Uncovering emotional and network dynamics in the speech of patients with chronic low back pain.

BACKGROUND: Computational linguistics allows an understanding of language structure and different forms of expression of patients' perceptions. AIMS: The aims of this study were (i) to carry out a descriptive analysis of the discourse of people with chronic low back pain using sentiment analysis (SA) and network analysis; (ii) to verify the correlation between patients' profiles, pain intensity and disability levels with SA and network analysis; and (iii) to identify clusters in our sample according to language and SA using an unsupervised machine learning technique. METHODS: We performed a secondary analysis of a qualitative study including participants with chronic non-specific low back pain. We used the data related to participants' feelings when they received the diagnosis. The SA and network analysis were performed using the Valence Aware Dictionary and sEntiment Reasoner, and the Speech Graph, respectively. Clustering was performed using the K-means algorithm. RESULTS: In the SA, the mean composite score was -0.31 (Sd. = 0.58). Most participants presented a negative discourse (n = 41; 72%). Word Count (WC) and Largest Strongly connected Component (LSC) positively correlated with education. No statistically significant correlations were observed between pain intensity, disability levels, SA, and network analysis. Two clusters were identified in our sample. CONCLUSION: The SA showed that participants reported their feeling when describing the moment of the diagnosis using sentences with negative discourse. We did not find a statistically significant correlation between pain intensity, disability levels, SA, and network analysis. Education level presented positive correlation with WC and LSC.

Falta de conhecimento sobre os fatores de risco não ocupacionais da dor lombar entre profissionais de saúde ocupacional brasileiros: um estudo observacional transversal / Lack of knowledge about non-occupational low back pain risk factors among brazilian occupational health professionals: a cross-sectional observational study

INTRODUÇÃO: A dor lombar possui alta prevalência, sendo uma das principais causas de incapacidade no Brasil e no mundo. A dor lombar apresenta etiologia multifatorial, sendo extremamente comum em trabalhadores. OBJETIVOS: Verificar o conhecimento sobre os fatores de risco para dor lombar, crenças e atitudes sobre o manejo da dor lombar entre profissionais de saúde (fisioterapeutas e ergonomistas) atuantes na área ocupacional. MATERIAIS E MÉTODOS: Foi realizado um estudo observacional transversal com 81 profissionais de saúde ocupacional brasileiros. Os participantes preencheram um questionário eletrônico composto por dados profissionais, sociodemográficos, itens sobre fatores de risco para dor lombar e a Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Conhecimentos, crenças e atitudes foram analisados por meio do teste do qui-quadrado para fatores de risco para dor lombar e um modelo de regressão linear para crenças e atitudes dos profissionais de saúde. RESULTADOS: Obesidade (7,4%), ficar sentado mais de 2 horas (8,6%), atividade física (9,9%), falta de apoio psicossocial no trabalho (11,1%) e consumo de álcool (37,0%), apresentaram os menores índices de conhecimento sobre fatores de risco da dor lombar pelos profissionais. Itens sobre saúde geral apresentaram o menor conhecimento. Uma orientação biomédica e psicossocial equilibrada de crenças e atitudes sobre o manejo da dor lombar foi observada. CONCLUSÃO: Profissionais de saúde ocupacional brasileiros carecem de conhecimento sobre os fatores de risco não ocupacionais da dor lombar, especialmente o estado geral de saúde. Esses profissionais também possuem conceitos biomédicos e psicossociais equilibrados no manejo da dor lombar.

INTRODUCTION: Low back pain (LBP) is highly prevalent and is one of the main causes of disability in Brazil and around the world. LBP presents a multifactorial etiology, being extremely common in workers. OBJECTIVE: This study aimed to verify the knowledge about the LBP risk factors, beliefs and attitudes about the management of LBP among health professionals (physiotherapists and ergonomists) working in the occupational area. MATERIALS AND METHODS: A cross-sectional observational study was conducted with 81 Brazilian occupational health professionals. Participants completed an electronic questionnaire comprising professional data, sociodemographics, items about LBP risk factors, and the Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Knowledge, beliefs and attitudes were analyzed using the chi-square test for LBP risk factors and the linear regression model for health professionals' beliefs and attitudes. RESULTS: Obesity (7.4%), sitting for more than 2 hours (8.6%), physical activity (9.9%), lack of psychosocial support at work (11.1%) and consuming alcohol (37.0%) presented the lowest rate of knowledge about LBP risk factors by professionals. Items about general health showed the lowest knowledge. A balanced biomedical and psychosocial orientation of beliefs and attitudes about managing LBP was observed. CONCLUSION: Brazilian occupational health professionals lack knowledge about non-occupational LBP risk factors, especially general health status. These professionals also have balanced biomedical and psychosocial concepts in managing LBP.

Hospital admission is associated with disability and late musculoskeletal pain in individuals with long COVID.

