Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial.

BACKGROUND: Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. METHODS: Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups. RESULTS: Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes. CONCLUSIONS: This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly. TRIAL REGISTRATION: Trial registration number: NCT01496144

Extending Compact-Diagram to Basic Smart Multi-Valued Variable Diagrams

International audienc

The valuation of decision and individual welfare: a Humean approach

Drawing on passages in Book II of the Treatise of Human Nature (1739/40), in the Enquiry Concerning the Principles of Morals (1751), in the Dissertation on the Passions (1757), and in some of the Essays (1777), this paper is built upon Hume's distinction between three alternative valuations of an individual position: desire (which leads to action), interest, and happiness. The difficulty comes from the fact that desire does not depend on pleasure as an impression, but on the force of an idea of pleasure, based upon a belief in the realisation of the correlative impression. Typically, this belief is linked to the underlying emotional state, expressed in the degree of violence of the passions, which governs both the individual's reactivity to pleasure, and his preference for present (compared with future) pleasures. On the contrary, interest and happiness do not depend on the distortion introduced by beliefs, and are directly linked to pleasure. It is shown that the decisional valuation only coincides with interest in the case of what Hume called a 'calm passion', which gives birth to the greatest happiness.Hume, decision, welfare, desire, pleasure, belief, passion, intertemporal choice, utility, interest, happiness,

Ethical and Methodological Challenges in Large Qualitative Participatory Studies

Participatory research studies utilizing qualitative data drawn from large, diverse samples appear increasingly common in the social sciences, particularly in international development. This reflects demand for participatory approaches to researching human well-being at scale, comparative research on globalization and development, and breadth and scale in evidence-based policy making. “Big Qual” studies in international development increasingly combine qualitative with participatory methods and incorporate action research, oral histories, case studies, and visual methods. Apart from their scale (more sites and research participants than conventional “face-to-face” research) and diversity of contexts, these studies broadly share a focus on application, and an epistemological and ideological commitment to hearing and amplifying the voices of research participants and contributing to positive change in their lives. Some ethical challenges of Big Qual research—for example, reuse, storage, and sharing of third party data—have been thoroughly debated. Less is known of how complexities across time, space, and culture may shape researcher relations in large-scale participatory research, biasing results against context-specificity and meaningful local political analysis. Drawing on almost a decade’s experience with large participatory research, this article explores why and how scale, encompassing a complex network of institutions, relationships, contexts, and cultures, affects the ethics of these studies. We propose that Bradbury and Reason’s (2001) five criteria for judging the value and contribution of social inquiry are helpful: (a) the quality of relationships built, (b) the usefulness of the research, (c) its trustworthiness, (d) its relevance to vital issues of human society, and (e) its enduring consequence. Drawn from an action research tradition, these criteria constitute a comprehensive ethical framework particularly applicable to Big Qual participatory work in development studies. Through an empirical application of these criteria, the article highlights emerging ethical challenges facing applied social research in increasingly complex, multiscalar, and globalized contexts