RESUMEN
Chronic neck pain (CNP) is one of the most common musculoskeletal conditions, is considered the second leading cause of pain, and is among the leading causes of disability. Cognitive Functional Therapy (CFT) is a novel behavioral therapy for individualizing the management of spinal pain targeting the multidimensional aspect of musculoskeletal pain. This study outlines the protocol for an assessor-blind randomized controlled trial (RCT) designed to compare an individualized Cognitive Functional Therapy (CFT) intervention with usual care in terms of pain and disability. Aiming for a pragmatic intervention, the CFT group will receive 16 sessions based on patient's condition characteristics, and clinical presentation and progression. The control group will receive 16 sessions of standardized usual care (electrotherapy, massage, posture exercise, and educations). Both groups will have the same intervention duration. Patients will be randomly allocated into groups and will be assessed at baseline, at the 8th session, at the 16th session, and 3 months after randomization. Primary outcomes will be pain, disability, cervical range of motion, and neck muscle isometric strength. To our knowledge, this study will be the first RCT to compare the clinical effectiveness of CFT compared to UC for adults with CNP. The study results will provide information about the use of CFT in clinical practice.
RESUMEN
ABSTRACT Objective: To investigate the efficacy of upper limb exercise training (ULExT) in improving the performance of activities of daily living (ADL) that involve the upper limbs (UL) in patients with COPD. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this systematic review. PubMed and EBSCOhost databases were searched to identify randomized controlled trials involving adults with COPD who underwent ULExT, compared with those who underwent other types of exercise or no exercise, in order to assess the performance of ADL that involve the UL. The methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale. Results: Five studies, with a total sample of 173 subjects, met the inclusion criteria. The results of the selected studies showed that ULExT is safe and can significantly improve the performance of ADL that involve the UL in patients with COPD. However, there were inconsistencies in the results, especially regarding the perception of symptoms during ADL. The small number of studies included and their methodological quality do not allow for firm conclusions. Conclusions: The findings of this review revealed that ULExT is a safe therapeutic approach and can improve the performance of ADL that involve the UL in patients with COPD, but the results are unclear. Further investigation through well-designed randomized trials is warranted to determine the effectiveness of ULExT in improving the performance of ADL that involve the UL in patients with COPD.
RESUMO Objectivo: Investigar a eficácia do treinamento de membros superiores (MMSS) na melhora na execução de atividades da vida diária (AVD) que envolvem os MMSS em pacientes com DPOC. Métodos: Nesta revisão sistemática foram utilizadas as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Os bancos de dados PubMed e EBSCOhost foram pesquisados para identificar ensaios controlados randomizados envolvendo adultos com DPOC submetidos a treinamento de MMSS, comparados àqueles submetidos a outros tipos de exercício ou a nenhum exercício, a fim de avaliar a execução de AVD que envolvem os MMSS. A qualidade metodológica dos estudos selecionados foi avaliada por meio da escala do Physiotherapy Evidence Database. Resultados: Cinco estudos, com uma amostra total de 173 indivíduos, preencheram os critérios de inclusão. Os resultados dos estudos selecionados mostraram que o treinamento de MMSS é seguro e pode melhorar significativamente a execução de AVD que envolvem os MMSS em pacientes com DPOC. No entanto, houve inconsistências nos resultados, especialmente em relação à percepção de sintomas durante as AVD. O pequeno número de estudos incluídos e a qualidade metodológica desses estudos não permitem conclusões firmes. Conclusões: Os achados desta revisão revelaram que o treinamento de MMSS é uma abordagem terapêutica segura e pode melhorar a execução de AVD que envolvem os MMSS em pacientes com DPOC, mas os resultados não são claros. São necessárias mais investigações, por meio de ensaios aleatorizados bem desenhados, para determinar a eficácia do treinamento de MMSS na melhora na execução de AVD que envolvem os MMSS em pacientes com DPOC.