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- 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.
- Minimum important change values for pain and disability: which is the best to identify a meaningful response in patients with chronic nonspecific low back pain?Publication . Pires, Diogo; Cruz, Eduardo; Canhão, Helena; Nunes, CarlaPurpose: To examine the association between different minimum important change (MIC) values for pain and disability and a successful response in global perception of improvement in patients with chronic nonspecific low back pain (CNLBP). Methods: A prospective cohort study was conducted. At baseline, all participants completed a sociodemographic and clinical questionnaire, the Numeric Pain Rating Scale and the Quebec Back Pain Disability Scale (QBPDS). After a physiotherapy program, the Global Perceived Effect Scale (GPES) was completed together with pain and disability measures. The association of the different literature MIC values for pain and disability with a successful response on the GPES was analyzed using logistic regression models. The discrimination power, sensitivity, specificity and predictive values were computed. Results: A total of 183 patients with CNLBP participated in this study. A reduction of 30% on the QBPDS (OR = 7.8; area under the curve = 0.73; sensitivity = 0.72; specificity = 0.76) most accurately identified patients who perceived a global improvement on the GPES. Composite criteria using both pain and disability MIC values presented high odds ratios and specificity values, but failed to identify patients who perceived a meaningful improvement. Conclusion: A 30% reduction on the QBPDS is recommended to identify patients with CNLBP who achieve a clinical improvement with physiotherapy treatment.
- 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.
- Acesso direto em fisioterapia: um serviço inerente ao profissional autónomoPublication . Almeida, Patrícia; Alves Lopes, António; Lopes, António M F; Pires, Diogo; Martins, Maria Elisabete; Santos, Hugo; Rosado, Maria Da Lapa
- Acesso direto: projeto de desenvolvimento de um instrumento para a realização de triagem em Fisioterapia para diagnóstico diferencialPublication . Almeida, Patrícia; Santos, Hugo; Martins, Maria Elisabete; Alves Lopes, António; Rosado, Maria Da Lapa; Pires, Diogo; Lopes, António M F