Association between patient independence in performing an exercise program and adherence to home exercise program in people with chronic low back pain.

BACKGROUND: A high percentage of patients with chronic low back pain (LBP) do not adequately adhere to home exercise programs. There is no information regarding a possible association between patient independence in performing an exercise program and adherence to this exercise program. OBJECTIVE: To assess a possible association between patient independence in performing two different home exercise programs (treatment based on the Movement System Impairment-Based classification model (MSI) and treatment based on stretching and strengthening exercises for chronic LBP and adherence to those exercise programs. DESIGN: This was a secondary analysis of a randomized controlled trial. METHODS: The physical therapist assessed the patient's independence in performing the exercise program at the initial physical therapy sessions. Adherence was calculated during the 8-week treatment by the number of days performing the home exercise programs. Multivariate linear regression models were built to investigate whether patient independence in performing the home exercise program was associated with adherence to home exercise program for each treatment group adjusted for possible confounders (age, physical activity status, pain duration, pain intensity and disability at baseline). RESULTS: We observed a clinically important association between patient independence in performing the home exercise and adherence to a treatment based on the MSI model group (ß = -15.6 days, 95%CI = -24.5 to -6.7, R2 = 16%, p = 0.001). CONCLUSIONS: People with chronic LBP adhered more to a home exercise program based on the MSI model when they are more independent in performing the exercise program.

Baseline characteristics did not identify people with low back pain who respond best to a Movement System Impairment-Based classification treatment.

STUDY DESIGN: Secondary analysis of data from a randomized controlled trial. BACKGROUND: Treatment based on the Movement System Impairment-Based classification for chronic low back pain results in the same benefit when compared to other forms of exercise. It is possible that participant's characteristics measured at baseline can identify people with chronic low back pain who would respond best to a treatment based on the Movement System Impairment model. OBJECTIVES: To assess if specific characteristics of people with chronic low back pain measured at baseline can modify the effects of a treatment based on the Movement System Impairment model on pain and disability. METHODS: Four variables assessed at baseline that could potentially modify the treatment effects of the treatment based on the Movement System Impairment model were selected (age, educational status, physical activity status and STarT back tool classification). Separate univariate models were used to investigate a possible modifier treatment effect of baseline participant's characteristics on pain and disability after the treatment. Findings of interaction values above 1 point for the outcome mean pain intensity or above 3 points for disability (Roland Morris questionnaire) were considered clinically relevant. RESULTS: Linear regression analyses for the outcomes of pain and disability did not show interaction values considered clinically relevant for age, educational status, physical activity status and STarT back tool classification. CONCLUSION: Age, educational status, physical activity status and STarT back tool classification did not modify the effects of an 8-week treatment based on the Movement System Impairment model in patients with chronic low back pain. Registered at www.clinicaltrials.gov: NCT02221609 (https://clinicaltrials.gov/ct2/show/NCT02221609).

Dengue endemic and its impact on the gross national product of BRAZILIAN'S economy.

In history disease has caused social and economic damage. Dengue is an illness typically found in the tropics that has affected more and more people. In Brazil, according to the Brazilian Institute of Geography and Statistics (IBGE), in 2013 at least 12.9% of the population (25.8 million) reported already having had dengue in their life. So, how wide are the economic impacts that dengue's contagion has on the gross national product? Using Leontief's method, it became possible to estimate the direct and indirect impact on the workforce and output by one country. Workforce absenteeism reduced the national productiveness and welfare state where we found maximum inoperability of 0.027% and a minimum of 0.002%. This paper develops a methodology for estimation of the impact dengue has incurred in each sector of an economy; designing a ranking with sectors that have been more affected and forecasting the propagation of the endemic throughout a region. This research measures the impact of dengue on economy, the result was that the total loss of the Brazilian economy in 2013 was around BRL 1,023,174,876.83; the importance of 0.02% of the Gross Domestic Product.

Movement System Impairment-Based Classification Versus General Exercise for Chronic Low Back Pain: Protocol of a Randomized Controlled Trial.

BACKGROUND: Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared with rehabilitation programs where the same interventions were applied to all patients. OBJECTIVE: This study will investigate the efficacy of treatment based on a Movement System Impairment (MSI)-based classification model for patients with chronic LBP compared with general exercise. The primary outcomes will be pain intensity and disability at 2 months after randomization. DESIGN: The study is a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor. SETTING: The study setting will be a university physical therapy clinic in Brazil. PARTICIPANTS: A total of 148 individuals with chronic LBP will participate in the study. INTERVENTION: Included individuals will be randomly allocated to participate in an 8-week treatment program based on the MSI-based classification or a general exercise program of stretching and strengthening exercises. MEASUREMENTS: Pain intensity, disability, and global impression of recovery will be assessed by a blinded assessor at baseline and at follow-up appointments after treatment (2 months) and 4 and 6 months after randomization. LIMITATIONS: Therapists will not be blinded. CONCLUSIONS: The results of this study may contribute to a better understanding of the efficacy of treatments based on classification of participants with chronic LBP into subgroups.