Renato Santos de Almeida

Analysis of the user satisfaction level in a public physical therapy service

BACKGROUND The concepts of quality management have increasingly been introduced into the health sector. Methods to measure satisfaction and quality are examples of this trend. OBJECTIVE This study aimed to identify the level of customer satisfaction in a physical therapy department involved in the public area and to analyze the key variables that impact the usersâ€(tm) perceived quality. METHOD A cross-sectional observational study was conducted, and 95 patients from the physical therapy department of the Hospital Universitário Gaffrée e Guinle - Universidade Federal do Estado do Rio de Janeiro (HUGG/UNIRIO) - Rio de Janeiro, Brazil, were evaluated by the SERVQUAL questionnaire. A brief questionnaire to identify the sociocultural profile of the patients was also performed. RESULTS Patients from this health service presented a satisfied status with the treatment, and the population final average value in the questionnaire was 0.057 (a positive value indicates satisfaction). There was an influence of the educational level on the satisfaction status (χ²=17,149; p=0.002). A correlation was found between satisfaction and the dimensions of tangibility (rho=0.56, p=0.05) and empathy (rho=0.46, p=0.01) for the Unsatisfied group. Among the Satisfied group, the dimension that was correlated with the final value of the SERVQUAL was responsiveness (rho=0.44, p=0.01). CONCLUSIONS The final values of the GGUH physical therapy department showed that patients can be satisfied even in a public health service. Satisfaction measures must have a multidimensional approach, and we found that people with more years of study showed lower values of satisfaction.

Trial Protocol: Cognitive functional therapy compared with combined manual therapy and motor control exercise for people with non-specific chronic low back pain: protocol for a randomised, controlled trial

INTRODUCTION Chronic low back pain is a public health problem, and there is strong evidence that it is associated with a complex interaction of biopsychosocial factors. Cognitive functional therapy is an intervention that deals with potentially modifiable multidimensional aspects of pain (eg, provocative cognitive, movement and lifestyle behaviours). There is evidence (from a single randomised, controlled trial) that cognitive functional therapy is better than combined manual therapy and motor control exercise. However, this study had significant methodological shortcomings including the failure to carry out an intention-to-treat analysis and a considerable loss of follow-up of participants. It is important to replicate this study in another domain through a randomised clinical trial with similar objectives but correcting these methodological shortcomings. AIM To investigate the efficacy of cognitive functional therapy compared to combined manual therapy and exercise on pain and disability at 3 months in patients with chronic non-specific low back pain. DESIGN Two-group, randomised, multicentre controlled trial with blinded assessors. PARTICIPANTS AND SETTINGS One hundred and forty-eight participants with chronic low back pain that has persisted for >3months and no specific spinal pathology will be recruited from the school clinic of the Centro Universitário Augusto Motta and a private clinic in the city of Rio de Janeiro, Brazil. INTERVENTION A Four to 10 sessions of cognitive functional therapy. The physiotherapists who will treat the participants in the cognitive functional therapy group have previously attended 2 workshops with two different tutors of the method. Such physiotherapists have completed 106 hours of training, including workshops and patient examinations, as well as conducting a pilot study under the supervision of another physiotherapist with>3 years of clinical experience in cognitive functional therapy. INTERVENTION B Four to 10 sessions of combined manual therapy and motor control exercises. Participants in the combined manual therapy and exercise group will be treated by two physiotherapists with an average of >10years of clinical experience in manual therapy and motor control exercises, including isolated contractions of the deep abdominal muscles. MEASUREMENTS The primary outcome measures will be pain intensity and disability 3 months after randomisation. Secondary outcomes will be pain and disability assessed 6 and 12 months after randomisation, and both global perceived effect and patient satisfaction at 3, 6 and 12 months after randomisation. The potential outcome mediators will be assessed at 3 and 6 months after randomisation, with brief screening questions for anxiety, social isolation, catastrophisation, depression, fear of movement, stress and sleep. Non-specific predictors and moderators will include age, gender, duration of chronic low back pain, chronicity risk (Örebro and Start Back score), number of pain areas, stressful life event, MRI scan imaging, and family history. ANALYSIS Intention-to-treat analysis will be performed. Linear mixed models will be used to compare the mean differences in pain intensity, disability and global perceived effect between the intervention arms. The analysis of the effect of potential mediators of the treatment will be performed using the causal mediation methods described by Imai and colleagues. The baseline variables will be evaluated as predictors and moderators of treatment, including terms and interaction models. A level of statistical significance of 5% will be used in the analysis. All the analyses will be performed using RStudio. SIGNIFICANCE This study will investigate whether the results of the first cognitive functional therapy randomised clinical trial are reproducible. The present study will have a sample size capable of detecting clinically relevant effects of the treatment with a low risk of bias. In pragmatic terms, this clinical trial is designed to reproduce the intervention as it would be performed in clinical practice by a trained physiotherapist who works with cognitive functional therapy, which increases the relevance of this study. The combined manual therapy and exercise group comprises an intervention strategy widely used by physiotherapists to treat low back pain. As evidence of efficacy is still limited, the results of a randomised, controlled clinical trial of high methodological quality will help physiotherapists in clinical decision-making.

Effects of manual therapy on cervicogenic headaches: a therapeutic approach

A coluna cervical e considerada como possivel fonte de dor de cabeca, entretanto ainda existem algumas controversias a respeito da fisiopatogenese, quadro clinico e tratamento. Objetivo: Propor um protocolo com abordagem multimodal para tratamento fisioterapico de pacientes com cefaleia cervicogenica e avaliar os efeitos deste protocolo em tais pacientes. Metodo: Trata-se de um estudo experimental nao controlado, no qual 9 pacientes da Clinica Escola de Fisioterapia do UNIFESO (Teresopolis, RJ) com diagnostico de cefaleia cervicogenica foram submetidos a 10 intervencoes fisioterapeuticas com tecnicas de terapia manual. O protocolo experimental incluiu tecnicas articulares, miofasciais e de recrutamento muscular. Como ferramentas de mensuracao foram utilizadas a escala funcional Neck Disabilty Index (NDI), a escala visual analogica de dor (EVA) e o registro do padrao do quadro algico. Resultados: Dos 9 pacientes selecionados, todos eram do genero feminino, e possuiam media de idade de 43,3 anos (± 15,5). Observou-se diferenca entre as medias da intensidade do quadro algico (EVA) antes do tratamento (8,0 ± 1,3) e apos (2,2 ± 0,9; p < 0,01). O indice de incapacidade cervical tambem mostrou melhora apos intervencao de 63,9% (p < 0,01). Em relacao a frequencia das crises semanais observa-se uma diminuicao de 70% apos a intervencao (p < 0,01). De maneira similar, houve reducao do tempo de permanencia das crises antes (4 horas ± 1,5) e apos (1 hora ± 0,5) (p < 0,01). Conclusao: A abordagem multimodal por meio de tecnicas de terapia manual foi benefica na reducao do quadro sintomatico dos pacientes e ainda proporcionou diminuicao do grau de incapacidade da regiao cervical.1 Professor, Physical Therapy Course at UNIFESO, Physical therapist at the Hospital Universitário Gaffrée e Guinle (UNIRIO). 2 Physical therapist Resident at the Hospital Universitário Pedro Ernesto (HUPE/UERJ). 3 Specialist in manual therapy and clinical biomechanics. 4 PhD. in Science, Professor at the Instituto Federal do Rio de Janeiro (IFRJ). 5 PhD. in Neuroscience, Professor at the Instituto Federal do Rio de Janeiro (IFRJ).