Effects of therapeutic alliance on clinical outcomes in patients with symptomatic knee osteoarthritis undergoing an exercise program: A randomized clinical trial protocol.

BACKGROUND: Previous evidence has shown that seniors physical therapists applying electrotherapy and an enhanced therapeutic alliance in their sessions can positively influence the levels of analgesia of patients with chronic low back pain. It is currently unknown if these effects can be achieved in people with symptomatic knee osteoarthritis when receiving treatment focused on therapeutic exercise. AIM: To determine the effects of different therapeutic alliance levels during the application of a therapeutic exercise program on pain intensity and pressure pain threshold in patients with symptomatic knee osteoarthritis. METHOD: This will be a randomized, parallel, two-arm, clinical trial. An intervention of three sessions of therapeutic exercise will be applied for one week. Patients aged 45 to 65 years old with a clinical and radiographic diagnosis of knee osteoarthritis will participate. Also, patients with a pain intensity of at least three months duration and 3 to 8 points in a numerical rating scale will be included. Patients will be randomly assigned to a therapeutic exercise experimental group with an enhanced therapeutic alliance (e.g., active listening, personalized conversation, empathy) or limited therapeutic alliance (e.g., one-way verbalization, brief interaction). Physical therapists will be trained in delivering these two levels of the therapeutic alliance. The pressure pain thresholds at the symptomatic knee and the pain intensity will be measured before and after the intervention. DISCUSSION: The results of this research will determine the impact of the therapeutic alliance as a nonspecific relevant factor during the application of a therapeutic exercise program in the treatment of patients with symptomatic knee osteoarthritis. CLINICAL TRIALS REGISTRATION NUMBER: NCT04390932.

ANTECEDENTES: Evidencia previa ha demostrado que los fisioterapeutas expertos que aplican electroterapia junto con una alianza terapéutica mejorada pueden influir positivamente en los niveles de analgesia de los pacientes con dolor lumbar crónico. Actualmente se desconoce si estos efectos se pueden lograr en personas con artrosis de rodilla sintomática cuando reciben un tratamiento basado en ejercicio terapéutico. OBJETIVO: Determinar los efectos de diferentes niveles de alianza terapéutica durante la aplicación de un programa de ejercicio terapéutico sobre la intensidad del dolor y el umbral del dolor a la presión en pacientes con artrosis de rodilla sintomática. MÉTODO: Este será un ensayo clínico aleatorizado, paralelo, de dos brazos. Se aplicará una intervención de tres sesiones de ejercicio terapéutico durante una semana. Participarán personas de 45 a 65 años con diagnóstico clínico y radiográfico de artrosis de rodilla sintomática, con intensidad del dolor entre 4-7 puntos en la escala numérica del dolor con al menos 3 meses de duración. Los participantes serán asignados al azar a un grupo experimental de ejercicio terapéutico con una alianza terapéutica mejorada (por ejemplo, escucha activa, conversación personalizada, empatía) o alianza terapéutica limitada (por ejemplo, verbalización unidireccional, breve interacción). Se capacitará a los fisioterapeutas para brindar estos dos niveles de alianza terapéutica. Los umbrales del dolor a la presión en la rodilla sintomática y la intensidad del dolor se medirán antes y después de la intervención. DISCUSIÓN: Los resultados de esta investigación determinarán el impacto de la alianza terapéutica como factor inespecífico durante la aplicación de un programa de ejercicio terapéutico en el tratamiento de pacientes con artrosis de rodilla sintomática. NÚMERO DE REGISTRO DE ENSAYOS CLÍNICOS: NCT04390932.

A preliminary investigation into the effects of active interferential current therapy and placebo on pressure pain sensitivity: a random crossover placebo controlled study.

OBJECTIVE: (1) To determine the effect of active and placebo interferential current on muscle pain sensitivity using an experimental mechanically induced pain model. (2) To evaluate the predictive role of expectations, gender, baseline muscle pain sensitivity, and intervention order on placebo response. DESIGN: Randomized placebo controlled cross-over trial. SETTING: University research laboratory. PARTICIPANTS: Forty healthy volunteers (20 females, 20 males). INTERVENTIONS: Active interferential current, placebo (sham) interferential current, and no treatment/control were applied to the lumbar area on different days. MAIN OUTCOMES MEASURES: Pressure pain thresholds and placebo response. RESULTS: The two-way ANOVA with repeated measures analysis determined a significant interaction between condition and time (P=0.002). Pairwise comparisons found differences between active interferential and the control condition at 15 minutes into treatment (mean difference=0.890 kg/cm(2), 95% CI 0.023 to 1.757, P=0.043) and at 30 minutes into treatment (mean difference=0.910 kg/cm(2), 95% CI 0.078 to 1.742, P=0.028). The increase in pressure pain thresholds between the active interferential and the control condition (1.12 kg/cm(2)) was clinically meaningful. Logistic regression analysis showed that the condition sequence order was the only variable that predicted placebo response (odds ratio 9.7; P=0.028). If a subject started the sequence receiving placebo treatment first, the odds of responding to placebo would be approximately 10 times higher (i.e. 90% probability of being a placebo responder) than that of starting with an active treatment. CONCLUSIONS: Active interferential was more efficient than control condition in decreasing muscle pain sensitivity. Placebo interferential was not significantly different from control. Treatment sequence demonstrated a strong association with placebo response. These findings have implications for future research characterizing and identifying placebo responders in physiotherapy.