Background: The acute clinical repercussions of SARS-CoV-2 infection have been widely studied. However, the possible late repercussions of long COVID have not yet been well defined in the literature. Objectives: To identify the presence of pain and musculoskeletal disability in patients with Long COVID and also to identify predictive factors for pain intensity in this population. Methods: In this cross-sectional and retrospective observational study individuals with Long COVID symptoms were included. It was collected musculoskeletal disability measures, data from patient-related outcome measures and variables from a COVID-19 outpatient service database. Associations and sub-group analyses were performed considering the variables pain, disability and hospitalization. Linear regression was performed to identify predictive factors for pain intensity in Long COVID patients. Results: We evaluated 195 patients and most of them (57%) presented musculoskeletal pain in one area of the body. Pain sub-group presented worse disability indices and worse clinical course during hospitalization. Hospitalized patients presented worse disability indices comparing to non-hospitalized. Significant correlations were found between pain and days of non-invasive oxygen support (r = 0.21; p = 0.003); days in intensive care unit (r = 0.22; p = 0.002) and days in invasive mechanical ventilation (r = 0.35; p = 0.001). Hospitalized individuals showed a higher chance of presenting late musculoskeletal pain (OR = 1.42: 95%CI 1.09-2.04). Days in intensive care unit (ß = 0,234: P = 0,001) and days in invasive mechanical ventilation (ß = 0.764: P = 0.001) were predictors of pain intensity [F(2,192) = 18.559; R2 = 0.231; p = 0.001]. Conclusion: Individuals with Long COVID presented musculoskeletal pain and disability. Hospitalized patients showed a greater chance of having musculoskeletal pain. Days in intensive care unit and days in invasive mechanical ventilation were predictors of late musculoskeletal pain intensity.

Sleep quality and polysomnographic changes in patients with chronic pain with and without central sensitization signs.

BACKGROUND: Insufficient sleep is common nowadays and it can be associated with chronic pain. OBJECTIVE: To describe the main polysomnographic findings in patients with chronic musculoskeletal pain and to estimate the association between sleep quality, polysomnography variables and chronic musculoskeletal pain. METHODS: This cross-sectional research analyzed a database from polysomnography type 1 exams results and then collected data via an electronic form from these patients. The form collected sociodemographic data and presented clinical questionnaires for measuring sleep quality, sleepiness, pain intensity and central sensitization signs. Pearson's correlation coefficient and odds ratio were used to estimate the associations. RESULTS: The mean age of the respondents was 55.1 (SD 13.4) years. The mean score of the Central Sensitization Inventory showed signs of central sensitization (50.1; SD 13.4) in the participants. Most patients (86%) had 1 or more nocturnal awakenings, 90% had one or more episodes of sleep apnea, 47% had Rapid Eye Movement sleep phase latency greater than 70-120 min and the mean sleep efficiency among all participants was 81.6%. The Pittsburgh Sleep Quality Index score was correlated with the CSI score (r = 0.55; 95% CI: 0.45, 0.61). People with central sensitization signs have 2.6 times more chance to present sleep episodes of blood oxygen saturation below 90% (OR = 2.62; 95% CI:1.23, 6.47). CONCLUSION: Most people with central sensitization signs had poor sleep quality, night waking episodes and specific disturbances in sleep phases. The findings showed association between central sensitization, sleep quality, nocturnal awakening, and changes in blood oxygen saturation during sleep.

Superficial Femoral Artery in-Stent Restenosis Treated with Paclitaxel-Coated Balloon Angioplasty - Results of Three-Year Follow-Up.

BACKGROUND: In-stent restenosis remains a common and important complication after endovascular treatment of superficial femoral artery peripheral artery disease. It occurs in 14 to 35% of cases in 1 year and there is still no efficient treatment for this condition. Paclitaxel-coated balloons have shown promising results. OBJECTIVE: Investigate the 3 year results of superficial femoral artery in-stent restenosis treated with paclitaxel-coated balloon angioplasty, using the Lutonix™ 035 device. METHODS: We conducted a retrospective observational study with patients with symptomatic (Rutherford 2 to 5) superficial femoral artery in-stent restenosis, that were treated with paclitaxel-coated balloon angioplasty using the Lutonix™ 035 device, in a single center from January 2016 to December 2020. Duplex scan was used to follow the patients. Primary patency was obtained through Kaplan-Meier analysis. Mortality, and amputation rates were also evaluated. RESULTS: 105 patients were included. Two patients had technical failure and required an additional stent, and were thus excluded. 103 patients were analyzed. Primary patency was 91.26, 80.47, and 67.71%, respectively, in the first, second, and third year after the procedure. There were no deaths 30 days after the procedure. There were no major amputations during the 3 year follow-up. CONCLUSION: Paclitaxel-coated balloon angioplasty with the Lutonix™ 035 device was a safe and effective treatment to superficial femoral artery in-stent restenoses. The results were maintained along the 3 year follow-up.

