Ensayo no aleatorizado de una intervención educativa basada en principios cognitivo-conductuales para pacientes con lumbalgia crónica inespecífica atendidos en fisioterapia de atención primaria

ResumenObjetivoValorar la influencia de una intervención educativa en la reducción del «miedo-evitación» (ME) y del «catastrofismo al dolor» (CAT) en población con lumbalgia crónica inespecífica (LCI) atendida en fisioterapia de atención primaria (AP).DiseñoEstudio cuasiexperimental.EmplazamientoCentros de salud (CS) del Distrito Sanitario Costa del Sol.ParticipantesPacientes con LCI entre 18-65años con comprensión del idioma español; ausencia de intervenciones educativas paralelas; ausencia de banderas rojas; ausencia de deterioro cognitivo y/o fibromialgia; ausencia de cirugía dorsolumbar, y tolerancia al ejercicio físico.IntervencionesEl grupo control recibió la EdE grupal habitual. El experimental recibió, además, un instrumento escrito para lectura domiciliaria, más la posterior puesta en común, aclaración de dudas y reestructuración de creencias y metas durante el desarrollo de las sesiones. Ambas intervenciones duraron unos 280min (7 sesiones de 40min).ResultadosLas variables principales incluyeron ME y CAT. Secundariamente se valoraron dolor y discapacidad. Algunas variables «sociodemográficas» y «relacionadas con el trastorno» fueron tenidas en cuenta en el análisis.Se observaron diferencias estadísticamente significativas en el grupo experimental versus control en la variación del ME −14 (−25,5; 0) vs −4 (−13; 0) (p=0,009), y del CAT −9 (−18; −4) vs −4,5 (−8,25; 0) (p=0,000). Igualmente se observaron diferencias en discapacidad (p=0,046), pero no en dolor (p=0,280).ConclusionesLos resultados deben ser considerados a la luz de las posibles limitaciones que plantea el estudio. Su naturaleza pragmática permitiría una potencial transferencia a la dinámica asistencial habitual.AbstractObjectiveTo assess the influence of an educational intervention in reducing «fear-avoidance» (FA) and «pain catastrophising» (CAT) in a population with unspecific chronic low back pain (UCLBP), attending physiotherapy in Primary Health Care. A pragmatic quasi-experimental study was conducted in Health Centres of a Costa del Sol Health District.DesignQuasi-experimental study.SettingPrimary Health Care physiotherapy Back Schools in Health Centres of a Costa del Sol Health District.ParticipantsThe selection criteria were: UCLBP; 18-65years; understanding of the Spanish language; absence of parallel educational interventions; absence of red flags; not showing cognitive impairment or fibromyalgia; absence of thoracic-lumbar surgery, and exercise tolerance.InterventionsThe control group received the usual Back Schools program. The experimental group also received a written document for home reading, plus the subsequent sharing, clarifying doubts, and beliefs and goals restructuring during the development of the sessions. Both interventions lasted about 280minutes (7 sessions×40min).ResultsThe main variables included FA and CAT. Pain and disability were also assessed. Some «demographic» and «related disorder» variables were considered in the analysis.Statistically significant differences were observed in the experimental group versus control, in the variation of FA −14 (−25.5; 0) vs −4 (−13; 0) (P=.009), and CAT −9 (−18; −4) vs −4,5 (−8.25; 0) (P=.000), were observed. Also differences in disability (P=.046), but not in pain (P=.280).ConclusionsThese results should be considered in light of possible limits imposed by the study. Its pragmatic nature would allow a potential transfer to usual care

The reference site collaborative network of the european innovation partnership on active and healthy ageing

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs

Factores clínico-demográficos asociados al miedo-evitación en sujetos con lumbalgia crónica inespecífica en atención primaria: análisis secundario de estudio de intervención