Effects of exercise therapy on endogenous pain-relieving peptides in musculoskeletal pain: a systematic review.

OBJECTIVE: To review the literature regarding the effects of exercise in patients with musculoskeletal pain on modifying: (1) the plasma or cerebral spinal fluid concentrations of pain-relieving peptides and (2) changing the cerebral activity of areas linked with pain processing and modulation systematically. METHODS: An extensive search of bibliographic databases including MEDLINE, EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, ISI Web of Science, Scopus, PeDro, AMED, and CINAHL was made. Two independent investigators screened the titles of publications and completed quality assessment of the selected studies. RESULTS: The search of the literature resulted in a total of 1819 published studies. Of these only 1 study of low methodological quality was considered to be relevant. The agreement between reviewers to select the articles was κ=1. The agreement for the methodological quality evaluation was κ=0.9. DISCUSSION: Given the small number of studies identified and the low quality of research, no firm conclusions could be reached about the impact of therapeutic exercise on modifying concentrations of pain-relieving peptides or its effect on changing the cerebral activity of areas linked with pain processing in patients with musculoskeletal pain. There is a clear need for well-designed trials examining exercise therapy interventions and their effect on both pain-relieving peptides and cerebral activity in patients with musculoskeletal pain.

Does amplitude-modulated frequency have a role in the hypoalgesic response of interferential current on pressure pain sensitivity in healthy subjects? A randomised crossover study.

OBJECTIVE: To investigate the hypoalgesic effect of amplitude-modulated frequency during interferential current therapy using an experimentally induced mechanical pain model in normal subjects. This study examined pain pressure sensitivities achieved when the amplitude-modulated frequency parameter was present (100Hz) and absent (0Hz). DESIGN: Randomised controlled crossover trial with repeated measures. SETTING: University research laboratory. PARTICIPANTS: Forty-six healthy volunteers (23 males, 23 females). INTERVENTIONS: Two interferential therapy protocols (with and without amplitude-modulated frequencies) were applied to the lumbar area on two different days. MAIN OUTCOME MEASURES: Pressure pain thresholds over the lumbar area were measured before, during and after application of the interferential therapy protocols. RESULTS: A three-way analysis of variance with repeated measures failed to show any statistically significant difference between the two protocols in modifying pressure pain threshold values (mean difference 0.017kg/cm(2), 95% confidence interval -0.384 to 0.350, P=0.93). Statistically significant differences were identified (P<0.001) between measurements, indicating a comparable decrease in pain sensitivity in both groups. However, the increase in pressure pain thresholds (0.76kg/cm(2)) failed to reach a level of clinical importance. CONCLUSIONS: The addition of an amplitude-modulated frequency parameter to interferential therapy did not influence mechanical pain sensitivity in healthy subjects. Amplitude-modulated frequency is therefore unlikely to have a physiological hypoalgesic effect.

Alteraciones posturales en niños escolares de la Ciudad de Talca de distinto nivel socioeconómico / Postural alterations in scholastic children of the City of Talca of different socioeconomic level

Introducción: Conocer la prevalencia de alteraciones posturales en escolares de distinto nivel socioeconómico permite detectar, oportunamente, anomalías posturales.Método: Se realizó un examen postural estático a dos grupos de escolares de Talca, de 10 a 12 años de edad. Un grupo formado por 75 escolares de nivel socioeconómico medio-alto y el otro por 80 escolares de nivel socioeconómico medio-bajo. Se calculó el porcentaje de niños con y sin alteraciones, estableciendo luego las diferencias entre los grupos para alteraciones a nivel segmentario, utilizando la prueba de diferencia de proporciones (p 0.05).Resultados: En el grupo de nivel socioeconómico medio-bajo existe mayor porcentaje de escolares que presentan alteraciones posturales; obteniendo diferencias significativas en la presencia de pie plano, genu valgo, escoliosis y actitudes escolióticas, lordótica y cifótica.Conclusiones: Los escolares de nivel socioeconómico medio-bajo presentan, con mayor frecuencia, alteraciones en la postura.

Transporte de glucosa en músculo esquelético: insulina, ejercicio físico y diabetes mellitus tipo 2 / Skeletal muscle glucose transport: insulin, physical exercise and diabetes mellitus type 2

La glucosa es un sustrato energético fundamental y su transporte y metabolismo debe mantenerse bajo un delicado control. Alteraciones por déficit o por exceso generan importes complicaciones para la salud del ser humano y el conocimiento de los mecanismos que regulan su homeostasis permite una mejor aproximación al tratamiento de disfunciones como el síndrome de insulino resistencia o la diabetes mellitus. Esta revisión muestra los aspectos moleculares fundamentales, relacionados con el control de la glicemia, haciendo énfasis en el transporte de la glucosa a través de la membrana plasmatica, así como en las rutas de señalización molecular utilizadas por los dos estímulos más importantes en su control, insulina y ejercicio físico, tanto en condiciones de salud, como en presencia de diabetes mellitus