Restrição à atividade física na pandemia está associada com menor autoeficácia para dor na população com dor musculoesquelética: um estudo transversal

During the COVID-19 pandemic, a lower levelof physical activity was observed in the population, whichmay influence the level of pain self-efficacy in the populationwith musculoskeletal pain. In this context, this study soughtto analyze whether there is an association between the timeof physical activity practice and the level of pain self-efficacyin the population with pain during the COVID-19 pandemic inthe state of São Paulo, controlled by biopsychosocial variables.This study was conducted via an online form with questionsabout sociodemographic aspects, weekly physical activitypractice, stress and anxiety levels, pain intensity and painself-efficacy (Pain Self-Efficacy Questionnaire – PSEQ-10).The analysis was determined by two models of multiplelinear regression, with (Model A) and without (Model B) thecontrol of data by psycho-emotional factors (anxiety andstress) in 150 subjects. An association was found betweenweekly physical activity practice time and pain self-efficacylevel, Model A (p=0.0271, β=1.914) and Model B (p=0.0333,physical activity practice was associated with a higher pain selfefficacy level in the population with musculoskeletal pain during theCOVID-19 pandemic. Pain intensity during the pandemic, BMI andsex also were associated with pain self-efficacy leveβ=1.826). Pain intensity during the pandemic, body massindex (BMI) and sex, among the control variables, also wereassociated with the pain self-efficacy level. A higher time ofDurante a pandemia de COVID-19, observou-seum menor nível de prática de atividade física pelapopulação, o que pode influenciar o nível de autoeficáciapara dor na população com dor musculoesquelética.Neste contexto, o objetivo deste estudo foi analisar seexiste associação entre o tempo de prática de atividadefísica e o nível de autoeficácia para dor na populaçãocom dor musculoesquelética durante a pandemiade COVID-19 no estado de São Paulo, controlada porvariáveis biopsicossociais. Realizou-se um estudo atravésde um formulário online com questões sobre aspectossociodemográficos, tempo semanal de prática de atividadefísica, níveis de estresse e ansiedade, intensidade de dore autoeficácia para dor (PSEQ-10 – Pain Self-EfficacyQuestionnaire). A análise estatística ocorreu por meio dedois modelos de regressão linear múltipla, com (modelo A)e sem (modelo B) o controle dos dados por fatorespsicoemocionais (ansiedade e estresse) em 150 pessoas.Foi encontrada associação entre o tempo de prática deatividade física semanal e o nível de autoeficácia para dorno modelo A (p=0,0271, β=1,914) e no modelo B (p=0,0333,β=1,826). Intensidade de dor durante a pandemia, índice demassa corporal (IMC) e sexo, dentre as variáveis de controle,também foram associadas ao nível de autoeficácia para dor.Maior tempo de prática de atividade física foi associado amaior nível de autoeficácia para dor na população comdor musculoesquelética durante a pandemia de COVID-19.Intensidade de dor durante a pandemia, IMC e sexo tambémforam associados ao nível de autoeficácia para dorDurante la pandemia del COVID-19 se observó unmenor nivel de actividad física en la población, lo que puede influiren el nivel de autoeficacia para el dolor en la población con dolormusculoesquelético. En ese contexto, el objetivo de este estudio fueanalizar si existe asociación entre el tiempo de práctica de actividadfísica y el nivel de autoeficacia para el dolor en la población con dolormusculoesquelético durante la pandemia del COVID-19 en el estadode São Paulo, controlado por variables biopsicosociales. Se realizóun estudio mediante un formulario por Internet con preguntas sobrelos aspectos sociodemográficos, el tiempo semanal de actividadfísica, los niveles de estrés y ansiedad, la intensidad del dolor y laautoeficacia del dolor (PSEQ-10 – Pain Self-Efficacy Questionnaire).El análisis estadístico se realizó utilizando dos modelos de regresiónlineal múltiple, con (modelo A) y sin (modelo B) control de datospara factores psicoemocionales (ansiedad y estrés) en 150 personas.Se encontró asociación entre el tiempo de práctica de actividadfísica semanal y el nivel de autoeficacia para el dolor en el modelo A(p=0,0271, β=1,914) y en el modelo B (p=0,0333, β=1,826). La intensidaddel dolor durante la pandemia, el índice de masa corporal (IMC) y elsexo, entre las variables de control, también se asociaron con el nivelde autoeficacia para el dolor. La práctica de actividad física durantemás tiempo se asoció con un mayor nivel de autoeficacia para el doloren la población con dolor musculoesquelético durante la pandemiadel COVID-19. La intensidad del dolor durante la pandemia, el IMC y elgénero también se asociaron con el nivel de autoeficacia para el dolor

