The effects of patient-professional partnerships on the self-management and health outcomes for patients with chronic back pain: a quasi-experimental study

Background: Self-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients’ health outcome. Contemporary pain management theories and models also suggest that a good patient-professional partnership enhances patients’ ability to self-manage their condition. Objectives: 1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); 2) to examine the impact of a good patient-professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain. Design and setting: This quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient-professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients’ health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients’ life situation. Patients were recruited following initial consultation and followed up three months later. Participants: A total of 147 patients (65% female) with a mean age of 48 years (SD: 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief. Methods: Self-reported measures of HRQoL, patient-professional partnerships and self- management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling. Results: There was no association between patients’ self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (-0.38, p<0.01). A patient-professional partnership was not found to be beneficial for patients’ HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (- 19.09, p<0.01). Conclusions: This study suggests that the increase in patients’ self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient-professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain

Influência da secção transversa de fios ortodônticos na fricção superficial de braquetes autoligados Influence of the cross-section of orthodontic wires on the surface friction of self-ligating brackets

OBJETIVO: o objetivo do presente trabalho foi determinar a força de atrito estático entre braquetes de aço inoxidável autoligados com sistema de fechamento resiliente e fios ortodônticos redondos e retangulares do mesmo material. MÉTODOS: empregaram-se 30 braquetes referentes aos caninos superiores divididos em 6 grupos formados por braquetes autoligados Smartclip, In-Ovation R e convencionais Gemini amarrados com ligaduras elásticas. A hipótese testada neste trabalho foi quanto à possibilidade dos braquetes autoligados ativos serem suscetíveis à elevação da força de atrito com o aumento e alteração da secção transversal dos fios ortodônticos. Os ensaios foram realizados com tração de 30s em fios de aço inoxidável 0,020" e 0,019"X0,025" na máquina de ensaios Emic DL 10000, com uma célula de carga de 20 newtons. Cada conjunto braquete/fio foi responsável pela geração de quatro corpos de prova, totalizando 120 leituras. As comparações entre as médias foram realizadas através da Análise de Variância (one way ANOVA) com correções pelo coeficiente de Bonferroni. RESULTADOS E CONCLUSÃO: os braquetes autoligados apresentaram maior força de atrito do que os braquetes convencionais amarrados com ligaduras elásticas. O grupo Smartclip foi o mais efetivo no controle do atrito (p<0,01). A hipótese em teste, influência da forma da seção transversal do fio na força de atrito, foi confirmada, uma vez que os fios de secção retangular 0,019"X0,025" apresentaram maior força de atrito ao serem tracionados do que os fios redondos 0,020" (p<0,01). O sistema Smartclip foi mais efetivo mesmo quando o tracionamento de fios retangulares foi comparado com o ensaio de braquetes In-Ovation R conjugados a fios redondos (p<0,01).<br>OBJECTIVES: The purpose of this study was to assess the surface friction produced by self-ligating stainless steel brackets equipped with a resilient closure system and compare the friction generated during traction of round and rectangular orthodontic wires made from the same material. METHODS: Thirty maxillary canine brackets were divided into six groups comprising SmartClip and In-Ovation R self-ligating brackets, and conventional Gemini brackets tied with elastomeric ligatures. This investigation tested the hypothesis that self-ligating brackets are susceptible to increases in friction that are commensurate with increases and changes in the cross-section of orthodontic wires. Traction was performed with the aid of thirty segments of 0.020" and 0.019" x 0.025" stainless steel wires in an EMIC DL 10000 testing machine with a 2N load cell. Each set of bracket/wire generated four samples, totaling 120 readings. Comparisons between means were performed using analysis of variance (one way ANOVA) corrected with the Bonferroni coefficient. RESULTS AND CONCLUSION: The self-ligating brackets exhibited lower friction than conventional brackets tied with elastomeric ligatures. The SmartClip group was the most effective in controlling friction (p <0.01). The hypothesis under test was confirmed to the extent that the traction performed with rectangular 0.019" x 0.025" cross-section wires resulted in higher friction forces than those observed in the 0.020" round wire groups (p<0.01). The SmartClip system was more effective even when the traction produced by rectangular wires was compared with the In-Ovation R brackets combined with round wires (p<0.01)