Eduardo Cruz

Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial

Objective: The aim of this study was to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in chronic low back pain patients. Design: Single-blind randomized controlled trial. Setting: Outpatient clinic. Subjects: Sixty-two chronic low back pain patients were randomly allocated to receive aquatic exercise and pain neurophysiology education (n = 30) or aquatic exercise alone (n = 32). Interventions: Twelve sessions of a 6-week aquatic exercise programme preceded by 2 sessions of pain neurophysiology education. Controls received only 12 sessions of the 6-week aquatic exercise programme. Main measures: The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale) at the baseline, 6 weeks after the beginning of the aquatic exercise programme and at the 3 months follow-up. Secondary outcome was kinesiophobia (Tampa Scale of Kinesiophobia). Results: Fifty-five participants completed the study. Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favoring the education group (mean SD change: −25.4± 26.7 vs −6.6 ± 30.7, P < 0.005). Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up (RR=1.63, 95%CI: 1.01–2.63), no significant differences were found in functional disability and kinesiophobia between groups at any time. Conclusions: This study’s findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercise.

A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students

Abstract Background: Narrative reasoning has been presented as a core component of the health professionals’ competencies. Aim of the study: This study aimed to explore the students’ perspectives about the contribution of a narrative reasoning course to promote patient-centred practice. Methods: An interpretative phenomenological analysis (IPA) was undertaken through focus groups. Eighteen volunteer final year students participated in three focus groups. Data analysis followed the IPA principles. Findings: Three themes emerged: (1) “developing distinctive competencies”; (2) “shifting students’ focus” and (3) “challenging students’ professional identity”. In the first theme, students distinguished their capability to better understand patients’ experiences and needs and to be aware of the importance of a collaborative therapeutic relationship. In the second theme, students emphasized a shift from themselves as clinicians towards their patients. Finally, in the third theme participants shared the perspective that they have developed a different clinical profile, and that their reasoning and clinical actions have changed. Conclusions: Students recognized the contribution of the course in developing competencies to facilitate patient-centred practice. Future research is needed to inform lecturers on how to best integrate narrative reasoning within the physiotherapy undergraduate curricula.

Tailoring pain neuroscience education and exercise programme for people with fibromyalgia who also have cognitive deficits: a case series

Abstract Purpose: The purpose of this case series was to describe the outcomes of a tailored pain neuroscience education (PNE) and individualised exercise programme for people with fibromyalgia (FM) who also have cognitive deficits. Materials and methods: Nine FM patients with memory and concentration problems underwent a six-week programme consisting of six PNE sessions followed by six sessions of individualised exercise. Participants were assessed at the baseline, 3 and 6 weeks, and at 3 and 6 months follow-ups. Outcomes measures included the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), the Numerical Pain Rating Scale (NPRS), the Fibromyalgia Impact Questionnaire-Revised (FIQ-R) and the Patient Global Improvement of Change Scale (PGIC). Results: At six weeks, all patients decreased their scores on the TSK, PCS, NPRS and FIQ-R and reported a moderate to considerable improvement in their perception of overall change. At the six-month follow-up, improvements in pain intensity, pain catastrophizing, kinesiophobia and perception of overall change, appeared clinically meaningful for the majority of the participants. Conclusions: This study’s findings demonstrate an example of how cognitive characteristics can be considered in the intervention of FM patients in order to optimise their results and encourage the need for a further randomised control trial.