Effectiveness of a multidisciplinary BIOPSYCHOSOCIAL intervention for non-specific SUBACUTE low back pain in a working population: a cluster randomized clinical trial.

BACKGROUND: Low back pain (LBP) is a multifactorial condition with individual and societal impact that affects populations globally. Current guidelines for the treatment of LBP recommend pharmacological and non-pharmacological strategies. The aim of this study was to compare usual clinical practice with the effectiveness of a biopsychosocial multidisciplinary intervention in reducing disability, severity of pain and improving quality of life in a working population of patients with subacute (2-12 weeks), non-specific LBP. METHODS: Longitudinal cluster randomized clinical trial conducted in 39 Primary Health Care Centres (PHCC) of Barcelona, with patients aged 18-65 years (n = 501; control group = 239; 26 PHCC, intervention group = 262; 13 PHCC). The control group received usual clinical care. The intervention group received usual clinical care plus a biopsychosocial multidisciplinary intervention, which consisted of physiotherapy, cognitive-behavioural therapy and medication. The main outcomes were changes in the Roland Morris Disability Questionnaire (RMDQ), and the minimal clinically important differences. Secondary outcomes were changes in the McGill Pain (MGPQ) and Quality of Life (SF-12) questionnaires. Assessment was conducted at baseline, 3 and 12 months. Analysis was by intention-to-treat and analyst-blinded. Multiple imputations were used. RESULTS: Of the 501 enrolled patients, 421 (84%) provided data at 3 months, and 387 (77.2%) at 12 months. Mean age was 46.8 years (SD: 11.5) and 64.7% were women. In the adjusted analysis of the RMDQ outcome, only the intervention group showed significant changes at 3 months (- 1.33 points, p = 0.005) and at 12 months (- 1.11 points, p = 0.027), but minimal clinically important difference were detected in both groups. In the adjusted analysis of the RMDQ outcome, the intervention group improvement more than the control group at 3 months (- 1.33 points, p = 0.005) and at 12 months (- 1.11 points, p = 0.027). The intervention group presented a significant difference. Both groups presented a minimal clinically important difference, but more difference in the intervention group. The intervention group presented significant differences in the MGPQ scales of current pain intensity and VAS scores at 3 months. No statistically significant differences were found in the physical and mental domains of the SF-12. CONCLUSIONS: A multidisciplinary biopsychosocial intervention in a working population with non-specific subacute LBP has a small positive impact on disability, and on the level of pain, mainly at short-term, but no difference on quality of life. TRIAL REGISTRATION: ISRCTN21392091 (17 oct 2018) (Prospectively registred).

Understanding knee osteoarthritis from the patients' perspective: a qualitative study.

BACKGROUND: No studies of Health Coach Interventions for knee OA sufferers that include patients' perspectives have been published. The study assesses current clinical practice and primary care professionals' advice from the patients' perspective, in order to obtain a participative design for a complex intervention based on coaching psychology. Moreover, wants to analyse the experiences, perceptions, cognitive evaluation, values, emotions, beliefs and coping strategies of patients with knee osteoarthritis, and secondly the impact of these factors in the Self-management of this condition. METHODS: It is an interpretative qualitative study. The study included patients with diagnosis of knee osteoarthritis (OA) from 4 primary health care centres in Barcelona. A theoretical sampling based on a prior definition of participants' characteristics was carried out. Ten semi-structured interviews with knee OA patients were carried out. A content thematic analysis was performed following a mixed-strategy text codification in Lazarus framework and in emerging codes from the data. RESULTS: The results are structured in two blocks: Experiences and perceptions of informants and Experiences of knee osteoarthritis according to the Lazarus model. Regarding experiences and perceptions of informants: Some participants reported that the information was mostly provided by health professionals. Informants know which food they should eat to lose weight and the benefits of weight loss. Moreover, participants explained that they like walking but that sometimes it is difficult to put into practice. Regarding experiences of knee osteoarthritis according Lazarus model: Cognitive evaluation is influenced by cognitive distortions such as obligation, guilt, dramatization and catastrophism. VALUES: Family is the value most associated with wellbeing. Helping others is another recurring value. Emotions: Most participants explain that they feel anxiety, irritability or sadness. Beliefs: To some, physiotherapy helps them feel less pain. However, others explain that it is of no use to them. Participants are aware of the association overweight- pain. Coping strategies: The strategies for coping with emotions aim to reduce psychological distress (anxiety, sadness, anger) and some are more active than others. CONCLUSIONS: The study highlights that patients with knee osteoarthritis require a person-centered approach that provides them with strategies to overcome the psychological distress caused by this condition.

Evaluación de la efectividad de un programa de mindfulness en profesionales de atención primaria / Effectiveness of a mindfulness program in primary care professionals

Objetivos: Evaluar la efectividad a largo plazo de un programa de entrenamiento en mindfulness dirigido a profesionales de atención primaria en el burnout, el estado emocional, la empatía y la conciencia plena. Métodos: Estudio de medidas repetidas antes-después. Participaron 87 profesionales de atención primaria. Se midieron el burnout (Inventario de Maslach), la alteración emocional (POMS), la empatía (Jefferson) y el mindfulness (FFMQ), la adherencia a la intervención y los cambios de actitudes. Las mediciones se realizaron al inicio, a las 8 semanas y a los 6 y 12 meses. La intervención duró 1 año, con dos fases: una intensiva de 28 horas, repartidas durante 8 semanas, y otra de mantenimiento de 2,5 horas mensuales en 10 meses. El efecto del programa se evaluó mediante diferencia de medias, respuesta media estandarizada (RME) y modelos mixtos de medidas repetidas. Resultados: La puntuación de todas las escalas mejoró significativamente durante todo el seguimiento respecto a los valores basales. Las mayores diferencias se obtuvieron a los 12 meses, destacando el FFMQ (RME: 1,4) seguido del POMS (RME: 0,8). La fase postintensiva presentó la mejora más acusada en la diferencia entre puntuaciones consecutivas. El FFMQ presentó grandes cambios en todas las fases. Al final de la intervención, el 89% de los participantes practicaba por su cuenta los ejercicios y el 94% indicó mejoras en autocuidado y profesionalismo. Conclusiones: Un programa psicoeducativo basado en mindfulness muestra en una disminución del burnout y de la alteración emocional, con una mejora en la empatía y en la conciencia plena, fomentando actitudes hacia el autocuidado (AU)

