RESUMEN
BACKGROUND: Tolerating physical tasks depends not only on task-specific characteristics but also on an individual's psychophysiological capacity to respond to the imposed load. People suffering from chronic low back pain (CLBP) may experience reduced psychophysiological capacity and are at risk for poor pain prognosis, which could lead to an increased walking workload. AIM: To investigate how the risk of unfavorable pain prognosis in CLBP can impact walking physiomechanical parameters and psychophysiological workload. METHODS: A cross-sectional observational study. The study classified 74 volunteers into four groups based on their prognosis for pain: pain-free control (CG/n = 20), low (LrG/n = 21), medium (MrG/n = 22), and high (HrG/n = 11) risk of poor prognosis for CLBP. The ground assessments identified the self-selected (SSW) and optimal (OWS) walking speeds, as well as the locomotor rehabilitation index (LRI). Treadmill assessments were conducted at two different speeds (0.83 and 1.11 m s-1, SSW and OWS) to record physiomechanical parameters. Psychophysiological workloads during walking were measured via workload impulse for the session (TRIMP), determined by variations in heart rate. RESULTS: CLBP groups exhibited slower SSW and lower LRI compared to the CG. The TRIMP was lower in the LrG. However, both MrG and HrG exhibited a comparable overload to the CG, even while walking at a lower intensity with a psychophysical demand. SSW and OWS displayed an increased TRIMP compared to fixed speeds. CONCLUSION: Psychosocial factors may affect SSW in people with CLBP but not among the risk strata. An unfavorable prognosis for pain could jeopardize the psychophysiological capacity to withstand walking demands.
Asunto(s)
Dolor Crónico , Dolor de la Región Lumbar , Caminata , Humanos , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/psicología , Estudios Transversales , Masculino , Femenino , Adulto , Caminata/fisiología , Pronóstico , Persona de Mediana Edad , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Frecuencia Cardíaca/fisiologíaRESUMEN
INTRODUÇÃO: A dor lombar crônica (DLC) é uma síndrome que compromete negativamente a capacidade funcional dos indivíduos. OBJETIVO: Verificar se há diferença no nível de incapacidade autorrelatado entre pacientes alocados nos diferentes estratos de risco para desenvolver mau prognóstico na DLC. MATERIAIS E MÉTODOS: Trata-se de um estudo piloto, observacional e transversal. A amostra foi composta por 17 voluntários com DLC, provenientes de um Centro de Reabilitação Física universitário local. Os voluntários foram solicitados a responder dois questionários, tanto para avaliação do nível de incapacidade quanto para determinar o risco de mau prognóstico. O nível de incapacidade autorrelatado foi determinado pela Versão Brasileira do Índice Funcional de Oswestry (IFO). O risco para desenvolver mau prognóstico foi determinado pelo questionário STarT Back Screening Tool (SBST), baseado na influência dos fatores psicossociais, e os voluntários foram classificados em baixo (n=6), médio (n=6) ou alto (n=5) risco de mau prognóstico. O teste estatístico utilizado foi o Generalized Linear Model (GLzM), com α=0,05. RESULTADOS: O grupo de baixo risco apresentou incapacidade mínima e os grupos com médio e alto risco apresentaram incapacidade severa, porém observouse diferença estatística no IFO apenas entre os grupos de baixo e alto risco. CONCLUSÃO: Houve diferença na incapacidade autorrelatada entre os estratos de risco de mau prognóstico, sendo a incapacidade significativamente mais alta no grupo alto risco em comparação com o baixo risco, sugerindo que os aspectos psicossociais impactam não só para o prognóstico, mas também o nível de incapacidade de pacientes com dor lombar crônica.
INTRODUCTION: Chronic low back pain (CLBP) is a syndrome that compromises individual functional capacity negatively AIM: To verify whether there is a difference in the self-reported disability level among patients allocated into different risk strata to develop poor prognosis in CLBP. MATERIALS AND METHODS: This is a pilot, observational and cross-sectional study. The sample consisted of 17 volunteers with CLBP from a local University Physical Rehabilitation Center. Volunteers were asked to answer two questionnaires to assess both the level of disability and to determine the risk of poor prognosis. The level of disability was determined by the Brazilian Version of the Oswestry Functional Index (IFO). The risk for developing poor prognosis was determined by the STarT Back Screening Tool (SBST) questionnaire, based on the influence of psychosocial factors, and volunteers were classified as low (n=6), medium (n=6) or high (n=5) risk of poor prognosis. The statistical test used was the Generalized Linear Model (GLzM), with α=0.05. RESULTS: The low-risk group presented minimal disability and the medium and high-risk groups presented severe disability, but there was a statistical difference in IFO only between the low and high-risk groups. CONCLUSION: There was a difference in disability between risk strata of poor prognosis, with disability significantly higher in the high-risk group compared to low-risk, suggesting that psychosocial aspects impact not only on prognosis but also on the level of disability of patients with chronic low back pain.