Rúben de Faria Negrão Filho

Communication that values patient autonomy is associated with satisfaction with care: a systematic review

QUESTION Which communication factors used by clinicians during patient-clinician interactions are associated with satisfaction with care? DESIGN Systematic review with meta-analysis of studies investigating the association of verbal or nonverbal factors or interaction styles used by clinicians with patient satisfaction during an encounter between clinician and patient. PARTICIPANTS : Clinicians interacting with patients in primary care or rehabilitation settings. RESULTS Twenty seven studies investigated 129 verbal, nonverbal, and interaction style factors. Of these, 38 factors were consistently associated with satisfaction. Verbal factors concerning clinicians involving, facilitating, and supporting patients were associated with satisfaction with care. Most communication factors presented a fair correlation (r≥0.21 but <0.41) with satisfaction with care. Nonverbal factors such as time spent discussing prevention and time spent reading patient charts had a fair association with satisfaction with care (correlations range from 0.21 to 0.40). A moderate association was found between interaction styles such as caring (pooled r=0.51, 95% CI 0.42 to 0.60) and satisfaction with care. Over half (58%) of the 129 identified factors never associated with satisfaction with care and the remainder associated inconsistently. CONCLUSION The number of potential modifiable communication factors associated with satisfaction with care and the magnitude of their association partially support interventions to train clinicians in communication skills that value patient autonomy.

Coordination of spinal motion in the transverse and frontal planes during walking in people with and without recurrent low back pain.

Study Design. Observational cohort study. Objective. To investigate spinal coordination during preferred and fast speed walking in pain-free subjects with and without a history of recurrent low back pain (LBP). Summary of Background Data. Dynamic motion of the spine during walking is compromised in the presence of back pain (LBP), but its analysis often presents some challenges. The coexistence of significant symptoms may change gait because of pain or adaptation of the musculoskeletal structures or both. A history of LBP without the overlay of a current symptomatic episode allows a better model in which to explore the impact on spinal coordination during walking. Methods. Spinal and lower limb segmental motions were tracked using electromagnetic sensors. Analyses were conducted to explore the synchrony and spatial coordination of the segments and to compare the control and subjects with LBP. Results. We found no apparent differences between the groups for either overall amplitude of motion or most indicators of coordination in the lumbar region; however, there were significant postural differences in the mid-stance phase and other indicators of less phase locking in controls compared with subjects with LBP. The lower thoracic spinal segment was more affected by the history of back pain than the lumbar segment. Conclusion. Although small, there were indicators that alterations in spinal movement and coordination in subjects with recurrent LBP were due to adaptive changes rather than the presence of pain.

Análise da fadiga muscular localizada em atletas e sedentários através de parâmetros de freqüência do sinal eletromiográfico

Although the analysis in the frequency domain of the Electromyographic Signal (EMG) has been used in the characterization of the localized muscular fatigue process, its application, specifically the Median Frequency (MF), is rarely explored in sports. The objective of this study was to verify the viability of the EMG signal application, through its frequency domain analysis, as a parameter for determination and differentiation of the behavior of localized muscle fatigue. Two groups of subjects, one characterized as athletes (n = 12) and the other as sedentary (n = 12), were submitted to analysis based on procedures from three different experimental situations, all involving isometric exercise modality: i) maximum test for determination of the Maximum Voluntary Isometric Contraction (MVIC); ii) fatigue test, 35 sec. sustained load of 80% of MVIC; iii) recovery test, 10 sec. sustained load of 80% of MVIC. In the latter, the MF behavior in the three first (Fmedi) and three last (Fmedf) seconds of the EMG signal of tibialis anterior muscle during the fatigue test have been monitored. During the 10 seconds of the recovery test, MF was calculated regarding the whole period (Fmedr); this parameter was used to calculate the Muscular Recovery Index (MRI). The results showed that Fmedf presented lower value in relation to Fmedi in both groups (p 0.05). Therefore, the results presented in this study allow inferring the viability in the application of the frequency domain parameters of the EMG signal for the determination and differentiation of localized muscle fatigue behavior.

