Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain: The SPINE CARE Randomized Clinical Trial.

Importance: Low back and neck pain are often self-limited, but health care spending remains high. Objective: To evaluate the effects of 2 interventions that emphasize noninvasive care for spine pain. Design, Setting, and Participants: Pragmatic, cluster, randomized clinical trial conducted at 33 centers in the US that enrolled 2971 participants with neck or back pain of 3 months' duration or less (enrollment, June 2017 to March 2020; final follow-up, March 2021). Interventions: Participants were randomized at the clinic-level to (1) usual care (n = 992); (2) a risk-stratified, multidisciplinary intervention (the identify, coordinate, and enhance [ICE] care model that combines physical therapy, health coach counseling, and consultation from a specialist in pain medicine or rehabilitation) (n = 829); or (3) individualized postural therapy (IPT), a postural therapy approach that combines physical therapy with building self-efficacy and self-management (n = 1150). Main Outcomes and Measures: The primary outcomes were change in Oswestry Disability Index (ODI) score at 3 months (range, 0 [best] to 100 [worst]; minimal clinically important difference, 6) and spine-related health care spending at 1 year. A 2-sided significance threshold of .025 was used to define statistical significance. Results: Among 2971 participants randomized (mean age, 51.7 years; 1792 women [60.3%]), 2733 (92%) finished the trial. Between baseline and 3-month follow-up, mean ODI scores changed from 31.2 to 15.4 for ICE, from 29.3 to 15.4 for IPT, and from 28.9 to 19.5 for usual care. At 3-month follow-up, absolute differences compared with usual care were -5.8 (95% CI, -7.7 to -3.9; P < .001) for ICE and -4.3 (95% CI, -5.9 to -2.6; P < .001) for IPT. Mean 12-month spending was $1448, $2528, and $1587 in the ICE, IPT, and usual care groups, respectively. Differences in spending compared with usual care were -$139 (risk ratio, 0.93 [95% CI, 0.87 to 0.997]; P = .04) for ICE and $941 (risk ratio, 1.40 [95% CI, 1.35 to 1.45]; P < .001) for IPT. Conclusions and Relevance: Among patients with acute or subacute spine pain, a multidisciplinary biopsychosocial intervention or an individualized postural therapy intervention, each compared with usual care, resulted in small but statistically significant reductions in pain-related disability at 3 months. However, compared with usual care, the biopsychosocial intervention resulted in no significant difference in spine-related health care spending and the postural therapy intervention resulted in significantly greater spine-related health care spending at 1 year. Trial Registration: ClinicalTrials.gov Identifier: NCT03083886.

Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials.

Psychologically informed physical therapy (PIPT) blends psychological strategies within a physical therapist's treatment approach for the prevention and management of chronic musculoskeletal pain. Several randomized trials have been conducted examining the efficacy of PIPT compared to standard physical therapy on important patient-reported outcomes of disability, physical function, and pain. In this review, we examine recent trials published since 2012 to describe current PIPT methods, discuss implications from findings, and offer future directions. Twenty-two studies, representing 18 trials, were identified. The studied PIPT interventions included (1) graded activity or graded exposure (n = 6), (2) cognitive-behavioral-based physical therapy (n = 9), (3) acceptance and commitment-based physical therapy (n = 1), and (4) internet-based psychological programs with physical therapy (n = 2). Consistent with prior reviews, graded activity is not superior to other forms of physical activity or exercise. In a few recent studies, cognitive-behavioral-based physical therapy had short-term efficacy when compared to a program of standardized exercise. There is a need to further examine approaches integrating alternative strategies including acceptance-based therapies (ie, acceptance and commitment therapy or mindfulness) or internet-based cognitive-behavioral programs within physical therapy. Although PIPT remains a promising care model, more convincing evidence is needed to support widespread adoption, especially in light of training demands and implementation challenges.

Musicians injuries: Upper quarter motor control deficits in musicians with prolonged symptoms - A case-control study.