'Your spine is so worn out' - the influence of clinical diagnosis on beliefs in patients with non-specific chronic low back pain - a qualitative study'.

BACKGROUND: Patients' beliefs have an important influence on the clinical management of low back pain and healthcare professionals should be prepared to address these beliefs. There is still a gap in the literature about the influence of patients' perceptions of their clinical diagnosis on the severity of their pain experience and disability. OBJECTIVES: To identify the perceptions of patients with chronic non-specific low back pain regarding the influence of their clinical diagnosis on pain, beliefs, and daily life activities. METHODS: Qualitative study of 70 individuals with chronic non-specific low back pain. A semi structured interview was conducted about patients' beliefs and perceptions regarding the influence of clinical diagnosis on their daily activities and pain intensity. RESULTS: Most participants believed that higher number of different clinical diagnoses for the same individual may be associated with high pain intensity and disability for daily activities and that pain and injury are directly related. Patients beliefs were grouped into four main themes: (1) pain has multifactorial explanation in physical dimension; (2) improvement expectation is extremely low in patients with chronic pain; (3) clinical diagnosis influences pain and disability levels; (4) clinical diagnosis is extremely valued by patients. CONCLUSIONS: Patients believe that there is a strong relationship between structural changes in the lower back, pain, and daily life activities; thus, providing evidence of a strong influence of the biomedical model on their beliefs.

Cross-cultural adaptation of the Richards-Campbell Sleep Questionnaire for intensive care unit inpatients in Brazil: internal consistency, test-retest reliability, and measurement error.

STUDY OBJECTIVES: To perform the cross-cultural adaptation of the Richards-Campbell sleep questionnaire (RCSQ) to Portuguese-Brazil and to eval its internal consistency, test-retest reliability, and measurement error in intensive care unit (ICU) inpatients. METHODS: The study enrolled 113 inpatients at medical/surgical ICU in Curitiba, Brazil. The RCSQ was first translated to Portuguese-Brazil according to the principles of good practice for the translation and cultural adaptation process for patient-reported outcomes and then applied in 30 inpatients. The final version (RCSQ-PT-Br) was applied to measure content validity (83 inpatients, 47 men [56.6%], 60.4 ± 14.2 years), and test-retest reliability and measurement error (a subset of 53 inpatients). Internal consistency of the RCSQ-PT-Br was estimated using Cronbach's a; test-retest reliability (2 independent rates) was assessed using the single measurement, absolute agreement, two-way random effects model (ICC2,1). RESULTS: Group-average RCSQ-PT-Br total score was 46.9 ± 26.7 (range 3.4-98.8). The RCSQ-PT-Br total score showed good content internal consistency (Cronbach's α = 0.850 95%CI = [0.789-0.897]) and excellent test-retest reliability (ICC2,1 = 0.840 95% CI = [0.739-0.904]). Measurement error was low (standard error of mean = 11 mm, mean difference = 30 mm). CONCLUSIONS: The RCSQ-PT-Br is a valid and reliable instrument to evaluate the sleep of patients hospitalized in the ICU in Brazil.

Central Sensitization Inventory is a useless instrument for detection of the impairment of the conditioned pain modulation in patients with chronic musculoskeletal pain.

OBJECTIVE: The current study aimed to evaluate the concurrent validity and the diagnostic accuracy of the Central Sensitization Inventory (CSI) in detecting the impairment of the pain modulation in patients with chronic musculoskeletal pain. METHODS: A cross-sectional study was conducted in 267 patients with chronic musculoskeletal pain enrolled consecutively in an outpatient department. The CSI (index method) were compared with the cold pressor test, which was the psychophysical test used to assess the conditioned pain modulation (CPM), (reference standard). Spearman's correlations assessed the concurrent validity, and measurements of the diagnostic accuracy were performed. RESULTS: Ninety-three (34.8%) patients had CSI scores≥40. No significant correlation was found between CSI findings and the results of the CPT (dorsal forearm site or tibialis anterior site) was found. The cutoff point of 40 of the CSI showed values of sensitivity (35.1%, 95% CI: 22.6, 49.3) and specificity (65.2%, 95% CI: 58.4, 71.6) below 70%, and an accuracy of 59.1 (95% CI: 53.0, 65.1) when compared to the CPT to detect deficit. The ROC curve analysis yielded an area under the curve of 0.54 (95% CI: 0.45, 0.63, P>0.05). CONCLUSIONS: The CSI is a useless instrument to detect the deficit in the CPM in patients with chronic musculoskeletal pain due to the absence of correlation with the psychophysical test result and the insufficient measurements of diagnostic accuracy.

The Reliability and Concurrent Validity of PainMAP Software for Automated Quantification of Pain Drawings on Body Charts of Patients With Low Back Pain.

