RESUMO
BACKGROUND: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP. METHODS: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%. DISCUSSION: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis. TRIAL REGISTRATION: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.
Assuntos
Dor Crônica , Terapia com Luz de Baixa Intensidade , Cervicalgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Cervicalgia/terapia , Cervicalgia/fisiopatologia , Cervicalgia/diagnóstico , Terapia com Luz de Baixa Intensidade/métodos , Dor Crônica/terapia , Dor Crônica/fisiopatologia , Dor Crônica/diagnóstico , Terapia Combinada , Resultado do Tratamento , Medição da Dor , Avaliação da Deficiência , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Terapia por Exercício/métodos , Fatores de Tempo , Qualidade de VidaRESUMO
BACKGROUND: Functional tests are important clinical tools, since they are non-invasive methods, with simple applicability, and low cost. However, there are few tests adapted for individuals with chronic low back pain. Thus, our objective was to evaluate the test-retest and inter-rater reliability of the 2-Minute Step Test in individuals with chronic low back pain and to correlate the test score with measures of pain and physical activity. METHODS: We included patients aged between 18 and 45 years, of both sexes, and with low back pain. The interval between the test and retest was 7 days. We analyzed the data via intra-class correlation coefficient (ICC), confidence interval at 95%, standard error of measurement, and minimum detectable change for reliability. We used the Spearman's correlation coefficient to verify the correlation between 2-Minute Step Test and measures of pain and physical activity (Numerical Pain Scale, Roland-Morris Disability Questionnaire, Pain-Related Catastrophizing Thoughts Scale, Tampa Scale of Kinesiophobia, and Baecke Habitual Physical Activity Questionnaire). RESULTS: Sample is composed of 37 individuals, most of them female, with overweight and low back pain > 60 months. 2-Minute Step Test showed excellent test-retest (ICC = 0.903) and inter-rater (ICC = 0.925) reliability. Sport domain of the Baecke showed a significant correlation with the 2-Minute Step Test (rho = 0.444). CONCLUSION: 2-Minute Step Test is a reliable measure to measure the functional capacity of patients with chronic low back pain considering different times and examiners, as well as being positively correlated with sports practice.
Assuntos
Dor Lombar , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Dor Lombar/diagnóstico , Reprodutibilidade dos Testes , Psicometria/métodos , Avaliação da Deficiência , Inquéritos e Questionários , Teste de Esforço , Comparação TransculturalRESUMO
BACKGROUND: The Work Role Functioning Questionnaire 2.0 (WRFQ 2.0) is an instrument that measures the difficulties perceived by workers in meeting work demands, given their physical or emotional health, but it has not yet been adapted for Brazil. Thus, this study aimed to translate, cross-culturally adapt and assess the psychometric properties of the WRFQ 2.0 into Brazilian Portuguese. METHODS: This is an observational study. Initially, translation and cross-cultural adaptation into Brazilian Portuguese was carried out. After that, this version was submitted to an evaluation of its internal structure. The internal consistency and test-retest reliability were assessed. To determine the construct validity, Spearman's correlation coefficient (rho) was used to determine the magnitude of correlation between the WRFQ 2.0 and the Work Ability Index (WAI), Numerical Pain Rating Scale (NPRS) and Self -Estimated Functional Inability because of Pain (SEFIP-work). RESULTS: The internal structure with five domains and 27 items presented adequate fit indices for the Brazilian version of the WRFQ 2.0. Adequate correlations of the five domains of the WRFQ 2.0 with the NPRS, WAI and SEFIP-work were found (rho ranged between 0.145 and 0.338). The test-retest reliability of the WRFQ 2.0 ranged from substantial to excellent (intraclass correlation coefficient ≥ 0.785) and internal consistency was adequate (Cronbach's alpha ≥ 0.852). CONCLUSION: The Brazilian Portuguese version of the WRFQ 2.0 presents valid internal structure with five domains and 27 items, adequate construct based on correlations with other instruments, and acceptable test-retest reliability and internal consistency.
