SSRI or selective NRI to overcome impaired hypoalgesia at rest or in response to exercise in people with chronic WAD. Effect of exercise and medication on pain in patients with chronic WAD is influenced by the occupational status.

13.
Clin Pract ; 13(3): 684-700, 2023 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-37366932

RESUMEN

(1) Background: Dysregulation in serotonergic and noradrenergic systems may be implicated in the neurobiophysiological mechanisms underlying pain-related cognitive impairment in chronic whiplash-associated disorders (CWAD). This study aimed to unravel the role of serotonergic and noradrenergic descending pathways in cognitive functioning at rest and in response to exercise in people with CWAD. (2) Methods: 25 people with CWAD were included in this double-blind, randomized, controlled crossover study. Endogenous descending serotonergic and noradrenergic inhibitory mechanisms were modulated by using a single dose of a selective serotonin reuptake inhibitor (Citalopram) or a selective norepinephrine reuptake inhibitor (Atomoxetine). Cognitive performance was studied at rest and in response to exercise (1) without medication intake; (2) after intake of Citalopram; and (3) after intake of Atomoxetine. (3) Results: After Atomoxetine intake, selective attention improved compared with the no medication day (p < 0.05). In contrast, a single dose of Citalopram had no significant effect on cognitive functioning at rest. When performing pairwise comparisons, improvements in selective attention were found after exercise for the no medication condition (p < 0.05). In contrast, after intake of Citalopram or Atomoxetine, selective and sustained attention worsened after exercise. (4) Conclusions: A single dose of Atomoxetine improved selective attention only in one Stroop condition, and a single dose of Citalopram had no effect on cognitive functioning at rest in people with CWAD. Only without medication intake did selective attention improve in response to exercise, whereas both centrally acting medications worsened cognitive performance in response to a submaximal aerobic exercise bout in people with CWAD.

14.
J Clin Med ; 12(6)2023 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-36983329

RESUMEN

BACKGROUND: A large proportion of people who sustain a whiplash injury will have persistent pain, disability, and participation problems. Several prognostic factors for functional recovery have been reported in the literature but these factors are often evaluated based on differing implementations in clinical practice. Additionally, physiotherapists also rely on their clinical intuition to estimate the functional prognosis of their patients, but this is seldom measured in experimental research. Furthermore, no study to date has explored the associations between clinical intuition, clinically estimated factors, and objectively measured factors for functional recovery of patients with Whiplash-Associated Disorders (WAD). AIM: The aim of this exploratory study is to evaluate associations between prognostic factors for functional recovery, based on routinely collected data in a specialized primary care physiotherapy practice in a consecutive sample of patients (n = 523) with WAD. METHODS: Three sources of prognostic factors were selected: (1) physiotherapists' synthesis of clinical intuition in terms of high-risk, inconclusive risk, or low-risk for functional recovery, (2) patient-registered factors from history taking, and (3) patient-reported prognostic factors derived from questionnaires. Prognostic factors were selected based on the literature, recommendations in Dutch clinical practice guidelines, and consensus between experts. Spearman's rank correlation coefficients were calculated to explore the associations between sources of prognostic factors, using a cutoff ≥0.25 for acceptable association. RESULTS: Associations between physiotherapists' intuitive synthesis and patient-registered variables were substantial (rs = 0.86), between patient-registered variables and patient-reported variables fair (ranging from 0.30 to 0.41) to substantial (ranging from 0.69 to 0.73), and between physiotherapists intuitive synthesis and patient-reported variables fair (ranging from 0.30 to 0.37). CONCLUSION: When estimating prognosis for functional recovery using clinical reasoning, physiotherapists should integrate patients' registered experience of their course of recovery, as well as the timeline after an accident, with their own synthesis of clinical intuition regarding prognostic factors in patients with WAD.

15.
Eur J Clin Invest ; 42(10): 1136-44, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22725992

RESUMEN

BACKGROUND: Despite the large number of studies emphasizing the effectiveness of graded exercise therapy (GET) and cognitive behavioural therapy (CBT) for people with chronic fatigue syndrome (CFS), clinicians are left wondering how exactly to apply exercise therapy to their patients with CFS. The aim of this literature review is to identify the appropriate exercise modalities (i.e. exercise duration, mode, number of treatment sessions, session length, duration of treatment, exercise intensity and whether or not to apply home exercise program) for people with CFS. MATERIALS AND METHODS: All studies that were identified through electronic databases (PubMed and PEDro) were assessed for methodological quality by using selection criteria (Delphi score). RESULTS: In this literature review, 12 studies fulfilled all study requirements. One study had a low methodological quality. The parameters used in the GET and CBT interventions were divided into subgroups: (i) time or symptom contingent, (ii) exercise frequency and (iii) exercise modality. CONCLUSION: The lack of uniformity in outcome measures and CFS diagnostic criteria make it difficult to compare the findings across studies. Based on the available evidence, exercise therapy for people with CFS should be aerobic and must comprise of 10-11 sessions spread over a period of 4-5 months. A time-contingent approach is preferred over a symptom-contingent way of exercising. In addition, people with CFS can perform home exercises five times a week with an initial duration of 5-15 min per exercise session. The exercise duration can be gradually increased up to 30 min.