BACKGROUND: The assessment of painful areas through printed body charts is a simple way for clinicians to identify patients with widespread pain in primary care. However, there is a lack in the literature about a simple and automated method designed to analyze pain drawings in body charts in clinical practice. PURPOSE: To test the inter- and intra-rater reliabilities and concurrent validity of software (PainMAP) for quantification of pain drawings in patients with low back pain. METHODS: Thirty-eight participants (16 [42.10%] female; mean age 50.24 [11.54] years; mean body mass index 27.90 [5.42] kg/m2 ; duration of pain of 94.35 [96.11] months) with a current episode of low back pain were recruited from a pool of physiotherapy outpatients. Participants were instructed to shade all their painful areas on a body chart using a red pen. The body charts were digitized by separate raters using smartphone cameras and twice for one rater to analyze the intra-rater reliability. Both the number of pain sites and the pain area were calculated using ImageJ software (reference method). The PainMAP software used image processing methods to automatically quantify the data from the same digitized body charts. RESULTS: The reliability analyses revealed that PainMAP has excellent inter- and intra-rater reliabilities to quantify the number of pain sites (intraclass correlation coefficient [ICC]2,1 : 0.998 [95% confidence interval (CI) 0.996 to 0.999]; ICC2,1 : 0.995 [95% CI 0.991 to 0.998]) and the pain area [ICC2,1 : 0.998 (95% CI 0.995 to 0.999); ICC2,1 : 0.975 (95% CI 0.951 to 0.987)], respectively. The standard error of the measurement was 0.22 (4%) for the number of pain sites and 0.03 cm2 (4%) for the pain area. The Bland-Altman analyses revealed no substantive differences between the 2 methods for the pain area (mean difference = 0.007 [95% CI -0.053 to 0.067]). CONCLUSION: PainMAP software is reliable and valid for quantification of the number of pain sites and the pain area in patients with low back pain.

A influência da Fisioterapia na redução da intensidade da dor e no efeito global percebido de pacientes com dores musculoesqueléticas / The influence of the Physiotherapy on pain reduction and global perceived effect of patients with musculoskeletal pain

A melhora clí­nica do paciente com dores musculoesqueléticas (DME) deve ser monitorada em conjunto com a percepção do paciente sobre o efeito do tratamento, apesar da falta de informação sobre esse tema. Objetivo: Analisar a influência do tratamento fisioterápico na redução da intensidade da dor e no efeito global percebido de pacientes com DME. Métodos: Foi realizado um estudo observacional analí­tico retrospectivo em 61 pacientes com DME que responderam uma questão relacionada í intensidade de dor e outra questão sobre o efeito global percebido do tratamento fisioterápico. A intensidade de dor medida após 10 meses de acompanhamento foi comparada aos valores iniciais. Resultados: Os participantes eram predominantemente mulheres (83,3%) adultas (média de idade de 59,6 anos). A média de intensidade da dor na avaliação inicial foi de 6,4 (± 2,7), com média de tempo de dor de 20,3 meses. A média de intensidade de dor após o contato telefônico foi de 4,37 (± 3,9). A análise do efeito global percebido evidenciou melhora na maioria dos participantes (16,7% completamente recuperados; 39,7% melhoraram muito, 26,7% melhoraram pouco). Conclusão: Pacientes com DME apresentaram redução da intensidade da dor e melhora no efeito global percebido após um programa de Fisioterapia. (AU)

The clinical improvement of the patient with musculoskeletal pain (MP) should be monitored together with the perception of the patient about the treatment effect, despite the lack of information on this subject. Objective: To analyze the influence of physiotherapeutic treatment on the pain reduction and global perceived effect in patients with MP. Methods: A retrospective observational analytic study was performed in 61 patients with MP that answered a question about their pain intensity and another question about the global perceived effect of the physical therapy treatment. The pain intensity measured after 10 months of follow-up was compared to the initial values. Results: Participants were predominantly female (83.3%) adults (mean age 59.6 years old). The mean pain intensity at the initial evaluation was 6.4 (± 2.7), with a mean of pain time of 20.3 months. The mean pain intensity after telephone contact was 4.37 (± 3.9). The analysis of the global perceived effect evidenced improvement in most of the participants (16.7% completely recovered, 39.7% much improved, 26.7% slightly improved). Conclusion: Patients with MP showed pain reduction and improvement on the global perceived effect after a Physiotherapy treatment. (AU)

The Variation of Cross-Sectional Area of the Sciatic Nerve in Flexion-Distraction Technique: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to compare the cross-sectional area of the sciatic nerve in different positions of spinal manipulation using flexion-distraction technique. METHODS: Thirty healthy participants were assessed in 6 different flexion-distraction technique positions of varying lumbar, knee, and ankle positions. Participants stood in the following 3 positions with the lumbar in the neutral position: (A) with knee extended, (B) with knee flexed, and (C) with the knee extended and ankle dorsiflexion. Participants then stood in the following 3 positions with the lumbar flexed: (D) with the knee extended, (E) with the knee flexed, and (F) with knee extended and ankle dorsiflexion. The cross-sectional area (CSA) of the sciatic nerve was measured with ultrasound imaging in transverse sections in the posterior medial region of the left thigh. The CSA values measured at each position were compared. RESULTS: We analyzed 180 ultrasound images. The cross-sectional area of the sciatic nerve (in mm2) in position B (mean; standard deviation) (59.71-17.41) presented a higher mean cross-sectional area value compared with position D (51.18-13.81; P =.005), position F (48.71-15.16; P = .004), and position C (48.37-16.35; P = .009). CONCLUSION: The combination of knee extension and ankle dorsiflexion reduced the CSA of the sciatic nerve, and flexing the knee and keeping the ankle in the neutral position increased it.

