Risk of unfavorable pain prognosis impacts walking physiomechanical parameters and psychophysiological workload in sufferers of chronic low back pain.

BACKGROUND: Tolerating physical tasks depends not only on task-specific characteristics but also on an individual's psychophysiological capacity to respond to the imposed load. People suffering from chronic low back pain (CLBP) may experience reduced psychophysiological capacity and are at risk for poor pain prognosis, which could lead to an increased walking workload. AIM: To investigate how the risk of unfavorable pain prognosis in CLBP can impact walking physiomechanical parameters and psychophysiological workload. METHODS: A cross-sectional observational study. The study classified 74 volunteers into four groups based on their prognosis for pain: pain-free control (CG/n = 20), low (LrG/n = 21), medium (MrG/n = 22), and high (HrG/n = 11) risk of poor prognosis for CLBP. The ground assessments identified the self-selected (SSW) and optimal (OWS) walking speeds, as well as the locomotor rehabilitation index (LRI). Treadmill assessments were conducted at two different speeds (0.83 and 1.11 m s-1, SSW and OWS) to record physiomechanical parameters. Psychophysiological workloads during walking were measured via workload impulse for the session (TRIMP), determined by variations in heart rate. RESULTS: CLBP groups exhibited slower SSW and lower LRI compared to the CG. The TRIMP was lower in the LrG. However, both MrG and HrG exhibited a comparable overload to the CG, even while walking at a lower intensity with a psychophysical demand. SSW and OWS displayed an increased TRIMP compared to fixed speeds. CONCLUSION: Psychosocial factors may affect SSW in people with CLBP but not among the risk strata. An unfavorable prognosis for pain could jeopardize the psychophysiological capacity to withstand walking demands.

Cryotherapy in Knee Arthroplasty: Systematic Review and Meta-Analysis.

Total knee arthroplasty is performed to relieve knee pain and disability related to end-stage osteoarthritis. Cryotherapy is used as an analgesic method, reducing the intraarticular temperature. The objective of this study was to review the literature on the efficacy of cryotherapy in knee arthroplasty. A total of 700 articles were found in databases according to the search criteria for each database and the included descriptors (EndNote Web). After exclusion of duplicate articles, automatically and manually, Phase 1 was performed-reading of titles and abstracts of 375 articles according to the eligibility criteria by two blinded reviewers using the Rayyan QCRI (Qatar Computing Research Institute) program, conflicts were resolved in consensus between the 2 reviewers. Thus, 21 articles were selected for Phase 2-reading in full, leaving 5 articles for this review. The Cochrane instrument Rob 2 was used to assess the quality of bias of the selected studies, and RevMan 5.4.1 was used for meta-analysis. The age of study participants ranged from 51 to 74 years. The sample size ranged from 37 to 389 subjects, with a total of 648 subjects. The risk of bias was almost entirely high and moderate for all endpoints: pain, range of motion (ROM), and function. There was a decrease in pain level and as secondary endpoints ROM and functionality, there were divergences between studies. It can be concluded that although cryotherapy is indicated to reduce pain in the postoperative period of knee arthroplasty, studies have many methodological biases and the meta-analysis performed could not confirm the effects; therefore, more primary studies are needed to better understand the effects.