Objectives: To determine the long-term effects of a mindfulness program on burnout, mood states, empathy, and mindfulness in primary care professionals. Methods: A repeated measures before-after study was performed in 87 participants working in primary care. The variables evaluated were scores of the Burnout Inventory (Maslach), mood states (Profile of Mood States [POMS]), empathy (Jefferson Scale of Physician Empathy [JSPE]) and mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), adherence to the intervention, and changes in attitudes. Evaluations were performed at baseline, at 8 weeks, and at 6 and 12 months. The intervention lasted for 1 year and consisted of two training phases, an intensive first phase lasting 28 hours, spread over 8 weeks, and a second, maintenance phase of 25 hours spread over 10 months. The effect of the intervention was assessed through observed change, standardized response mean (SRM), and linear mixed-effects models on repeated measures. Results: The scores of all the scales improved significantly during the follow-up compared with baseline scores. The greatest differences were obtained at 12 months, especially in the the FFMQ (SRM: 1.4), followed by the POMS (SRM: 0,8). The greatest improvement in the maintenance phase was found in the difference between consecutive scores. The only scale that showed major changes in all phases was the FFMQ scale. At the end of the intervention, 89% of participants practiced the exercises of the program on their own and 94% reported improvements in self-care and greater professionalism. Conclusions: A psychoeducational program based on mindfulness reduces burnout and improves mood states, empathy, and mindfulness, while encouraging better self-care (AU)

[Effectiveness of a mindfulness program in primary care professionals]. / Evaluación de la efectividad de un programa de mindfulness en profesionales de atención primaria.

OBJECTIVES: To determine the long-term effects of a mindfulness program on burnout, mood states, empathy, and mindfulness in primary care professionals. METHODS: A repeated measures before-after study was performed in 87 participants working in primary care. The variables evaluated were scores of the Burnout Inventory (Maslach), mood states (Profile of Mood States [POMS]), empathy (Jefferson Scale of Physician Empathy [JSPE]) and mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), adherence to the intervention, and changes in attitudes. Evaluations were performed at baseline, at 8 weeks, and at 6 and 12 months. The intervention lasted for 1 year and consisted of two training phases, an intensive first phase lasting 28 hours, spread over 8 weeks, and a second, maintenance phase of 25 hours spread over 10 months. The effect of the intervention was assessed through observed change, standardized response mean (SRM), and linear mixed-effects models on repeated measures. RESULTS: The scores of all the scales improved significantly during the follow-up compared with baseline scores. The greatest differences were obtained at 12 months, especially in the the FFMQ (SRM: 1.4), followed by the POMS (SRM: 0,8). The greatest improvement in the maintenance phase was found in the difference between consecutive scores. The only scale that showed major changes in all phases was the FFMQ scale. At the end of the intervention, 89% of participants practiced the exercises of the program on their own and 94% reported improvements in self-care and greater professionalism. CONCLUSIONS: A psychoeducational program based on mindfulness reduces burnout and improves mood states, empathy, and mindfulness, while encouraging better self-care.

Las metáforas en la psicología cognitivo-conductual / No disponible

Las metáforas, asociadas más a la literatura que a la ciencia, todavía son poco utilizadas en la psicología más científica (lacorriente cognitivo-conductual). Aunque infrautilizadas en esta psicología, sí que nos las podemos encontrar cómodamenteinstaladas en otras perspectivas psicológicas (psicoanalítica, humanista y constructivista). En los últimos años, probablementepor la convergencia entre las distintas corrientes de pensamiento, las puertas de la psicología cognitivo-conductual se hanabierto en mayor medida para las metáforas. En este artículo, se analiza cómo se ha llevado a cabo esta apertura, cómo seemplean dentro de las terapias cognitivo-conductuales y qué ventajas presenta su utilización

Metaphors, associated more with literature than science, have not been totally introduced within the more scientific form ofpsychology (the cognitive-behavioural school of thought). Although they are not totally introduced in this type of psychology,we find them comfortably installed in other psychological perspectives (psychoanalytic, humanist and constructivist). In recentyears, probably due to the convergence of different lines of thought, the doors of cognitive-behavioural psychology have beenopened to metaphors. In this article, we analyse how this has come about, how metaphors are employed within cognitive-behaviouraltherapies and what advantages this offers

¿Sienten el dolor del mismo modo los diferentes grupos étnicos? / Do subjects from different ethnic groups feel pain in the same way?

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El voluntariado hospitalario en España / Hospital voluntary service in Spain

Con el objetivo de conocer la realidad del voluntariado hospitalario en nuestro país, la Asociación para el Voluntariado en Europa ha promovido un estudio en el que han participado 15 Universidades españolas. Se han obtenido datos de un total de 55 hospitales y 76 asociaciones de voluntariado. Dos de las conclusiones extraídas son: las labores que realizan los voluntarios cubren una gran variedad de necesidades del enfermo y los beneficios que se desprende de esta colaboración no sólo repercuten positivamente en el paciente, sino también en: el propio voluntario, la familia del enfermo, el personal sanitario, el hospital e incluso en la sociedad (AU)

No disponible