Pragmatic neural tissue management improves short-term pain and disability in patients with sciatica: a single-arm clinical trial.

Objectives: To evaluate the clinical effect of sciatic neural mobilization in combination with the treatment of surrounding structures for sciatica patients. Secondly, we were also interested in identifying possible baseline characteristics that may be associated with improvements in pain and disability for sciatica patients. Methods: Twenty-eight patients with a clinical diagnosis of sciatica were treated with neural mobilization, joint mobilization and soft tissue techniques. Pain intensity and lumbar disability were assessed at baseline and after treatment using a Numerical Rating Scale (0-10) and the Oswestry Disability Index (0-100), respectively. The pre- and post-intervention data were compared. The research protocol was registered under the number NCT03663842. Results: Participants attended an average of 16 (SD±5.6) treatmentsessions over an average of 12 weeks. Decrease in pain scores (before median = 8, after median = 2; p < 0.001) and improvement in lumbar disability scores (before median = 33.3%, after median = 15.6%; p < 0.001) were observed. A multiple linear regression analysis showed that duration of pain and age of the patient predicted the disability improvement: F (2, 24) = 4.084, p < 0.030, R2 = 0.254. Discussion: Patients with sciatica may benefit from neural mobilization in combination with manual therapy for pain and lumbar disability. Longer pain duration and younger age had a negative influence on lumbar disability improvement.

Cross-cultural adaptation of the Revised Neurophysiology of Pain Questionnaire into Brazilian Portuguese language / Adaptação transcultural do Questionário Neurofisiológico da Dor revisado para língua portuguesa do Brasil

ABSTRACT Objective To perform a cross-cultural adaptation of the Neurophysiology of Pain Questionnaire for the Brazilian population (NPQ-BR). Methods A translation and cross-cultural adaptation study were conducted in 11 stages according to standard procedures. Descriptive and inferential statistics were performed. The internal consistency of the questionnaire was assessed using Cronbach's Alpha test (α). Results Four translators, six experts, twenty-one patients and ten physiotherapists participated in the study. The NPQ-BR was obtained after seven versions. The expert committee adapted four out of twelve items (item 1, 3, 11, and 12) to adapt the content of the instrument to the Brazilian context. The pre-test phase showed good internal consistency (α = 0.63). The comparison of the correct answers of the questionnaire between the groups (physical therapist group mean = 7.0 ± 1.7; patient group mean = 3.7 ± 2.1; p < 0.01) confirmed the discriminative validity of the NPQ-BR. Conclusion The Neurophysiology of Pain Questionnaire was cross-culturally adapted into a Brazilian context and can be used to assess the level of neurophysiological knowledge of pain of Brazilian patients. The interpretation of the results of the NPQ-BR must be taken with caution due to the absence of a robust validation methodology of the instrument.

RESUMO Objetivo Realizar a adaptação transcultural do Questionário Neurofisiológico de Dor (QND) para a população brasileira. Métodos Um estudo de tradução e adaptação transcultural foi conduzido em 11 estágios de acordo com procedimentos padronizados. Foi realizada estatística descritiva e inferencial. A consistência interna do questionário foi avaliada pelo teste de Alfa de Cronbach (α). Resultados Participaram do estudo quatro tradutores, seis especialistas, vinte e um pacientes e dez fisioterapeutas. A versão brasileira do QND foi obtida após sete versões. O comitê de especialistas adaptou quatro dos doze itens (item 1, 3, 11 e 12) para ajustar o conteúdo do instrumento ao contexto brasileiro. A fase de pré-teste evidenciou boa consistência interna (α = 0,63). A comparação dos acertos dos itens do questionário entre os grupos (média dos fisioterapeutas = 7,0 ± 1,7; média dos pacientes = 3,7 ± 2,1; p < 0,01) confirmou a validade discriminativa da versão brasileira do QND. Conclusão O Questionário Neurofisiológico de Dor revisado foi adaptado para o contexto brasileiro e pode ser utilizado para avaliar o nível de conhecimento neurofisiológico da dor de pacientes brasileiros. A interpretação dos resultados da versão brasileira do QND deve ser feita com cautela devido à ausência de metodologia robusta de validação do instrumento.

Trial Protocol: Cognitive functional therapy compared with combined manual therapy and motor control exercise for people with non-specific chronic low back pain: protocol for a randomised, controlled trial.

