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ABSTRACT BACKGROUND AND OBJECTIVES: Physical exercise is recommended by the guidelines for the treatment of chronic low back pain, but the patients' perspective on this therapeutic modality is little explored. The aim of this study was to investigate the perception of patients with chronic low back pain about physical exercise for symptom control. METHODS: This is a descriptive qualitative study, which investigated people with chronic low back pain on the waiting list for Physiotherapy outpatient clinic. Data was collected through individual, semi-structured interviews. The interviews were conducted online, investigating the perception of memory from previous experiences of exercise. Thematic content analysis was used to analyze the data. RESULTS: Fourteen adults (10 women and 4 men) were interviewed. The data was categorized into three moments: (1) perceptions during exercise, (2) perceptions after exercise, and (3) long-term perceptions. The perceptions of pain and discomfort that occur at the beginning of any type of exercise or physical activity usually disappear in the first few weeks, however, when they are not well tolerated, they can lead to withdrawal or discontinuing of the practice. Although the majority reported pain relief, a feeling of relaxation and ease in performing functional activities, in the period immediately after exercise some participants noticed exacerbation of the pain and fear of worsening the condition. In the long term, the majority saw benefits (reduction in pain intensity, return to activities and reduced need for painkillers), but for some participants exercise alone does not seem to be enough to reduce pain. CONCLUSION: People with chronic low back pain can have varying perceptions and results in relation to exercise.
RESUMO JUSTIFICATIVA E OBJETIVOS: O exercício físico é recomendado pelas diretrizes para o tratamento da dor lombar crônica, mas a perspectiva dos pacientes sobre essa modalidade terapêutica é pouco explorada. Este estudo teve como objetivo investigar a percepção de pacientes com dor lombar crônica sobre o exercício físico para o controle dos sintomas. MÉTODOS: Trata-se de um estudo qualitativo descritivo, que investigou pessoas com dor lombar crônica na lista de espera para atendimento fisioterapêutico. Os dados foram coletados por meio de entrevistas individuais e semiestruturadas. As entrevistas foram realizadas no formato online, investigando a percepção de memória pela experiência prévia da prática de exercício. Para a análise dos dados foi utilizada a análise de conteúdo temática. RESULTADOS: Quatorze adultos (10 mulheres e 4 homens) foram entrevistados. Os dados foram categorizados em três momentos: (1) percepções durante o exercício físico, (2) percepções após o exercício, e (3) percepções a longo prazo. As percepções de dor e desconforto que ocorrem no início de alguma modalidade de exercício costumam desaparecer nas primeiras semanas, no entanto, quando não são bem toleradas, podem levar à desistência ou interrupção da prática. Embora a maioria tenha relatado alívio da dor, sensação de relaxamento e facilidade para realizar atividades funcionais, no período imediatamente posterior ao exercício alguns participantes perceberam exacerbação da dor e receio de agravamento do quadro. Em longo prazo, a maioria percebeu benefícios (redução da intensidade da dor, retorno às atividades e diminuição da necessidade de analgésicos), mas para alguns participantes somente a prática de exercícios parece não ser suficiente para a redução da dor. CONCLUSÃO: Pessoas com dor lombar crônica podem ter percepções e resultados variados em relação à prática de exercício.
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Abstract Background Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. Methods 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. Results There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, - 3.25 to - 1.15). The standardized mean difference and their 95% confidence intervals (Cohen's d) revealed a large effect of pain at 22 weeks: (Cohen's d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. Conclusions In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. Trial Registration ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.
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SUMMARY OBJECTIVE: The main aim of this study was to evaluate the structural validity of the Brazilian version of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). METHODS: Individuals with chronic low back pain were included. The data collection of the study occurred by means of online platform. Confirmatory factor analysis was performed. The theoretical version proposed for the JOABPEQ with five domains was tested. The following indices were considered to verify the fit of the model: comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and chi-square/degrees of freedom (DF). RESULTS: The final sample consisted of 175 volunteers, mostly women (68%), adults (mean age of 28.98 years), lean (mean body mass index of 25 kg/m2), with incomplete higher education, single, with mean of pain chronicity of 61.50 months and mean of pain intensity of 6.78 points on the Numeric Pain Scale. Regarding the structure of the JOABPEQ, the original version with five domains was adequate: chi-square/DF=1.52, CFI=0.954, TLI=0.948, and RMSEA=0.055. The factorial load ranges from 0.41 to 0.90. CONCLUSIONS: This study confirms the structure of JOABPEQ with 5 domains (low back pain, lumbar function, walking ability, social life function, and mental health) and 25 items in individuals with chronic low back pain.
