Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud \ud This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud \ud We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud \ud This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u

Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

Supported by F. Hoffmann–La Roche

Effet du Kétoconazole sur le temps d’immobilité et la réponse immunitaire au cours de la nage forcée chez le rat Wistar

La depression est installée suite aux perturbations des activités de l’axe corticotrope et du système immunitaire. L’objectif de cette étude est d'explorer les effets du ketoconazole (KTCZ), un dérivé d'imidazole, inhibiteur de stréroїdogénèse surrénalienne, sur les variations du nombre de globules blancs totaux et des pourcentages des sous-populations leucocytaires, au cours de la nage forcée chez le rat, modèle animal de dépression. Des cathéters ont été implantés sous anesthésie générale dans la veine jugulaire droite et des prises de sang (0.2 ml) ont été réalisées à des intervalles de temps de 15 minutes, alors que les animaux se comportaient librement pendant les expériences. Le degré d’anxiété et de l’activité locomotrice des rats ont été mesurés au labyrinthe en croix surélevé. L'amélioration des comportements des rats traités au KTCZ suggérerait que le corticostérone soit le médiateur le plus important dans la pathogénie de la dépression.Mots clés : nage forcée ; corticostérone ; cytokines

Freund's complete adjuvant (FCA) could reverse the depressive-like symptoms induced by chronic mild stress (CMS) in mice

International audienc

Emphysematous Pyelonephritis in a Diabetic Patient on Maintenance Hemodialysis: A Case Report

No Abstract