INTRODUCTION: Chronic low back pain is a public health problem, and there is strong evidence that it is associated with a complex interaction of biopsychosocial factors. Cognitive functional therapy is an intervention that deals with potentially modifiable multidimensional aspects of pain (eg, provocative cognitive, movement and lifestyle behaviours). There is evidence (from a single randomised, controlled trial) that cognitive functional therapy is better than combined manual therapy and motor control exercise. However, this study had significant methodological shortcomings including the failure to carry out an intention-to-treat analysis and a considerable loss of follow-up of participants. It is important to replicate this study in another domain through a randomised clinical trial with similar objectives but correcting these methodological shortcomings. AIM: To investigate the efficacy of cognitive functional therapy compared to combined manual therapy and exercise on pain and disability at 3 months in patients with chronic non-specific low back pain. DESIGN: Two-group, randomised, multicentre controlled trial with blinded assessors. PARTICIPANTS AND SETTINGS: One hundred and forty-eight participants with chronic low back pain that has persisted for >3months and no specific spinal pathology will be recruited from the school clinic of the Centro Universitário Augusto Motta and a private clinic in the city of Rio de Janeiro, Brazil. INTERVENTION A: Four to 10 sessions of cognitive functional therapy. The physiotherapists who will treat the participants in the cognitive functional therapy group have previously attended 2 workshops with two different tutors of the method. Such physiotherapists have completed 106 hours of training, including workshops and patient examinations, as well as conducting a pilot study under the supervision of another physiotherapist with>3 years of clinical experience in cognitive functional therapy. INTERVENTION B: Four to 10 sessions of combined manual therapy and motor control exercises. Participants in the combined manual therapy and exercise group will be treated by two physiotherapists with an average of >10years of clinical experience in manual therapy and motor control exercises, including isolated contractions of the deep abdominal muscles. MEASUREMENTS: The primary outcome measures will be pain intensity and disability 3 months after randomisation. Secondary outcomes will be pain and disability assessed 6 and 12 months after randomisation, and both global perceived effect and patient satisfaction at 3, 6 and 12 months after randomisation. The potential outcome mediators will be assessed at 3 and 6 months after randomisation, with brief screening questions for anxiety, social isolation, catastrophisation, depression, fear of movement, stress and sleep. Non-specific predictors and moderators will include age, gender, duration of chronic low back pain, chronicity risk (Örebro and Start Back score), number of pain areas, stressful life event, MRI scan imaging, and family history. ANALYSIS: Intention-to-treat analysis will be performed. Linear mixed models will be used to compare the mean differences in pain intensity, disability and global perceived effect between the intervention arms. The analysis of the effect of potential mediators of the treatment will be performed using the causal mediation methods described by Imai and colleagues. The baseline variables will be evaluated as predictors and moderators of treatment, including terms and interaction models. A level of statistical significance of 5% will be used in the analysis. All the analyses will be performed using RStudio. SIGNIFICANCE: This study will investigate whether the results of the first cognitive functional therapy randomised clinical trial are reproducible. The present study will have a sample size capable of detecting clinically relevant effects of the treatment with a low risk of bias. In pragmatic terms, this clinical trial is designed to reproduce the intervention as it would be performed in clinical practice by a trained physiotherapist who works with cognitive functional therapy, which increases the relevance of this study. The combined manual therapy and exercise group comprises an intervention strategy widely used by physiotherapists to treat low back pain. As evidence of efficacy is still limited, the results of a randomised, controlled clinical trial of high methodological quality will help physiotherapists in clinical decision-making.

Estado funcional de pacientes com quadro crônico de ciatalgia / Functional status of patients with chronic sciatica

Introdução: Dor lombar persistente e ciatalgia são queixas comuns na população geral. A dor lombar é amplamente estudada, porém o estado funcional de pacientes com quadro crônico de ciatalgia é pouco descrito. Objetivo: O objetivo deste estudo foi descrever o estado funcional de pacientes com ciatalgia. Métodos: Estudo transversal foi conduzido em 44 pacientes com ciatalgia. Os pacientes preencheram a Escala Numérica de Dor (END) e o questionário Oswestry Disability Index (ODI). Um exame físico foi realizado com avaliação clínica e os testes funcionais: teste de caminhada de 10 metros e a Síndrome de Disfunção de Movimento (SDM). Foi realizada a estatística descritiva e a correlação das variáveis. Resultados: A média de idade observada foi de 58,1 anos, com alta intensidade (END = 7,57) e duração (31,22 meses) de dor. A média de incapacidade autopercebida foi 32,79% e foi observada redução da velocidade de caminhada em 97,7% dos participantes. A intensidade da dor, levantar, ficar de pé e sentar foram os itens mais prejudicados. A SDM mais prevalente foi rotação com extensão (48,6%). O Índice de Massa Corporal e desempenho da caminhada se correlacionaram. Conclusão: A velocidade da caminhada e a capacidade funcional estão comprometidas nos pacientes com ciatalgia. (AU)

