'It's very complicated': Perspectives and beliefs of newly graduated physiotherapists about the biopsychosocial model for treating people experiencing non-specific low back pain in Brazil.

Non-specific low back pain is a common complaint frequently presented by patients and this complex clinical condition has challenged the biomedical model. The Biopsychosocial (BPS) model is recognized as an option for better guidance and patient management. However, physiotherapy training is based on the biomedical perspective, added to which, in clinical practice the applicability of the BPS model is a challenge for many professionals. In this article, we explore the feelings, beliefs, and attitudes of newly trained physiotherapists about using the BPS model to treat people with non-specific low back pain. It also aims to understand to what extent these physiotherapists are willing and prepared to use this model. Method: A qualitative phenomenological research was carried out in the Brazilian federal capital. A set of criteria was used to select 10 physiotherapists. The data were collected through semi-structured interviews and analyzed using five steps: familiarization, identification, indexation, mapping, and interpretation. Results: We identified one theme and three categories. The theme 'a practitioner physiotherapist can consider BPS aspects, but it is not necessary in his/her role to approach them' explains a shared belief about the use of BPS. The theme is better understood when looking at the three categories that explore and exemplify key elements of the theme: (i) understanding the BPS model and its relation to non-specific low back pain; (ii) the role of practitioner physiotherapists regarding the BPS model; and (iii) barriers: from undergraduate training to clinical settings.

Effects of Elastic Resistance Exercise on Muscle Strength and Functional Performance in Healthy Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Elastic Resistance Exercise (ERE) has already demonstrated its effectiveness in older adults and, when combined with the resistance generated by fixed loads, in adults. This review summarizes the effectiveness of ERE performed as isolated method on muscle strength and functional performance in healthy adults. METHODS: A database search was performed (MEDLine, Cochrane Library, PEDro and Web of Knowledge) to identify controlled clinical trials in English language. The mean difference (MD) with 95% confidence intervals (CIs) and overall effect size were calculated for all comparisons. The PEDro scale was used assess the methodological quality. RESULTS: From the 93 articles identified by the search strategy, 5 met the inclusion criteria, in which 3 presented high quality (PEDro > 6). Meta-analyses demonstrated that the effects of ERE were superior when compared with passive control on functional performance and muscle strength. When compared with active controls, the effect of ERE was inferior on function performance and with similar effect on muscle strength. CONCLUSIONS: ERE are effective to improve functional performance and muscle strength when compared with no intervention, in healthy adults. ERE are not superior to other methods of resistance training to improve functional performance and muscle strength in health adults.

Immediate changes in electroencephalography activity in individuals with nonspecific chronic low back pain after cranial osteopathic manipulative treatment: study protocol of a randomized, controlled crossover trial.

BACKGROUND: Osteopathic medicine is based on a diagnostic and therapeutic system to treat tissue mobility/ motility dysfunctions in general, using different approaches (depending on the target tissue) known as osteopathic manipulative treatment. Among the available techniques those ones addressed to the cranial field are the most questioned because of the lack of scientific evidence; but the compression of the 4th ventricle technique has been largely studied in clinical trials. Studies have shown that the technique may affect both central and autonomous nervous system, modulating some reflexes (Traube-Hering baro signal), and modifying brain cortex electrical activity through central sensitization in subjects with chronic low back pain. Thus, investigators hypothesize that the compression of the 4th ventricle may modulate peak alpha frequency (eletroencephalographic assessment) and promote physical relaxation in subjects in vigil. METHODS/DESIGN: A randomized, controlled crossover trial with blinded assessor was designed to test the hypothesis. A total of 81 participants will be assigned to three treatment conditions, with seven days of washout: (I) compression of the 4th ventricle; (II) sham compression of the fourth ventricle; (III) control (no intervention). The (I) power amplitude and the (II) frequencies of the dominant peak in the alpha band will be the primary outcome measures of the study. All participants will be recruited at the Outpatient Rehabilitation Service of the University Hospital of Brasília-University of Brasília. All the electroencephalographic exams will be conducted by a blinded assessor. DISCUSSION: The investigators hypothesize that patients with chronic low back pain submitted to the technique would have the peak alpha frequency modulated and, thus, would experience physical relaxation. TRIAL REGISTRATION: NCT02111382.