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- Tailoring pain neuroscience education and exercise programme for people with fibromyalgia who also have cognitive deficits: a case seriesPublication . Pires, Diogo; Costa, Daniela; Martins, Isabel; Cruz, EduardoPurpose: The purpose of this case series was to describe the outcomes of a tailored pain neuroscience education (PNE) and individualised exercise programme for people with fibromyalgia (FM) who also have cognitive deficits. Materials and methods: Nine FM patients with memory and concentration problems underwent a sixweek programme consisting of six PNE sessions followed by six sessions of individualised exercise. Participants were assessed at the baseline, 3 and 6 weeks, and at 3 and 6 months follow-ups. Outcomes measures included the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), the Numerical Pain Rating Scale (NPRS), the Fibromyalgia Impact Questionnaire-Revised (FIQ-R) and the Patient Global Improvement of Change Scale (PGIC). Results: At six weeks, all patients decreased their scores on the TSK, PCS, NPRS and FIQ-R and reported a moderate to considerable improvement in their perception of overall change. At the six-month follow- up, improvements in pain intensity, pain catastrophizing, kinesiophobia and perception of overall change, appeared clinically meaningful for the majority of the participants. Conclusions: This study’s findings demonstrate an example of how cognitive characteristics can be considered in the intervention of FM patients in order to optimise their results and encourage the need for a further randomised control trial.
- Beyond pain and disability: an explanatory mixed methods study exploring outcomes after physiotherapy intervention in patients with chronic low back painPublication . Pires, Diogo; Cruz, Eduardo; Costa, Daniela; Nunes, CarlaPurpose: The primary aim of this study was to explore relevant outcome domains for patients with chronic low back pain (CLBP) undergoing physiotherapy. A secondary aim was to examine potential discrepancies between meaningful changes in pain and disability and the global perception of improvement. Methods: An explanatory mixed methods design was employed. Twenty-two patients with CLBP completed self-reported measures before and after a physiotherapy programme. After the intervention, three focus groups were conducted with patients who perceived an overall improvement. Discussions were recorded, transcribed and analysed using thematic analysis. Results: Quantitative analysis showed an inconsistent relationship between changes in pain and disability measures and global improvements as perceived by patients. Two main themes emerged from the thematic analysis: “pain relief” (subthemes: reducing pain intensity and other symptoms; reducing medication intake; improving sleep quality) and “gaining control over the LBP condition” (subthemes: ability to selfmanage; return to function; and sense of well-being and normality). Conclusion: Patients with CLBP perceived multiple outcomes from physiotherapy treatment that cover the domains of global, physical, mental and social health. These study findings suggest that the targets of measurement for physiotherapy need to be expanded in order to reflect outcome domains valued by patients.
- A pain neuroscience education program for fibromyalgia patients with cognitive deficits: a case seriesPublication . Pires, Diogo; Costa, Daniela; Martins, Isabel; Cruz, EduardoBackground: The literature has suggested that Pain neurophysiology education (PNE) can have positive effects on pain, disability and maladaptive pain cognitions in fibromyalgia (FM) patients but no significant changes in these variables have been found in response to PNE in FM patients. Reasons for these findings may relate with the design of the PNE programmes, traditionally composed of only 1 or 2 sessions with a wide variety of complex contents, which do not take into account the memory and concentration problems identified in those patients. Purpose: This case series aims to describe the effects of a combined programme of PNE and exercise for FM patients. The PNE was specifically designed for FM patients with cognitive deficits and included 6 sessions of PNE in a face-to-face format complemented with an educational booklet, the discussion of a case study and involvement of family members in treatment sessions. Methods: Nine consecutive patients with a diagnosis of FM and concentration and memory problems (identified by the concentration subscale of the checklist of Individual strength- CIS-20, and a numeric scale to access memory) were included in this case series. All patients underwent in a 6-week programme (first 3 weeks) followed by 6 sessions of individualized exercise (aerobic exercise, motor control training and aquatic exercise). Participants were assessed at the baseline, 3 and 6 weeks, and at 3 and 6 months follow-ups. Outcomes measures included the Numerical Pain Rating Scale, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale, and the Patient Global Improvement of Change Scale. Results: All 9 participants were women with a median age of 53 years (range: 38e64). Six weeks after the beginning of the intervention, all the patients reported perceived benefits in perception of overall change, and 7 of the 9 patients (78%) demonstrated a clinically meaningful improvement in pain intensity. Of the 9 participants, 8 exhibited reductions in pain catastrophization and 7 in kinesiophobia. However, at the 6 months follow-up, the proportion of patients with a clinically meaningful improvement in pain intensity and in the perception of overall change decreases to 5/9 and 7/9, respectively. Conclusion: This case series suggests that an adjusted programme of PNE followed by individualized exercise could change maladaptive pain cognitions and decrease pain intensity in FM patients. The dilution of the course content for several sessions and the inclusion of additional learning strategies may have been critical for these results. Implications: This study’s results suggest that cognitive characteristics of FM patients should be considered in the design of PNE programmes in order to optimize their results. However, since a cause-effect relationship cannot be deduced from this case series, a randomized controlled trial should be taken into account to evaluate the effectiveness of this programme in FM patients.
- Successful pain relief in chronic low back pain undergoing multimodal physiotherapy are associated with early response to treatmentPublication . Cruz, Eduardo; Fernandes, Rita; Pires, Diogo; Ribeiro, Ana; Caldeira, Carolina; Costa, Daniela; Duarte, Susana; Domingues, Lúcia
- How to define the success of physiotherapy in chronic low back pain patients?Publication . Pires, Diogo; Cruz, Eduardo; Costa, Daniela; Ribeiro, Ana Margarida; Vieira, Ana Cristina; Moniz, Sara; Nunes, Carla