Introduction: Persistent back pain and sciatica are common complaint in the general population. Back pain is widely studied, but the functional status of sciatica patients is poorly described. Objective: The aim of this study was to describe the functional status of patients with sciatica. Methods: This cross-sectional study was conducted in 44 sciatica patients. The patients filled a Numeric Rating Pain Scale (NRPS) and the Oswestry Disability Index (ODI). A physical examination was performed with clinical examination and functional tests: ten meters walk test (TWT) and Lumbar Movement Impairment. A descriptive statistics and variables correlation was performed. Results: The mean age observed was 58.1 years, with a high intensity (NRPS = 7.57) and duration (31.22 months) of pain levels. Self-perceived disability average was 32.79% and lower walking speed was observed on 97.7% of the sample. Pain intensity, lifting, standing, and siting section were the most impaired sections. The most prevalent lumbar syndrome was rotation with extension (48.6%). Body mass index and gait performance were correlated. Conclusion: The walking speed and functional capacity are affected in patients with sciatica. (AU)

The effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain.

Anterior knee pain is a common complaint and can cause difficulty with its inability to bear weight. The aim of the study was to analyse the effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain. A clinical trial with 18 patients with a clinical diagnosis of anterior knee pain was conducted. One group (E) with nine individuals was treated with hip muscle strengthening exercises; another group (EM), with nine individuals, had myofascial techniques added. To quantify the results, the Numeric Pain Rating Scale (NPRS) and the Lower Extremity Functional Scale (LEFS) were used. The E group showed an improvement in pain (p = 0.02), but not in the mean degree of disability. The EM group showed an improvement in pain (p = 0.01), as well as the degree of disability (p = 0.008). The effect size analysis showed that participants of the EM group had a greater impact on clinical pain and disability (Cohen's d = .35 and .30, respectively). The addition of myofascial techniques should be considered to improve the functionality of the lower limbs and reduce pain in patients with anterior knee pain.

Satisfaction measurement instruments for healthcare service users: a systematic review.

Patient satisfaction surveys can be an interesting way to improve quality and discuss the concept of patient-centered care. This study aimed to conduct a systematic review of the validated patient satisfaction measurement instruments applied in healthcare. The systematic review searched the MEDLINE/PubMed, LILACS, SciELO, Scopus and Web of Knowledge. The search strategy used the terms: "Patient Satisfaction" AND "Patient centered care" AND "Healthcare survey OR Satisfaction questionnaire" AND "Psychometric properties". 37 studies were included and almost all studies showed that satisfaction is a multidimensional construct. In these studies, 34 different instruments were used and most surveys contained the dimension patient-healthcare professional interactions, physical environment and management process. The COSMIN score for methodological quality showed that most of them scored a good or fair average. We can conclude that there is not a gold standard instrument for patient satisfaction assessment but some dimensions are essential for this construct.

Satisfaction measurement instruments for healthcare service users: a systematic review / Instrumentos para mensuração de satisfação de usuários de serviços de saúde: uma revisão sistemática / Los instrumentos para medir la satisfacción del usuario de los servicios de salud: una revisión sistemática

Patient satisfaction surveys can be an interesting way to improve quality and discuss the concept of patient-centered care. This study aimed to conduct a systematic review of the validated patient satisfaction measurement instruments applied in healthcare. The systematic review searched the MEDLINE/PubMed, LILACS, SciELO, Scopus and Web of Knowledge. The search strategy used the terms: "Patient Satisfaction" AND "Patient centered care" AND "Healthcare survey OR Satisfaction questionnaire" AND "Psychometric properties". 37 studies were included and almost all studies showed that satisfaction is a multidimensional construct. In these studies, 34 different instruments were used and most surveys contained the dimension patient-healthcare professional interactions, physical environment and management process. The COSMIN score for methodological quality showed that most of them scored a good or fair average. We can conclude that there is not a gold standard instrument for patient satisfaction assessment but some dimensions are essential for this construct.

Questionários para satisfação dos pacientes podem ser uma boa maneira para melhorar a qualidade e discutir aspectos do cuidado centrado no paciente. O objetivo foi conduzir uma revisão sistemática referente a instrumentos já validados para mensuração de satisfação de pacientes em serviços de saúde. A revisão sistemática realizou buscas nas bases MEDLINE/PubMed, LILACS, SciELO, Scopus and Web of Knowledge. A estratégia de busca foi: "Patient Satisfaction" AND "Patient centered care" AND "Healthcare survey OR Satisfaction questionnaire" AND "Psychometric properties". Trinta e sete estudos foram incluídos e quase todos demonstraram que a satisfação é um construto multidimensional. Foram encontrados 34 diferentes instrumentos e a maioria deles possuía as dimensões paciente-profissional da saúde, ambiente físico e processos gerenciais. A pontuação COSMIN em qualidade metodológica dos artigos indicou que a maioria apresenta um valor bom ou médio neste aspecto. Não existe um padrão ouro para mensuração da satisfação do paciente, mas algumas dimensões são essenciais para este construto.

