Beyond mere respect: new perspectives on dignity for healthcare workplace learning.

Introduction: Although dignity in workplace learning in healthcare is gathering interest, we know little about stakeholders' conceptualizations in this area across professional groups. Dignity breaches in workplace learning are common, often with serious and long-lasting consequences for the affected. Conceptualizations shape behaviours and experiences. To prevent dignity violations in students' learning, it is thus important to understand stakeholders' understandings of the topic. This study therefore explores the dignity conceptualizations around workplace learning that students, placement educators and university staff hold across seven allied health professional groups. Methods: Using a social constructionist perspective, we conducted individual and group narrative interviews (n = 51) with students, placement educators and university workplace learning staff from seven allied health professional groups. We used the 5-step Framework Analysis to explore and develop themes, identifying differences and similarities across stakeholder groups. Results: We identified eight distinct, yet interrelated, dimensions of dignity from participants' narratives: dignity as respect, dignity as self-x (the various relationships we have with ourselves), dignity as feeling safe, dignity as understanding otherness, dignity as supporting others, dignity as equality, dignity as professionalism, and dignity as belonging. Dignity as respect was identified across all participants, although mutual respect and a culture of respect were only present in academic participants' talk. The remaining seven dimensions all present important factors extending our understanding of the construct of dignity. Discussion: In line with existing research, our study identifies the absence of an unambiguous, positive conceptualization of dignity in workplace learning among stakeholders. It adds novelty in two ways: by identifying dignity dimensions that require informed action beyond respecting others, and by revealing a tension between dignity as professionalism and dignity as equality. We suggest revising existing dignity concepts in workplace learning to address this tension and to reinforce that active care, team integration and skilled support are all non-negotiable elements of dignified behaviour within workplace learning.

Psychological distress in early childhood and the risk of adolescent spinal pain with impact.

BACKGROUND: Spinal pain (SP), including neck and back pain, is common and often associated with poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests the stronger influence of psychological rather than other factors. OBJECTIVES: We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence. METHODS: 1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalizing and externalizing symptoms) were converted to age-standardized scores and dichotomized according to t-scores (>60=high distress). Life-time spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models. RESULTS: Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (OR 1.33; 95% CI 1.01-1.76), but not spinal pain with greater impact (OR 1.22; 95% 0.83-1.80). Internalizing symptoms were associated with SP with greater impact and externalizing symptoms with SP with impact after adjusting for a range of potential child and family confounders. CONCLUSION: Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target. SIGNIFICANCE: Our findings provide evidence that psychological distress early in life is an independent risk factor for spinal pain with impact during adolescence. As psychological distress during childhood is potentially modifiable, it may be a promising target for research on the prevention of consequential spinal pain in adolescence. Identifying and addressing psychological distress in children may be an important component of best practice to reduce consequential spinal pain in adolescents.

Estado de humor na Artrite Reumatoide / Mood state in Rheumatoid Arthritis

Introdução: A Artrite Reumatoide (AR) é uma doença autoimune de caráter progressivo e incapacitante, associada a perturbações de humor. Contudo, constata-se pouca atenção aos potenciais efeitos das alterações emocionais. Objetivos: Caracterizar e comparar o estado de humor de pacientes com AR, com base no nível de atividade da doença. Métodos: Foram avaliados 80 indivíduos com AR, com 52,72 ± 15,14 anos. Para avaliação do nível de atividade de doença, foi utilizado o Disease Activity Score-28 (DAS-28). A avaliação do Estado de Humor foi realizada com a Escala de Humor Brasileira (BRAMS). Resultados: Foram observadas alterações de humor nos domínios raiva, tensão e vigor sendo que o grupo classificado em alta atividade da doença apresentou os piores quadros de humor. Conclusão: Estes dados ressaltam a importância de um tratamento multidisciplinar, visando melhora do estado de humor e da qualidade de vida desses indivíduos, conduzindo a uma melhor gestão terapêutica da AR.

Introduction: Rheumatoid arthritis (RA) is a progressive and disabling autoimmune associated with mood disorders. However, little attention is paid to the potential effects on the emotional alterations. Objectives: To characterize and compare the mood state of patients with RA, based on the level of disease activity. Methods: 80 subjects were evaluated with RA, with 52.72 ± 15.14 years. The Disease Activity Score-28 (DAS-28) was used to assess the level of the disease activity. The evaluation of the Mood State was performed with the Brazilian Humor Scale (BRAMS). Results: Mood alterations were observed in the anger, tension and vigor domains, of which the group classified as having a high disease activity had the worst mood pictures. Conclusion: These data highlight the importance of a multidisciplinary treatment aiming to improve the mood and quality of life of these individuals, leading to a better therapeutic management of RA

Effectiveness of telehealth-based interventions in the management of non-specific low back pain: a systematic review with meta-analysis.

