RESUMO
When treating patients suffering from chronic low back pain, it is important to determine therapeutic objectives that are realistic, measurable and focused on the activities of everyday life. To help patients and therapists to elaborate these objectives, we developped a clinical tool made of a metric scale graduated from 0 to 10 and of a series of photographs. Within the framework of a semi-structured interview, this tool is a help not only in the detection of relevant activities that may induce fear avoidance behaviours but also in the determination and negotiation of objectives that can be realised in the care process and are adapted to the patient's context of living.
Il est important de déterminer avec les patients souffrant de douleurs chroniques du dos, des objectifs thérapeutiques réalistes, mesurables et qui soient centrés sur les activités de la vie quotidienne. Pour aider patients et thérapeutes dans la détermination de ces objectifs, nous avons développé un outil clinique composé d'une échelle métrique graduée de 0 à 10 et d'une série de photographies. Dans le cadre d'un entretien semi-dirigé, cet outil est non seulement une aide dans la détection des activités significatives pour lesquelles se révèle une kinésiophobie, c'est-à-dire une peur ou une appréhension du mouvement, mais également un support dans la détermination et la négociation d'objectifs adaptés au contexte de vie du patient, réalisables dans le processus de soins.
Assuntos
Dor Lombar , Manejo da Dor , Aprendizagem da Esquiva , Dor Crônica , Medo , Objetivos , Humanos , Dor Lombar/terapia , Manejo da Dor/normas , Medição da Dor , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Several treatments exist for chronic low back pain (cLBP) patients although none has shown superiority. Among group treatments, muscle reconditioning programmes (MRPs) are the most commonly used. Multidisciplinary functional rehabilitation programmes (MFRPs) are an alternative. OBJECTIVE: To compare a MFRP with a MRP as few studies compare these treatments METHODS: This was a prospective, nonrandomised, controlled study comparing cLBP patients participating in a MRP or MFRP in an outpatient setting. The predetermined primary outcome measure was the daily life activity subscale (DLA) of the Dallas Pain Questionnaire (DPQ) within one year after the end of the treatment. RESULTS: Twenty-one patients were included in the MRP and 24 in the MFRP. At inclusion, the groups were similar in terms of age (mean 40 years), sex (50%-60% males), sick leave duration (mean 6.0 months, standard deviation (SD) 4.4 months) and follow up (mean 9.0 months, SD 2.0 months). The DLA score decreased from 59.5% (SD 16.9) to 44.8% (SD 25.4), p <0.01, in the MFRP and from 62.3 (SD 20.3) to 58.8 (SD 20.7), p = 0.3, in the MRP. The between-groups difference at follow-up was 13.8, p = 0.05, and the difference in the mean improvement was -11.5 (5.9), p = 0.058. Seventy-eight percent of MFRP patients versus 47 % in the MRP group returned to work (p = 0.08). DISCUSSION: In a population of highly disabled cLBP patients, MFRP seems more effective in increasing function and return to work. Interpretation is limited by the small population included and by the type of trial. CONCLUSION: Randomised studies are needed to confirm these results and explore the cost-effectiveness of MFRP.
Assuntos
Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Dor Lombar/psicologia , Dor Lombar/reabilitação , Modalidades de Fisioterapia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Retorno ao Trabalho , Licença Médica/estatística & dados numéricosRESUMO
OBJECTIVE: To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits. DESIGN: Randomized trial. SETTING: Rehabilitation center. PARTICIPANTS: Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program. INTERVENTION: The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily. MAIN OUTCOME MEASURES: Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups. RESULTS: At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups. CONCLUSIONS: Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.