Subject(s)
Humans , Female , Adult , Low Back Pain/diagnosis , Psychometrics , Brazil , Surveys and Questionnaires , Reproducibility of Results , JapanABSTRACT
[Objective] In the past, we reported results focusing on the immediate effect of psychosocial factors that influence the effects of acupuncture on patients with chronic low back pain. In the present study, we conducted a retrospective analysis of the data before and after four weeks of acupuncture therapy.[Materials and Methods] Fifty-three patients with an initial diagnosis of chronic low back pain who visited the Acupuncture Department of the Center for Integrative Medicine, Tsukuba University of Technology between August and December 2019 and showed baseline lumbar pain intensity by Visual Analogue Scale (VAS) > 30 mm, were subjects of this study. Psychosocial scales viz, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), Roland-Morris Disability Questionnaire (RDQ), and impression of acupuncture were recorded using a self-administered questionnaire at the first visit and at four weeks after the first acupuncture therapy. Based on VAS, RDQ, and anchor questions about low back pain before and four weeks after the acupuncture therapy, patients were classified into "effective group" and "non-effective group"; then, the logistic regression analysis was performed using this classification as a dependent variable. In addition, r repeated measures analysis of variance (rANOVA) was performed on the data before and after four weeks of acupuncture therapy.[Results and Discussion] The number of patients in the "effective group" and "non-effective group" were 24 and 29, respectively. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.924, P = 0.037) and age (OR: 0.418, P = 0.005) showed statistical significance. In the rANOVA, all the evaluated items showed statistically significant differences before and after four weeks; only VAS in motion showed a statistically significant difference (P = 0.046) regarding the presence or absence of an immediate effect. Therefore, it was suggested that it is important to focus on psychosocial factors from an early stage of therapy, and to make appropriate evaluations and judgments based on both physical and psychosocial aspects of patients to treat them effectively.
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Acupuncture is a promising treatment for relieving pain and improving lower back function in clinical practice. However, evidence from randomized clinical trials (RCTs) remains controversial. Most RCTs conclude that acupuncture procedures for chronic low back pain (CLBP) had no significant difference in efficacy and belonged to placebo. We carefully reviewed and analyzed the methodology and implementation of sham acupuncture in RCTs. Controversial evidence of acupuncture for CLBP is only a microcosm of the evaluation methodological limitation of acupuncture. Inappropriate selection of sham acupuncture controls, rigorous RCT research models, and incorrect interpretation of results may contribute to negative evidence. Evaluating and disregarding the holistic efficacy of acupuncture with an explanatory RCT model based on evaluation drugs may be unwise. Moreover, sham acupuncture is often proven to be non-inert, unreasonable, and with low fidelity. Pitfalls of the explanatory RCT model and sham acupuncture design should be avoided. Establishing a new evaluation system that is in line with the clinical characteristics of acupuncture and obtaining high-quality evidence are difficult but promising tasks.
Subject(s)
Humans , Acupuncture Therapy , Chronic Pain/therapy , Low Back Pain/therapy , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
OBJECTIVE@#To observe the analgesic effect of manipulation loading on chronic low back pain (CLBP) model rats and the expression of inflammatory factors in psoas major muscle tissue, and to explore the improvement of manipulation on local inflammatory microenvironment.@*METHODS@#Thirty two SPF male SD rats weighing 340-360g were randomly divided into blank group, sham operation group, chronic low back pain model group and treatment group, with 8 rats in each group. In the model group, L@*RESULTS@#There was no significant difference in PWT and PWL between the blank group and the sham operation group after modeling (@*CONCLUSION@#Local massage loading has analgesic effect on CLBP rats, at the same time, it can inhibit the content of CGRP and NGF in psoas muscle tissue of CLBP rats, and improve the local inflammatory microenvironment.