BACKGROUND: Telehealth has emerged as a potential alternative to deliver interventions for low back pain (LBP); however, its effectiveness has not been investigated. PURPOSE: The aim of this review was to evaluate whether interventions delivered by telehealth improve pain, disability, function, and quality of life in non-specific LBP. STUDY DESIGN: This is a systematic review with meta-analysis. METHODS: Seven databases were searched from the earliest records to August 2015. Eligible studies were randomized controlled trials that investigated the effectiveness of telehealth-based interventions, solo or in combination with other interventions, for non-specific LBP compared with a control group. Trials deemed clinically homogeneous were grouped in meta-analyses. RESULTS: Eleven studies were included (n=2,280). In chronic LBP, telehealth interventions had no significant effect on pain at short-term follow-up (four trials: 1,089 participants, weighted mean difference [WMD]: -2.61 points, 95% confidence interval [CI]: -5.23 to 0.01) or medium-term follow-up (two trials: 441 participants, WMD: -0.94 points, 95% CI: -6.71 to 4.84) compared with a control group. Similarly, there was no significant effect for disability. Results from three individual trials showed that telehealth was superior to a control intervention for improving quality of life. Interventions combining telehealth and usual care were more beneficial than usual care alone in people with recent onset of LBP symptoms. CONCLUSION: There is moderate-quality evidence that current telehealth interventions, alone, are not more effective than minimal interventions for reducing pain and disability in chronic LBP. To date, modern telehealth media (eg, apps) and telehealth as an adjunct to usual care remain understudied.

Obesity does not increase the risk of chronic low back pain when genetics are considered. A prospective study of Spanish adult twins.

BACKGROUND CONTEXT: Obesity is commonly investigated as a potential risk factor for low back pain (LBP); however, current evidence remains unclear. Limitations in previous studies may explain the inconsistent results in the field, such as the use of a cross sectional design, limitations in the measures used to assess obesity (eg, body mass index-BMI), and poor adjustment for confounders (eg, genetics and physical activity). PURPOSE AND DESIGN: To better understand the effects of obesity on LBP, our aim was to investigate in a prospective cohort whether obesity-related measures increase the risk of chronic LBP outcomes using a longitudinal design. We assessed obesity through measures that consider the magnitude as well as the distribution of body fat mass. A within-pair twin case-control analysis was used to control for the possible effects of genetic and early shared environmental factors on the obesity-LBP relationship. PATIENT SAMPLE AND OUTCOME MEASURES: Data were obtained from the Murcia Twin Registry in Spain. Participants were 1,098 twins, aged 43 to 71 years, who did not report chronic LBP at baseline. Follow-up data on chronic LBP (>6 months), activity-limiting LBP, and care-seeking for LBP were collected after 2 to 4 years. RISK FACTORS: The risk factors were BMI, percentage of fat mass, waist circumference, and waist-to-hip ratio. METHODS: Sequential analyses were performed using logistic regression controlling for familial confounding: (1) total sample analysis (twins analyzed as independent individuals); (2) within-pair twin case-control analyses (all complete twin pairs discordant for LBP at follow-up); and within-pair twin case-control analyses separated for (3) dizygotic and (4) monozygotic twins. RESULTS: No increase in the risk of chronic LBP was found for any of the obesity-related measures: BMI (men/women, odds ratio [OR]: 0.99; 95 % confidence interval [CI]: 0.86-1.14), % fat mass (women, OR: 0.87; 95% CI: 0.66-1.14), waist circumference (women, OR: 0.98; 95% CI: 0.74-1.30), and waist-to-hip ratio (women, OR: 1.05; 95% CI: 0.81-1.36). Similar results were found for activity-limiting LBP and care-seeking due to LBP. After the adjustment for genetics and early environmental factors shared by twins, the non-significant results remained unchanged. CONCLUSIONS: After 2 to 4 years, obesity-related measures did not increase the risk of developing chronic LBP or care-seeking for LBP with or without adjustment for familial factors such as genetics in Spanish adults.

