RESUMEN
BACKGROUND: Moderately vigorous physical activity (PA) may be beneficial for people with sub-acute low back pain (LBP), but may initially be painful for patients and challenging for physical therapists to facilitate. OBJECTIVES: This study investigated motivational interviewing (MI) delivered by physical therapists and a smartphone app for increasing PA in people with LBP. METHODS: A mixed methods cluster randomised controlled trial involving 46 adults with LBP in Melbourne, Australia. Participants attended weekly 30-min physical therapy consultations for 6 weeks. Experimental group physical therapists were taught to embed MI into consultations and patients were provided with a self-directed app. The primary outcome was accelerometer-derived moderately vigorous PA. Secondary outcomes were LBP disability (Oswestry Disability Index), functional capacity (Patient Specific Functional Scale), and self-efficacy (Pain Self-Efficacy Questionnaire). Between-group differences were analysed by ANCOVA post-intervention. RESULTS: There was no statistically significant difference between the experimental group and control group for PA. Between-group differences in LBP disability (MD= 19.4 units, 95% CI: 8.5, 30.3), functional capacity (primary MD= -4.1 units, 95% CI: -6.9, -1.3; average MD= -3.1, 95% CI: -4.9, -1.2) and self-efficacy (MD -11.3 units, 95%CI -20.2, -2.5) favoured the control group with small to moderate effect sizes. There were low levels of overall engagement with the app. CONCLUSION: The embedded MI intervention was no more beneficial than physical therapy alone for PA and was associated with poorer LBP disability, function, and self-efficacy. The effectiveness of embedding MI and a smartphone app into usual care for LBP was not supported.
Asunto(s)
Ejercicio Físico , Dolor de la Región Lumbar , Entrevista Motivacional , Teléfono Inteligente , Humanos , Dolor de la Región Lumbar/terapia , Entrevista Motivacional/métodos , Aplicaciones Móviles , Australia , Adulto , Autoeficacia , Masculino , Modalidades de FisioterapiaRESUMEN
BACKGROUND: Supporting children and adolescents with cancer to be physically active can improve medium- and long-term health outcomes. OBJECTIVE: To assess the feasibility of CanMOVE, a 10-week complex, theoretically-informed, behaviour change intervention to promote physical activity for children and adolescents undergoing acute cancer treatment. METHODS: A feasibility study using a single-group, repeated measures, mixed methods design. Participants completed CanMOVE, which included provision of a Fitbit (child/adolescent and carer) and structured support from a physical therapist. Feasibility domains of demand, acceptability, implementation, practicality, limited efficacy, and integration were evaluated. Data sources included service level data, objective assessment of physical activity, physical function, and health-related quality of life; and qualitative data collected via semi-structured interviews with participants and focus groups with staff. RESULTS: Twenty children/adolescents (median age 13yrs, interquartile-range 9-14) with a mix of cancer diagnoses, 20 parents, and 16 clinicians participated. There was high demand with 95% enrolment rate. CanMOVE was acceptable for participants. All feasibility thresholds set for implementation were met. Under practicality, there were no serious adverse events related to the intervention. Limited efficacy data indicated CanMOVE showed positive estimates of effect in influencing child/adolescent physical activity behaviour, physical function, and health-related quality of life. Positive impacts were also seen in parent and staff attitudes towards physical activity promotion. To improve integration into the clinical setting, it was suggested the duration and scope of CanMOVE could be expanded. CONCLUSION: CanMOVE was feasible to implement in a paediatric cancer setting. CanMOVE is appropriate to be tested in a large-scale trial.
Asunto(s)
Neoplasias , Calidad de Vida , Niño , Adolescente , Humanos , Estudios de Factibilidad , Ejercicio Físico , Grupos Focales , Actividad MotoraRESUMEN
BACKGROUND: Osteoporotic vertebral fractures affect a large number of older adults OBJECTIVES: Systematically review evidence of the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with standard care (control); and evaluate the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with an alternative non-pharmacological, non-invasive intervention. DESIGN: Systematic review and meta-analysis of randomized controlled trials. Five electronic databases (CINAHL, EMBASE, MEDLINE, PUBMED, and COCHRANE) were searched. Eligible trials included participants with primary osteoporosis and at least one vertebral fracture diagnosed on radiographs, with treatment that was non-surgical and non-pharmacological involving more than one session. RESULTS: Twenty randomized controlled trials were included with 2083 participants with osteoporotic vertebral fractures. Exercise, bracing, multimodal therapy, electrotherapy, and taping were investigated interventions. Meta-analyses provided low certainty evidence that exercise interventions compared to no exercise were effective in reducing pain in patients with osteoporotic vertebral fractures (mean difference (MD)= 1.01; 95% confidence interval (CI): 0.08, 1.93), and low certainty evidence that rigid bracing intervention compared with no bracing was effective in reducing pain in patients with osteoporotic vertebral fractures (MD= 2.61; 95%CI: 0.95, 4.27). Meta-analyses showed no differences in harms between exercise and no exercise groups. No health-related quality of life or activity improvements were demonstrated for exercise interventions, bracing, electrotherapy, or multimodal interventions. CONCLUSIONS: Exercise and rigid bracing as management for patients with osteoporotic vertebral fractures may have a small benefit for pain without increasing risk of harm. TRIAL REGISTRATION: PROSPERO registration number CRD42012002936.