Assuntos
Comparação Transcultural , Idioma , Brasil , Humanos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários , TraduçõesRESUMO
Exercise is often pointed out as an effective form of treatment in the clinical management of chronic neck pain (CNP). However, due to its complex range of causal factors and great diversity of signs and symptoms, other resources such as photobiomodulation therapy (PBMT) have been routinely used for the treatment of CNP. The aim of this study was to systematically review the literature on the use of the association of PBMT and therapeutic exercises in relation to pain intensity and neck disability in individuals with CNP. PubMed, Medline (via Ovid), Embase (via Ovid), Cinahl (via Ebsco), and Central (via Cochrane library) databases were searched using the following terms: "laser," "low-level laser," "photobiomodulation," "light emitting diodes," "phototherapy," "exercise," "chronic neck pain." After verification and implementation of eligibility criteria, seven manuscripts were considered eligible for data analysis. These manuscripts had methodological quality between 5 and 8 points on the PEDro scale. Most studies used low infrared laser therapy to perform PBMT, with a wide range of parameters and energy density between 2 and 7 J/cm2 and a total treatment time between 2 and 6 weeks. Four studies showed significant benefits in terms of pain intensity at short-term follow-up and one at intermediate-term follow-up. However, only one showed a minimal clinically important change. No studies have shown significant improvement in disability. This review demonstrates that the association of PBMT with therapeutic exercises in general promotes significant benefits only for the intensity of pain. However, it does not seem to promote a minimally effective clinical difference in individuals with CNP.
Assuntos
Dor Crônica , Terapia com Luz de Baixa Intensidade , Dor Crônica/radioterapia , Humanos , Cervicalgia/radioterapia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: Evaluate whether there is an association between convergence insufficiency and temporomandibular disorder (TMD) and whether there is an association between pain and range of motion in different degrees of TMD. METHODS: We evaluated 138 individuals with TMD and 46 without TMD using the Research Diagnostic Criteria for temporomandibular disorders, the Fonseca Anamnestic Index (FAI), Numeric Pain Rating Scale, and the measurement of mandibular range of motion (ROM). Convergence insufficiency was diagnosed using the convergence test and Convergence Insufficiency Symptom Survey. Analysis of variance was used to compare age and mandibular ROM. The Kruskal-Wallis was used to compare mandibular ROM and pain between groups. The chi-square test was used to evaluate associations between TMD subgroups and the FAI, sex, and ocular convergence. RESULTS: The majority of individuals without TMD did not exhibit convergence insufficiency. The frequency convergence insufficiency was significantly higher among individuals with severe TMD (p < 0.003). Mean pain severity differed between individuals with and without TMD. Mandibular ROM diminished with the increase in TMD severity. CONCLUSIONS: Convergence insufficiency, age, the increase in pain, and the reduction in mandibular range of motion were associated with the degrees of TMD severity. Despite the significant associations between convergence insufficiency and both pain and TMD severity, these variables cannot be indicated as predictive factors due to the low variability in the linear regression analysis. CLINICAL RELEVANCE: The present findings can assist in decision making regarding the treatment of severe TMD and the evaluation of ocular convergence.
Assuntos
Transtornos da Motilidade Ocular , Transtornos da Articulação Temporomandibular , Estudos Transversais , Dor Facial , Humanos , Mandíbula , Amplitude de Movimento Articular , Transtornos da Articulação Temporomandibular/complicaçõesRESUMO
BACKGROUND: It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA. METHODS: This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week. RESULTS: In all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference. CONCLUSION: The addition of ICT, SDT or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014.
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Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Terapia com Luz de Baixa Intensidade/métodos , Osteoartrite do Joelho/terapia , Terapia por Ondas Curtas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Limiar da Dor , Estudos Prospectivos , Qualidade de Vida , Resultado do TratamentoRESUMO
The aim of the present study was to evaluate the effect of intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes on pain, mandibular range of motion, and functioning in women with myogenous temporomandibular disorder. A randomized, sham-controlled, double-blind clinical trial was conducted involving 30 women with myogenous temporomandibular disorder diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders. The participants were randomly allocated to two groups (active and sham photobiomodulation). The evaluations involved this use of the visual analog scale, digital calipers, and a functional scale. Photobiomodulation was administered intraorally in the region of the pterygoid muscles, bilaterally, in all participants for a total of six sessions. Evaluations were performed on five occasions: prior to the intervention, immediately after the first session, 24 h and 48 h after the first session, and after the six sessions. Significant differences between groups were found regarding pain (p ≤ 0.01) and functioning (p ≤ 0.04). However, no statistically significant difference was found regarding range of mandibular motion. The findings demonstrate that intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes diminishes pain and improves functioning but does not exert an influence on mandibular range of motion in women with temporomandibular disorder.Trial registration: NCT02839967.