Subject(s)
Animals , Male , Rats , Calcitonin , Calcitonin Gene-Related Peptide , Low Back Pain/therapy , Nerve Growth Factor/genetics , Rats, Sprague-DawleyABSTRACT
BACKGROUND: This study was based on filling a gap in our knowledge regarding the issue of what the protective effect of physical exercise on patients within the Brazilian National Health System could be, in relation to low back pain. OBJECTIVES: To determine the prevalence of chronic low back pain (CLBP) and to analyze the protective effect of physical exercise among patients over 50 years old attended at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs (Parque Cedral and Vila Real), located in different regions of the city of Presidente Prudente, Brazil. METHODS: In total, 327 patients were interviewed and evaluated at which retrospective characteristics covering the previous 12 months. The Nordic questionnaire was used to classify CLBP, and the Baecke questionnaire for physical activity level. The body mass index (kg/m2) was calculated using body mass and height values, both collected at the time of the interview. RESULTS: High prevalence of low back pain was found; 175 patients (53.5%) reported having had at least one episode of low back pain in the previous year. Of these, 71 (21.7%) answered yes to all four questions on the Nordic questionnaire and were classified as CLBP. Physical exercise remained associated with CLBP, independent of other factors (odds ratio = 0.35; 95% confidence interval = 0.15-0.80). CONCLUSION: High prevalence of low back pain was identified among PHU users. Physical exercise was associated as an independent protective factor against this pathological condition.
Subject(s)
Humans , Middle Aged , Low Back Pain , Chronic Pain , Brazil , Exercise , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Surface electromyography can record the neuroelectric signals responding the activity of muscle during exercise, which has been used to observe the characteristics of trunk and lower limb muscles in patients with chronic low back pain. It may be used in the researches about pathogenesis, diagnosis and treatment of chronic low back pain by comparing the surface electromyography signals between patients and normal controls during various activities.
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OBJECTIVE@#To observe the effect of acupuncture combined with suspension exercise therapy on the clinical symptoms, lumbar proprioception and trunk isokinetic muscle strength in patients with chronic low back pain.@*METHODS@#A total of 100 patients with chronic low back pain were randomly divided into an observation group and a control group, 50 cases in each group. The patients in the control group were treated with suspension exercise therapy, and the training exercise was selected according to the patient's exercise ability, the suspension exercise therapy was given once a day, three times a week, for totally 4 weeks. Based on the treatment of the control group, the patients in the observation group were treated with acupuncture at Dachangshu (BL 25), Weizhong (BL 40), Qihaishu (BL 24), Shenshu (BL 23) and points, the acupuncture was given once a day, six times as a course of treatment, and a total of two courses of treatment were given. Before and after treatment, the scores of symptoms and signs, the pain rating index (PRI), present pain intensity (PPI) and the visual analogue scale (VAS) in the short-form of McGill pain questionnaire (SF-MPQ) in the two groups were recorded. The isokinetic feedback biomechanical test system was used to measure the lumbar proprioception and isokinetic muscle strength of the trunk, and the clinical efficacy of the two groups was evaluated.@*RESULTS@#The scores of symptoms and signs, PRI, PPI and VAS after treatment were lower than those before treatment in the two groups (<0.05), and those in the observation group were lower than those in the control group (<0.05). The absolute error angle (AE) of lumbar proprioceptive index in the flexion and extension positions after treatment was lower than that before treatment in the two groups (<0.05), and that in the observation group was lower than that in the control group (<0.05). After treatment, the peak torque (PT) of musculus flexor and musculus extensor as well as peak torque/body weight (PT/BW) of musculus extensor were increased in the two groups, and the flexor/extensor (F/E) was reduced (<0.05). The PT of musculus flexor and musculus extensor as well as PT/BW of musculus extensor in the observation group were higher than those in the control group (<0.05), and F/E was lower than that in the control group (<0.05). The total effective rate was 90.0% (45/50) in the observation group, which was higher than 76.0% (38/50) in the control group (<0.05).@*CONCLUSION@#The acupuncture combined with suspension exercise therapy could effectively improve the symptoms and signs of patients with chronic low back pain, enhance the lumbar proprioception and trunk isokinetic muscle strength.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Combined Modality Therapy , Exercise Therapy , Low Back Pain , Therapeutics , Treatment OutcomeABSTRACT
Objective: Various psychosocial factors were exploratively investigated in order to specify items that influence on immediate effect of acupuncture among patients with chronic low back pain. Method: Fifty-six outpatients with initial diagnosis of chronic low back pain, visiting the Acupuncture Department of Center for Integrative Medicine, Tsukuba University of Technology between August to December 2019 were included in the study. The baseline lumbar pain intensity of the patients evaluated using the Visual Analogue Scale (VAS) was >30 mm. Psychological scales viz., Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), lumbar dysfunction, and impression on acupuncture were recorded using a self-administered questionnaire during the first visit. Patients showing decreased VAS scale (≦30 mm) after the first acupuncture treatment as well as self-recognition of improvement in pain were classified as “high responders” while the others were treated as “low responders”. Physical and psychosocial factors were exploratively compared between high and low responders and logistic regression analysis of the two groups was performed using a dichotomous dependent variable. Results and Discussion: The number of high and low responders were 22 and 34, respectively. On comparing these groups exploratively, positive (P＝0.001) and negative (P＝0.004) impression on acupuncture were the only items that showed statistical significance. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.886 (95% CI: 0.808 to 0.971); P＝0.010), positive impression on acupuncture (OR: 5.085 (95% CI: 1.724 to 15.002); P＝0.003), and number of people living together (OR: 0.355 (95% CI: 0.149 to 0.844); P＝0.019) showed statistical significance. Hence, it may be suggested that psychosocial factors influence the immediate effect of acupuncture among patients with chronic low back pain.