Resumen: Objetivo: Describir algunas características sociodemográficas y clínicas de los sujetos con lumbalgia crónica inespecífica (LCI) atendidos habitualmente en atención primaria (AP), así como investigar su asociación con el miedo-evitación (ME). Diseño: Descriptivo transversal. Análisis secundario de estudio de intervención. Emplazamiento: Zonas Básicas de Salud del Distrito Sanitario de AP Costa del Sol (Málaga). Participantes: Un total de 147 sujetos con LCI extraídos de la base de datos de un estudio de intervención previo en fisioterapia de AP. Características: edad, 18-65 años; comprensión del idioma español; ausencia de deterioro cognitivo, ausencia de fibromialgia, ausencia de cirugía dorsolumbar, y tolerancia al ejercicio físico. Mediciones principales: La variable principal fue el ME (FABQ y subescalas FABQ-PA y FABQ-W); las variables clínicas incluyeron: dolor (NRPS-11), discapacidad (RMQ), tiempo de evolución, tratamientos previos y diagnósticos de imagen; las variables sociodemográficas incluyeron: sexo, edad, nivel educativo y situación laboral. Resultados: El 51,7% de los sujetos presentaron elevado ME con la escala FABQ-PA. Incapacidad temporal (IT) [β = 24,45 (p = 0,009*); β = 13,03 (p = 0,016*); β = 14,04 (p = 0,011*) para FABQ, FABQ-PA y FABQ-W, respectivamente]; estudios primarios [β = 15,09 (p = 0,01*); β = 9,73 (p = 0,01*) para FABQ y FABQ-PA], y discapacidad [β = 1,45 (p < 0,001); β = 0,61 (p < 0,001); β = 0,68 (p < 0,001) para FABQ, FABQ-PA y FABQ-W, respectivamente] aparecieron asociados al ME cuando fueron modelados por regresión multivariante. Conclusiones: Algunos rasgos sociodemográficos y clínicos de la población con LCI son presentados. Las pruebas de imagen (81,63%) y los tratamientos previos pasivos (55,78%) podrían reflejar problemas de adherencia a las recomendaciones de las GPC. IT, estudios primarios y discapacidad se asociaron al ME. Los hallazgos deben ser interpretados a la luz de las posibles limitaciones. Algunas sugerencias para la práctica clínica son aportadas. Abstract: Objective: To describe some sociodemographics and clinical characteristics of subjects with Non-specific Chronic Low Back Pain (NCLBP) in Primary Care, as well as to investigate their association with Fear-Avoidance (FA). Design: Cross-sectional. Secondary analysis of an intervention study. Location: Basic Health Areas in Costa del Sol Health District (Málaga, Spain). Participants: An analysis was performed on 147 subjects with NCLBP from a previous intervention study database in Primary Care Physiotherapy (PCP). Characteristics: age 18-65; understanding of the Spanish language; absence of cognitive disorders, fibromyalgia or dorsolumbar surgery, and to be able to perform physical exercise. Main measurements: The main variable was FA level (FABQ and the FABQ-PA and FABQ-W) sub-scales. Clinical variables included: pain (NRPS-11), disability (RMQ), evolution, previous treatments and diagnostic imaging. The sociodemographic variables included: gender, age, educational level, and employment status. Results: Just over half (51.7%) of the subjects had high FA on the FABQ-PA sub-scale. Sick leave (SL) [β = 24.45 (P = .009*); β = 13.03 (P = .016*); β = 14.04 (P = .011*) for FABQ, FABQ-PA and FABQ-W, respectively]; primary studies level [β = 15.09 (P = .01*); β = 9.73 (P = .01*) for FABQ and FABQ-PA], and disability [β = 1.45 (P < .001); β = 0.61 (P < .001); β = 0.68 (P < .001) for FABQ, FABQ-PA and FABQ-W, respectively] were associated with FA when they were modeled by multivariate regression. Conclusions: Some sociodemographic and clinical features of the NCLBP population are presented. Imaging tests (81.63%) and previous passive treatments (55.78%) could reflect problems of adherence to recommendations of CPGs. Sick leave, primary studies level, and disability were associated with FA. The findings should be interpreted in the light of possible limitations. Some suggestions for clinical practice are provided. Palabras clave: Lumbalgia, Miedo, Atención primaria, Fisioterapia, Keywords: Low back pain, Fear, Primary health care, Physical therapy modalitie

Psychological factors are associated with local and generalized pressure pain hypersensitivity, pain intensity, and function in people with chronic shoulder pain : a cross-sectional study

To explore the association between psychological factors and shoulder pain intensity, function, as well as local and generalized pressure pain hypersensitivity. a cross-sectional study. 90 participants with chronic shoulder pain were included. Pressure pain thresholds determined the presence of pain hypersensitivity. Pain intensity, function, pain self-efficacy, emotional distress, and pain catastrophizing were also assessed. Analyses were adjusted for gender and age. The diagnosis of depression (yes/no answer) was associated with both greater local (standardized β = -0.19[95%CI -0.37 to -0.00]) and generalized (standardized β = -0.20[95%CI -0.39 to -0.01]) pressure pain hypersensitivity. Greater pain self-efficacy was associated with lower local pressure pain hypersensitivity (standardized β = 0.19[95%CI 0.04 to 0.38]). The standardized beta coefficient for the diagnosis of depression indicated that this variable showed the strongest association with pressure pain hypersensitivity. Additionally, greater pain self-efficacy was associated with lower pain intensity (standardized β = -0.34[95%CI -0.51 to -0.17]) and better function (standardized β = -0.47[95%CI -0.63 to -0.30]). Greater pain catastrophizing was associated with more pain intensity (standardized β = 0.35[95%CI 0.18 to 0.52]) and worse function (standardized β = 0.26[95%CI 0.10 to 0.43]). The standardized beta coefficients for pain catastrophizing and pain self-efficacy indicated that both variables showed the strongest association with shoulder pain intensity and function, respectively CONCLUSION: Psychological factors were associated with local and generalized pressure pain hypersensitivity, pain intensity, and function in people with chronic shoulder pain

