Tratamento de pacientes com dor lombar crônica inespecífica por fisioterapeutas: um estudo transversal

What are the benefits of cultivating self-compassion in adults with low back pain? A systematic review

Introduction

Low back pain is one of the most prevalent public health problems in the world, generating psychosocial impacts on quality of life and a high demand for medical care. Self-compassion may be beneficial for low back pain control, however, studies in the area are scarce. Therefore, this systematic review aimed to investigate the benefits of self-compassion-related interventions on low back pain and mental health in adults.

Methods

The review protocol was registered in PROSPERO and the method was performed according to the PRISMA guidelines. Searches were conducted using the keywords "self-compassion" and "low back pain" in Portuguese, English, and Spanish in the following databases: PubMed, LILACS, SciELO, PePSIC, PsycInfo, Embase, Scopus, Web of Science, and Cochrane. Additional searches were also conducted through the references of the included studies.

Results

Thirty-three articles were identified and analyzed by two independent reviewers using Rayyan. Four of these studies were included. RoB 2 was used to assess the risk of bias of each study. The main findings suggest that self-compassion-related interventions demonstrate benefits in the treatment of low back pain, as well as reduction in pain intensity, psychological stress, and improvement of pain acceptance.

Discussion

However, these positive data must be analyzed carefully, as only two studies presented a low risk of bias. Despite growing interest in this field, more research self-compassion-related interventions for low back pain are suggested, since biopsychosocial aspects associated with low back pain can impact the outcome of treatment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier (CRD42022376341).

Profile, attitudes and beliefs of physiotherapists in the management of chronic nonspecific low back pain

Abstract Introduction: About 84% of the population have had some low back symptom during their lifetime; where 23% of cases become chronic pain. It is observed that in around 85% of cases of chronic low back pain, there is no specific cause or diagnosis, where it is referred to as chronic nonspecific low back pain. Given its disabling potential, the comprehensive assessment, attitudes and beliefs of the physiotherapist in clinical management become essential to the prognosis. Objective: To evaluate the relationship between sociodemographic/socioeducational and work profile and the attitudes and beliefs of physiotherapists in the management of chronic nonspecific low back pain treatment. Methods: This was a cross-sectional quantitative study. For data collection, two questionnaires were used, one referring to the sociodemographic/socioeducational profile information and the other referring to attitudes and beliefs determined by the Pain Attitudes and Beliefs Scale for Physiotherapists. Data were analyzed using the BioEstat 5.0 program using descriptive statistics, t-test and Pearson correlation (p < 0.05). Results: Fifty-seven physical therapists were analyzed, where most were women (61.4%), had specialization (56.2%), worked in private clinics (63.2%) and used specific methods in the management of chronic nonspecific low back pain (84.2%). Biomedical belief was predominant (70.2%) and showed a significant relationship with age (p = 0.0006). Conclusion: The biomedical model is still predominantly used, which is related to the age of the professionals surveyed.

The genetic influence of the brain-derived neurotrophic factor Val66Met polymorphism in chronic low back pain

BACKGROUND

The Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene is a potential biomarker of vulnerability to pain. Thus, the present study aimed to investigate the association of this polymorphism with clinical and biopsychosocial factors in patients with chronic low back pain (CLBP).

METHODS

A total of 107 individuals with CLBP answered questionnaires that were validated and adapted for the Brazilian population, including the Brief Inventory of Pain, the Central Sensitization Inventory, the Roland Morris Disability Questionnaire, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, the Survey of Pain Attitude-Brief, and the Hospital Anxiety and Depression Scale. All of the subjects were genotyped for the BDNF Val66Met polymorphism.

RESULTS

The sample showed moderate scores of disability, central sensitization, and kinesiophobia, in addition to mild anxiety, hopelessness, and ruminant thoughts. No significant association was observed between the Val66Met polymorphism and the variables analyzed. Besides, there was no relationship between the BDNF Val66Met polymorphism with CSI, catastrophization, or disabilities that were generated by CLBP.

