Comparison of supervised exercise therapy with or without biopsychosocial approach for chronic nonspecific low back pain: a randomized controlled trial.

BACKGROUND: A biopsychosocial rehabilitation is recommended for chronic nonspecific low back pain (CNLBP); however, its effectiveness compared to the traditional supervised exercise therapy of CNLBP treatment is still unclear. METHODS: This was a parallel-group randomized controlled clinical trial. The sample consisted of 180 participants of both sexes, aged ≥18 years, with CNLBP for ≥3 months. Using web randomization and concealed allocation, they were assigned to three groups; graded activity receiving cognitive-behavioral therapy, group-based combined exercise therapy and education (GA; n = 59), supervised group-based combined exercise therapy and education (SET; n = 63), and a control group receiving usual care (n = 58). Interventions were administered for 4 weeks (8 sessions). The primary outcome was pain intensity. Outcome measures were collected baseline, after interventions (4 weeks), and during two follow-up periods (3 and 6 months). RESULTS: After the intervention, GA had a significant large effect on pain reduction compared to the control group (MD of 22.64 points; 95% CI = 16.10 to 29.19; p < 0.0001; Cohen's d = 1.70), as well as SET compared with the control group (MD of 21.08 points; 95% CI = 14.64 to 27.52; p < 0.0001; Cohen's d = 1.39), without significant difference between two intervention groups. At 3 and 6 months of follow-up, GA had a statistically significantly better effect in reducing pain, disability and fear-avoidance beliefs, and improving spinal extensor endurance, range of extension and quality of life compared to SET and the control group. A statistically significantly better effect of SET compared with the control group was found in reducing pain, disability, fear-avoidance beliefs, and improving the physical component of quality of life. Harms were not reported. CONCLUSION: This study suggests that graded activity and group-based supervised exercise therapy have beneficial effects over the control group in the treatment of CNLBP. The graded activity was more beneficial than supervised group-based exercise therapy only during the follow-up. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04023162; registration date: 17/07/2019).

Impact of COVID-19 Pandemic on Mental Health of Medical Students at the University of Mostar.

BACKGROUND: Previous studies have shown that medical students are more prone to depression, more tired, and more prone to emotional exhaustion, depersonalization and burnout syndrome than other students. In terms of mental health, they are a "more vulnerable" than individuals of the same age in the general population. In December 2019 in Wuhan (China) the outbreak of pneumonia caused by the new coronavirus captured worldwide attention. The implementation of strict quarantine measures kept a large number of people in self-isolation which affected all aspects of life. Objective of the study is to determine the direct impact of the COVID-19 pandemic on mental health and quality of life of medical students and the differences in the impact between genders and years of study. SUBJECT AND METHODS: This is a cross-sectional study conducted from May 25 to June 5 2020. It includes medical students who resided in the country affected by the COVID-19 pandemic. Participants completed a modified anonymous online questionnaire that assessed the Impact of Event Scale, indicators of negative mental health impacts, social and family support, and lifestyle changes due to a pandemic. RESULTS: The mean IES score in the participants showed a moderate stressful impact, with the mean IES score of females being significantly higher than that of males (29 vs. 19) with p<0.001. More than half of the participants had an IES score ≥26. With the onset of the pandemic, 71.5% of all medical students reported feeling increased stress from commitments. CONCLUSIONS: the pandemic had stressful impact on the mental health of medical students and it was significantly more stressful for women and students in the preclinical years of study. The COVID-19 pandemic had no impact on social and family support, however a positive impact on the lifestyle of medical students was found.