Efeitos da eletroestimulação do músculo vasto medial oblíquo em portadores de síndrome da dor patelofemoral: uma análise eletromiográfica

BACKGROUND: The use of surface electromyography (SEMG) has been considered a tool for quantitative assessment of patellofemoral pain syndrome (PFPS). Conservative treatments aim to improve patellar alignment, and electrical stimulation of the vastus medialis obliquus (VMO) muscle has been considered effective because it is selective and does not cause joint irritation. OBJECTIVE: This study aims to investigate the efficiency of a muscle strengthening program with electrical stimulation of the VMO muscle in PFPS by SEMG. METHODS: A group of ten young women (age: 23.1±4.9 years; body mass: 66.8±14.0 kg; height: 1.63±6.9 cm; BMI: 25.1±5.6 kg/m2) with unilateral PFPS participated in the study. They performed the functional test of stair stepping to capture the electromyographic (EMG) activity of the VMO and vastus lateralis (VL) muscles, before and after a program of electrical stimulation of the VMO muscle. The electrical stimulation was performed three times per week for six weeks. For analysis between the VMO and VL muscles, we considered the variables: ratio of time of onset to peak of activation, ratio of the integrals of the signals (t-test for dependent samples), and difference between onsets of activation (Wilcoxon test), with significance level of p<0.05. RESULTS: The results only showed change in behavior in the EMG signal for the ratio of the integrals of the signals, indicating that changes occurred in the force-generating capacity of the muscle after the training. CONCLUSION: The use of electrical stimulation should be considered to complement the conservative therapeutic approach in patients with PFPS, and the analysis of the ratio of the integrals of the SEMG signals should be considered as an instrument of evaluation. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN 12609000079246.

Physical Activity Interventions for Increasing Objectively Measured Physical Activity Levels in Patients With Chronic Musculoskeletal Pain: A Systematic Review

To investigate whether physical activity interventions increase objectively measured physical activity levels of patients with chronic musculoskeletal pain (e.g., osteoarthritis, low back pain) compared to no/minimal intervention.

Do people with recurrent back pain constrain spinal motion during seated horizontal and downward reaching

BACKGROUND Although the effect of symptomatic back pain on functional movement has been investigated, changes to spinal movement patterns in essentially pain-free people with a history of recurrent back pain are largely unreported. Reaching activities, important for everyday and occupational function, often present problems to such people, but have not been considered in this population. The purpose of this study was to compare the amplitude and timing of spinal and hip motions during two, seated reaching activities in people with and without a history of recurrent low back pain (RLBP). METHODS Spinal and hip motions during reaching downward and across the body, in both directions, were tracked using electromagnetic sensors. Analyses were conducted to explore the amplitudes, velocities and timings of 3D segmental movements and to compare controls with subjects with recurrent, but asymptomatic lumbar or lumbosacral pain. FINDINGS We detected significant differences in the amplitude and timing of movement in the lower thoracic region, with the RLBP group restricting movement and demonstrating compensatory increased motion at the hip. The lumbar region displayed no significant between-group differences. The order in which the spinal segments achieved peak velocity in cross-reaching was reversed in RLBP compared to controls, with lumbar motion leading in controls and lagging in RLBP. INTERPRETATION Subjects with a history of RLBP show a number of altered kinematic features during reaching activities which are not related to the presence or intensity of pain, but which suggest adaptive changes to movement control.

Análise da reprodutibilidade de parâmetros no domínio da frequência do sinal EMG utilizados na caracterização da fadiga muscular localizada

The aim of this study was to analyze the reproducibility of the electromyography signals parameters (EMG) in the frequency domain used in the characterization of localized muscle fatigue. Fifteen male subjects underwent a fatigue test based on isometric knee extension, being held at three different times at intervals of seven days. To assess the reproducibility of data between the tests we calculated the correlation coefficient (ICC) for the median frequency (MF) in total exercise time (MFT), MF obtained for every 10% of exercise time (MF10%) and the powers of the frequency bands obtained by dividing the power spectrum at windows of 20 Hz. The results showed: (1) excellent reproducibility for MFT, (2) good reproducibility for MF10%, and (3) greater variation in the signal EMG bands from 20 to 120 Hz, especially at the bands of 20-40 Hz and 40-60 Hz, which showed greater sensitivity to the process of muscle fatigue. We conclude that the MF is a variable that shows good reproducibility and that the fragmented analysis of the power spectrum, by means of frequency bands, showed that significant variations occur in the EMG signal during the installation of the fatigue process, having potential to become a new method for the characterization of localized muscle fatigue.