Asunto(s)
Terapia por Ejercicio/métodos , Síndrome de Fatiga Crónica/terapia , Práctica Clínica Basada en la Evidencia , Servicios de Atención de Salud a Domicilio , Humanos , Guías de Práctica Clínica como Asunto , Factores de Tiempo
16.
Front Pain Res (Lausanne) ; 3: 929385, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36110289

RESUMEN

Quality improvement is now a central tenet in physiotherapy care, and quality indicators (QIs), as measurable elements of care, have been applied to analyze and evaluate the quality of physiotherapy care over the past two decades. QIs, based on Donabedian's model of quality of care, provide a foundation for measuring (improvements in) quality of physiotherapy care, providing insight into the many remaining evidentiary gaps concerning diagnostics, prognostics and treatment, as well as patient-related outcome measures. In this overview we provide a synthesis of four recently published articles from our project group on the topic of quantitative measures of quality improvement in physiotherapy care, in this context specifically focused on patients with WAD in primary care physiotherapy. A set of process and outcome QIs (n = 28) was developed for patients with WAD and linked to a database consisting of routinely collected data (RCD) on patients with WAD collected over a 16-year period. The QIs were then embedded per step of the clinical reasoning process: (a) administration (n = 2); (b) history taking (n = 7); (c) objectives of examination (n = 1); (d) clinical examination (n = 5); (e) analysis and conclusion (n = 1); (f) treatment plan (n = 3); (g) treatment (n = 2); (h) evaluation (n = 5); and (i) discharge (n = 2). QIs were expressed as percentages, allowing target performance levels to be defined ≥70% or ≤30%, depending on whether the desired performance required an initially high or low QI score. Using RCD data on primary care patients with WAD (N = 810) and a set of QIs, we found that the quality of physiotherapy care has improved substantially over a 16-year period. This conclusion was based on QIs meeting predetermined performance targets of ≥70% or ≤30%. Twenty-three indicators met the target criterium of ≥70% and three indicators ≤30%. Our recommended set of QIs, embedded in a clinical reasoning process for patients with WAD, can now be used as a basis for the development of a validated QI set that effectively measures quality (improvement) of primary care physiotherapy in patients with WAD.

17.
J Bodyw Mov Ther ; 24(4): 239-244, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33218517

RESUMEN

PURPOSE: To describe the Pilot Study: Pain Neuroscience Education in Cancer Survivors and describe the innovative educational component of Pain Neuroscience Education (PNE). DESIGN: Quasi experimental design. METHOD: The PNE program, encompassing a one-on-one education session and an information leaflet was given to 30 cancer survivors. At baseline and two weeks after the PNE, participants were asked to fill out following outcome measures; pain intensity, pain catastrophizing, and HRQoL. FINDINGS: Following PNE, a significant decrease on pain intensity (p = 0.001), on the SF-36 subscale pain (p = 0.003) and for the following PCS subscales: Helplessness (p < 0.001), Rumination (p = 0.002) and Total score (p < 0.001) was found compared to baseline. CONCLUSIONS: Although the current results need to be verified in a larger randomized, controlled trial, preliminary evidence shows a decrease in pain intensity and pain catastrophizing following PNE in cancer survivors with persistent pain.


Asunto(s)
Supervivientes de Cáncer , Dolor Crónico , Neoplasias , Catastrofización , Humanos , Dimensión del Dolor , Proyectos Piloto
18.
J Clin Med ; 9(5)2020 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-32443565

RESUMEN

BACKGROUND: Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorders (cWAD) present a reduced ability to activate central descending nociceptive inhibition after exercise, compared to measurements before exercise. It was hypothesised that a dysfunctional motor-induced inhibition of nociception partly explains this dysfunctional exercise-induced hypoalgesia. This study investigates if engagement of the motor system during movement preparation inhibits nociception-evoked brain responses in these patients as compared to healthy controls (HC). METHODS: The experiment used laser-evoked potentials (LEPs) during three conditions (no task, mental task, movement preparation) while recording brain activity with a 32-channel electroencephalogram in 21 patients with cWAD, 20 patients with CFS and 18 HC. Two-factor mixed design Analysis of variance were used to evaluate differences in LEP amplitudes and latencies. RESULTS: No differences in N1, N2, N2P2, and P2 LEP amplitudes were found between the HC, CFS, and cWAD groups. After nociceptive stimulation, N1, N2 (only at hand location), N2P2, and P2 LEP amplitudes significantly decreased during movement preparation compared to no task (within group differences). CONCLUSION: Movement preparation induces a similar attenuation of LEPs in patients with CFS, patients with cWAD and HC. These findings do not support reduced motor-induced nociceptive inhibition in these patients.

