Psychological, pain, and disability factors influencing the perception of improvement/recovery from physiotherapy in patients with chronic musculoskeletal pain: a cross-sectional study

13 p.Objectives: The aim of this study was to identify the possible relationships between psychological, pain, and disability variables with respect to the perception of change/recovery from physiotherapy in patients with chronic musculoskeletal pain (CMP). Methods: A cross-sectional observational study was performed with 150 patients. All patients completed a series of self-administered questionnaires and a series of self-reports to quantify the perception of change with respect to the physiotherapy they underwent, the level of disability and pain intensity, the level of fear of movement, the level of catastrophism, the degree of self-efficacy, the level of therapeutic alliance and their adherence to the physiotherapy. Results: The strongest correlations were between the subjective perception of change and the number of sessions, treatment beliefs, self-efficacy, pain intensity, collaboration, and bonding. The linear regression model showed that the number of sessions, treatment beliefs, self-efficacy, compliance, pain intensity, and bonding were predictors of subjective perception of improvement, with 50% of the variance. Conclusions: Treatment beliefs, therapeutic alliance, degree of self-efficacy, and pain intensity have been shown to be predictors of a subjective perception of improvement in patients with CMP. In turn, multimodal treatments had the greatest positive impact on the subjective perception of improvement

Evaluación de los aspectos sensoriomotores y cognitivo-afectivos de los pacientes con síndrome post- COVID-19 persistente y las posibles diferencias con los que presentan dolor musculoesquelético asociado

11 p.Introducción: Entre los síntomas más frecuentes que aparecen en pacientes con síndrome de post-COVID persistente destaca la presencia de dolor musculoesquelético, pero actualmente existe una falta de evidencia sobre el impacto de la presencia de este síntoma sobre otras variables cognitivas, afectivas, funcionales y de discapacidad. En base a ello, el objetivo principal del proyecto es comparar la capacidad funcional y el grado de discapacidad entre pacientes con síndrome post-COVID-19 persistente que sufren dolor y pacientes con dicho síndrome que no sufren dolor. Métodos: Se llevará a cabo un estudio descriptivo transversal. Los pacientes serán reclutados y evaluados en el Centro XXXXX de Valladolid, España. Se recogerán datos mediante cuestionarios autoadministrados para determinadas variables de carácter cognitivo o afectivo y se realizarán pruebas de carácter físico/funcional como la prueba del escalón para evaluar la resistencia cardiorrespiratoria o la dinamometría para evaluar la fuerza muscular, entre otras. Para analizar los datos, se empleará la prueba estadística t de student para estudiar la comparación entre las variables continuas. Las relaciones entre las variables de las dimensiones capacidad física, sensorial, cognitiva y afectiva-motivacional, se examinarán mediante el coeficiente de correlación de Pearson. Ética y difusión: El estudio se realizará atendiendo a la legislación nacional para la protección de datos de los voluntarios según la LOPD y la declaración de Helsinki. Una vez se analicen los datos obtenidos, los resultados serán publicados en una revista de impacto y se difundirán en congresos científicos.Colegio Profesional de Fisioterapeutas de la Comunidad de Madri

Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study

The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n= 14) and an ineffective-movement group (n= 14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pressure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P= 0.042; Cohen d= 0.81) and after 10 min (P= 0.019; Cohen d= 0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P= 0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5-C6 as the pre to post (P= 0.010) as the pre to 10-min post (P= 0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately

Combining motor imagery with action observation training does not lead to a greater autonomic nervous system response than motor imagery alone during simple and functional movements: a randomized controlled trial