CONCLUSION

The results showed that the Val66Met polymorphism of the BDNF gene was not associated with clinical and biopsychosocial characteristics of CLBP in the sample studied.

Association Between Low Back Pain and Biomedical Beliefs in Academics of Physiotherapy

STUDY DESIGN

Observational cross-sectional study.

OBJECTIVE

To analyze the association between low back pain and biomedical beliefs in physiotherapy students of the first and last year.

SUMMARY OF BACKGROUND DATA

There is a hypothesis that the presence of low back pain may be a risk factor for biomedical beliefs in physiotherapy academics.

METHODS

Three hundred sixty-five students of first and last year of the physiotherapy course from three universities in city of Fortaleza completed a questionnaire with sociodemographic factors and a Pain Attitude and Beliefs Scale used to determine the orientation (biopsychosocial or biomedical approach) of practitioners to the management of people with low back pain.

RESULTS

The mean age of participants was 23.57 ± 4.77 years, with a predominance of females (80.27%, n = 239). Approximately 23.84% reported low back pain, 18.9% had undergone imaging tests at the site, and 36.71% reported that family members with low back pain also underwent these examinations. The means of the biopsychosocial subscale of the Pain Attitude and Belief Scale corresponded to 20.19 and 20.63 in the first and last year academics, respectively, whereas the biomedical subscale corresponded to 32.10 and 32.73 in the first and last year academics, respectively. There was no statistical difference between the scores of the first and last year students. Linear regression analyses showed that low back pain was associated with lower levels of biomedical beliefs in the students of the last year (beta coefficient = -2.17, 95% confidence interval = -3.95 to -0.3, P = 0.02). We did not find association between low back pain and levels of biomedical beliefs in academics of both years and with academics of the first year. Also, we did not find association between low back pain and levels of biopsychosocial beliefs.

CONCLUSION

First and last year physical therapy students did not present a difference between biomedical and biopsychosocial beliefs. Although biomedical beliefs were prevalent in both groups, the academics of the last year who had low back pain presented lower levels of biomedical beliefs than the academics of the last year without low back symptoms.

LEVEL OF EVIDENCE

4.

Função, atividade e participação na percepção do paciente com dor lombar crônica: estudo em um grupo focal

Objetivo: Identificar a percepção da dor lombar (DL) crônica em usuários de uma unidade de reabilitação fisioterapêutica de um município de Minas Gerais, Brasil. Métodos: Trata-se de uma pesquisa exploratória descritiva e qualitativa. Realizaram-se grupos focais com usuários do serviço de saúde de ambos os sexos com idade superior a 18 anos, diagnóstico médico de DL crônica, e em reabilitação física. As unidades norteadoras foram: conversando sobre dor e tratamentos prévios para alívio da dor, programadas por roteiro semiestruturado. Emergiram as unidades: fala dos profissionais de saúde e a fala dos colegas de trabalho e familiares. As falas foram gravadas, transcritas e analisadas utilizando a Técnica de Elaboração e Análise de Unidades de Significado. Utilizou-se o escore de dor do Índice de Incapacidade de Oswestry (IIO) e o IIO completo para avaliação da dor e da funcionalidade. Resultados: 14 pacientes (média de idade 52 ± 3 anos), na maioria mulheres, relataram DL crônica em média há 5 ± 5 anos. O valor médio do escore de dor foi de 1,37 ± 1,72 e média de incapacidade de 21,96% (IC95% 15,43 – 28,50%).  Os relatos sobre a dor foram: ‘um incômodo’, ‘uma doença’, ‘incapacidade’, tratada com remédios e Fisioterapia; profissionais da saúde demonstram ‘negligência’, ‘agressão’ ou ‘proibição’; enquanto família e colegas de trabalho demonstram ‘desprezo’, ‘represália’ ou ‘apoio’. Conclusão: A percepção da DL crônica equivale a incômodo, desconforto, doença, restrições, agressão, negligência, desprezo, represália ou apoio a um misto de sensações físicas e psicológicas.