ABSTRACT
Abstract Aim: Low back pain (LBP) is disabling in older adults. Although physical activity interventions positively affect LBP, older adults are underrepresented in the literature. We aim to investigate the feasibility of conducting a study to evaluate a primary care program of exercise therapy and pain education, supported by mobile technology, for older adults with chronic LBP (compared to best practice advice). Methods: In this parallel, two-arm randomized pilot trial, we will recruit adults aged 60 years and older with chronic LBP. The experimental group (Physical Activity supported by low-cost mobile technology for Back pain-PAT-Back) will consist of an 8-week group exercise program based on pain education, exercises, graded activities, and in-home physical activity. Text messages will be sent to promote adherence to home exercises. The control group will receive an evidence-based educational booklet given during one individual consultation. Outcomes will include recruitment rate, adherence and retention rates, level of understanding of the intervention content, perception of the utility of mobile technology, compliance with the accelerometer in a sub-sample of patients, and adverse events. Discussion: The results of this study will form the basis for a large randomized controlled trial. This innovative approach to managing LBP in the primary care setting for older adults, if proven to be effective, can bring an important advance in the knowledge of chronic LBP management to this population.
ABSTRACT
Resumo Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.
Abstract This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.
Subject(s)
Humans , Male , Female , Aged , Low Back Pain/psychology , Disabled Persons/psychology , Acute Pain/psychology , Pain Measurement , Brazil , Sex Factors , Mental Health , Cross-Sectional Studies , Surveys and Questionnaires , Low Back Pain/physiopathology , Self Efficacy , Disability Evaluation , Acute Pain/physiopathologyABSTRACT
Estudos anteriores têm mostrado que o nível aeróbico e de força pré-treinamento influenciam os ganhos obtidos após um período de treino. Nenhum estudo investigou esta relação em um programa de flexibilidade. O objetivo deste estudo foi observar a influência da limitação da amplitude de movimento (ADM) sobre a melhora da ADM de rotação externa de ombro após um programa de alongamento de seis semanas. 30 voluntários, estudantes de fisioterapia, com limitação da ADM de rotação externa de ombro foram divididos de forma randomizadas em três grupos: grupo controle (GC), grupo experimental 1 (GE1), com maior limitação de ADM e grupo experimental 2 (GE2), com menor limitação de ADM. Os sujeitos do grupo experimental foram submetidos a um programa de seis semanas de alongamento ativo para melhora da ADM de rotação externa de ombro. Na análise dos resultados, o teste de ANOVA one-way mostrou uma diferença significativa entre a média do ganho de ADM de rotação externa de ombro entre os três grupos (p=0,001), sendo que o GE1 teve o maior ganho de ADM (30,1° ± 8,6°) seguido pelos grupos GE2 (15,2° ± 7,5°) e GC (1,1° ± 5,8°). O teste de correlação de Pearson mostrou uma correlação negativa significativa entre ADM prévia e ganho de ADM (r= -0,70, p=0,001). Os resultados deste estudo mostraram que a ADM prévia de rotação externa de ombro influencia o ganho de ADM deste movimento após um programa de alongamento de seis semanas em uma população jovem e saudável. Indivíduos com maior limitação de ADM respondem com um ganho de ADM mais pronunciado.
Previous research has shown that pre-training aerobic and strength status can influence on the training results, with untrained individuals presenting a more pronounced improvement. No study has investigated this correlation in a flexibility program so far. The purpose of this study was to observe the influence of the range of motion (ROM) limitation on ROM gain after a six-week shoulder external rotation stretching training. 30 volunteer physiotherapy students, with limited shoulder external rotation ROM were randomly assigned to one of three groups: control group (CG), experimental group 1 (EG1), with wider ROM limitation, and experimental group 2 (EG2), with narrower ROM limitation. Subjects in the experimental groups were submitted to a 6-week program of active shoulder external rotation stretching. One-way ANOVA showed a significant difference in mean external rotation ROM gains among all three groups (p=0.001), with EG1 having the highest ROM increase (30.1° ± 8.6°), followed by EG2 (15.2° ± 7.5°) and CG (1.1° ± 5.8°). The Pearson correlation analysis showed a significant negative correlation between previous ROM and ROM improvement (r= -0.70, p=0.001).The results of our study showed that shoulder external rotation ROM limitation influences ROM improvement after a six-week stretching program in a healthy young population. Subjects with more pronounced ROM limitation respond with a more remarkable ROM improvement.