STUDY DESIGN: Case-control study. BACKGROUND: A large number of student and professional musicians are affected by long term playing related musculoskeletal disorders (PRMSDs) during their career, with prevalence rates above 80%. OBJECTIVE: To investigate if there were differences between musicians with and without prolonged symptoms of upper quarter PRMSDs in the presence of: (1) scapular dyskinesis; (2) cervical motor control and endurance deficits. METHODS: Seventy-two musicians (24 males; 48 females) were matched based on sex, type of instrument and average hours played per week and assigned to one of two groups: A symptomatic group (mean age 23.3 ±â€¯8.2 years) with history of prolonged PRMSDs (constant symptoms lasting more than one week) during the past year; and a control group (mean age 25 ±â€¯10.5 years) with no history of PRMSDs lasting more than one week. Musicians completed a questionnaire and underwent clinical testing for the presence of scapular dyskinesis and cervical motor control and endurance deficits using the following tests: (1) cervical flexor endurance test; (2) scapular dyskinesis test; and (3) craniocervical flexion test. Assessor blinding as to group assignment was ensured. RESULTS: Participants in the symptomatic group presented with a statistically significant higher prevalence of positive scapular dyskinesis (P < .0001; OR = 7.8) and lower scores for the craniocervical flexion test (P < .0001). CONCLUSION: Musicians with prolonged symptoms of PRMSDs presented with higher prevalence of scapular and cervical motor control deficits detected by standard clinical tests when compared to the control group. LEVEL OF EVIDENCE: Therapy, level 4. CLINICALTRIALS. GOV IDENTIFIER: NCT02267395.

Cell damage induced by copper: an explant model to study anemone cells.

Sea anemones are benthic organisms, of low mobility and can be directly affected by water pollution. This work studied the defense mechanisms and DNA damage caused by copper toxicity in cells from the anemone Bunodosoma cangicum. For this, exposure of anemones cells were held, kept in primary culture through explant of podal disk to copper (7.8 and 15.6 µg/L), and the control group, for 6 and 24h. Cytotoxicity was seen through the viability and cell number, MXR phenotype through the accumulation of rhodamine-B, ROS generation by H2DCF-DA and DNA damage by comet assay. The results obtained show that there is a drop in viability and number of cells, especially after exposure of 24h in 15.6 µg/L. There is an induction of the MXR activity only at 7.8 µg/L for 24h. As for ROS, there is an increase in the generation of reactive species in greatest concentration of copper for 6h, and in both for 24h, which leads to oxidative stress, which culminates with a DNA damage. What was evidenced by the increase of the tail size, % DNA presented and moment of tail. Therefore, the copper represents an adversity to the anemones cells, being cytotoxic and genotoxic.

Molecular characterization of Giardia duodenalis in dogs from Brazil.

The intestinal protozoan parasite Giardia duodenalis (syn. Giardia intestinalis and Giardia lamblia) is a widespread enteric pathogen in human and domestic animals. This organism is one of the most common parasites in domestic dogs in Brazil. In this study, we determined the occurrence and genetic characterization of G. duodenalis isolated from dogs from south-central São Paulo state, Brazil. A total of 300 fecal samples were collected. Fecal specimens were screened for the presence of G. duodenalis using microscopy (zinc sulfate solution flotation technique) and polymerase chain reaction (PCR) targeting the small subunit ribosomal (SSU-rDNA) and glutamate dehydrogenase (GDH) genes. Genetic characterization was performed using restriction fragment length polymorphisms (RFLP) and sequencing analysis of the GDH gene. In addition, selected samples were further characterized by RFLP and sequencing of the ß-giardin gene. The overall occurrence of G. duodenalis was 17.3% (52/300). The occurrence was higher in stray dogs (28%) than in household dogs (6.25%). Of the 36 PCR-positive samples that were selected for genotyping, only dog-specific genotype C (20 isolates), D (11 isolates) and mixed C + D (five isolates) isolates were detected in the study. This study provides current information on the infection rates of G. duodenalis genotypes in canine populations and describes for the first time the presence of mixed infections within host-specific C and D genotypes in dogs in Brazil. These genotypes were widespread and commonly found in domestic dogs living in urban and suburban environments of the studied area and confirmed the endemic status of Giardia in this region.

[Occurrence of gastrointestinal parasites in dogs and cats in the laboratory of routine of parasitic diseases FMVZ/Unesp-Botucatu, SP]. / Ocorrência de parasitas gastrintestinais em cães e gatos na rotina do laboratório de enfermidades parasitárias da FMVZ/Unesp-Botucatu, SP.

With the object of determining the occurrence and prevalence of parasites in dogs and cats in the region of Botucatu, a survey was conducted from the results of fecal parasitologic exams feces, processed by the laboratory of parasitic diseases of FMVZ-UNESP/Botucatu from January 2002 to December 2006. 1,012 fecal samples of dogs and cats were evaluated by the technique of Willis Mollay and Faust. In dogs the higher incidence was found for Ancylostoma caninum eggs (38%). In cats, the oocysts of Isospora spp were present in 48.38% of positive samples.