Measurement Properties of the Brazilian-Portuguese Version of the Lumbar Spine Instability Questionnaire

Study Design. Cross-cultural adaptation and analysis of measurement properties. Objective. To translate and cross-culturally adapt the Lumbar Spine Instability Questionnaire (LSIQ) into Brazilian-Portuguese and to test its measurement properties in Brazilian patients with low back pain. Summary of Background Data. The selection of subgroup of patients that respond better to specific interventions is the top research priority in the field of back pain. The LSIQ is a tool able to stratify patients with low back pain who responds better to motor control exercises. There is no Brazilian-Portuguese version of the LSIQ available. Methods. The original version of the LSIQ was translated and cross-culturally adapted. We collected data from 100 patients with low back pain. In addition to LSIQ, we also collected information about physical activity levels (measured by the International Physical Activity Questionnaire short version), disability (measured by the Roland Morris Disability Questionnaire), pain intensity (measured by the Pain numerical Rating Scale), kinesiophobia (measured by the Tampa Scale of Kinesiophobia), and depression (measured by the Beck Depression Inventory). The measurement properties tested were internal consistency, reproducibility (reliability and agreement), construct validity, and ceiling and floor effects. Results. The Brazilian-Portuguese version of the LSIQ showed good measurement properties with a Cronbach alpha of 0.79, an intraclass correlation coefficient of 0.75, a standard error of measurement of 1.65 points, and a minimal detectable change of 3.54 points. We did not detect ceiling and floor effects. The construct validity analysis was observed a moderate correlation between the LSIQ and Pain Numerical Rating Scale r = 0.46, Roland Morris Disability Questionnaire r = 0.66, Tampa Scale of Kinesiophobia r = 0.49, and Beck Depression Inventory r = 0.44. Conclusion. The Brazilian-Portuguese version of LIQ has adequate measurement properties and can be used in clinical practice and research. Level of Evidence: NA

Terapia manual no tratamento da espondilólise e espondilolistese: revisão de literatura

Spondylolysis is a defect in the pars interarticularis of a vertebra with a disruption in the intervertebral segment. Progression of the defect leads to one vertebra slipping over another - which is called spondylolisthesis - which may cause low-back pain. Non-surgical treatment is the initial course of action in most cases of spondylolisthesis. However, few studies have assessed the efficacy of conservative treatment. The purpose of the present study is to review literature on conservative treatment for spondylolysis/listhesis, especially manual therapy, in order to guide practitioners for effective intervention. Results show that both manual therapy and conventional physiotherapy were effective in relieving low-back pain and beneficial for patients functional outcome. Manual therapy involved spine manipulation, sacroiliac joint manipulation, muscle-energy techniques and stretching affected muscles. Stabilizing lombopelvic exercises, postural muscles strengthening, and hamstring and psoas stretching were also considered important in treating spondylolysis/listhesis. Each cases clinical and radiological features must be individually considered in order to determinate therapeutic strategy. Among non-surgical options, none has proved better than others and all may be included in symptomatic treatment of patients with spondylolysis/listhesis.

Association between abdominal muscles recruitment with clinical outcomes and prognostic risk in patients with chronic non-specific low back pain: a preliminary study

Este estudo investigou a associacao entre testes clinicos, desfechos clinicos e risco prognostico de pacientes com dor lombar cronica nao especifica. Para esta pesquisa, 20 pacientes, maiores de 18 anos, foram selecionados por conveniencia e submetidos a avaliacao dos desfechos clinicos por meio de Escala numerica de dor e Questionario de incapacidade. Para classificacao de risco prognostico utilizou-se o questionario STarT Back, e para avaliar o recrutamento do musculo transverso do abdome foram utilizados os seguintes testes clinicos: Escala de classificacao clinica (ECC); e medida da espessura dos musculos do abdome por meio de imagens ultrassonograficas (MEM-US). Os testes foram realizados em um unico dia por avaliador treinado, e a ordem dos testes foi aleatoria. Os coeficientes de correlacao de Pearson (r) e Spearman (rS) foram utilizados para investigar a associacao. Os resultados mostraram que as associacoes entre o risco prognostico de dor lombar com os desfechos clinicos, dor e incapacidade foram moderadas (r=0,68 e r=0,57, respectivamente). Para ECC, as associacoes com incapacidade e risco prognostico foram consideradas razoaveis (r=-0,34 e r=-0,36, respectivamente). Nao houve associacoes com a MEM-US. Na amostra de baixo risco prognostico, a relacao do ECC com a incapacidade foi considerada moderada para boa, enquanto para dor a correlacao foi razoavel (rS=-0,62 e rS=-0,24, respectivamente). Concluimos que existe associacao entre ECC com desfechos clinicos e risco prognostico, e a estratificacao, segundo o risco prognostico, aumenta a relacao observada. Futuros estudos devem ser conduzidos com novas medidas para avaliacao do recrutamento muscular abdominal com amostras maiores.