Pain Neuroscience Education Plus Usual Care Is More Effective than Usual Care Alone to Improve Self-Efficacy Beliefs in People with Chronic Musculoskeletal Pain: A Non-Randomized Controlled Trial

Self-efficacy beliefs are associated with less physical impairment and pain intensity in people with chronic pain. Interventions that build self-efficacy beliefs may foster behavioral changes among this population. A non-randomized trial has been carried out to evaluate the effectiveness of pain neuroscience education (PNE) plus usual care in modifying self-efficacy beliefs, pain intensity, pain interference and analgesics consumption in people with chronic musculoskeletal pain. Participants were allocated to an experimental (PNE plus usual care, n = 49) and a control (usual care alone, n = 51) group. The primary outcome was self-efficacy beliefs (Chronic Pain Self-Efficacy Scale), and the secondary outcomes were pain intensity, pain interference (Graded Chronic Pain Scale) and analgesics consumption. The participant&rsquo;s pain knowledge (revised Neurophysiology of Pain Questionnaire) after PNE intervention was also assessed to analyze its influence on every outcome measure. All the outcome measures were assessed at the baseline and at four-week and four-month follow-ups. PNE plus usual care was more effective than usual care alone to increase self-efficacy beliefs and decrease pain intensity and pain interference at all follow-up points. No differences between groups were found in terms of analgesics consumption. Knowledge of pain neurophysiology did not modify the effects of PNE plus usual care in any of the outcome measures. These results should be taken with caution because of the non-randomized nature of this design, the limited follow-ups and the uncertainty of the presence of clinical changes in self-efficacy for participants. Larger, methodological sound trials are needed

Pain neuroscience education plus usual care is more effective than usual care alone to improve self-efficacy beliefs in people with chronic musculoskeletal pain: a non-randomized controlled trial

Self-efficacy beliefs are associated with less physical impairment and pain intensity in people with chronic pain. Interventions that build self-efficacy beliefs may foster behavioral changes among this population. A non-randomized trial has been carried out to evaluate the effectiveness of pain neuroscience education (PNE) plus usual care in modifying self-efficacy beliefs, pain intensity, pain interference and analgesics consumption in people with chronic musculoskeletal pain. Participants were allocated to an experimental (PNE plus usual care, n = 49) and a control (usual care alone, n = 51) group. The primary outcome was self-efficacy beliefs (Chronic Pain Self-Efficacy Scale), and the secondary outcomes were pain intensity, pain interference (Graded Chronic Pain Scale) and analgesics consumption. The participant's pain knowledge (revised Neurophysiology of Pain Questionnaire) after PNE intervention was also assessed to analyze its influence on every outcome measure. All the outcome measures were assessed at the baseline and at four-week and four-month follow-ups. PNE plus usual care was more effective than usual care alone to increase self-efficacy beliefs and decrease pain intensity and pain interference at all follow-up points. No differences between groups were found in terms of analgesics consumption. Knowledge of pain neurophysiology did not modify the effects of PNE plus usual care in any of the outcome measures. These results should be taken with caution because of the non-randomized nature of this design, the limited follow-ups and the uncertainty of the presence of clinical changes in self-efficacy for participants. Larger, methodological sound trials are needed

The Role of Positive Psychological Factors in the Association between Pain Intensity and Pain Interference in Individuals with Chronic Musculoskeletal Pain: A Cross-Sectional Study

This study aimed to test the cross-sectional mediating and moderating role that positive psychological factors play in the association between pain intensity and pain interference in individuals with chronic musculoskeletal pain. A descriptive cross-sectional study using mediation analyses was conducted, including 186 individuals with chronic musculoskeletal pain. We conducted cross-sectional mediation and moderation analyses to determine whether the positive psychological factors mediated or moderated the association between pain intensity and pain interference. Pain acceptance, pain self-efficacy, and optimism were all significantly and weakly related to pain interference when controlling for pain intensity. Pain self-efficacy and pain acceptance partially mediated the association between pain intensity and pain interference. On the other hand, the multiple mediation model did not show significant effects. The three positive psychological factors were not found to significantly moderate the association between pain intensity and pain interference. The findings suggest that in chronic musculoskeletal pain patients, the treatments may focus on [i] what they are capable of doing to manage the pain (i.e., pain self-efficacy) and [ii] being better able to accept the pain as pain waxes and wanes might be also particularly helpful. However, these results must be tested in longitudinal studies before drawing any causal conclusion.This study was funded by the Progress and Health Andalusian Public Foundation (AP-0156-2018) through a competitive and public call (Call for Research and Innovation Projects in the Field of Primary Care at the Andalusian Health Service). The foundation, which is under the Andalusian Ministry of Health, assessed and approved the research project and will carry out a follow-up on their development. The funding is managed by the Andalusian Public Foundation for Biomedical and Health Research in Malaga (FIMABIS). Javier Martinez-Calderon is supported by the University of Malaga through a postdoctoral grant.Ye