19.
Patient Prefer Adherence ; 14: 1733-1750, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33061316

RESUMEN

BACKGROUND: Whiplash-associated disorders (WADs) constitute a state of health characterized by a wide diversity of symptoms as a result of impairments of functions, activity limitations, and participation restrictions. Patient-reported outcome measurements (PROMs) and patient-reported outcomes (PROs) seem appropriate when describing and evaluating the health status of patients with WAD. AIM: To measure the use of PROMs and PROs as quality indicators in clinical reasoning, and to analyze and evaluate pre- and post-treatment 'pain intensity' and 'functioning', and for 'perceived improvement' in patients with WAD in primary care physiotherapy practice by year of referral, with the phase after accident and prognostic health profile embedded in the clinical reasoning process. MATERIALS AND METHODS: Data were collected over a period of 10 years. Pain intensity, functioning, and perceived improvement were measured using the Visual Analogue Scale for Pain (VAS-P), the Neck Disability Index (NDI) and the Global Perceived Effect scale (GPE). Pre- and post-treatment mean differences were tested for statistical significance and compared to minimal clinically important differences (MCID). Effect sizes were expressed as Cohen's d. Multivariable regression analysis was performed to explore independent associations of year of referral, phase after the accident, and the patient's prognostic health profile with post-treatment pain intensity and functioning. RESULTS: A consecutive sample of 523 patients was included. Pre- and post-treatment mean differences on VAS-P and NDI were statistically significant (P<0.000) and clinically relevant, with 'large' effect sizes for pain intensity and functioning. MCIDs were achieved by 80% for VAS-P and for 60% for NDI. Year of referral and phase after the accident were independently associated with worse post-treatment functioning. About half of the patients (n=241 [46.1%]) perceived themselves as improved. CONCLUSION: The PROMs and PROs pain intensity, functioning and perceived improvement were integrated as quality indicators in the physiotherapy clinical reasoning process for patients with WAD. Significant differences in pain intensity and functioning were found but were unrelated to year of referral, phase after whiplash-related injury or prognostic health profile. The MCID VAS-P scores did not differ depending on experienced pain.

20.
Patient Prefer Adherence ; 14: 425-442, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32184572

RESUMEN

BACKGROUND: Quality indicators (QIs) are measurable elements of practice performance and may relate to context, process, outcome and structure. A valid set of QIs have been developed, reflecting the clinical reasoning used in primary care physiotherapy for patients with whiplash-associated disorders (WAD). Donabedian's model postulates relationships between the constructs of quality of care, acting in a virtuous circle. AIM: To explore the relative strengths of the relationships between context, process, and outcome indicators in the assessment of primary care physiotherapy in patients with WAD. MATERIALS AND METHODS: Data on WAD patients (N=810) were collected over a period of 16 years in primary care physiotherapy practices by means of patients records. This routinely collected dataset (RCD-WAD) was classified in context, process, and outcome variables and analyzed retrospectively. Clinically relevant variables were selected based on expert consensus. Associations were expressed, using zero-order, as Spearman rank correlation coefficients (criterion: rs >0.25 [minimum: fair]; α-value = 0.05). RESULTS: In round 1, 62 of 85 (72.9%) variables were selected by an expert panel as relevant for clinical reasoning; in round 2, 34 of 62 (54.8%) (context variables 9 of 18 [50.0%]; process variables 18 of 34 [52.9]; outcome variables 8 of 10 [90.0%]) as highly relevant. Associations between the selected context and process variables ranged from 0.27 to 0.53 (p≤0.00), between selected context and outcome variables from 0.26 to 0.55 (p≤0.00), and between selected process and outcome variables from 0.29 to 0.59 (p≤0.00). Moderate associations (rs >0.50; p≤0.00) were found between "pain coping" and "fear avoidance" as process variables, and "pain intensity" and "functioning" as outcome variables. CONCLUSION: The identified associations between selected context, process, and outcome variables were fair to moderate. Ongoing work may clarify some of these associations and provide guidance to physiotherapists on how best to improve the quality of clinical reasoning in terms of relationships between context, process, and outcome in the management of patients with WAD.

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