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Objective: Various psychosocial factors were exploratively investigated in order to specify items that influence on immediate effect of acupuncture among patients with chronic low back pain. Method: Fifty-six outpatients with initial diagnosis of chronic low back pain, visiting the Acupuncture Department of Center for Integrative Medicine, Tsukuba University of Technology between August to December 2019 were included in the study. The baseline lumbar pain intensity of the patients evaluated using the Visual Analogue Scale (VAS) was >30 mm. Psychological scales viz., Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), lumbar dysfunction, and impression on acupuncture were recorded using a self-administered questionnaire during the first visit. Patients showing decreased VAS scale (≦30 mm) after the first acupuncture treatment as well as self-recognition of improvement in pain were classified as “high responders” while the others were treated as “low responders”. Physical and psychosocial factors were exploratively compared between high and low responders and logistic regression analysis of the two groups was performed using a dichotomous dependent variable. Results and Discussion: The number of high and low responders were 22 and 34, respectively. On comparing these groups exploratively, positive (P＝0.001) and negative (P＝0.004) impression on acupuncture were the only items that showed statistical significance. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.886 (95% CI: 0.808 to 0.971); P＝0.010), positive impression on acupuncture (OR: 5.085 (95% CI: 1.724 to 15.002); P＝0.003), and number of people living together (OR: 0.355 (95% CI: 0.149 to 0.844); P＝0.019) showed statistical significance. Hence, it may be suggested that psychosocial factors influence the immediate effect of acupuncture among patients with chronic low back pain.
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Background: Neural mobilization (NM) constitutes the most effective, common method for assessing and treating several neuromuscular disorders. The study at hand aims to determine the effectiveness of the NM technique compared to lumbar stabilization exercise (LSE) and Radial Extracorporeal Shock Wave Therapy (rESWT) in the physical therapy management of chronic low back pain (CLBP) with radiculopathy. Methods: Two groups comprising 30 participants and randomly chosen formed the basis of this investigation: Group A (NM, LSE, and rESWT) and Group B (LSE and rESWT). The period of three to six weeks constituted the time it took to measure the results herein reached baseline. The results of the observations focused on pain assessed by numerical pain rating scale (NPRS), Lumbar flexion range of motion (Lumbar FROM) by Schober’s method, and disability level as measured by the Modified Oswestry Disability Questionnaire (MODQ). Results: In the control group, the mean scores of pain, lumbar FROM, and MODQ at baselines showed a high level of similarity (6.47, 2.87, and 43.71 respectively in the intervention group, and 6.20, 2.93 and 44.66. Both groups showed improvement in their pain scores at three weeks (P<0.05). However, only lumbar FROM and MODQ showed statistically significant improvement in favor of the intervention group at three weeks (P<0.05). By week 6, both groups achieved a statistically significant difference in the values of all variables. Conclusion: NM with LSE and rESWT is more effective than LSE and rESWT in the third week, and was similarly effective in the sixth week of the treatment. NM with LSE and rESWT may be an alternative treatment option in the treatment of CLBP.
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Introduction: Low back pain is a symptom and not a disease.The low back pain is considered to incorporate dorsal painfound any place between the 12 thoracic vertebra and lowerbuttock up to gluteal folds or anus. Lumbar spondylosis is atypical reason for chronic low back pain and chronic disability.Objective: The main purpose of this research is to give acomparative analysis between short wave diathermy andinfrared radiation for treating lower back pain caused byspondylosis.Method: This was an observational study. A randomizedclinical trial study was conducted on Department of PhysicalMedicine and Rehabilitation, BSMMU, Shahbagh, Dhaka on153 patients who came to hospital with lower back pain andsuffered from spondylosis. The study duration was from 1stMarch 2010 to 15 September, 2010.Results: Out of 153 patients, irrespective of sex, it was foundthat most of the patients (50.98%) belong to 40-49 years agegroup followed by: 50-59 years (27.45%), 30-39 years(11.11%) and 60-70 years (10.46%) age group. in 72.2%patients prolonged sitting exacerbate the lower back pain.Prolonged standing was also found as another aggravatingfactor of pain among the study patients (17.6%). Prolongedwalking (5.9%) and leaning forward (3.3%) came next in theorder of aggravating factors for lower back pain. The study alsoshowed the performance difference between SWD and IRR onthe patients.Conclusion: Considering the information gathered from thisstudy, it can be concluded that all the tested therapies seemedto improve the patients with chronic low back pain. But IRR andSWD showed no significant difference in improvement for thepatients with chronic LBP due to lumbar spondylosis.
