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- Cross-cultural adaptation and psychometric properties of the european portuguese version of the Global Perceived Effect Scale in patients with chronic low back painPublication . Freitas, Petra; Pires, Diogo; Nunes, Carla; Cruz, EduardoPurpose: To cross-culturally adapt the Global Perceived Effect Scale (GPES) into Portuguese and investigate its psychometric properties in patients with chronic low back pain. Methods: Cross-cultural adaptation was carried out according to published guidelines. Along with measures for pain and disability, GPES was administered at baseline, 48-h later and post-intervention. To estimate test-retest reliability, the intraclass correlation coefficient was used. The validity was examined through the correlation between the GPES and the Patient Global Improvement Change Scale and the contribution of baseline status to GPES scores. Responsiveness was assessed by analyzing hypotheses regarding areas under the curve and correlations with changes in other measures. Results: The test-retest reliability, the convergent validity and the contribution of the baseline status to GPES scores were demonstrated. The EPES correlated strongly with global perception of change (r=0.677), and moderately with pain and disability changes (r=0.457 and r=0.452, respectively). Areas under the curve values of 0.71(95% CI = 0.607–0.825) and 0.83 (95% CI = 0.749–922) were found. Conclusion: The GPES demonstrated adequate psychometric properties. This study’s findings supported its use in clinical and research studies with patients with chronic low back pain.
- 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.
- The role of pain and disability changes after physiotherapy treatment on global perception of improvement in patients with chronic low back painPublication . Pires, Diogo; Cruz, Eduardo; Canhão, Helena; Nunes, CarlaBackground: The effectiveness of physiotherapy in patients with chronic low back pain is usually measured through changes in pain and disability domains. However, recent research has suggested that these two domains are not sufficient to capture all the physiotherapy benefits when patients’ perspective is considered. Objective: The aim of this study was to investigate the role of pain and disability changes in explaining the global perception of improvement in patients with chronic low back pain undergoing physiotherapy. Design: Prospective cohort study. Methods: The study was conducted on183 patients who were referred to physiotherapy treatment due to low back pain lasting more than 12 weeks. Sociodemographic and clinical characteristics were measured at baseline, together with pain intensity and disability. Eight (post-intervention) and twelve weeks later, global perception of improvement was measured together with pain and disability. The Pearson correlation coefficient and linear regression models were used for analyses. Results: Of the 183 participants included, 144 completed the 12-weeks follow-up. Significant and moderate correlation was found between pain and disability changes and the global perception of improvement after intervention and at the 12-weeks follow-up. Pain and disability changes explained 20.7%–36.3% of the variance in the global perception of improvement. Conclusions: Pain and disability changes are related and contributed to explaining a partial proportion of variance in the global perception of improvement. The findings suggest that these domains are not sufficient to explain and measure all of the benefits of physiotherapy when patients’ global perception of improvement is considered.
- How do physical therapists measure treatment outcomes in adults with chronic low back pain? a systematic reviewPublication . Pires, Diogo; Cruz, Eduardo; Gomes, Luís A; Nunes, CarlaBackground. There is an increasing recognition of the importance of using a conceptual framework covering the full range of relevant health domains and outcome measures addressed by physical therapy modalities in patients with chronic low back pain (CLBP). However, little is known about what outcome domains have been measured and through what measures in physical therapy research. Objective. The purpose of this review was to synthesize outcome domains, instruments, and cutoff values reported in published randomized controlled trials and their compliance with the original Patient-Reported Outcomes Measurement Information System (PROMIS) framework. Data sources. Embase, MEDLINE, Cochrane Library, and Physiotherapy Evidence Database electronic databases were systematically searched from January 2008 to April 2019. Study selection. Randomized controlled trials that compared physical therapy with any other intervention for adults with CLBP were included. Data extraction. Study characteristics, outcome domains, instruments, and cutoff values were extracted by 2 reviewers. The PROMIS framework was used for domain categorization. Data synthesis. One hundred ninety-five studies were included, with 52 outcome domains and 45 cutoff values identified from 182 instruments reported. Only 14 of 195 studies assessed all PROMIS health core areas, whereas the PROMIS physical health core area was assessed in all included studies. Pain intensity and disability were the most frequently used domains. Limitations. Only studies for which full texts were available in English were included. Conclusions. This review identified a poor overlap between the PROMIS framework and outcome domains used to define the effectiveness of physical therapy in adults with CLBP. This finding suggests that other potential benefits resulting from physical therapy modalities are not being measured. Furthermore, a large diversity in the outcome domains and instruments was found.
- Individual patient responder analysis of the effectiveness of a pain neuroscience education programme in chronic low back painPublication . Pires, Diogo; Caeiro, Carmen; Cruz, EduardoBackground: Chronic low back pain (CLBP) is a common health problem to which a large number of types of treatments seem to produce similar mean improvement in patient’s symptoms. Individual responder analyses offer the possibility of providing patients and clinicians with supplementary information about the chance of achieving particular degrees of pain relief, which may improve the decision-making process as well as communication with patients. Purpose: To examine the effectiveness of a combined programme of pain neuroscience education and aquatic exercise (EDU+EXE) versus aquatic exercise alone (EXE) in pain intensity in CLBP patients, and to determine the time course of response in pain intensity and the time course of effectiveness for clinically significant improvements. Methods: A single blind randomized trial, was conducted in patients with CLBP lasting >3 months. The EDU+EXE group (n=30) received 2 sessions of pain neuroscience education followed by 12 sessions of a 6-week aquatic exercise programme, whereas the EXE group (n=32) received 12 sessions of the aquatic exercise programme alone. Patients were assessed at baseline, 3 and 6 weeks after the beginning of the aquatic exercise programme and then at a 12 weeks follow-up. The primary outcome was pain intensity (Visual Analogue Scale). Clinically significant treatment response was defined as a pain relief over baseline of >50%. Results: Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favouring the EDU+EXE group (mean SD change: -25.4±26.7 vs -6.6±30.7, p<0.005). At patient-level response, there were differences in the response rates and patterns. In the EDU+EXE group, the proportion of patients that experienced substantial pain relief (>50%) raised from 47% to 70%, at 3 and 12 weeks, respectively. In the EXE group this proportion raised from 25% to 34% (Relative risk of 1.87, and 2.04 respectively). At 3 weeks, 41% of the participants in the EXE group achieved a level of response of “no important change” (<15%) compared to 27% in the EDU+EXE group. In the EDU+EXE group, and for those who achieved a pain relief of at least 50% at 3 weeks, the rate of sustained pain relief response was approximately 93% and 86%, at 6 and 12 weeks respectively. These rates were higher than those of 63% and 50% found in the EXE group. Conclusion: This study’s findings support the provision of pain neuroscience education as a clinically effective addition to aquatic exercise. Individual response analysis showed that the patients receiving EDU+EXE achieved an early response to pain, had higher response rates at all the endpoints and were also more likely to achieve a sustained response over time compared to those receiving EXE only. Implications: Intervention studies should examine patient-level responses in addition to average treatment effects in order to enhance the clinical decision-making and patient communication.