Assuntos
Terapia com Luz de Baixa Intensidade , Dor/radioterapia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Mandíbula/fisiopatologia , Mandíbula/efeitos da radiação , Dor/fisiopatologia , Medição da Dor , Amplitude de Movimento Articular , Fatores de Tempo , Escala Visual AnalógicaRESUMO
OBJECTIVE: To correlate the range of movement and functional performance of the shoulder with pain measures in inactive individuals with and without neck pain. In addition, comparisons were made between the groups. METHODS: The sample comprised two groups of inactive adults, aged 18-45 years: chronic neck pain (n = 30) and healthy subjects (n = 30). All participants had no clinical dysfunction in the shoulder joint. Aspects related to neck pain were evaluated with the Numerical Rating Scale, Neck Disability Index, and the Catastrophic Thoughts about Pain Scale. Range of motion and shoulder functionality was evaluated by means of goniometry and the Closed Kinetic Chain Upper Extremity Stability (CKCUES) test, respectively. RESULTS: Individuals with neck pain presented reduction in CKCUES test (absolute score, mean difference [MD] = -1.50, 95% confidence interval [CI] [-2.87, -0.12]) and in abduction (MD = -7.36°, 95% CI [-13.84, -0.89]) and lateral rotation (MD = -8.61°, CI [-15.94, -1.28]) range of motion. Moreover, weak, significant, and negative association (p < 0.05, r = -0.262 to -0.384) was observed between the CKCUES test and pain intensity at rest and during active cervical movements, as well as catastrophizing. A weak, significant, and negative association (p < 0.05, r = -0.256 to -0.389) was also observed between the lateral rotation range of motion and catastrophizing, as well as pain intensity both at rest and during active movements. CONCLUSION: The greater the neck pain intensity and catastrophizing, the lower the functional performance and lateral rotation range of motion of the shoulder.
Assuntos
Cervicalgia/fisiopatologia , Amplitude de Movimento Articular , Articulação do Ombro/fisiopatologia , Artrometria Articular , Estudos de Casos e Controles , Catastrofização , Estudos Transversais , Feminino , Humanos , Masculino , Rotação , Comportamento Sedentário , Adulto JovemRESUMO
OBJECTIVE: To evaluate the intra- and inter-rater reliability of fleximetry in the measurement of range of motion (ROM) in individuals with chronic shoulder pain. DESIGN: Reliability study. SETTING: Physiotherapy clinic. PARTICIPANTS: Thirty individuals of both genders, ages between 18 and 45 years, with chronic shoulder pain. MAIN OUTCOME MEASURES: Fleximetry was used to measurement shoulder ROM (flexion, hyperextension, abduction, medial and lateral rotation, and horizontal abduction and adduction). Two examiners performed the evaluations of the shoulder ROM at two time points (interval of one week between them). RESULTS: In the intra-rater reliability, substantial to excellent reliability was found, with intraclass correlation coefficient (ICC) values ranging from 0.79 to 0.92, standard error of the measurement (SEM) values ranging from 5.70 to 8.72°, and minimum detectable change (MDC) values varying between 15.80 and 25.18°. Regarding the inter-rater reliability, moderate to excellent reliability was observed, with ICC values ranging from 0.68 to 0.96, SEM values ranging from 4.98 to 11.53°, and MDC values ranging from 13.82 to 31.97°. CONCLUSION: The use of the fleximeter to measure shoulder ROM presents acceptable reliability values in individuals with chronic shoulder pain, which supports the use of this method of evaluation in research and clinical practice.