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BACKGROUND: As of now, the impact of low back pain (LBP) and its chronic state, chronic low back pain (CLBP), on mental health-related quality of life (HRQOL) has never been investigated among police officers. The present investigation aims at studying this relationship using a biopsychosocial model. METHODS: Between May and October 2014, a Web-based cross-sectional study was conducted among Quebec police officers (Quebec, Canada). Mental HRQOL was measured using the role emotional (RE) and the mental health (MH) domains of the SF-12v2 Health Survey. The impact of CLBP on mental HRQOL (as opposed to acute/subacute LBP or no LBP) was studied with a multivariate linear regression model. RESULTS: Of the 3,589 police officers who participated in the study, 1,013 (28.4%) reported CLBP. The mean age of respondents was 38.5 ± 8.7 years, and 32.0% were females. The RE (44.1/100) and MH (49.0/100) mean scores of the CLBP group were comparable with the scores found in populations suffering from cancer or heart diseases. Compared to officers without LBP, the presence of CLBP was significantly associated with lower RE (β: −0.068; p = 0.003) and MH (β: −0.062; p = 0.002) scores. These relationships were not found in the acute/subacute LBP group. CONCLUSION: Our results underscore how frequent CLBP is among police officers and how burdensome it is. Considering the importance of good physical and mental health for this occupational population, police organizations should be aware of this issue and contribute to the efforts toward CLBP prevention and management in the workplace.
Subject(s)
Female , Humans , Cross-Sectional Studies , Health Surveys , Heart Diseases , Linear Models , Low Back Pain , Mental Health , Police , Quality of Life , Quebec , Surveys and QuestionnairesABSTRACT
Objective:To evaluate the effect of Kinesio taping on chronic nonspecific low back pain (CNLBP). Methods:The Cochrane Library, PubMed, Web of Science, CNKI, CBM, VIP, and Wanfang Data were searched for the randomized controlled trials (RCT) about the effect of Kinesio taping on CNLBP from establishment to January, 2019. The included studies were evaluated according to the method recommended by the Cochrane Collaboration. RevMan 5.3 software was used to analyze the extracted data. Results:Finally, nine RCTs involving 545 patients were included. Meta-analysis showed that the effect of Kinesio taping was significantly different in the improvement of pain compared with the non-stimulated group (MD = -0.76, 95%CI: -1.43 to -0.08, P = 0.03), the difference might be significant compared with the sham stimulation group (MD = -1.10, 95%CI: -2.22 to 0.02, P = 0.05); For improving dysfunction, the Oswestry Disability Index (ODI) scores were better in the Kinesio taping group than in the non-stimulation group (MD = -6.02, 95%CI: -8.63 to -3.41, P < 0.001) and the sham stimulation group (MD = -4.11, 95%CI: -5.82 to -2.41, P < 0.001), however, their was no significant difference in Roland Morris Disability Questionnaire (RMDQ) score between the Kinesio taping group and the non-stimulated group (MD = 0.69, 95%CI: -2.35 to 3.74, P = 0.66), and between the Kinesio taping group and the sham stimulation group (MD = -0.17, 95%CI: -1.43 to 1.08, P = 0.78). Conclusion:For the patients with CNLBP, the intervention of Kinesio taping could alleviate pain and improve function.