Los cuestionarios para la satisfacción del paciente pueden ser una buena opción de mejorar la calidad y discutir la atención centrada en el paciente. El objetivo era llevar a cabo una revisión sistemática, en relación con los instrumentos previamente validados para medir la satisfacción de los pacientes. La revisión sistemática realizó búsquedas en las bases de datos MEDLINE/PubMed, LILACS, SciELO, Scopus y Web of Knowledge. La estrategia de búsqueda fue: "Patient Satisfaction" AND "Patient centered care" AND "Healthcare survey OR Satisfaction questionnaire" AND "Psychometric properties". Se incluyeron treinta y siete estudios y casi todos han demostrado que la satisfacción es multidimensional. Se encontraron 34 instrumentos y la mayoría contaba con las dimensiones: interacción paciente-profesional de la salud, entorno físico y procesos administrativos. La puntuación COSMIN en calidad metodológica indica que la mayoría de los estudios tiene un valor bueno o medio. No existe un estándar clave para la medición de la satisfacción del paciente, pero algunas dimensiones son esenciales para este constructo.

Instrumentos para mensuração de satisfação de usuários de serviços de saúde: uma adaptação transcultural do instrumento MedRisk para o contexto brasileiro / Instruments for measuring health service user satisfaction: a cross-cultural adaptation of MedRisk instrument for the Brazilian context

A satisfação dos pacientes é um eixo importante relacionado ao cuidado centrado no paciente e, consequentemente, está imbricada nas discussões referentes à qualidade do cuidado. Existem diferentes instrumentos para mensuração da satisfação disponíveis para diversas especialidades do campo da saúde. Especificamente na fisioterapia, o instrumento MedRisk (composto por duas dimensões e 12 itens) se destaca atualmente pelo interesse de diferentes grupos de pesquisadores. O objetivo do estudo foi conduzir o processo de adaptação transcultural do instrumento Medrisk para mensuração da satisfação do paciente para o contexto brasileiro. Assim, a metodologia foi desenvolvida em duas etapas: (i) Equivalência conceitual, equivalência de itens e equivalência semântica; (ii) Equivalência de mensuração - psicometria (avaliação da validade dimensional, itens componentes e avaliação da confiabilidade). Na primeira etapa, para avaliação das traduções e pertinência dos itens, foi utilizado um painel de especialistas e um pré-teste do instrumento com 55 pacientes do Hospital Universitário Gaffrée e Guinle. Na segunda etapa, foi realizada a análise fatorial exploratória / confirmatória para identificação das dimensões e itens componentes do instrumento, com dados coletados de 325 indivíduos do mesmo serviço onde foi realizado o pré-teste. Foi realizada ainda a avalição da confiabilidade do instrumento, índice de correlação intra-classe e medidas de erro. Na etapa 1, o painel de especialistas propôs a retirada de dois itens devido ao contexto de aplicação do instrumento. O pré-teste identificou dificuldade de compreensão de um item e após modificação semântica, o problema foi minimizado. O resultado das análises indicaram um instrumento com 6 itens específicos e duas medidas globais de satisfação. Três itens foram retidos na dimensão 1- Interpessoal e três na dimensão 2- Estrutura física e apoio ao serviço...

Patient satisfaction is an important construct for patient-centered care concept and it is usually embedded in discussions regarding the quality of care. There are different instruments to measure patient satisfaction available in various specialties of healthcare. Specifically in the physiotherapy the MedRisk instrument gain currently notoriety because the common interest form different researchers groups. The objective of the study was to conduct the MedRisk cross-cultural adaptation for measuring patient satisfaction in the Brazilian context. Therefore, methods have been developed in two stages: (i) Conceptual equivalence, item equivalence, and semantic equivalence; (ii) Measurement Equivalence - psychometry (dimensional validity evaluation, items and realiability). In the first stage it were evaluated the pertinence of the items, relevance of the content for the target population and also the comprehension of the items after the translation to the portuguese language. For this we used a panel of experts and a pre-testing of the instrument in 55 patients from Gaffrée and Guinle Universtity Hospital. In the second stage it was performed an exploratory / confirmatory factor analysis in 325 patients from the same health service of pre-testing to identify the dimensions and items that should remain in the instrument. The reliability of the MedRisk was evaluated also in this phase. Another aspect of reliability was measure with intra-class correlation indices and error measurements. The expert panel proposed the exclusion of two items due to the context of instrument application. The pre-testing identified only one item with difficult comprehension and after semantic adjustment, this issue was resolved. The results proposed an instrument with six specific items and two global measures of satisfaction. Three items were retained in Interpersonal dimension and three other items in Physical structure and service support dimension...