Development and validation of a model of psychophysical ratio scale that is capable to measure the gradient of movement related pain generalization in patients with chronic musculoskeletal complaints

A percepção dolorosa envolve um processo ativo de interpretação de informações cujo principal objetivo é a subsequente seleção de comportamentos protetivos para um contexto ou conjunto de estímulos que foram associados por nosso cérebro a uma lesão ou a um risco potencial de lesão, sem que necessariamente existam alterações estruturais físicas que expliquem estes sintomas. Enquanto atualmente a dor relacionada a execução de movimentos e a manutenção de posturas é o principal motivo pelo qual pacientes com queixas musculoesqueléticas crônicas buscam auxílio médico, a maior parte dos instrumentos de mensuração específicos para esta população de pacientes não avaliam a dor no contexto em que ela é percebida e, os que o fazem, possuem acesso a níveis de mensuração pouco informativos e apresentam diversos erros de construção. Objetivo: Desenvolver e validar uma escala psicofísica de razão que seja capaz de avaliar o gradiente de generalização da dor relacionada a execução de movimentos em indivíduos com dor no ombro. Métodos: Um total de 180 indivíduos com dor no ombro, destros, sintomáticos, sedentários e com início da queixa há pelo menos 3 meses foram recrutados entre os pacientes em atendimento no Grupo do Ombro do IOTFMUSP para a realização de 3 experimentos. Nos primeiros 2 experimentos, foi realizada a validação interna da escala psicofísica de razão por meio do procedimento de emparelhamento inter-modalidades e foram selecionados os movimentos que comporiam a escala oficial, respectivamente. Durante o experimento 3, o desenvolvimento da Escala Psicofísica de Avaliação da Dor Relacionada ao Movimento para pacientes com dor no ombro (EPADRMO) foi finalizado e seu processo de validação psicométrica teve início. Resultados: A validação interna da escala com base na teoria psicofísica, realizada no experimento 1, comprovou que a dor relacionada ao movimento pode ser mensurada dentro de um nível escalar de razão. Por meio da análise dos valores obtidos através das estimativas de magnitude da dor percebida durante a execução de 10 movimentos, selecionadas durante o experimento 2, e do expoente da função de potência obtido a partir destes valores, fomos capazes de compreender como a dor de cada indivíduo se manifestou no contexto em que ela é vivenciada e de mensurar seu gradiente de generalização ao longo dos movimentos que compõe a escala. As análises psicométricas realizadas durante o experimento 3 demonstraram validade de conteúdo, consistência interna e validade de constructo positivas com ausência de efeitos teto e piso, apresentando uma confiabilidade inter-examinadores adequada. Conclusão: A EPADRMO demonstrou ser capaz de mensurar quantitativamente o gradiente de generalização e a magnitude de variação da dor funcional de um indivíduo com dor no ombro com uma capacidade informativa superior as outras escalas disponíveis que se prezam a avaliar a dor funcional nesta população de pacienteThe pain perception involves an active process of information interpretation whose main goal is the subsequent selection of protective behaviors to contexts or a set of stimuli that were associated by our brain to an injury or a potential risk of injury, without a necessarily structural change that could explain these symptoms. While the pain related to the execution of movements and the maintenance of postures is currently the main reason why patients with chronic musculoskeletal complaints seek medical help, most of the measurement instruments specific to this patient population do not assess pain in the context in which it is perceived and those who do so, have access to inferior levels of measurement and exhibit various construction errors. Objective: To develop and validate a psychophysical ratio scale that is capable of evaluationg the movement related pain generalization gradient in individuals with shoulder pain. Methods: A total of 180 patients with shoulder pain, right-handed, symptomatic, sedentary and with complaint for at least 3 months were recruited from patients in care in the Shoulder Group of IOTFMUSP to perform three experiments. In the first two experiments, the internal validation of the psychophysical ratio scale were made by the cross-modality matching procedure and 10 movements have been selected to compose the official scale, respectively. During the experiment 3, the development of The Psychophysical Scale for Movement Related Shoulder Pain (PSMRSP) was completed and the psychometric validation process of the instrument was initiated. Results: The internal validation of the scale based on the psychophysical theory, held in experiment 1, demonstrated that the movement related pain can be measured in a ratio level of measurement. Through the analysis of the values obtained by the magnitude estimations of the perceived pain during the execution of 10 movements, selected during the experiment 2, and the power function exponent obtained from these values, we were able to understand how the pain of each individual manifests in the context in which it is felt and to measure the gradient of pain generalization along the movements selected for the scale. The psychometric analyzes performed during the experiment 3 demonstrated positive content validity, internal consistency and construct validity with no ceiling and floor effects, presenting an adequate inter-rater reliability. Conclusion: The findings of the present study demonstrated that the PSMRSP provide a quantitative measure of the generalization gradient and of the range of variation of the movement related pain in subjects with shoulder pain with a higher informativeness than the other scales available to evaluate the functional pain in this patient populatio

A dor relacionada ao movimento como uma resposta aprendida: uma investigação dos possíveis mecanismos subjacentes à persistência e melhora da dor relacionada ao movimento em indivíduos com quadros de dor musculoesquelética crônica

Although our understanding about pain neurobiology have increased over the last decades, there is still a gap of knowledge regarding the understanding of the mechanisms associated with pain persistence and the mechanisms of action of interventions for subjects with chronic musculoskeletal pain. The main focus of this thesis was to discuss in depth the possible underlying mechanisms associated with pain persistence and recovery in an effort to contribute to the bridging of this gap of knowledge throught four researchs. The first three studies investigated assumptions of current hypothesis about pain persistence through the lens of learning theories, by verifyng if (1) pain can be conditioned to movements through associative learning; (2) investigating which factors were associated with pain distribution through movements and daily activities commonly reported as painful by subjects with chronic pain; and by (3) investigating if chronic musculoskeletal pain is associated with perceptual distortions in other perceptual continuums associated with movements that could foster avoidance behaviors. The last study of this thesis was (4) a systematic review that aimed to systematically identify and synthesise studies that conducted mediation analyses of randomized controlled trials that test or estimate indirect effects of cognitive-behavioral and exercise-based interventions for pain and disability in people with chronic musculoskeletal pain. The basis for the conduction of these studies, as well as its main findings were discussed throughout this thesisApesar do entendimento sobre a neurobiologia da dor ter aumentado exponencialmente ao longo das últimas décadas, ainda existem lacunas de conhecimento importantes relacionadas aos mecanismos associados à persistência da dor e aos mecanismos de ação de abordagens voltadas para o tratamento da dor musculoesquelética crônica. O objetivo desta tese foi contribuir para o preenchimento desta lacuna de conhecimento através da condução de quatro estudos. Os primeiros três estudos investigaram premissas de hipóteses atuais sobre a persistência da dor por uma perspectiva de teorias de aprendizagem, investigando (1) se a dor pode ser condicionada ao movimento através de aprendizado associativo; (2) os fatores associados com a sua manifestação clínica através de movimentos e atividades de vida diária comumente relatadas como dolorosas em pacientes com quadros de dor persistente; e (3) a associada da dor musculoesquelética crônica com distorç?es perceptuais em outros contínuos perceptuais relacionados ao movimento que podem estar associados com a manutenção de comportamentos de evitação. O último estudo desta tese foi (4) uma revisão sistemática da literatura científica sobre estudos de mediação, conduzidos a partir de ensaios clínicos randomizados, que avaliaram os mediadores de efeito de intervenç?es baseadas em exercício e cognitivocomportamentais para a dor e função em pacientes com quadros de dor musculoesquelética crônica. As bases para a condução destes estudos e os seus principais achados foram discutidos ao longo da dissertaçã

Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

Abstract Background Causal mediation analysis is one way to bridge this gap by exploring the causal pathways of a given intervention. The aim of this study was to assess whether scapular motion, position, and periscapular muscle strength are mediators for pain and shoulder disability outcomes following a scapular stabilization intervention for patients with subacromial pain syndrome. Methods Sixty patients were randomized into two groups: scapular stabilization or periscapular strengthening exercises. The intervention consisted of three sessions per week for 8 weeks. The primary outcome measures were pain and disability and the following outcome measures were considered as potential mediators: scapular motion, scapular position, periscapular muscle strength, age, duration of symptoms, and side of the complaint. A model-based inference approach with bootstrap simulations was used to estimate the average causal mediation effect, average direct effect, and the average total effect from the data of a randomized clinical trial that evaluated the effect of adding scapular stabilization exercises to a scapulothoracic strengthening program in people with subacromial pain syndrome. Results The results demonstrated that none of the putative mediators were influenced by the intervention. However, muscle strength of serratus anterior, upper, middle, and lower trapezius muscles was associated with shoulder disability. Conclusion Scapular kinematic and periscapular muscle strength did not mediate the effect of scapular stabilization exercises on shoulder pain or disability scores in subjects with subacromial pain syndrome. Muscle strength of serratus anterior, upper, middle and lower trapezius were associated with shoulder disability scores at 8-weeks follow-up

Development of a Pain Training Program via the Internet (TED-On) for physical therapists: Protocol of a Mixed Method Trial

We aim to verify the effectiveness of an online teaching program on pain for physical therapists and to investigate the professionals' perceptions about the change in their knowledge and attitudes towards the management patients' pain

Shoulder pain across more movements is not related to more rotator cuff tendon findings in people with chronic shoulder pain diagnosed with subacromial pain syndrome

INTRODUCTION: People with chronic shoulder pain commonly report pain during arm movements in daily-life activities. Pain related to movement is commonly viewed as an accurate representation of tissue damage. Thus, when a person reports pain across a variety of movements, this is often understood as indicative of greater damage. OBJECTIVES: We aimed to investigate if movement-related pain that occurs across a wider variety of movements was associated with the number or severity of rotator cuff tendons reported as abnormal on a magnetic resonance imaging (MRI). To answer this question, this study was designed in 3 phases. METHODS: We recruited 130 individuals with chronic shoulder pain diagnosed with subacromial pain syndrome. First, a list of daily functional activities commonly reported as painful by people with chronic shoulder pain was generated from 3 well-established outcome measures with 30 individuals and a measurement tool was developed with data from further 100 individuals, which demonstrated to have acceptable content validity, construct validity, internal consistency, interrater reliability, and structural validity. Multiple linear regression was then used to evaluate the hypotheses of the study. A direct acyclic graph was used to select variables for linear regression modelling. RESULTS: There was no association between movement-related pain occurrence across movements and the MRI findings. CONCLUSION: Our study provides evidence that neither the number of rotator cuff tendons reported as abnormal nor the severity of each tendon imaging finding were associated with pain occurrence across movements and activities commonly perceived as painful by people with chronic shoulder pain