Both motor imagery (MI) and action observation (AO) trigger the activation of the neurocognitive mechanisms that underlie the planning and execution of voluntary movements in a manner that resembles how the action is performed in a real way. The main objective of the present study was to compare the autonomic nervous system (ANS) response in an isolated MI group compared to a combined MI + AO group. The mental tasks were based on two simple movements that are recorded in the revised movement imagery questionnaire in third-person perspective. The secondary objective of the study was to test if there was any relationship between the ANS variables and the ability to generate mental motor imagery, the mental chronometry and the level of physical activity. The main outcomes that were measured were heart rate, respiratory rate and electrodermal activity. A Biopac MP150 system, a measurement device of autonomic changes, was used for the quantification and evaluation of autonomic variables. Forty five asymptomatic subjects were selected and randomized in three groups: isolated MI, MI + AO and control group (CG). In regards to the activation of the sympathetic nervous system (SNS), no differences were observed between MI and MI + AO groups (p > .05), although some differences were found between both groups when compared to the CG (p < .05). Additionally, even though no associations were reported between the ANS variables and the ability to generate mental motor imagery, moderate-strong positive associations were found in mental chronometry and the level of physical activity. Our results suggest that MI and MI + AO, lead to an activation of the SNS, although there are no significant differences between the two groups. Based on results obtained, we suggest that tasks of low complexity, providing a visual input through the AO does not facilitates their subsequent motor imagination. A higher level of physical activity as well as a longer time to perform mental task, seem to be associated with a greater increase in the ANS response

Acupuncture in the Treatment of Pain in Temporomandibular Disorders: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objectives: The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs). Methods: By using electronic databases, the goal was to search and evaluate all the randomized controlled trials (RCTs) in which acupuncture was used in the management of pain attributed to these clinical entities. For the meta-analysis, an adequate description of the results&apos; statistical data was required along with a comparison of the treatment with a control group using a placebo or sham. Two independent reviewers evaluated the quality of the studies using the Jadad scale. Results: A total of 8 RCTs were selected, and the quality of only 4 was considered acceptable. These 4 studies showed positive results such as reducing pain, improving masticatory function, and increasing maximum interincisal opening. By combining the studies (n=96) and analyzing the results, it was concluded that acupuncture is more effective than placebo in reducing pain intensity in TMD (standardized mean difference 0.83; 95% confidence interval, 0.41-1.25; P=0.00012). Discussion: The results of this meta-analysis suggest that acupuncture is a reasonable adjunctive treatment for producing a shortterm analgesic effect in patients with painful TMD symptoms. Although the results described are positive, the relevance of these results was limited by the fact that substantial bias was present. These findings must be confirmed by future RCTs that improve the methodologic deficiencies of the studies evaluated in this metaanalysis. Key Words: acupuncture, temporomandibular disorders, orofacial pain, randomized controlled trial, meta-analysis, review (Clin J Pain 2010;26:541-550) T emporomandibular disorders (TMDs) refer to various conditions affecting the temporomandibular joint, masticatory muscles, and contiguous tissues components. 1 Different types of painful TMDs are encountered: myogenous or muscle-generated pain; arthrogenous or joint generated pain; or both. 1-4 According to Stohler, 5 between 90% and 95% of TMD patients have facial pain of muscular origin without identifiable structural causes. Among the painful TMD of muscular origin, the most frequent is myofascial pain (MP). 6 At present, the therapeutic management of TMD is approached using a medical multidisciplinary model, and the treatment options range from conservative, noninvasive therapeutic measures to more aggressive treatment interventions. However, in most of the mild and moderate cases of TMD, a significant clinical improvement can be obtained with conservative therapeutic modalities. Acupuncture is an increasingly used treatment modality for the therapeutic management of pain symptoms. A meta-analysis performed by Ter Riet et al 9 showed that the majority of the studies documented positive results. However, the main conclusion obtained from that meta-analysis was that the methodologic quality of the studies analyzed required more evidence. For this reason, the investigators concluded that the effects of acupuncture for chronic pain are doubtful. In terms of TMD and acupuncture treatment, the results obtained were similar to those obtained in an earlier systematic review published in 1999. It is important to emphasize that in the last 10 years, additional studies have been published using acupuncture to treat TMD. This meta-analysis will review the publications of the last 10 years to include the improved evidence that has accumulated over that time. The aim of this study is to perform an analysis that evaluates the quality of the studies and the effectiveness of acupuncture treatment in relieving painful TMD symptomatology

The roots of chaos: the problem with theoretical understanding in osteopathy

Osteopathy is categorized as complementary and alternative medicine. It is a profession which is present in most countries, with a variety of practices and regulations. While it is sometimes integrated within other disciplines of manual therapy, such as physiotherapy, unlike the latter, osteopathy continues to be based on philosophical principles that shape its identity, anchoring it to the 19th century. However, these osteopathic tenets do not meet the criteria of representativeness and truthfulness and thus, cannot coexist with a science-based medical practice. This commentary analyzes the underlying theoretical principles that dictate osteopathic care, its deficiencies and weaknesses and why they might place osteopathy in the realm of pseudoscienc

Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: A clinical trial

Objectives: The purpose of this study was to compare the effects of a cervical vs thoracic spine manipulation on pressure pain threshold (PPT) and pain-free grip strength in patients with lateral epicondylalgia (LE). Methods: A single-blind randomized clinical trial was completed with 18 participants with LE. Each subject attended 1 experimental session. Participants were randomized to receive either a cervical or thoracic spine manipulation. Pressure pain threshold over the lateral epicondyle of both elbows pain-free grip strength on the affected arm and maximum grip force on the unaffected side were assessed preintervention and 5 minutes postintervention by an examiner blind to group assignment. A 3-way analysis of variance with time and side as within-subject variable and intervention as between-subject variable was used to evaluate changes in PPT and pain-free grip. Results: The analysis of variance detected a significant interaction between group and time (F = 31.7, P \u3c.000) for PPT levels. Post hoc testing revealed that the cervical spine manipulation produced a greater increase of PPT in both sides compared with thoracic spine manipulation (P \u3c.001). For pain-free grip strength, no interaction between group and time (F =.66, P =.42) existed. Conclusions: Cervical spine manipulation produced greater changes in PPT than thoracic spine manipulation in patients with LE. No differences between groups were identified for pain-free grip. Future studies with larger sample sizes are required to further examine the effects of manipulation on mechanisms of pain and motor control in upper extremity conditions. © 2011 National University of Health Sciences

Somatosensory and Motor Differences between Physically Active Patients with Chronic Low Back Pain and Asymptomatic Individuals

Background and Objectives: Chronic low back pain (CLBP) is the most common occupational disorder due to its associated disability and high risk of recurrence and chronicity. However, the mechanisms underlying physical and psychological variables in patients with CLBP remain unclear. The main objective of this study was to assess whether there were differences between physically active patients with nonspecific CLBP compared with asymptomatic individuals in sensorimotor and psychological variables. Materials and Methods: This was an observational cross-sectional design with a nonprobabilistic sample. The sample was divided into two groups: individuals with nonspecific CLBP (n = 30) and asymptomatic individuals as a control (n = 30). The psychological variables assessed were low back disability, fear of movement, pain catastrophizing, and self-efficacy. The sensorimotor variables assessed were two-point discrimination, pressure pain threshold, lumbopelvic stability, lumbar flexion active range of motion, and isometric leg and back strength. Results: Statistically significant differences between the groups in terms of catastrophizing levels (p = 0.026) and fear of movement (p = 0.001) were found, but no statistically significant differences between groups were found in self-efficacy (p &gt; 0.05). No statistically significant differences between the groups in any of the sensorimotor variables were found (p &gt; 0.05). Conclusion: No sensorimotor differences were found between patients with asymptomatic and chronic low back pain, but differences were found in the psychological variables of catastrophizing and fear of movement

Effects of movement representation techniques on motor learning of thumb-opposition tasks

Abstract The present work is the first study that assess long run change after motor learning. The study’s main objective was to evaluate the short to medium-term impact of motor imagery (MI) and action observation (AO) on motor learning of a sequence of thumb-opposition tasks of increasing complexity. We randomly assigned 45 participants to an AO, MI, or placebo observation (PO) group. A sequence of 12 thumb-opposition tasks was taught for 3 consecutive days (4 per day). The primary outcome was accuracy. The secondary outcomes were required time and perfect positioning. The outcomes were assessed immediately after the intervention and at 1 week, 1 month and 4 months postintervention. Regarding the primary outcome, AO group had significantly higher accuracy than the MI or PO group until at least 4 months (p  0.80). However, in the bimanual positions, AO was not superior to MI at 1 week postintervention. Regarding secondary outcomes, AO group required less time than the MI group to remember and perform the left-hand and both-hand gestures, with a large effect size (p  0.80). In terms of percentage of perfect positions, AO group achieved significantly better results than the MI group until at least 4 months after the intervention in the unimanual gestures (p  0.80) and up to 1 month postintervention in the bimanual gestures (p = 0.012, d = 1.29). AO training resulted in greater and longer term motor learning than MI and placebo intervention. If the goal is to learn some motor skills for whatever reason (e.g., following surgery or immobilization.), AO training should be considered clinically