ABSTRACT
This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure finished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant "short term" result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.
Subject(s)
Musculoskeletal Manipulations , Neck Pain/rehabilitation , Transcutaneous Electric Nerve Stimulation , Adult , Female , Humans , Intention to Treat Analysis , Male , Middle Aged , Multivariate Analysis , Primary Health Care , SpainSubject(s)
Job Satisfaction , Primary Health Care , Quality of Life , Confidence Intervals , Humans , Motivation , Spain , Surveys and Questionnaires , WorkforceABSTRACT
No disponible
Subject(s)
Humans , Job Satisfaction , Primary Health Care , Quality of Life , Confidence Intervals , Motivation , Surveys and Questionnaires , SpainABSTRACT
OBJECTIVE: To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. DESIGN: Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. PARTICIPANTS: Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. INTERVENTIONS: Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. MAIN VARIABLES: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. DISCUSSION: Restrictions: Hawthorne effect or bias in the person observed and participants stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge.
Subject(s)
Needs Assessment/statistics & numerical data , Physicians/statistics & numerical data , Research Design , Humans , Primary Health Care/statistics & numerical data , Spain , Surveys and QuestionnairesABSTRACT
Objetivo. Determinar las necesidades de información de los médicos de atención primaria de 5 áreas de salud de Madrid mediante la descripción de la frecuencia y el tipo de preguntas clínicas, el patrón de búsqueda y nivel de resolución de éstas. Diseño. Estudio observacional descriptivo. Emplazamiento. Consultas de atención primaria. Áreas de salud 1, 3, 8, 9 y 10 de Madrid. Participantes. Muestra aleatoria, estratificada por zona y tipo de médico, de 125 médicos de cada una de las áreas (Madrid). Se excluye a los médicos residentes, a los suplentes y a los que realizan actividades de enseñanza universitaria. Intervenciones. Se invitará a los médicos a ser observados mediante cámara de vídeo durante aproximadamente 4 h de consulta a demanda. Se les pedirá que especifiquen, entre paciente y paciente, las preguntas que surjan y las fuentes de información utilizadas dentro de la consulta. Las preguntas sin resolver serán seguidas mediante contacto telefónico 2 semanas después para determinar si se han obtenido respuestas y los métodos utilizados. Mediciones principales. Variables principales: número de preguntas clínicas formuladas reconocidas y sus respuestas; número de preguntas clínicas no reconocidas (observadas a través del vídeo); tema y tipo de información de cada pregunta; tiempo utilizado en buscar respuestas; recursos de información utilizados. Otras variables: características de los profesionales de atención primaria participantes, consultas, centros de salud y presión asistencial. Discusión. Una limitación es el efecto Hawthorne o sesgo del observado y miedo escénico de los participantes. En cuanto a la aplicabilidad de los resultados de la investigación, servirán para planificar los recursos necesarios para que los médicos dispongan y apliquen la mejor evidencia científica
Objective. To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. Design. Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. Participants. Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. Interventions. Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. Main measurements. Main variables: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. Discussion: Restrictions: Hawthorne effect or bias in the person observed and participants´ stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge
