Background: Pain associated with the spine (PAWS) refers to pain in the neck, thorax, lower back or sacrum. It impacts on patients' Quality of Life (QoL), including working ability, daily functioning, sleep and psychological well-being. A number of clinical trials have demonstrated that acupuncture was beneficial for patients with PAWS. However the overall effect of acupuncture on these patients' QoL is unknown. Aims: The current study aimed to conduct a systematic review (SR) of clinical trials to determine the effect of acupuncture on QoL and pain for patients with PAWS. In addition, a narrative review (NR) was conducted to compare patients' perceived changes (PCC) with the standard QoL instruments used in acupuncture clinical trials for pain. Methods: For the SR, PubMed, Embase (via ScienceDirect), CINAHL (Via EBSCO) and Cochrane Central Register of Controlled Trials were searched. Randomised controlled trials (RCTs) of acupuncture for PAWS condition(s) that include both QoL and pain assessments with a Jadad score of three or greater were included. For the NR, PubMed was searched to identify studies reporting PPC after acupuncture and/or traditional Chinese medicine. Extracted data were grouped and compared with domains of the QoL instruments. Results: In total, 21 RCTs were included and 17 of them had sufficient data for analysis. QoL was measured using 15 different instruments. Randomisation procedures and dropouts were adequately reported in all 17 studies. Four studies compared acupuncture with wait-list or usual-care. Two demonstrated that acupuncture had a superior effect on improving physical and mental components of QoL measured by Short Form-36 health survey questionnaire and pain at the three month follow-up. Studies comparing acupuncture with sham/placebo acupuncture or placebo-TENS found either no difference between the treatments or conflicting results. When acupuncture was compared with active interventions, there was no difference except that at the intermediate-term follow-up massage was better for disability and pain and physiotherapy was better for Northwick Park Neck Pain Questionnaire. Acupuncture was also better than TENS for pain. The combined therapy of acupuncture and an active intervention showed a superior result than the latter alone in the short-term. Six studies were identified for the NR. Patients reported 11 categories of changes after acupuncture, such as reduced reliance on other therapies, enhanced spirituality, prevention of disease. However, these clinical outcomes were not included in any of the QoL instruments used in the included RCTs. Conclusion: There is moderate to strong evidence that acupuncture is more effective than wait-list or usual-care at the short-term follow-up in improving QoL of patients with PAWS. When acupuncture is combined with another therapy, the combined therapy seems to produce a better outcome. Acupuncture is not better than sham/placebo acupuncture or placebo-TENS. Surprisingly, the commonly used QoL instruments do not measure all the changes perceived by patients as a result of acupuncture and/or traditional Chinese medicine. There is a pressing need to design QoL assessments that are suitable for acupuncture research. Further studies should have larger sample sizes and additional validated outcome assessments are required to detect effects of acupuncture.

Low back pain is characterised by loss of ability to carry out everyday tasks, the disruption of life plans, and psychological distress as well as pain. This study examined the adaptation of individuals with low back pain. In a departure from established models used to study and understand illness representation and adjustment, this study used a personal projects approach to examine the relationship between individuals' appraisals of projects and their functional adaptation to low back pain in the context of their day-to-day goal-directed activities. A functional personal project system was proposed; specifically, those individuals whose project dispositions were highly concordant and socially oriented would have better function and health. For people dealing with low back pain, it was expected that these dispositions, and personal competency, would enhance adaptation. Conversely, poor adaptive abilities, such as difficulties with physical function, social function, and poorer health, would be associated condition-specific perceptions of pain and negative appraisals of project stress[.] The results showed there was a relationship between personal project dispositions and functional ability, well-being, and perceived general health of individuals with low back pain. The results did not confirm that a functional project system possessed adaptive benefits. However, the appraisal of pain as salient to the progress and success of projects and stressfulness of personal projects were predictive of limited function and poorer health. Notably, all aspects of function, both social and physical, were associated with pain-salience cognition. Furthermore, pain salience cognition was still predictive of function after traditional predictors of low back pain disability, pain severity or pain-related fear, were included in the analysis. The significance of the relationship of pain and negative appraisals of the effect of pain on performance supports functional self-efficacy and pain-related fears models used to explain disability level in individuals with low back pain. Since this personal projects analysis was an integrated assessment of individuals' dispositions in the context of participants' everyday lives, it was concluded that pain salience and stressfulness of projects outweighed any advantages offered by their other dispositions in negotiating the participant's personal projects.

Orientadores: Maria Yolanda Makuch, José Guilherme Cecatti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T04:27:59Z (GMT). No. of bitstreams: 1 Spilla_MariaAmeliaMiquelutti_D.pdf: 2533271 bytes, checksum: 737080e4c94c6b1f07963f584eba80f3 (MD5) Previous issue date: 2012 / Resumo: Introdução: Programas de preparo para o parto são recomendados mundialmente para que se possa promover uma gravidez saudável, com maior autonomia durante o trabalho de parto e parto, prevenindo desconfortos físicos e altos níveis de ansiedade. Objetivo: Avaliar a efetividade do Programa de Preparo para o Parto (PPP) na prevenção de dor, incontinência urinária, ansiedade na gestação e resultados perinatais de nulíparas, comparativamente a gestantes que não participaram do programa. Métodos: Foi realizado um ensaio controlado aleatorizado com 197 participantes, e um estudo qualitativo baseado em entrevistas semi-estruturadas com 21 participantes. Participaram nulíparas entre 16 e 40 anos, com idade gestacional ?18 semanas, sem contraindicação para realizar exercícios físicos. O PPP consistiu de encontros no pré-natal que incluiu exercícios físicos e informações sobre prevenção de dor na gravidez, papel da musculatura perineal, fisiologia do trabalho de parto e técnicas de alívio da dor. Foram avaliadas: incontinência urinária, prática de atividade física, lombalgia e dor pélvica posterior, ansiedade, variáveis perinatais, controle do trabalho de parto, técnicas de alívio da dor e satisfação com o parto. Resultados: As participantes do PPP tiveram menor risco de apresentar incontinência urinária nas avaliações intermediária (RR 0,69; IC 95% 0,51-0,93) e final (RR 0,60; IC 95% 0,45-0,81), e referiram maior prática de exercício físico (p=0,009). Não houve diferenças em relação ao nível de ansiedade, algias lombopélvicas e dados perinatais. Na análise qualitativa, as participantes do PPP relataram maior controle do trabalho de parto, facilidade no uso das técnicas de alívio da dor, utilizaram maior variedade de posições verticais e relataram uma maior satisfação com o a experiência do trabalho de parto e parto. Conclusão: O PPP foi efetivo no controle da incontinência urinária e na melhora da prática de exercícios físicos, aumentou a autonomia das mulheres no controle do trabalho de parto, promoveu maior satisfação com o parto, e não apresentou efeitos adversos maternos-fetais / Abstract: Introduction: Antenatal preparation programs are recommended worldwide so you can promote a healthy pregnancy and greater autonomy during labor and delivery, preventing physical discomfort and high levels of anxiety. Objective: To evaluate the effectiveness of a Birth Peparation Program (BPP) in the prevention of pain, urinary incontinence and anxiety during pregnancy and perinatal outcomes of nulliparous compared with women who did not participate in the program. Methods: A randomized controlled trial was conducted with 197 participants, and a qualitative study based on semi-structured interviews with 21 participants. Participants was low risk nulliparas between 16 and 40 years, with ? 18 weeks gestational age.The intervention consisted of meetings held on the days of prenatal consultations, and involved physical exercises, educational activities and instructions on exercises to be performed at home. Were assessed: urinary incontinence, physical activity, lumbopelvic pain, anxiety, perinatal variables, labor control, pain relief techniques and satisfaction with childbirth. Results: The participants in the experimental group had a lower risk for urinary incontinence in intermediate (RR 0.69, 95% CI 0.51-0.93) and final assessments (RR 0.60, 95% CI 0.45-0.81), and reported greater physical activity (p = 0.009). There were no differences in the anxiety level, lumbopelvic pain, and perinatal data. Qualitative analysis of the experimental group reported greater control of labor, autonomy in the use of pain-relief techniques and vertical positions and reported greater satisfaction with the the experience of labor and delivery. Conclusion: The PPP was effective in controlling urinary incontinence and improvement in physical exercise, increased women's control of labor, promoted greater satisfaction with childbirth, and showed no adverse maternal and fetal effects / Doutorado / Saúde Materna e Perinatal / Doutor em Ciências da Saúde

Prior studies have reported differences in lower back biomechanics during activities of daily living between individuals with and without chronic low back pain (LBP). Nevertheless, the literature on lower back biomechanics of patients with non-chronic LBP is scant. Therefore, the objective of this study, as the first step towards future prospective studies, was to investigate the lower back biomechanics in patients with non-chronic LBP. Case-control studies were conducted wherein measures of lumbo-pelvic coordination during bending and return tasks as well as measures of mechanical demand on the lower back during lifting tasks in the sagittal plane were investigated between patients with non-chronic LBP and matched asymptomatic individuals. Patients were enrolled into the study at the non-chronic stage of their LBP. We found distinct difference in measures of lumbo-pelvic coordination as well as mechanical demands on the lower back between patients with non-chronic LBP and controls. Reduced lumbar range of flexion and slower task pace as well as the more in-phase and less variable lumbo-pelvic coordination observed in patients with non-chronic low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Such a neuromuscular adaptation, however, resulted in a larger shearing demand on the lower back. Persistent abnormal lumbo-pelvic coordination might play a role in transition to chronic stage or recurrence of LBP. However, such inferences need to be further investigated using prospective studies as well as clinical trials involving a combination of physical and psychological treatments aimed at correction of lumbo-pelvic coordination.

Lietuvoje 2003 m. pirmą kartą pripažinti neįgaliais dėl nugaros problemų 2 064 asmenys. Paprastai medicininis gydymas ar reabilitacija nėra labai orientuoti į asmens sugrįžimą į darbą. Į darbą orientuota darbinė reabilitacija tai galimybė išsaugoti ankstesnę darbo vietą ir/ar išvengti chroniškumo ir nuolatinės negalios. Tarptautinėje funkcionavimo, negalumo ir sveikatos klasifikacijoje profesinė reabilitacija apibūdinama pirmiausia, kaip funkcinis ištyrimas ir reabilitacinių intervencijų kompleksas nukreiptas į asmens aktyvinimą ir dalyvumo profesinėje veikloje skatinimą. Vertinant kliento funkcines galimybes ir trūkumus ergonomiškai atlikti bet kokį darbą yra taikoma Funkcinio pajėgumo vertinimo metodika (FPV). Reabilitacinėje ergonomijoje pirmiausiai reikia ištirti ir treniruoti pagrindines fizines funkcijas optimalios profesinės integracijos požiūriu. Šio darbo tikslas: Nustatyti, darbingumo atkūrimo programų poveikį nugaros apatinės dalies skausmui vykdant profesinę reabilitaciją. Uždaviniai: 1. Įvertinti tiriamųjų funkcinį pajėgumą profesinės reabilitacijos darbingumo atkūrimo etapo pradžioje ir pabaigoje. 2. Įvertinti tiriamųjų skausmą profesinės reabilitacijos darbingumo atkūrimo etapo pradžioje bei pabaigoje. 3. Įvertinti pacientus savęs vertinimo anketa profesinės reabilitacijos darbingumo atkūrimo etapo pradžioje bei pabaigoje. Taikyti metodai. Tiriamuosius sudarė 50 klientų (amžiaus vidurkis 4,6 ± 3,30m.) atvykusių į profesinę reabilitaciją iš kurių 10 buvo moterų... [toliau žr. visą tekstą] / 2003 in Lithuania 2064 people were admit as being disabled due to back problems. Usually medical treatment or rehabilitation is not focused on the person’s return to work. The work oriented vocational rehabilitation should be an opportunity to retain previous work place and/or avoid chronic and permanent disability. Vocational rehabilitation in International Classification of Functioning, Disability and Health classification is defined primarily as functional testing and rehabilitation interventions in complex focused on an activation of the person and the promotion of participation in professional activities. The Functional capacity evaluation methodology (FPV) is applied to assess the client's functional capabilities and weaknesses ergonomically to perform any work. Firstly is necessary to investigate and to train the basic physical functions in rehabilitation ergonomic on optimal integration of professional attitude. The aim of this thesis is to determine the impact of work rehabilitation programs for low back pain in vocational rehabilitation. Objectives: 1. To evaluate the functional capacity of the subjects' at the beginning and at the end of recovery phase of vocational rehabilitation. 2. To evaluate the person’ pain at the beginning and at the end of recovery phase of vocational rehabilitation. 3. To evaluate the patient self-assessment questionnaire and at the end of recovery phase of vocational rehabilitation. Methodology Research accounted for 50 clients... [to full text]

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The intervertebral disc (IVD), situated between adjoining vertebrae, consists of the gelatinous nucleus pulposus (NP) in the centre surrounded by the tougher annulus fibrosus (AF). Its main roles are to distribute loads and to act as joints. With aging, degenerative disc disease (DDD) occurs due to an imbalance in anabolic and catabolic events in the IVD, which results in a loss of function. Lower back pain (LBP) affects 84% of people at some point in their lifetime and is strongly associated with DDD. Current LBP treatments have limited long term efficacy and are symptomatic rather than curative. Cell-based therapies are regarded to hold great potential for the treatment of DDD as it has been hypothesised that they could regenerate the damaged tissue and alleviate LBP. A number of natural and synthetic biomaterials have been investigated as NP tissue engineering scaffolds with varying results. In this study, a self assembling peptide hydrogel (SAPH) was investigated for its potential as a cell carrier and/or scaffold for NP tissue engineering. SAPHs display the advantages of natural polymer hydrogels such as biocompatibility and biodegradability whilst combining the advantages of synthetic materials such as controlled structural and mechanical propertiesCharacterisation determined that the SAPH nanofibrous architecture had features that were of similar scale to extracellular matrix (ECM) components of the human NP. The mechanical properties of the SAPH could be optimised to closely match the native tissue. The system could shear thin and self-heal making the system ideally suited to delivery via minimally invasive procedure. The three dimensional (3D) culture of bovine NP cells (bNPCs) in the SAPH demonstrated that the NP phenotype could be restored after de-differentiation during monolayer culture. Gene expression results demonstrated that ‘traditional’ and ‘novel’ NP markers were highly expressed throughout in vitro culture. Cell viability was high, cell population remained stable and bNPCs adopted the characteristic rounded morphology of native NPCs. Finally, type II collagen and aggrecan, the main ECM components of the NP, were deposited with increasing production over culture period. Growth differentiation factor 6 (GDF-6) has been identified as the most promising current growth factor for inducing discogenic differentiation from human bone marrow mesenchymal stem cell (h-BMMSCs). After samples were stimulated with GDF-6, gene expression results confirmed that a NP-like phenotype could be induced with high expression of ‘traditional’ and ‘novel’ NP markers. Cell viability was high, cell population remained stable and NP associated ECM components were deposited with cells displaying a rounded morphology. Interestingly, when h-BMMSCs were cultured without GDF-6, it was strongly suggested that spontaneous discogenic differentiation occurred after culture in the SAPHs as ‘traditional’ and ‘novel’ NP markers were highly expressed, morphology was comparable to native NPCs and type II collagen and aggrecan were deposited extracellularly. If these findings were accurate then this is the first study to demonstrate that a NP-like phenotype could be induced from MSCs without use of an exogenous growth factor or a discogenic bioactive motif. Despite exciting and novel results, further work is required to confirm the potential of SAPHs for NP tissue engineering scaffolds.

Chronic lower back pain (CLBP) presents a significant challenge in healthcare, requiring effective tools for rehabilitation and assessment. This study explores the use of virtual reality (VR) for the assessment of CLBP and addresses two research questions. Firstly, it investigates how movements and tasks considered problematic for individuals with CLBP can be incorporated into the VR application for assessment purposes. Secondly, it examines physiotherapists' perceptions of the VR application regarding tasks, feasibility, user experience, and overall design. To answer our questions, we conducted three design workshops with physiotherapists and HCI researchers and designed three VR applications that we evaluated with six physiotherapy students. The study provides valuable insights into participants' perceptions and experiences, shedding light on both the promising aspects and potential pitfalls of using VR in physiotherapy assessment. The findings underscore the value of incorporating user feedback into the design and implementation process, emphasizing the need for a user-centered approach, and provide several implications for the design of VR applications for assessment. This study lays the groundwork for the integration of VR as a valuable tool in physiotherapy assessment for CLBP.

Made available in DSpace on 2016-04-28T20:39:50Z (GMT). No. of bitstreams: 1 Fernando Lourenco Maeda.pdf: 503002 bytes, checksum: 7aa342814a5c45db50d1356bb3f56ffc (MD5) Previous issue date: 2008-05-30 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This study had as general goal investigate the perception of partner s support and the impact of the pain in the relationship as a couple of patients suffering of chronic lower back pain, of both gender, in ambulatory treatment in a big public hospital of São Paulo city. The study was made with 50 patients, where 25 were men and 25 were women, aged 35 to 65 years. The main used instruments were: social-demographic questionnaire, visual analogical scale of pain intensity, medical Outcomes study 36- item short form-health survey and semi directed interviews. The results demonstrated that all the participants of the study had the quality of their lives harmed, and that women showed intensity pain levels considered severe, whereas men obtained intensity pain levels considered moderate. 70% percent of the sample mentioned a negative impact on their sexual relations, due to their functional limitation and intensity of the pain, while the rest mentioned a marital adjustment when facing the symptoms of the pain. 86% of the sample mentioned perceiving their partners as supportive, being the helpful behavior considered the main way of support. The analysis of the results showed that the participants that had received partner s support, obtained better levels in the control of Vitality and Mental Health, when compared to the ones that had had no support. The conclusion of the results indicated that the chronic lower back pain causes a negative impact in the couple s relationship and that the partners support can work as a protection factor for depressive and anxiety symptoms, being this an important aspect to be considered in the health process of individual with chronic pain and in the planning of therapeutic procedures / Este estudo teve como objetivo geral investigar a percepção de apoio conjugal e o impacto da dor no relacionamento de casal de pacientes portadores de dor lombar crônica, de ambos os gêneros, em tratamento ambulatorial em um hospital de grande porte da rede pública da cidade de São Paulo. O trabalho foi realizado com 50 pacientes, sendo 25 homens e 25 mulheres, com faixa etária entre 35 e 65 anos. Os principais instrumentos utilizados foram: Questionário Sócio-demográfico, Escala VAS de intensidade da dor, Questionário de Qualidade de Vida SF 36 e Entrevista Semi-dirigida. Os resultados demonstraram que todos os participantes do estudo obtiveram qualidade de vida prejudicada, sendo que as mulheres apresentaram intensidade de dor considerada severa, enquanto os homens obtiveram intensidade de dor moderada. 70% da amostra relataram impacto negativo no relacionamento sexual, em decorrência da limitação funcional e gravidade da dor, enquanto que o restante referiu um reajustamento conjugal frente aos sintomas da dor. 86% da amostra relataram que percebem seus cônjuges como apoiadores, sendo que o comportamento solícito foi considerado o principal meio de apoio. A análise dos resultados demonstrou que os participantes que receberam apoio do cônjuge, obtiveram melhores índices nos domínios Vitalidade e Saúde Mental, quando comparados com aqueles que não receberam apoio. A conclusão dos resultados indicou que a dor lombar crônica causa impacto negativo no relacionamento de casal e o apoio conjugal pode funcionar como fator de proteção para sintomas depressivos e de ansiedade, sendo este um aspecto importante a ser considerado no processo da saúde dos indivíduos com dor crônica e no planejamento de condutas terapêuticas