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Objective@#To investigate the effects of abdominal drawing-in maneuver with real-time ultrasound biofeedback on transversus abdominis activation level during functional tasks in different positions in patients of chronic low back pain with stabilization-deficit.@*Methods@#Nineteen patients of chronic low back pain with stabilization-deficit were randomly divided into verbal instruction group(n=9) and ultrasound biofeedback group(n=10), and received abdominal drawing-in maneuver with verbal instruction and ultrasound biofeedback respectively. Percentage changes of transversus abdominis thickness during supine and upright loaded tasks were compared before and after intervention.@*Results@#After intervention, percentage changes of transversus abdominis thickness increased significantly in verbal instruction group during supinehip external rotation, straight leg raising and upright loaded functional tasks (P<0.05), and percentage changes of transversus abdominis thickness during supine hip and knee flexion demonstrated great increases(P<0.01). After intervention, percentage changes of transversus abdominis thickness demonstrated great increases in ultrasound biofeedback group during all functional tasks(P<0.01). No differences were observed between the two groups(P>0.05).@*Conclusions@#Ultrasound image could effectively assess the thickness changes of transversus abdominis in patients with chronic low back pain during supine and upright loaded functional tasks. Ultrasound image could provide chronic low back pain patients with real-time and dynamic visual feedback. However, compared with verbal instruction, adding real-time ultrasound biofeedback to abdominal drawing-in maneuver does not further increase the transversus abdominis activation level.
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Objective To investigate the effects of abdominal drawing‐in maneuver with real‐time ultrasound biofeedback on transversus abdominis activation level during functional tasks in different positions in patients of chronic low back pain with stabilization‐deficit . Methods Nineteen patients of chronic low back pain with stabilization‐deficit were randomly divided into verbal instruction group( n ＝9 ) and ultrasound biofeedback group ( n ＝ 10 ) ,and received abdominal drawing‐in maneuver with verbal instruction and ultrasound biofeedback respectively . Percentage changes of transversus abdominis thickness during supine and upright loaded tasks were compared before and after intervention . Results After intervention , percentage changes of transversus abdominis thickness increased significantly in verbal instruction group during supinehip external rotation ,straight leg raising and upright loaded functional tasks ( P＜0 .05) ,and percentage changes of transversus abdominis thickness during supine hip and knee flexion demonstrated great increases( P ＜0 .01) . After intervention ,percentage changes of transversus abdominis thickness demonstrated great increases in ultrasound biofeedback group during all functional tasks ( P ＜0 .01) . No differences were observed between the two groups( P ＞0 .05) . Conclusions Ultrasound image could effectively assess the thickness changes of transversus abdominis in patients with chronic low back pain during supine and upright loaded functional tasks . Ultrasound image could provide chronic low back pain patients with real‐time and dynamic visual feedback . However ,compared with verbal instruction , adding real‐time ultrasound biofeedback to abdominal drawing‐in maneuver does not further increase the transversus abdominis activation level .
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La ansiedad y la depresión son las formas más frecuentes de alteraciones psicológicas que se ven en pacientes con dolor crónico, en general; y lumbalgia crónica, en particular. No existen, en nuestro medio, reportes sobre estos trastornos psicológicos en pacientes con lumbalgia crónica, siendo pocos los estudios en latinoamérica. El objetivo del presente estudio piloto fue evaluar la presencia de ansiedad y depresión en pacientes con lumbalgia crónica, acompañada o no de dolor radicular, que consultaron en el servicio de tratamiento del dolor de nuestro hospital universitario. La escala de ansiedad y depresión Hospitalaria (EADH, versión en español de la hospital anxiety and depression scale, HADS) fue el instrumento utilizado para la valoración de ansiedad y depresión. La muestra fue de 25 pacientes. De éstos, 16 (64 por ciento) presentaron diagnóstico de ansiedad y 7 (28 por ciento) de depresión. La frecuencia de ansiedad en esta muestra fue más alta que la de depresión que, sin contar los casos probables, fue de 28 por ciento. Se registraron 3 casos de diagnóstico probable de ansiedad y 7 de depresión. Los pacientes estudiados presentaban dolor intenso e incapacitante, evaluado por el Inventario abreviado de dolor. Se observó una correlación lineal positiva moderada a débil, pero estadísticamente significativa entre ansiedad y depresión, y la intensidad del dolor medido el Índice de Intensidad. Se encontró una correlación positiva débil, aunque estadísticamente significativa entre ansiedad y depresión y el Índice de Interferencia. En conclusión, en este estudio piloto en pacientes con lumbalgia crónica se detectaron, utilizando la escala de ansiedad y depresión hospitalaria, niveles elevados de ansiedad, con niveles menores de depresión, trastornos que se correlacionan con la intensidad del dolor y la incapacidad derivada de éste de manera moderada a débil. Este es el primer estudio en nuestro medio que evalúa ansiedad y depresión en pacientes con lumbalgia crónica, utilizando la escala de ansiedad y depresión hospitalaria validada en español. Los hallazgos obtenidos exigen un abordaje interdisciplinario de la lumbalgia crónica, que podrá incluir el uso de antidepresivos con acción ansiolítica como la duloxetina.