Efeitos da fisioterapia aquática em indivíduos com dor lombar crônica / Effects of aquatic therapy in patients with chronic low back pain

Trata-se de um estudo piloto com objetivo de avaliar o efeito de um programa de fisioterapia aquática na aptidão física, no equilíbrio postural e na dor de pacientes com dor lombar crônica oriunda de hérnia de disco lombar. A amostra foi composta por sete indivíduos,que foram avaliados e submetidos ao programa de tratamento em grupo durante 20 sessões. Como instrumentos foram utilizados: a)Teste Time Up and Go (TUG); b) Teste de Velocidade da Marcha;c) Questionário Rolland Morris e d) Escala Visual Analógica de dor,que foram aplicados antes do início do programa e após a décima e a vigésima sessão. Os resultados demonstram que não houve melhora significativa em nenhuma das variáveis estudadas, embora tenham sido registradas discretas modificações benéficas na velocidade da marcha (0,98 m/s; 1,03 m/s e 1,05 m/s), no tempo do TUG (13,2s; 12,6 s e 11,5 s) e na intensidade da dor (6,42; 5,57 e 5,28). Portanto, o programa de Fisioterapia Aquática proposto promoveu uma discreta alteração no quadro de dor e na capacidade funcional do grupo pesquisado, porém esses dados devem ser vistos com cautela, já que não houve diferença significativa. Assim, sugere-se continuar as investigações utilizando essa terapêutica com número maior de sujeitos.

This pilot study aimed to evaluate the effect of an aquatic therapy program on physical fitness, postural balance and pain in patients with chronic low back pain after lumbar disc herniation. The sample consisted of seven individuals who were evaluated and subjected to the treatment program in group, for 20 sessions. The instruments used were: a) Time up and Go Test (TUG), b) March Speed Test,c) Rolland Morris Disability Questionnaire, and d) Visual Analogue Scale (VAS), which were applied before the program starts and after the tenth and twentieth session. Regarding the results, there was no significant improvement in any of the variables studied, although it was registered a slight increase in walking speed (0.98 m/s, 1.03 m/sand 1.05 m/s), slight decrease in the TUG (13.2 s, 12.6 s and 11.5s) and pain intensity (6.42, 5.57 and 5.28). The refore, the proposed Aquatic Physical Therapy program promoted a little improvement on postural balance and on intensity of pain. However, these results should be viewed with caution since there was no significant difference. Thus, it is suggested to continue investigations using this therapy with larger number of subjects.

Artrite reumatóide e exercício físico: resgate histórico e cenário atual / Rheumatoid arthritis and physical exercise: historical research and current scenario

A Artrite Reumatóide (AR) é considerada uma doença inflamatória crônica, de origem auto-imune e etiologia desconhecida. Além do tratamento fisioterápico e farmacológico, fortes evidências apontam benefícios no uso de exercícios físicos (EF) na sua terapêutica. Porém, ainda não existe consenso quanto ao melhor tipo, intensidade, freqüência e duração. O presente estudo de revisão teve por objetivo realizar um resgate histórico da interpretação e tratamento da doença e expor uma perspectiva atualizada da prescrição de EF para portadores de AR. A seleção das publicações foi realizada a partir das bases de dados Web of Science e Pubmed Central. Outros artigos foram eventualmente incluídos para fortalecer e aprimorar a discussão. Sob a luz da literatura revisada, a terapia com fármacos, repouso e Crisoterapia parecem ter sido a base do tratamento no século passado. Os EF, já mencionados nos primeiros anos de estudos, permanecem até hoje como parte da terapêutica e se configuram cada vez mais como protagonistas na história do controle da AR. É possível admitir que, embora não exista consenso com relação a um protocolo ou programa padrão de EF, existem pontos de comum acordo entre autores que podem ser assumidos como norteadores na confecção de programas terapêuticos para o tratamento da AR. Parece ser fundamental no tratamento da doença que a prática regular de EF seja incluída na rotina da vida diária do paciente o que, em conjunto com a terapia farmacológica, pode proporcionar maior independência e qualidade na vida dos portadores de AR.

The Rheumatoid Arthritis (RA) is considered a chronic inflammatory disease, of autoimmune origin and unknown etiology. Besides the physical therapy and the pharmacological treatment, strong evidences point out to the benefits of the use of physical exercises (PE) in its treatment. However, there is still no consensus regarding the best type, intensity, frequency and duration. The aim of the present study was to perform a historical research of the interpretation and therapeutics of the disease and to expose an up to date perspective of the prescription of PE in the treatment of RA. The selection of these publications was performed on the Web of Science and Pubmed Central data basis. Other articles were eventually included to strengthen and improve the discussion. Regarding the revised literature, the pharmacological therapy, rest and Crisotherapy were the basis for the treatment of the disease. The PE, already mentioned in the first years of study remain until this day as a part of the therapy and seem to be increasingly important in the history of the control of the RA. It is possible to admit that, even though there is no consensus regarding a protocol or a standard program of PE, there are points in which many authors agree, that may be assumed as references in the creation of therapeutic programs for the treatment of RA. It seems to be fundamental in the treatment of the disease that the regular practice of PE is included in the daily routine of the patient, which, along with the pharmacological therapy, may provide a greater independence and quality of life to the people with RA.