Anxiety and depression are frequent disorders in patients with chronic pain, in particular in the spine. No studies evaluating these psychological disorders have been performed in our country in chronic low back pain patients, and a few were found in latin America. The goal of the present pilot study was to evaluate the presence of anxiety and depression in chronic back pain patients with or without radicular pain, utilizing the hospital anxiety and depression scale, in the Spanish validated version. 25 patients were chosen of the ambulatory consultation of the chronic pain treatment unit of the university hospital. 16 (64 percent) presented anxiety and 7 depression (28 percent). The probable cases were 3 for anxiety and 7 for depression. All the patients had intense pain and functional impairment, evaluated by the brief pain Inventory instrument. A moderate to weak, statistically significant, positive correlation, were observed between anxiety and depression and pain intensity and interference, measured by the Intensity and interference scores. In conclusion, in the present pilot study in chronic low back pain patients, high levels of anxiety was observed, with lower frequency of depression, utilizing, for first time in our country, the hospital anxiety and depression scale in Spanish. Weak to moderate positive correlations were observed between anxiety and depression and pain intensity and interference in patient daily activities. Under the light of these findings, an interdisciplinary approach of chronic low back pain patients is mandatory, including the use of antidepressants with a tranquilizer profile, as it is duloxetine.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anxiety/diagnosis , Low Back Pain/psychology , Depression/diagnosis , Chronic Pain/psychology , Anxiety/epidemiology , Uruguay , Pain Measurement , Surveys and Questionnaires , Pain Clinics , Depression/epidemiology , Hospitals, UniversityABSTRACT
Resumo O objetivo deste artigo é avaliar a prevalência e os fatores associados à dor lombar nos últimos 12 meses entre adolescentes de um município do sul do estado do Piauí, Brasil. Estudo transversal com 1112 adolescentes de 13-19 anos do município de Caracol. Investigaram-se características demográficas, socioeconômicas, nutricionais, comportamentais e comorbidades. O desfecho foi a ocorrência de dor lombar (DL) nos últimos 12 meses. Foi calculada a prevalência do desfecho de acordo com as variáveis independentes. Entre os adolescentes com DL no último ano, foi calculada a proporção de indivíduos com dor lombar crônica. Para análise dos fatores associados, foi utilizada a regressão de Poisson bruta e ajustada para cálculo das razões de prevalência. A prevalência de dor lombar nos últimos 12 meses foi de 32,9%. De acordo com a análise ajustada, sexo feminino (RP = 1,75; IC95%:1,45-2,10), idade entre 18-19 anos (RP = 1,27; IC95%:1,01-1,62), maior renda (RP = 1,33; IC95%:1,06-1,67), estar trabalhando (RP 1,25 IC95%:1,02-1,53) e apresentar distúrbios psiquiátricos menores (RP 1,51 IC95%: 1,25-1,82) permaneceram associados à DL nos últimos 12 meses. Este estudo encontrou elevada prevalência de DL entre adolescentes de um município pequeno do semiárido nordestino.
Abstract The scope of this article is to assess low back pain prevalence and associated factors in the last 12 months among adolescents in a city in the south of the State of Piauí. It was a cross-sectional study which included 1,112 adolescents aged 13-19 in the city of Caracol, Piauí. Demographic, socio-economic, nutritional, behavioral and comorbidty characteristics were investigated. The outcome was the occurrence of low back pain (LBP) in the last 12 months. The outcome prevalence was calculated in accordance with independent variables. The proportion of individuals with chronic LBP was calculated among adolescents with LBP in the last 12 months. Crude and adjusted Poisson regression was used to estimate the prevalence ratio in the analysis of associated factors. The prevalence of LBP in the last 12 months was 32.9%. According to the adjusted analysis, being female (PR = 1.75; 95%CI:1.45-2.10), being aged 18-19 (PR = 1.27; 95%CI:1.01-1.62), having higher income (PR = 1.33; 95%CI:1.06-1.67), having a job (PR 1.25 95%CI:1.02-1.53) and having minor psychiatric disorders (PR 1.51 95%CI: 1.25-1.82) were associated with LBP in the last 12 months. This study found a high prevalence of LBP among adolescents in a poor city in the semiarid region of Northeast Brazil.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Low Back Pain/epidemiology , Chronic Pain/epidemiology , Mental Disorders/epidemiology , Brazil/epidemiology , Poisson Distribution , Sex Factors , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Age Factors , IncomeABSTRACT
A dor lombar crônica é um importante problema de Saúde Pública. Profissionais de saúde que trabalham com doenças crônicas com frequência se deparam com as dificuldades que alguns pacientes apresentam em aderir aos tratamentos prescritos. Analisamos a adesão ao tratamento de pacientes com dor lombar crônica, em uma clínica de neurocirurgia do interior paulista e implementamos um guia de orientação que facilite a adesão ao tratamento da dor lombar crônica desses pacientes, demanda discutida com os gestores da clínica. A adesão terapêutica foi o referencial desse estudo. Utilizamos um método transversal e descritivo com abordagem qualitativa, e instrumento de coleta de dados, entrevista semiestruturada e fonte documental. Foram considerados sujeitos do estudo, todos os pacientes que procuraram atendimento na referida clínica de neurocirurgia com patologias da coluna vertebral, no período de seis meses (Fevereiro à Agosto) referente ao ano de 2017 com idade superior a 18 anos. Foram incluídos pacientes com diagnóstico médico de dor lombar crônica específica e inespecífica há pelo menos seis meses, com capacidade de expressão e comunicação preservados. A entrevista semiestruturada, abordou a compreensão dos pacientes quanto ao diagnóstico médico, ao tratamento e uma pergunta aberta para expressarem a percepção sobre a dor lombar no seu cotidiano. Para a análise dos dados utilizamos a Análise de Conteúdo. Na caracterização dos sujeitos, encontramos 57,2% do sexo feminino, a faixa etária predominante 62% foi entre 40 a 59 anos. Estado civil, 66,7% casados, escolaridade 47,6% ensino superior completo, cor da pele auto referida, branca 90,5%. Quanto ao IMC prevaleceu sobrepeso com 42,9%, profissão 33,3% eram do lar, ocupação 38% estavam ativos e quanto ao tempo de dor, de 1 a 5 anos, 62% e 76,2% dos participantes do estudo não faziam atividade física. Consideramos que analisar o conceito de adesão e seus fatores multidimensionais facilitou compreender as diferentes formas de lidar com a DLC. Destacamos as redes de apoio (trabalho, família e amigos), o bom relacionamento entre o profissional de saúde e o paciente promovendo uma compreensão sobre seu diagnóstico e tratamento. Importante promover o acolhimento, escuta qualificada para que o paciente se torne o sujeito ativo do seu tratamento e reabilitação. Para isto, a Integralidade do cuidado depende de um novo arranjo de práticas e conformações dos serviços de saúde que incluam a singularidade dos sujeitos. O estudo inicialmente pactuado e os resultados serão devolvidos para os gestores do local de estudo
Chronic low back pain is an important Public Health problem. Health professionals working with chronic illnesses often deal with the difficulties some patients face in adhering to the prescribed treatments. We have Analyzed the adherence to the treatment of patients with chronic low back pain in a neurosurgery clinic in a city in the countryside of São Paulo state and developed a guideline that facilitates adherence to the treatment of chronic low back pain in these patients, a demand discussed with the clinic managers. Therapeutic adherence was the referential of this study. We used a transversal and descriptive method with qualitative approach, data collection instrument, semi-structured interview, and documentary source. The study subjects were all patients who sought care in the referred neurosurgery clinic with spinal pathologies, in the six-month from February to August, referring to the year 2017, aged over 18 years. We included patients with a specific and non-specific chronic low back pain medical diagnosis for at least six months, with preserved expression and communication capacity. The semi-structured interview addressed the patients' understanding of the medical diagnosis, the treatment and an open question to express the perception about low back pain in their daily life. The data were analysed using a content analysis method. In the characterization of the subjects, we found 57.2% of female patients; the predominant age group representing 62% was between 40 and 59 years old; 66.7% of patients were married; 47.6% had higher education; regarding skin color, 90.5% of the patients reported themselves as white; as for BMI, overweight was predominant with 42.9%, on occupation 33.3% developed home activities; 38% of the patients were active and 62% of them stated to have had pain for 1 to 5 years, and 76.2% of study participants did not practice any physical activity. We consider that analyzing the concept of adherence and its multidimensional factors makes it easier to understand the different ways of dealing with chronic low back pain. We highlight the support networks (work, family and friends), the good relationship between the health professional and the patient, promoting a good understanding of their diagnosis and treatment. To promote the acceptance, the extended listening so that the patient becomes the active subject of its treatment and rehabilitation. For this, the integrality of the care depends on a new arrangement of practices and conformations of the health services that include the singularity of the subjects. The study initially agreed and the results will be returned to the managers of the study site